Citation Nr: 21001026 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 16-61 598 DATE: January 6, 2021 ORDER Entitlement to service connection for a right eye condition is denied. Entitlement to service connection for a left eye condition is denied. The reduction of the disability rating for right hip limitation of abduction from 20 percent to a noncompensable rating, effective August 1, 2016, was not proper; the 20 percent rating is restored, subject to the laws and regulations governing the payment of monetary benefits. The reduction of the disability rating for left hip limitation of abduction from 20 percent to a noncompensable rating, effective August 1, 2016, was not proper; the 20 percent rating is restored, subject to the laws and regulations governing the payment of monetary benefits. Entitlement to a rating in excess of 20 percent for right hip limitation of abduction is denied. Entitlement to a rating in excess of 20 percent for left hip limitation of abduction is denied. Entitlement to an evaluation in excess of 10 percent for right knee osteoarthritis with limitation of extension is denied. Entitlement to an evaluation in excess of 10 percent for left knee osteoarthritis is denied. An effective date of May 10, 2016 for a 10 percent rating for left knee instability is granted. Entitlement to a 10 percent rating for left knee instability is denied. FINDINGS OF FACT 1. The competent medical evidence does not demonstrate that either the Veteran’s dermatochalasis or nuclear cataracts was incurred in service or are otherwise attributable to his service; furthermore, diagnosed astigmatism and presbyopia are congenital conditions for which service connection is not warranted absent superimposed service-related disability. 2. The reduction of the rating for the Veteran’s right hip limitation of abduction from 20 percent to a noncompensable rating, effective August 1, 2016, was not proper, as the evidence did not show overall improvement maintained under the ordinary conditions of life so as to warrant the reduction. 3. The reduction of the rating for the Veteran’s left hip limitation of abduction from 20 percent to a noncompensable rating, effective August 1, 2016, was not proper, as the evidence did not show overall improvement maintained under the ordinary conditions of life so as to warrant the reduction. 4. The Veteran is in receipt of the highest possible schedular rating for right hip limitation of abduction and has not specifically asserted that he is entitled to an extraschedular rating for right hip limitation of abduction; moreover, there is no evidence of favorable ankylosis of the right hip coupled with flexion at an angle between 20 degrees and 40 degrees. 5. The Veteran is in receipt of the highest possible schedular rating for left hip limitation of abduction and has not specifically asserted that he is entitled to an extraschedular rating for left hip limitation of abduction; moreover, there is no evidence of favorable ankylosis of the left hip coupled with flexion at an angle between 20 degrees and 40 degrees, nor is there evidence of left hip extension limited to 5 degrees. 6. For the entire period of the appeal, the Veteran’s right knee has not exhibited limitation of extension approximating 15 degrees or more; moreover, there is no indication of right knee dislocated semilunar cartilage, and the evidence is against a finding of ankylosis of the right knee. 7. For the entire period of the appeal, the Veteran’s left knee exhibited flexion limited to no less than 75 degrees; moreover, there is no indication of left knee dislocated semilunar cartilage, and the evidence is against a finding of ankylosis of the left knee. 8. From May 10, 2016, the Veteran has exhibited slight instability of the left knee; however, at no point from that date has the left knee exhibited moderate or worse instability. CONCLUSIONS OF LAW 1. Service connection for a right eye condition, to include dermatochalasis and nuclear cataracts, is not warranted. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. § 3.303. 2. Service connection for a left eye condition, to include dermatochalasis and nuclear cataracts, is not warranted. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. § 3.303. 3. The reduction in the rating assigned for the Veteran’s service-connected right hip limitation of abduction from 20 percent to a noncompensable rating was not proper; it is therefore void, and a restoration of a 20 percent rating from August 1, 2016 is warranted. 38 U.S.C. § 1155, 5112(b)(6); 38 C.F.R. §§ 3.102, 3.105(e), 3.344(c), 4.71a, Diagnostic Code 5253. 4. The reduction in the rating assigned for the Veteran’s service-connected left hip limitation of abduction from 20 percent to a noncompensable rating was not proper; it is therefore void, and a restoration of a 20 percent rating from August 1, 2016 is warranted. 38 U.S.C. § 1155, 5112(b)(6); 38 C.F.R. §§ 3.102, 3.105(e), 3.344(c), 4.71a, Diagnostic Code 5253. 5. The criteria for entitlement to a rating in excess of 20 percent for right hip limitation of abduction are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5253. 6. The criteria for entitlement to a rating in excess of 20 percent for left hip limitation of abduction are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5253. 7. The criteria for entitlement to a rating in excess of 10 percent for right knee limitation of extension are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5261. 8. The criteria for entitlement to a rating in excess of 10 percent for left knee osteoarthritis manifested by limitation of flexion are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5003-5260. 9. A 10 percent rating, but not higher, is warranted for left knee instability from the earlier effective date of May 10, 2016. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5257. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty, including from August 1978 to January 1984. These matters were last before the Board in December 2019, whereupon it was remanded to the Agency of Original Jurisdiction (AOJ) for further development of the record. In May 2020, the AOJ issued a supplemental statement of the case continuing the denial of each claim listed above. In addition, the AOJ issued a rating decision granting a separate 10 percent rating for left knee instability effective January 13, 2020. Following this adjudication, this case was returned to the Board for its own adjudication. As mentioned, in a May 2020 rating decision, the Regional Office granted a 10 percent rating for left knee instability, effective January 13, 2020. As the 10 percent award does not represent a full grant of the benefits sought, entitlement to a higher rating for left knee instability is still on appeal. AB v. Brown, 6 Vet. App. 35, 38 (1993). The Veteran testified at a September 2019 videoconference hearing before the undersigned Veterans Law Judge; a copy of the transcript of that hearing is of record. The Board notes that it has considered whether a claim for a total rating based on individual unemployability (TDIU) has been raised by the Veteran during the pendency of this appeal. In Rice v. Shinseki, 22 Vet. App. 447 (2009), the United States Court of Appeals for Veterans Claims (Court) held that VA must address the issue of entitlement to a TDIU in increased rating claims when the issue of unemployability either is raised expressly or by the record. The Board acknowledges that the Veteran submitted a claim seeking entitlement to TDIU in February 2012 and noted on his formal application for such benefits that his various service-connected disabilities, to include his bilateral knee disabilities, precluded him from securing and following substantially gainful employment. However, that claim was eventually denied in a February 2013 rating decision that the Veteran did not appeal. This occurred well before the current appeal period. Since that denial, during the current appeal period the Board can find no documentation of the Veteran having asserted that he was unemployable as due to his service-connected disabilities, to include the bilateral knee and hip disabilities that are currently on appeal. Furthermore, there is no indication from any of the medical examinations of record pertaining to the period on appeal that the Veteran is precluded from securing and following substantially gainful employment as due to the service-connected bilateral knee and hip conditions that are presently before the Board. Indeed, on the most recent January 2020 VA knee and hip examinations it was reported that the Veteran was retired, and the examiner for both examinations did not state that either the bilateral knee or hip conditions contributed to such a decrease in occupational functioning that the Veteran was precluded from securing and following substantially gainful employment. Under these circumstances, the Board concludes that a TDIU claim is not presently raised by the record. The Board also notes that the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). Entitlement to Service Connection for Right and Left Eye Conditions The Veteran contends that he experiences a variety of right and left eye conditions that were incurred in service or otherwise are attributable to distinct treatment he underwent in service for both his right and left eye. He seeks service connection for both right and left eye conditions on these bases. As the evidence in support of both claims is largely identical, the Board will consider them together. At the outset, the Board reiterates its determination from the December 2019 Remand that the AOJ properly found that the Veteran’s diagnoses of astigmatism and presbyopia are congenital conditions not subject to service connection. See VAOPGCPREC 82-90 (observing that even congenital defects “can be subject to superimposed disease or injury” and that “if during an individual’s military service, superimposed disease or injury does occur, service-connection may indeed be warranted for the resultant disability”). As such, the Board’s analysis will focus on the other eye conditions that the Veteran has been diagnosed with since service. To establish service connection on a direct basis, the evidence must show (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the current disability and the disease or injury incurred or aggravated during active service.  Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). Thus, the question for the Board is whether the Veteran has a right and/or a left eye condition that at least as likely as not began during service or is related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has been diagnosed with a variety of bilateral eye disorders during the pendency of the appeal, the preponderance of the evidence is against a finding that any right or left eye disorder began during active service, or is otherwise related to an in-service injury, event, or disease.  38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. §§ 3.303(a), (d).  A review of available service treatment records does reflect that the Veteran underwent treatment for ophthalmological symptomatology on two occasions in service. A February 1979 outpatient note shows that the Veteran sought treatment due to his left eye being swollen and draining fluid for the past three days. After an in-person evaluation, the impression was acute conjunctivitis. There are no subsequent records documenting treatment for the left eye following this note. Thereafter, records dating from November 1982 show that the Veteran experienced an injury to his right eye when he was hit with a football. He complained of symptoms of pain, irritation and headaches and was diagnosed with a contusion. There are no subsequent records showing further treatment for residuals of this injury. Beyond these two isolated instances of the Veteran having sought treatment for bilateral ophthalmological symptomatology in service, there is no further documentation of the Veteran complaining of or receiving treatment for symptoms of an eye condition. To the Board’s knowledge, a portion of the Veteran’s service medical records, to specifically include his discharge examination and related documents, have not been associated with the claims file. VA is required to obtain relevant documents held by any Federal department or agency that the Veteran adequately identifies and authorizes the Secretary to obtain. 38 U.S.C. § 5103A (c)(3); 38 C.F.R. § 3.159 (e). The Board acknowledges that VA has a heightened duty to assist the Veteran in developing his claims since the records may have been lost, as well as an obligation to explain its findings and conclusions and carefully consider the benefit-of-the-doubt rule. Washington v. Nicholson, 19 Vet. App. 362, 369-70 (2005); O’ Hare v. Derwinski, 1 Vet. App. 365 (1991). Case law does not, however, lower the legal standard for proving a claim for service connection but simply increases the Board’s obligation to consider that evidence which may be favorable to the Veteran. Russo v. Brown, 9. Vet. 46, 51 (1996). To that end, no eye abnormalities were noted on a December 1981 Report of Medical History. There is no indication from the record that any additional records could be made available were VA to attempt to secure them; as such, the Board will thus proceed with the record as currently constituted. Post-service, VA medical records show that the Veteran was receiving treatment through VA for astigmatism and presbyopia as early as 2004. Thereafter, there are no records of specific treatment for any eye conditions until 2009, wherein he reported in December 2009 that he had been experiencing intermittent headaches above his right eye for the past two months. No vision changes were reported at that time. Subsequent records show continued treatment for a variety of eye conditions, to include a refractive error and nuclear cataracts bilaterally as reflected in a January 2017 ophthalmological evaluation. More recently, a May 2018 ophthalmological evaluation resulted in diagnoses of a bitemporal pituitary adenoma as well as bilateral hyperopia, astigmatism, and presbyopia. The most contemporary available medical record showing treatment for eye conditions is a November 2019 ophthalmological evaluation which showed no significant changes in the Veteran’s symptomatology or diagnoses. The Veteran submitted a May 2016 ophthalmological evaluation from a private treatment provided, which shows diagnoses of bilateral age-related nuclear cataracts as well as dermatochalasis bilaterally over the upper eyelids. No specific treatment was ordered other than to recommend glasses. During the September 2019 hearing, the Veteran detailed that he had been experiencing pain intermittently above his eyes since service. Pursuant to the Board’s December 2019 remand instructions, the Veteran was afforded a VA eye examination in January 2020 to evaluate the nature and likely etiology of the claimed bilateral eye conditions. He reported experiencing bilateral drooping eyelids attributable to dermatochalasis as well as worsening vision attributable to bilateral cataracts. After an in-person evaluation, to include diagnostic testing, the examiner confirmed diagnoses of bilateral dermatochalasis, bilateral age-related nuclear cataracts, and generalized contraction of the right eye visual field. In summation, the examiner found that the cataracts would continue to slowly diminish the Veteran’s visual acuity, which could be corrected with the use of eyeglasses. As for the likely etiology of the claimed bilateral eye conditions, the January 2020 examiner opined that it was less likely than not that the Veteran had a right or left eye condition that was incurred in or otherwise attributable to service. With regard to the right eye condition, the examiner acknowledged the history of the right eye injury in service when the Veteran was struck with a football, but found it unlikely that such an injury would lead to the later development of the diagnosed eye conditions as they were bilateral and symmetrical. Instead, the examiner found it far more likely that both conditions were age-related. The examiner utilized the same rationale in discounting any likely nexus between the left eye treatment in service in February 1979 and the later development of the left eye conditions. This examination and opinion are highly probative as they are based on a thorough review of the claims file and are supported by a rationale that references the Veteran’s documented medical history. Sklar v. Brown, 5 Vet. App. 140 (1993). The Board acknowledges that the Veteran has asserted that he has diagnosable right and left eye conditions that are attributable to service. The Veteran is competent to testify as to when his symptoms began. Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, the fact that the claims file does not contain a diagnosis of a non-congenital eye condition until the 2016 diagnosis of cataracts, over 30 years after his discharge from service, is persuasive evidence tending to demonstrate that there is no continuity of symptomatology after service. The Veteran has provided no objective medical evidence in support of his assertion that his bilateral eye conditions are attributable to the two isolated instances of in-service treatment for ophthalmological symptomatology. The absence of such evidence coupled with the lack of a diagnosis at any point strongly suggests that no eye condition began in service. See Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006). As such, the preponderance of the evidence is against the claim of service connection for a right or left eye condition on both a direct basis under 38 C.F.R. § 3.303(a) or based on continuity of symptomatology under 38 C.F.R. § 3.303(b). The Veteran may still be entitled to service connection for an eye condition if all of the evidence establishes that the condition is otherwise attributable to an in-service occurrence. 38 C.F.R. § 3.303(d). As stated above, however, the Veteran has presented no objective medical evidence to support a determination that the diagnosed cataracts and dermatochalasis are attributable to an in-service injury or event. The Board ascribes considerable probative value to the January 2020 VA examiner opinion, as it is supported by the weight of the evidence, which shows that the Veteran was never evaluated as having a diagnosable eye condition in service and did not receive a diagnosis of an eye condition for over 30 years after service. The Board further notes that there is no evidence in the record showing that the Veteran has the medical training, credentials, or other expertise to competently conclude that any diagnosed eye condition is attributable to service. Jandreau v. Nicholson, 491 F.3d 1372 (Fed. Cir. 2007). Ultimately, the Board finds that the VA examiner’s opinion of record substantially outweighs the lay evidence of record, in light of the rationale presented and the absence of training or credentials on the part of the Veteran. Therefore, the preponderance of the evidence is against the claim for service connection for a right or left eye condition, the benefit-of-the-doubt standard of proof does not apply, and the claims are denied. 38 U.S.C. § 5107(b). Propriety of Reductions and Increased Rating 1. Right and Left Hip Abduction Conditions The Veteran is currently in receipt of noncompensable ratings for right and left hip limitation of abduction. These ratings were reduced from 20 percent effective August 1, 2016. He seeks to restore the 20 percent ratings for both the right and left hip conditions and further seeks ratings in excess of 20 percent for both conditions. A Veteran’s disability rating shall not be reduced unless an improvement in the disability is shown to have occurred. 38 C.F.R. § 3.344. The United States Court of Appeals for Veterans Claims (Court) has consistently held that when a disability rating is reduced without following the applicable regulations, the reduction is void ab initio. See Greyzck v. West, 12 Vet. App. 288, 292 (1999). Pursuant to 38 C.F.R. § 3.105(e), where a reduction in the rating of a service-connected disability is considered warranted and the lower evaluation would result in a reduction or discontinuance of compensation payments currently being made, a rating proposing the reduction or discontinuance will be prepared setting forth all material facts and reasons. The beneficiary will be notified at his latest address of record of the contemplated action and furnished detailed reasons therefore and will be given 60 days for the presentation of additional evidence to show that compensation payment should be continued at their present level. Final rating action will reduce or discontinue the compensation effective the last day of the month in which a 60-day period from the date of notice to the beneficiary of the final rating action expires. The due process protections of 38 C.F.R. § 3.105(e) apply in this case because the May 2016 rating decision reducing the ratings at issue resulted overall in a reduction of compensation payments. The Veteran was notified of the proposed reduction of the left knee disability evaluation in two rating decisions dating in October 2015 and again in March 2016. Furthermore, in a corresponding letter, he was also notified of his right to request a hearing regarding the proposed reductions as well as submit new evidence to support the original rating percentage. The claims file does show that the Veteran submitted an October 2015 notice of disagreement as to the October 2015 rating decision that first proposed the reductions at issue; however, in a November 2015 correspondence, the AOJ appropriately informed him that this notice of disagreement was premature, as no actual decision had been promulgated at that time. Ultimately, the reductions were made final in a May 2016 rating decision, effective August 1, 2016, exactly 60 days from the first day of the month following the month of the rating decision at issue. Accordingly, the Board finds that the RO complied with the procedural and notice requirements for reducing the ratings at issue. That being said, the Board must still determine whether the reductions at issue were proper based on the evidence of record. Prior to reducing a Veteran’s disability rating, VA is required to comply with several regulations applicable to all rating-reduction cases, regardless of the rating level or the length of time that the rating has been in effect. See 38 C.F.R. §§ 4.1, 4.2, 4.10, 4.13; see Brown v. Brown, 5 Vet. App. 413, 420 (1993). These provisions impose a clear requirement that VA rating reductions be based upon review of the entire history of a Veteran’s disability. See Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Such review requires VA to ascertain, based upon review of the entire recorded history of the condition, whether the evidence reflects an actual change in the disability and whether the examination reports reflecting such change are based upon thorough examinations. Thus, in any rating-reduction case, not only must it be determined that an improvement in a disability has actually occurred but also that that improvement actually reflects an improvement in the Veteran’s ability to function under the ordinary conditions of life and work. See Faust v. West, 13 Vet. App. 342, 350 (2000). The Board notes that the provisions of 38 C.F.R. § 3.344(a), which apply to evaluations in effect for five years or more, are not for application in this case, as both ratings at issue were not in effect for the necessary five years. Rather, the provisions of 38 C.F.R. § 3.344(c) concerning disabilities that have not stabilized, are applicable. This regulation provides that reexaminations disclosing improvement will warrant a rating reduction. In any rating reduction case, not only must it be determined that an improvement in disability has occurred, but also that the improvement in disability actually reflects an improvement in the appellant’s ability to function under the ordinary conditions of life and work. Faust at 349. In considering the propriety of a reduction, the Board must focus on the evidence available to the RO at the time the reduction was effectuated (although post-reduction medical evidence may be considered in the context of considering whether actual improvement was demonstrated). Dofflemyer v. Derwinski, 2 Vet. App. 277, 281-82 (1992). The Veteran need not demonstrate that he is entitled to retain the higher evaluation; rather, it must be shown by a preponderance of the evidence that the AOJ’s reduction was warranted. See Kitchens v. Brown, 7 Vet. App. 320, 324 (1995). Moving on to the analytical criteria for increased ratings, such ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. In cases in which a claim for a higher initial evaluation stems from an initial grant of service connection for the disability at issue, multiple (“staged”) ratings may be assigned for different periods of time during the pendency of the appeal. See generally Fenderson v. West, 12 Vet. App. 119 (1999). 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. See 38 C.F.R. § 4.7. In determining the appropriate rating for musculoskeletal disabilities, particular attention is focused on functional loss of use of the affected part. Factors of joint disability include increased or limited motion, weakened movement, excess fatigability, incoordination, and painful movement, including during flare-ups and after repeated use. DeLuca v. Brown, 8 Vet. App. 202, 206-08 (1995); 38 C.F.R. § 4.45. A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the claimant. 38 C.F.R. § 4.40. Additionally, “pain itself does not rise to the level of functional loss as contemplated by the VA regulations applicable to the musculoskeletal system.” Mitchell v. Shinseki, 25 Vet. App. 32, 38 (2011). Pain in a particular joint may result in functional loss, but only if it limits the ability to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance. Id.; 38 C.F.R. § 4.40. Under 38 C.F.R. § 4.59, painful joints are entitled to at least the minimum compensable rating for the joint. Although the ratings at issue were assigned pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5253, pertaining to impairment of the thigh, the Board will consider all of the potentially applicable criteria for evaluation disabilities of the hip and thigh, which are rated under Diagnostic Codes 5250 through 5255. Diagnostic Codes 5254 (flail joint) and 5255 (impairment of the femur) will not be considered by the Board, however, as they are not shown in the Veteran’s case. Under Diagnostic Code 5250 (ankylosis of the hip), a disability rating of 60 percent is assigned when the hip manifests favorable ankylosis with flexion at an angle between 20 degrees and 40 degrees and slight adduction or abduction, and a disability rating of 70 percent is assigned when there is intermediate ankylosis. A disability rating of 90 percent is assigned when there is unfavorable ankylosis such that the foot does not reach the ground and crutches are necessitated. Under Diagnostic Code 5251 (limitation of extension of the thigh), a maximum rating of 10 percent is assigned when extension is limited to 5 degrees. Under Diagnostic Code 5252 (limitation of flexion of the thigh), a 10 percent rating is warranted for flexion limited to 45 degrees, while a 20 percent rating is warranted for flexion limited to 30 degrees, a 30 percent rating is warranted for flexion limited to 20 degrees, and a 40 percent rating is warranted for flexion limited to 10 degrees. Finally, under Diagnostic Code 5253 (impairment of the thigh), a rating of 10 percent is assigned for limitation of rotation (cannot toe-out more than 15 degrees for the affected leg) or for limitation of adduction (cannot cross legs) while a 20 percent rating is assigned for limitation of abduction when motion is lost beyond 10 degrees. Normal range of motion (ROM) of the hip and thigh is flexion from 0 to 125 degrees and abduction from 0 to 45 degrees. 38 C.F.R. § 4.71a, Plate II. The reduction at issue was proposed in October 2015 on the basis of an examination earlier that month which showed that the Veteran’s bilateral hip abduction was limited to only 15 degrees, an improvement over the abduction limited to 10 degrees bilaterally that was exhibited on the previous July 2014 examination. The Board also notes that on the October 2015 examination the Veteran reported experiencing flare-ups of additional pain in both hips that resulted in his hips locking up and preventing him from ambulating. The examiner acknowledged as much when evaluating the severity of the bilateral hip conditions, and noted that pain, fatigue and weakness would significantly limit functional ability with flare-ups; however, the examiner declined to describe any additional loss of range of motion during flare-ups, stating that such estimation would depend on the type of activity performed and the severity of the pain experienced by the Veteran. Based solely on the apparent improvement in the Veteran’s range of hip abduction bilaterally on the October 2015 examination, the reduction from a 20 percent rating to noncompensable was warranted. That being said, although the Veteran did exhibit 15 degrees of abduction in his hips bilaterally on the October 2015 examination, the examiner noted that he experienced significant functional impairment during flare-ups of hip pain; moreover, the Veteran himself attested to his loss of ambulation during flare-ups. Without any estimation as to the potential increase in loss of range of motion during such a flare-up, however, the Board cannot ascribe much probative value to the findings on the October 2015 examination. In reviewing the prior July 2014 VA hip examination, the Board notes that the examiner detailed range of motion results that were slightly less severe than those recorded on the subsequent October 2015 examination. Indeed, while the October 2015 examiner recorded abduction limited to 15 degrees bilaterally, the July 2014 examiner recorded abduction limited to 30 degrees in the right hip and 40 degrees in the left hip. The only distinction between the two examinations is that the July 2014 examiner marked on the computerized form that abduction was lost beyond 10 degrees in both hips. This question was not even included on the computerized form utilized by the October 2015 VA examiner. Ultimately, the Board finds considerable uncertainty in the determination that the purported improvement shown on the October 2015 examination would be maintained under ordinary circumstances. In the Board’s estimation, the October 2015 examination showed not an improvement of symptomatology but actually a worsening of symptomatology, with the only difference being the lack of the inclusion of a specific question on the more contemporary examination. Furthermore, the testing results reported on the October 2015 examination is marred by the examiner’s unwillingness to estimate additional loss of range of motion during the acknowledged flare-ups, which the Veteran reported contributed to loss of ambulation. More importantly, however, is the fact that the AOJ did not set forth an adequate discussion of the sustained improvement in the Veteran’s ability to function under the ordinary conditions of life and work. The decision did not discuss the Veteran’s ability to function under the ordinary conditions of life and work and did not make any comparison of the functional impairment reflected in the July 2014 examination with the functional impairment detailed in the October 2015 examination. In addition, the decision did not discuss the continued complaints of the Veteran as to his chronic bilateral hip pain and how that pain hindered his ability to work and carry out functions of daily living. It is also noted that no discussion of improvement was included in the May 2016 decision that effectuated the reduction. Accordingly, the Board finds that the actions to reduce the right and left hip rating are void, and the 20 percent ratings are restored as though the reduction had not occurred. See 38 C.F.R. § 3.344; see also Greyzck v. West, 12 Vet. App. 288, 292 (1999). Having restored the prior 20 percent evaluation from August 1, 2016 for both the right and left hip limitation of abduction, the Board also finds that the preponderance of the evidence is against a determination that a rating in excess of 20 percent is warranted for either condition at any point during the pendency of the appeal. To begin, the Board notes that the Veteran is already in receipt of ratings for both hips corresponding to limitation of flexion under Diagnostic Code 5252 as well as a rating for the right hip corresponding to limitation of extension under Diagnostic Code 5251, and as the propriety of these ratings is not before the Board, they will not be addressed collaterally in this decision. Coupled with the Board’s previously noted dismissals of ratings pursuant to Diagnostic Codes 5253 and 5255, this leaves only ratings in excess of 20 percent for limitation of abduction of the hips bilaterally as well as a separate rating for limitation of extension of the left hip and ratings pursuant to 5250 for ankylosis as potential avenues for increased ratings. To that end, the Board notes that for claims for an increase in a service-connected disability, if an increase in disability occurred within one year prior to the claim, the increase is effective as of the date the increase was “factually ascertainable.” 38 U.S.C. § 5110(b)(2); 38 C.F.R. § 3.400(o). Accordingly, the relevant period of evaluation extends up to year prior to the date of the initial claim for increase, which in this case was May 21, 2014. During this period, as detailed previously, the Veteran was first afforded a VA hip examination to evaluate the severity of the bilateral hip conditions in July 2014. The Veteran reported that he experienced progressively worsening pain in his hips with flare-ups of additional pain preventing him from sitting or walking for long periods of time. Range of motion testing revealed the following: right hip flexion of 0 to 90 degrees with painful motion at 45 degrees, right hip extension greater than 5 degrees, left hip flexion of 0 to 110 degrees, and left hip extension greater than 5 degrees. Furthermore, on the right side abduction was lost beyond 10 degrees, but it was not limited such that the Veteran could not cross his legs. On the left side abduction was not lost beyond 10 degrees nor was it limited such that the Veteran could not cross his legs. On both sides, rotation was not limited such that the Veteran could not toe-out more than 15 degrees. There was no additional loss of range of motion after repetitive use testing, and the examiner did not note any additional limitation in range of motion due to any functional loss. The examiner did note that the Veteran experienced localized tenderness and/or pain to palpation in his right hip as well as some resistance during muscle strength testing. No ankylosis, malunion/nonunion of femur, flail hip joint, or leg length discrepancy was noted. The examiner concluded by stating that the bilateral hip conditions restricted the Veteran’s movement during flare-ups, which resulted in some impairment of occupational functioning. The severity of the bilateral hip conditions was next evaluated in an October 2015 VA examination, the results of which were reported in a disability benefits questionnaire (DBQ). The Veteran reported that he experienced progressively worsening pain in his hips with flare-ups of additional pain that interfered with ambulation. Range of motion testing revealed the following: right hip flexion of 0 to 90 degrees, right hip extension, abduction and adduction of 0 to 15 degrees, right hip external rotation of 0 to 30 degrees, and right hip internal rotation 0 to 25 degrees. Left hip flexion was 0 to 95 degrees, left hip extension, abduction and adduction was 0 to 15 degrees, left hip external rotation was 0 to 40 degrees, and left hip internal rotation was 0 to 30 degrees. Furthermore, the examiner noted pain with weight-bearing bilaterally as well as localized tenderness or pain on palpation bilaterally, with pain noted to cause additional functional loss. After repetitive use testing, flexion was reduced to 80 degrees bilaterally. As noted previously, although the examiner acknowledged that the Veteran experienced functional loss during flare-ups, they were unwilling to estimate the additional loss of range of motion attributable to this functional loss. Muscle strength testing did reveal some resistance, but no ankylosis, malunion/nonunion of femur, flail hip joint, or leg length discrepancy was noted. The examiner concluded by stating that the bilateral hip conditions did not result in any impairment of occupational functioning. Following the promulgation of the May 2016 rating decision confirming the reductions at issue, the Veteran submitted a disability benefits questionnaire (DBQ) prepared by a Dr. K.F. and dated in April 2016. The Veteran reported that he was limited in his ability to walk or stand from a sitting position and also experienced difficulty sleeping due to chronic hip pain. Range of motion testing revealed right hip abduction of 0 to 30 degrees, external rotation of 0 to 20 degrees, and internal rotation of 0 to 10 degrees; however, Dr. K.F. noted that he was unable to test right hip flexion, extension or adduction because the Veteran exhibited too much pain during testing. Left hip flexion was 0 to 90 degrees, left hip extension was 0 to 20 degrees, left hip abduction was 0 to 30 degrees, and left hip internal rotation was 0 to 20 degrees. Dr. K.F. also was unable to do repetitive use testing due to the Veteran’s pain, and relatedly noted pain with weight-bearing bilaterally as well as localized tenderness or pain on palpation bilaterally, with pain noted to cause additional functional loss in the form of less movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, atrophy of disuse, disturbance of locomotion, and interference with standing. Muscle strength testing did reveal some resistance on the right side but no loss on the left, with some muscle atrophy on the right lower extremity attributable to the right hip condition. Dr. K.F. also found evidence of favorable ankylosis bilaterally. No malunion/nonunion of femur, flail hip joint, or leg length discrepancy was noted. Dr. K.F. concluded by stating that the bilateral hip conditions resulted in limited ambulation and standing, both of which contributed to impairment of occupational functioning. Pursuant to the Board’s December 2019 remand instructions, the Veteran was afforded a new VA hip examination in January 2020, during which he reported daily stiffness and pain bilaterally as well as flare-ups of pain during ambulation or standing which prevented him from walking or standing for long periods of time. Range of motion testing revealed the following: right hip flexion of 0 to 85 degrees, right hip extension of 0 to 15 degrees, right hip abduction of 0 to 35 degrees, right hip adduction of 0 to 20 degrees, right hip external rotation of 0 to 50 degrees, and right hip internal rotation 0 to 30 degrees. Left hip flexion was 0 to 80 degrees, left hip extension was 0 to 20 degrees, left hip abduction was 0 to 35 degrees, left hip adduction was 0 to 20 degrees, left hip external rotation was 0 to 50 degrees, and left hip internal rotation was 0 to 35 degrees. Furthermore, the examiner noted pain with weight-bearing bilaterally as well as localized tenderness or pain on palpation bilaterally and crepitus bilaterally, with pain noted to cause additional functional loss. While repetitive use testing did not show any reduction in range of motion, the examiner did estimate a loss of 5 degrees in all ranges of motion after repeated use and/or during a flare-up. Muscle strength testing did reveal some resistance, but no ankylosis, malunion/nonunion of femur, flail hip joint, or leg length discrepancy was noted. The examiner concluded by stating that the bilateral hip conditions resulted in difficulty with walking, standing, and squatting. During the September 2019 hearing, the Veteran detailed that he had difficulty arising out of bed and experienced stiffness and pain throughout his hips in the morning. According to the Veteran, his ambulation was significantly impaired. A review of VA medical records shows continued treatment for bilateral hip pain for the entirety to the appeal period. A May 2014 left hip X-ray examination revealed minimal degenerative changes. Thereafter, the Veteran reported experiencing left leg pain from his hip down to his knee and was prescribed topical jelly for relief of his symptoms. Most recently, the Veteran sought treatment for left hip pain in October 2017 after he fell and hit his hip on a table. An evaluation at that time revealed no loss of range of motion or ambulation, and an X-ray examination showed no fracture or dislocation. He was discharged without any significant change in diagnosis or treatment plan. Upon review of the record, the Board does not find that a rating in excess of 20 percent for limitation of abduction in either hip is warranted. Moreover, separate ratings for limitation of extension of the left hip and ankylosis in either hip are also not warranted. Beginning with the ratings in excess of 20 percent for limitation of abduction, the Board notes that the 20 percent rating is the highest possible schedular rating available for limitation of abduction under Diagnostic Code 5253. Moreover, as the Veteran has not asserted that he is entitled to an extraschedular rating for the bilateral hip limitation of abduction, the Board need not consider whether such a rating is warranted. Doucette, supra. As for a possible rating for ankylosis in either hip, the Board does acknowledge that Dr. K.F. in his April 2016 DBQ noted that the Veteran exhibited favorable ankylosis in both hips. However, the 60 percent rating for favorable ankylosis under Diagnostic Code 5250 contemplates both ankylosis as well as flexion between 20 and 40 degrees, which has never been shown by the record. Accordingly, the Board does not find that a separate rating is warranted for ankylosis in either hip, especially in light of the fact that ankylosis was not noted on any other evaluation by a VA examiner during the relevant time period on appeal. Finally, with regards to whether a separate rating is warranted for left hip limitation of extension, there has been no indication on any evaluation during the appeal period that the Veteran’s left hip was limited to 5 degrees as would be necessary for the 10 percent rating under Diagnostic Code 5251. Accordingly, the Board finds that the restored 20 percent evaluation, but no more, is warranted for the right and left hip limitation of abduction from August 1, 2016. 2. Right and Left Knee Conditions The Veteran is in receipt of a 10 percent rating for right knee osteoarthritis manifested by limitation of extension from July 15, 2013. In addition, he is in receipt of a 10 percent rating for left knee osteoarthritis. As detailed above, the Veteran was also awarded a separate 10 percent rating for left knee instability when these matters were before the AOJ following the Board’s previous remand, and this separate rating is before the Board as well. In light of the fact that the evidence in support of the right and left knee disabilities is largely identical, the Board will evaluate the increased rating claims together. Moreover, the Board notes that the Veteran’s claim seeking increased ratings for the right and left knee disabilities was filed on May 2, 2016. The evaluation for right knee osteoarthritis manifested by limitation of extension was assigned pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5261, while the evaluation for left knee osteoarthritis was assigned pursuant to Diagnostic Code 5003-5260 and the evaluation for left knee instability was assigned pursuant to Diagnostic Code 5257. In the selection of code numbers assigned to disabilities, injuries will generally be represented by the number assigned to the residual condition on the basis of which the rating is determined. With injuries and diseases, preference is to be given to the number assigned to the injury or disease itself; if the rating is determined on the basis of residual conditions, the number appropriate to the residual condition will be added, preceded by a hyphen. 38 C.F.R. § 4.27. The hyphenated diagnostic code in this case indicates that the symptomatology of the left knee osteoarthritis is manifested as degenerative arthritis pursuant to Diagnostic Code 5003, with Diagnostic Code 5260 representing a manifestation of the arthritis corresponding to limitation of flexion. The other two ratings at issue correspond solely to distinct manifestations of impairment of the knee. Diagnostic Code 5003 provides for a rating of 10 percent for each major joint or group of minor joints affected by noncompensable limitation of motion. An increased rating of 20 percent is warranted with x-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations.  38 C.F.R. § 4.71a, Diagnostic Code 5003. The Board will consider additional diagnostic codes pertinent to the evaluation of knee disabilities in order to determine the highest possible evaluation for the right and left knee disabilities during the entire period of the appeal. That being said, it is noted that the Veteran himself restricted the scope of the Board’s analysis when he declined to appeal the separate 20 percent rating for right knee instability as well as the noncompensable evaluation for right knee flexion. Moreover, in considering the applicability of the remaining available diagnostic codes, the Board finds that Diagnostic Codes 5258 (dislocated semilunar cartilage), 5259 (symptomatic removal of semilunar cartilage) and 5263 (genu recurvatum) are not applicable in this instance as the medical evidence does not show that the Veteran experiences these conditions in either knee. 38 C.F.R. § 4.71a, Diagnostic Codes 5258, 5259, 5263. Under Diagnostic Code 5256, ankylosis, a 30 percent rating is warranted for favorable angle in full extension, or in slight flexion between 0 degrees and 10 degrees, while a 40 percent rating is called for with flexion between 10 and 20 degrees, a 50 percent rating for flexion between 20 and 45 degrees. Extremely unfavorable ankylosis, with flexion at an angle of 45 degrees or more warrants a maximum 60 percent evaluation. Under Diagnostic Code 5257, recurrent subluxation or lateral instability, a 10 percent rating is assigned when the impairment is slight, while a 20 percent rating is assigned for moderate impairment and a 30 percent rating is for severe impairment. Under Diagnostic Code 5260, limitation of flexion of the leg, a noncompensable rating is assigned when flexion is limited to 60 degrees; a 10 percent rating is assigned when flexion is limited to 45 degrees; a 20 percent rating is assigned when flexion is limited to 30 degrees; and a 30 percent rating is assigned when flexion is limited to 15 degrees. Under Diagnostic Code 5261, limitation of extension of the leg, a noncompensable rating is assigned when extension is limited to 5 degrees; a 10 percent rating is assigned when extension is limited to 10 degrees; a 20 percent rating is assigned when extension is limited to 15 degrees; a 30 percent rating is assigned when extension is limited to 20 degrees; a 40 percent rating is warranted for extension limited to 30 degrees; and a 50 percent rating is assigned when extension is limited to 45 degrees. The standardized description of joint measurements is provided in Plate II under 38 C.F.R. § 4.71a. For VA purposes, “normal” extension and flexion of the knee is from zero to 140 degrees, and references to normal motion below indicate that the Veteran, in fact, had motion from zero to 140 degrees. 38 C.F.R. § 4.71a, Plate II. The VA General Counsel has held that a knee disability may receive separate ratings under diagnostic codes evaluating instability (Code 5257) and those evaluating range of motion (Codes 5003, 5010, 5256, 5260, and 5261). See VAOPGCPREC 23-97. The Board additionally notes that separate ratings under Diagnostic Codes 5260 and 5261 may be assigned for disability of the same knee joint. See VAOPGCPREC 9-2004. During the appeal period, the Veteran was first afforded a VA examination to evaluate the nature and severity of his bilateral knee conditions in October 2015. He reported experiencing flare-ups of additional symptomatology including pain and locking up resulting in weakness and lack of endurance in both legs. Range of motion testing revealed flexion reduced to 100 degrees bilaterally, and no loss of extension in either knee. The examiner noted that the right knee loss of range of motion contributed to functional loss in the form of pain, weakness and fatigue, and further noted that there was pain with weight bearing bilaterally as well as localized tenderness in the right knee. After repetitive use testing right knee flexion was reduced to 90 degrees; there was no additional loss of range of motion in the left knee following repetitive use testing. The examiner did note that the Veteran would experience additional functional impairment during flare-ups but was unwilling to estimate this degree of additional impairment, as it would depend on the type of activity performed by the Veteran. Muscle strength testing revealed a slight loss of strength with resistance. No ankylosis, recurrent subluxation or lateral instability were noted in either knee, but stability testing did show slight medial instability in the right knee. In summation, the examiner did not find that the bilateral knee condition was result in any impairment of occupational functioning. The Veteran submitted a disability benefits questionnaire (DBQ) prepared by a Dr. K.F. and dated in May 2016. The Veteran reported that he was limited in his ability to walk or stand from a sitting position. Range of motion testing revealed flexion reduced to 90 degrees in the right knee and 100 degrees in the left knee, while extension was reduced to 170 degrees in the right knee, with no loss of extension in the left knee. Dr. K.F. did not note any change in range of motion after repetitive use testing, but did find that the Veteran experienced pain in both knees during movement as well as with weight-bearing; in addition, Dr. K.F. also noted localized tenderness in the medial compartment with crepitus in the right knee. Functional loss included the following: less movement than normal, weakened movement, pain on movement, deformity, instability of station, disturbance of locomotion, and interference with standing. Dr. K.F. also found that during flare-ups the Veteran was unable to walk or stand. Muscle strength testing showed a slight loss of strength in the right leg but no loss in the right leg, with the right leg loss of strength attributed to right lower extremity muscle atrophy. Dr. K.F. did endorse a finding of ankylosis on the right side in flexion between 10 and 20 degrees and on the left side in full extension or in slight flexion between zero and 10 degrees. Although Dr. K.F. found no evidence of recurrent subluxation, instability testing showed slight medial instability in the right knee, moderate medial instability in the left knee and moderate lateral instability bilaterally. Dr. K.F. further noted that the Veteran exhibited frequent episodes of joint pain and effusion in the right knee as well as pain in the left knee. In summation, Dr. K.F. reiterated that the Veteran experienced impairment of occupational functioning as due to his difficulty ambulating. During the September 2019 hearing, the Veteran asserted that his knees had worsened in severity since the previous VA examination. Pursuant to the Board’s December 2019 remand, the Veteran was scheduled for a new VA knee examination in January 2020, during which he reported daily bilateral stiffness and chronic pain that worsened after periods of extended standing or walking. He also endorsed experiencing flare-ups of additional pain making it difficult for him to walk or stand for long periods of time and also interrupting his sleep. Range of motion testing revealed flexion reduced to 85 degrees in the right knee and 80 degrees in the left knee, and no loss of extension in either knee. The examiner also noted pain with weight-bearing, localized tenderness, and crepitus bilaterally. After repetitive use testing there was no additional loss of range of motion; however, the examiner estimated that after repeated use over time and/or during a flare up flexion would be reduced by 5 degrees bilaterally, with this additional loss attributed to pain, fatigue, weakness and lack of endurance bilaterally. Muscle strength testing revealed a moderate loss of strength but no muscle atrophy. No ankylosis or recurrent subluxation were noted in either knee, but stability testing did show 1+ instability throughout both knees (service connection is separately in effect for right knee instability, and that rating is not on appeal currently). Diagnostic testing revealed degenerative arthritis bilaterally. In summation, the examiner found that the bilateral knee conditions resulted in impairment of occupational functioning in the form of difficulty with ambulation, sitting, standing, kneeling and squatting. A review of VA medical records reflects that the Veteran has had bilateral knee arthritis listed as an active problem for the entirety of the appeal period. A May 2015 outpatient note shows that he complained of bilateral knee pain; an evaluation at that time revealed only slight impairment attributable to the knees in the form of pain and marginal instability. Subsequent medical records show that the Veteran reported experiencing chronic bilateral knee pain during his periodic evaluations at his local VA medical center, and bilateral knee arthritis continued to be listed as an active problem; however, there are no more instances of the Veteran seeking specific treatment for his right and left knee symptomatology through VA. Upon consideration of the evidence, the Board finds that a rating in excess of 10 percent for right knee limitation of extension is not warranted at any point during the appeal. The evidence shows that the Veteran’s extension of the right knee has not approximated 15 degrees, which is contemplated by the 20 percent rating. The Board acknowledges the Veteran’s statements regarding the pain he experiences in his right knee. However, painful motion is contemplated and compensated by the 10 percent rating currently assigned. Similarly, a rating in excess of 10 percent for osteoarthritis of the left knee manifested by limitation of flexion is also not warranted at any point during the appeal. The evidence shows that the Veteran’s flexion of the left knee has not approximated 30 degrees, which is contemplated by the 20 percent rating. The Veteran’s flexion was at most limited at 75 degrees. The Board acknowledges the Veteran’s statements regarding the pain he experiences in his left knee. However, painful motion is contemplated and compensated in the 10 percent rating assigned. Moreover, there is no evidence that the Veteran exhibits a compensable degree of limitation of extension, and so a separate rating under Diagnostic 5261 is also not warranted. The Board has further considered whether higher ratings for the right and left knee limitation of motion are warranted under Diagnostic Code 5256 pertaining to ankylosis. It is acknowledged that Dr. K.F. detailed on the May 2016 DBQ that the Veteran exhibited ankylosis in the right knee in flexion between 10 and 20 degrees and in a favorable angle in full extension of the left knee or in slight flexion between zero and 10 degrees. However, the Board finds that this evaluation of the severity of the Veteran’s limitation of range of motion of his bilateral knees does not accord with the evidence of record. Both the October 2015 and January 2020 VA examiners noted no evidence of ankylosis, and furthermore both VA examiners as well as Dr. K.F. recorded range of motion test results that were noncompensable in nature. Moreover, the Veteran has not reported on any examination or during the September 2019 hearing that he experienced any degree of immobility of the knee joint bilaterally, as would be necessary for a finding of ankylosis. Under these circumstances, the Board finds that an increased rating for symptomatology commensurate with ankylosis of either knee is not warranted. The Board also does not find that the Veteran is entitled to a separate rating for either knee under Diagnostic Code 5258 which evaluates dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint. Although crepitus was noted bilaterally on the January 2020 examination, the VA examiner also denied the existence of dislocated semilunar cartilage or frequent effusion, which would also need to be present to warrant a 20 percent rating under 5258. 38 C.F.R. § 4.71a, Diagnostic Code 5258. Finally, regarding the rating for left knee instability, the Board finds that a 10 percent rating, but no more, is warranted from the earlier effective date of May 10, 2016, the date of Dr. K.F.’s DBQ which first documented evidence of left knee instability. Although this finding was not further corroborated until the January 2020 VA knee examination, the Veteran did report a history of worsening left knee instability during that examination. The Veteran also asserted that his bilateral knee symptomatology had worsened since the prior VA examination in October 2015. Under these circumstances, the Board can assume that the left knee instability was present at least as early as the date of Dr. K.F.’s DBQ. There is no indication from the record, however, that the left knee instability was moderate in severity. Both Dr. K.F. on the May 2016 DBQ and the January 2020 VA examiner recorded only a small impairment of balance and stability for the left knee, and there is no documentation of the Veteran having reported experiencing a fall or other indication of a loss of balance as due to the left knee during the appeal period. Any instability that was present thus does not constitute “moderate” instability for rating purposes. The Board has reviewed the Veteran’s lay testimony and the VA treatment records in the claims file, but this evidence does not tend to show that the symptoms of the bilateral knee conditions warrant ratings in excess of those assigned. As stated, the evidence does support extending the 10 percent separate rating for left knee instability back to May 10, 2016, the date of Dr. K.F.’s DBQ. However, for any additional functional loss to warrant a higher rating, that loss must rise to the level of the more severe symptomatology represented by the ratings in excess of those assigned percent and/or must reflect additional symptomatology not encompassed within the current assigned ratings which is sufficient to be rated separately, none of which has been shown. Furthermore, although the Veteran reported experiencing flare-ups of bilateral knee pain on the October 2015 and January 2020 examinations as well as on Dr. K.F.’s May 2016 DBQ, there is no indication from those examinations or the available treatment records that any increase in symptomatology during such flare-ups would equate to an significant increase in limitation of motion, as would be necessary for an evaluation in excess of the currently assigned ratings or which would warrant a separate rating. Sharp v. Shinseki, 29 Vet. App. 26 (2017); Correia v. McDonald, 28 Vet. App. 158 (2016). Therefore, the Board finds that the current 10 percent ratings for right and left knee osteoarthritis contemplate the impaired motion exhibited by the Veteran during the appeal period. Furthermore, the 10 percent rating for left knee instability from now-earlier effective date of May 10, 2016 also adequately contemplates the impaired stability exhibited by the Veteran during the appeal period. See Id., 4.40, 4.45; DeLuca, 8 Vet. App. at 20. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Christopher M. Collins, 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.