Citation Nr: 21001451 Decision Date: 01/08/21 Archive Date: 01/08/21 DOCKET NO. 20-08 280 DATE: January 8, 2021 ORDER The evaluation for service-connected lumbar degenerative joint disease with lumbar disc herniation is restored to 40 percent, effective May 1, 2020. For the rating period prior to July 17, 2017, entitlement to an increased rating in excess of 30 percent disabling for service-connected left knee degenerative arthritis, limitation of extension, is denied. For the rating period from July 17, 2017 to August 31, 2017, entitlement to a 100 percent disabling for the period of convalescence after total left knee replacement is granted. For the rating period from September 1, 2017 through August 31, 2018, entitlement to a 100 percent disability rating for total left knee replacement is granted. For the rating period as of August 31, 2018, entitlement to an increased rating in excess of 30 percent disabling for service-connected residuals of total left knee replacement, is denied. Entitlement to an increased rating in excess of 20 percent disabling for service-connected right knee osteoarthritis prior to March 27, 2018, and in excess of 30 percent disabling thereafter is denied. Entitlement to an effective date, prior to February 5, 2014, for the assignment of a 40 percent rating for service-connected degenerative joint disease with lumbar disc herniation is denied. Entitlement to an effective date, prior to February 5, 2014, for the assignment of a 20 percent rating for service-connected peripheral neuropathy of the left lower extremity is denied. Entitlement to an effective date, prior to February 5, 2014, for the assignment of a 20 percent rating for service-connected peripheral neuropathy of the right lower extremity is denied. Entitlement to an effective date, prior to February 5, 2014, for the assignment of a 20 percent rating for service-connected left knee degenerative arthritis, limitation of extension, is denied. REMANDED Entitlement to an increased rating in excess of 40 percent disabling for service-connected degenerative joint disease with lumbar disc herniation is remanded. Entitlement to an increased rating in excess of 20 percent disabling for service-connected peripheral neuropathy of the left lower extremity is remanded. Entitlement to an increased rating in excess of 20 percent disabling for service-connected peripheral neuropathy of the right lower extremity is remanded. FINDINGS OF FACT 1. The Veteran’s 40 percent disability rating for service-connected lumbar degenerative joint disease with lumbar disc herniation was effective from February 5, 2014 to May 1, 2020, a period of more than five years; sustained improvement has not been demonstrated during this time period. 2. For the rating period prior to July 17, 2017, service-connected left knee degenerative arthritis manifested as extension to 20 degrees with pain. 3. The Veteran had a total left knee replacement on July 17, 2017, and he was discharged from the hospital the next day. 4. For the rating period as of September 1, 2018, residuals of total left knee replacement manifested as intermediate residuals of pain, with extension to 20 degrees with pain. 5. For the rating period prior to March 27, 2018, right knee osteoarthritis manifested as malunion of the right tibia and fibula with moderate knee disability. 6. For the rating period as of March 27, 2018, right knee osteoarthritis manifested as extension to 20 degrees with pain. 7. The claim for an increased rating for service-connected degenerative joint disease with lumbar disc herniation was received on February 2, 2014; it is not factually ascertainable that an increase in disability had occurred within one year of the receipt of the February 2, 2014 claim. 8. The claim for an increased rating for service-connected peripheral neuropathy, left lower extremity was received on February 2, 2014; it is not factually ascertainable that an increase in disability had occurred within one year of the receipt of the February 2, 2014 claim. 9. The claim for an increased rating for service-connected peripheral neuropathy, right lower extremity was received on February 2, 2014; it is not factually ascertainable that an increase in disability had occurred within one year of the receipt of the February 2, 2014 claim. 10. The claim for service connection left knee degenerative arthritis, limitation of extension, was received on February 2, 2014; it is not factually ascertainable that an increase in disability had occurred within one year of the receipt of the February 2, 2014 claim. CONCLUSIONS OF LAW 1. Restoration of the 40 percent rating for service-connected lumbar degenerative joint disease with lumbar disc herniation is granted. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.105 (e), 3.344 (2019). 2. For the rating period prior to July 17, 2017, the criteria for an increased rating in excess of 30 percent disabling for service-connected left knee degenerative arthritis, limitation of extension, have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.71a, DC 5003-5261 (2019). 3. For the rating period from July 17, 2017 to August 31, 2017, the criteria for a 100 percent disability rating for a total left knee replacement have been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.30, 4.71a, DC 5055 (2019). 4. For the rating period from September 1, 2017 to August 31, 2018, the criteria for an increased 100 percent disability rating for a total left knee replacement have been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.71a, DC 5055 (2019). 5. For the rating period as of September 1, 2018, the criteria for an increased rating in excess of 30 percent disability rating for a residuals of total left knee replacement have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.71a, DC 5505, 5261 (2019). 6. The criteria for an increased rating in excess of 20 percent disabling for service-connected right knee osteoarthritis prior to March 27, 2018, and in excess of 30 percent disabling thereafter have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.3, 4.7, 4.71a, DC 5505, 5261 (2019). 7. The criteria for earlier effective date than February 5, 2014 for service-connected degenerative joint disease with lumbar disc herniation have not been met. 38 U.S.C. §§ 1155, 5110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.321, 3.340, 3.341, 3.400(o) (2019). 8. The criteria for earlier effective date than February 5, 2014 for service-connected peripheral neuropathy of the left lower extremity have not been met. 38 U.S.C. §§ 1155, 5110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.321, 3.340, 3.341, 3.400(o) (2019). 9. The criteria for earlier effective date than February 5, 2014 for service-connected peripheral neuropathy of the right lower extremity have not been met. 38 U.S.C. §§ 1155, 5110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.321, 3.340, 3.341, 3.400(o) (2019). 10. The criteria for earlier effective date than February 5, 2014 for service-connected left knee degenerative arthritis, limitation of extension, have not been met. 38 U.S.C. §§ 1155, 5110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.321, 3.340, 3.341, 3.400(o) (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service with the U.S. Marine Corps from May 1963 to August 1967. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2015 rating decision from the Department of Veterans Affairs (VA) Regional Office in Providence, Rhode Island (RO). Within a March 2016 notice of disagreement, in addition to contesting the assigned ratings for the increased rating claims on appeal, the Veteran contested the effective date of the increased rating claims for service-connected lumbar degenerative joint disease with lumbar disc herniation; peripheral neuropathy of the right lower extremity; peripheral neuropathy of the left lower extremity; and left knee degenerative arthritis, limitation of extension. During the course of the appeal, within a March 2015 rating decision, service-connected degenerative joint disease with lumber disc herniation was increased to 40 percent disabling, effective February 5, 2014, and service-connected peripheral neuropathy of the bilateral lower extremities were each increased to 20 percent disabling, effective February 5, 2014. Also, within an April 2018 rating decision, service-connected right knee osteoarthritis, rated at 20 percent disabling, was increased to 30 percent disabling as of March 27, 2018, the date of a VA examination which showed an increase in disability. The Board notes that these grants constitute a partial grant of the full benefits sought on appeal, and therefore, the issues remain pending on appeal. A.B. v. Brown, 6 Vet. App. 35, 38 (1993). The Board notes that the Veteran claimed entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) within the March 2016 notice of disagreement, which was raised in conjunction with his increased rating claims on appeal. See Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). However, entitlement to a TDIU was granted within a February 2020 rating decision, effective February 5, 2014, the date of the increased rating claims on appeal. Because the Board has denied the earlier effective dates of the increased rating claims on appeal within this decision, the Board finds that entitlement to a TDIU has been granted in full and there remains no question of law or fact on appeal for the Board to adjudicate as to this issue. See 38 U.S.C. § 7105 (d)(5). Rating Reduction 1. Rating reduction of service-connected lumbar degenerative joint disease with lumbar disc herniation from 40 percent disabling to 10 percent disabling, effective May 1, 2020 The provisions of 38 C.F.R. § 3.105 (e) allow for the reduction in evaluation of a service-connected disability when warranted by the evidence, but only after following certain procedural guidelines. The RO must issue a rating action proposing the reduction and setting forth all material facts and reasons for the reduction. The Veteran must then be given 60 days to submit additional evidence and to request a predetermination hearing. Then a rating action will be taken to effectuate the reduction. 38 C.F.R. § 3.105 (e). The effective date of the reduction will be the last day of the month in which a 60-day period from the date of notice to the Veteran of the final action expires. 38 C.F.R. § 3.105 (e), (i)(2)(i) (2019). In a March 2015 rating decision, the RO assigned a non-initial increased rating of 40 percent disabling for service-connected lumbar degenerative joint disease with lumbar disc herniation, effective February 2, 2014, the date of the non-initial increased rating claim. The Veteran had previously been in receipt of a 20 percent rating for service-connected lumbar degenerative joint disease with lumbar disc herniation, as of July 14, 2004. Within a subsequent January 2016 rating decision, the RO proposed a rating reduction for service-connected lumbar spine disability from 40 percent disabling to 10 percent disabling, based off findings made within a January 2016 VA spine examination. The rating reduction was effectuated within a December 2019 statement of the case and subsequent February 2020 rating decision, which reduced service-connected lumbar spine disability to 10 percent disabling effective May 1, 2020. Here, the Board finds that the RO met the procedural requirements associated with a reduction, and the next question is whether the reduction was proper based on the evidence of record. The regulations pertaining to the reduction of a disability rating are contained in 38 C.F.R. § 3.344. Where a disability rating has been in effect less than five years, a rating reduction is warranted where reexamination of the disability discloses improvement of that disability. 38 C.F.R. § 3.344 (c). Where a disability rating has been in effect over five years or has “stabilized” the provisions of 38 C.F.R. § 3.344 (a) and (b) apply. In such cases, the evidence of record at the time of the reduction decision must demonstrate a sustained and material improvement based on the entire record of pertinent medical evidence. Lehman v. Derwinski, 1 Vet. App. 339 (1991). Here, the Veteran’s 40 percent rating for service-connected back disability was assigned from February 5, 2014 to May 1, 2020, a period of more than five years. Therefore, the provisions of 38 C.F.R. § 3.344 (a) and (b) apply. Ratings on account of disease subject to temporary or episodic improvement will not be reduced on any one examination, except in those instances where all the evidence of record clearly warrants the conclusion that sustained improvement has been demonstrated. Moreover, though material improvement in the physical or mental condition is clearly reflected, the rating agency will consider whether the evidence makes it reasonably certain that the improvement will be maintained under the ordinary conditions of life. 38 C.F.R. § 3.344 (2019). In essence, a rating that has existed for five years or more may not be reduced on any one examination, unless all the evidence of record establishes that a claimant's condition has undergone sustained material improvement. Id. The duration of a rating is measured from the effective date of assignment to the effective date of actual reduction. Brown v. Brown, 5 Vet. App. 413 (1993). 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 evaluating whether the condition had demonstrated actual improvement. Cf. Dofflemyer v. Derwinski, 2 Vet. App. 277, 281-282 (1992). In addition, it must be determined that an improvement in a disability has actually occurred and that such improvement actually reflects an improvement in the Veteran's ability to function under the ordinary conditions of life and work. See 38 C.F.R. §§ 4.1 , 4.2, 4.13 (2019). As an initial matter, the Veteran’s lumbar spine disability is rated under Diagnostic Code 5273, lumbosacral strain, which is rated under the General Rating Formula for Diseases or Injuries of the Spine (General Rating Formula). 38 C.F.R. § 4.71a (2019). Under the General Rating Formula, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour, or vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted when there is forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, combined range of motion of the thoracolumbar spine not greater than 120 degrees; or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour, such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted when there is forward flexion of the thoracolumbar spine 30 degrees or less, or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, DC 5237 (2019). From February 5, 2014 to May 1, 2020, the duration of the 40 percent rating for service-connected lumbar degenerative joint disease with lumbar disc herniation, the evidence of record pertaining to the claim included two VA examinations as well as lay statements from the Veteran. A March 2015 VA examination included, in pertinent part, range of motion testing, which showed forward flexion of the thoracolumbar spine to 30 degrees – criteria for a higher 40 percent disability rating, which was effectuated in a March 2015 rating decision. The Veteran submitted an October 2015 statement, in which he reported symptoms of constant back pain which had limited his ability to work. A January 2016 VA examination included range of motion testing, which showed forward flexion to 90 degrees, with extension to 5 degrees, which more nearly met the criteria for a 10 percent rating under Diagnostic Code 5237. Upon review of the record from February 5, 2014 to May 1, 2020, the Board finds that the medical evidence of record did not clearly warrant the conclusion that sustained improvement has been demonstrated as required under the 38 C.F.R. § 3.344 (a) criteria. While two VA examinations were conducted during this time period, the RO only considered the January 2016 VA examination in initiating the rating reduction for the Veteran’s service-connected back disability. Both the January 2016 rating decision, proposing the reduction, and the December 2019 statement of the case, effectuating the reduction, did not compare the findings of the March 2015 VA examination and the January 2016 VA examination of the lumbar spine. Further, the March 2015 VA examination showed a worsening of the Veteran’s lumbar spine disability, much less an improvement in the ability to function under the ordinary conditions of life and work. Finally, within the January 2016 rating decision and December 2019 statement of the case, the RO did not discuss whether the evidence makes it reasonably certain that the improvement will be maintained under the ordinary conditions of life but merely compared the most recent VA examination findings with the General Rating Formula criteria. 38 C.F.R. § 3.344 (a) (2019). Failure to demonstrate improvement in the Veteran’s service-connected lumbar degenerative joint disease with lumbar disc herniation and failure to consider and apply the provisions of 38 C.F.R. § 3.344 renders the rating reduction void ab initio. Dofflemyer v. Derwinski, 2 Vet. App. 277, 282 (1992) (rating reduction that failed to consider 38 C.F.R. §§ 3.343 (a) and 3.344 (b) was void ab initio); see also Kitchens, 7 Vet. App. 325; Brown, 5 Vet. App. at 419. As such, the Board restores the 40 percent disability rating for service-connected lumbar degenerative joint disease with lumbar disc herniation, effective May 1, 2020. 38 U.S.C. § 5107 (b) (2012); 38 C.F.R. §§ 3.102, 3.344 (2019). Increased Rating Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities. The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2019). 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 rating will be assigned. 38 C.F.R. § 4.7 (2019). Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3 (2019). The United States Court of Appeals for Veterans Claims (Court) has held that staged ratings are appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). The relevant temporal focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. Id. The Board finds that an additional staged-rating for service-connected right knee disability is also not warranted. However, a staged rating for service-connected left knee disability is warranted. As discussed below, Pyramiding, that is the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when evaluating a Veteran’s service-connected disability. 38 C.F.R. § 4.14 (2019). However, it is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes; the critical element in permitting the assignment of several evaluations under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261- 62 (1994). In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). Functional loss may be due to due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. 38 C.F.R. § 4.40 (2019). Weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity, or atrophy of disuse are relevant factors in regard to joint disability. 38 C.F.R. § 4.45 (2019). With any form of arthritis, painful motion is an important factor of the disability; therefore, 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 schedule is to recognize painful motion with joint or particular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. Crepitation either in the soft tissues such as the tendons or ligaments, or crepitation within the joint structures should be noted carefully as points of contact which are diseased. Flexion elicits such manifestations. The joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint. 38 C.F.R. § 4.59 (2019). Under Diagnostic Code 5261, limited extension of the leg, a 10 percent evaluation is warranted where extension is limited to 10 degrees; a 20 percent evaluation is warranted where extension is limited to 15 degrees; a 30 percent evaluation is warranted where extension is limited to 20 degrees; and a 40 percent evaluation is warranted where extension is limited to 30 degrees. 38 C.F.R. § 4.71a (2019). Under Diagnostic Code 5260, limited flexion of the leg, a 10 percent evaluation is warranted where flexion is limited to 45 degrees; a 20 percent evaluation is warranted where flexion is limited to 30 degrees; and a 30 percent evaluation is warranted where flexion is limited to 15 percent. 38 C.F.R. § 4.71a (2019). Under Diagnostic Code 5262, a 20-percent rating is warranted where there is malunion with moderate knee or ankle disability; a 30-percent rating is warranted where there is malunion with marked knee or ankle disability; and a 40-percent rating, which is the highest rating available under the schedule, is warranted where there is nonunion of the tibia and fibula, with loose motion, requiring brace. 38 C.F.R. § 4.71a (2019). Under Diagnostic Code 5003, degenerative arthritis is rated based on limitation of motion under the appropriate diagnostic codes for the specific joint involved. However, when 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, to be combined, not added under Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, a 10 percent evaluation is assigned with x-ray evidence of involvement of two or more major joints; a 20 percent rating is assigned with x-ray evidence of involvement of two or more major joints with occasional incapacitating exacerbations. 38 C.F.R. § 4.71a (2019). Under Diagnostic Code 5055, a 100 percent evaluation will be assigned for a prosthetic replacement of a knee joint for one year following implantation of the prosthesis. Thereafter, the service-connected knee disability will be evaluated based upon any residual impairment. Note (1) under Diagnostic Code 5055 indicates that the 100 percent rating for one year following implantation of the prosthesis will commence after the initial grant of the one-month total rating assigned under 38 C.F.R. § 4.30 following hospital discharge. 38 C.F.R. § 4.71(a), DC 5055 (2019). A 60 percent rating is assigned where chronic residuals consist of severe painful motion or weakness in the affected extremity. An intermediate degree of residual weakness, pain or limitation of motion rate by analogy to diagnostic codes 5260, 5261, 5262. A minimum rating is assigned a 30 percent rating. 38 C.F.R. § 4.71(a), DC 5055 (2019). In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). Functional loss may be due to due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. 38 C.F.R. § 4.40 (2019). Weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity, or atrophy of disuse are relevant factors in regard to joint disability. 38 C.F.R. § 4.45 (2019). VA’s Office of General Counsel has provided guidance concerning increased rating claims for knee disorders. Separate disability ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition was not “duplicative of or overlapping with the symptomatology” of the other condition. See Esteban, 6 Vet. App. at 262. VA’s General Counsel interpreted that compensating a claimant for separate functional impairment under Diagnostic Code 5257 and 5003 does not constitute pyramiding. VAOPGCPREC 23-97. In VAOPGCPREC 9-98, VA’s General Counsel reiterated that if a veteran has a disability rating under Diagnostic Code 5257 for instability of the knee, and there is also X-ray evidence of arthritis, a separate rating for arthritis could also be based on painful motion under 38 C.F.R. § 4.59. In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court of Appeals for Veteran’s Claims (Court) provided a precedential interpretation of the final sentence of 38 C.F.R. § 4.59, which reads: “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.” Specifically, the Court held “that the final sentence of § 4.59 creates a requirement that certain range of motion testing be conducted whenever possible in cases of joint disabilities.” The Court also stated that “to be adequate, a VA examination of the joints must, wherever possible, include the results of the range of motion testing described in the final sentence of § 4.59.” In addition, the General Counsel considered a hypothetical situation in which a knee disability was evaluated under Diagnostic Code 5259 that was productive of pain, tenderness, friction, osteoarthritis established by x-rays, and a slight loss of motion. For the purposes of the hypothetical, it was assumed that Diagnostic Code 5259 did not involve limitation of motion. Given the findings of osteoarthritis, the General Counsel stated that the availability of a separate evaluation under Diagnostic Code 5003 in light of sections 4.40, 4.45, 4.59 must be considered. See Lichtenfels v. Derwinski, 1 Vet. App. 484, 488 (1991). Absent x-ray findings of arthritis, limitation of motion should be considered under Diagnostic Codes 5260 and 5261. The claimant’s painful motion may add to the actual limitation of motion so as to warrant a rating under Diagnostic Codes 5260 or 5261. The General Counsel further noted in VAOPGCPREC 9-98 that the removal of the semilunar cartilage may involve restriction of movement caused by tears and displacements of the menisci, but that the procedure may result in complications such as reflex sympathetic dystrophy, which can produce loss of motion. Therefore, limitation of motion is a relevant consideration under Diagnostic Code 5259, and the provisions of 38 C.F.R. § 4.40, 4.45, and 4.59 must be considered. Finally, the VA General Counsel has held that separate ratings may be assigned under Diagnostic Code 5260 and Diagnostic Code 5261 for disability of the same joint. VAOPGCPREC 9-2004. Specifically, where a veteran has both a limitation of flexion and a limitation of extension of the same leg, the limitations must be rated separately to adequately compensate for functional loss associated with injury to the leg. 2. Entitlement to an increased rating for service-connected left knee degenerative arthritis, limitation of extension Service-connected left knee degenerative arthritis, limitation of extension, is assigned a 30 percent disability rating under Diagnostic Code 5261, limitation of extension of the knee. As an initial matter, the Board finds that staged ratings are warranted for service-connected left knee degenerative arthritis. The Veteran had a total left knee replacement on July 17, 2017, warranting a temporary 100 percent rating effective July 17, 2017, the date of surgery, and continuing for one month from August 1, 2017, as the first day of the month following discharge. Pursuant to Diagnostic Code 5055, the one-year period for a total rating following the left total knee replacement should begin September 1, 2017, and continue through August 31, 2018. Therefore, the following stages are warranted for the Veteran’s left knee disability: (a) entitlement to a rating of 30 percent disabling prior to July 17, 2017; (b) entitlement to a 100 percent rating from July 17, 2017 through August 31, 2017; (c) entitlement to a 100 percent rating from September 1, 2017 through August 31, 2018; (d) entitlement to a 30 percent rating for residuals of a total left knee replacement as of September 1, 2018. Here, the Veteran was afforded a March 2015 VA examination of the left knee, which showed a diagnosis of left knee osteoarthritis. Upon interview, the Veteran reported that he was recommended to undergo bilateral knee replacement surgery, however, he was hesitant to proceed. He had steroid injections with little to any relief. The Veteran reported bilateral knee pain as a 10 out of 10, described as aching and stabbing, which was exacerbated by cold/damp weather. He described functional loss as being unable to sit in one position for longer than 15-20 minutes, stand for more than five minutes, or walk greater than half-a-block due to severe bilateral knee pain. He always walked with a cane and noted sleep disturbance at night due to knee pain. The Veteran also reported chronic swelling of the left knee. He reported having flare-ups, described as pain usually occurring with no associated triggers, but sometimes due to cold/damp weather. On range of motion testing of the right knee, flexion was to 40 degrees, with extension to 10 degrees, with pain. The VA examiner noted that abnormal range of motion contributed to functional loss, in that the Veteran was unable to ambulate for greater than a half block due to severe pain, and could only do weight bearing activity for five minutes or less. There was evidence of pain with weight bearing, and evidence of localized tenderness on palpitation of the joint. There was no evidence of crepitus. The Veteran was unable to conduct repetitive use testing due to extreme pain after one series of range of motion testing. While repetitive use over time testing wasn’t conducted, the VA examiner noted that pain, fatigue, weakness and lack of endurance limited the functional ability with repeated use over a period of time. Similarly, while the examination was not conducted during a flare-up, the VA examiner indicated that pain, fatigue, weakness and lack of endurance limited functional ability with flare-ups. The Veteran reported that instability of station, disturbance of locomotion, interference with sitting, interference with standing were additional contributing factors of disability. Muscle strength testing showed active movement against some resistance with flexion and extension, with a reduction of muscle strength. The Veteran did not have muscle atrophy or a meniscus condition. Joint stability testing showed normal joint stability. A January 2016 VA examination of the left knee showed diagnosed left knee osteoarthritis. On interview, the Veteran reported symptoms of pain, limping, crackling and stiffness of the knees. The Veteran didn’t report flare-ups, but reported functional limitation due to pain with prolonged walking and fatigue. On range of motion testing of the left knee, flexion was 20 to 80 degrees, with extension 80 to 20 degrees, with pain. The VA examiner noted that abnormal range of motion contributed to functional loss, in that the Veteran had impaired mobility with stairs and arising. There was evidence of pain with weight bearing, and evidence of localized tenderness on palpitation of the joint. There was no evidence of crepitus. Repetitive use testing did not show additional functional loss or range of motion. Muscle strength testing showed normal strength, with no muscle atrophy. The Veteran did not have ankylosis and had normal joint stability test results, with no recurrent subluxation, lateral instability or recurrent effusion. The Veteran did not have a meniscus condition but did undergo a debridement of the left patella in 1966. Private treatment records from May 2015 show the Veteran had complained of increasing pain, loss in range of motion, and inability to ambulate any distance due to his left knee disability. The Veteran received a cortisone shot at this time. In a December 2015 follow-up appointment, in which the Veteran reported experiencing lasting relief from the cortisone shot, having only developed pain and swelling a week prior. Examination of the knee showed tense effusion and painful arc of motion. The Veteran was again injected with cortisone. In May 2017, the Veteran presented for a follow-up, reporting a return of symptoms to his bilateral knees, worse with the left than right. On examination, the left knee showed 115 degrees flexion, with 15 degree flexion contracture, with effusion. An x-ray of the left knee showed complete loss of medial compartment with chondrocalcinosis. At this time, the Veteran reported that he was ready to pursue knee arthroplasty. A July 2017 operative report shows the Veteran had undergone total left knee replacement surgery. In a July 2017 post-operative appointment, the Veteran complained of pain status post total left knee replacement. In August 2017, the Veteran had his staples removed, and range of motion testing showed -10 degrees extension and 110 degrees flexion. For the remainder of August 2017, the Veteran attended regularly scheduled post-operative aftercare and physical therapy, in which he complained of left knee pain, and reported in September 2017 that his knees had not been so straight in years. A September 2017 note shows the Veteran was walking without a cane and had no pain and in November 2017, he reported he was able to walk on uneven terrain, carrying thing, kneeling, and squatting. A March 2018 VA examination of the left knee showed diagnosed left knee osteoarthritis. On interview, the Veteran reported symptoms left knee pain, swelling, giving way and stiffness, and that he had received cortisone injections with no relief. The Veteran reported experiencing flare-ups, which manifested as increased pain with prolonged standing, walking, kneeling and squatting. He also reported functional loss as having his ability to stand, walk, knee and squat limited due to his right knee. On range of motion testing of the left knee, flexion was 20 to 110 degrees, with extension 110 to 20 degrees, with pain. The VA examiner noted that abnormal range of motion contributed to functional loss, in that the Veteran had limited standing, walking, kneeling and squatting. There was evidence of pain with weight bearing, and evidence of localized tenderness on palpitation of the joint. There was no evidence of crepitus. Repetitive use testing did not show additional functional loss or range of motion. Muscle strength testing showed active movement against some resistance in flexion and extension of the right knee, without reduction in muscle strength, with no muscle atrophy. The Veteran did not have ankylosis and had normal joint stability test results, with no recurrent subluxation, lateral instability or recurrent effusion. The Veteran had a total knee replacement in 2017 with residuals of intermediate degrees of residual weakness, pain or limitation of motion. The Veteran occasionally ambulated with a cane. An August 2019 VA examination of the left knee showed diagnosed left knee degenerative arthritis with total knee replacement. On interview, the Veteran reported he was no longer receiving treatment for his left knee disability. The Veteran reported experiencing flare-ups, which would occur all day long, and manifested as severe constant pain, which were precipitated by nothing and were alleviated by nothing. He also reported functional loss as having a hard time walking any distance, and that he could not carry heavy loads of 20 pounds or more. On range of motion testing of the left knee, flexion was 10 to 95 degrees, with extension 95 to 20 degrees, with pain. The VA examiner noted that abnormal range of motion contributed to functional loss, in that the Veteran had difficulty walking. There was evidence of pain with weight bearing, and evidence of localized tenderness on palpitation of the joint. There was objective pain on passive range of motion and non-weight bearing of the left knee. There was no evidence of crepitus. Repetitive use testing did not show additional functional loss or range of motion. Repeated use over time showed flexion from 10 to 95 degrees, with extension 95 to 10 degrees, with pain that significantly limited functional ability. The examination was being conducted during a flare-up, with range of motion showing flexion from 10 to 95 degrees, with extension 95 to 10 degrees, with pain that significantly limited functional ability with flare-ups. In addition to the above, less movement than normal due to ankyloses, adhesions, etc was a contributing factor of disability. Muscle strength testing showed normal muscle strength, with no muscle atrophy. The Veteran did not have ankylosis and had normal joint stability test results, with no recurrent subluxation, lateral instability or recurrent effusion. The Veteran had a total knee replacement in 2017 with residuals of intermediate degrees of residual weakness, pain or limitation of motion. For the rating period prior to July 17, 2017, entitlement to a rating in excess of 30 percent disabling for left knee degenerative arthritis, limitation of extension The Board finds, based upon review of all the evidence, lay and medical, that a left knee degenerative arthritis, limitation of extension, manifested as extension to 20 degrees with pain for the rating period to July 17, 2017. The Veteran is currently in receipt of a 30 percent rating under Diagnostic Code 5261. The next higher 40 percent evaluation is warranted where extension is limited to 30 degrees. 38 C.F.R. § 4.71a (2019). Throughout for the entire rating period prior to July 17, 2017, range of motion testing of the left knee showed extension to 20 degrees, with pain, as evidenced by VA examinations of record. The Veteran’s disability does not approximate the aforementioned range for a higher disability rating even with consideration of pain on passive and active range of motion, with weight-bearing and non-weight-bearing testing, and with the Veteran’s competent reports of flare-ups. Correia, 28 Vet. App. 158; DeLuca v, 8 Vet. App. 206. Therefore, the Board finds that a rating in excess of 30 percent disabling for left knee degenerative arthritis, limitation of extension is not warranted under Diagnostic Code 5261 for the entire rating period on appeal. 38 C.F.R. § 4.71, DC 5261 (2019). For the rating period of from July 17, 2017 through August 31, 2017, and from September 1, 2017 through August 31, 2018, entitlement to 100 percent disability rating for total left knee replacement, temporary and otherwise Private treatment records evidence that the Veteran had a total left knee replacement on July 17, 2017. As discussed above, under Diagnostic Code 5055, a 100 percent evaluation will be assigned for a prosthetic replacement of a knee joint for one year following implantation of the prosthesis. Thereafter, the service-connected knee disability will be evaluated based upon any residual impairment. Note (1) under Diagnostic Code 5055 indicates that the 100 percent rating for one year following implantation of the prosthesis will commence after the initial grant of the one-month total rating assigned under 38 C.F.R. § 4.30 following hospital discharge. 38 C.F.R. § 4.71(a), DC 5055 (2019). Here, the Veteran was not assigned a temporary 100 percent disability rating after his total left knee replacement or a 100 percent disability rating for one year following the implantation of his left knee prosthesis. Because the Veteran had a total left knee replacement on July 17, 2017, a temporary 100 percent rating is warranted, effective July 17, 2017, the date of surgery, and continuing for one month from August 1, 2017, as the first day of the month following hospital discharge. Private treatment records show the Veteran was discharged following surgery and seeking private treatment on July 19, 2017. Pursuant to Diagnostic Code 5055, the one-year period for a total rating following the left total knee replacement should begin September 1, 2017, and continue through August 31, 2018. For the rating period as of September 1, 2018, entitlement to an increased rating for residuals of a total left knee replacement Under Diagnostic Code 5055, total knee replacement, a 60 percent rating is assigned where chronic residuals consist of severe painful motion or weakness in the affected extremity. An intermediate degree of residual weakness, pain or limitation of motion rate by analogy to diagnostic codes 5260, 5261, 5262. A minimum rating is assigned a 30 percent rating. 38 C.F.R. § 4.71(a), DC 5055 (2019). For the rating period as of September 1, 2018, the day after the Veteran’s 100 percent rating under Diagnostic Code 5505 for total left knee replacement, the Board finds that the residuals of the total knee replacement manifested as intermediate degrees pain, with extension to 20 degrees with pain under Diagnostic Code 5261. See 38 C.F.R. § 4.71(a), DC 5055 (2019). The August 2019 VA examination range of motion testing showed left knee extension to 20 degrees, with pain. The next higher 40 percent evaluation is warranted where extension is limited to 30 degrees. 38 C.F.R. § 4.71a, DC 5261 (2019). The Veteran’s disability does not approximate the aforementioned range for a higher disability rating even with consideration of pain on passive and active range of motion, and with weight-bearing and non-weight-bearing testing. Correia, 28 Vet. App. 158. And while the Veteran competently reported flare-ups in VA examinations, the Board notes that range of motion testing conducted during a flare-up within the August 2019 VA examination showed extension to 10 degrees. Therefore, the Board finds that a rating in excess of 30 percent disabling for residuals of total left knee replacement is not warranted under Diagnostic Code 5261. 38 C.F.R. § 4.71, DC 5261 (2019). The Board does not find that a higher 60 percent rating is warranted under Diagnostic Code 5055, for chronic residuals consist of severe painful motion or weakness in the left knee for the rating period as of September 1, 2018. The July 2019 VA examination showed normal muscle strength, with no muscle atrophy, on muscle strength testing of the left knee. And while the Veteran reported pain on range of motion testing, the Board finds that such limitation of range of motion due to pain is accurately represented under the criteria set forth in Diagnostic Code 5261. Specifically, the August 2019 VA examiner noted that the Veteran had a total knee replacement in 2017 and opined that residuals of such replacement resulted in intermediate degrees of residual weakness, pain or limitation of motion. Therefore, the Board finds that the Veteran’s residuals of a total left knee replacement were intermediate in degrees of pain. 3. Entitlement to an increased rating in excess of 20 percent disabling for service-connected right knee osteoarthritis prior to March 27, 2018, and in excess of 30 percent disabling thereafter Service-connected right knee osteoarthritis has been assigned a 20 percent disability rating prior to March 27, 2018 under Diagnostic Code 5262, impairment of tibia, and a 30 percent rating thereafter under Diagnostic Code 5261, limitation of extension. Here, a March 2015 VA examination of the right knee, which showed a diagnosis of right knee osteoarthritis. Upon interview, the Veteran reported that he was recommended to undergo bilateral knee replacement surgery, however, he was hesitant to proceed. He had steroid injections with little to any relief. The Veteran reported bilateral knee pain as a 10 out of 10, described as aching and stabbing, which was exacerbated by cold/damp weather. He described functional loss as being unable to sit in one position for longer than 15-20 minutes, stand for more than five minutes, or walk greater than half-a-block due to severe bilateral knee pain. He always walked with a cane and noted sleep disturbance at night due to knee pain. He reported having flare-ups, described as pain usually occurring with no associated triggers, but sometimes due to cold/damp weather. On range of motion testing of the right knee, flexion was to 60 degrees, with extension to zero degrees, with pain. The VA examiner noted that abnormal range of motion contributed to functional loss, in that the Veteran was unable to ambulate for greater than a half block due to severe pain, and could only do weight bearing activity for five minutes or less. There was evidence of pain with weight bearing, and evidence of localized tenderness on palpitation of the joint. There was no evidence of crepitus. The Veteran was unable to conduct repetitive use testing due to extreme pain after one series of range of motion testing. While repetitive use over time testing wasn’t conducted, the VA examiner noted that pain, fatigue, weakness and lack of endurance limited the functional ability with repeated use over a period of time. Similarly, while the examination was not conducted during a flare-up, the VA examiner indicated that pain, fatigue, weakness and lack of endurance limited functional ability with flare-ups. The Veteran reported that instability of station, disturbance of locomotion, interference with sitting, interference with standing were additional contributing factors of disability. Muscle strength testing showed active movement against some resistance with flexion and extension, with a reduction of muscle strength. The Veteran did not have muscle atrophy or a meniscus condition. Joint stability testing showed normal joint stability. Private treatment records from May 2015 show the Veteran had complained of increasing pain, loss in range of motion, and inability to ambulate any distance due to his bilateral knee disability, which was worse in the left knee. In May 2017, the Veteran presented for a follow-up, reporting a return of symptoms to his bilateral knees, worse with the left than right. On examination, the right showed 110 degrees flexion, with 10 degree flexion contracture, with effusion. An x-ray of the right knee showed complete loss of medial compartment with chondrocalcinosis. At this time, the Veteran reported that he was ready to pursues knee arthroplasty. A January 2016 VA examination of the right knee showed diagnosed right knee osteoarthritis. On interview, the Veteran reported symptoms of pain, limping, crackling and stiffness of the knees. The Veteran didn’t report flare-ups, but reported functional limitation due to pain with prolonged walking and fatigue. On range of motion testing of the right knee, flexion was 5 to 90 degrees, with extension 90 to 5 degrees, with pain. The VA examiner noted that abnormal range of motion contributed to functional loss, in that the Veteran had impaired mobility with stairs and arising. There was evidence of pain with weight bearing, and evidence of localized tenderness on palpitation of the joint. There was no evidence of crepitus. Repetitive use testing did not show additional functional loss or range of motion. Muscle strength testing showed normal strength, with no muscle atrophy. The Veteran did not have ankylosis and had normal joint stability test results, with no recurrent subluxation, lateral instability or recurrent effusion. The Veteran did not have a meniscus condition. A March 2018 VA examination of the right knee showed diagnosed right knee osteoarthritis. On interview, the Veteran reported symptoms right knee pain, swelling, giving way and stiffness, and that he had received cortisone injections with no relief. The Veteran reported experiencing flare-ups, which manifested as increased pain with prolonged standing, walking, kneeling and squatting. He also reported functional loss as having his ability to stand, walk, knee and squat limited due to his right knee. On range of motion testing of the right knee, flexion was 20 to 110 degrees, with extension 110 to 20 degrees, with pain. The VA examiner noted that abnormal range of motion contributed to functional loss, in that the Veteran had limited standing, walking, kneeling and squatting. There was evidence of pain with weight bearing, and evidence of localized tenderness on palpitation of the joint. There was no evidence of crepitus. Repetitive use testing did not show additional functional loss or range of motion. Muscle strength testing showed active movement against some resistance in flexion and extension of the right knee, without reduction in muscle strength, with no muscle atrophy. The Veteran did not have ankylosis and had normal joint stability test results, with no recurrent subluxation, lateral instability or recurrent effusion. The Veteran occasionally ambulated with a cane. An August 2019 VA examination of the right knee showed diagnosed degenerative arthritis of the right knee. On interview, the Veteran reported he was no longer receiving treatment for his disability. The Veteran reported experiencing flare-ups, which would occur all day long, and manifested as severe constant pain, which were precipitated by nothing and were alleviated by nothing. He also reported functional loss as having a hard time walking any distance, and that he could not carry heavy loads of 20 pounds or more. On range of motion testing of the left knee, flexion was 20 to 100 degrees, with extension 100 to 20 degrees, with pain. The VA examiner noted that abnormal range of motion contributed to functional loss, in that the Veteran had difficulty walking. There was evidence of pain with weight bearing, and evidence of localized tenderness on palpitation of the joint. There was objective pain on passive range of motion and non-weight bearing of the right knee. There was no evidence of crepitus. Repetitive use testing did not show additional functional loss or range of motion. Repeated use over time showed flexion from 20 to 100 degrees, with extension 100 to 20 degrees, with pain that significantly limited functional ability. The examination was being conducted during a flare-up, with range of motion showing flexion from 20 to 100 degrees, with extension 100 to 20 degrees, with pain that significantly limited functional ability with flare-ups. In addition to the above, less movement than normal due to ankyloses, and adhesions was a contributing factor of disability. Muscle strength testing showed normal muscle strength, with no muscle atrophy. The Veteran did not have ankylosis and had normal joint stability test results, with no recurrent subluxation, lateral instability or recurrent effusion. For the rating period prior to March 27, 2018, entitlement to a rating in excess of 20 percent disabling for service-connected right knee osteoarthritis For the rating period prior to March 27, 2018, the Board finds that service-connected right knee osteoarthritis manifested as malunion of the tibia and fibula with a moderate knee disability. Under Diagnostic Code 5262, the next higher 40 percent rating, which is the highest rating available under the schedule, is warranted where there is nonunion of the tibia and fibula, with loose motion, requiring brace. 38 C.F.R. § 4.71a (2019). VA examinations of record, as well as private treatment records, do not show nonunion of the tibia and fibula at any point during the rating period prior to March 27, 2018. However, the Board has considered whether separate or increased ratings are warranted for the right knee under other applicable diagnostic codes. Under Diagnostic Code 5261, a 30 percent evaluation is warranted where extension is limited to 20 degrees, and under Diagnostic Code 5260, a 30 percent evaluation is warranted where flexion is limited to 15 percent. Here, VA examinations and private treatment records do not show right knee extension limited to 20 degrees or flexion limited to 15 percent. Rather, VA examinations throughout the rating period show, at its worst, right knee extension to 5 degrees, with pain, and flexion to 60 degrees, with pain – criteria of a noncompensable rating under both Diagnostic Code 5260 and 5261. And while the Veteran has demonstrated noncompensable limitation of motion of the right knee under the Diagnostic Codes 5260 and 5261, a separate 10 percent is not warranted under Diagnostic Code 5003. Here, a separate 10 percent rating under Diagnostic Code 5003 would violate the rule against pyramiding where the currently assigned 20 percent rating is based upon painful motion of the right knee. See 38 C.F.R. §§ 4.59, 4.71a, DC 5003 (2019). Therefore, the Board finds that the preponderance of the evidence is against the Veteran’s claim for an increased rating in excess of 20 percent disabling for service-connected right knee osteoarthritis for the rating period prior to March 27, 2018. 38 C.F.R. § 4.71, DC 5262 (2019). For the rating period as of March 27, 2018, entitlement to a rating in excess of 30 percent disabling for service-connected right knee osteoarthritis Based on review of all the evidence, lay and medical, for the rating period as of March 27, 2018, the Board finds that service-connected right knee osteoarthritis manifested as extension to 20 degrees with pain. The next higher 40 percent evaluation is warranted where extension is limited to 30 degrees. 38 C.F.R. § 4.71a (2019). Throughout for the entire rating period as of March 27, 2018, range of motion testing of the right knee showed extension to 20 degrees, with pain, as evidenced by VA examinations of record. The Veteran’s disability does not approximate the aforementioned range for a higher disability rating even with consideration of pain on passive and active range of motion, with weight-bearing and non-weight-bearing testing, and with the Veteran’s competent reports of flare-ups. Correia, 28 Vet. App. 158; DeLuca v, 8 Vet. App. 206. Therefore, the Board finds that a rating in excess of 30 percent disabling for right knee osteoarthritis is not warranted under Diagnostic Code 5261 for the entire rating period on appeal. 38 C.F.R. § 4.71, DC 5261 (2019). Other considerations The Board has considered whether separate compensable ratings are warranted for the right knee during both rating periods on appeal. The evidence of record does not reflect ankylosis of the right knee to warrant a rating under Diagnostic Code 5256. VA examinations of record show that the Veteran had measurable range of motion in his right knee joint, and specifically denoted the presence of no ankylosis. The Veteran does not have recurrent subluxation or lateral instability of the right knee to warrant a compensable rating under Diagnostic Code 5257. VA examinations of record show that there was no joint instability, and that the knee joint was found to be normal on stability testing. Additionally, there was no recurrent patellar dislocation. In the absence of recurrent subluxation and lateral instability in the right knee, the Veteran’s right knee disability has not met or more nearly approximated the criteria for separate rating under Diagnostic Code 5257. 38 C.F.R. § 4.71a (2019). The record does not reflect dislocated semilunar cartilage in the right knee to warrant a rating under Diagnostic Code 5258. Id. For these reasons, a separate rating is not warranted under Diagnostic Code 5258. Additionally, medical records and VA examinations do not show that the Veteran had a removal of semilunar cartilage in the right knee to warrant a rating under Diagnostic Code 5259 for removal of semilunar cartilage which is symptomatic. Id. For the reasons discussed above, the Board finds that the preponderance of the evidence is against the Veteran’s claim for an increased rating in excess of 20 percent disabling for service-connected right knee osteoarthritis for the rating period prior to March 27, 2018, and for an increased rating in excess of 30 percent disabling thereafter. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application and the claim must be denied. See 38 U.S.C. § 5107 (2012); 38 C.F.R. § 3.102 (2019). Earlier Effective Date The effective date of an award based on a claim for increase of compensation “shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application.” 38 U.S.C. § 5110 (a) (2012). The effective date for increased rating shall be the earliest date as of which it is factually ascertainable that an increase in disability had occurred, if the claim is received within one year from such date; otherwise, the effective date for the increase is the date of receipt of the claim for increase. 38 U.S.C. § 5110 (b)(2) (2012); 38 C.F.R. § 3.400 (o)(2) (2019). VA regulations provide that the effective date for increased ratings shall be the “date of receipt of claim or date entitlement arose, whichever is later.” 38 C.F.R. § 3.400 (o)(1) (2019). An effective date for an increased rating may be assigned later than the date of receipt of the claim, if the evidence shows that the increase in disability actually occurred after the claim was filed, but never earlier than the date of receipt of the claim for increase. In general, “date of receipt” means the date on which a claim, information or evidence was received in VA. 38 C.F.R. § 3.1 (r) (2019). A claim is “a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit.” 38 C.F.R. § 3.1 (p) (2019). 7. Earlier effective dates for service-connected degenerative joint disease with lumbar disc herniation; peripheral neuropathy, right lower extremity, sciatic branch; peripheral neuropathy, left lower extremity, sciatic branch; and left knee degenerative arthritis, limitation of extension. On March 5, 2014, the Veteran filed a claim for entitlement to increased ratings for service-connected degenerative joint disease with lumbar disc herniation; peripheral neuropathy, right lower extremity; peripheral neuropathy, left lower extremity; and left knee degenerative arthritis, limitation of extension. The March 5, 2014, claim is the earliest document of record that can be construed as a clam for increased rating for the above-mentioned issues on appeal. There were no earlier claims received subsequent to the unappealed February 1980 rating decision which granted service connection for bilateral hammer toes. The Board must next determine when it was “factually ascertainable” that the criteria for an increased ratings of service-connected degenerative joint disease with lumbar disc herniation; peripheral neuropathy, right lower extremity; peripheral neuropathy, left lower extremity; and left knee degenerative arthritis, limitation of extension, were met within one year prior to March 5, 2014, the date of the claim. VA regulations provide that the effective date for increased rating shall be the earliest date as of which it is factually ascertainable that an increase in disability had occurred, if the claim is received within one year from such date; otherwise the effective date for the increase is the date of receipt of the claim. 38 U.S.C. § 5110 (b)(2) (2012); 38 C.F.R. § 3.400 (o)(2) (2019). It is not factually ascertainable that an increase in disability had occurred within one year of the receipt of the Veteran’s claim. The first filing within the Veteran’s record prior to the March 2014 claim is a June 2011 VA memo, showing the transfer of the Veteran’s file to the Baltimore VA RO. Further, a review of VA treatment records spanning the year prior to the March 2014 do not show the Veteran sought treatment for these disabilities on appeal. In that regard, there is no evidence which identified an increase in disability prior to the February 2014 claim for the issues on appeal. For these reasons, an effective date, prior to February 5, 2014, is not warranted for the increased rating claims for service-connected degenerative joint disease with lumbar disc herniation; peripheral neuropathy, right lower extremity; peripheral neuropathy, left lower extremity; and left knee degenerative arthritis, limitation of extension. Because the preponderance of the evidence is against the appeal for earlier effective dates, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107 (2012); 38 C.F.R. §§ 4.3, 4.7 (2019). REASONS FOR REMAND 1. Entitlement to an increased rating for service-connected degenerative joint disease with lumbar disc herniation in excess of 40 percent disabling Unfortunately, the Board finds that remand is required to obtain a VA examination consistent with Correia v. McDonald, 28 Vet. App. 158 (2016). Barr v. Nicholson, 21 Vet. App. 303 (2007) (holding that when VA undertakes to provide the Veteran with an examination, it must ensure the examination is adequate). Specifically, within the March 2015 and January 2016 VA examinations of record, prior to the holding in Correia, the Veteran’s lumbar spine was not tested for pain in both active and passive range of motion testing, as well as in weight-bearing and nonweight-bearing testing. In Correia, the United States Court of Appeals for Veterans Claims (Court) issued directives regarding VA examinations for musculoskeletal disabilities, namely, requiring for a pain assessment in an examination in order for the examination to be adequate. In 38 C.F.R. § 4.59, which addresses musculoskeletal claims where pain on motion is involved, the “joints involved should be tested for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with the range of the opposite undamaged joint.” In light of the foregoing, the Veteran must be afforded another VA examination which fully complies with Correia. Namely, the VA examiner must test the lumbar spine for pain in both active and passive motion, as well as in weight-bearing and nonweight-bearing. Therefore, remand is required for a VA examination in compliance with Correia prior to rendering a decision on the appeal. 2. Entitlement to an increased rating in excess of 20 percent disabling for service-connected peripheral neuropathy of left and right lower extremities During the course of the appeal, the Veteran has not been afforded a VA examination to determine the nature and severity of service-connected peripheral neuropathy of the left and right lower extremities. The RO, in granting increased 20 percent disability ratings for peripheral neuropathy of the left and right lower extremities in a March 2015 rating decision based the increased ratings on a March 2015 VA examination of the spine, which found radiculopathy of the bilateral lower extremities to be moderate in degree. Interestingly, a subsequent January 2016 VA examination of the spine found no diagnosis radiculopathy. While the March 2015 VA examination discussed bilateral lower extremity radiculopathy, specifically findings of constant pain, intermittent pain, paresthesias and/or dysesthesias, and numbness, the Board finds that such examination was not a peripheral neuropathy examination and was therefore not thorough enough to Further, there is no other medical evidence of record during the rating period pertinent to peripheral neuropathy of the right and left lower extremities. VA treatment records do not show that the Veteran receives regular care at a VA Medical Center, and the Veteran has only authorized VA to obtain private medical records spanning March 2017 and April 2017. The Board finds that on remand, the RO should confirm any private treatment the Veteran is receiving in reference to his pending claims on appeal, and request and associate such records with the Veteran’s claims file. The matters are REMANDED for the following action: (Please note, this appeal has been advanced on the Board’s docket. Expedited handling is requested.) 1. Contact the Veteran regarding any outstanding private treatment records relating to his pending claims on appeal. Obtain necessary authorizations for release of this information and associate any private treatment records with the claims file. 2. Schedule the Veteran for a VA orthopedic examination to determine the current severity of the Veteran’s service-connected degenerative joint disease with lumbar disc herniation. All indicated tests and studies should be performed and all findings should be reported in detail. The entire record should be made available to the examiner. The VA examiner should specifically test the range of motion in active motion, passive motion, weight-bearing, and nonweight bearing. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. 3. Schedule the Veteran for a VA orthopedic examination to determine the current severity of the Veteran’s peripheral neuropathy of the left and right lower extremities. All indicated tests and studies should be performed and all findings should be reported in detail. The entire record should be made available to the examiner. 4. The AOJ must review the claims file and ensure that the foregoing development actions have been completed in full. If any development is incomplete, appropriate corrective action must be implemented. If any report does not include adequate responses to the specific opinions requested, it must be returned to the providing examiner for corrective action. 5. After all development has been completed, the AOJ should review the claims again based on the additional evidence. If the benefits sought are not granted, the AOJ should furnish the Veteran and his representative with a supplemental statement of the case, and should give the Veteran a reasonable opportunity to respond before returning the record to the Board for further review. K. Parakkal Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. R. Woodarek 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.