Citation Nr: 21001723 Decision Date: 01/11/21 Archive Date: 01/11/21 DOCKET NO. 15-27 272A DATE: January 11, 2021 ORDER A rating higher than 10 percent under DC 5260 for left knee patellofemoral syndrome is denied. For the period since May 26, 2020, a separate rating of 20 percent under DC 5261 for limitation of left knee extension is granted. A rating higher than 10 percent under DC 5260 for right knee patellofemoral syndrome is denied. For the period since May 26, 2020, a separate rating of 20 percent under DC 5261 for limitation of right knee extension is granted. FINDINGS OF FACT 1. The Veteran’s left knee is manifest by pain and flexion limited to 45 degrees, but not less. 2. Since May 26, 2020, the Veteran’s left knee disability is manifest by extension limited to 15 degrees. 3. The Veteran’s right knee disability is manifest by pain and flexion limited to 45 degrees, but not less. 4. Since May 26, 2020, the Veteran’s right knee disability is manifest by extension limited to 15 degrees. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for left knee patellofemoral syndrome are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5260. 2. Since May 26, 2020, the criteria for a separate rating of 20 percent for limitation of left knee extension are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5261. 3. The criteria for a rating in excess of 10 percent for right knee patellofemoral syndrome are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5260. 4. Since May 26, 2020, the criteria for a separate rating of 20 percent for limitation of right knee extension are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5261. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from December 1976 to August 1996. This matter comes before the Board of Veterans’ Appeals (Board) from a May 2014 rating decision. The Veteran testified at a Board hearing in January 2019. In June 2019, the Board remanded the Veteran’s appeal for additional development.   1. Entitlement to a higher rating for the Veteran’s left knee disability, currently rated as 10 percent disabling under DC 5260. 2. Entitlement to a higher rating for the Veteran’s right knee disability, currently rated as 10 percent disabling under DC 5260. The Veteran seeks a higher rating for his bilateral knee disability. 07/24/2013, Veteran Supplemental Claim & Statement in Support of Claim. He is service-connected for bilateral patellofemoral syndrome, to include traumatic arthritis. Each knee is currently rated as 10 percent disabling under DC 5010-5260. The Board notes that the RO assigned a temporary rating of 100 percent from February 6, 2018, through April 30, 2018, for the left knee. 03/19/2018, Rating Decision. Since July 2013, date of the Veteran’s claim, the Veteran has undergone five VA examinations. See VA examination from April 2014, May 2015, September 2017, September 2018, and March 2019. These examinations consistently show bilateral knee pain with limitation of motion that is noncompensable under the applicable diagnostic codes. Most of these examinations also note reports of flare-ups, particularly when going up and down stairs or bending the knees, and with any sudden application of pressure. Regarding functional loss during flare ups, the September 2017 VA examiner indicated that he was unable to say without mere speculation because the Veteran was not having a flare up at the time of examination. Similarly, the September 2018 VA examiner indicated he could not describe functional loss during flare ups in terms of range of motion because pain prevented accurate testing. At the March 2019, the examiner acknowledged the Veteran’s report of flare ups, described as sharp pain, but concluded that the pain did not cause functional loss. This finding, however, appears to be inconsistent with the examiner’s own remarks at the end of the DBQ, indicating that the Veteran appeared to be in severe pain while doing ROM/repetitive exercises, adding that he had difficulty doing the exercises but got through it slowly. Furthermore, the examiner indicated that the Veteran’s bilateral knee disability appears to be worsening. 03/14/2019, CAPRI, at 11. In June 2019, the Board determined that these VA examinations did not appear to comply with the requirements in Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). Consequently, the Board remanded for a new VA examination. An August 2019 VA examination shows diagnoses of bilateral knee meniscal tear, bilateral patellofemoral syndrome, and bilateral traumatic arthritis. Regarding currently symptoms, the Veteran reported constant pain (pain level: 7/10), with flare-ups that mostly occur when he is relaxed and laying down. He mentioned that his orthopedic doctor had recommended bilateral knee replacements. Regarding functional impact, the Veteran stated that he could no longer run, jump, squat, or perform any high impact sports due to pain and limitation of range of motion. On physical examination, the Veteran was found to have knee flexion to 95 degrees on the right knee and 110 degrees on the left knee, to include consideration of additional functional loss due to pain and during flare-ups. The examination report indicates that the examination was conducting during a flare-up. The examination was negative for ankylosis or instability after performing joint stability testing. Regarding the bilateral meniscal tears, it was noted that the Veteran had left meniscal tear repair in January 2017. Regarding residual symptoms from this procedure, the examiner noted a thickening of patellar retinacula. The report was negative for frequent episodes of locking, pain, or effusion. Regarding functional impact, the examiner indicated that the Veteran’s pain increases with prolonged standing, sitting, walking, and driving for more than five minutes, requiring him to stop and take breaks. In June 2020, the Veteran submitted a DBQ (dated May 2020) completed by a private provider. The report shows diagnoses of bilateral knee joint osteoarthritis and bilateral patellofemoral syndrome. As noted in the report, the Veteran complained of severe lack of range of motion and consistent flare-ups, which cause him to lose functioning while walking, sitting, standing, and climbing stairs. It was also noted that Veteran’s knees regularly tighten causing an inability to fully straighten the legs without physical manipulation. Initial range of motion measurements reflects flexion limited to 60 degrees and extension limited to 5 degrees in both knees. The examiner estimated that flexion was further limited to 45 degrees and extension further limited to 15 degrees, bilaterally, during flare-ups. The examination was negative for ankylosis, instability, or symptoms related to a meniscal condition. Regarding functional impact, it was noted that the Veteran is not able to sustain prolong standing or walking long distances without pain and fatigue. The examiner further indicated that the examination results were consistent with the Veteran’s statements describing functional impairment during flare-ups or when used repeatedly over time. Based on the evidence of record, the Board finds no support for a rating higher than 10 percent based on limitation of flexion under DC 5260. While the May 2020 DBQ shows a significant increase in limitation of flexion, the degree of limitation does not more nearly approximate the criteria for a higher rating. More specifically, for a higher rating (20 percent) to be warranted under DC 5260, the evidence must show flexion limited to 30 degrees. In this case, however, the evidence shows flexion limited to no less than 45 degrees, including consideration of additional functional loss during flare-ups or with repeated use over time. In view of this, the Board concludes that, for both knees, the criteria for a rating higher than 10 percent under DC 5260 have not been met. Notwithstanding, the Board finds that the May 2020 DBQ supports separate ratings of 20 percent under DC 5261 (one rating of 20 percent per knee) based on evidence of extension limited to 15 degrees, during flare-ups. A higher rating is not warranted as DC 5261 states that extension would need to be limited to 20 degrees. (Continued on the next page)   The Board has considered whether the newly assigned ratings of 20 percent under DC 5261 are warranted prior to May 2020. Unfortunately, the Board has found no evidence indicating that the Veteran’s bilateral knee disability manifested as limitation of extension. Rather, all VA examinations prior to May 2020 show normal full extension (to 0 degrees), with no indication that the Veteran was unable to fully extend or stretch his legs, and the first indication of such symptomatology appears in the May 2020 DBQ submitted by the Veteran. In view of this, the Board finds that the Veteran meets the criteria for separate rating of 20 percent under DC 5161 for limitation of extension, but only from May 26, 2020, forward. Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board López, P. 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.