Citation Nr: 21003059 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 16-35 001 DATE: January 19, 2021 ISSUES 1. Entitlement to an increased disability evaluation greater than 20 percent for bilateral hearing loss disability. 2. Entitlement to an increased disability evaluation greater than 10 percent for post-traumatic arthritis and chondromalacia patella, status-post ACL reconstruction and arthroscopy, left knee. ORDER Entitlement to an increased disability evaluation greater than 20 percent for bilateral hearing loss disability is denied. Entitlement to an increased disability evaluation greater than 10 percent for post-traumatic arthritis and chondromalacia patella, status-post ACL reconstruction and arthroscopy, left knee, is denied. FINDINGS OF FACT 1. For the entire period on appeal, the Veteran demonstrated at worst, level VI sensorineural hearing loss in the right ear, and level V in the left ear. 2. For the entire period on appeal, post-traumatic arthritis and chondromalacia patella, status-post ACL reconstruction and arthroscopy, left knee has been manifested by x-ray evidence of degenerative arthritis with flexion and extension to 90 degrees with flare ups, painful motion on examination, and slight lateral instability; but no x-ray evidence of involvement of two or more major joints or two or more minor joint groups with incapacitating exacerbations, limitation of flexion to 16 to 30 degrees, limitation of extension 15 to 19 degrees, ankylosis, or removal of semilunar cartilage. CONCLUSIONS OF LAW 1. The criteria for an increased disability evaluation in excess of 20 percent for bilateral hearing loss disability have not been met or approximated. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 4.1, 4.3, 4.7, 4.10, 4.85, 4.86, Diagnostic Code 6100 (2018). 2. The criteria for a disability evaluation greater than 10 percent for post-traumatic arthritis and chondromalacia patella, status-post ACL reconstruction and arthroscopy, left knee have not been met or approximated. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.2, 4.3, 4.7, 4.10, 4.27, 4.40, 4.45, 4.59, 4.71a; Diagnostic Code 5010 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1987 to July 1988, May 1992 to September 2003, February 2005 to September 2006, October 2009 to January 2010, September 2011 to September 2012, December 2012 to July 2013, and from August 2013 to July 2014. This matter is before the Board of Veterans Appeals (Board) on appeal from an August 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas. The Board observes that during the pendency of these appeals, a May 2016 Rating decision granted service connection for right knee strain. This represented a full grant of the benefit sought. AB v. Brown, 6 Vet. App. 35, 38 (1993). A December 2016 Rating decision later increased the evaluation of intervertebral disc syndrome (IVDS) of the cervical spine to 30 percent effective October 19, 2016 and decreased the evaluation of irritable bowel syndrome (IBS) to 10 percent effective November 10, 2016. The Veteran testified before the undersigned Veterans Law Judge (VLJ) in January 2019. A copy of the hearing transcript has been associated with the claims file. Next, the Board observes that an April 2019 Statement of the Case (SOC) concluded that a drill pay adjustment for fiscal year (FY) 2016 is valid and accurate. Later, in July 2020, the Board remanded the issues for additional development. VA examinations for both disabilities were obtained and associated with the claims file. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The appeals are now back before the Board. Recently, during the pendency of his appeals, an October 19, 2020 Rating decision granted service connection for a separate left knee disability based upon instability. This awarded the Veteran an additional 10 percent disability rating for the left knee. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2018). The Veteran submitted a March 2011 Brief. Later, the Veteran and his representative were reminded of the critical evidentiary requirements necessary to substantiate his claim by way of an October 19, 2020 Supplemental Statement of the Case (SSOC). The Veteran in this case has not referred to any deficiencies in either the duties to notify or assist; therefore, the Board may proceed to the merits of the claim. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015, cert denied, U.S.C. Oct. 3, 2016) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board....to search the record and address procedural arguments when the [appellant] fails to raise them before the Board”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to an appellant’s failure to raise a duty to assist argument before the Board). The Board has reviewed all of the evidence in the Veteran’s claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-130 (2000). Increased Rating Disability evaluations are determined by the application of VA’s Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran’s condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21. Separate evaluations may be assigned for separate periods of time based on the facts found. In other words, the evaluations may be staged. Staged ratings are appropriate for any rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Here, the disability ratings have been previously staged, although the left knee has remained constantly at 10% despite having been staged. There is also a notation that during previous stages, the ratings were discontinued because the Veteran was serving on active duty. So, he is effectively only entitled to the current uniform evaluation, as determined by the RO. As discussed below, the ratings for both disabilities are still warranted across the entire appeals period. VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154 (a). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Lay evidence cannot be determined not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). However, the lack of contemporaneous medical evidence can be considered and weighed against a Veteran’s lay statements. Id. Further, a negative inference may be drawn from the absence of complaints for an extended period. See Maxson v. West, 12 Vet. App. 453, 459 (1999), aff’d sub nom. Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). 1. Entitlement to an increased disability evaluation greater than 20 percent for bilateral hearing loss disability The Board incorporates its discussion from the sections above by reference. By way of rating criteria, the threshold for normal hearing is from 0 to 20 decibels, and higher threshold levels indicate some degree of hearing loss. Hensley v. Brown, 5 Vet. App. 155, 157 (1993). VA regulations do not preclude service connection for a hearing loss which first met VA’s definition of disability after service. Id. Under the applicable criteria disability ratings are determined by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are performed. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Hearing loss disability evaluations range from 0 percent to 100 percent based on organic impairment of hearing acuity, as measured by controlled speech discrimination tests in conjunction with the average hearing threshold, as measured by puretone audiometric tests in the frequencies 1000, 2000, 3000, and 4000 Hertz. The rating schedule establishes 11 auditory acuity levels designated from Level I for essentially normal hearing acuity, through Level XI for profound deafness. VA audiometric examinations are conducted using a controlled speech discrimination test together with the results of a puretone audiometry test. The vertical lines in Table VI represent nine categories of the percentage of discrimination based on the controlled speech discrimination test. See 38 C.F.R. § 4.85. The horizontal columns in Table VI represent nine categories of decibel loss based on the pure tone audiometry test. The numeric designation of impaired hearing (Levels I through XI) is determined for each ear by intersecting the vertical row appropriate for the percentage of discrimination and the horizontal column appropriate to the puretone decibel loss. The percentage evaluation is found from Table VII by intersecting the vertical column appropriate for the numeric designation for the ear having the better hearing acuity and the horizontal row appropriate to the numeric designation level for the ear having the poorer hearing acuity. For example, if the better ear has a numeric designation Level V and the poorer ear has a numeric designation Level VII, the percentage evaluation is 30 percent. See 38 C.F.R. § 4.85. The Board further observes that Table VIa, “Numeric Designation of Hearing Impairment Based Only on Puretone Threshold Average,” is used to determine a Roman numeral designation (I through XI) for hearing impairment based only on the puretone threshold average. Table VIa will be used when the examiner certifies that use of the speech discrimination test is not appropriate because of language difficulties, inconsistent speech discrimination scores, etc., or when indicated under the provisions of § 4.86. See 38 C.F.R. § 4.85 (c). Where there is an exceptional pattern of hearing impairment as defined in 38 C.F.R. § 4.86, the rating may be based solely on puretone threshold testing. An exceptional pattern of hearing impairment occurs when the puretone thresholds in each of the four frequencies of: 1000, 2000, 3000, and 4000 Hertz are 55 decibels or greater, or when the puretone threshold at 1000 Hertz is 30 decibels or less and the threshold at 2000 Hertz is 70 decibels or more. 38 C.F.R. § 4.86 (a), (b). The Veteran contends that he is entitled to an increased disability evaluation in excess of 20 percent for bilateral hearing loss disability. By way of background, the Veteran was provided with a December 29, 2009 VA Hearing examination, upon which the current 20 percent disability evaluation is based. The VA examiner described her findings, “For the right ear, the claimant has a moderately severe sensorineural hearing loss. For the left ear, the claimant has a moderately severe sensorineural hearing loss. Based on the audiologic results, medical follow-up is not needed.” Years later, a September 11, 2013 VA Audiology Consultation shows in part: Audiologic assessment revealed a slight decrease in hearing sensitivity, right. Left hearing sensitivity essentially stable since last audio. Mild to severe SNHL, .75-8 kHz right and a moderate to severe SNHL, .5-8 kHz left. Speech discrimination was good, bilaterally. Immittance test results indicated normal tympanic membrane mobility, AU. Next, in the June 2016 VA Form 9, the Veteran requested a new VA audiological examination. He also referenced consideration of locking affecting the left knee every time he bends it. Later, at the January 2019 hearing, the Veteran’s representative opened with the request, “So, I would ask that to be fair to him, that he be given a test for his hearing and for the knee.” See January 2019 Hearing Transcript, p. 5. Regarding bilateral hearing loss disability and the left knee disability, the Veteran testified that the last examinations were in 2011. He testified, “I think it’s gotten, continued to get significantly worse. I had bilateral hearing loss determination, however, I had two sequential worsenings (sic) of my hearing. It started in one ear and it dropped and then it dropped again and got worse in the other ear. So, both ears have gotten significantly worse in the last five years or so.” See January 2019 Hearing Transcript, p. 16. He testified that a December 2009 VA audiological examination from Dr. S. showed worse hearing loss than more recent examinations. Id. at p. 17. In light of the Veteran’s reports of a worsening of his hearing acuity, he was scheduled for new VA examinations as part of the July 2020 Board Remand. Importantly, the Veteran was most recently afforded an October 2020 VA audiological examination. The VA examiner reviewed the entire claims file, and performed an in-person examination. On the authorized audiological evaluation, pure tone thresholds, in decibels, were as follow: HERTZ 1000 2000 3000 4000 Average RIGHT 60 75 75 75 71.25 LEFT 60 70 70 60 65 The average decibel loss is 71.25 in the right ear. The average decibel loss is 65 in the left ear. The VA examiner indicated that tests results are valid for rating purposes. However, speech audiometry results were not available, with the VA examiner inputting “CNT.” The VA examiner opined that use of word recognition score is not appropriate for this Veteran because of language difficulties, cognitive problems, inconsistent speech discrimination scores, etc., that make combined use of puretone average and speech discrimination. This was for both ears. The VA examiner went on to diagnose sensorineural hearing loss in both frequency ranges, for both ears. Next, the VA examiner documented the functional impact of the Veteran’s bilateral hearing loss disability. It shows, “Can’t function without hearing aids. Even with hearing aids still frustrated having to ask people to repeat constantly. Can’t read lips with face masks.” Ongoing VA treatment records are substantially the same. They show reports of hearing impairment and the use of hearing aids to control hearing loss. The Board has considered the data obtained from the available frequencies and their related puretone averages. With no speech audiometry results, the Board is still able to rate the Veteran using Table VIa of 38 C.F.R. § 4.85 based upon only puretone threshold averages. From Table VIa of 38 C.F.R. § 4.85, Roman Numeral VI is derived for the right ear and Roman Numeral V for the left ear when considering the puretone threshold averages. A 20 percent evaluation is derived from Table VII by intersecting row V, the left ear, with column VI, the right ear. The evaluation for hearing loss is based on objective testing. Higher evaluations are assigned for more severe hearing impairment. Application of these findings to Table VII corresponds to a 20 percent rating under 38 C.F.R. § 4.85, Diagnostic Code 6100. The Board also considered the provisions of 38 C.F.R. § 4.86 governing exceptional patterns of hearing impairment. The Veteran contends that the severity of bilateral hearing loss disability more closely reflects the level required for a higher disability rating. As such, he asserts that an increased disability evaluation is warranted. Next, the Board observes that the Veteran is competent to report difficulty hearing and ringing in his ears. The Veteran is competent to provide evidence of that which he experiences, including a history of noise exposure during several tours. Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board finds these reports credible. Here, there are impressions or diagnoses of bilateral sensorineural hearing loss. The Veteran is competent to relate such facts. The Board finds the results of the October 2020 VA audiological examination to be the most probative evidence of record. This examination was conducted from after the Veteran testified about a worsening in his hearing acuity and requested a new VA examination to support his claim. This is consistent with reports of ongoing, significant bilateral hearing loss evidenced in the VA treatment records. The Board finds that these records, taken together, describe a constant picture of symptomatology associated with bilateral hearing loss disability. VA recognizes the Veteran’s sincere belief that he is entitled to a rating in excess of 20 percent. However, the Board is bound to apply the VA rating schedule, under which the rating criteria are defined and limited by audiometric findings. This criteria measures hearing acuity directly in a controlled laboratory environment. There are no probative objective audiometric evaluations to the contrary. See 38 C.F.R. §§ 4.85, 4.86, Diagnostic Code 6100. In summary, the Veteran has been provided with a rating matching a recent VA examination from after he reported a worsening in his hearing acuity. The VA examiner documented the Veteran’s lay reports of needing a hearing aid to function, and difficulty reading lips when people are masked. The Board is sympathetic to this. However, there is no probative evidence to support a higher rating, and the Veteran has had several years to submit any private audiometric readings to support his claim. Moreover, VA satisfied its duty to assist when it provided a medical examination performed by a person who is qualified through education, training, or experience to offer medical diagnosis, statements, or opinions, whether that is a doctor, nurse practitioner, or physician’s assistant. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (affirming that a medical opinion is adequate if it provides sufficient detail so that the Board can perform a fully informed evaluation of the claim). The October 2020 VA examiner considered the Veteran’s impairment, and he is already assigned a compensable rating. Therefore, we find that an increased disability evaluation in excess of 20 percent for bilateral hearing loss disability is not warranted at any time. 2. Entitlement to an increased disability evaluation greater than 10 percent for post-traumatic arthritis and chondromalacia patella, status-post ACL reconstruction and arthroscopy, left knee The Board incorporates its discussion from the sections above by reference. Post-traumatic arthritis and chondromalacia patella, status-post ACL reconstruction and arthroscopy, left knee is assigned a 10 percent rating under DC 5010. 38 C.F.R. § 4.71a. By way of specific rating criteria, DC 5010 evaluates traumatic arthritis established by X-ray findings and advises the evaluator to rate as degenerative arthritis under DC 5003. Under DC 5003, arthritis established by X-ray findings is rated on the basis of limitation of motion of the affected joints. When, however, the limited motion of the specific joint or joints involved would be noncompensable under the appropriate diagnostic codes, a 10 percent rating is assigned for each involved major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. 38 C.F.R. § 4.71a, DC 5003 (degenerative arthritis) and 5010 (traumatic arthritis). 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, however, arthritis is rated as 10 percent disabling when shown by X-ray evidence of the involvement of two or more major joints or two or more minor joint groups, or as 20 percent disabling when show by x-ray evidence of the involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations. Id. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a (musculoskeletal system) or § 4.73 (muscle injury); a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a [or 4.73] criteria.”). See 38 C.F.R. §§ 4.40, 4.45, 4.59. Further, in claims for higher ratings for musculoskeletal disabilities, where the Veteran has a noncompensable rating and complains of pain on motion, he may be entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011). The provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to arthritis and must be considered when raised by the claimant or when reasonably raised by the record. Id. Looking to other diagnostic codes, DC 5260 provides ratings based on limitation of flexion of the leg, where flexion limited to 45 degrees is rated 10 percent disabling; flexion of the leg limited to 30 degrees is rated 20 percent disabling; and, flexion of the leg limited to 15 degrees is rated 30 percent disabling. 38 C.F.R. § 4.71a. Moreover, arthritis due to trauma under DC 5010 substantiated by x-ray findings is rated as degenerative arthritis under DC 5003. 38 C.F.R. § 4.71a, DC 5003. DC 5003 (arthritis, degenerative) provides that if degenerative arthritis is established by x-rays, then the disability is rated under the appropriate DC for the specific joint limitation of motion. When the rating of a specific joint is noncompensable under the DCs pertaining to limitation of motion, a rating of 10 percent is for application for involvement of two or more major joints or two or more minor joint groups affected by limitation of motion, with occasional incapacitation exacerbations. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Under DC 5261, where extension is limited to 5, 10, 15, 20, 30 and 45 degrees, ratings of 0, 10, 20, 30, 40, and 50 percent, respectively, are assigned. DC 5257 contemplates impairment of the knee manifested by recurrent subluxation or lateral instability. Where instability is severe, moderate and slight, disability evaluations of 30, 20, and 10 are assigned, respectively. Separate ratings may be assigned for knee disability under DCs 5257 and 5003 where there is x-ray evidence of arthritis in addition to recurrent subluxation or lateral instability. The symptomatology supporting the evaluations does not overlap; limitation of motion and stability are distinct from each other. See generally VAOPGCPREC 23-97 and VAOPGCREC 9-98. Further, VAOPGCPREC 9-04 provides that where a claimant has both limitation of flexion and limitation of extension of the same leg separate ratings under diagnostic codes 5260 and 5261 are warranted to adequately compensate for functional loss associated with injury to the leg. Thus, evaluations under DC 5257 and either or both DC 5260 and DC 5261 are permissible, as each of the three codes measures different criteria. By contrast, an evaluation under DC 5003 may not be combined with one under DC 5260 or DC 5261; DC 5003 does not specify the plane of limited motion considered, and so evaluation under either of the other limitation of motion DCs forecloses the possibility of multiple evaluations. See generally VAOPGCPREC 23-97 and VAOPGCREC 9-98; 38 C.F.R. § 4.14. The Veteran contends that he is entitled to a disability evaluation greater than 10 percent for post-traumatic arthritis and chondromalacia patella, status-post ACL reconstruction and arthroscopy, left knee. Post-traumatic arthritis and chondromalacia patella, status-post ACL reconstruction and arthroscopy, left knee is assigned a 10 percent rating. This contemplates x-ray evidence of degenerative arthritis with flexion and extension to 90 degrees with flare ups, painful motion on examination, and slight lateral instability. By way of background, the Veteran was afforded a January 2010 VA examination. The Veteran reported stiffness, locking, fatiguability, deformity, tendonous, and pain. He denied experiencing weakness, swelling, heat, redness, giving way, lack of endurance, subluxation, and dislocation. He reported flare ups as often as two times per day lasting for three hours. He took Motrin during flare ups. Initial range of motion (ROM) testing for the left knee showed forward flexion to 130 degrees, with no additional impairment due to pain. Extension was clinically normal to 0 degrees. Next, the Veteran perfected his appeals in June 2016. He stated that he had surgery to repair left knee “locking” episodes in 1990 or 1991. Years later, at the January 2019 hearing, the Veteran’s representative opened with the request, “So, I would ask that to be fair to him, that he be given a test for his hearing and for the knee.” See January 2019 Hearing Transcript, p. 5. Regarding the left knee, he testified that he experiences locking because it is dislocated. See January 2019 Hearing Transcript, pp. 16-18. Ongoing VA treatment records show a prior medical history of left knee ACL reconstruction. They show limited flexion of the left knee. During the pendency of his appeals, an October 19, 2020 Rating decision granted service connection for a separate left knee disability based upon instability. This awarded the Veteran an additional 10 percent disability rating for the left knee. Recently, the Veteran was afforded an October 2020 VA knees examination with Disability Benefits Questionnaire (DBQ). The VA examiner reviewed the entire claims file, elicited a lay history from the Veteran, and performed a physical examination. The lay history reads, “Veteran states that he injured his knee in 1987 and again in 1988. States that he underwent scope in 1988. States that he underwent ACL reconstruction in 1988. States that he underwent physical therapy and was continuing to have knee problems.” The Veteran reported that the condition had progress/worsened since its onset. He takes ibuprofen as needed. The VA examiner documented, “States that his knee has continued to worsen as the year have gone on. States that he has increased pain with long periods of standing, sitting and difficulty going up and down stairs. States that his knee does buckle on him. States that he is a pilot and states difficulty getting in and out of aircraft.” The Veteran reported increased pain with standing, sitting, and going up and down stairs. He reported that his knee buckles on him. Upon clinical evaluation, initial range of motion testing was productive of 100 degrees of flexion and 100 degrees of extension for the left knee. There was pain on both flexion and extension. The VA examiner described, “There is moderate pain at the lateral knee due to arthritis, chondromalacia of patella and residuals of surgery.” There was pain with weight bearing, and objective evidence of crepitus. There was no additional loss of function with repetitive use. Pain, fatigue, and weakness significantly limited functional ability with repeated use over time. Still, range of motion results were the same, 100 degrees of both flexion and extension. With flare ups, range of motion results were reduced to 90 degrees of both flexion and extension. The Veteran reported flare ups daily depending on the level of activity. Muscle strength was 4/5 for both flexion and extension for the left knee. There was no muscle atrophy. There was no ankylosis. There was only slight lateral instability for the left knee. No shin splints or meniscus conditions were diagnosed. Under meniscus conditions, there was no indication of frequent episodes of joint locking. The Veteran contends that he is entitled to a disability evaluation greater than 10 percent for post-traumatic arthritis and chondromalacia patella, status-post ACL reconstruction and arthroscopy, left knee. Post-traumatic arthritis and chondromalacia patella, status-post ACL reconstruction and arthroscopy, left knee is assigned a 10 percent rating under DC 5010. 38 C.F.R. § 4.71a. The 10 percent evaluation contemplates x-ray evidence of degenerative arthritis with flexion and extension to 90 degrees with flare ups, painful motion on examination, and slight lateral instability. Under DC 5010 and 5003, a higher rating requires x-ray evidence of two or more minor joint groups affected by limitation of motion, with occasional incapacitation exacerbations. Alternatively there must be limitation of flexion to 16 to 30 degrees under DC 5260, or extension limited to 15 to 19 degrees under DC 5261. 38 C.F.R. § 4.71a This is not the case here, as the most probative evidence does not show severe impairment. The most probative evidence is the recent findings of the October 2020 VA examination from after the Veteran reported a worsening. We have favorably considered the examination showing the most severe impairment. The VA examiner considered the Veteran’s lay statements, including regarding any locking and flare ups. At the October 2020 VA examination, left knee flexion and extension were both at worst to 90 degrees with flare ups. The Veteran reported flare ups daily depending on the level of activity. Under meniscus conditions, there was no clinical finding of such disability, including no frequent episodes of joint locking. We also have fully considered the Veteran’s lay statements, including impairment due to pain. The Board finds that the Veteran’s range of motion testing during the October 2020 VA examination did not show that the impairment warrants an evaluation in excess of 10 percent. The current rating best summarizes the Veteran’s level of impairment for the left knee. Turning to each diagnostic code, the longstanding 10 percent evaluation under DC 5010 contemplates degenerative arthritis with x-ray evidence of involvement of two or more major joints or two or more minor joint groups. There is no x-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations. A higher evaluation of 20 percent under DC 5260 is not warranted unless extension of the leg is limited to 16 to 30 degrees. A higher evaluation of 20 percent under DC 5261 is not warranted unless extension of the leg is limited to 15 to 19 degrees. Here, the most probative evidence suggests only slightly worse impairment in flexion and extension since the inception of his increased rating claim. Although the left knee has flare ups, he takes ibuprofen, there is still significant range left knee of flexion and extension. Likewise, in addition to amounting to pyramiding, DC 5256 is inapplicable in this case because the medical and lay evidence of record does not show that the Veteran has ankylosis in his knee. Moreover, there is no indication in the claims file that the Veteran is symptomatic due to semilunar cartilage removal (DC 5259), or that dislocated semilunar cartilage in the knees was causing frequent episodes of locking, pain, and effusion in the joint (DC 5258). Additionally, DC 5262 does not apply in the Veteran’s case as the evidence does not demonstrate impairment of the tibia or fibula, specifically malunion or nonunion. Likewise, range of motion testing revealed full extension to zero degrees and did not indicate the presence of any objective hyperextension. As the evidence in the record does not reflect that the Veteran has genu recurvatum, DC 5263 does not apply to his knee disability. In sum, the current rating best contemplates reported flare ups and other impairment described in his lay statements. Although he reports joint locking and surgery in 1990 or 1991, no meniscal conditions were clinically diagnosed at the recent VA examination. Even if meniscal impairment was found, though we do not concede this, this finding alone would not necessarily result in an increased rating for the left knee. The lay statements are outweighed by the more probative medical evidence of record, performed by a professional with medical expertise. The Board acknowledges the Veteran’s sincere belief that his condition has worsened such that an increased rating is warranted, however, we are bound by the governing rating criteria discussed above. We have rated the Veteran based upon the recent VA examination showing the most severe impairment under the rating criteria. 38 C.F.R. § 3.344, 4.3, 4.6, 4.7. There are no other probative clinical findings showing more severe impairment based upon flexion or extension than are already encompassed by the current 10 percent rating. Accordingly, we find that the Veteran’s post-traumatic arthritis and chondromalacia patella, status-post ACL reconstruction and arthroscopy, left knee does not warrant a rating in excess of 10 percent at any time during the appeal period, as the criteria for a higher rating have been neither met nor approximated. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). In reaching these conclusions, the Board finds that the preponderance of the evidence is against the claims. As such, the benefit of the doubt rule is not for application, and the claims must be denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Michael A. Pappas Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Bodi, Associate 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.