Citation Nr: 21061399 Decision Date: 10/01/21 Archive Date: 10/01/21 DOCKET NO. 18-32 816 DATE: October 1, 2021 ORDER Entitlement to a 10 percent evaluation for a right knee surgical scar is denied. Entitlement to a 10 percent rating for left knee surgical scar is denied. Entitlement to a rating greater than 10 percent for left knee osteoarthritis is denied. Entitlement to a rating greater than 10 percent for left knee instability (laxity of medial and lateral collateral ligaments) is denied. Entitlement to a rating greater than 10 percent for right knee osteoarthritis and meniscal tear, status post arthroscopy is denied. Entitlement to a separate rating of 10 percent for right knee instability is granted. REMANDED The issue of entitlement to individual unemployability is remanded. FINDINGS OF FACT 1. The Veteran's three right knee surgical scars are not unstable, not painful, and their total area is less than 39 square centimeters. 2. The Veteran's three left knee surgical scars are not unstable, not painful, and their total area is less than 39 square centimeters. 3. The Veteran's left knee osteoarthritis is manifest by flexion to 120 degrees. There is no ankylosis, no subluxation, no disability related to the cartilage, no limitation of extension, no impairment of the tibia or fibula, and no genus recurvatum. 4. The Veteran's left knee instability is manifest by slight lateral instability. The Veteran is not prescribed an assistive device for ambulation. 5. The Veteran's right knee osteoarthritis is manifest by flexion to 110 degrees. There is no ankylosis, no subluxation, no disability related to the cartilage, no limitation of extension, no impairment of the tibia or fibula, no genus recurvatum, and no instability. 6. The Veteran's right knee instability causes instability without a prescription from a medical provider for any assistive device. CONCLUSIONS OF LAW 1. The criteria for a 10 percent disability rating for right knee surgical scar have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.118a, Diagnostic Codes 7801-7805 (2020). 2. The criteria for a 10 percent disability rating for left knee surgical scar have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.118a, Diagnostic Codes 7801-7805 (2020). 3. The criteria for a disability rating greater than 10 percent for left knee osteoarthritis have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.71a, Diagnostic Codes 5256, 5258-5263 (2021). 4. The criteria for a disability rating greater than 10 percent for left knee instability have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.71a, Diagnostic Code 5257 (2021). 5. The criteria for a disability rating greater than 10 percent for right knee osteoarthritis have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.71a, Diagnostic Codes 5256-5263 (2021). 6. The criteria for entitlement to a separate 10 percent rating for a right knee disability under Diagnostic Code 5257 have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.17a, Diagnostic Code 5257 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty in the United States Army from October 1986 to October 1989. These matters come before the Board of Veterans' Appeals (Board) from a January 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran submitted Notices of Disagreement (NOD) in June 2017 and in August 2018. Statements of the Case (SOC) were issued in May 2018 and in January 2019. A supplementary SOC was issued in May 2018. The Veteran perfected an appeal by submitting a timely VA Form 9s in June 2018 and in February 2019. The issue was previously before the Board. In June 2020, the Board remanded the appeal to the agency of original jurisdiction (AOJ) for additional development. Specifically, the Board directed the AOJ to schedule new VA examinations for the current severity of the Veteran's scars and bilateral knee disabilities. The Veteran was afforded VA examinations for his scars and knees in August 2020. Thus, the Board finds that the AOJ substantially complied with the remand directives and no further action is necessary in this regard. Stegall v. West, 11 Vet. App. 268 (1998). Following evidentiary development, the VA Appeals Management Center (AMC) continued the previous denials in a supplemental statement of the case (SSOC) issued in September 2020. A claim of individual unemployability (TDIU) was inferred as an element of the increased rating claims pursuant to Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009) (holding that, when evidence of unemployability is submitted during the course of an appeal from an assigned disability rating, a claim for a TDIU will be considered part and parcel of the claim for benefits for the underlying disability). The Veteran, in an April 2020 hearing, testified that he went to a part-time position due to pain caused by his service-connected disabilities. The AOJ also obtained medical opinions in August 2020 on the impact of the Veteran's service-connected disabilities on employment but did not adjudicate the issue. Accordingly, the issue of entitlement to TDIU is properly raised on appeal as part of the claims for increased ratings and has thus been added as an issue on appeal. Id. Increased Rating Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability is resolved in favor of the Veteran. 38 C.F.R. § 4.3. It is not expected that every case will show every criterion for a particular rating. 38 C.F.R. § 4.21. In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where, as here, a claimant appeals the initial rating assigned following an award of service connection for surgical scar of the right knee, evidence contemporaneous with the claim for service connection and with the rating decision granting service connection would be most probative of the degree of disability existing at the time that the initial rating was assigned and should be the evidence "used to decide whether an [initial] rating on appeal was erroneous." Fenderson v. West, 12 Vet. App. 119, 126 (1999). If later evidence obtained during the appeal period indicates that the degree of disability increased or decreased following the assignment of the initial rating, "staged" ratings may be assigned for separate periods of time based on facts found. Id. 1. Entitlement to a 10 percent evaluation for a right knee surgical scar The Veteran contends that he is entitled to a 10 percent rating for his right knee surgical scar as it is painful. The Veteran also testified that "it blisters up on the scar and busts open and bleeds and weeps." Although he did not specify which scar, he did state that it was a "two inch long scar." The Veteran's right knee surgical scars are currently rated under 38 C.F.R. § 4.118, Diagnostic Code (DC) 7805. The Veteran does not contend that his scars are burn scars. Scars not of the head, face, or neck that are associated with underlying soft tissue damage are rated under DC 7801, and those that are not associated with underlying soft tissue damage are rated under DC 7802. Painful or unstable scars are rated under DC 7804, and other scars are rated under DC 7805. For a compensable rating, DC 7801 requires an area of at least 6 square inches (39 square centimeters) but less than 12 square inches (77 square centimeters); DC 7802 requires an area of 144 square inches (929 square centimeters) or greater; and DC 7804 requires one or two scars that are unstable or painful. An unstable scar is defined as one there is frequent loss of covering of skin over the scar. The Veteran was afforded a VA examination in August 2020, four months after his testimony of painful and bleeding scars. The examiner observed that the Veteran had three scars on his right knee, each 0.2 cm long and 0.2 cm wide. The total area of the scars on his right knee was 1.2 square centimeters and none had underlying tissue damage. The examiner, after removing the bandages covering the Veteran's right knee, observed that the skin was dry and intact with no evidence of open areas, fluid drainage, or scabbing. All scars were well-healed with no evidence of post-surgical infection or keloid formation. The Veteran also denied bloody drainage, pus, redness, warmth, or fever during flare-ups, only reporting that they oozed "clear fluid." The Veteran did not report that the scars of the extremities were painful. The examiner added that the removed band-aids were dry. In an April 2018 VA examination, the examiner noted that the Veteran had "distant arthroscopy scars" that were "too small and faint today to accurately measure." There were no painful or unstable scars. Similarly, the January 2017 VA examiner also did not observe any scars. VA Medical Center treatment records show that the Veteran reported that his scars "scab up all the time and ruins my pants" in March 2018. The medical practitioner, however, did not note any bleeding or drainage. In September 2017, the Veteran reported occasional skin lesion on his knee with scanty drainage, although he did not specify the scar or scars involved. The Veteran had right knee arthroscopy in March 2016. After weighing the evidence of record, the Board finds that the evidence weighs against finding a compensable rating for the Veteran's right knee surgical scar. As discussed above, contrary to the Veteran's report of bleeding or oozing, there was no evidence of bleeding or oozing in January 2017, March 2018, April 2018, and in August 2020. Although it is possible that the Veteran's right knee was not fully healed and thus bled or oozed "clear fluid" where his current scars formed shortly after his right knee arthroscopy in March 2016, there is no medical evidence of record supporting an "unstable scar" showing "frequent loss of covering of skin over the scar" as defined in 38 C.F.R. § 4.118. Similarly, in the most recent VA examination in August 2020, the Veteran reported flare-ups that oozed "clear fluid" but did not report that the scars were painful. Although the Veteran testified in April 2020 that his scar "aches quite often" and that it stung as if there were "bees in it," the Board assigns greater probative weight to the Veteran's statements to the August 2020 VA examiner that were made in-person in a medical setting with each of the three scars under close inspection. The Board also notes that there were no two-inch scars in his right knee. In summary, the Board finds that the Veteran's right knee surgical scars are not unstable, not painful, and less than 39 square centimeters. Thus, the Veteran's right knee surgical scars do not meet any of the criteria for a compensable rating under 38 C.F.R. § 4.118, Diagnostic Codes 7801-05. For the foregoing reasons, the weight of competent and credible evidence reflects that the criteria for a compensable rating for the Veteran's service-connected right knee surgical scar have not been met or more nearly approximated. The benefit-of-the-doubt-doctrine is therefore not for application and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. 2. Entitlement to a 10 percent rating for left knee surgical scar The Veteran contends that he is entitled to a 10 percent rating for his left knee surgical scar as it is painful. The Veteran also testified that "it blisters up on the scar and busts open and bleeds and weeps." Although he did not specify which scar, he did state that it was a "two inch long scar." The Veteran's left knee surgical scars are currently rated under 38 C.F.R. § 4.118, Diagnostic Code (DC) 7805. The Veteran does not contend that his scars are burn scars. The Veteran was afforded a VA examination in August 2020, four months after his testimony of painful and bleeding scars. The examiner observed that the Veteran had 6 scars on his left knee. Three of the scars were 0.2 cm long and 0.2 cm wide. The others were 5 cm long and 1 cm wide and 1 cm long and 0.1 cm wide respectfully. The latter two scars were caused by a chainsaw injury and a barbed wire injury as a child, respectively. The total area of the scars on his left knee, according to the examiner, was 5.44 square centimeters and none had underlying tissue damage. This total area included scars that were not connected to the Veteran's service, such as the scar from the chainsaw injury and the scar from a barbed wire. The examiner, after removing the bandages covering the Veteran's left knee, observed that the skin was dry and intact with no evidence of open areas, fluid drainage, or scabbing. All scars were well-healed with no evidence of post-surgical infection or keloid formation. The Veteran also denied bloody drainage, pus, redness, warmth, or fever during flare-ups, only reporting that they oozed "clear fluid." The Veteran did not report that the scars of the extremities were painful. The examiner added that the removed band-aids were dry. In an April 2018 VA examination, the examiner noted that the Veteran had "distant arthroscopy scars" that were "too small and faint today to accurately measure." There were no painful or unstable scars. Similarly, the January 2017 VA examiner also did not observe any scars. VA Medical Center treatment records show that the Veteran reported that his scars "scab up all the time and ruins my pants" in March 2018. The medical practitioner, however, did not note any bleeding or drainage. In September 2017, the Veteran reported occasional skin lesion on his knee with scanty drainage, although he did not specify the scar or scars involved. The Veteran had left knee surgery in 1989. After weighing the evidence of record, the Board finds that the evidence weighs against finding a compensable rating for the Veteran's left knee surgical scar. As discussed above, contrary to the Veteran's report of bleeding or oozing, there was no evidence of bleeding or oozing in January 2017, March 2018, April 2018, and in August 2020. Although it is possible that the Veteran's right knee was not fully healed and thus bled or oozed "clear fluid" where his current scars formed shortly after his right knee arthroscopy in March 2016, there is no medical evidence of record supporting an "unstable scar" showing "frequent loss of covering of skin over the scar" as defined in 38 C.F.R. § 4.118. Similarly, in the most recent VA examination in August 2020, the Veteran reported flare-ups that oozed "clear fluid" but did not report that the scars were painful. Although the Veteran testified in April 2020 that his scar "aches quite often" and that it stung as if there were "bees in it," the Board assigns greater probative weight to the Veteran's statements to the August 2020 VA examiner that were made in-person in a medical setting with each of the 5 scars under close inspection. The Board also notes that the scar that was two inches long (approximately 5 centimeters) is the scar from the chainsaw injury and not the scars that are service connected as residuals from his left knee arthroscopy. In summary, the Board finds that the Veteran's left knee surgical scars are not unstable, not painful, and less than 39 square centimeters. Thus, the Veteran's right knee surgical scars do not meet any of the criteria for a compensable rating under 38 C.F.R. § 4.118, Diagnostic Codes 7801-05. For the foregoing reasons, the weight of competent and credible evidence reflects that the criteria for a compensable rating for the Veteran's service-connected left knee surgical scar have not been met or more nearly approximated. The benefit-of-the-doubt-doctrine is therefore not for application and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. 3. Entitlement to a rating greater than 10 percent for left knee osteoarthritis 4. Entitlement to a rating greater than 10 percent for left knee instability (laxity of medial and lateral collateral ligaments) The Veteran contends that he is entitled to a rating greater than 10 percent for left knee osteoarthritis. Specifically, the Veteran testified that he had difficulty sitting down and getting up from chairs that were too low. The Veteran also contends that he is entitled to a rating greater than 10 percent for left knee instability (laxity of medial and lateral collateral ligaments). Factual Background VA Medical Center treatment records show that the Veteran was "advised" to use knee braces in March 2018 for his right knee. There was no advice or prescription to use a knee brace for his left knee, while records show that he was ordered a right knee brace in October 2015. In a July 2017 VA examination, the examiner noted that the Veteran complained of constant pain and would not let the examiner touch nor flex the knees and therefore was unable to test the Veteran's range of motion in the left knee. The Veteran indicated joint instability, but no testing was performed due to the Veteran's complaints. The examiner noted that the Veteran used braces but did not make any specific observations. In the remarks following the examination, the examiner noted that the Veteran "got up normally from chair with normal gait walking over 150 feet to my office" and that the Veteran was able to put on his own trousers, walked without knee braces, and with an antalgic gait. In an April 2018 VA examination, the examiner specifically noted that the Veteran used a knee brace for the right knee. Range of motion for flexion was to 140 degrees and extension to 0 degrees, and therefore "all normal." Repetitive-use testing showed no change in range of motion although the examiner noted that pain and lack of endurance would limit range of motion after repetitive use over time. The resulting range of motion for flexion was estimated to be 120 degrees and extension to 0 degrees. The Veteran did not report flare-ups, and joint instability testing showed no instability in the left knee. The Veteran was afforded a VA examination in August 2020 to determine the current severity of his left knee disability. The Veteran was diagnosed as having meniscal tear in the left knee and patellofemoral pain syndrome on both knees. The Veteran reported that he underwent arthroscopic surgery in 1989 and that his knee locked up and gave away occasionally rendering him unable to walk or bear weight. The Veteran had his menisci, or semi-lunar cartilage, repaired but not removed on both knees. He also reported unstable gait, use of bilateral knee braces, and clicking noises from the left knee. Flare-ups were described as knee locking up preventing him from walking or just giving way, happening about once a month with increased pain and lasting 2-3 weeks. Range of motion for flexion was to 125 degrees and extension was to 0 degrees. Pain did not result or cause functional loss and the examiner felt and heard two loud "pops" when moving the knee to measure range of motion. Repetitive-use testing did not result in additional loss of function. Repeated use over time and flare-up testing and the examiner noted that the examinations were medically consistent with the Veteran's statements describing functional loss in repeated use over time and during a flare-up. There was no muscle atrophy, no loss of muscle strength, no ankylosis, and no history of recurrent subluxation. There was a history of slight lateral instability. Joint instability was indicated but the Veteran was not able to perform testing as he reported severe pain when the left knee was palpated or manipulated in any way. The examiner observed intense guarding, wincing, and startled response from the Veteran. The Veteran did not have recurrent patellar dislocation, "shin splints," stress fractures, chronic exertional compartment syndrome or any other tibial or fibular impairment. The Veteran had a meniscal tear (repaired), frequent episodes of joint "locking," and frequent episodes of joint pain. He reported regular use of braces, and the examiner opined that the Veteran's left knee disability did not impact his ability to perform any type of occupational task. Objective evidence of pain was shown in passive range of motion but not in non-weight bearing. The examiner opined that the diagnosis for the left knee changed from osteoarthritis to patellofemoral pain syndrome. Regulations pertaining to the knees For VA compensation purposes, normal range of motion for the knee is flexion to 140 degrees and extension to 0 degrees. 38 C.F.R. § 4.71, Plate II. Diagnostic Codes 5260 and 5261 provide for rating based on limitation of motion. Ratings for limitation of flexion of the knee are assigned as follows: flexion limited to 60 degrees is 0 percent; flexion limited to 45 degrees is 10 percent; flexion limited to 30 degrees is 20 percent; and flexion limited to 15 degrees is 30 percent. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Ratings for limitation of extension of the knee are assigned as follows: extension limited to 5 degrees is 0 percent; extension limited to 10 degrees is 10 percent; extension limited to 15 degrees is 20 percent; extension limited to 20 degrees is 30 percent; extension limited to 30 degrees is 40 percent; and extension limited to 45 degrees is 50 percent. Id., Diagnostic Code 5261. VA General Counsel has held that separate ratings may be assigned under Diagnostic Code 5260 and Diagnostic Code 5261, where a Veteran has both a limitation of flexion and limitation of extension of the same leg; limitations must be rated separately to adequately compensate for functional loss associated with injury to the leg. VAOPGCPREC 9-2004 (Sept. 17, 2004). Because ratings may be separately assigned for limitation of flexion and limitation of extension, the Board will consider both Diagnostic Codes. During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. Prior to the regulatory change, Diagnostic Code 5257 pertained to other impairment of the knee involving recurrent subluxation or lateral instability and provides a 10 percent rating for slight impairment, a 20 percent rating for moderate impairment, and a 30 percent rating for severe impairment. 38 C.F.R. § 4.71a, Diagnostic Code 5257. VA General Counsel has held that separate ratings may be assigned for arthritis and instability under Diagnostic Codes 5003 and 5257. See VAOPGCPREC 23-97 (July 1, 1997). The words "slight," "moderate," and "severe" are not defined in the VA Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just." See 38 C.F.R. § 4.6. As of February 7, 2021, under the amended criteria, DC 5010 refers to post-traumatic arthritis, which is to be rated as limitation of motion, dislocation, or other specified instability under the affected joint. If there are 2 or more joints affected, each rating shall be combined in accordance with § 4.25. Diagnostic Codes 5258, 5259, 5261 and 5260 were not changed under the amended criteria. Under the amended criteria, DC 5257 (knee, other impairment of) indicates that recurrent subluxation or instability should be rated as follows: Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation warrants a 30 percent rating. One of the following: (a) Sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation; (b) Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation warrants a 20 percent rating. Sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation warrants a 10 percent rating. Note (1): For patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. Note (2): A surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration). Analysis osteoarthritis and limitation in range of motion Applying the criteria set forth above to the facts in this case, the preponderance of the evidence is against the assignment of ratings greater than 10 percent for either left knee disability in either the criteria prior to February 7, 2021 or the amended criteria. The Veteran's left knee osteoarthritis is rated as 10 percent disabling. In order to warrant a rating in excess of 10 percent, the disability would have to be manifested by flexion limited to 30 degrees. At the Veteran's most recent August 2020 VA examination, he achieved flexion to 125 degrees after repeated-use testing. In April 2018, the Veteran's range of motion after repetitive use testing was estimated to be to 120 degrees for flexion. Although less than normal, the range of motion itself does not warrant a compensable rating and the Veteran's rating is based on painful motion. For extension, the Veteran demonstrated full extension (to 0 degrees) in both VA examinations. Consequently, a separate compensable rating under Diagnostic Code 5261 is not warranted. As these Diagnostic Codes were not amended in February 2021, the analysis remains the same under the new regulations. Diagnostic Code 5256 allows for a higher rating for ankylosis. No such increased rating is warranted in so far as ankylosis has not been shown in any of the medical examinations. The Veteran was not diagnosed as having any dislocation or removal of the semilunar cartilage, and therefore Diagnostic Codes 5258 and 5259 also do not apply. For the foregoing reasons, the preponderance of the evidence reflects that the criteria for a rating greater than 10 percent for the Veteran's service-connected left knee osteoarthritis have not been met or more nearly approximated. The benefit-of-the-doubt-doctrine is therefore not for application and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. Analysis left knee instability Turning to the Veteran's left knee instability, pursuant to 38 C.F.R. § 4.71a (Diagnostic Code 5257), a rating greater than 10 percent is warranted when the Veteran's knee shows moderate subluxation or lateral instability. As discussed above, however, moderate left knee instability was not observed during the period on appeal, with VA examiners relying on the Veteran's statements of instability when the Veteran participated in the examination. There is also no evidence of the Veteran being prescribed braces for his left knee instability, while records show that he was prescribed and ordered knee braces for his right knee. Thus, the Veteran's left knee instability does not warrant a rating greater than 10 percent under the regulations prior to February 2021. Also, as the Veteran does not have an "unrepaired or failed repair of complete ligament tear," his left knee instability does not warrant a 20 percent rating under the amended regulations. Although the Veteran was diagnosed as having patellofemoral pain syndrome, the Veteran did not receive any surgery involving the patellofemoral complex. There is also no evidence of the Veteran's left knee brace being prescribed by a medical provider, and no evidence of an unrepaired or failed repair of a complete ligament tear that is also required for a 20 percent rating. 38 C.F.R. § 4.71a, DC 5257 (2021). As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply, and the claim for a rating in excess of 10 degrees for the Veteran's left knee instability must be denied. See Gilbert, 1 Vet. App at 49. 5. Entitlement to a rating greater than 10 percent for right knee osteoarthritis and meniscal tear, status post arthroscopy The Veteran contends that he is entitled to a rating greater than 10 percent for right knee osteoarthritis. Specifically, the Veteran testified that he had difficulty sitting down and getting up from chairs that were too low. As discussed above, the Veteran was diagnosed as having patellofemoral pain syndrome in August 2020 and status post arthroscopic procedure, meniscal tear and joint osteoarthritis of the right knee with effusion. The Veteran was diagnosed as having patellofemoral pain syndrome in the right knee. The Veteran reported that he received arthroscopic surgery in 2016 and that his knee locked up and gave away occasionally rendering him unable to walk or bear weight. The Veteran had his menisci, or semi-lunar cartilage, repaired but not removed. Flare-ups were escribed as knee locking up preventing him from walking or just giving way, happening about once a month with increased pain and lasting 2-3 weeks. Range of motion for flexion was to 130 degrees and extension was to 0 degrees. Pain did not result or cause functional loss. Repetitive-use testing did not result in additional loss of function. Repeated use over time and flare-up testing and the examiner noted that the examinations were neither medically consistent or inconsistent with the Veteran's statements describing functional loss in repeated use over time and during a flare-up. There was no muscle atrophy, no loss of muscle strength, no ankylosis, no history of recurrent subluxation and no history of slight lateral instability. Joint instability testing was performed and there was no joint instability. The Veteran did not have recurrent patellar dislocation, "shin splints," stress fractures, chronic exertional compartment syndrome or any other tibial or fibular impairment. The Veteran had a meniscal tear, frequent episodes of joint "locking," and frequent episodes of joint pain. He reported regular use of braces, and the examiner opined that the Veteran's right knee disability did not impact his ability to perform any type of occupational task. Objective evidence of pain was shown in passive range of motion but not in non-weight bearing. Applying the criteria set forth above to the facts in this case, the preponderance of the evidence is against the assignment of ratings greater than 10 percent for right knee disability in either the criteria prior to February 7, 2021 or the amended criteria. The Veteran's right knee osteoarthritis is rated as 10 percent disabling. In order to warrant a rating in excess of 10 percent, the disability would have to be manifested by flexion limited to 30 degrees. At the Veteran's most recent August 2020 VA examination, he achieved flexion to 130 degrees after repeated-use testing. In April 2018, the Veteran's range of motion after repetitive use testing was estimated to be to 110 degrees for flexion. Although less than normal, the range of motion itself does not warrant a compensable rating and the Veteran's rating is based on painful motion. For extension, the Veteran demonstrated full extension (to 0 degrees) in both VA examinations. Consequently, a separate compensable rating under Diagnostic Code 5261 is not warranted. As these Diagnostic Codes were not amended in February 2021, the analysis remains the same under the new regulations. Diagnostic Code 5256 allows for a higher rating for ankylosis. No such increased rating is warranted in so far as ankylosis has not been shown in any of the medical examinations. The Veteran was not diagnosed as having any dislocation or removal of the semilunar cartilage, and therefore Diagnostic Codes 5258 and 5259 also do not apply. Turning to the Veteran's contention of right knee instability, pursuant to 38 C.F.R. § 4.71a (Diagnostic Code 5257), a separate compensable rating is warranted when the Veteran's knee shows slight subluxation or lateral instability. As discussed above, however, joint instability testing in August 2020 did not show any instability. As with the left knee, the Veteran did not participate in joint instability testing in April 2018. Thus, the Veteran does not have right knee instability that warrants a separate compensable rating under the regulations prior to February 2021. Also, as the Veteran does not have a "sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability," his contended right knee instability does not warrant a compensable rating under the amended regulations. Although the Veteran was prescribed a right knee brace by a medical provider, there is no evidence of a sprain, incomplete ligament tear, or complete ligament tear that is also required for a compensable rating. 38 C.F.R. § 4.71a, DC 5257 (2021). For the foregoing reasons, the preponderance of the evidence reflects that the criteria for a rating greater than 10 percent for the Veteran's service-connected right knee osteoarthritis have not been met or more nearly approximated. The benefit-of-the-doubt-doctrine is therefore not for application and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. 6. Entitlement to a separate 10 percent rating for right knee instability Resolving doubt in favor of the Veteran, the Board finds that the Veteran was prescribed a knee brace for his right knee instability on March 28, 2018. The Veteran was also diagnosed as having patellofemoral pain syndrome in his right knee. Although the Veteran had surgery performed in his right knee, the surgery did not involve the patellofemoral complex (defined as consisting of the quadriceps tendon, the patella, and the patellar tendon). Medical records only show surgery to repair the Veteran's meniscus. Thus, the Veteran's right knee instability meets the criteria for a 10 percent rating under Diagnostic Code 5257. In addition to the Veteran's lay remarks of instability, and, despite objective tests not showing instability, the Veteran was prescribed knee braces for instability. See English v. Wilkie, 30 Vet. App. 347 (2018). The Veteran's right knee instability, however, does not warrant a 20 percent rating as the lack of objective test results weigh against a finding of "moderate" instability and as the Veteran did not have surgical repair done on the right knee that involved the patellofemoral complex as required under the revised Diagnostic Code 5257. In light of the above evidence, the Board concludes that there is credible and probative lay and clinical evidence of record for slight instability of the right knee, warranting a 10 percent rating under Diagnostic Code 5257. See 38 C.F.R. § 4.71a. REASONS FOR REMAND 1. The issue of entitlement to individual unemployability is remanded. The Board deems TDIU to be a component of the claim for an increased rating for the claims above in light of the Veteran's testimony that his service-connected disabilities significantly limit his ability to perform work-related tasks, including in his current position as a mathematics teacher. See Rice, 22 Vet. App. at 453-54. The Board will remand the claim for TDIU for appropriate development. The matter is REMANDED for the following action: Send appropriate notice to the Veteran and his attorney regarding TDIU and complete any necessary development. This should include sending the Veteran an application form (VA Form 21-8940) and advising the Veteran of the necessity of notifying the AOJ of his employment history and his educational background for proper adjudication of this matter. J.W. FRANCIS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H.S. Yun, 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.