Citation Nr: 21061755 Decision Date: 10/05/21 Archive Date: 10/05/21 DOCKET NO. 17-05 810 DATE: October 5, 2021 ORDER Entitlement to a disability rating in excess of 10 percent for left knee degenerative joint disease is denied. Entitlement to a separate 10 percent rating for symptomatic residuals of left knee semilunar cartilage removal is granted. REMANDED Entitlement to a disability rating in excess of 10 percent for right knee degenerative joint disease is remanded. FINDINGS OF FACT 1. The Veteran's left knee degenerative joint disease with residual meniscal tear is manifested by objective evidence of arthritis and painful motion, with flexion to 90 degrees at worst. 2. The Veteran has experienced feelings of instability following his left knee meniscectomy. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 10 percent for left knee degenerative joint disease have not been met. 38 U.S.C. §§ 1155, 5103, 5103, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.71a, Diagnostic Code 5260-5003. 2. The criteria for the assignment of a separate 10 percent disability rating on the basis of symptomatic removal of semilunar cartilage have been met. 38 U.S.C. §§ 1155, 5103, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1, 4.2, 4.3, 4.7, 4.71a, Diagnostic Code 5259. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1973 to October 1979. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board previously remanded the case in September 2019 for further development. The requested development as to the claim adjudicated below has been completed to the extent possible, and no further action is necessary to comply with the Board's remand directives. Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to a disability rating in excess of 10 percent for left knee degenerative joint disease is denied. 2. Entitlement to a separate 10 percent rating for symptomatic residuals of left knee semilunar cartilage removal is granted. The Veteran is seeking an increased disability rating for his service-connected left knee degenerative joint disease with residual meniscal tear. He asserts his left knee disability is more severe than reflected by his assigned disability rating. The Veteran's left knee degenerative joint disease with residual meniscal tear was rated at 10 percent under Diagnostic Code 5260-5003 prior to July 16, 2021. In July 2021, the Veteran underwent a left total knee arthroplasty and was granted a temporary 100 percent rating under Diagnostic Code 5055 from July 16, 2021, to be followed by a 30 percent rating from December 1, 2021, the first day of the month following the four-month time period after prosthetic replacement of his knee joint. The 30 percent rating from December 1, 2021 is a placeholder preliminary rating assignment to come into effect following the current temporary 100 percent rating. As this rating is not yet effective, it is not within the scope of the appeal before the Board at this time, and thus, the Board shall not otherwise discuss 38 C.F.R. § 4.71a, Diagnostic Code 5055 in this decision. Consequently, the time period on appeal is prior to July 16, 2021. A disability rating is determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). 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 for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings," whether it is an initial rating case or not. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). 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; 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 criteria."). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). As noted above, the Veteran's left knee disability during the period on appeal was rated under Diagnostic Code 5260-5003. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27. Here, the Veteran was compensated for limitation of flexion (Diagnostic Code 5260) due to degenerative arthritis (Diagnostic Code 5003). Disabilities of the knees are evaluated pursuant to the criteria within 38 C.F.R. § 4.71a, including Diagnostic Code 5256 (ankylosis), Diagnostic Code 5257 (other impairment, including recurrent subluxation or lateral instability), Diagnostic Code 5258 (dislocated semilunar cartilage), Diagnostic Code 5259 (symptomatic removal of semilunar cartilage), Diagnostic Code 5260 (limitation of flexion), Diagnostic Code 5261 (limitation of extension), Diagnostic Code 5262 (impairment of the tibia and fibula), and Diagnostic Code 5263 (genu recurvatum). The Board notes that, during the pendency of the appeal, VA revised the rating criteria for Diagnostic Codes 5003, 5257, and 5262, effective February 7, 2021. See 85 Fed. Reg. 76453 (November 30, 2020). When the regulations concerning entitlement to a higher rating are changed during the course of an appeal, the veteran may be entitled to resolution of his claim under the criteria that are to his advantage. The former rating criteria may be applied throughout the period of the appeal, if they are more favorable to him. The revised rating criteria may be applied only prospectively, however, from the effective date of the change forward unless the regulatory change specifically permits retroactive application. 38 U.S.C. § 5110(g); VAOPGCPREC 7-03; VAOPGCPREC 3-00; Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Under the former rating criteria, Diagnostic Code 5003 provides that degenerative arthritis that is established by x-ray findings will be rated on the basis of limitation of motion under the appropriate codes for the specific joint or joints involved. 38 C.F.R. § 4.71a. When, however, the limitation of motion of the specific joint 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. 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, x-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations warrants a 20 percent evaluation. X-ray evidence of involvement of two or more major joints or two or more minor joints warrants a 10 percent evaluation. See 38 C.F.R. § 4.71a, Diagnostic Code 5003. However, Note (2) notes that the 20 percent and 10 percent ratings based on x-ray findings are not to be utilized in rating conditions listed under Diagnostic Codes 5013 to 5024. Id. For the purpose of rating disability from arthritis, the knee is considered a major joint. See 38 C.F.R. § 4.45. Here, the appropriate limitation of motion codes for the knee are Diagnostic Codes 5260 and 5261. 38 C.F.R. § 4.71. The revised criteria for Diagnostic Code 5003, effective February 7, 2021, evaluates degenerative arthritis, other than posttraumatic. Diagnostic Code 5256, which evaluates ankylosis of the knee, provides for a 30 percent rating for favorable angle in full extension, or in slight flexion between 0 degrees and 10 degrees. A 40 percent rating is assigned when there is ankylosis of the knee in flexion between 10 and 20 degrees. A 50 percent rating is assigned when there is ankylosis of the knee in flexion between 20 and 45 degrees. A 60 percent rating is assigned for extremely unfavorable, in flexion at an angle of 45 degrees or more. 38 C.F.R. § 4.71a. Under the former rating criteria for Diagnostic Code 5257, which evaluates recurrent subluxation or lateral instability of a knee, a 10 percent rating is assigned for slight impairment; a 20 percent rating for moderate impairment; and a 30 percent rating for severe impairment. 38 C.F.R. § 4.71a. The terms "mild," "moderate," and "severe" are not defined in the 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." 38 C.F.R. § 4.6 The revised criteria for Diagnostic Code 5257, effective February 7, 2021, evaluates other impairment of the knee, to include recurrent subluxation or instability and patellar instability. Regarding recurrent subluxation or instability, a 10 percent rating is assigned for 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. A 20 percent rating is assigned for either (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, or (b) unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 30 percent rating is assigned for 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. Regarding patellar instability, under the revised criteria for Diagnostic Code 5257, a 10 percent rating is assigned for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent rating is assigned for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: a brace, cane, or walker. A 30 percent disability rating is assigned for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. Note (1) provides that for patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. See 38 C.F.R. § 4.71a, Diagnostic Code 5257, Note (1). Note (2) provides that 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). See 38 C.F.R. § 4.71a, Diagnostic Code 5257, Note (2). Diagnostic Code 5258 provides for a 20 percent rating when semilunar cartilage is dislocated with frequent episodes of "locking," pain, and effusion into the joint. 38 C.F.R. § 4.71a. Diagnostic Code 5259 provides for a 10 percent rating when semilunar cartilage has been removed but remains symptomatic. 38 C.F.R. § 4.71a. Under Diagnostic Code 5260, which evaluates limitation of flexion, a noncompensable rating is assigned when flexion is limited to 60 degrees; a 10 percent rating is assigned when flexion is limited to 45 degrees; a 20 percent rating is assigned when flexion is limited to 30 degrees; and a 30 percent rating is assigned when flexion is limited to 15 degrees. 38 C.F.R. § 4.71a. Under Diagnostic Code 5261, which evaluates limitation of extension, a noncompensable rating is assigned when extension is limited to 5 degrees; a 10 percent rating is assigned when extension is limited to 10 degrees; a 20 percent rating is assigned when extension is limited to 15 degrees; a 30 percent rating is assigned when extension is limited to 20 degrees; a 40 percent rating is warranted for extension limited to 30 degrees; and a 50 percent rating is assigned when extension is limited to 45 degrees. 38 C.F.R. § 4.71a. Separate ratings under Diagnostic Codes 5260 and 5261 may be assigned for disability of the same knee joint. See VAOPGCPREC 9-2004. Additionally, VAOPGCPREC 23-97 held that a claimant who has both arthritis and instability of the knee may receive two separate disability ratings under Diagnostic Codes 5003-5010 and Diagnostic Code 5257 without violating the prohibition of pyramiding of ratings. It was specified that, for a knee disorder already rated under Diagnostic Code 5257, a claimant would have additional disability justifying a separate rating if there is limitation of motion under Diagnostic Code 5260 or Diagnostic Code 5261. Under the former rating criteria for Diagnostic Code 5262, which evaluates impairment of the tibia and fibula, a 10 percent rating is assigned for slight knee or ankle disability, a 20 percent rating for moderate knee or ankle disability, a 30 percent rating for malunion with marked knee or ankle disability, and a 40 percent rating for nonunion with loose motion, requiring a brace. 38 C.F.R. § 4.71a The revised criteria for Diagnostic Code 5262, effective February 7, 2021, evaluates impairment of the tibia and fibula. A noncompensable rating is assigned for medial tibial stress syndrome (MTSS) or shin splints requiring treatment for less than 12 consecutive months of one of both lower extremities. A 10 percent rating is assigned for MTSS or shin splints requiring treatment for no less than 12 consecutive months, and unresponsive to either show orthotics or other conservative treatment of one or both lower extremities. A 20 percent rating is assigned for MTSS or shin splints requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment for one lower extremity. A 30 percent rating is assigned for MTSS or shin splints requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment of both lower extremities. A 40 percent rating is assigned for nonunion of the tibia and fibula, with loose motion, requiring brace. Malunion of the tibia and fibula must be evaluated under Diagnostic Codes 5256, 5257, 5260, or 5261 for the knee, or 5270 or 5271 for the ankle, whichever results in the highest evaluation. Under Diagnostic Code 5263, acquired traumatic genu recurvatum, with objectively demonstrated weakness and insecurity in weight-bearing, is rated at 10 percent. 38 C.F.R. § 4.71a. When assigning ratings, the combined rating for disabilities of an extremity shall not exceed the rating for the amputation at the elective level, were amputation to be performed. 38 C.F.R. § 4.68. Amputation not improvable by prosthesis controlled by natural knee action warrants a 60 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5165. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the United States Court of Appeals for Veterans Claims (Court) held that VA examiners must provide opinions regarding flare-ups based upon estimates derived from information procured from relevant sources, including lay statements, when a flare-up is not observable at the time of examination. The Court has also issued the opinion of Correia v. McDonald, 28 Vet. App. 158, 169-170 (2016), which clarifies additional requirements that VA examiners should address when assessing musculoskeletal disabilities, holding specifically, that 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 September 2019, the Board remanded the Veteran's claims for increased ratings for his service-connected bilateral knee disabilities because the VA examinations of record did not comply with the findings in Correia. The Veteran was afforded another VA examination in December 2019, which again failed to include range of motion measurements in compliance with Correia. However, as the Veteran has since undergone a left total knee arthroscopy, the Board finds that remand for a new VA examination or retroactive medical opinion speculating as to the Veteran's level of disability in relation to Correia would provide little to no probative value here, as well as cause unnecessary delay to the appeal process, with no benefit to the Veteran. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (stating that remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran should be avoided). As such, the Board will precede with the Veteran's left knee claim. Turning to the evidence of record, an April 2014 treatment indicated that the Veteran reported increasing knee pain over the last two years. He had difficultly ascending stairs and performing similar activities. He noted a sense of weakness. The clinician indicated there was no true instability, no true swelling, no locking, and no dysesthesia. Radiographs from that month revealed marked degenerative changes of the medial and lateral joint space and mild to moderate changes of the patellofemoral joint. Range of motion testing revealed 2 to 3 degrees of recurvatum to 135 degrees of flexion bilaterally. A June 2014 VA treatment record indicated that the Veteran had intermittent difficulties ascending stairs. Examination revealed no evidence of effusion and the Veteran was able to achieve neutral extension and beyond 95 degrees of flexion. A December 2014 VA treatment record noted that the Veteran reported ongoing symptoms of his knee disabilities that included some swelling of the left knee, bilateral anterior pain, and bilateral medial sided pain. The clinician noted there was no true locking and no pain free giving way. Examination revealed +1 effusion, mainly over the suprapatellar bursa. A January 2015 physical therapy treatment record noted left knee flexion to 118 and extension to -3. The Veteran was afforded a VA examination for his knees in February 2015. He reported his knee disabilities were aggravated by climbing stairs and he avoided prolonged standing. He wore a knee brace to work. The Veteran reported that an arthroplasty had been suggested and he had been treated by a physiatrist/rehab medicine in 2014. The Veteran reported his left knee flared intermittently and lasted one to three days. He endorsed functional loss/impairment and noted he could not climb stairs well due to left knee instability and had symptoms with prolonged standing or walking. The VA examiner confirmed diagnoses of bilateral knee joint osteoarthritis and left knee meniscal tear. On examination, range of motion testing revealed left knee flexion to 100 degrees and extension to 0 degrees. Range of motion itself did not contribute to functional loss. Pain was noted on examination but did not result in or cause functional loss. There was no evidence of pain with weightbearing. Crepitus and medial and posterior tenderness were noted. The Veteran was able to perform repetitive use testing with at least three repetitions with no additional functional loss or loss in range of motion. The examiner indicated he was unable to say whether pain, weakness, fatigability, or incoordination significantly limited functional ability with repeated use over a period of time without resorting to speculation. Similarly, as the examination was not conducted during a period of flare-up, the examiner indicated he was unable to say whether pain, weakness, fatigability, or incoordination significantly limited functional ability with flare-ups without resorting to speculation. Muscle strength testing for the left knee was normal and there was no reduction in muscle strength. There was no muscle atrophy and no ankylosis. Joint stability testing was normal bilaterally and there was no history of left knee lateral instability or recurrent effusion. The Veteran did not have or had ever had recurrent patellar dislocation, "shin splints," stress fractures, chronic exertional compartment syndrome, or any other tibial and/or fibular impairment. The Veteran did have a left side meniscal tear with frequent episodes of joint pain and frequent episodes of joint effusion. No additional factors contributed to the Veteran's left knee disability. The Veteran made regular use of a regular left knee brace to aid in locomotion. The examiner indicated that the Veteran's bilateral knee disabilities impacted his ability to perform occupational tasks, noting that his knees affected prolonged standing or walking and stair climbing. A March 2015 physical therapy treatment record noted left knee flexion to 118 and extension to -3. A May 2015 physical therapy treatment record noted left knee flexion to 120 and extension to -2. In a May 2015 private treatment record, Dr. J. C. noted that the Veteran reported pain and decreased range of motion in both knees but worse on the left. He had difficulties with activities of daily living and sleep disturbances. On examination, Dr. J. C. noted that the Veteran's left knee had 10 to 15-degree flexion contracture and flexion to 95 degrees. Actively, he had 25-degree flexion contracture but passively, Dr. J. C. noted he could straighten his knee out a bit further. The Veteran was afforded a VA examination for knees in December 2016. He reported increased chronic pain in his knees and that his orthopedist advised him he needed knee replacements. The Veteran denied flare-ups of the knee and did not report having any functional loss or functional impairment of the knee. The VA examiner confirmed diagnoses of bilateral knee joint osteoarthritis and left knee meniscal tear. On examination, range of motion testing revealed left knee flexion to 120 degrees and extension to 0 degrees. Range of motion itself did not contribute to functional loss. Pain was noted on examination but did not result in or cause functional loss. Pain was noted on flexion and extension and there was evidence of pain with weightbearing. The patella, medial, and lateral joint lines were tender to palpation. There was no objective evidence of crepitus. The Veteran was able to perform repetitive use testing with at least three repetitions with no additional functional loss or loss in range of motion. The examiner indicated he was unable to say whether pain, weakness, fatigability or incoordination significantly limited functional ability with repeated use over a period of time without resorting to speculation. Muscle strength testing for the left knee was normal and there was no reduction in muscle strength. There was no muscle atrophy and no ankylosis. There was no history of left knee recurrent subluxation, lateral instability, or recurrent effusion. Joint stability testing was performed with no instability found for the left knee. The Veteran did not have or had ever had recurrent patellar dislocation, "shin splints," stress fractures, chronic exertional compartment syndrome, or any other tibial and/or fibular impairment. The Veteran did have a left side meniscal tear. Additional contributing factors of the Veteran's left knee disability included less movement than normal due to ankylosis, adhesions, etc. and disturbance of locomotion. The Veteran did not use any assistive devices as a normal mode of locomotion. The examiner indicated that the Veteran's bilateral knee disabilities did not impact his ability to perform occupational tasks. A January 2017 VA treatment record noted that the Veteran reported increasing knee pain during the last few months. He stated he had been standing and walking more on a concrete surface at work and had increased activity. Radiographs reflected a worsening of the Veteran's bilateral knee osteoarthritis, worse medially and worse on the left compared to the right. Flexion was noted beyond 95 degrees and no effusions were noted. The Veteran was afforded a VA examination for knees in December 2019. The Veteran reported fairly constant medial knee pain that worsened with activity. He had injections in the past but stopped getting them because they seemed ineffective. The Veteran noted he had been advised to have both knees replaced but he had been putting it off. He reported experiencing flare-ups of the knees about twice a week for two days. He noted functional loss/impairment due to his knees and avoided steps and prolonged walking when possible. The VA examiner confirmed diagnoses of degenerative joint disease of the left and right knees. On examination, range of motion testing revealed left knee flexion to 110 degrees and extension to 0 degrees. Range of motion itself contributed to functional loss and the Veteran was unable to bend his knee fully. Pain was noted on examination but did not result in or cause functional loss. Pain was noted on flexion and extension and there was evidence of pain with weightbearing. Objective evidence of localized tenderness or pain was noted at the medial joint line. There was objective evidence of crepitus. The Veteran was able to perform repetitive use testing with at least three repetitions with no additional functional loss or loss in range of motion. The examiner noted that pain, weakness, fatigability or incoordination did not significantly limit functional ability with repeated use over a period of time, as no additional functional limitation was reported. Pain significantly limited functional ability with flare-ups with flexion of the left knee to 90 degrees and extension to 0 degrees. Muscle strength testing for the left knee was normal and there was no reduction in muscle strength. There was no muscle atrophy and no ankylosis. There was no history of left knee recurrent subluxation, lateral instability or recurrent effusion. Joint stability testing was performed with no instability found for the left knee. The Veteran did not have or had ever had recurrent patellar dislocation, "shin splints," stress fractures, chronic exertional compartment syndrome, or any other tibial and/or fibular impairment. The Veteran did have a left side meniscal tear. Additional contributing factors of the Veteran's left knee disability included less movement than normal due to ankylosis, adhesions, etc., disturbance of locomotion, and interference with standing. The Veteran used knee braces intermittently. The examiner indicated that the Veteran's bilateral knee disabilities impacted his ability to perform occupational tasks, noting that he was unable to do work that required extended standing or walking. The examiner noted there was bilateral knee pain at rest, with range of motion, and with weightbearing. A May 2021 treatment record noted left knee flexion to 120 degrees and extension to 5 degrees. The Veteran reported hyperextension of the left knee and denied locking. Based on the evidence of record, the Board finds that a disability rating in excess of 10 percent is not warranted for the Veteran's service-connected left knee degenerative joint disease with residual meniscal tear, as the criteria for a more severe rating has not been met. The evidence does not show flexion of the left knee limited to 45 degrees to warrant a compensable disability rating under the appropriate limitation of motion code for the knee. 38 C.F.R. § 4.71a, Diagnostic Codes 5260. VA examinations and treatment records consistently show flexion greater than 45 degrees. Specifically, range of motion testing in April 2014 and June 2014 revealed left knee flexion to 135 degrees and beyond 95 degrees, respectively. A January 2015 treatment record noted left knee flexion to 118 degrees. A February 2015 VA examination noted left knee flexion to 100 degrees with no evidence of pain on weightbearing. Further, pain noted on examination did not result in or cause functional loss. March and May 2015 physical therapy records noted left knee flexion to 118 degrees and 120 degrees, respectively. A May 2015 private treatment record indicated left knee flexion to 95 degrees. A December 2016 VA examination reflected left knee flexion to 120 degrees. Pain noted on examination did not result in functional loss. A January 2017 treatment record revealed left knee flexion beyond 95 degrees. A December 2019 VA noted left knee flexion to 110 degrees and to 90 degrees due to repeated use over a period of time and during flare-ups. A May 2021 treatment record reflected left knee flexion to 120 degrees. Accordingly, as degenerative arthritis of the left knee is documented by x-ray and results in confirmed limitation of flexion that is noncompensable under Diagnostic Code 5260, the Board finds that the Veteran is properly compensated for his left knee disability with a 10 percent disability rating under Diagnostic Code 5260-5003. In considering whether other diagnostic codes might more accurately reflect the Veteran's disability picture, the Board finds that Diagnostic Codes 5256 (ankylosis of the knee), 5261 (limitation of extension), and 5262 (tibia and fibula impairment) are not applicable because the medical evidence does not show that the Veteran has any of those conditions. See 38 C.F.R. § 4.71a. While the Veteran reported he could not climb stairs well due to instability, the April 2014 treatment record found no real instability and stability testing conducted during the February 2015, December 2016, and December 2019 VA examinations were negative for instability. There was also no evidence of recurrent subluxation or patellar instability. Therefore, Diagnostic Code 5257 is not applicable. Similarly, while physical therapy treatment records noted minimal hyperextension of the left knee, Diagnostic Code 5263 is not applicable because the record does not indicate that genu recurvatum resulted in objectively demonstrated weakness and insecurity in weight bearing. Finally, as noted above, when semilunar cartilage has been removed, but remains symptomatic, a 10 percent rating is assigned. 38 C.F.R. § 4.71a, Diagnostic Code 5259. Separate ratings for limitation of motion under Diagnostic Codes 5260 and/or 5261 do not preclude a separate rating for meniscal symptoms under Diagnostic Codes 5258 or 5259. See Lyles v. Shulkin, 29 Vet. App. 107 (2017). Here, the evidence indicates that the Veteran received a left knee arthroscopy for a torn meniscus. While he is being compensated for pain and loss of range of motion, treatment records reflect that the Veteran also experiences feelings that his left knee is unstable. Given that the Veteran has symptomatic removal of semilunar cartilage, and feels that his left knee is unstable, the Board resolves all doubt in the Veteran's favor and finds that a separate 10 percent rating is warranted for his additional symptoms of the left knee aside from pain and limited motion. In sum, the Board finds that a 10 percent disability rating for the Veteran's left knee degenerative joint disease is not warranted. However, a separate 10 percent disability rating for symptomatic residuals of left knee semilunar cartilage removal is granted. As the preponderance of the evidence is against the denied claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). REASONS FOR REMAND 1. Entitlement to a disability rating in excess of 10 percent for right knee degenerative joint disease is remanded. As noted above, the Veteran's claim for an increased disability rating for right knee degenerative joint disease was remanded in September 2019 for further development. The Board determined that the VA examinations of record failed to comply with the holding in Correia and directed the AOJ to schedule the Veteran for a new VA examination. The Veteran was afforded a VA examination for his knees in December 2019; however, the examiner failed to conduct range of motion testing as required by Correia and directed by the Board. A remand by the Board confers on the claimant a legal right to compliance with the remand order. Stegall v. West, 11 Vet. App. 268, 271 (1998). As such, remand for a new VA examination of the right knee is required. The matter is REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected right knee degenerative joint disease. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. In so doing, the examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). Further, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). (Continued on the next page) 2. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the Veteran's claim should be readjudicated based on the entirety of the evidence. If any benefit sought remains denied, furnish the Veteran and his representative a supplemental statement of the case (SSOC) and return the case to the Board. KRISTI L. GUNN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Silverblatt, 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.