Citation Nr: 21063820 Decision Date: 10/18/21 Archive Date: 10/18/21 DOCKET NO. 17-24 192 DATE: October 18, 2021 ORDER Entitlement to a disability rating in excess of 10 percent for left knee arthritis prior to March 3, 2015 is denied. Entitlement to a rating of 40 percent from February 14, 2017 for left knee arthritis is granted. Entitlement to a rating in excess of 10 percent for a right knee strain with arthritis prior to December 13, 2019 is denied. Entitlement to a rating in excess of 20 percent for left knee arthritis from December 13, 2019 is denied. FINDINGS OF FACT 1. Prior to March 3, 2015, the Veteran's left knee disability manifested by arthritis with painful motion. Flexion was not limited to 45 degrees or less. Extension was not limited to 10 degrees or more. 2. From February 14, 2017, the Veteran's limitation of motion relating to left knee extension more nearly approximated 30 degrees, but did not more nearly approximate 45 degrees, to include consideration of functional loss during flare-ups. 3. Prior to December 13, 2019, the Veteran's right knee strain with arthritis was manifested by painful motion and limitation of extension. 4. From December 13, 2019, the Veteran's right knee strain with arthritis was manifested by painful motion and instability. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating in excess of 10 percent for left knee arthritis prior to March 3, 2015 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Codes 5010-5260, 5261. 2. The criteria for entitlement to a rating of 40 percent from February 14, 2017 for left knee arthritis have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Codes 5010-5260, 5261. 3. The criteria for entitlement to a rating in excess of 10 percent for a right knee strain with arthritis prior to December 13, 2019 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Codes 5010-5258. 4. The criteria for entitlement to a rating in excess of 20 percent for left knee arthritis from December 13, 2019 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Codes 5010-5258. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1979 to March 1984. In April 2019, the Veteran's claims were remanded by the Board for additional development, including a new VA examination. That development having been completed, the Board finds there has been substantial compliance with its remand. See Dyment v. West, 13 Vet. App. 141, 146-147 (1999) (remand not required under Stegall v. West, 11 Vet. App. 268 (1998) where Board's remand instructions were substantially complied with). Increased Rating Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 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 the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321 (a), 4.1. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § 4.1 (2018); Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). 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). If the evidence for and against a claim is in equipoise, the claim will be granted. 38 C.F.R. § 4.3. A claim will be denied only if the preponderance of the evidence is against the claim. See 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. 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 evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. 1. Entitlement to a rating in excess of 10 percent for left knee arthritis prior to March 3, 2015 and from February 14, 2017 The Veteran's service-connected left knee arthritis has been rated at 10 percent prior to March 3, 2015, and from February 14, 2017. At the outset, the Board notes that the Veteran has been awarded separate ratings for instability. The Veteran's claims for left knee instability are not on appeal and will not be considered in this decision. Rather, the Board will provide an opinion regarding the Veteran's claim for left knee arthritis. In addition, the Board notes that the appeal period between March 3, 2015 and February 14, 2017 has been adjudicated separately by the Board in a prior opinion. As such, that period is not before the Board. The Veteran's left knee has been rated under Diagnostic Code 5010-5260 throughout the periods on appeal. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. In this case, the hyphenated code indicates that the Veteran's disability is evaluated as arthritis based on the criteria found under Diagnostic Code 5010. Relevant to this appeal, Diagnostic Code 5010 instructs VA to rate traumatic arthritis as degenerative arthritis by refence to Diagnostic Code 5003. Diagnostic Code 5003 directs that the Veteran's right and left knee disabilities should be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. 38 C.F.R. § 4.71a, Diagnostic Code 5003. If limitation of motion is noncompensable, a 10 percent rating should be assigned if objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Id. In other words, a veteran receiving a compensable rating based on painful motion cannot be provided separate ratings for arthritis and painful range of motion, as the arthritis rating criteria defers to the limitation of motion criteria of the individual joint involved, and rating the same manifestation of a disability under different diagnoses would be considered impermissible pyramiding. Lyles v. Shulkin, 29 Vet. App. 107, 113 (2017); 38 C.F.R. § 4.14. In contrast, separate ratings can be assigned for knee disabilities when none of the symptomatology overlaps and the separate rating is based on additional disabling symptomatology; this includes separate ratings based on limitation of flexion (Diagnostic Code 5260), limitation of extension (Diagnostic Code 5261), lateral instability or recurrent subluxation (Diagnostic Code 5257), and meniscal conditions (Diagnostic Codes 5258, 5259). See VAOPGCPREC 23-97, 62 Fed. Reg. 63,603 (1997); VAOPGCPREC 9-98, 63 Fed. Reg. 56,703 (1998); VAOPGCPREC 9-2004; 69 Fed. Reg. 59,988 (2004); Lyles v. Shulkin, 29 Vet. App. 107 (2017). The normal range of motion of the knee is from 0 degrees extension to 140 degrees flexion. 38 C.F.R. § 4.71, Plate II. Limitation of flexion warrants 10, 20, and 30 percent ratings when limitation is to 45 degrees, 30 degrees and 15 degrees, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Limitation of extension warrants 10, 20, 30, 40, and 50 percent ratings when limitation is to 10 degrees, 15 degrees, 20 degrees, 30 degrees, and 45 degrees respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5261. Diagnostic Code 5257 provides ratings of 10, 20, and 30 percent for recurrent subluxation or lateral instability of the knee, which is slight, moderate, or severe, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5257. Diagnostic Code 5258 provides a 20 percent rating may be assigned for dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint. Diagnostic Code 5259 provides for a 10 percent rating for symptomatic removal of the semilunar cartilage. The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. In Mitchell v. Shinseki, 25 Vet. App. 32 (2011), the Court held that, although pain may cause a functional loss, "pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system." Rather, pain may result in functional loss, but only if it limits the ability "to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance." Id., quoting 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45. In determining the degree of limitation of motion, the provisions of 38 C.F.R. §§ 4.10, 4.40, and 4.45 are for consideration. See DeLuca v. Brown, 8 Vet. App. 202 (1995). While portions of the Rating Schedule addressing the musculoskeletal system recently were revised effective February 7, 2021, DC 5260 was not changed. Turning to the evidence, in January 2011 the Veteran was evaluated for his left knee condition. The examiner noted that there was swelling around the patella, and there was tenderness over the medial joint line at the back of the Veteran's knee. The knee was instable. There was slight pain with valgus and varus stress and normal alignment. His gait was antalgic with a cane and a left knee brace. After repetition three times, the Veteran's range of motion (ROM) showed flexion to 92 degrees with pain at the endpoint, and extension lag to 11 degrees from being able to straightening his leg fully, with pain at the endpoint. The examiner determined that the Veteran suffered from torn anterior cruciate ligament of the left knee, posterior horn the medial meniscus absent, with arthritic changes of degenerative joint disease. In December 2011, the Veteran was examined again. The examiner noted that the Veteran suffered from left knee anterior cruciate ligament tear, left knee arthritis, and left knee medial meniscus tear. The Veteran reported flare-ups, described as usual pain close to a 10 on a scale of 1 to 10, and constant. Initial ROM showed right knee flexion from 0 to 90 degrees, and no limitation of extension. Left knee ROM showed no results for flexion, and normal extension. The Veteran was able to perform repetitive use testing with three repetitions. After repetition, right knee flexion ended at 90 degrees and extension remained normal. Post repetition left knee flexion ended at 40 degrees, and there was no hyperextension. The examiner noted that the Veteran did not have additional limitation of ROM of the knee and lower leg following repetitive use testing. The Veteran did exhibit functional loss of the knee, causing less movement than normal and pain on movement bilaterally. There was also disturbance of locomotion and interference with sitting, standing, and weight bearing on the left side. On the left side, the Veteran experienced tenderness or pain to palpation of the joint. Muscle strength showed active movement against some resistance for right knee flexion, and active movement with gravity eliminated for left knee flexion. The results were the same for knee extension for the left and right knee. The Veteran's right knee had normal stability. The Veteran's left knee had 2+ and 1+ instability. There was no patellar subluxation. On the left side, the Veteran had a history of meniscal tear, and experienced frequent episodes of joint locking. At the time of the examination, the Veteran has using braces and a cane. The examiner determined that the Veteran's knee condition impacted his ability to work, due to severe pain and problems with standing and bending. In April 2014 the Veteran was afforded a VA examination. His left knee arthritis was confirmed. The Veteran reported flare-ups, described as pain and stiffness. Initial ROM showed right knee flexion to 140 degrees or greater, and no evidence of painful motion. Right knee extension was to 0, or no limitation of extension and no evidence of painful motion. Left knee flexion was to 50 degrees, with pain at 50 degrees. Left knee extension was normal with no painful motion. The Veteran was able to perform repetitive use testing with at least three repetitions bilaterally. Right knee ROM did not change following repetitive testing. Left knee ROM also remained the same. There was no additional limitation of ROM following repetitive use, though there was functional loss of the lower leg. There was less movement tan normal on the left side, excess fatigability, incoordination, and instability of station. These results applied to the left knee only. There was no tenderness or pain to palpation of the joint. Muscle strength was all normal bilaterally. The Veteran's right knee had no joint instability. The left side was 1+ for anterior instability, but normal for posterior and medial lateral instability. There was no patellar subluxation. At the time of the examination, the Veteran was using braces regularly. The examiner found that the Veteran's knees impaired his ability to work; the impact of the Veteran's left knee included pain, stiffness, limited range of motion, difficulty with bending, prolonged standing, walking, and climbing stairs. The Veteran underwent another examination in March 2015. The examiner noted the Veteran's bilateral diagnosis of knee strain, and the Veteran's left knee anterior cruciate ligament tear. The Veteran reported flare-ups described as right knee flares after prolonged standing, walking, squatting, and occurring about eight times per month. The Veteran also reported functional loss, described as when his right knee flared, there was swelling, and he rested for a day or two. Initial ROM of the right side showed flexion 10 to 70 degrees, and extension 70 to 10 degrees, with pain causing functional loss. There was evidence of pain with weight bearing, but no crepitus. Left knee extension as 15 to 50 degrees, and extension 50 to 15 degrees. ROM contributed to functional loss. There was pain on weight bearing, but no crepitus. The Veteran was able to perform repetitive use testing with at least three repetitions bilaterally, and there was no additional loss of range of motion. The Veteran was not being examined immediately after repetitive use over time, but the examination was medically consistent with the Veteran's statements. Pain, fatigue, weakness, and lack of endurance significantly limited functional ability with repeated use over time bilaterally. The examiner did not describe this in terms of ROM. The examination was also medically consistent with the Veteran's statements describing functional loss during a flare-up. Pain, fatigue, weakness, and lack of endurance significantly limited functional ability with flare-ups bilaterally. The examiner noted that the Veteran's right and left knee had less movement than normal due to ankylosis, and adhesions, and weakened movement due to muscle or peripheral nerve injury. There was also disturbance of locomotion, interference with sitting, and interference with standing. Right knee muscle strength testing showed flexion and extension as a 4 out of 5 or active movement against some resistance with a reduction in muscle strength. The results on the left knee were the same. The Veteran exhibited muscle atrophy bilaterally. The examiner noted no ankylosis on the left or right side. No recurrent subluxation was noted. Joint stability testing was not performed because the Veteran was in pain. The Veteran was currently using braces. The Veteran's knees caused functional impairment, noted as walking with a limp and putting more weight on his right heel when walking. In a correspondence from the Veteran in April 2016, he explained that his right knee had more than a sprain and arthritis, but gave out on him daily causing him to collapse. The Veteran submitted August 2015 medical records showing that he has persistent bilaterally knee pain, and changes of the chondromalacia patella of the right knee. There were also some small subcortical cysts in the fibular medial surface. There was also a scattered partial to full thickness tear of the cartilage overlying the joint surfaces, with scattered osteophyte formation. There was tricompartmental degenerative arthritis changes. There was also a tiny joint effusion. There was also a horizontal tear in the posterior horn of the lateral meniscus, with the anterior horn of the lateral meniscus being very small. At a February 2017 VA examination, the Veteran reported movement in his left knee that "scared" him when he walked and that his knee felt very unstable. He stated he always wore a knee brace when leaving his home and that over the past six years he had gone from not needing a cane to being unable to go anywhere without it. Despite this, the examination report indicated that joint stability testing was normal with no instability in either knee. Notably, repetitive use testing was not possible due to knee pain. In December 2019, the Veteran underwent an additional VA examination. The Veteran reported flare-ups of the knee, described as occurring with prolonged standing, sitting, walking, climbing, descending stairs, and any kind of strenuous activity. The Veteran did not report any functional loss. Right knee initial ROM showed flexion to 50 degrees, and extension from 50 degrees. ROM did not contribute to functional loss, despite pain. There was evidence of pain with weight bearing, but no evidence of localized tenderness. There was evidence of crepitus. Left knee initial ROM showed flexion to 40 degrees, and extension from 40 degrees. ROM, while painful, did not contribute to functional loss. There was evidence of pain with weight bearing, but no evidence of localized tenderness. There was evidence of crepitus. The Veteran was able to perform repetitive use testing with three repetitions bilaterally, and there was no additional functional loss or range of motion after three repetitions. While the Veteran was being examined after repetitive use, the examiner found that he could not say whether pain, weakens, fatigability, o incoordination significantly limited functional ability with repeated use over time. The examiner explained that after listening to the Veteran's history, combined with his records, he had no basis to offer additional loss of function or motion when it came to repetitive use. The examiner had the same findings regarding functional ability due to flare-ups. The Veteran's right knee muscle strength showed 4/5 or active movement against some resistance for flexion and extension, as was his left knee. There was no muscle atrophy or ankylosis on either side. The examiner found that the Veteran's right knee had joint instability anteriorly and laterally. The Veteran's left knee also exhibited anterior and lateral instability. At the time of the examination the Veteran was using braces and crutches. The examiner concluded that the Veteran's knees impacted his ability to work. The examiner explained that the Veteran's work restrictions may include avoidance of prolonged exertion, no heavy lifting, and no heavy carrying of excess poundage. The examiner also noted that for both knees, there was no pain with non-weight bearing, there was pain with passive ROM which did not cause functional loss, as well as pain with weight bearing that did not cause functional loss. Prior to March 2015, the Board finds that the Veteran's assigned rating of 10 percent is appropriate for his left knee disability based on limitation of extension or flexion. Notably, the ranges of motion demonstrated during the appeal period are limited only to a noncompensable degree, to include after repetitive use and during flare-ups. The Veteran has been in receipt of what amounts to at least the minimum compensable rating for limitation of motion for his left knee joint. Increased ratings based on limitation of motion under Diagnostic Code 5260 or 5261 are not warranted. Furthermore, as the Board has noted above, separate compensable ratings are not warranted under Diagnostic Code 5257 for recurrent subluxation or instability. 38 C.F.R. § 4.71a. In this regard, the Veteran has previously been rated separately for joint instability and has not appealed this issue. As such it is not before the Board. While the Veteran has had some problems with his meniscus, he has not had any prior surgery. The Veteran's symptoms of locking have been considered in his other ratings for his left knee, which has been rated at 20 percent since 2010. Thus, separate ratings under Diagnostic Codes 5258 or 5259 are not warranted either. Ratings can also be assigned for impairment of the tibia or fibula, genu recurvatum, or ankylosis of the knee. 38 C.F.R. § 4.71a, Diagnostic Codes 5256, 5262, 5263. Ankylosis is stiffening or fixation of a joint as the result of a disease process, with fibrous or bony union across the joint. Dinsay v. Brown, 9 Vet. App. 79, 81 (1996). Ankylosis is also defined as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 93 (30th ed. 2003). In this case the evidence does not reflect, and the Veteran does not allege that he has tibia or fibula impairment, genu recurvatum, or ankylosis of either knee. As such, those diagnostic codes are not for application. The Board adds the Veteran's complaints of pain, impacting standing and walking for long periods of time, along with limiting strength and range of motion, as well as the Veteran's reports of flare-ups, have been considered. Even in contemplation of the Veteran's subjective complaints of pain and limitation, including during flare-ups, the Board finds that the Veteran's left knee disability does not warrant higher or separate ratings. See DeLuca, Mitchell, supra. The Veteran has been afforded the benefit of the doubt that he experienced painful functional loss for the entire period on appeal. The VA examination reports do not indicate limitation of flexion or extension to a compensable degree at any time; and the Veteran is assigned a compensable rating to compensate for his painful motion. Based on the above, the Board finds that the Veteran's left knee arthritis prior to March 3, 2015 was not so severe as to warrant ratings in excess of 10 percent. From February 14, 2017, the Board finds that the Veteran's left knee arthritis has been manifested by extension limited to 30 degrees, but not greater than 45 degrees, and as such, meets the criteria for a 40 percent rating under Diagnostic Code 5261, but no higher. In this regard, the Board notes that in the Veteran's December 2019 VA examination, his extension was notably limited to 40 degrees. The Veteran's left knee disability with limitation of extension does not more nearly approximate a 50 percent which requires extension limited to 45 degrees. At no point during the appeal period has the Veteran's left knee extension been limited to 45 degrees. Even considering flare-ups, which were addressed in the December 2019 VA examination, the Veteran's left knee extension would not more closely approximate 45 degrees. For the foregoing reasons, a 40 percent rating is warranted for the Veteran's left knee disability with limitation of extension throughout the appeal period, but the preponderance of the evidence is against a higher rating. The benefit of the doubt doctrine is not otherwise for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. The Veteran's flexion on the other hand, has not been so limited as to warrant an increased rating. Under DC 5260, a 10 percent rating is warranted if flexion is limited to 45 degrees; a 20 percent rating if limited to 30 degrees; and a maximum 30 percent rating if limited to 15 degrees. At worst, the Veteran is unable to flex his left knee beyond 85 degrees. For the period on appeal, the Veteran's flexion was at worst limited to 40 degrees. Based on the Veteran's flexion, his disability rating is more closely described by the criteria for a noncompensable rating. At no point during the appeal period has the Veteran's left knee flexion been limited to 60 degrees, to include consideration of flare-ups. As noted several times above, while the Veteran experiences instability, this disability has been rated separately and is not before the Board. Similarly, any meniscus symptoms have also been considered separately for the Veteran's previously assigned separate ratings. The Veteran has not been found to have ankylosis (DC 5256), removed semilunar cartilage (DC 5259), or impairment of the tibia and fibula in the left knee (DC 5262) which would warrant separate ratings. Based on the above, the Board finds that the Veteran's left knee arthritis from to February 14, 2017 was not so severe as to warrant ratings in excess of 10 percent for flexion, or in excess of 40 percent for extension. 2. Entitlement to a rating in excess of 10 percent for a right knee strain with arthritis prior to December 13, 2019 3. Entitlement to a rating in excess of 20 percent for left knee arthritis from December 13, 2019 The Veteran's right knee strain has been rated at 10 percent from July 30, 2013 to December 13, 2019, and at 20 percent from December 13, 2019. Throughout the periods on appeal the Veteran's disability has been rated under Diagnostic Code 5010-5258. The Veteran's right knee disability was initially granted in a March 2015 rating decision, effective July 30, 2103, the date the RO initially received the Veteran's claim. In April 2014, the Veteran submitted a statement regarding his right knee. He explained he had not received treatment for his right knee from a VA center at the time of his letter. The Board has noted the appropriate ratings for knees in the above section, as well as the relevant evidence of record regarding the Veteran's knee disabilities. As such, the Board will refer to the above rating criteria and evidence in the forthcoming analysis. Prior to December13, 2019, the Board finds that the Veteran's 10 percent rating is appropriate. The Veteran exhibited right knee flexion from 10 to 70 degrees and extension from 70 to 10 degrees in March 2015. In order to receive a higher rating, the Veteran's extension would need to be limited to 15 degrees, or his flexion would need to be limited to 30 degrees. However, the record does not indicate such findings. Moreover, the Board notes that upon performing repetitive use testing, the Veteran's right knee ROM was not reduced. Consideration of other diagnostic codes for rating the right knee disability (5256, 5259, 5262, 5263) is inappropriate in this case because the Veteran's knee disability does not include the pathology required in the criteria for those Codes (ankylosis, symptomatic removal of semilunar cartilage, malunion or nonunion of tibia or fibula, or genu recurvatum). 38 C.F.R. § 4.71a. From December 13, 2019, the Board finds that the Veteran has been awarded the highest schedular rating, a 20 percent rating, under Diagnostic Code 5258 for his right knee disability (rated based on episodes of locking, pain, and effusion into the joint). Accordingly, no higher ratings are available under this diagnostic code. In order to be entitled to a higher rating based on loss of motion, the Veteran would have to meet the requirements for a higher rating under Diagnostic Code 5260 or Diagnostic Code 5261. Here, however, the Veteran has not met the requirements for a 30 percent rating under either Diagnostic Code 5260, which requires that flexion be limited to 15 degrees, nor the requirements for a 30 percent rating under Diagnostic Code 5261, which requires that extension be limited to 20 degrees. In the Veteran's December 2019 VA examination, flexion was noted to 50 degrees, and extension from 50 degrees. In order to be entitled to the minimum compensable rating under Diagnostic Code 5260 the Veteran must exhibit flexion to 45 degrees or less, and to be entitled to a compensable rating under Diagnostic Code 5261 the Veteran must exhibit extension to 10 degrees or less. As such, due to the actual range of motion demonstrated, separate evaluations for limited flexion and extension of the left knee under Diagnostic Code 5260 and/or Diagnostic Code 5261 are not warranted here, as is permitted by VAOPGCPREC 9-2004. With regard to other potentially applicable diagnostic codes, the Board notes that there is no evidence of ankylosis to warrant higher or separate ratings under Diagnostic Code 5256, and there is no evidence during this period of nonunion of the tibia and fibula to warrant higher or separate ratings under Diagnostic Code 5262. The Board also finds that additional or higher increased ratings are not warranted for limitation of motion based on functional impairment under DeLuca during either appeal period. In this regard, the Veteran reported chronic bilateral knee pain and flare-ups of bilateral knee pain, as well as functional impairment, such as inability to walk or stand for prolonged periods of time and inability to climb, bend, kneel, and squat. However, the Board notes that the Veteran's functional impairment is already considered in his currently assignee 20 percent and 10 percent ratings. Thus, a higher rating is not warranted for either period under the factors set forth in DeLuca. The Board finds that for the period prior to December 13, 2019, the Veteran's right knee disability was adequately compensated by Diagnostic Code 5010-5258 and that no higher ratings are available. Similarly, the Board finds that for the period from December 13, 2019, the Veteran's right knee disability was adequately compensated by Diagnostic Code 5010-5258 and that no higher ratings are available. K.A. KENNERLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Vosburgh, 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.