Citation Nr: 21064143 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 21-00 150 DATE: October 19, 2021 ORDER 1. A 30 percent rating for a post-total knee replacement (TKR) right knee disability is granted from (the earlier effective date of) May 17, 2017, subject to the regulations governing payment of monetary awards; ratings in excess of 30 percent, throughout, from May 17, 2017, are denied. 2. Entitlement to a rating in excess of 10 percent for a right ankle disability is denied. 3. Entitlement to a rating in excess of 10 percent for right knee surgical scars is denied. FINDINGS OF FACT 1. Throughout, from the earlier effective date of May 17, 2017, the Veteran's was post-TKR; chronic residuals consisting of severe painful motion and weakness were not shown; ankylosis, limitation of extension at more than 20 degrees, and nonunion or malunion of tibia or fibula were not shown. 2. At no time is the Veteran's right ankle disability shown to have been manifested by marked limitation of motion. 3. At no time is the Veteran shown to have had more than one right knee surgical scars (out of a total of four) that was shown to be painful; none was unstable. CONCLUSIONS OF LAW 1. A 30 percent rating for the Veteran's post-TKR right knee disability is warranted from (the earlier effective date of) May 17, 2017; a rating in excess of 30 percent is not warranted at any time (from May 17, 2017). 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.71a; Diagnostic Codes (Codes) 5055, 5256, 5261, 5262. 2. A rating in excess of 10 percent for a right ankle disability is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1-4.7, 4.21, 4.40, 4.45, 4.71a, Code 5271. 3. A rating in excess of 10 percent for right knee surgical scars is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.118, Code 7804. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served on active duty from August 1966 to May 1970. These matters are before the Board of Veterans' Appeals (Board) on appeal of a June 2018 Department of Veterans Affairs (VA) rating decision. An interim ( December 2020 ) rating decision (issued after the Veteran initiated an appeal) increased the rating for the post TKR right knee disability to 30 percent, effective May 17, 2018 and granted service connection for right knee surgical scars, rated 10 percent, effective May 17, 2018. Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule). The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. 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. Reasonable doubt as to the degree of disability will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). Under 38 C.F.R. § 4.40, consideration must be given to functional loss due to pain and weakness causing additional disability beyond that reflected by range of motion measurements. Under 38 C.F.R. § 4.45, consideration must be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. Instability of station, disturbance of locomotion, interference with sitting, standing and weight bearing are related considerations. Painful, unstable, or misaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59. Although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Where a musculoskeletal disability is evaluated at the highest rating available based upon limitation of motion, further DeLuca analysis is foreclosed. See Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Where entitlement to compensation has already been established (as here for the right knee and right ankle disabilities) 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). However, separate ratings may be assigned for separate periods of time based on the facts found. This practice is known as "staged" ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). The relevant temporal focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from one year before the claim was filed until VA makes a final decision on the claim. Id. As the instant claims for increase were received on May 17, 2018, the period for consideration is from May 17, 2017, to the present. Where the appeal is from the initial rating decision assigned with an award of service connection, (as is the case for the scars claim) separate ratings can be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999). 1. Entitlement to a rating in excess of 30 percent for a post-TKR right knee disability, is denied. Post-TKR knee disability is rated under Code 5055. A 100 percent rating is to be assigned for 1 year following implantation of prosthesis. Following expiration of the 1-year period, a 30 percent rating is the minimum rating to be assigned for residuals following a total knee replacement. A 60 percent [maximum schedular] rating is warranted for chronic residuals consisting of severe painful motion or weakness in the affected extremity. Intermediate degrees of residual weakness, pain, or limitation of motion are rated by analogy to Codes 5256 (for ankylosis), 5261 (for limitation of extension), or 5262 (for impairment of the tibia and fibula). 38 C.F.R. § 4.71a. Under Code 5256, a 30 percent rating is assigned for ankylosis of a knee at a favorable angle (in full extension), or in slight flexion between 0 degrees and 10 degrees. A 40 percent rating is assigned for ankylosis of a knee in flexion between 10 degrees and 20 degrees. A 50 percent rating is assigned for ankylosis of a knee between 20 degrees and 45 degrees. A 60 percent rating is assigned for extremely unfavorable ankylosis of a knee (in flexion at 45 degrees or more). 38 C.F.R. § 4.71a. Under Code 5261, limitation of extension of a leg warrants a 30 percent rating when limited at 20 degrees, a 40 percent rating when limited at 30 degrees, and a (maximum) 50 percent rating when limited at 45 degrees. 38 C.F.R. § 4.71a. Under Code 5262, for impairment of the tibia and fibula, a 30 percent rating is assigned for malunion with marked knee or ankle disability, and a (maximum) 40 percent rating is assigned for nonunion with loose motion requiring a brace. 38 C.F.R. § 4.71a. Normal or full range of motion of the knee is from 0 degrees of extension to 140 degrees of flexion. 38 C.F.R. § 4.71, Plate II. Separate ratings may be assigned for compensable limitations of motion, instability, and dislocation of semilunar cartilage. The Veteran underwent right TKR surgery in March 2016; a 30 percent (minimum schedular) rating was assigned under Code 5055 from May 17, 2018 (in a December 2020 rating decision, discussed in more detail below). A January 2018 VA treatment record notes that the Veteran reported constant right knee pain and stiffness after inactivity. He related that he walked for exercise but could not do yard work due to right knee pain. On examination, right knee range of motion (ROM) testing showed flexion was -4 degrees to 109 degrees and was limited by pain. On June 2018 VA knee examination, right knee anterior cruciate ligament tear and patellofemoral pain syndrome were diagnosed. The Veteran reported ongoing right knee pain and decrease in ROM and strength since a recent right TKR. He related that he experienced flare-ups that consisted of dull ache with periods of sharp pain and functional impairment including inability to squat, kneel, or run. On right knee ROM testing flexion was to 120 degrees and extension to 0 degrees. Pain (that did not result in [additional] functional loss) was noted on flexion and extension. There was no evidence of pain with weight-bearing or on palpation of the knee joint, and no crepitus. There was no objective evidence of pain on passive ROM testing or when the joint was in non-weight-bearing. The Veteran was able to perform repetitive use testing, and there was no additional functional loss or loss of ROM after three repetitions. The examiner indicated that the Veteran was not being examined immediately after repetitive use over time or during a flare-up, and that the examination was neither medically consistent or inconsistent with his statements describing functional loss with repetitive use over time or during flare-ups. Regarding whether pain, weakness, fatigability, or incoordination significantly limits the Veteran's functional ability with repeated use over time or during flare-ups, the examiner opined that he was unable to say without resort to speculation. He indicated that he reviewed the evidence of record, to include available medical records and the Veteran's lay description of symptoms after repetitive motion and during flare-ups. The examiner explained that since objective evaluation of functionality with repetitive use over time and during flare-ups is not generally evaluated at medical encounters, the medical record evidence lacks any evidence for such determination. The Veteran provided a lay description of subjective functionality factors, but it would not be possible for a medical examiner to objectively state such presumed findings, including the loss of ROM as a consequence of repetitive use over a period of time or during flare-ups outside the clinical setting, without resort to speculation since there is no common medical knowledge base (medical literature or common medical practice) to support such a conclusion. Muscle strength testing was normal, and there was no muscle atrophy or ankylosis. Joint stability testing was normal. The examiner opined that the Veteran had an intermediate degree of residual weakness, pain, or limitation of motion following the TKR. The Veteran indicated that he did not use any assistive devices. Regarding functional impact, the examiner opined that activities involving weight-bearing and knee ROM caused right knee pain and that the decreased ROM affects ambulation and the use of the lower extremity. On December 2020 VA knee examination, right knee osteoarthritis and right TKR were diagnosed. The Veteran reported that his knee pain had worsened since his last examination. He related that he has constant knee pain of 1/10 with flare-ups that increase the pain to 6-7/10 with activity. He related that the flare-ups, which occurred daily, were usually somewhat short in nature and improved with position change and movement. The Veteran related that he had difficulty sitting for a prolonged period, that he found it hard to rise from a seated position, that his ability to walk was limited, and that his gait had changed. He reported greater difficulty climbing stairs, and that now, typically, he uses an elevator. He related that he cannot squat or kneel, and that at night his knee sometimes wakes him due to pain, and that he is able to fall back to sleep after he adjusts his position. He reported that he is still able to play golf, but has to use a cart with a handicap placard, and that he no longer is able to do yard work, due to his knee pain. Right knee ROM testing showed flexion from 5 to 85 degrees and extension from 85 to 5 degrees. The examiner indicated that the ROM contributed to functional loss due to pain on flexion and extension. There was evidence of pain with weight-bearing, diffuse moderate knee pain on palpation, and objective evidence of crepitus. There was objective evidence of pain on passive ROM testing and when the joint was used in non-weight-bearing. The Veteran was able to perform repetitive use testing, and no additional function loss or loss of ROM was noted after three repetitions. He was not examined immediately after repetitive use over time or during a flare-up, the examination was neither medically consistent or inconsistent with the Veteran's statements describing functional loss with repetitive use over time or during flare-ups, and pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over a period of time or during flare-ups. Muscle strength testing showed flexion and extension were 4/5; muscle atrophy was not shown. Right knee ankylosis was not shown, but there was intermittent swelling. Joint stability testing was normal. The examiner noted a history of meniscal tear prior to the TKR. The examiner opined that the Veteran had an intermediate degree of residual weakness, pain, or limitation of motion following the TKR. The Veteran reported he did not use assistive devices. Regarding functional impact, the examiner opined that activities involving weight-bearing and knee ROM caused right knee pain, and reduced ROM affected ambulation and use of the lower extremity. As noted above, a December 2020 rating decision increased the rating for a post-TKR right knee disability to 30 percent, effective May 17, 2018, the date of the claim for increase. A clear and unmistakable error was identified, namely that the evidence of record shows that the Veteran underwent a total right knee replacement on March 16, 2016, a claim for increase was received on May 17, 2018, and that he was entitled to at least a minimum rating for a post-TKR right knee disability. Prior to May 17, 2018, the Veteran's right knee disability was rated 20 percent for limitation of extension of 15 to 19 degrees, X-ray evidence of degenerative arthritis, and symptomatic residuals of semilunar cartilage removal. Upon review of the evidence, the Board finds that a 30 percent (the minimum schedular under Code 5055) rating is warranted from May 17, 2017 (when the period for consideration begins) because throughout the period the right knee disability was in post TKR status (the surgery was in March 2016). [While such rating [30 percent minimum], following termination of the one-year 100 percent schedular rating assigned post TKR, was warranted immediately upon termination of the 100 percent rating, the "look-back" period for consideration with the instant claim for increase received May 17. 2018 begins May 17, 2017.] The analysis proceeds to consideration whether a rating in excess of 30 percent is warranted at any time from May 17, 2017. At no time (from May 17, 2017) is the Veteran's post-TKR right knee disability shown to have been manifested by chronic residuals of severe painful motion or weakness (so as to warrant a 60 percent rating under Code 5055) or my ankylosis, limitation of extension at more than 20 degrees, of malunion or nonunion of tibia and fibula (so as to warrant an intermediate rating under Codes 5256, 5261, or 5262. On June 2018 VA examination, right knee extension was to 0 degrees. Pain was noted on extension, but did not result in functional loss. There was no pain with weight-bearing, no pain on palpation of the knee joint, and no crepitus. There was no objective evidence of pain on passive ROM testing or when the joint was in non-weight-bearing. The Veteran was able to perform repetitive testing, with no additional functional loss or loss of ROM after three repetitions. The examiner opined that the Veteran had an intermediate (not severe) degree of residual weakness, pain, or limitation of motion following the TKR. On December 2020 VA knee examination, right knee ROM testing showed extension to 5 degrees. The examiner indicated that the ROM contributed to functional loss due to pain noted on extension. There was evidence of pain with weight-bearing, and diffuse moderate knee pain on palpation. There was objective evidence of pain on passive ROM testing and when the joint was in non-weight-bearing. The Veteran was able to perform repetitive use testing with no additional functional loss or loss of ROM was noted after three repetitions. The examiner opined that the Veteran had an intermediate (i.e., less than severe) degree of residual weakness, pain, or limitation of motion following the TKR. Malunion or nonunion of tibia or fibula is not shown in the record, and has not been alleged. The Board notes the Veteran's reports of daily flare-ups and an inability to squat, kneel, and run, but he also reported he continues to golf (albeit with use of a golf cart) and has not required use of assistive devices. The disability picture presented is not one of TRK residuals of severe painful motion or weakness (or approximating such severity) and the symptoms warranting and impairment warranting a 60 percent rating or an intermediate rating between 30 and 60 percent are simply not shown (or approximated). The Board acknowledges that due to his right knee disability and related pain the Veteran has had to limit his functioning; however, the level of severity and functional impairment shown are encompassed by the 30 percent rating assigned. Accordingly, a rating in excess of the 30 percent schedular rating assigned under Code 5055 is not warranted at any time during the period for consideration (since May 17, 2017). 2. Entitlement to a rating in excess of 10 percent for a right ankle disability is denied. The Veteran's right ankle disability has been rated 10 percent under Code 5271. Under Code 5271, a maximum 20 percent rating is assigned for marked limitation of ankle motion. 38 C.F.R. § 4.71a. Normal range of motion of the ankle is from 0 to 20 degrees of dorsiflexion and 0 to 45 degrees of plantar flexion. 38 C.F.R. § 4.71a, Plate II. Under Code 5270, a 20 percent and higher ratings are warranted for ankylosis of the ankle, depending on the angle/position of ankylosis. 38 C.F.R. § 4.71a. Other codes for ankle disabilities (Codes 5272, 5273, and 5274) do not provide for ratings in excess of 20 percent and require pathology not shown here, i.e., ankylosis of the subastragalar or tarsal joint, malunion of the os calcis or astragalus, or astragalectomy. 38 C.F.R. § 4.71a. A January 2018 right ankle X-ray found no acute fracture. The provider indicated that a well corticated osseous density at the inferior margin of the lateral malleolus may reflect sequelae of an old fracture or other trauma. The talar dome was intact, ankle mortise was largely preserved, and there may be mild narrowing of the lateral aspect of ankle mortise, possibly projectional. Other joint spaces were preserved. The assessment was right ankle instability with ligamentous laxity; an ankle brace, as needed, was recommend. A March 2018 VA treatment record notes that the Veteran reported right ankle pain. The right ankle was tender to palpation; ROM testing was completed without finding of pain or crepitus. On June 2018 VA ankle examination, the Veteran reported ongoing right ankle pain with periods of weakness and flare-ups consisting of dull ache with weakness. He related that he had difficulty standing and walking for a prolonged period due to his ankle disability. ROM testing showed right ankle dorsiflexion to 15 degrees and plantar flexion to 35 degrees. Pain was noted on dorsiflexion and plantar flexion that did not result in functional loss. The examiner noted that there was no evidence of pain with weight-bearing or on palpation of the joint, and no crepitus. There was no objective evidence of pain on passive ROM testing or when the joint was in non-weight-bearing. The Veteran was able to perform repetitive use testing with no additional loss of function or loss of ROM noted. The examiner noted that the Veteran was not being examined immediately after repetitive use over time or during a flare-up, and that the examination was neither medically consistent or inconsistent with his statements describing functional loss with repetitive use over time or during flare-ups. Regarding whether pain, weakness, fatigability, or incoordination significantly limits functional ability with repeated use over time or during flare-ups, the examiner opined that he was unable to so say without resort to speculation. He indicated that he reviewed the evidence of record, to include available medical records and the Veteran's lay description of symptoms after repetitive motion and during flare-ups, and explained that since objective evaluation of functionality with repetitive use over time and during flare-ups is not generally done on medical encounters, the medical record evidence lacks any evidence to allow for such determination. The Veteran provided a lay description of subjective functionality factors, but it would not be possible for a medical examiner to objectively state such presumed findings, including the loss of ROM as a consequence of repetitive use over a period of time or during flare-ups outside the clinical setting, without resort to speculation since there is no common medical knowledge base (medical literature or common medical practice) to support such a conclusion (convert lay reports to additional loss of motion in degrees). Muscle strength testing was 4/5 (i.e., reduced, but not to severe degree) in plantar flexion and dorsiflexion, and there was no muscle atrophy or ankylosis. The examiner opined that activities involving weight-bearing and right ankle ROM caused right ankle pain and that decreased ROM affected ambulation and use of the lower extremity. On December 2020 VA ankle examination, the diagnosis was residuals of a right ankle fracture. The Veteran reported that his ankle twisted easily, and that he had experienced a few falls when his ankle twisted. He related that his ankle pain was intermittent, he experienced flare-ups of ankle pain upon twisting his ankle, and that such flare-ups occurred several times a year and last days at a time, up to a week. He reported difficulty with prolonged standing, walking, and stair-climbing. Right ankle ROM testing showed dorsiflexion to 10 degrees and plantar flexion to 20 degrees. The examiner noted that decreased ROM affected ambulation and use of the lower extremity and pain on dorsiflexion and plantar flexion caused functional loss. There was pain on weight-bearing, mild lateral ankle pain on palpation of the joint, and objective evidence of crepitus. There was objective evidence of pain on passive ROM testing and when the joint was used in non-weight-bearing. The Veteran was able to perform repetitive use testing with no additional loss of function or loss of ROM. The examiner noted that the Veteran was not being examined after repetitive use over time, the examination was neither medically consistent or inconsistent with his statements describing functional loss with repetitive use over time, and pain, weakness, fatigability, and incoordination did not significantly limit functional ability with repeated use over a period of time. The examiner also noted that the examination was not conducted during/or following a flare-up and that the examination was neither medically consistent or inconsistent with his statements describing functional loss during flare-ups. The examiner noted that pain, weakness, fatigability and/or incoordination did significantly limit functional ability during a flare-up due to pain and lack of endurance but that he was unable to describe in terms or ROM. He explained that a flare-up was not directly observed during the examination, and the medical records provided made no specific references to flare-up frequency, duration, or severity of decreased range of motion in degrees. After examination of the Veteran, listening to his complete history and subjective complaints, combined with a review of the medical records, the examiner indicated that he had no basis to offer [an opinion regarding] additional losses of function or motion. Muscle strength testing was 5/5 (full) on plantar flexion and dorsiflexion. Muscle atrophy and ankylosis were not shown. Regarding joint stability, anterior drawer test and talar tilt test were positive. The Veteran reported occasional use of an ankle brace. During the period on appeal, the VA examination reports, VA treatment records, and lay statements, overall, do not show that the symptoms of the Veteran's right ankle disability resulted in marked limited motion so as to meet, or approximate, the criteria for a 20 percent rating. On June 2018 examination, ROM testing showed right ankle dorsiflexion to 15 degrees and plantar flexion to 35 degrees. Pain was noted on dorsiflexion and plantar flexion that did not result in functional loss. There was no muscle atrophy or ankylosis was shown. The examiner seemingly clarified an earlier statement and opined that activities involving weight-bearing and right ankle ROM caused right ankle pain and that decreased ROM affected ambulation and use of the lower extremity. The disability picture presented does not reflect or suggest marked limitation of motion. On December 2020 examination, the Veteran reported intermittent right ankle pain, that he experienced flare-ups of ankle pain after twisting his ankle, and that such flare-ups occurred several times a year and lasted for days at a time up to a week. However, his reports do not identify any specific period when his ankle symptoms and impairment rose to the marked limitation level warranting a 20 percent rating. Right ankle ROM testing showed dorsiflexion to 10 degrees and plantar flexion to 20 degrees (approximately midway through normal, and not reflecting "marked" limitation. Although the December 2020 examiner indicated that he was unable to describe in terms of ROM how much a flare-up limited functional ability due to lack of observation on examination and lack of references to such flare-ups in the medical records, on both examinations, it is noteworthy that the Veteran was able to perform repetitive use testing with no additional loss of function or ROM; regardless, the Veteran's reports of flare-ups do not identify any distinct periods when symptoms and impairment rose to a level of marked limitation warranting a staged higher rating (they suggest infrequent episodes of such limitations-not resulting in sufficient additional disability to seek medical attention) . Such evidence demonstrates no more than moderate limitation of right ankle motion. Consequently, a 20 percent rating under Code 5271 is not warranted. 3. Entitlement to a rating in excess of 10 percent for right knee surgical scars is denied. Scars are evaluated under 38 C.F.R. § 4.118, Codes 7800 through 7805. Code 7800 applies to scars of the head, face, and neck. Code 7801 applies to scars, not of the head, face, or neck that are deep and nonlinear. A 10 percent rating is assigned for an area or areas of at least 6 square inches (39 square centimeters) but less than 12 square inches (77 square centimeters). A 20 percent rating is assigned for an area or areas of at least 12 square inches (77 square centimeters) but less than 72 square inches (465 square centimeters). A 30 percent rating is assigned for an area or areas of at least 72 square inches (465 square centimeters) but less than 144 square inches (929 square centimeters). And a 40 percent rating is assigned for an area or areas of at least 144 square inches (929 square centimeters). Note 1 provides that a deep scar is one associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Code 7801. Code 7802 (for superficial and nonlinear scars not of the head, face, or neck) provides for a 10 percent rating for scars with an area or areas of at least 144 square inches (929 square cm). Note 1 provides that a superficial scar is one not associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Code 7802. Code 7804 (for scars that are unstable or painful) provides for a 10 percent rating for one or two qualifying scars, a 20 percent rating for three or four qualifying scars, and a 30 percent rating for five or more qualifying scars. Note 1 provides that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. 38 C.F.R. § 4.118, Code 7804. Note 2 provides that 10 percent may be added to the evaluation if one or more scars are both unstable and painful. Under Code 7805, any disabling effect(s) not considered in a rating under Codes 7800-04 are to be rated under an appropriate Code. 38 C.F.R. § 4.118, Code 7805. On June 2018 VA knee examination, a right knee scar was noted that measured 18 cm by .25 cm that was not painful or unstable. As noted above, based on the findings of a June 2018 knee examination, a June 2018 rating decision granted service connection for a right knee scar at 0 percent, effective May 17, 2018. On December 2020 VA scars examination, four right knee surgical scars were noted. The first was 23 cm by 1 cm and was painful to the touch, the second was 7 cm by 1 cm and was not painful to the touch, and the third and fourth measured 4 cm by 0.5 cm, each, and were not painful to the touch. He indicated that he cannot kneel on his right knee due to the one painful scar. None of the scars had underlying tissue damage or were unstable, and the approximate total area of the scars was 34 square centimeters. Based on the findings on December 2020 scars examination, a December 2020 rating decision granted service connection for residuals of right knee surgical scars at 10 percent, effective May 17, 2018, the original date of claim (which essentially just increased the rating for the previously service-connected (and now painful) right knee scar back to the date of claim). Initially, the Board notes that Codes 7800, 7801, and 7802 do not apply in this matter. Code 7800 applies to scars of the head, face, and neck and thus is not relevant). Code 7801 applies to scars, not of the head, face, or neck that are deep and nonlinear; the scars here are not shown to be deep, underlying soft tissue damage is not shown. Code 7802 provides for a 10 percent (maximum) rating for superficial and nonlinear scars with an area of 144 square inches (929 square cm) or greater; here, the area of involvement is not shown to be of such (or near such) extent. On review of the record, the Board finds that a rating in excess of 10 percent for the right knee surgical scars is not warranted. On June 2018 VA examination, only one right knee scar was noted and was not painful or unstable. On December 2020 VA scars examination, four scars were noted; only one was found to be painful; none were found to be unstable. The findings on these examinations do not meet the criteria for next higher (20 percent ) rating under Code 7804 (of three or four scars that are unstable or painful). Accordingly, a rating in excess of 10 percent for right knee surgical scars is not warranted. GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Bayles, 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.