Citation Nr: 21065150 Decision Date: 10/25/21 Archive Date: 10/25/21 DOCKET NO. 10-20 324 DATE: October 25, 2021 ORDER Entitlement to a disability rating in excess of 10 percent for lumbar strain with degenerative arthritis (back disability) prior to May 7, 2012 is denied. Entitlement to an increased 20 percent disability rating for the Veteran's back disability for the period from May 7, 2012 to December 17, 2018 is granted. Entitlement for a disability rating in excess of 40 percent for the Veteran's back disability for the period after December 17, 2018 is denied. Entitlement to a 10 percent disability rating for right lower extremity radiculopathy, from August 8, 2018, is granted. Entitlement to a 10 percent disability rating for left lower extremity radiculopathy, from August 8, 2018, is granted. Entitlement to an initial disability rating in excess of 10 percent for a right knee limitation of flexion is denied. Entitlement to a separate 10 percent disability rating for painful extension of the right knee is granted. Entitlement to a disability rating in excess of 10 percent for left knee meniscal strain with degenerative arthritis (left knee disability) for the period prior to October 31, 2019 is denied. Entitlement to a disability rating in excess of 20 percent for the left knee disability for the period from October 31, 2019 is denied. Entitlement to a separate 10 percent disability rating for painful extension of the left knee is granted. FINDINGS OF FACT 1. Prior to May 7, 2012 the Veteran's back disability manifested as forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees. 2. For the period from May 7, 2012 to December 17, 2018, the Veteran's back disability manifested as combined range of motion of the thoracolumbar spine not greater than 120 degrees. 3. For the period since December 17, 2018 the Veteran's back disability manifested as forward flexion of the thoracolumbar spine of 30 degrees or less, without ankylosis or the functional equivalent thereof or incapacitating episodes of intervertebral disc syndrome (IVDS). 4. Resolving doubt in the Veteran's favor, his back disability is productive of radiculopathy of the right lower extremity analogous to mild incomplete paralysis of the sciatic nerve from August 8, 2018. 5. Resolving doubt in the Veteran's favor, his back disability is productive of radiculopathy of the left lower extremity analogous to mild incomplete paralysis of the sciatic nerve from August 8, 2018. 6. The Veteran's right knee disability was productive of painful flexion causing functional loss throughout the claim period. At no time during the claim period, however, was flexion limited to 30 degrees or less, even considering pain on use and during flareups. 7. The Veteran's right knee disability was productive of painful extension causing functional loss throughout the claim period. 8. Prior to October 31, 2019, the Veteran's left knee disability manifested as flexion limited to 45 degrees. At no time during the claim period, however, was flexion limited to 30 degrees or less, even considering pain on use and during flareups. 9. For the period from October 31, 2019, the Veteran's left knee disability manifested as frequent episodes of painful locking and joint effusion. 10. The Veteran's left knee disability was productive of painful extension causing functional loss throughout the claim period. CONCLUSIONS OF LAW 1. The criteria for entitlement to a disability rating in excess of 10 percent for the Veteran's back disability prior to May 7, 2012 are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.10, 4.21, 4.71a, Diagnostic Code 5237. 2. The criteria for entitlement to a 20 percent disability rating for the Veteran's back disability for the period from May 7, 2012 to December 17, 2018 are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.10, 4.21, 4.71a, Diagnostic Code 5237. 3. The criteria for entitlement for a disability rating in excess of 40 percent for the back disability for the period after December 17, 2018 are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.10, 4.21, 4.71a, Diagnostic Code 5237. 4. The criteria for a separate evaluation of 10 percent for radiculopathy of the right lower extremity are met. 38 C.F.R. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.124a, Diagnostic Code 8520. 5. The criteria for a separate evaluation of 10 percent for radiculopathy of the left lower extremity are met. 38 U.S.C. § 1154, 1155, 5107; 38 C.F.R. §§ 3.102, 4.124a, Diagnostic Code 8520. 6. The criteria for entitlement to an initial disability rating in excess of 10 percent for the right knee limitation of flexion are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.10, 4.21, 4.71a, Diagnostic Code 5260. 7. The criteria for entitlement to a separate 10 percent disability rating for painful extension of the right knee are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.10, 4.21, 4.71a, Diagnostic Code 5261. 8. The criteria for entitlement to a disability rating in excess of 10 percent for the left knee disability for the period prior to October 31, 2019 are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.10, 4.21, 4.71a, Diagnostic Code 5260. 9. The criteria for entitlement to a disability rating in excess of 20 percent for the left knee disability for the period from October 31, 2019 are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.10, 4.21, 4.71a, Diagnostic Code 5258. 10. The criteria for entitlement to a separate 10 percent disability rating for painful extension of the left knee are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.10, 4.21, 4.71a, Diagnostic Code 5261. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1986 to October 1986, October 2003 to July 2004 and November 2006 to March 2008. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2008 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, Puerto Rico. This matter was previously before the Board in January 2018. At that time, the Board remanded the claims for increased ratings for the Veteran's back and bilateral knee disabilities in order to obtain outstanding treatment records and afford the Veteran updated VA examinations. As the record reflects that outstanding treatment records were obtained and VA examinations were conducted, the Board finds that there has been substantial compliance with the remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Increased Ratings Generally, disability ratings are determined by applying the rating criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule) and represent the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations 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 determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA compensation, as well as the whole recorded history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; see generally Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question of which of two evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria for that rating. 38 C.F.R. § 4.7. Otherwise, the lower rating is assigned. Id. Additionally, while it is not expected that all cases will show all the findings specified, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. When evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). 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). Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. See id. In evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. The Court has held that the provisions of 38 C.F.R. § 4.59 are not limited to arthritis and must be considered when raised by the claimant or when reasonably raised by the record. Burton v. Shinseki, 25 Vet. App. 1 (2011). The intent of the rating schedule is to recognize painful motion with joint and periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or maligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. The Board notes that during the pendency of this appeal, the schedule for rating musculoskeletal disabilities was amended, effective February 7, 2012. See 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5257). Where, as here, a diagnostic code is amended while a claim is pending, VA is required to consider both versions of the code and apply the version most favorable to the Veteran. Back Disability The criteria for rating all disabilities of the spine are set forth in 38 C.F.R. § 4.71a, which provides that spine disabilities are to be evaluated under the General Rating Formula for Diseases and Injuries of the Spine (General Spinal Formula) or under the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Formula), whichever method results in the higher evaluation when all disabilities are combined under 38 C.F.R. § 4.25. Prior to the regulatory change, Diagnostic Code 5242 was assigned for degenerative arthritis of the spine (see also Diagnostic Code 5003) and Diagnostic Code 5243 for IVDS. As of February 7, 2021, under the amended criteria, Diagnostic Code 5242 is assigned for degenerative arthritis and degenerative disc disease (DDD) other than IVDS (see also either Diagnostic Code 5003 or 5010). It also amends Diagnostic Code 5243 for IVDS allowing the Diagnostic Code to be assigned only when there is disc herniation with compression and/or irritation of the adjacent nerve root; otherwise, Diagnostic Code 5242 must be used for all other disc diagnoses. Although the amended criteria for 5242 and 5243 separated DDD from IVDS, the rating formula under each Diagnostic Code was unchanged. Ratings under the General Spinal Formula are made with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. As relevant here, a 20 percent rating requires evidence of forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees, or a combined range of motion of the thoracolumbar spine not greater than 120 degrees; a 40 percent rating requires evidence of forward flexion of the thoracolumbar spine to 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. 38 C.F.R. § 4.71a, General Spinal Formula. For an increase to 50 percent, the evidence must show unfavorable ankylosis of the entire thoracolumbar spine. See id. A 100 percent evaluation is assigned for unfavorable ankylosis of the entire spine. See id. For VA compensation purposes, normal forward flexion of the thoracolumbar spine is 0 to 90 degrees. See id., at Note (2). Note 5 to the General Spinal Formula defines unfavorable ankylosis as "a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dislocation; or neurologic symptoms due to nerve root stretching." Under the IVDS Formula, ratings are based on evidence of incapacitating episodes, defined as periods of acute signs and symptoms that require bed rest prescribed by a physician and treatment by a physician. The maximum rating under this formula is 60 percent. As demonstrated below, the evidence of record does not demonstrate IVDS and, as such, the ratings are inapplicable. The Board recognizes that, in some circumstances, it must consider functional impairment in addition to limitation of motion due to factors such as pain, weakness, premature or excess fatigability, and incoordination when deciding an appropriate rating. See 38 C.F.R. §§ 4.40, 4.45, 4.59; De Luca v Brown, 8 Vet. App. 202, 204-7 (1995). The Veteran has been assigned a 10 percent rating for his back disability from April 4, 2008 to August 8, 2018, a 20 percent rating until December 17, 2018 and a 40 percent rating thereafter, pursuant to 38 C.F.R. § 4.71a, Diagnostic Codes 5237-5242. VA received his claim for an increased rating on April 4, 2008. After a review of the evidence of record, the Board finds that a 20 percent rating is warranted from May 7, 2012 to December 17, 2018, but finds no basis to increase the 10 percent rating prior to May 7, 2012, or the 40 percent rating from December 17, 2018. As relevant here, the Veteran was afforded VA examinations for his back in April 2008, May 2012, August 2018, December 2018, May 2019 and October 2019. In April 2008 the forward flexion of the Veteran's thoracolumbar spine was measured to 80 degrees. The combined range of motion of the thoracolumbar spine was measured to 100 degrees during the May 2012 VA examination. The August 2018 VA examination measured forward flexion to 80 degrees, with a combined range of motion of 180 degrees, but noted muscle spasm resulting in abnormal gait or abnormal spinal contour. The December 2018 VA examination measured forward flexion to 30 degrees. The May 2019 VA examination measured forward flexion to 50 degrees. The October 2019 VA examination did not record measurements for forward flexion other than to describe it as "normal," but noted forward flexion was limited to 5 degrees with flareups. None of the examinations noted ankylosis or IVDS. The Veteran reported to the April 2008 and May 2012 VA examiners that he had non-radiating, chronic back pain. The Veteran reported to the August 2018 examiner that he experienced low back pain that radiated down both of his legs. He reported to the December 2018 and May 2019 examiners that he experienced constant, stabbing-like low back pain. Treatment records note the Veteran's chronic low back pain. A January 2019 VA treatment note recorded the Veteran's forward flexion to 20 degrees. An October 2010 VA treatment note described pain in the lumbar area but noted that the Veteran had full range of motion of his back. Based on the foregoing, the Board finds no basis for a disability rating in excess of 10 percent for the period prior to May 7, 2012. The Veteran's forward flexion of the thoracolumbar spine was not limited to greater than 30 degrees but not greater than 60 degrees during that time period and his combined range of motion of the thoracolumbar spine was greater than 120 degrees. As noted, the Veteran is entitled to an increased disability rating of 20 percent from May 7, 2012 to December 17, 2018 based on the combined range of motion measurement in the May 2012 VA examination. The Board finds no basis for a rating in excess of 40 percent at any point in the appeal period. As noted, the VA examiners did not find ankylosis or IVDS and there is no objective medical evidence of either condition in the Veteran's treatment records. The Board notes that the Court recently found in Chavis v. McDonough, 34 Vet. App. 1 (2021) that the application of 38 C.F.R. §§ 4.40 and 4.45 permits consideration under the General Rating Formula of an evaluation based on ankylosis if a claimant's functional loss is consistent with that contemplated by ankylosis or if it is the functional equivalent of ankylosis. Here, when considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by such statements do not result in symptoms more nearly approximating ankylosis of the entire thoracolumbar spine, or even the functional equivalent of ankylosis. See generally Chavis, supra. The evidence of record shows that the Veteran retained motion of his lumbar spine and was thus not ankylosed. There is simply no evidence that the Veteran's spine was ever fixed in flexion or extension or had the functional equivalent of being so fixed during the worst times of back pain. To the extent the Veteran's claims for increased ratings are denied, the preponderance of evidence is against those claims, and the benefit of the doubt doctrine is inapplicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Radiculopathy Consideration of associated objective neurologic abnormalities is inherent in the evaluation of a claim for an increased rating for a spinal disability. See Note (1) following 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Here, the Board finds that the Veteran is entitled to separate 10 percent disability ratings pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8520 for radiculopathy of the bilateral lower extremities from August 8, 2018. That Code provides disability ratings of 10, 20 and 40 percent, respectively, for mild, moderate and moderately severe incomplete paralysis of the sciatic nerve. A 60 percent rating is warranted for severe incomplete paralysis and an 80 percent rating is warranted for complete paralysis. The term "incomplete paralysis" with this and other peripheral nerve injuries indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. VA examinations in April 2008 and May 2012 specifically note that the Veteran's back pain did not radiate. However, as noted, the Veteran reported to the August 2018 VA examiner that he experienced lower back pain that radiated down both legs. VA treatment records from December 2018 also note the Veteran's complaint of radiating pain in his bilateral lower extremities. Although the objective medical evidence does not reflect the existence of radiculopathy, the Board finds the Veteran's subjective reports credible. The Veteran is competent to provide evidence of his observable symptoms (Layno v. Brown, 6 Vet. App. 465 (1994)) and the lack of contemporaneous medical evidence is not an absolute bar to service connection. See Buchanan v. Nicholson, 451 F.3d 1131, 1336 (2006). Thus, resolving doubt in the Veteran's favor, the Board finds that separate awards of 10 percent for bilateral lower extremity radiculopathy are warranted. Ratings in excess of 10 percent are not warranted as there is no objective evidence of radiculopathy, and the subjective complaints are sensory and most closely characterized as slight in severity. Also, the Veteran did not report radiation symptoms in the 2019 VA examinations, suggesting that the radicular pain is intermittent. Accordingly, the Board has determined that the Veteran's radiculopathy of the bilateral lower extremities is not moderate, moderately severe or severe. A review of the claims file shows no basis for finding of entitlement to an additional rating for any other associated objective neurologic abnormality. Bilateral Knees Normal flexion of the knee is to 140 degrees, and normal extension of the knee is to 0 degrees. 38 C.F.R. § 4.71, Plate II. Generally, the joints involved should be tested for pain on both active and passive motion, in weight-bearing and non-weightbearing and, if possible, with the range of the opposite undamaged joint. Correia v. McDonald, 28 Vet. App. 158, 168-69 (2016); 38 C.F.R. § 4.59. Under Diagnostic Code 5260, leg flexion limited to 45 degrees warrants a 10 percent rating; leg flexion limited to 30 degrees warrants a 20 percent rating and leg flexion limited to 15 degrees warrants a 30 percent rating. See 38 C.F.R. § 4.71a, Diagnostic Code 5260. Under Diagnostic Code 5261, leg extension limited to 10 degrees warrants a 10 percent rating; 15 degrees warrants a 20 percent rating; 20 degrees warrants a 30 percent rating; 30 degrees warrants a 40 percent rating and 45 degrees warrants a 50 percent rating. See 38 C.F.R. § 4.71a, Diagnostic Code 5261. Diagnostic Code 5258 provides a 20 percent rating for dislocated cartilage with frequent episodes of "locking" pain and effusion into the joint. A knee disability can be rated for both limitation of leg flexion under Diagnostic Code 5260 and limitation of leg extension under Diagnostic Code 5261. See VAOPGCPREC 9-2004 (Sept. 17, 2004). Additionally, General Counsel Opinion 9-98 directs that with respect to Diagnostic Code 5259, limitation of motion can be a relevant consideration so the provisions of 38 C.F.R. § 4.40 and 4.45 must be considered. Here, the Veteran has an initial 10 percent rating for his right knee pursuant to Diagnostic Code 5260. The Veteran is rated at 10 percent for his left knee disability pursuant to Diagnostic Code 5260 from April 4, 2008 to October 31, 2019 and is rated at 20 percent thereafter pursuant to Diagnostic Code 5258. He filed the claim for increased ratings for the left knee disability on April 4, 2008. After reviewing the evidence of record, the Board declines to assign an initial disability rating greater than 10 percent for limitation of flexion of the Veteran's right knee. The Board also declines to assign a rating greater than 10 percent for limitation of flexion of the Veteran's left knee prior to October 31, 2019 and declines to assign a rating greater than 20 percent for frequent episodes of locking pain and effusion into the joint from that date. However, the Board assigns a separate 10 percent rating for painful extension of the bilateral knees throughout the claim period. As relevant here, the Veteran was afforded VA examinations for his knees in April 2008, May 2012, August 2018 and October 2019. The April 2008 examiner reported no instability or subluxation and no locking episodes. The Veteran had forward flexion to 120 degrees and full extension in both knees. No instability or patellar or meniscal abnormality was noted. The Veteran's range of motion in the May 2012 VA examination was measured to 40 degrees of flexion and full extension bilaterally reduced to 35 degrees flexion after repetitive use testing. The Veteran reported to the August 2018 examiner that his knees had gotten worse, with increased pain, swelling and locking up. The Veteran also described flareups that made it hard to stand, walk or exercise and frequent locking episodes that made it hard to walk. Range of motion was measured as 110 degrees flexion and 0 degrees extension bilaterally with no loss of range of motion with repeated use over time or flareups. The examiner noted no ankylosis and no instability in the knees. Meniscal tears were noted bilaterally but no episodes of joint locking, pain or effusion were noted. The Veteran reported that he regularly used knee braces. The Veteran reported to the October 2019 VA examiner that his pain had increased in intensity and that he had weekly flareups. Right knee range of motion was measured as 90 degrees flexion and 0 degrees extension with flexion reduced to 70 degrees during flareups. Left knee range of motion was measured as 90 degrees flexion and 0 degrees extension with flexion reduced to 60 degrees during flareups. The examiner noted no ankylosis in either knee. The Veteran had no instability in his right knee on testing. The left knee exhibited instability and the left sided meniscal tear was noted to result in frequent episodes of joint locking and pain. The Veteran reported constant use of knee braces for his pain. The examiner noted that the Veteran did not have ankylosis in either knee. The Veteran submitted a lay statement in December 2008 noting that he used knee braces. VA treatment records confirm the Veteran's complaints of bilateral knee pain and locking. A May 2009 treatment record notes recurrent knee pain with the left knee noted to be worsened on kneeling or flexing, with locking at times but no mediolateral instability. An October 2010 treatment record noted constant pain inside the knees, made worse with prolonged standing or walking. A VA treatment note from October 2010 noted full active and passive range of motion in the Veteran's knees. An October 2012 VA treatment note indicated limitation and pain on extension and flexion of both knees. Based on the foregoing, the Board finds that the Veteran is not entitled to a rating in excess of 10 percent for limitation of flexion of his left or right knee at any time during the claim period or in excess of 20 percent for joint pain and locking in the left knee from October 31, 2019. The Board finds, however, that the Veteran is entitled to separate 10 percent disability ratings for painful extension. The range of motion testing performed during the claim periods does not reveal flexion limited to 30 degrees so as to warrant a 20 percent rating for limitation of flexion, even when considering pain on use and during flareups. As to extension, while there is no indication of extension limited to 10 degrees, the competent medical and lay evidence of record reflects that the Veteran experienced pain on extension. The Board thus finds that the Veteran is entitled disability ratings of 10 percent for limitation of extension of the bilateral knees under the DeLuca factors and 38 C.F.R. § 4.59. The Board has also considered the other diagnostic codes pertaining to the knee and leg. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). As there is no evidence that the Veteran had ankylosis of the knee joint, malunion or nonunion of the tibia or fibula, or genu recurvatum at any time during the period on appeal, Diagnostic Codes 5256, 5262, and 5263 are not for application. The Board has considered whether a rating under Diagnostic Code 5258 is appropriate for the right knee. While the Veteran occasionally described symptoms of locking, the preponderance of the evidence supports a finding that the Veteran's right knee disability was predominantly characterized by pain and limitation of motion. The VA examinations did not demonstrate evidence of locking or effusion of the right knee, and the Board thus finds that the Veteran's right knee disability is most appropriately rated based on his predominant symptoms. Finally, the Board has considered whether a separate rating is warranted under Diagnostic Code 5257. That code covers "other impairment of the knee," and the prior version provides ratings for slight recurrent subluxation or lateral instability, moderate recurrent subluxation or lateral instability or severe knee impairment with recurrent subluxation or lateral instability. The amended version of the Diagnostic Code rates knee instability based on the existence of ligament tears or a diagnosed condition involving the patellofemoral complex. Initially, there is no evidence of a ligament tear or a diagnosed condition involving the patellofemoral complex in the record. There is also no objective medical evidence of recurrent subluxation or lateral instability of the right knee. The Veteran's subjective complaints of locking are contemplated by the rating assigned under Diagnostic Code 5258 for the left knee and the complaints of locking of the right knee do not meet the criteria for a 20 percent rating under that code. As the symptoms of locking are contemplated by the rating under Diagnostic Code 5258, the Board finds no application for Diagnostic Code 5257. To the extent the Veteran's claims for increased ratings are denied, the preponderance of evidence is against those claims, and the benefit of the doubt doctrine is inapplicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. S.C. KREMBS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Snyder, 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.