Citation Nr: 21066031 Decision Date: 10/28/21 Archive Date: 10/28/21 DOCKET NO. 17-48 218A DATE: October 28, 2021 ORDER An initial rating in excess of 10 percent for right knee degenerative joint disease (DJD) is denied. Subject to the laws and regulations governing the award of VA monetary benefits, an initial 10 percent rating, but no more, for right knee instability is granted. FINDINGS OF FACT 1. At no point during the appeal period did the Veteran's right knee DJD result in flexion limited to 30 degrees nor did it result in incapacitating exacerbations. 2. Throughout the entire appeal period, the Veteran's right knee disability resulted in slight instability based on his subjective description notwithstanding the lack of objective findings. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 10 percent for right knee DJD have not been met. 38 U.S.C. §§ 1155, 5107, 5110; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.14, 4.40, 4.45, 4.59, 4.71, 4.71a, Diagnostic Code (DC) 5003-5260. 2. The criteria for an initial 10 percent rating, but no more, for right knee instability have been met. 38 U.S.C. §§ 1155, 5107, 5110; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.14, 4.40, 4.45, 4.59, 4.71, 4.71a, DC 5257. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from July 1976 to May 1982 and from January 1991 to May 1991. He had additional service in the Army Reserves. This matter comes before the Board of Veterans Appeals (Board) on appeal from a February 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). This issue was most recently remanded by the Board in September 2019. Substantial compliance with the remand requests having been accomplished, the Board may proceed to consider the claim. See Stegall v. West, 11 Vet. App. 268 (1998). The Veteran submitted a request for higher-level review in the modernized review system in June 2020. However, the RO indicated that higher-level review was not available for the claim in a July 2020 letter. Accordingly, the Board will continue to consider the claim in the legacy system. The Board notes that several VA treatment records were added to the claims file after the June 2020 Supplemental Statement of the Case. However, a close review of the records indicated that any references to the right knee disability echoed information already reviewed by the RO. As such, the Board may proceed to consider the claim. The Board has limited the discussion below to the relevant evidence required to support its finding of fact and conclusion of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). Increased Rating Service connection for right knee DJD was granted at 10 percent under 38 C.F.R. § 4.71a, DC 5003-5260, effective December 30, 2014. The Veteran appealed the initial February 2016 rating decision. Accordingly, the Board will consider the extent and severity of the disability since the date of claim, December 30, 2014. 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; Peyton v. Derwinski, 1 Vet. App. 282 (1991); Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Whether the issue is one of an initial rating or an increased rating, separate ratings can be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; separate ratings may be assigned for distinct disabilities resulting from the same injury only where the symptomatology for one condition is not duplicative or overlapping with the symptomatology of the other condition. See 38 C.F.R. § 4.14; see also Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of his symptoms. Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a veteran is competent to report on that of which he or she has personal knowledge). 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. The Court of Appeals for Veterans Claims (Court), in Correia v. McDonald, 28 Vet. App. 158 (2016), held that the final sentence of 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. Thus, the Court's holding in Correia establishes additional requirements that must be met prior to finding that a VA examination is adequate. Further, in evaluating joint disabilities, 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). The Court clarified that 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); cf. Powell v. West, 13 Vet. App. 31, 34 (1999); Hicks v. Brown, 8 Vet. App. 417, 421 (1995); Schafrath v. Derwinski, 1 Vet. App. at 592. Additionally, the Court has stated that flare-ups must be factored into an examiner's assessment of functional loss. Sharp v. Shulkin, 29 Vet. App. 26, 32 (2017). Effective February 7, 2021, VA revised the criteria for evaluating musculoskeletal disorders. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76464 (Nov. 30, 2020); Correction, 86 Fed. Reg. 8142, 8143 (Feb. 4, 2021) (changing new diagnostic code applicable to plantar fasciitis from 5285 to 5269). VA's General Counsel has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the veteran. In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation. If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. The Board must generally apply both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change. VA thus must consider the claims for a higher rating pursuant to the former and revised regulations during the latter part of this appeal. See VAOPGCPREC 3 2000, 65 Fed. Reg. 33,422 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997). Therefore, the Board will consider the Veteran's claims under the old criteria prior to February 7, 2021, and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. The Board observes that former regulation 38 C.F.R. § 19.9(b)(2) (now renumbered as 38 C.F.R. § 20.904(d)(2)) provided that the Board has the authority to consider appeals in light of laws, including but not limited to statutes, regulations and court decisions that were not previously considered by the AOJ. In Disabled American Veterans v. Sec of Veterans Affairs, 327 F.3d 1339 (Fed. Cir. 2003), the United States Court of Appeals for the Federal Circuit (Federal Circuit) specifically upheld the validity of 38 C.F.R. § 19.9(b)(2) (now as noted renumbered as 38 C.F.R. § 20.904(d)(2)). Id. at 1349. As such, pursuant to 38 C.F.R. § 20.904(d)(2), the Board will proceed to adjudicate the Veteran's claims. As noted above, the Veteran's right knee disability is rated under DC 5003-5260. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating, with the first code representing the underlying condition and the second code representing the residuals. 38 C.F.R. § 4.27. Here, the hyphenated diagnostic code indicates that the right knee disability is rated based on evidence of degenerative arthritis with painful flexion. Degenerative arthritis as shown by x-ray studies are rated based on limitation of motion of the affected joint. 38 C.F.R. § 4.71a, DCs 5003. When, however, the limitation of motion is noncompensable under the appropriate diagnostic code, a rating of 10 percent may be applied to each such major joint or group of minor joints affected by limitation of motion. A rating of 20 percent may be applied where there are occasional incapacitating exacerbations. 38 C.F.R. § 4.71a, DCs 2003. The limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Id. Under DC 5260, flexion of the leg limited to 60 degrees is rated noncompensably (0 percent) disabling; flexion of the leg limited to 45 degrees is rated 10 percent disabling; flexion of the leg limited to 30 degrees is rated 20 percent disabling; and flexion of the leg limited to 15 degrees is rated 30 percent disabling. Also relevant to any discussion of knee disabilities are the criteria under Diagnostic Codes 5256 through 5263. 38 C.F.R. § 4.71a. Under DC 5256, favorable ankylosis of the knee, in full extension or in slight flexion between 0 degrees and 10 degrees warrants a 30 percent disability rating; ankylosis in flexion between 10 degrees and 20 degrees warrants a 40 percent disability rating; ankylosis in flexion between 20 degrees and 45 degrees warrants a 50 percent disability rating; and extremely unfavorable ankylosis in flexion at an angle of 45 degrees or more warrants a 60 percent disability rating. Under the pre-amended criteria, DC 5257 provides that slight recurrent subluxation or lateral instability will be rated as 10 percent disabling, moderate recurrent subluxation or lateral instability will be rated as 20 percent disabling, and severe recurrent subluxation or lateral instability warrants a 30 percent rating. Effective February 7, 2021, DC 5257 was amended to provide ratings for recurrent subluxation or lateral instability. A 30 percent rating is warranted for unrepaired or failed repair of complete ligament tear causing persistent instability and a medical provider prescribing both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation. A 20 percent rating is warranted for either (a) sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribing a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation; or (b) unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribing either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 10 percent rating is warranted for sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. DC 5257 also provides for ratings based on patellar instability. A 30 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. A 20 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: a brace, cane, or walker. A 10 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. Note [1] to DC 5257 states that for patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. Note [2] to DC 5257 states that a surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration. Under DC 5258, a claimant is entitled to a 20 percent rating for dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint. Under DC 5259, a 10 percent evaluation is assigned for symptomatic removal of semilunar cartilage. Under DC 5261, extension of the leg limited to 5 degrees is rated noncompensably (0 percent) disabling; extension of the leg limited to 10 degrees is rated 10 percent disabling; extension of the leg limited to 15 degrees is rated 20 percent disabling; extension of the leg limited to 20 degrees is rated 30 percent disabling; extension of the leg limited to 30 degrees is rated 40 percent disabling; and extension of the leg limited to 45 degrees is rated 50 percent disabling. Under the pre-amended criteria, DC 5262 provides that a 10 percent rating is warranted for malunion of the tibia and fibula with slight knee or ankle disability. A 20 percent rating is warranted for malunion of the tibia and fibula with moderate knee or ankle disability. A 30 percent rating is warranted for malunion of the tibia and fibula with marked knee or ankle disability. A maximum 40 percent rating is warranted with nonunion of the tibia and fibula, with loose motion, requiring a brace. Effective February 7, 2021, DC 5262 is amended to provide for a 40 percent rating for nonunion of the tibia and fibula, with loose motion, requiring brace. Malunion of the tibia and fibula are to be evaluated under diagnostic codes 5256, 5257, 5260, or 5261 for the knee or 5270 or 5271 for the ankle, whichever results in the highest evaluation. Under DC 5263, a 10 percent rating is warranted for genu recurvatum (acquired, traumatic, with weakness and insecurity in weight-bearing objectively demonstrated). Effective February 7, 2021, separate ratings are also provided for medial tibial stress syndrome (MTSS) or shin splints. Normal ranges of motion of the knee are to 0 degrees in extension, and to 140 degrees in flexion. 38 C.F.R. § 4.71, Plate II. Turning to the evidence of record, the Veteran's wife wrote in a January 2015 letter that he had fallen more than 10 times in the last year and had a hard time walking around doing normal everyday activities due to his bilateral knee disabilities. He had difficulty rising from a sitting position and getting in and out of bed. A private treatment record from January 2015 noted that the Veteran used a cane for ambulation due to his bilateral knee disabilities. In February 2015, he received a Kenalog injection in his right knee. An x-ray revealed DJD. Another x-ray was conducted in July 2015 which demonstrated tricompartmental degenerative changes without significant joint space narrowing; patellar enthesophytes; and no fractures, dislocations, or soft tissue abnormalities. A VA kinesiotherapy record noted in July 2015 that the Veteran's bilateral knee pain was worse with increased activity, stairs, and squatting, and better with rest. He endorsed that his knees would pop, lock, grate, and give way. He also experienced stiffness in his knees. Active range of motion in the right knee was from 25 to 70 degrees and painful. Muscle testing was 2 out of 5. In September 2015, the Veteran described similar symptomology. Active range of motion in the right knee was from 15 to 60 degrees with pain. Atrophy, tenderness to palpation, and crepitation were noted in the bilateral knees. The Veteran reported that he had fallen on his right knee recently. Later in September 2015, he described occasional swelling in the bilateral knees with increased activity and morning stiffness. He again received bilateral knee injections. Similar symptomology was reported in October 2015 and active range of motion in the right knee was 5 to 75 degrees. An MRI demonstrated mild degenerative free edge fibrillation body medial and lateral meniscus without compelling evidence for a meniscal tear; mild tendinosis distal quadricep tendon with a prominent superior patellar enthesophyte; and small focus of intra-tendinous ossification. Clinicians noted that there was no meniscal tear in the right knee. The Veteran underwent a VA examination in January 2016. He described pain, stiffness, and swelling in his right knee that had progressively gotten worse over time. Previous treatment included physical therapy and injections. He stated that his functional impairment was that he could not put a lot of pressure on his right knee, he would get up and fall, and he needed to use a walker. He denied flare-ups. Initial range of motion was from 0 to 80 degrees in flexion and 80 to 0 degrees in extension. Pain was noted on both ranges of motion and limited motion contributed to a functional loss of frequent falls and limited walking. There was objective evidence of pain on palpation, with the vocalization and grimacing of moderate pain to palpation of the right knee on the medial side. There was evidence of pain with weight-bearing and crepitus. The Veteran was able to perform repetitive use testing without additional loss of function or range of motion. There were no additional factors of functional loss. The examiner was unable to determine without speculation whether pain, weakness, fatigability, or incoordination significantly limited functional ability or whether range of motion would be further limited with repeated use over a period of time or during flare-ups. In explanation, she stated that the Veteran was not examined after repetitive use or during a flare-up. Additional factors contributing to disability included less movement than normal, weakened movement, disturbance of locomotion, and interference with standing. Muscle strength testing was 5 out of 5 and there was no muscle atrophy. Ankylosis was not demonstrated in the right knee. The examiner determined there was no history of recurrent subluxation or lateral instability. There was a history of recurrent effusion as the Veteran reported that his right knee was always swollen. There was no joint instability. The Veteran had no meniscal conditions, prior surgical procedures, or other pertinent physical findings in the right knee. He constantly used a knee brace and walker and occasionally used a cane or crutches for his bilateral knee disabilities. An x-ray demonstrated mild degenerative changes of the femoral patellar joint space with a small effusion. The examiner determined that the functional impact of the right knee disability was limited walking, frequent falls, and an inability to bend and squat. In January 2016, the Veteran was fitted for new bilateral knee braces and prescribed a cane. He received bilateral knee injections in February 2016 and reported that he could walk about half a block before needing to rest due to his knees. Kinesiotherapy appointments in February 2016 and April 2016 demonstrated active range of motion in the right knee from 15 to 85 degrees. X-rays were conducted again in April 2017, demonstrating tricompartmental DJD with narrowing; superior and inferior patellar tendon ossifications; and patellar tilt laterally with no effusion or loose bodies noted. The Veteran underwent more kinesiotherapy from April 2017 to May 2017. Active range of motion in the right knee was within normal limits. Bilateral knee injections were administered in August 2017. During kinesiotherapy appointments from August 2017 to November 2017, active range of motion in the right knee was from 8 to 118 degrees and muscle strength was 2 out of 5. The Veteran continued to report popping, giving way, and stiffness in the bilateral knees. An MRI was conducted in August 2018 which demonstrated no acute osseous findings, no significant interval change, and stable tricompartmental DJD. In May 2019, the Veteran reported to VA clinicians that his right knee had given out. An MRI performed in October 2019 revealed mild degenerative free edge fibrillation body medial and lateral meniscus without compelling evidence for a meniscus tear, mild tendinosis distal quadricep tendon with prominent superior patellar enthesophyte, and small focus of intra-tendinous ossification. Another VA examination was conducted in December 2019. The Veteran reported that his knees had been giving out on him more, that he could not put a lot of pressure on them, and he had daily sharp pain. His right knee swelled up a bit, as well. He had pain with walking, standing, driving for long periods of time, and he could not kneel, squat, stoop, or run without pain. He endorsed flare-ups in his right knee of pain, aching, and stiffness, occurring one to two times per week, lasting 30 minutes or so, reaching a 9 out of 10 in severity. He also noted that his knees sometimes locked up, especially his right knee. Initial range of motion in the right knee was 0 to 110 degrees in flexion and 110 to 0 degrees in extension. Pain was noted on examination which caused limitation in ambulation, driving, standing, and running. Sharp pain was observed at the posterior, medial, and lateral aspects of the right knee of a 5 out of 10 in severity. There was evidence of pain with weight-bearing, nonweight-bearing, and with passive range of motion testing. The right knee also demonstrated crepitus. The Veteran was able to perform repetitive use testing without any additional loss of function or range of motion. The examiner was unable to determine whether pain, weakness, fatigability, or incoordination significantly limited functional ability or reduced range of motion with repeated use over time or during flare-ups. In support, she stated that upon review of the Veteran's medical history, physical examination, and subjective complaints and using her medical knowledge and expertise, there was no basis to offer additional losses of function or motion with repeated use over time or during flare-ups. There were no additional factors contributing to disability. Muscle strength testing was 4 out of 5 in flexion and extension but there was no muscle atrophy. Ankylosis was not observed in the right knee. The examiner indicated that the Veteran did not have a history of recurrent subluxation, lateral instability, or recurrent effusion. Joint stability testing yielded normal results. The Veteran had no meniscal conditions, surgical procedures, or other pertinent findings in the right knee. He regularly used a knee brace and a walker for his bilateral knee disabilities. The examiner determined that due to the bilateral knee disabilities, the Veteran had pain and difficulty with walking, standing, kneeling, and squatting, and could not run any more due to pain. He had stiffness, especially in the mornings, and his right knee sometimes locked up. An x-ray of the right knee conducted in February 2020 demonstrated mild to moderate bicompartmental DJD with narrowing, medial compartment worse than lateral; superior and inferior patellar tendon ossifications; and no effusion or loose bodies. The knee was stable with no changes since the prior imaging. 1. An initial rating in excess of 10 percent for right knee DJD is denied. The Board notes at the outset that the VA examinations of record, taken in conjunction with records of VA medical treatment and the Veteran's lay statements, provide an adequate basis upon which to determine the extent and severity of his right knee disability. Although whether there was pain with passive movement and nonweight-bearing was not elicited at the January 2016 examination, the December 2019 examination provided that information in detail. The Veteran has not indicated that his right knee disability improved over time; as such, the December 2019 examination results represent the most severe limitations caused by the disability. Additionally, although neither examiner was able to provide additional limitation of function and range of motion in terms of degrees with repeated use over time and during flare-ups, the December 2019 examiner provided a medically-based reason for the inability to provide that information. The Veteran himself provided a detailed description of his flare-ups. Further, kinesiotherapy records offered ample information about limitation during repeated use and during flare-ups, as his symptomology worsened through the therapeutic process. Given the totality of the information, including the Veteran's own descriptions of his limitations, the Board finds that the requirements of DeLuca, Sharp, and Correia have been adequately addressed. DeLuca v. Brown, 8 Vet. App. at 202; Sharp v. Shulkin, 29 Vet. App. at 32; Correia v. McDonald, 28 Vet. App. at 158. Additionally, as no medical evidence relevant to the right knee has been added to the record reflecting treatment since February 7, 2021, consideration under the amended criteria is not warranted. As such, the Board will consider the severity of the Veteran's right knee disability under the pre-amended criteria. Based on the foregoing, the Board finds that an initial rating in excess of 10 percent for right knee DJD under 38 C.F.R. § 4.71a, DC 5003-5260, is not warranted. There is no evidence in the medical record of incapacitating exacerbations of the right knee disability warranting a 20 percent evaluation under the criteria of DC 5003. Further, flexion was at no point limited to 30 degrees, even during therapy, warranting a 20 percent evaluation under the criteria of DC 5260. Accordingly, a rating in excess of 10 percent under DC 5003-5260 is not merited. 2. A 10 percent rating, but no more, for right knee instability is granted. The Board has considered whether additional or alternative evaluations under other diagnostic codes relevant to the knees are indicated, as well. However, at no point has ankylosis or the functional equivalent of ankylosis been evident, deserving evaluation under DC 5256. No meniscal conditions have been diagnosed throughout the appeal period warranting rating under DC 5258 or 5259. Finally, the Veteran's left knee has not demonstrated nonunion or malunion of the tibia and fibula or genu recurvatum requiring rating under DC 5262 or 5263. However, the Veteran has reported ongoing instability resulting in frequent falls. He has been prescribed a knee brace and a cane/walker for support. As such, consideration under DC 5257 is warranted. According to Merriam Webster's Collegiate Dictionary 999 (11th Ed. 2007), "slight" means small in amount. "Moderate" means limited in scope or effect. "Severe" means very painful or harmful or of a great degree. On clinical evaluation, there has been no objective evidence of instability in the right knee. Objective medical evidence, however, is not required to establish lateral knee instability under the pre-2/7/2021 Diagnostic Code 5257, so objective medical evidence cannot be categorically found more probative than lay evidence with respect to this Diagnostic Code. See English v. Wilkie, 30 Vet. App. 347, 352-53 (2018). As outlined above, the Veteran has reported instability and falls, along with his prescription of a knee brace and cane/walker for support, to be indicative of instability. Throughout much of the medical record, his falls were reported to be due to his service-connected left knee disability which is already in receipt of a rating for instability. Further, no clinicians have observed instability within the right knee anatomy. On the other hand, the Veteran and his wife both indicate he falls frequently and feels that this is due to, at a minimum, his bilateral knees and not solely his left knee. One private treatment record from January 2015 noted that the Veteran used a cane for ambulation due to his bilateral knee disabilities. In light of the evidence of record, the Board will resolve reasonable doubt in favor of the Veteran and presume that the Veteran's feelings of instability and history of falls is at least in "small amount" related to his right knee notwithstanding the normal objective findings. On the other hand, the Board does not find evidence that would support a finding of a moderate or severe indication of, specifically, right knee instability. Thus, a rating of 10 percent under the criteria of DC 5257 will be awarded resolving reasonable doubt in favor of the Veteran, but no higher throughout the entire appeal period. The Board determines that the Veteran's disability is fully capable of evaluation under the rating schedule. There is no applicable provision that would warrant a higher rating in this case. SHEREEN M. MARCUS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Rachel E. Jensen, 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.