Citation Nr: 21066489 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 16-41 538 DATE: November 1, 2021 ORDER Entitlement to a rating in excess of 20 percent for right knee arthritis, status post partial meniscectomy, status post debridement and resection of torn lateral meniscus is denied. Entitlement to a rating in excess of 30 percent for right knee degenerative arthritis with a meniscal tear (limited extension) for the appeal period beginning on July 15, 2021 is denied. Entitlement to a higher rating for left knee osteoarthritis with baker cyst, meniscal tear and cruciate ligament tear, rated as 10 percent disabling prior to July 15, 2021 and 30 percent thereafter, is denied. FINDINGS OF FACT 1. Throughout the period on appeal, the Veteran's right knee arthritis manifested as flexion limited to 60 degrees, at worst, on flare-ups even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups without ankylosis, instability, recurrent subluxation, malunion or nonunion of the tibia and fibula or genu recurvatum. 2. For the appeal period prior to July 15, 2021, the Veteran's right knee degenerative arthritis with a meniscal tear (limited extension) manifested as extension to zero degrees, at worst, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination. 3. For the appeal period beginning on July 15, 2021, the Veteran's right knee degenerative arthritis with a meniscal tear (limited extension) manifested as extension limited to 25 degrees, at worst, on flare-ups even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination. 4. For the appeal period prior to July 15, 2021, the Veteran's left knee osteoarthritis manifested as flexion limited to 60 degrees and extension limited to zero degrees, both at worst, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups without ankylosis, instability, recurrent subluxation, malunion or nonunion of the tibia and fibula or genu recurvatum. 5. For the appeal period beginning on July 15, 2021, the Veteran's left knee osteoarthritis manifested as flexion limited to 60 degrees and extension limited to 20 degrees, both at worst, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups without ankylosis, instability, malunion or nonunion of the tibia and fibula or genu recurvatum. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 20 percent for right knee arthritis, status post partial meniscectomy, status post debridement and resection of torn lateral meniscus have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4.40, 4.45, 4.71a, Diagnostic Codes 5010, 5258. 2. The criteria for a rating in excess of 30 percent for right knee degenerative arthritis with a meniscal tear (limited extension) for the appeal period beginning on July 15, 2021 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4.40, 4.45, 4.71a, Diagnostic Code 5261. 3. The criteria for a higher rating for left knee osteoarthritis with baker cyst, meniscal tear and cruciate ligament tear, rated as 10 percent disabling prior to July 15, 2021 and 30 percent thereafter, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.14.14, 4.40, 4.45, 4.71a, Diagnostic Code 5261. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from May 1976 to May 1996. These matters come before the Board of Veterans' Appeals (Board) from a February 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In a November 2018 and June 2021 decision, the Board remanded these matters to the RO for further development. More specifically, the Board directed the RO to obtain updated VA treatment records and obtain a VA examination to determine the severity of the Veteran's knee disabilities. Updated VA treatment records have been associated with the record and a VA examination was conducted in July 2021. The Board determines that there has been substantial compliance with its previous remands. The RO issued a Supplemental Statement of the case continuing the current ratings for both knees. The Board therefore finds that there has been substantial compliance with its previous remands. Stegall v. West, 11 Vet. App. 268 (1998). The matter now returns to the Board for further appellate review. A July 2021 rating decision awarded a 30 percent rating for left knee osteoarthritis with Baker cyst and a separate 30 percent rating for right knee degenerative arthritis with meniscal tear effective July 15, 2021 The Veteran is presumed to seek the maximum available benefit for a disability. As such, this claim for an increased rating for the left knee is still considered to be on appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993). Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Schedule), found in 38 C.F.R. Part 4. The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered because of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the appellant working or seeking work. 38 C.F.R. § 4.2. Where entitlement to compensation has been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. Separate ratings can be assigned for separate periods based on the facts found, a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that "[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint." Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the Diagnostic Code under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). For disabilities evaluated on the basis of limitation of motion, VA is required to apply the provisions of 38 C.F.R. §§ 4.40, 4.45, pertaining to functional impairment. The Court of Appeals for Veterans Claims (Court) has instructed that in applying these regulations VA should obtain examinations in which the examiner determined whether the disability was manifested by weakened movement, excess fatigability, incoordination, or pain. Such inquiry is not to be limited to muscles or nerves. These determinations are, if feasible, be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, flare-ups, or pain. Mitchell v. Shinseki, 25 Vet. App. 32 (2011); DeLuca v. Brown, 8 Vet. App. 202 (1995). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Although the Board has an obligation to provide reasons and bases supporting its decision, there is no obligation to discuss, in detail, the extensive evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as it relates to the Veteran's claim. 1. Entitlement to a rating in excess of 20 percent for right knee arthritis, status post partial meniscectomy, status post debridement and resection of torn lateral meniscus is denied. 2. Entitlement to a rating in excess of 30 percent for right knee degenerative arthritis with a meniscal tear (limited extension) for the appeal period beginning on July 15, 2021 is denied. 3. Entitlement to a higher rating for left knee osteoarthritis with baker cyst, meniscal tear and cruciate ligament tear, rated as 10 percent disabling prior to July 15, 2021 and 30 percent thereafter, is denied. The Veteran contends that his right and left knee disabilities are worse than is currently contemplated by the rating schedule. See August 2018 Appellate Brief. Specific argument in support of this appeal has not been presented. The Veteran is currently in receipt of a 30 percent rating for right knee degenerative arthritis with a meniscal tear as of July 15, 2021 under Diagnostic Code 5261; left knee osteoarthritis with Baker cyst, meniscal tear and cruciate ligament tear, rated as 10 percent disabling prior to July 15, 2021 and 30 percent thereafter under Diagnostic Code 5261; right knee arthritis status post partial meniscectomy debridement and resection of torn lateral meniscus rated as 20 percent disabling under Diagnostic Codes 5010 and 5258. Under Diagnostic Code 5010, post-traumatic arthritis is rated as limitation of motion, dislocation, or other specified instability under the affected joint. If there are 2 or more joints affected, each rating shall be combined in accordance with § 4.25. Limitation of motion will be analyzed under the ratings for knee disabilities. 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 zero 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. A 10 percent rating can also be assigned for the knee joint if there is painful motion without compensable limitation of motion. 38 C.F.R. §§ 4.59, 4.71a, Diagnostic Code 5003; see also Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that the applicability of 38 C.F.R. § 4.59 is not limited to arthritis claims). Recurrent subluxation and lateral instability of the knee warrants a 10, 20, or 30 percent rating if slight, moderate, or severe, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5257. Ratings can be assigned when the knee disability affects the meniscus, with a 20 percent rating for dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint and a 10 percent rating for removal of semilunar cartilage (e.g., meniscectomy) and current residual symptoms. 38 C.F.R. § 4.71a, Diagnostic Codes 5258, 5259. 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 she has tibia or fibula impairment, genu recurvatum, or ankylosis of either knee. As such, those diagnostic codes are not for application. The Board notes that effective February 7, 2021, the criteria for schedule of ratings for the musculoskeletal system was revised. See 86 Fed. Reg. 8142 (Feb. 4, 2021) (codified at 38 C.F.R. pt. 4). In the present case, Diagnostic Codes 5260, 5261 and 5258 are unchanged under the revised criteria. There were significant changes related to knee disabilities were to add Diagnostic Code 5002 for active arthritic process, which the Veteran does not have; change the total replacement and resurfacing criteria under Diagnostic Code 5055, again, which the Veteran does not have in this case; and, finally, to add the requirement of assistive devices to the criteria for Diagnostic Code 5257 and the Veteran does not have instability. A January 2014 VA examination report reflects the Veteran's reports of a past meniscus rupture in his right knee and that a portion of the meniscus was removed. The Veteran reported flare-ups of pain that occurred several times per day, last one to two hours and during which he cannot do much of anything. Right knee flexion was found to be to 100 degrees with pain at 90 degrees, right knee extension to zero degrees without objective evidence of painful motion, left knee flexion was to 100 degrees with pain at 100 degrees and left knee extension was to zero degrees without objective evidence of pain. Repetitive testing revealed right knee flexion to 90 degrees, right knee extension to zero degrees, left knee flexion to 95 degrees and left knee extension to zero degrees. The examiner noted that pain, weakness, fatigability or incoordination could significantly limit functional ability during flare-ups or when the joint is used repeatedly over a period of time, but that it is not possible to be expressed in terms of degrees of additional range of motion loss due to pain on use or during flare-ups. Joint stability testing to include anterior instability, posterior instability and medial-lateral instability were normal bilaterally. There was no evidence of history of recurrent patellar subluxation/dislocation or shin splints. A meniscal tear in both knees with frequent episodes of joint pain and effusion were found. In August 2019, the Veteran was afforded a VA examination with regard to his right and left knee disabilities. The examiner diagnosed the Veteran with bilateral knee degenerative joint disease. At that time, the Veteran reported increased pain and stiffness in both knees. The Veteran denied flare-ups and functional loss but reported having two surgeries on his right knee and one surgery on his left knee. He indicated that he took tramadol to alleviate pain symptoms. On range of motion testing, the Veteran demonstrated right knee flexion to 125 degrees and zero degrees of extension. The Veteran demonstrated left knee flexion to 130 degrees and zero degrees of extension. Pain was noted to exhibit during flexion, but where pain began on range of motion was not documented. Furthermore, range of motion testing was not noted for passive motion and on weight and non-weight bearing. Therefore, the June 2021 Board remand deemed this examination inadequate for adjudicative purposes. In November 2020, the Veteran was afforded another VA examination. The Veteran was diagnosed with arthritis, right knee, status post partial meniscectomy, status post debridement and resection of torn lateral meniscus and left knee osteoarthritis status post arthroscopic surgery. The Veteran reported moderate flare-ups of both knees lasting a few hours to all day, which are precipitated by standing or walking for long periods of time. On range of motion testing, the Veteran demonstrated right knee flexion to 90 degrees and zero degrees of extension. The Veteran demonstrated left knee flexion to 90 degrees and zero degrees of extension. There was evidence of pain with weight-bearing and nonweight-bearing, as well as on passive and active range of motion, but the passive range of motion measurements were not reported. Thus, the June 2021 Board remand also deemed this examination inadequate for adjudicative purposes. At a July 2021 VA examination, the Veteran was diagnosed with meniscal tear in both knees, degenerative arthritis, other than post-traumatic arthritis in both knees, left knee anterior cruciate ligament tear and baker cyst on the left knee. The Veteran reported a constant sharp/grinding pain in both knees and difficulty with ambulation. He also reported flare-ups in both knees when standing and walking every 2-3 days with the pain threshold being a 10 out of 10. On passive range of motion testing, the Veteran demonstrated right knee flexion to 75 degrees and 5 degrees of extension. The Veteran demonstrated left knee flexion to 70 degrees and 5 degrees of extension. Active range of motion was the same. There was evidence of pain on weight and non-weight bearing noted. There was no evidence of crepitus and localized tenderness or pain on palpation of the joint. Repetitive use testing with at least three repetitions demonstrated right knee flexion up to 70 degrees and extension to 10 degrees and left knee flexion to 65 degrees and extension to 10 degrees, with functional loss demonstrated by pain. Range of motion was also tested with repeated use over time with right knee flexion up to 65 degrees and extension to 15 degrees and left knee flexion up to 60 degrees and extension to 15 degrees with pain significantly limiting functional ability with flare-ups. The estimated range of motion during a flare-up for right knee flexion was up to 60 degrees and extension is to 20 degrees and for the left knee, flexion is up to 55 degrees and extension to 20 degrees. No muscle atrophy or ankylosis were noted. Also, there were no recurrent subluxation or persistent instability, no ligament tear, no recurrent patellar instability and no tibial or fibular impairment. Further review of the record shows that the Veteran receives VA treatment for various disabilities to include his knee disabilities. However, there is no indication from the treatment records that the Veteran has reported knee symptoms worse than those already noted in the VA examinations. With regards to the left right and left knee disabilities, the record reflects a higher or separate rating is not warranted for either disability under Diagnostic Code 5260 for limitation of flexion. The July 2021 VA examination revealed right knee flexion limited to 60 degrees during flare-ups and left knee flexion limited to 55 degrees during flare-ups, both at worst. In this regard, there is no evidence that the Veteran experienced 45 degrees of flexion or worse in either knee during this period on appeal. Therefore, Board finds that such factors do not result in functional loss more nearly approximating flexion limited to 45 degrees in the knee. See DeLuca v. Brown, supra; Mitchell v. Shinseki, supra. Therefore, a higher or separate rating based on limitation of flexion in either knee is not warranted. Pursuant to VAOPGCPREC 9-04, the Board has considered whether the Veteran is entitled to a separate rating for limitation of extension in either knee. Under Diagnostic Code 5261, a 20 percent rating is warranted for limitation of extension of the leg to 20 degrees, a 10 percent rating is warranted for limitation of extension of the leg to 10 degrees and a noncompensable rating is warranted for extension limited to five degrees. The evidence shows, however, that the Veteran had full right and knee extension for the appeal period prior to July 15, 2021, even in consideration of additional functional loss due to symptoms such as pain, swelling, weakness, fatigue, or incoordination or a result of repetitive motion and/or flare-ups. For the appeal period beginning on July 15, 2021, the limitation of extension was limited to 25 degrees on flare-ups in the right knee and 20 degrees on flare-ups in the left knee, both at worst. See DeLuca v. Brown, supra; Mitchell v. Shinseki, supra. Such warrants a separate rating of 30 percent for the right knee and 20 percent for the left knee based on the limitation of extension. The Board notes that the Veteran is currently in receipt of separate ratings of 30 percent for the right and left knees beginning on July 15, 2021 for limitation of extension. Therefore, a higher or separate rating for limitation of extension in either knee is not warranted for the appeal period. The Board notes that the Veteran underwent surgery for a torn meniscus in the right knee in 1988 and surgery on his left knee in 2013. The Veteran's is currently in receipt of a separate 20 percent rating for right knee arthritis status-post partial meniscectomy debridement under Diagnostic Code 5258; this is the highest schedular rating available. A July 2021 VA examination noted that the Veteran also has a left knee meniscus tear with frequent episodes of joint pain without effusion or locking. While an rating under Diagnostic Codes 5260 or 5261 does not preclude a separate evaluation under Diagnostic Codes 5258 or 5259, such a separate rating is not warranted for the left knee as there were not frequent episodes of locking, pain and effusion. In addition, there was not removal of the semilunar cartilage (e.g., meniscectomy) in the left knee. Therefore, a higher or separate rating is not warranted in either knee under Diagnostic Codes 5258 or 5259. The Board has considered the applicability of other potential diagnostic codes. As the evidence of record fails to demonstrate ankylosis, instability, impairment of the tibia or fibula, or genu recurvatum, the Veteran is not entitled to a higher or separate rating under 5256, 5257, 5262, or 5263, respectively, for either knee disability. Although the Veteran reported ambulating with a cane, objective examination has not revealed joint instability or that he required a prescription by a medical provider for a cane or a brace. Finally, the Board has considered the effects of repeated use over time and flare-ups along with the adequacy of the VA examinations in light of the Court's holdings in Correia and Sharp. See Correia v. McDonald, supra, and Sharp v. Shulkin, supra. The Board notes that the Veteran is service connected for both knees and hence there is not an undamaged joint to test. In this case, the January 2014 VA examination occurred before these holdings and hence contains partial information. The July 2021 VA examination measured active and passive range of motion as well as on weight-bearing and nonweight-bearing. To the extent that the January 2014 and August 2019 VA examinations did not measure active and passive range of motion, the Board notes that active range of motion testing usually results in further limitation than passive range of motion testing. See Massie v. Shinseki, 25 Vet. App. 123, 131 (2011). Regarding repeated use over time and flare-ups, the Board notes that November 2020 and July 2021 VA examiners conducted repetitive-use testing and additional limitation of motion was noted in the examination reports. Therefore, the Board finds that all information required for rating purposes was provided. In this regard, the Board notes that the examiners clearly noted that the Veteran specifically reported pain and flare-ups with consistent sharp tabbing pain when standing and walking. There is no other indication from the record, to include the Veteran's own statements, that he experiences additional decreased range of motion, weakness, or incoordination during flare-ups or following repeated use other than shown above. As the Veteran has not endorsed those symptoms, the Board finds the examinations of record to be adequate for rating purposes. See Correia v. McDonald, supra; see also Sharp v. Shulkin, supra. To the extent that the Veteran and contends that his left and right knee disorders are more severe than currently evaluated during any period on appeal, the Board observes that the Veteran, while competent to report symptoms, is not competent to report that his knee disabilities are of sufficient severity to warrant higher evaluations under VA's rating schedule because such an opinion requires medical expertise (training in evaluating musculoskeletal impairment), which he has not been shown to possess. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Charles v. Principi, 16 Vet. App. 370 (2002); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). The Board has considered whether a staged rating or a further staged rating under Hart, supra is appropriate; however, the Board finds that the remainder of his symptomatology has been stable throughout each period on appeal. Therefore, assigning a staged rating is not warranted. Neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the increased rating claim adjudicated herein. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). (Continued on the next page) Finally, the Board is cognizant of the ruling of the Court in Rice v. Shinseki, 22 Vet. App. 447 (2009). In Rice, the Court held that a claim for a TDIU, either expressly raised by the Veteran or reasonably raised by the record, involves an attempt to obtain an appropriate rating for a disability and is part of the claim for an increased rating. In this case, the Veteran has been in receipt of TDIU based upon his posttraumatic stress disorder (PTSD) since December 1, 2013. The Veteran has not alleged being unable to obtain and maintain employment due to his knee disabilities alone. In addition, the Veteran has been awarded special monthly compensation at the housebound rate pursuant to 38 U.S.C. §1114(s)(1), effective July 15, 2021, as the Veteran's PTSD a single disability upon which a TDIU is based and additional service connected disabilities of right knee degenerative arthritis with meniscal tear (limited extension), right knee arthritis status post partial meniscectomy, left knee osteoarthritis and gastroesophageal reflux disease (GERD) independently ratable at 60 percent or more since July 15, 2021. See also Bradley v. Peake, 22 Vet. App. 280 (2008) (finding that special monthly compensation "benefits are to be accorded when a veteran becomes eligible without need for a separate claim"); Buie v. Shinseki, 24 Vet. App. 242 (2011) (requiring the Board to consider awarding special monthly compensation at the housebound rate if a veteran meets the requisite schedular or extraschedular criteria). Accordingly, further consideration of a TDIU under Rice is not warranted. Therefore, a rating in excess of 20 percent for right knee arthritis, status post partial meniscectomy, a rating in excess of 30 percent for right knee degenerative arthritis with a meniscal tear (limited extension) for the appeal period beginning on July 15, 2021 and a higher rating for left knee osteoarthritis with baker cyst, meniscal tear is denied. The preponderance of the evidence is against a higher or separate rating for the Veteran's claim and the benefit of the doubt doctrine is not applicable. To that extent, a higher rating is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Adeyemi, 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.