Citation Nr: 21067987 Decision Date: 11/08/21 Archive Date: 11/08/21 DOCKET NO. 15-41 021 DATE: November 8, 2021 ORDER Entitlement to a disability rating in excess of 10 percent for right knee arthritis based on range of motion is denied. Entitlement to a separate disability rating of 10 percent, but not more, for right knee instability as of August 22, 2016, is granted. FINDINGS OF FACT 1. Throughout the period on appeal, the Veteran's right knee disability has been characterized by painful limitation of motion and arthritis; limitation of flexion to 45 degrees, limitation of extension to 10 degrees, ankylosis, removal of semilunar cartilage, dislocated semilunar cartilage with frequent episodes of "locking pain" and effusion into the joint, or impairment of the tibia or fibula have not been shown. 2. Prior to August 22, 2016, recurrent subluxation or lateral instability of the right knee had not been shown. 3. As of August 22, 2016, the Veteran's right knee has been characterized by "slight" instability; "moderate" instability, a diagnosed condition of the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for either a brace, cane, or walker, or a sprain, incomplete ligament tear, or repaired complete ligament tear have not been shown. CONCLUSIONS OF LAW 1. The criteria for entitlement to a disability rating in excess of 10 percent for right knee arthritis based on range of motion have not been met. 38 U.S.C. §§ 1155, 2103, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71, 4.71a, Diagnostic Code (DC) 5260. 2. The criteria for entitlement to a separate disability rating of 10 percent, but not more, for "slight" right knee instability as of August 22, 2016, have been met. 38 U.S.C. §§ 1155, 5103, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.7, 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 Marine Corps from November 1983 to January 1988 and from March 1989 to November 1995. This matter was previously denied by the Board in April 2020 and the Veteran timely appealed to the Court of Appeals for Veterans Claims (the Court). In a March 2021 Joint Motion for Remand, the Court remanded the matter for further adjudication after it was determined that the Board provided inadequate reasons and bases for its denial. Specifically, the Court noted that the Board did not consider the Veteran's lay statements adequately in denying a separate rating for instability and did not properly address the Veteran's statements that he cannot stand or walk for long periods, has difficulty going up and down stairs, and cannot run, kneel, or squat. The appeal has returned to the Board for further appellate consideration. Increased ratings Disability evaluations are determined by applying a schedule of ratings which is based on average impairment of earning capacity based on the specific diagnostic codes identifying the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two separate evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that particular rating. 38 C.F.R. § 4.7. For musculoskeletal disabilities, a higher rating may be granted based on greater limitation of motion due to pain on use, including during flare-ups. 38 C.F.R. §§ 4. 10, 4.40, 4.45; see also DeLuca v. Brown, 8 Vet. App. 202 (1995). The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability, and therefore, actually painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimum compensable rating for the joint. See 38 C.F.R. § 4.59. The provisions of 38 C.F.R. § 4.14 (avoidance of pyramiding) do not forbid consideration of a higher rating based on greater limitation of motion due to pain on use, including flare-ups. Regarding knee claims, a claimant who has arthritis and instability of the knee may be rated separately under DCs 5003 and 5257 or 5258/5259. See VAOPGCPREC 23-97. For example, when a knee disorder was already rated under DC 5257 (addressing lateral instability), a separate rating may be warranted if the Veteran's knee also shows limitation of motion which at least meets the criteria for a zero-percent rating under DC 5260 (flexion limited to 60 degrees or less) or 5261 (extension limited to 5 degrees or more). Moreover, a separate rating could also be warranted under 38 C.F.R. § 4.59, based on x-ray findings of arthritis with painful motion. See VAOPGCPREC 9-98; see also Degmetich v. Brown, 104 F.3d 1328, 1331 (Fed. Cir. 1997). In addition, the General Counsel has also held that separate ratings may be granted based on limitation of flexion (DC 5260) and limitation of extension (DC 5261) of the same knee joint. VAOPGCPREC 09-04. 1. Entitlement to a disability rating in excess of 10 percent for right knee arthritis 2. Entitlement to a separate disability rating of 10 percent, but not more, for right knee instability as of August 22, 2016 The Veteran's right knee chondromalacia patella with patellofemoral pain syndrome and osteoarthritis has been rated 10 percent throughout the period at issue under C.F.R. § 4.59, DC 5260 based on painful motion of the knee. The Veteran contends that he is entitled to an increased disability rating for his service-connected right knee disability throughout the period at issue. Specifically, he contends that he has had knee instability that causes falls, his knee gives out frequently when walking, he has limited range of motion, he has sharp stabbing pain when walking, he cannot walk for long periods, he has difficulties going up and down the stairs, and he cannot run, kneel, or squat. Range of Motion The Board first considers whether an increased rating is based on range of motion. Based on the evidence of record, the Board finds that a rating in excess of 10 percent for range of motion limitations in the Veteran's right knee is not warranted under DCs 5260 or 5261. It should be noted that, during the course of this appeal, the schedular rating for evaluating other impairments of the knee has been amended. Specifically, the criteria pertaining to recurrent subluxation or lateral instability of the knee under 38 C.F.R. § 4.71a, was amended effective February 7, 2021. See 85 Fed. Reg. 76, 453 (November 30, 2020). Where a law or regulation changes during the pendency of a claim for increased rating, the Board should first determine whether application of the revised version would produce retroactive results. In particular, a new rule may not extinguish any rights or benefits the claimant had prior to enhancement of the new rule. VAOPGCPREC 07-03 (November 19, 2003). However, if the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of the change. 38 U.S.C. § 5110; Kamas v. Derwinski, 1 Vet. App. 308, 313 (1991), overruled in part, Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). As the Veteran's claim was received prior to the effective date of the regulation changes, the Board must consider the Veteran's knee disability under both the old and the revised rating criteria and must apply the old rating criteria if the result is more favorable to the Veteran. Id. Here, as the amended criteria include additional restrictions, the pre-amended criteria are more favorable, and will be applied here. Under the pre-amended criteria, in order to warrant an additional or different 10 percent rating for a right knee disability, the evidence must show: Slight recurrent subluxation or lateral instability (10 percent under DC 5257); Removal of semilunar cartilage, symptomatic (10 percent under DC 5259); Limitation of extension of the leg to 10 degrees (10 percent under DC 5261). 38 C.F.R. § 4.71a. Under the pre-amended criteria, in order to warrant a rating in excess of 10 percent for a right knee disability, the evidence must show: Favorable ankylosis of the knee in full extension, or in slight flexion between 0 degree and 10 degrees (30 percent under DC 5256); Moderate recurrent subluxation or lateral instability (20 percent under DC 5257); Dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint (20 percent under DC 5258); Limitation of flexion of the leg to 30 degrees (20 percent under DC 5260); or Limitation of extension of the leg to 15 degrees (20 percent under DC 5261). 38 C.F.R. § 4.71a. In this case, the requirements for an increased rating are not met. First, medical records between April 2011 and April 2013 fail to demonstrate flexion limited to 45 degrees or less or extension limited to 10 degrees or more. Specifically, despite noting chronic intermittent knee pain and a mildly antalgic gait, physical examinations were generally normal with normal muscle movement and tone and intact range of motion. As such, increased ratings are not supported under DCs 5260 or 5261. Next, the Veteran was given a VA examination in April 2013 where he was diagnosed with right knee chondromalacia and reported worsening symptoms. He stated that he experienced flare-ups once per year and that his range of motion worsens with repeated use over time. However, upon examination, the Veteran demonstrated full range of flexion and extension in the right knee initially and after three repetitions, which does not support increased ratings under DCs 5260 or 5261. The examiner also noted that there was pain on movement but no pain on palpation. However, although the examiner noted that the Veteran had reduced ranged of motion after repetitive use, they did not estimate the degree of the Veteran's range of motion limitations, making this examination inadequate. Between June and August 2014, the Veteran's medical records fail to show any evidence to support increased or additional ratings under DCs 5260 or 5261. Specifically, despite reports of intermittent pain, physical examination notes showed no use of an assistive device for ambulation, normal gait, and good range of motion. Next, the Veteran submitted a September 2014 Disability Benefits Questionnaire (DBQ) which indicated diagnoses of residuals of a cartilage injury with chondromalacia and osteoarthritis of the right knee. The Veteran reported worsening knee pain and incoordination that causes range of motion limitations, difficulty going up and down stars, and "giving up" of the right knee joint. He also reported flare-ups once per week that did not cause additional range of motion limitations but resulted in pain rated seven on a scale of ten and loss of function that included an inability to run, squat, or kneel. However, the Veteran denied weakness or fatigability. Upon examination, the Veteran demonstrated full range of motion with no objective evidence of painful motion in flexion or extension. There was also no additional limitation of range of motion after repetitive use testing, but the Veteran exhibited incoordination, impaired ability to execute skilled movements smoothly, pain on movement, and disturbance of locomotion. Lastly, the physician noted that his condition did not affect his ability to perform his work as a custodian, although he had additional range of motion limitations and could not run, squat, or kneel due to pain and incoordination. The physician did not, however, estimate the additional range of motion limitations. As such, the range of motion testing is not adequate. Although the Veteran reported that he could not run, squat, or kneel due to pain and incoordination, as noted by the Court, the Board finds that his symptoms were adequately contemplated by the 10 percent rating he was assigned, as these limitations can be best categorized as painful motion in accordance with DC 5260. As stated by the physician during the September 2014 DBQ examination, his limitations did not affect his ability to perform his work as a custodian. There is no other higher rating that would more closely approximate the Veteran's symptoms, as there is no indication that the Veteran's limitation of flexion or extension during flare-ups was so great as to warrant higher or additional ratings under DCs 5260 or 5261. Even though the April 2013 VA examiner and September 2014 DBQ physician stated that the Veteran experienced additional range of motion limitations due to pain, incoordination, or flare-ups and failed to estimate the degrees of limitation, he had full initial range of motion, and the medical records before and after these examinations failed to show that the Veteran's limitation of flexion at its worst was so reduced as to limit it from 140 degree to 45 degrees, or to reduce his extension from 0 degrees to 10 degrees. Finally, medical records from September 2014 through February 2017 fail to support a rating in excess of 10 percent for the Veteran's right knee disability due to range of motion limitations under DCs 5260 or 5261. Specifically, the Veteran consistently sought treatment for knee stiffness and pain that sometimes radiated to his groin and was aggravated by inactivity or getting in and out of his truck at work, but that improved with activity such as walking. In August 2016 his private physician reported that the Veteran's is unable to do his job because of prolonged sitting and persistent pain. Despite these reported symptoms, upon physical examination in November 2014, December 2015, May 2016, August 2016, and January and February 2017, there was no limitation of motion and he had a normal gait with his knee brace. Additionally, the records indicate he continued performing his duties as a custodian. As a result, the record does not demonstrate reduced range of flexion or extension to a degree to support increased or additional ratings under DCs 5260 or 5261. Next, the Veteran underwent a February 2017 VA examination, which similarly failed to support a higher rating than 10 percent for painful motion under DC 5260. The examiner noted diagnoses of osteoarthritis and chondromalacia patella, and the Veteran reported continuous knee pain. He also reported that prolonged sitting or standing causes flare-ups that exacerbate his knee pain, and he cannot walk long distances or exercise due to knee pain. Upon examination, his initial right knee flexion was 95 degrees with no limitation in extension, and there was evidence of pain with weight bearing, but no crepitus. There was tenderness to palpation of the inferior aspect of the patella, but no additional functional loss of motion after three repetitions. Although the examiner stated that the Veteran experiences pain during flare-ups, they concluded that they were unable to say whether there is additional loss of function or range of motion limitations after repetitive use over time or during flare-ups without resorting to mere speculation, making this examination inadequate. Next, medical records from March 2017 through June 2018 fail to support increased or additional ratings for range of motion limitations under DCs 5260 or 5261. In March 2017, the Veteran reported that he drives a trash truck, which is inconsistent with his February 2017 reports to the VA examiner that he stopped driving truck in 2012 due to knee symptoms. He reported that he experiences pain when getting in and out of the truck. A January 2018 x-ray showed only mild degenerative changes of the right knee. Aside from the reports of knee pain and some observed pain with flexion in May 2017, upon examination, there was no swelling, tenderness, or erythema of the right knee, and there is no evidence limitation of flexion of 45 degrees or less or extension of 10 degrees or greater. In June 2018, the Veteran submitted statements that he has chronic painful motion in his right knee, cannot stand for long periods of time, and cannot put any weight on his right knee. He also reported less movement than normal and excess fatigability. Finally, he reported experiencing pain on movement, swelling, disturbances of locomotion, and difficulty sleeping at night due to pain. However, there is no evidence to support that the Veteran experienced flexion of 45 degrees or less or extension of 10 degrees or greater in accordance with DCs 5260 or 5261. Specifically, in September and October 2018, the Veteran's physician noted that the Veteran has no warmth, effusion, or laxity in the knee, and he only reported knee pain as a four on a scale of ten. Additionally, in February 2019 medical records, he described his knee pain as "intermittent" after completing physical therapy. During that same appointment, he again reported working as a trash truck driver despite reporting during his February 2017 VA examination that he had not driven truck since 2012 due to pain. Furthermore, medical records from June 2019 indicate that the Veteran has decreased range of motion in the right knee, but there is no evidence that his range of motion was so decreased that he is limited to 45 degrees of flexion or 10 degrees of extension. Upon physical examination, the Veteran had a normal gait and station, normal reflexes, and normal strength. As such, there is no evidence to support increased or separate ratings under DCs 5260 or 5261. Next, the Veteran underwent a VA examination in June 2019 and reported experiencing sharp stabbing pain, radiating pain to his ankle, limited range of motion, an inability to walk for long periods, that his knee gives out frequently when he is walking, and difficulty going up and down stairs. Furthermore, he stated that he cannot run, kneel, squat, or lift items for a long period. He also reported experiencing flare-ups five times per week with pain rated seven-to-eight on a scale of ten with the duration lasting three hours. It was noted that the Veteran regularly uses a knee brace and that he has missed no more than one week of work in the past 12 months because his knee pain prevents him from standing or walking for a long time. Upon examination, the Veteran's right knee flexion was measured to 100 degrees and extension was measured to 0 degrees with pain exhibited on motion. The examiner stated that, considering the Veteran's statements, a review of the record, and their medical knowledge and expertise, there is no basis to offer additional loss of function or motion with repeated use over time or during flare-ups. As the examiner reviewed the evidence of record, examined the Veteran, and considered his contentions, the Board finds this opinion highly probative. Based on a review of the record, there is no evidence of limitation of flexion or extension so great as to warrant increased or additional limitations under DCs 5260 or 5261, and the Veteran's painful range of motion is most appropriately contemplated by the 10 percent rating he receives under DC 5260. Additional separate ratings Next, the Board has also considered whether any separate ratings are warranted. As an initial matter, a separate rating based on dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint, symptomatic removal of semilunar cartilage, impairment of tibia and fibula, or genu recurvatum are not warranted under DCs 5258, 5259, or 5256. Specifically, in both medical treatment records and VA examinations throughout the period at issue, the evidence specifically indicates that the Veteran has no ankylosis, effusion, removal of the semilunar cartilage, tibia or fibula impairment, or genu recurvatum. Furthermore, although the Veteran has been diagnosed with chondromalacia patella since at least April 2013, the Veteran only reported that he experiences his right knee "locking up" on one occasion in December 2013. As such, the Board finds that one report of his knee "locking up" during the six-year period at issue is not indicative of his normal level of functioning and does not qualify as "frequent episodes of "locking," pain, and effusion into the joint" to support an additional rating under DC 5258. Regarding instability, the Board also finds that a separate rating for recurrent subluxation or instability is not warranted under DC 5257 prior to August 22, 2016. As an initial matter, the pre-amended version of DC 5257 provides ratings for "slight," "moderate," or "severe" recurrent subluxation or lateral instability. However, neither the Diagnostic Code nor the overall rating schedule defines "slight," "moderate," and "severe." However, "slight" is generally defined as "small in kind or amount." Merriam-Webster's Collegiate Dictionary, 1173 (11th ed. 2003). "Moderate" is defined as "tending toward the mean or average amount." Id. at 798. "Severe" is generally defined as "of a great degree." Id. at 1140. However, the record fails to demonstrate that the Veteran's right knee disability exhibited such symptoms prior to August 22, 2016. Specifically, medical records between April 2011 and April 2013 demonstrated that the Veteran had chronic intermittent knee pain, mild infra-patellar crepitus and, specifically in May 2011 only, a mildly antalgic gait. However, physical examinations revealed normal muscle movement and tone, as well as independent ambulation and transfers from sitting to standing. As such, there is no evidence of recurrent subluxation or instability to support an additional rating under DC 5257 prior to August 22, 2016. Furthermore, during the Veteran's April 2013 VA examination, the Veteran demonstrated full strength, no recurrent subluxation, no instability, and no use of an assistive device. Additionally, medical records between June and August 2014 fail to show recurrent subluxation or instability to support a separate rating under DC 5257. Specifically, physical examinations of the knee were normal with symmetrical knees, a normal gait, and no use of an assistive device. Next, in the Veteran's September 2014 DBQ, he reported worsening knee pain and incoordination that caused difficulty going up and down stairs and giving out of the right knee joint. He also reported flare-ups once per week that did not cause additional range of motion limitations but resulted in pain rated seven on a scale of ten and loss of function that included an inability to run, squat, or kneel. However, the Veteran denied weakness or fatigability. While the Veteran exhibited incoordination, impaired ability to execute skilled movements smoothly, pain on movement, and disturbance of location, he also demonstrated full strength in his right knee, no evidence of instability during joint stability testing, and no evidence of recurrent patellar subluxation or dislocation. Lastly, the physician noted that his condition did not affect his ability to perform his work as a custodian, although he had additional range of motion limitations and could not run, squat, or kneel due to pain and incoordination. Although this examination failed to estimate additional range of motion limitations during flare-ups, making it inadequate, normal joint stability testing, full knee strength, no evidence of subluxation, and the ability to perform his work as a custodian does not support that the Veteran's symptoms warranted an additional 10 percent rating for instability under DC 5257 prior to August 22, 2016. Finally, medical records from September 2014 through August 2016 fail to support an additional rating for instability or recurrent subluxation under DC 5257 prior to August 22, 2016. Specifically, aside from some patellar pain, patellar crepitus, and lateral facet tenderness, physical examinations were mostly normal with no swelling, catching, locking, or giving away, no use of an assistive device, a normal gait, no laxity, and no joint line tenderness. Additionally, his knee pain was described as "stable." Furthermore, although he was prescribed a knee brace in May 2016, the medical notes specifically state that the brace was prescribed for pain, and there is no indication, either from the Veteran's reports to physicians or physical examinations, that the Veteran was experiencing instability that required a brace or other assistive device. Next, after reviewing the evidence of record, the Board determines that an additional 10 percent rating, but no more, for "slight" right knee instability under DC 5257 is warranted as of August 22, 2016. First, on August 22, 2016, the Veteran's private physician indicated he has occasional knee instability, pain that is usually eight on a scale of ten, particularly if he has to sit or stand for long periods of time, joint line tenderness, and crepitus. The physician noted that the Veteran requires treatment with ibuprofen and possible cortisone injection, and he is unable to do his job because of prolonged sitting and persistent pain. However, the physician also noted that the Veteran has a normal gait with knee brace, normal reflexes, and normal strength. As such, this supports that the Veteran's knee instability is only "slight" in accordance with DC 5257, as his instability is only occasional. Furthermore, even though the physician noted that the Veteran is unable to perform his job, the records indicate he continued to work as a custodian throughout the period at issue. Next, medical records from January and February 2017 fail to demonstrate that a rating in excess of 10 percent for instability under DC 5257 is warranted. Specifically, the records indicate the Veteran has chronic knee pain that is likely osteoarthritis given previous trauma and crepitus, and he requires treatment with a nonsteroidal anti-inflammatory drug (NSAID), ice, and a knee brace. However, there is no evidence of moderate instability or recurrent subluxation. The Veteran's February 2017 VA examination similarly failed to support a higher rating than 10 percent for "slight" instability. A physical examination revealed normal muscle strength and no history of recurrent subluxation, effusion, or lateral instability. While the Veteran reported regularly using a cane and constantly using a brace, joint stability testing revealed no instability, further supporting that the Veteran's reported instability in the record is no more than "slight" in accordance with a 10 percent rating under DC 5257. Next, medical records from March 2017 through June 2018 demonstrate that the Veteran experiences only "mild" or "slight" crepitus and consistent pain in his knee that is not improved with his knee sleeve. In March 2017, he also reported that he drives a trash truck, which is inconsistent with his February 2017 reports to the VA examiner that he stopped driving truck in 2012. Additionally, in January 2018, he reported that he has not experienced falls in the past three months. An x-ray the same month showed only mild degenerative changes of the right knee. Aside from the reports of knee pain, there is no evidence of "moderate" instability or recurrent subluxation to warrant a rating in excess of 10 percent under DC 5257. In June 2018, the Veteran submitted statements that he has chronic painful motion in his right knee, cannot stand for long periods of time, and cannot put any weight on his right knee. He also reported less movement than normal and excess fatigability. Finally, he reported swelling and disturbances of locomotion. Based on the Veteran's reports to physicians before and after these statements were submitted, the Board finds that these symptoms were adequately contemplated by 10 percent rating under DC 5257 for "slight" instability, as there is no evidence of "moderate" instability or recurrent subluxation to support a 20 percent rating under DC 5257. Specifically, in September and October 2018, the Veteran's physician noted that the Veteran has no warmth, effusion, or laxity in the knee, and he only reported the pain in his knee as a four on a scale of ten. Additionally, in February 2019 medical records, he described his knee pain as "intermittent" after completing physical therapy. During that same appointment, he again reported working as a trash truck driver despite reporting during his February 2017 VA examination that he had not driven truck since 2012 due to pain. Once again, the Veteran reported no history of falls within the past three months, supporting that his instability is only "slight." Furthermore, medical records from June 2019 reveal a normal gait and station, normal reflexes, and normal strength. As such, there is no evidence to support a rating in excess of 10 percent under DC 5257. Next, during a June 2019 VA examination, the Veteran reported experiencing an inability to walk for long periods, that his knee gives out frequently when he is walking, and difficulty going up and down stairs. Furthermore, he stated that he cannot run, kneel, squat, or lift items for a long period. He also reported experiencing flare-ups five times per week with pain rated seven-to-eight on a scale of ten with the duration lasting three hours. Upon examination, the examiner stated that, considering the Veteran's statements, a review of the record, and their medical knowledge and expertise, there is no basis to offer additional loss of function or motion with repeated use over time or during flare-ups. The examiner also stated that additional factors that contribute to the Veteran's disability are locomotion because the Veteran reported that his knee frequently gives out while walking, and interference with standing due to his inability to stand for long periods. However, his strength was normal, there was no history of recurrent subluxation, lateral instability, or effusion, and joint stability testing was all normal. The Veteran reported that he regularly uses a knee brace. Lastly, the examiner noted that the Veteran works as a driver and he has missed no more than one week of work in the past twelve months because his knee pain prevents him from standing or walking for a long time. Despite the Veteran's reports of his knee frequently giving out when walking, as well as his flare-ups causing difficulty walking up and down stairs, walking or standing for long periods, running, squatting, or kneeling, or lifting weight for long periods, the Board finds that the Veteran's symptoms are accurately contemplated by the 10 percent rating he is assigned under DC 5260 for painful motion and 10 percent under DC 5257 for only "slight" instability as joint stability testing and strength were all normal. Specifically, joint stability testing in both February 2017 and June 2019 found no joint instability, and the Veteran's reports of his knee frequently giving out are inconsistent with his reports to treating physicians throughout most of the record. For example, his physician reported only occasional instability in August 2018, and in January 2018 and February 2019 the Veteran reported no falls in the previous three months. While he reported in October 2019 that he tripped and fell, he reported in February 2020 that he has had no history of falls in the past 12 months, and he reported in April 2021 that he has no history of falls but feels his right knee gives away "at times." Based on the infrequent reports of falls and "giving way" of the right knee throughout the record, combined with normal joint stability testing, the Board finds that the Veteran's instability is only "slight" in accordance with DC 5257, as the medical records are inconsistent with the frequency with which the Veteran reported his right knee giving away during the June 2019 VA examination, and the evidence indicates he experiences these symptoms only occasionally. Furthermore, his increased pain during flare-ups and difficulty walking or standing for long periods, walking up or down stairs, or running, squatting, kneeling, or lifting weight for long periods is adequately contemplated by a 10 percent rating for painful motion under DC 2560 and 10 percent rating for instability under DC 5257 because there is no evidence of moderate instability or recurrent subluxation. Next, medical records between July 2019 and August 2021 fail to support a rating in excess of 10 percent under DC 5257 for instability. Specifically, a July 2019 x-ray was negative for fracture, subluxation, or other significant bone, joint, or soft tissue abnormality. In September 2019, both heel and toe gait were within normal limits despite some difficulty balancing. In October 2019, the Veteran reported falling and tripping on the right knee, but in February 2020 he stated that he had no history of falls in the past 12 months. The Veteran's infrequent and inconsistent reports of falling or experiencing his knee giving away, and the lack of evidence on examination of instability or recurrent subluxation, fail to support that a rating in excess of 10 percent is warranted under DC 5257. Similarly, while the Veteran reported in April 2021 and July 2021 that he has not experienced a history of falls but feels his knee gives away "at times," and he is treated with a brace and cane, the infrequent falls and lack of physical evidence of instability or subluxation fail to qualify as "moderate" instability or recurrent subluxation under DC 5257. Furthermore, the Veteran reported difficulty standing, walking, or negotiating stairs, and his knee strength was between three and four out of five during physical therapy. However, physical therapy examinations since July 2019 have also primarily revealed no use of an assistive device, right knee strength of four-out-of-five, and no warmth or laxity, suggesting no more than "slight" instability. As such, his limitations based on feeling like his knee gives away, but finding no evidence of joint instability upon testing, supports that the Veteran has no more than "slight" instability consistent with a 10 percent rating under DC 5257. Additionally, his pain while standing or walking for long periods, climbing stairs, and lifting weight for long periods, as well as his inability to run, squat, or kneel, is most adequately contemplated by the 10 percent rating under DC 5260 as of August 22, 2016 for painful motion, as he is still able to drive truck and work as a custodian, and he performs his activities of daily living independently, as noted in April 2021. There is no other evidence to support greater or additional ratings than those awarded under DCs 5257 and 5260. The Board considered the statements of the Veteran and his friends and coworkers in determining the appropriate disability ratings. Specifically, the Board considered the reported instances of the Veteran's limitation of motion, falling on a weekly basis or sometimes more due to knee pain, difficulty getting in and out of his truck, throbbing pain and swelling in his knee, and sharp pain inside the right knee. While the Veteran and his friends and coworkers, as laypersons, are competent to report observable symptomatology, once basic competency is met, the Board must consider credibility of testimony. Here, these statements are inconsistent with the evidence of record and, therefore, are less probative than the medical evidence of record and the Veteran's own reports of symptoms to VA examiners and treating physicians. Additionally, the Veteran's friends and family are not competent to determine the source of the Veteran's falls. First, in October 2019, the Veteran's friend reported that the Veteran's migraines cause him to pass out and have affected his balance. Consistent with this, the Veteran submitted a statement in August 2020 stating that his migraines cause him to lose balance and have caused him to fall on many occasions. In these statements, neither the Veteran nor his friend attributed the falls to his right knee problem and instead reported that he falls due to migraine headaches. Additionally, the medical treatment records throughout the period at issue specifically note that the Veteran repeatedly denied a history of falls except for one incident in October 2019. Despite the Veteran and a friend separately alleging that the Veteran has fallen due to migraines rather than knee pain, in May 2021, the Veteran's coworker submitted a statement stating that he has observed the Veteran falling or experiencing a bothersome knee three times per week for at least the past three years. The Veteran submitted a statement the same day stating: "on numerous occasions" he has tendencies to fall and has fallen on a weekly basis due to his knee pain. Again, this is inconsistent with reports throughout the record that the Veteran has no history of falls, including a July 2021 medical treatment note two months after those lay statements were submitted where the Veteran reported that he has had some instances of almost falling without actually falling. Because these statements contradict the Veteran's reports in his robust medical record, the Board finds they lack credibility. Furthermore, in addition to the May 2021 statements submitted by the Veteran and his coworker, as well as earlier statements submitted by the Veteran in the record, another friend of the Veteran submitted a statement in April 2021 stating that he observed the Veteran having difficulties with his mobility due to an injury that he sustained in his right knee. Although the Veteran and his coworkers and friends are competent to report symptoms because this requires only personal knowledge as it comes to them through their senses, they are not competent to identify a specific level of disability of his right knee disorder according to the appropriate DCs. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartwright v. Derwinski, 2 Vet. App. 24, 25 (1991). On the other hand, such competent evidence concerning the nature and extent of the Veteran's right knee disability have been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with their evaluations. The medical findings of the physicians who performed the VA examinations directly address the criteria under which this disability is evaluated. Because the examiners were able to review the medical file and examine the Veteran, and their findings are consistent with the physical examination results in the medical evidence of record, the Board finds the examiners' assessments of greater probative weight. In conclusion, the Veteran's symptoms prior to August 22, 2016, including persistent pain, painful motion, limitation of motion due to pain and incoordination, stiffness, and an inability to run, squat, kneel, or climb stairs during a flare-up, are most appropriately contemplated by the 10 percent rating he was assigned under DC 5260 prior to August 22, 2016, as physical examinations were mostly normal and failed to demonstrate evidence of limitation of flexion to 45 degrees or less or limitation of extension to 10 degrees or less in accordance with DCs 5260 or 5261. Furthermore, there was no evidence to support additional ratings under DCs 5256, 5257, 5258, 5259, 5262, or 5263, and he was able to continue working a job as a custodian and truckdriver without evidence of greater functional limitations due to his knee. Furthermore, as of August 22, 2016, the Veteran's additional symptoms, which include his knee intermittently feeling like it is "giving away" and an October 2019 fall, are most adequately contemplated by a 10 percent rating for "slight" instability under DC 5257 and a 10 percent rating for painful motion under DC 5260. As such, a rating in excess of 10 percent for painful motion under DC 5260 prior to August 22, 2016, and ratings in excess of 10 percent for painful motion under DC 5260 and in excess of 10 percent for instability under DC 5257 as of August 22, 2016 are not warranted. There is no doubt to be otherwise resolved. See Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). 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. B.T. KNOPE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Veltri, Associate Counsel