Citation Nr: 21068092 Decision Date: 11/09/21 Archive Date: 11/09/21 DOCKET NO. 16-45 587 DATE: November 9, 2021 ORDER A rating in excess of 20 percent for postoperative internal derangement, left knee, with degenerative joint disease (DJD) and instability is denied. A compensable rating for limited extension of the left knee is denied. FINDINGS OF FACT 1. The Veteran served on active duty from October 1983 to January 1989; he has been 100 percent disabled since October 2015 plus in receipt of special monthly compensation. 2. Left knee DJD/instability been manifested by subjective complaints of pain and instability; objective findings include limited range of motion with no ligament tear and no finding of ankylosis. 3. Limitation of extension of the left knee has been manifested by subjective complaints of pain and instability; objective findings include flexion, at worst, to 90 degrees and extension, at worst, to 5 degrees. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 20 percent for postoperative internal derangement, left knee, with DJD and instability have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Code (DC) 5257 (2021). 2. The criteria for a compensable rating for limited extension of the left knee have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.59, 4.71a, DC 5261 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the amended 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 that change. If the pre-amended regulation is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board will consider the claim for a rating in excess of 20 percent for left knee instability under the pre-amended criteria prior to February 7, 2021, and both the pre-amended and amended rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. As for the claim for a compensable rating for limitation of extension of the left knee, service connection for the disability was granted in March 2021, after the change to the rating criteria. Therefore, only the amended rating criteria will be considered. Left Knee DJD/Instability The Veteran is rated at 20 percent under DC 5257 for postoperative internal derangement with DJD and instability of the left knee. Under the pre-amended regulations, a 30 percent rating is warranted when the objective medical evidence shows: ankylosis of the knee with favorable angle in full extension, or in slight flexion between 0 and 10 degrees; or, severe recurrent subluxation or lateral instability; or, flexion of the leg limited to 15 degrees; or, extension of the leg limited to 20 degrees; or malunion of the tibia or fibula with marked knee or ankle disability. Turning to the medical evidence, March 2015, January 2016, and March 2021 VA examinations reflected no ankylosis of the left knee. Further, the clinical treatment records do not show evidence of ankylosis. Accordingly, the medical evidence does not support a higher rating on this basis. Next, March 2015 VA examiner found no history of recurrent subluxation or lateral instability. In January 2016, a VA physician noted a history of moderate recurrent subluxation and slight lateral instability. In a subsequent March 2021 VA examination, the Veteran reported a history of instability and recurrent subluxation. Specifically, she stated that her left knee gave way approximately once per week which resulted in falling down; however, the physician indicated there was no recurrent subluxation or persistent instability upon examination. The clinical treatment records reflect complaints of instability and falling down. Further, a June 2017 MRI reflected mild to moderate degenerative changes of the left knee with subluxation of the patella. However, the evidence does not support an objective finding of severe recurrent subluxation or lateral instability. As such, the medical evidence does not support an increased rating on this basis. As to range of motion, the March 2015 VA physician measured forward flexion from 0 to 130 degrees and extension from 130 to 0 degrees. Normal range of motion is between 0 and 140 degrees. In January 2016, the VA examiner reported left knee flexion from 0 to 100 degrees and extension from 100 to 0 degrees. Further, the March 2021 VA examination report showed flexion to 90 degrees and extension to 5 degrees. Accordingly, the medical evidence does not support an increased rating based on loss of range of motion. In addition, the March 2015 VA examination report indicated no tibial or fibular impairment. In January 2016, a different VA physician indicated slight recurrent patellar dislocation of the left knee, but no other impairments of the tibia or fibula were noted. Further, in March 2021, the VA examiner found evidence of shin splints, but no malunion of the tibia or fibula. The clinical treatment records also do not show malunion of the tibia or fibula with a marked knee or ankle disability. Accordingly, the medical evidence does not support an increased rating under the pre-amended regulations. Under the revised criteria, a 30 percent rating is warranted when the objective medical evidence shows: ankylosis of the knee with favorable angle in full extension, or in slight flexion between 0 and 10 degrees; unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation; flexion of the leg limited to 15 degrees; extension of the leg limited to 20 degrees; or MTSS or shin splints requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment, both lower extremities. Turning to the medical evidence, as noted above, the March 2021 VA examination reflected that the left knee was not ankylosed. Further, there are no clinical treatment records which contradict this finding. Accordingly, the medical evidence does not support an increased rating based on ankylosis. Next, the March 2021 VA examiner noted that the Veteran has been diagnosed with a meniscal tear with frequent episodes of joint pain and joint effusion. Specifically, she had a tear of the posterior horn of the medial meniscus and a questionable tear of the posterior horn of the lateral meniscus shown on an MRI. However, the examiner indicated that there has never been a ligament tear or sprain of the left knee. Further, the clinical records do not show evidence of a complete or partial ligament tear. As such, the medical evidence does not support an increased rating based on a ligament tear requiring the use of an assistive device. As to range of motion, as noted above, the March 2021 VA physician measured left knee flexion to 90 degrees and extension to 5 degrees. In addition, the clinical treatment records during the relevant period do not show flexion limited to 15 degrees or extension limited to 20 degrees. Therefore, the medical evidence does not support an increased rating based on limited range of motion. Further, the March 2021 VA physician noted a diagnosis of shin splints; however, shin splints did not require surgery or treatment as contemplated by the rating criteria. The clinical treatment records do not contradict this finding. Accordingly, the medical evidence does not support a rating in excess of 20 percent for a left knee disability. Left Knee Extension Based on the findings of the March 2021 VA examination, the Veteran was assigned a separate noncompensable rating for limited extension of the left knee under DC 5010-5261. The Board will consider all appropriate diagnostic codes. Under the amended regulations, a 10 percent rating is warranted when the objective medical evidence shows: Flexion of the leg limited to 45 degrees; or Extension of the leg limited to 10 degrees. Turning to the medical evidence, the March 2021 VA examination revealed left knee flexion to 90 degrees and extension to 5 degrees. There are no clinical treatment records which show flexion limited to 45 degrees or extension limited to 10 degrees. Accordingly, the medical evidence does not support a compensable rating for limited extension of the left knee. The Board notes that the Veteran is separately rated at 20 percent for a left knee disability under DC 5257 for instability. Her symptomatology, which includes complaints of pain, locking, joint effusion, and instability, is contemplated by the current ratings. Accordingly, the Veteran is already being compensated for these symptoms by the assigned 20 percent rating under DC 5257. As such, these symptoms are not considered when addressing the separate rating for limitation of extension. In sum, the medical evidence does not support a compensable rating for limitation of extension of the left knee. The Board has considered the Veteran's lay statements that her disabilities are worse. While she is competent to report symptoms because this requires only personal knowledge as it comes to her through her senses, she is not competent to identify a specific level of disability of these disorders according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran's left knee disabilities has been provided by the medical personnel who have examined her during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which these disabilities are evaluated. Moreover, as the examiners have the requisite medical expertise to render medical opinions regarding the degree of impairment caused by the disabilities and had sufficient facts and data on which to base the conclusions, the Board affords the medical opinions great probative value. As such, these records are more probative than the Veteran's subjective complaints of increased symptomatology. In sum, after a careful review of the evidence of record, the benefit of the doubt rule is not applicable and the appeals are denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (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). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Kokolas, 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.