Citation Nr: 21068369 Decision Date: 11/10/21 Archive Date: 11/10/21 DOCKET NO. 15-19 889 DATE: November 10, 2021 ORDER Entitlement to service connection for ischemic heart disease, to include as secondary to exposure to herbicide agents, is granted. Entitlement to a disability rating in excess of 10 percent for right knee osteoarthritis is denied. Entitlement to a compensable disability rating prior to February 15, 2012 and in excess of 10 percent thereafter, for service-connected left knee osteoarthritis is denied. Entitlement to an additional rating of 10 percent for right knee extension is granted. Entitlement to an additional rating of 10 percent for left knee extension is granted. FINDINGS OF FACT 1. The evidence of record is at least in equipoise as to whether the Veteran's duties while serving at Udorn Royal Thai Air Force Base (RTAFB) during the Vietnam War took him at or near the base of the perimeter, and he is therefore presumed to have been exposed to herbicide agents. 2. The preponderance of the evidence shows that the Veteran's right knee disability is not manifested by ankylosis; symptomatic removal of semilunar cartilage; dislocated semilunar cartilage; malunion or nonunion of the tibia and fibula; genu recurvatum; or limitation of flexion to 30 degrees or limitation of extension to 15 degrees. 3. Prior to February 15, 2012, the preponderance of the evidence shows that the Veteran's left knee disability was not manifested by limitation of flexion to 45 degrees or painful motion of the left knee. 4. After February 15, 2012, the preponderance of the evidence shows that the Veteran's left knee disability was not manifested by ankylosis; malunion or nonunion of the tibia and fibula; genu recurvatum; or limitation of flexion to 30 degrees or limitation of extension to 15 degrees. 5. The Veteran's right knee disability is manifested by extension limited to 10 degrees. 6. The Veteran's left knee disability is manifested by extension limited to 10 degrees. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for ischemic heart disease, to include as secondary to exposure to herbicide agents have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309. 2. The criteria for entitlement to a disability rating in excess of 10 percent for right knee osteoarthritis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a. DC 5260. 3. The criteria for entitlement to a compensable disability rating prior to February 15, 2012 and in excess of 10 percent thereafter, for service-connected left knee osteoarthritis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a. DC 5260. 4. The criteria for an additional rating of 10 percent for a right knee extension disability have been met. 38 U.S.C. § § 1155; 38 C.F.R. § 4.171a, DC 5261. 5. The criteria for an additional rating of 10 percent for a left knee extension disability have been met. 38 U.S.C. § § 1155; 38 C.F.R. § 4.171a, DC 5261. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1966 to August 1970. This matter was previously before the Board in September 2018, at which time it was remanded to the Department of Veterans Affairs (VA) Regional Office (RO) for further development. The RO most recently readjudicated the appeal in a July 2021 supplemental statement of the case. The Board finds that VA has substantially complied with the September 2018 Board remand. Entitlement to service connection for ischemic heart disease, to include as secondary to exposure to herbicide agents The Veteran claims that he is entitled to service connection for a heard disability, based on alleged exposure to certain herbicide agents. To establish service connection a Veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303 (d). In addition, certain chronic diseases, may be presumed to have been incurred during service if they become manifested to a compensable degree within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Service connection may also be granted on a presumptive basis for certain diseases associated with exposure to certain herbicide agents, even though there is no record of such disease during service, if they manifest to a compensable degree any time after service. 38 C.F.R. § 3.307(a)(6). Among the list of covered diseases is diabetes mellitus. 38 C.F.R. § 3.309(e). In determining whether service connection is warranted for a disability, VA must determine whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. In this case, there is sufficient competent and credible evidence to suggest that the Veteran's duties placed him at or near the base perimeter at Udorn RTAFB. His DD Form 214 indicates that his military occupational specialty at that time was a weapons mechanic. Service personnel records reflect service at Udorn RTAFB from July 1968 to April 1969. The Veteran has alleged that his duties required him to be close to the perimeter of the base. The Veteran testified that loading and unloading aircraft took him in close proximity to the perimeter fence and that he crossed the fence on multiple occasions going in and out of the base. Additionally, the Veteran submitted a photograph of the base indicating where his duties primarily placed him at the outside perimeter of the base. Although there are no contemporaneous records specifically documenting his presence in close proximity to the base perimeter from so many years ago, there is no affirmative evidence of record showing otherwise, and the Board finds no reason to doubt the credibility of the Veteran, who has been consistent. The Board finds the Veteran is competent to discuss facts or circumstances concerning his experience during active service, including his report of service in close proximity to the base perimeter fence. Moreover, the Board finds that the accounts of the Veteran are inherently credible when considered with other evidence of record. Caluza v. Brown, 7 Vet. App. 498, 506 (1995). As the Veteran's service personnel records clearly show that he had service on Udorn RTAFB, and that herbicides were known to be used in the fenced in perimeters of military bases in Thailand during the time period in which the Veteran served at Udorn RTAFB during the Vietnam Era, and the Board has found the Veteran's statements regarding service near the perimeter areas of Udorn credible, the Board will resolve all reasonable doubt in favor of the Veteran and finds that he was exposed to herbicides while serving at Udorn. Considering the totality of the evidence, the Board finds that the Board will resolve all reasonable doubt in favor of the Veteran and finds that he was exposed to herbicides while serving at Udorn RTAFB. Having conceded exposure to herbicide agents, the record shows that the Veteran has been diagnosed with multi-vessel coronary artery disease. See Phoenix VAMC records generally. Therefore, service connection for coronary artery disease is warranted on a presumptive basis. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102 (2015); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Increased Rating Disability evaluations are determined by the application of a schedule of ratings which is based, as far as can practically be determined, on the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Each service-connected disability is rated on the basis of specific criteria identified by a Diagnostic Code. 38 C.F.R. § 4.27. When rating the Veteran's service-connected disability, the entire medical history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Separate higher or lower compensable evaluations may be assigned for separate periods of time if such distinct periods are shown by the competent evidence of record during the appeal, a practice known as "staged" ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). Regulations require that where there is a question as to which of two evaluations is to be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The assignment of a particular diagnostic code is "completely dependent on the facts of a particular case." See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, the current diagnosis and demonstrated symptomatology. Any change in a diagnostic code by VA must be specifically explained. Pernorio v. Derwinski, 2 Vet. App. 625 (1992). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under the laws administered by VA. VA shall consider all information and medical and lay evidence of record. Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA 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). In evaluating the evidence, the Board has been charged with the duty to assess the credibility and weight given to evidence. Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). Indeed, the Court has declared that in adjudicating a claim, the Board has the responsibility to do so. Bryan v. West, 13 Vet. App. 482, 488-89 (2000). In doing so, the Board is free to favor one medical opinion over another, provided it offers an adequate basis for doing so. Owens v. Brown, 7 Vet. App. 429, 433 (1995). 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). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. However, the Board finds that none of the ways the Veteran's bilateral knee disabilities are rated are impacted by this change in law except Diagnostic Code 5010 is now rated under Diagnostic Code 5003. Moreover, while the new criteria materially changed Diagnostic Code 5257 and Diagnostic Code 5262, as explained below the Veteran's disabilities are not manifested by subluxation, instability, malunion/nonunion of the tibia/fibula. See Owens, supra. Therefore, the Board finds that the Veteran will not be prejudiced by adjudicating his appeal at this time. Under old 38 C.F.R. § 4.71a, Diagnostic Code 5010 traumatic arthritis is rated under Diagnostic Code 5003 as degenerative arthritis. Under new and old 38 C.F.R. § 4.71a, Diagnostic Code 5003 degenerative arthritis established by x-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion. A rating of 20 percent is assigned for each such major joint or group of minor joints, with occasional incapacitating exacerbations, affected by limitation of motion. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a. Under 38 C.F.R. § 4.71a, Diagnostic Code 5256, ankylosis at a favorable angle in full extension or in slight flexion between 0 degrees and 10 degrees warrants a 30 percent rating; ankylosis with flexion between 10 degrees and 20 degrees warrants a 40 rating; ankylosis with flexion between 20 degrees and 45 degrees warrants a 50 rating; and extremely unfavorable ankylosis (flexion at an angle of 45 degrees or more) warrants a 60 percent rating. Under old 38 C.F.R. § 4.71a, Diagnostic Code 5257, 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. Severe recurrent subluxation or lateral instability warrants a 30 percent rating. The terms "mild," "moderate," "moderately severe" and "severe" are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. The use of terminology such as "mild" or "moderate" by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. Under new 38 C.F.R. § 4.71a, Diagnostic Code 5257, 10 percent rating is warranted for a 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. A 20 percent rating is warranted for (a) Sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes 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 prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 30 percent rating is warranted for severe 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. Id. In addition to the above, the amended rating criteria under Diagnostic Code 5257 also provides ratings specific to patellar instability, a diagnosed condition involving the patellofemoral complex with recurrent instability. A 10 percent rating is warranted for patellar instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent rating is warranted for patellar instability after surgical repair that requires a prescription by a medical provider for one of the following: A brace, cane, or walker. A 30 percent rating is warranted for patellar instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. Id. For patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. Id. at Note 1. Under 38 C.F.R. § 4.71a, Diagnostic Code 5258, dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint warrants a 20 percent rating. Under 38 C.F.R. § 4.71a, Diagnostic Code 5259, removal of the semilunar cartilage when symptomatic warrants a 10 percent rating. Under 38 C.F.R. § 4.71a, Diagnostic Code 5260, if flexion of the knee is limited to 45 degrees a 10 percent rating is in order. If flexion of the knee is limited to 30 degrees a 20 percent rating is in order. If flexion of the knee is limited to 15 degrees a 30 percent rating is in order. Under 38 C.F.R. § 4.71a, Diagnostic Code 5261, if extension of the knee is limited to 10 degrees a 10 percent rating is in order. If extension of the knee is limited to 15 degrees a 20 percent rating is in order. If extension of the knee is limited to 20 degrees a 30 percent rating is in order. If extension of the knee is limited to 30 degrees a 40 percent rating is in order. If extension of the knee is limited to 45 degrees a 50 percent rating is in order. Full range of motion of the knee is from 0 to 140 degrees. 38 C.F.R. § 4.71, Plate II. Under old 38 C.F.R. § 4.71a, Diagnostic Code 5262, impairment of the tibia and fibula with slight knee or ankle disability warrants a 10 percent rating; with moderate knee or ankle disability warrants a 20 percent rating; with marked knee or ankle disability warrants a 30 percent rating; and with nonunion (loose motion requiring brace) warrants a 40 percent rating. Under 38 C.F.R. § 4.71a, Diagnostic Code 5263, Genu recurvatum (acquired, traumatic, with weakness and insecurity in weight-bearing objectively demonstrated) warrants a 10 percent rating. When evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59 (2016); DeLuca v. Brown, 8 Vet. App. 202 (1995). The Court has 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. 589, 592 (1991). Instead, the Mitchell Court explained that pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance, as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing. See 38 C.F.R. §§ 4.40, 4.45. Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. Therefore, in evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. The provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to arthritis, and must be considered when raised by the claimant or when reasonably raised by the record. See Burton v. Shinseki, 25 Vet. App. 1 (2011). Moreover, the United States Court of Appeals for Veterans Claims (Court) in Southall-Norman v. McDonald, 28 Vet. App. 346, 352 (2016) held that the provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to the evaluation of musculoskeletal disabilities under Diagnostic Codes predicated on range of motion measurements. In Burton v. Shinseki, 25 Vet. App. 1 (2011), the Court held that 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. Furthermore, in Jones v. Shinseki, 26 Vet. App. 56, 61-63 (2012) the Court held that the Board may not deny entitlement to an increased rating on the basis of relief provided by medication when those effects are specifically contemplated by the rating criteria. In Esteban v. Brown, 6 Vet. App. 259, 261 (1994), that Court held that in cases where the record reflects that the appellant has multiple problems due to service-connected disability, it is possible for an appellant to have "separate and distinct manifestations" from the same injury, permitting separate disability ratings. The critical element is that none of the symptomatology for any of the conditions is duplicative or overlapping with the symptomatology of the other conditions. Id. In this regard, VA General Counsel has held that separate ratings may be assigned in cases where a service-connected knee disorder includes both a compensable limitation of flexion under Diagnostic Code 5260, and a compensable limitation of extension under Diagnostic Code 5261 provided that the degree of disability is compensable under each set of criteria. VAOPGCPREC 9-2004; 69 Fed. Reg. 59990 (2004). The basis for the opinion was a finding that a limitation in planes of movement were each compensable. Id. VA General Counsel has also held that separate ratings may be assigned in cases where the service-connected knee disorder includes both arthritis and instability, provided of course, that the degree of disability is compensable under each set of criteria. VAOPGCPREC 23-97 (July 1, 1997). As the Veteran can understand from the above, the evaluation of knee problems is complex. Entitlement to a disability rating in excess of 10 percent for service-connected right knee osteoarthritis The Veteran filed a claim for a right knee disability on February 15, 2012. An April 2013 rating decision granted the Veteran service connection for a right knee disability and assigned a 10 percent rating effective January 5, 2012. The Veteran underwent a VA examination of his knees in November 2012. The examiner reported the Veteran's bilateral knee flexion was to 120 degrees with normal extension with no objective evidence of painful motion. After repetitive use testing, there was no additional loss of range of motion. The examiner found less movement than normal and pain on movement bilaterally. The Veteran was found to have normal muscle strength, no ankylosis, and no history of subluxation or instability. The April 2013 rating decision awarded an effective date prior to the date of the Veteran's application because a January 5, 2012 treatment record specifically references the Veteran's knee pain on the right side only. See January 5, 2012 treatment notes. The Veteran's right knee disability is currently assigned a 10 percent disability rating under diagnostic code 5003-5260. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. Following the September 2019 Remand, the Veteran underwent a VA examination of his right knee in October 2020 in which the examiner saw the Veteran in person and reviewed his record. The Veteran was noted to constantly use a cane. The examiner diagnosed the Veteran with a right knee osteoarthritis. On examination, right knee flexion was to 110 degrees with extension to 5 degrees, with pain noted on both flexion and extension. The examiner found pain to palpation, evidence of pain with weight bearing and objective evidence of crepitus. After repetitive use testing, there was no additional loss of range of motion. Strength was full and there were no indications of joint instability. The Veteran reported flare-ups with pain, fatigue, weakness, and lack of endurance. The examiner estimated that during flareups, flexion was to 80 degrees and extension to 10 degrees. The Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for the Veteran's right knee disability. The Board finds that even when considering functional limitations due to pain with and without weight bearing and resistance in passive and active range of motion as well as during flare-ups and the other factors identified in 38 C.F.R. §§ 4.40, 4.45, 4.59 as well as the Court's holdings in Correia, Sharp, Mitchell, Burton, Southall-Norman, and DeLuca, and when considering the appellant's competent reports of his observable adverse symptomatology (see Davidson, supra), his functional losses do not equate to the criteria required for at least a 20 percent rating because flexion of the left and right knee is not limited to 30 degrees because it was 80 degrees or higher at all of his VA examinations, even during flare-ups. Moreover, while the Veteran's treatment records document his complaints and treatment for right knee problems, the Board finds that above VA examiners ranges of motion are not contradicted by any other medical evidence of record because treatment records never document less flexion in either knee. 38 C.F.R. §§ 4.2, 4.3, 4.7, 4.71a; Hart, supra; Fenderson, supra, Colvin, supra. The Board has also considered whether separate or increased evaluations are warranted under any other Diagnostic Codes pertaining to knee disabilities that would afford the Veteran higher ratings. Here, there is no evidence of ankylosis of the knee to warrant a rating under Diagnostic Code 5256; no evidence of malunion or nonunion of the tibia and fibula to warrant a rating under Diagnostic Code 5262 for impairment of the tibia, and no evidence of genu recurvatum to warrant a rating under Diagnostic Code 5263. Hence, the Board will not discuss these Diagnostic Codes any further. As to additional ratings based on limitation of extension of the knee under diagnostic code 5261, the Board will discuss these issues further below. This does not suggest that the Veteran is having no problems with his right knee, simply that the current knee problem is being addressed by the current disability evaluation of the problem. The question is only the degree of the problem based on the multifaceted criteria cited above for knee problems. Entitlement to a compensable disability rating prior to from January 5, 2012 to February 15, 2012 and in excess of 10 percent disabling thereafter for service-connected left knee osteoarthritis An April 2013 rating decision granted service connection granted service connection for left knee osteoarthritis. The rating decision then issues a staged rating with a noncompensable evaluation effective January 5, 2012 and a 10 percent evaluation effective February 15, 2012. As discussed earlier, the earlier effective date of January 5, 2012 was granted for the opposite, right, knee in the April 2013 rating decision based on January 5, 2012 treatment notes which indicated painful motion of the right knee. However, the same treatment notes explicitly noted that the same symptoms were not present on the left side. There is no other evidence in the record to support a compensable disability rating for the period between January 5, 2012 and February 15, 2012. As referenced above, the Veteran underwent a VA examination of his knees on February 15, 2012. The examiner reported the Veteran's bilateral knee flexion was to 120 degrees with normal extension with no objective evidence of painful motion. After repetitive use testing, there was no additional loss of range of motion. The examiner found less movement than normal and pain on movement bilaterally. The Veteran was found to have normal muscle strength, no ankylosis, and no history of subluxation or instability. The Veteran underwent a VA examination of his right knee in October 2020 in which the examiner saw the Veteran in person and reviewed his record. The Veteran was noted to constantly use a cane. The examiner diagnosed the Veteran with a right knee osteoarthritis. On examination, right knee flexion was to 110 degrees with extension to 5 degrees, with pain noted on both flexion and extension. The examiner found pain to palpation, evidence of pain with weight bearing and objective evidence of crepitus. After repetitive use testing, there was no additional loss of range of motion. Strength was full and there were no indications of joint instability. The Veteran reported flare-ups with pain, fatigue, weakness, and lack of endurance. The examiner estimated that during flareups, flexion was to 80 degrees and extension to 10 degrees. The Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for the Veteran's left knee disability based on limitation of extension throughout the period on appeal. The Board finds that even when considering functional limitations due to pain with and without weight bearing and resistance in passive and active range of motion as well as during flare-ups and the other factors identified in 38 C.F.R. §§ 4.40, 4.45, 4.59 as well as the Court's holdings in Correia, Sharp, Mitchell, Burton, Southall-Norman, and DeLuca, and when considering the appellant's competent reports of his observable adverse symptomatology (see Davidson, supra), his functional losses do not equate to the criteria required for at least a 20 percent rating because flexion of the left and right knee is not limited to 30 degrees because it was 80 degrees or higher at all of his VA examinations, even during flare-ups. Moreover, while the Veteran's treatment records document his complaints and treatment for right knee problems, the Board finds that above VA examiners ranges of motion are not contradicted by any other medical evidence of record because treatment records never document less flexion in either knee. 38 C.F.R. §§ 4.2, 4.3, 4.7, 4.71a; Hart, supra; Fenderson, supra, Colvin, supra. This does not suggest that the Veteran is having no problems with his left knee, simply that the current knee problem is being addressed by the current disability evaluation of the problem. The question is only the degree of the problem based on the multifaceted criteria cited above for knee problems. The Board has also considered whether separate or increased evaluations are warranted under any other Diagnostic Codes pertaining to knee disabilities that would afford the Veteran higher ratings. Here, there is no evidence of ankylosis of the knee to warrant a rating under Diagnostic Code 5256; no evidence of malunion or nonunion of the tibia and fibula to warrant a rating under Diagnostic Code 5262 for impairment of the tibia, and no evidence of genu recurvatum to warrant a rating under Diagnostic Code 5263. Hence, the Board will not discuss these Diagnostic Codes any further. As to additional ratings based on limitation of extension of the knee under diagnostic code 5261, the Board will discuss these issues further below. Neither the Veteran nor his representative has identified any other rating criteria that would provide a higher rating or an additional rating. However, the potential applications of various provisions of Title 38 of the Code of Federal Regulations (2016) have been considered as required by the holding of the Court in Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). Regarding the claims above, the Board acknowledges the Veteran's statements that his knees cause him pain, cause him difficulty in daily activities involving walking, standing, sitting, or stooping, and that he continues to seek treatment for them. However, while the Veteran is competent to discuss the symptoms of his disabilities, the Veteran is not competent to opine on medical issues, such as the severity of his medical conditions. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Therefore, the Board places more probative weight on the objective medical evidence of record as discussed above. This does not mean that the Veteran's statements regarding the severity of his pain or his symptoms are untrue. While the Veteran's knees clearly bother him a great deal, it is important for the Veteran to understand that this is the basis for the current findings and the separate ratings cited above. If his knees did not cause him problems, there would be no basis for his ratings or the additional ratings granted, the only question is the degree. The Board has considered the applicability of the benefit of the doubt doctrine. Because the preponderance of the evidence is against the Veteran's claim, the benefit of the doubt doctrine does not apply. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57(1990). Entitlement to additional ratings of 10 percent for right knee and left knee disabilities based on limitation of extension As noted earlier, the Veteran underwent a VA examination of his right knee in October 2020 in which the examiner saw the Veteran in person and reviewed his record. The examination showed that the Veteran showed limitation of the Veteran's ability to extend both of his knees due to this disability. During a flare up, the examiner opined the Veteran's extension was limited to 10 degrees, which, under DC 5261, warrants an additional 10 percent rating for each knee. Therefore, while there is some evidence against this claim, with consideration of the Veteran's statements an additional rating of 10 percent is warranted for each knee. John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board V. Woehlke 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.