Citation Nr: 21069952 Decision Date: 11/22/21 Archive Date: 11/22/21 DOCKET NO. 15-39 397 DATE: November 22, 2021 ORDER Entitlement to a rating higher than 10 percent for a right knee disorder rated under Diagnostic Codes 5010-5260 from August 30, 2012, to July 31, 2014, is denied. Entitlement to a rating higher than 10 percent for right knee lost flexion rated under Diagnostic Code 5260 from October 1, 2014, to February 18, 2016, is denied. Entitlement to a separate 40 percent rating, but no higher, for right knee lost extension rated under Diagnostic Code 5261 from August 30, 2012, to July 31, 2014, is granted. Entitlement to a rating higher than 40 percent for right knee lost extension rated under Diagnostic Code 5261 from October 1, 2014, to February 18, 2016, is denied. Entitlement to a rating of 60 percent, but no higher, for the right knee disorder, status post total right knee replacement, rated under Diagnostic Code 5055 from April 1, 2017, is granted. FINDINGS OF FACT 1. From August 30, 2012, to July 31, 2014, the preponderance of the evidence shows that the Veteran's right knee disorder rated under Diagnostic Codes 5010-5260 was not manifested by flexion limited to at least 30 degrees or ankylosis even when considering his complaints of pain with and without weight bearing and resistance in passive and active range of motion as well as during flare-ups nor was it manifested by at least slight recurrent subluxation or lateral instability, impairment of the tibia and fibula, medial tibial stress syndrome, or tibia and fibula malunion. 2. From October 1, 2014, to February 18, 2016, the preponderance of the evidence shows that the Veteran's right knee disorder rated under Diagnostic Code 5260 was not manifested by flexion limited to at least 30 degrees or ankylosis even when considering his complaints of pain with and without weight bearing and resistance in passive and active range of motion as well as during flare-ups nor was it manifested by at least slight recurrent subluxation or lateral instability, impairment of the tibia and fibula, medial tibial stress syndrome, or tibia and fibula malunion. 3. From August 30, 2012, to July 31, 2014, the preponderance of the evidence shows that the Veteran's right knee lost extension rated under Diagnostic Code 5261was manifested by extension limited to 30 degrees, but not at least 45 degrees, even when considering his complaints of pain with and without weight bearing and resistance in passive and active range of motion as well as during flare-ups. 4. From October 1, 2014, to February 18, 2016, the preponderance of the evidence shows that the Veteran's right knee lost extension rated under Diagnostic Code 5261was not manifested by extension limited to at least 45 degrees even when considering his complaints of pain with and without weight bearing and resistance in passive and active range of motion as well as during flare-ups. 5. From April 1, 2017, the preponderance of the evidence shows that the Veteran's for the right knee disorder, status post total right knee replacement, rated under Diagnostic Code 5055 is manifested by no more than severe painful motion or weakness in the affected area even when considering his complaints of pain with and without weight bearing and resistance in passive and active range of motion as well as during flare-ups nor is it manifested by at least ankylosis even when considering his complaints of pain with and without weight bearing and resistance in passive and active range of motion as well as during flare-ups, slight recurrent subluxation or lateral instability, a sprain, incomplete ligament tear or complete ligament tear causing persistent instability, patellar instability, or dislocated semilunar cartilage. CONCLUSIONS OF LAW 1. From August 30, 2012, to July 31, 2014, the criteria for a rating in excess of 10 percent for a right knee disorder rated under Diagnostic Codes 5010-5260 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.10, 4.71a, Diagnostic Codes 5003, 5010, 5256, 5259, 5260, 5261, 5261, 5262, and 5263. 2. From October 1, 2014, to February 18, 2016, the criteria for a rating in excess of 10 percent for right knee lost flexion rated under Diagnostic Code 5260 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.10, 4.71a, Diagnostic Codes 5003, 5010, 5256, 5259, 5260, 5261, 5261, 5262, and 5263. 3. From August 30, 2012, to July 31, 2014, the criteria for a separate 40 percent rating, but no higher, for right knee lost extension rated under Diagnostic Code 5261 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.10, 4.71a, Diagnostic Code 5261. 4. From October 1, 2014, to February 18, 2016, the criteria for a rating in excess of 40 percent for right knee lost extension rated under Diagnostic Code 5261 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.10, 4.71a, Diagnostic Code 5261. 5. From April 1, 2017, the criteria for a 60 percent rating, but no higher, for the right knee disorder, status post total right knee replacement, rated under Diagnostic Code 5055 have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.10, 4.71a, Diagnostic Codes 5003, 5010, 5055, 5256, 5259, 5260, 5261, 5261, 5262, and 5263. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty with the United States Army from September 1986 to December 1986 and from January 1991 to June 1991. In October 2018, the Veteran testified at a video-conference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In a March 2019 decision, the Board of Veterans' Appeal (Board) denied the Veteran's claims for a rating in excess of 10 percent for a right knee disability from August 30, 2012, to July 31, 2014, a rating in excess of 10 percent for limitation of flexion of the right knee from October 1, 2014 to February 18, 2016, and a rating in excess of 30 percent for status post total right knee replacement from April 1, 2017, as well as granted a separate 40 percent rating for limitation of extension of the right knee from October 1, 2014, to February 18, 2016. The Veteran appealed the March 2019 Board decision to the United States Court of Appeals for Veterans Claims (Court). In a subsequent February 2020 order, that incorporated the parties of Joint Motion for Partial Remand (JMPR), the Court vacated and remanded the March 2019 Board decision to the extent that it denied higher and other separate ratings for the right knee disorders. In July 2020, the Board Remanded the appeal. In a January 2021 rating decision, the regional office (RO) granted the Veteran's right knee disorder, status post total right knee replacement, a 60 percent rating under Diagnostic Code 5055 effective September 28, 2020, even though this issue has been pending since April 1, 2017. See Fenderson v. West, 12 Vet. App. 119, 125-26 (1999); Also see AB v. Brown, 6 Vet. App. 35 (1993) (in an appeal in which the veteran expresses general disagreement with the assignment of a particular rating and requests an increase, the RO and the Board are required to construe the appeal as an appeal for the maximum benefit allowable by law or regulation). As to the characterization of the issues on appeal, the Board notes that at all times from July 31, 2014, to October 1, 2014, and from February 18, 2016, to April 1, 2017, the Veteran was in receipt of ta 100 percent rating (i.e., the maximum rating possible under VA's laws and regulations) for his right knee disorders due to surgeries. Therefore, the Board finds that the below decision need not address these periods when adjudicating the appeal. Lastly, the Board also finds that the record does not raise a claim for a total rating based on individual unemployability (TDIU) despite the Court's holding in Rice v. Shinseki, 22 Vet. App. 447 (2009) because the record shows the Veteran is working full-time and had only lost 0 to 1 week of work in any 12-month period because of his service-connected right knee disabilities. See, e.g., VA examinations dated in March 2017 and May 2021. The Concerns Raised by the JMPR and Post-Remand Development Initially, the Board finds that the post-Remand development substantially complied with the JMPR and Remand including addressing the Court's concerns in Correia v. McDonald, 28 Vet. App. 158 (2016) and Sharp v. Shulkin, 29 Vet. App. 26 (2017). The Board has reached this conclusion because it finds that the September 2020 and May 2021 VA examinations and/or opinions, when taken together, provide all needed information to rate the right knee disorders under all applicable rating criteria at all times from August 30, 2012, because they included range of motion studies that considered the Veteran's complaints of pain, provided the knee's ranges of motion during flare-ups as well as with and without weight bearing and resistance in passive and active range of motion as well as considered instability and subluxation. See 38 U.S.C. § 5103A(d); Barr v. Nicholson, 21 Vet. App. 303 (2007); Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97 (2008) (holding that only substantial, and not strict compliance with the terms of a remand request, is required); Dyment v. West, 13 Vet. App. 141, 146-47 (holding that there was no Stegall violation when the examiner made the ultimate determination required by the Board's remand, because such determination more than substantially complied with the Board's remand order). The Board also finds that the post-Remand development substantially complied with the Remands because while the appeal was at the regional office (RO) obtained and associated with the record all identified and available VA and private treatment records. See 38 U.S.C. § 5103A(b); Stegall, supra. Lastly, and as directed in the JMPR, the below decision includes a discussion as to whether the Veteran met the criteria for a separate rating for right knee instability or subluxation under Diagnostic Code 5257 at any time during the pendency of the appeal. Therefore, the Board finds that it need not further discuss this matter at this time. Therefore, the Board finds that further delay by remanding these issues to provide the Veteran with a new VA examination or to obtain additional records is not required. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the veteran are to be avoided). Lastly, the Board notes that adjudicating claims for increased ratings for knee disorders, are very common problem for our Nations Veterans, have become increasingly more complex and difficult given the Court's ever changing interpretation of the Board's rating requirements, General Counsel opinions, and the recent amendments to the musculoskeletal rating criteria. See, e.g., Correia, supra; and Sharp, supra; VAOPGCPREC 23-97 (July 1, 1997); VAOPGCPREC 9-2004; 69 Fed. Reg. 59990 (2004); Also see 85 Fed Reg 76453 (November 30, 2020); 85 Fed Reg 85523 (December 29, 2020); 86 Fed Reg 8142 (February 4, 2021). The Board also finds that rating this Veteran's right knee disorder is even more problematic given the fact that his appeal dates back to 2012, he had two intervening surgeries, and a JMPR directs the Board to apply the Court's holdings in Correia, supra; and Sharp, supra, to a rating time-period (i.e., 2012 to 2016) before the Court even issued these decisions. The Board will endeavor to address the concerns raised. Nonetheless, the Board with granting the Veteran the benefit of doubt in this appeal, will nonetheless due its' best to rate the Veteran's right knee disorder applying all applicable laws and regulations to the facts of this appeal. The Rating Claims The Veteran contends that his right knee disorder is more severely disabling than represented by the ratings assigned at all times during the appeal. In this regard, 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). The Court has also held that, "it is the information in a medical opinion, and not the date the medical opinion was provided that is relevant when assigning an effective date." Tatum v. Shinseki, 24 Vet. App. 139, 145 (2010) (discussing assignment of an effective date for a reduction in disability rating under Diagnostic Code 7528); see also Young v. McDonald, 766 F.3d 1348, 1352-53 (Fed. Cir. 2014). (holding that a medical opinion can diagnose the presence of the condition and identify an earlier onset date based on preexisting symptoms). 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). As noted above, the Veteran's right knee disorders are rated as follows: from August 30, 2012, to July 31, 2014, a 10 percent rating under Diagnostic Code 5010-5260; from October 1, 2014, to February 18, 2016, a 10 percent for right knee lost flexion rated under Diagnostic Code 5260; from October 1, 2014, to February 18, 2016, a 40 percent for right knee lost extension rated under Diagnostic Code 5261; from April 1, 2017, a 30 percent rating for a right knee disorder, status post total right knee replacement, under Diagnostic Code 5055; and from September 28, 2020, a 60 percent rating for a right knee disorder, status post total right knee replacement, under Diagnostic Code 5055. i. The Recent Amendments to the Musculoskeletal Rating Criteria Initially, the Board notes that during the pendency of the appeal VA amended some of its' criteria for rating musculoskeletal disabilities effective February 7, 2021. See 85 Fed Reg 76453 (November 30, 2020); 85 Fed Reg 85523 (December 29, 2020); 86 Fed Reg 8142 (February 4, 2021). Claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the Veteran will be applied. However, the Board cannot apply a current regulation prior to its effective date unless the regulation explicitly provides otherwise. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). In this case, the regulation does not provide for retroactive application. 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a). Therefore, the Board finds that they are not applicable to the pre-February 7, 2021, time-period. Moreover, the Board finds that none of the amendments change how this Veteran's right knee disorders are rated. See Owens, supra. The Board has reached this conclusion because the specific rating criteria were not amended or because the Veteran's disabilities are not ratable under the amended criteria. Therefore, the Board finds that a Remand to provide the Veteran with notice of these new rating criteria and have the claims adjudicating applying them is not required because he is not prejudiced by this lack of notice. See Sabonis, supra. ii. The Old and New Rating Criteria Under 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. Old Diagnostic Code 5010 provides, in substance, that traumatic arthritis is rated under Diagnostic Code 5003. 38 C.F.R. § 4.71a. New Diagnostic Code 5010 provides, in substance, that post-traumatic arthritis is rated as limitation of motion, dislocation, or other specified instability under the affected joint. See 85 Fed Reg 76453 (November 30, 2020); 85 Fed Reg 85523 (December 29, 2020); 86 Fed Reg 8142 (February 4, 2021). Under 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 old and new Diagnostic Code 5055 provides, following a total knee replacement, a 60 percent rating for chronic residuals consisting of severe painful motion or weakness in the affected area and, otherwise, a minimum 30 percent evaluation is warranted. See 38 C.F.R. § 4.71a. They also provide that intermediate degrees of residual weakness, pain, or limitation of motion are rated by analogy to Diagnostic Codes 5256, 5261, or 5262. Id. Old Diagnostic Code 5055 also provided for a 100 percent rating for one year following implantation of prosthesis and new Diagnostic Code 5055 only provides a 100 percent rating for four months following implantation of prosthesis or resurfacing. Id. 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. And, 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. Effective February 7, 2021, VA amended Diagnostic Code 5257. For recurrent subluxation or lateral instability, a 10 percent rating is assigned for a sprain, incomplete ligament tear or complete ligament tear causing persistent instability without prescribed assistive device or bracing for ambulation. A 20 percent rating is warranted when a) a sprain, incomplete ligament tear, or repaired complete ligament tear causes persistent instability; or b) an unrepaired or failed repair of a complete ligament tear causes peristent instability. A prescribed assistive device or bracing for ambulation is required. A 30 percent rating requires unrepaired or failed repair of complete ligament tear causing persistent instability and a prescription for both an assistive device and bracing for ambulation. For patellar instability also rated under Diagnostic Code 5257, a 10 percent rating is assigned for a diagnosed condition that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent rating is warranted when there is a diagnosed condition with a prescription for either a brace, cane, or walker. A 30 percent rating requires a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription for brace and either a cane or a walker. Id. NOTE 1 following the criteria provides, for patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. NOTE 2 following the criteria provides a surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration). Under 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. Effective February 7, 2021, VA amended Diagnostic Code 5262. Medial tibial stress syndrome (MTSS), or shin splints is rated as 0 percent disabling with treatment less than 12 consecutive months, one or both lower extremities; 10 percent disabling when requiring treatment for no less than 12 consecutive months, and unresponsive to either shoe orthotics or other conservative treatment, one or both lower extremities; 20 percent disabling when requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment, one lower extremity; and 30 percent disabling when requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment, both lower extremities. Tibia and fibula are rated as 40 disabling with nonunion with loose motion, requiring brace. Tibia and fibula with malunion are evaluated under diagnostic codes 5256, 5257, 5260, or 5261 for the knee, or 5270 or 5271 for the ankle, whichever results in the highest evaluation. Under 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. As the Veteran can clearly see, the evaluation of knee problem over time is complex. Court decisions are issued, regulations are changed, in part, to address the concerns raised in those Court decisions. Other Court decisions are then nearly immediately issued, which then leads to additional development as the condition itself becomes worse. As noted above, prior to February 7, 2021, the Board will apply the prior rating criteria. See Kuzma, supra. From February 7, 2021, onward, the Board applies the criteria that is more favorable to the Veteran. Id. 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; 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 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. Lastly, in Chavis v. McDonough, No. 18-2928 (2021) the Court held that ankylosis of the spine may be shown based on symptoms of fixation of the joint equivalent to ankylosis. 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). iii. Correia and Sharp Compliance Next, in adjudicating below whether the Veteran meets the criteria for higher evaluations for his right knee disorders, the Board has not overlooked the Court's holdings in Correia, supra, and Sharp, supra. Tellingly, the Board finds that the record is adequate to address the concerns raised by the Court in both these cases as well as addressed the concerns raised in the JMPR because the September 2020 and May 2021 VA examinations and/or opinions, when taken together, provide range of motion of the right knee considered his complaints of pain with and without weight bearing and resistance in passive and active range of motion as well as during flare-ups. Moreover, in adjudicating below the issues on appeal the Board notes that the Court has held that, "it is the information in a medical opinion, and not the date the medical opinion was provided that is relevant when assigning an effective date." Tatum, supra; see also Young, supra. The Board has also not overlooked the fact the JMPR found the pre-March 2017 VA examinations inadequate because they neither addressed the concerns of the Court in Correia, supra, and Sharp, supra, even though neither case was issued by the Court at the time of the VA examinations. Accordingly, the Board finds that when rating his right knee disorders from August 30, 2012, to July 31, 2014, and from October 1, 2014, to February 18, 2016, it will take into account the findings by the September 2020 and May 2021 VA examiners in order to addressed the concerns of the Court in Correia, supra, and Sharp, supra, as well as the JMPR even those opinions are provided after the Veteran had two surgeries on his right knee. Therefore, the Board finds that further delay by remanding these issues to provide the Veteran with a new VA examination is not required even though the September 2020 and May 2021 VA examiners did not provide retroactive medical opinions addressing the severity pf the Veteran's right knee disorders from August 30, 2012, to July 31, 2014, and from October 1, 2014, to February 18, 2016. See Sabonis, supra. iv. The Merits of the Knee Rating Claims a. The claim for a rating in excess of 10 percent for the right knee disorder under Diagnostic Code 5010-5260 from August 30, 2012, to July 31, 2014, and from October 1, 2014, to February 18, 2016. As to a rating in excess of 10 percent for the Veteran's right knee disorder from August 30, 2012, to July 31, 2014, and from October 1, 2014, to February 18, 2016, under Diagnostic Code 5260 due to lost flexion, 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 did not equate to the criteria required for at least a 20 percent rating because the most probative evidence of record shows that flexion of right knee were not limited to at least 30 degrees during these times because at its' worst his flexion was still 75 degrees when considering his complaints of pain with and without weight bearing and resistance in passive and active range of motion as well as during flare-ups and not the 30 degrees required for a higher rating. See Owens, supra. The Board has reached this conclusion because, even though the Court has held that, "it is the information in a medical opinion, and not the date the medical opinion was provided that is relevant when assigning an effective date" (see Tatum, supra; see also Young, supra.), the range of motion studies provided by the Veteran's VA examiners show that right knee flexion was 140 degrees at the November 2012 VA examination, 100 degrees at the October 2014 VA examination, 95 degrees at the October 2015 VA examination, 110 degrees at the March 2017 VA examination, 95 degrees at the September 2020 VA examination, and 75 degrees at the May 2021 VA examination. In this regard, the Board finds these range of motion studies both competent and credible as well as the most probative evidence of record because they are supported by the examinations as well as the Veteran's treatment records. See Owens, supra. 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 the right knee. Id. Furthermore, the Board finds that the Veteran is not qualified to provide range of motion findings because these are medical findings. See Davidson, supra. Therefore, the Board finds that the criteria for an increased rating for the right knee disorder due to lost flexion under Diagnostic Code 5260 are not met at any time from August 30, 2012, to July 31, 2014, and from October 1, 2014, to February 18, 2016. See 38 C.F.R. §§ 4.2, 4.3, 4.7, 4.71a; Hart, supra; Fenderson, supra. b. The claim for a separate compensable rating for right knee lost extension under Diagnostic Code 5261 from August 30, 2012, to July 31, 2014, and a rating in excess of 40 percent from October 1, 2014, to February 18, 2016. As to a separate compensable rating for the right knee disorder from August 30, 2012, to October 1, 2014, under Diagnostic Code 5261 and VAOPGCPREC 9-2004 due to lost extension, the Board finds that 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 equate to the criteria required for at least a 40 percent rating during this time because at its' worst his extension was 30 degrees when considering his complaints of pain with and without weight bearing and resistance in passive and active range of motion as well as during flare-ups. See Owens, supra. The Board has reached this conclusion because the Court has held that, "it is the information in a medical opinion, and not the date the medical opinion was provided that is relevant when assigning an effective date" (see Tatum, supra; see also Young, supra.), and the range of motion studies provided by the Veteran's VA examiners show that right knee extension was 0 degrees at the November 2012 VA examination, 5 degrees at the October 2014 VA examination, 30 degrees at the October 2015 VA examination, 0 degrees at the March 2017 VA examination, 15 degrees at the September 2020 VA examination, and 30 degrees at the May 2021 VA examination. In this regard, the Board finds these range of motion studies both competent and credible as well as the most probative evidence of record because they are supported by the examinations as well as the Veteran's treatment records. See Owens, supra. Therefore, the Board finds that the criteria for a separate 40 percent rating for the right knee disorder due to lost extension under Diagnostic Code 5261 are met at all times from August 30, 2012, to October 1, 2014. See 38 C.F.R. §§ 4.2, 4.3, 4.7, 4.71a; Hart, supra; Fenderson, supra. As to a rating in excess of 40 percent for right knee lost extension from August 30, 2012, to October 1, 2014, and from October 1, 2014, to February 18, 2016, under Diagnostic Code 5261, 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 the next higher, 50 percent rating, during these time periods because at its' worst his extension was 30 degrees when considering his complaints of pain with and without weight bearing and resistance in passive and active range of motion as well as during flare-ups and not the 45 degrees required for a higher rating. See Owens, supra; Colvin, supra. Moreover, while the Veteran's treatment records document his complaints and treatment for right knee problems, the Board finds that above examiners range of motion are not contradicted by any other medical evidence of record because treatment records never document less extension in the right knee. Id. Furthermore, the Board finds that the Veteran is not qualified to provide range of motion findings in the right knee because these are medical findings. See Davidson, supra. Therefore, the Board finds that the criteria for a rating in excess of 40 percent for right knee lost extension under Diagnostic Code 5261 are not met at any time from August 30, 2012, to October 1, 2014, and from October 1, 2014, to February 18, 2016. See 38 C.F.R. §§ 4.2, 4.3, 4.7, 4.71a; Hart, supra; Fenderson, supra. c. The claim for a separate compensable rating for right knee instability and/or subluxation under Diagnostic Code 5257 at any time from August 30, 2012. Given the VAOPGCPREC 23-97 and the JMPR, the Board will next address whether the Veteran meets the criteria for a higher rating and/or a separate compensable rating for his right knee disorder from August 30, 2012, under old and new Diagnostic Code 5257. In this regard, the Board notes that VA examiners noted and/or the Veteran's treatment records show the appellant used a cane and/or a brace and had a history of anterior cruciate ligament and meniscus surgery. See, e.g., VA examinations dated in November 2012, October 2014, October 2015, March 2017, September 2020, and May 2021. However, the November 2012, October 2014, October 2015, March 2017, September 2020, and May 2021 VA examinations are uniform in opining that the right knee did not had a problem with instability and/or subluxation as well as negative for an incomplete ligament tear, complete ligament tear causing persistent instability, or patellar instability despite using a cane and brace. See Owens, supra. Moreover, the Board notes that while treatment records document the Veteran's complaints and treatment for right knee problems, nothing in these records contradicts the above examiners findings. Id. Furthermore, the Board finds that the Veteran is not qualified to provide stability finding because this is a medical finding. See Davidson, supra. Therefore, the Board finds that the most probative evidence of record is the above examiners findings and the treatment records which are negative for any of the criteria required for a least a 10 percent rating for right knee instability under old and new Diagnostic Code 5257 at all times from August 30, 2012. See Owens, supra. Accordingly, the Board finds that the criteria for an increased rating as well as a separate compensable rating for right knee instability under old and new Diagnostic Code 5261 are not met at any time from August 30, 2012. See 38 C.F.R. §§ 4.2, 4.3, 4.7, 4.71a; Hart, supra; Fenderson, supra. d. The claim for higher and/or separate ratings for the right knee disorders under any other Diagnostic Code from August 30, 2012. As to a higher evaluation for the Veteran's right knee disorders under Diagnostic Code 5256 due ankylosis from August 30, 2012, the Board finds that even when considering his reports of pain as per 38 C.F.R. §§ 4.40, 4.45, 4.59 and the Court's holding in Correia, Sharp, Mitchell, Burton, Southall-Norman, DeLuca, and Chavis, as well as when considering his competent reports of observable adverse symptomatology (see Davidson, supra), the right knee does not meet the criteria for a higher rating by rating it as ankylosis. See Owens, supra. The Board has reached this conclusion because the record is uniform in documenting at least some right knee motion and ankylosis is defined as immobility and consolidation of a joint due to disease, injury, or surgical procedure. See VA examinations dated November 2012, October 2014, October 2015, March 2017, September 2020, and May 2021; Also see Lewis v. Derwinski, 3 Vet. App. 259 (1992); Owens, supra. In fact, the VA examiners in October 2015, March 2017, September 2020, and May 2021 opined that the right knee was not ankylosed and these medical opinions are not contradicted by any other medical evidence of record even though his treatment records document numerous instances where he sought treatment for pain caused by his service-connected righty knee disorder. See Colvin, supra. Moreover, the Board finds that the Veteran is not competent to provide the missing diagnosis of ankylosis because this is a medical finding. See Davidson, supra. Additionally, the Board finds the examiners opinions as to the Veteran's adverse symptomatology more probative than any lay claims to the contrary even though the symptomatology is observable by a lay person because the examiners have medical training. See Black v. Brown, 10 Vet. App. 297, 284 (1997) (in evaluating the probative value of medical statements, the Board looks at factors such as the individual knowledge and skill in analyzing the medical data). Consequently, the Board finds that the criteria for an increased rating is not warranted for the Veteran's service-connected right knee disorders under Diagnostic Code 5256 due to ankylosis at any time from August 30, 2012. See 38 C.F.R. § 4.71a; Fenderson, supra; Hart, supra. As to a higher evaluation for the Veteran's right knee disorders from August 30, 2012, under Diagnostic Code 5258 for symptomatic removal of semilunar cartilage, Diagnostic Code 5259 for removal of the semilunar cartilage when symptomatic, under Diagnostic Code 5262 for impairment of the tibia and fibula, and/or under Diagnostic Code 5263 for Genu recurvatum, the Board finds that the right knee disorders do not manifest any of the above adverse symptomatology and/or the at least 10 percent ratings already assigned meets the maximum rating possible under these Diagnostic Codes. See 38 C.F.R. § 4.71a; Also see VA examinations dated November 2012, October 2014, October 2015, March 2017, September 2020, and May 2021; Also see Colvin, supra. Therefore, the Board finds that an increased rating under these criteria is not warranted for the Veteran's service-connected right knee disorders at any time from August 30, 2012. See 38 C.F.R. § 4.71a; Butt's, supra; Hart, supra; Fenderson, supra. e. The claims for a rating in excess of 30 percent from April 1, 2017, and 60 percent from September 28, 2020, for the right knee disorder, status post total right knee replacement, under Diagnostic Code 5055. As to a rating in excess of 30 percent for the right knee disorder, status post total right knee replacement, under Diagnostic Code 5055 from April 1, 2017, the Board notes that while the March 2017 VA examiner opined that the Veteran only had intermediate degrees of residual weakness, pain, or limitation of motion since his February 2016 surgery, the September 28, 2020, VA examiner opined that he had post-prosthesis placement with chronic residuals of severe painful motion and severe weakness. Tellingly, and as noted above, the Court has held that, "it is the information in a medical opinion, and not the date the medical opinion was provided that is relevant when assigning an effective date." Tatum, supra; see also Young, supra. Therefore, when considering the frequency, severity, and duration of the Veteran's impairment to assess his disability picture and when resolving all reasonable doubt in his favor (as not all evidence in this case, supports this finding), the Board finds that 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), the most probative evidence of record is the September 2020 VA examination report that shows that his right knee disorder, status post total right knee replacement, adverse symptomatology approximates the criteria for at least a 60 percent rating at all times from April 1, 2017, because it is manifested by chronic residuals of severe painful motion and severe weakness. See 38 C.F.R. § 4.71a; Owens, supra; Fenderson, supra. Tatum, supra; Young, supra. As to a rating in excess of 60 percent from April 1, 2017, for the right knee disorder, status post total right knee replacement, under Diagnostic Code 5055, as noted above, old and new Diagnostic Code 5055 provide a maximum 60 percent rating for chronic residuals consisting of severe painful motion or weakness. Accordingly, because the Veteran is in receipt of the maximum schedular rating (i.e., a 60 percent rating) under old and new 38 C.F.R. § 4.71a, Diagnostic Code 5055, the Board finds that there is no legal basis for assignment of a higher scheduling rating from April 1, 2017. See Sabonis, supra. Therefore, the Board finds that the criteria for higher rating for the Veteran's right knee disorder, status post total right knee replacement, under Diagnostic Code 5055 from April 1, 2017, are not met. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.2, 4.3, 4.7, 4.71a; Fenderson, supra; Hart, supra. The Board also notes that a rating under Diagnostic Code 5055 encompasses all identifiable residuals of post total knee replacement, including limitation of motion, instability, and functional impairment. The rule against pyramiding prohibits compensating twice for the same manifestations. See 38 C.F.R. § 4.14. Therefore, the Board finds that separate ratings under Diagnostic Codes 5256 through 5263 (discussed above), are not warranted for his right knee disorder, status post total right knee replacement, from April 1, 2017. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.2, 4.3, 4.7, 4.71a; Fenderson, supra; Hart, supra. Similarly, a review of the Diagnostic Codes 5256 through 5263 reveals that there is no rating higher than 60 percent under these codes. Therefore, the Board finds that the Veteran is not entitled to a rating in excess of 60 percent for his right knee disorder, status post total right knee replacement, from April 1, 2017, under Diagnostic Codes 5256 through 5263. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.2, 4.3, 4.7, 4.71a; Fenderson, supra; Hart, supra. Conclusion Lastly, the Board wishes to draw the Veteran and his representative's attention to the amputation rules found at Diagnostic Codes 5165 which provide, in substance, that the claimant could not receive a rating in excess of 40 percent for his right knee disorder even if he had had a below the knee amputation of the right leg with prosthesis. See 38 C.F.R. § 4.71a. Simply stated, the Veteran can not get more compensation for a knee problem than a Veteran who does not have a knee. In reaching all of the above conclusions, the Board has also not overlooked the lay claims from the Veteran and others regarding his adverse symptomatology. See Davidson, supra. However, the Board finds the VA examiners opinions as to the Veteran's adverse symptomatology more probative than the lay claims to the contrary even though his symptomatology is observable by a lay person because the examiners have medical training. See Black, supra. In reaching all the above conclusions, the Board has also considered the doctrine of reasonable doubt. See 38 U.S.C. § 5107(b). However, as the preponderance of the evidence is against the claims to the extent outlined above, the doctrine is not for application. See also, e.g., Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001); Gilbert, supra. John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N.T. Werner, 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.