Citation Nr: 21070430 Decision Date: 11/23/21 Archive Date: 11/23/21 DOCKET NO. 18-45 944 DATE: November 23, 2021 ORDER Entitlement to revision, based on clear and unmistakable error (CUE), of a June 2008 rating decision granting service connection and assigning an initial 10 percent rating for early osteoarthritis of the left knee partly owing to a prior tear of the anterior cruciate ligament (ACL) is denied. Entitlement to a rating higher than 20 percent for acromioclavicular (AC) degenerative joint disease (DJD), i.e., arthritis of the right shoulder and ankylosis prior to June 16, 2016 and higher than 30 percent since is denied (however, the effective date of this rating increase is June 16, 2016 rather than June 30, 2016). Entitlement to a compensable rating for recurrent corneal erosion syndrome is denied. REMANDED Entitlement to a rating higher than 10 percent for early osteoarthritis of the left knee is remanded. FINDINGS OF FACT 1. The June 2008 rating decision assigning an initial 10 percent rating for the early osteoarthritis of the Veteran's left knee, but not a separate rating for his ACL tear, was reasonably supported by the evidence then of record; it is not shown that the applicable statutory and regulatory provisions existing at that time were incorrectly applied; there was not an undebatable error that would have resulted in a materially different outcome; the decision was not fatally flawed or egregious. 2. Prior to June 16, 2016, the AC DJD (arthritis) of the Veteran's right shoulder was manifested by complaints of pain and consequent loss of motion, but he was still able to raise his right arm to at least shoulder level. 3. Since June 16, 2016, his right shoulder disability has continued to be manifested by complaints of pain but with greater limitation of arm motion to midway between his side and shoulder level. 4. His service-connected bilateral recurrent corneal erosion syndrome manifest in visual acuity of 20/40 or better in both eyes with no visual field defects, incapacitating episodes, or muscle impairment. CONCLUSIONS OF LAW 1. There was not CUE in the June 2008 decision assigning an initial 10 percent rating for the left knee disability. 38 U.S.C. § 5109A; 38 C.F.R. §§ 3.104, 3.105(a). 2. The criteria are not met for entitlement to a rating higher 20 percent for the right shoulder disability prior to June 16, 2016 or a rating higher than 30 percent since. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5201. 3. The criteria are not met for entitlement to a compensable rating for recurrent corneal erosion syndrome. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326, 4.3, 4.7, 4.10, 4.20, 4.21, 4.75, 4.76, 4.79, Diagnostic Code 6066. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U. S. Air Force from November 1986 to May 1998 and from March 1999 to September 2007. In December 2019, the Board remanded these claims back to the local Regional Office (RO), so back to the Agency of Original Jurisdiction (AOJ), for further development and consideration. 1. Entitlement to revision of a June 2008 rating decision, based on CUE, assigning a 10 percent rating for early osteoarthritis of the left knee is denied. The 10 percent rating for the Veteran's left knee disability is to compensate him for the osteoarthritis in this knee owing to the tear of his ACL of this knee. In Mitchell v. Shinseki, 25 Vet. App. 32 (2011), the U. S. Court of Appeals for Veterans Claims (Veterans Court/CAVC) held that the evaluation of painful motion as limited motion only applies when limitation of motion is noncompensable under the applicable diagnostic code. The Court further explained that, although painful motion is entitled to a minimum 10 percent rating under Lichtenfels v. Derwinski, 1 Vet. App. 484, 488 (1991), when read together with DC 5003 regarding arthritis, it does not follow that the maximum rating is warranted under the applicable DC pertaining to range of motion simply because pain is present throughout the range of motion. See id. Moreover, the Court has held that 38 C.F.R. § 4.40 does not require a separate rating for pain (so including if due to arthritis) but rather provides guidance for determining ratings under other DCs assessing musculoskeletal function. See Spurgeon v. Brown, 10 Vet. App. 194 (1997). The Veteran nonetheless contends that, in its June 2008 rating decision granting service connection and assigning a 10 percent evaluation for the osteoarthritis in his left knee, the RO committed CUE by assigning just a single 10 percent rating rather than two separate 10 percent ratings one of the osteoarthritis and another for his ACL tear precipitating it. When assigning a rating for this left knee disability in that June 2008 decision, it was under hyphenated Diagnostic Code (DC) 5099-5024. Unlisted disabilities requiring rating by analogy will be coded by the numbers of the most closely related body part and "99." 38 C.F.R. § 4.27. The hyphenated DC in this case indicates that an unlisted musculoskeletal disability, under DC 5099, was the service-connected disability, and tenosynovitis, under DC 5024, which is to be rated as limitation of motion of affected parts as degenerative arthritis under DC 5003. See 38 C.F.R. § 4.71a, DC 5024 (2008). Limitation of motion of the knee, in turn, is rated under DC 5260 (for limited flexion) and under DC 5261 (for limited extension). With regards to the Veteran's claim of CUE to try and collaterally attack and vitiate the "finality" of that prior June 2008 rating decision, the Board notes that CUE is a very specific and rare kind of error that compels the conclusion, to which reasonable minds could not differ, that the result would have been manifestly different but for the error. See Fugo v. Brown, 6 Vet. App. 40, 43 (1993). In general, CUE exists when either the correct facts, as they were known at the time, were not before the decision maker, or the statutory and regulatory provisions that existed at the time were incorrectly applied. See 38 C.F.R. § 20.1403(a); see also Luallen v. Brown, 8 Vet. App. 92 (1995) (providing that mere disagreement with how the RO evaluated the facts is not sufficient to raise a valid claim of CUE). Here, the Veteran was provided an initial VA examination in May 2008. That examiner noted the history of the Veteran's left knee disability. First, to this end, the examiner listed the Veteran's knee injuries in service, which included his injury while playing softball. That injury was noted during an August 1999 pre-deployment examination. In August 1999, he had an orthopedic consultation and was provided a knee brace, though exhibited full range of motion (ROM). Follow-up to that consultation occurred in December 1999, and his knee was assessed as healed. His original injury was determined at that time to be the aforementioned softball injury. In April 2001, a medial collateral ligament (MCL) injury was noted, and the Veteran was provided a knee brace. In October 2004, he was treated for knee pain. In January 2005, he had an MRI that revealed a normal ACL. In April 2006, an MRI again noted a normal ACL, though mild degenerative changes within the ACL also were observed along with small joint effusion. In May 2008, he had an X-ray, which revealed early osteoarthritis. During the May 2008 examination, the Veteran's left knee did not exhibit joint line tenderness, and there additionally was no tenderness over the patella. Moreover, he could flex his knee from 0 to 130 degrees and extend it to 0 degrees, so he had nearly normal range of motion of this knee, which is from 0 degrees of extension to 140 degrees of flexion. See 38 C.F.R. § 4.71, Plate II. As well, he had a negative Lachman's test and a negative McMurray's test, meaning there was no objective evidence of a meniscus tear or instability or subluxation of this knee. Indeed, multiple repetition-of-motion tests revealed no further disability due to pain. No subjective complaint of pain was noted during squatting. No joint instability was reported, so even aside from none being detected clinically. The examiner did note that the Veteran had stopped doing squats with weights about two years prior to the examination, although he continued to do leg extensions with between 60 and 80 pounds. He also reported decreasing his running mileage after injuring his knee. No knee surgery was reported. Overall, this knee was assessed as having early osteoarthritis based on the results of his May 2008 X-ray with subjective tightness but no locking or catching. In the June 2008 rating decision at issue, the RO resultantly granted a 10 percent rating based on the X-ray confirmation of osteoarthritis and subjective complaints of tightness. DC 5003, on referral from DC 5024, indicates this the rating to be assigned in this circumstance when there is osteoarthritis, even absent (as here) a showing of a compensable level of limitation of motion either under DC 5260 (for flexion) or DC 5261 (for extension). While both ACL and MCL injuries are noted in the report of the Veteran's VA examination, they were, as evidenced in treatment notes, determined to be resolved injuries through multiple MRIs at various points in time. Moreover, the Veteran's only reported symptom during his June 2008 VA examination was tightness and limited ROM (the latter, as explained, did not meet the requirements for a compensable rating based on either flexion (DC 5260) or extension (5261). Consequently, he was awarded a 10 percent rating under DC 5099-5024 for a confirmed diagnosis of osteoarthritis via X-ray and noncompensable ROM for knee flexion. As noted by the RO at the time, for a higher rating, he would have had to demonstrate flexion limited to 30 degrees or extension limited to 15 degrees. He had far more flexion and extension than that; indeed, he did not have sufficient limitation of flexion or extension to even warrant the most minimum 0 percent (noncompensable) ratings under DCs 5260 and 5261. So, the only basis for assigning that initial 10 percent rating was because of the osteoarthritis that, under DC 5003 (on referral from DC 5024), permits assignment of this minimum compensable rating (10 percent) even in this situation when there is what amounts to noncompensable limitation of motion meaning limitation of motion that otherwise would be rated as 0-percent disabling. He also could have received a higher or separate evaluation for moderate recurrent subluxation or lateral instability under DC 5257 (addressing "other" impairments of the knee), but he did not have that either. The Board acknowledges the Veteran's contentions that he should have initially been assigned a separate 10 percent rating for his ACL and MCL tears. In 2008, these impairments potentially would have been rated by analogy under either DC 5258 (Cartilage, semilunar, dislocated, with frequent episodes of "locking" pain, and effusion into the joint) or DC 5259 (Cartilage, semilunar, removal of, symptomatic). Indeed, evaluation of a knee disability under DC 5257 or 5260/61 (on referral from DC 5003), or both, does not, as a matter of law, preclude separate evaluation of a meniscal disability of the same knee under DC 5258/59, or vice versa. See Lyles v. Shulkin, 29 Vet. App. 107 (2017). Lyles had not yet been issued in 2008, however. Moreover, entitlement to a separate evaluation in a case depends on whether the manifestations of the disability for which a separate evaluation is being sought already are being compensated by an assigned evaluation under a different DC. Therefore, separate ratings can be assigned only where appropriate symptomatology is shown since the evaluation of the same disability under several Diagnostic Codes, known as pyramiding, must be avoided. See 38 C.F.R. § 4.14. Separate ratings may be assigned for distinct disabilities resulting from the same injury only where the symptomatology for one condition is not duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). Here, the Veteran's reported symptomatology at the time of his May 2008 VA examination was limited to tightness and noncompensable limitation of flexion and extension of his left knee. He did not report instability, locking, dislocation, frequent effusion into the joint, or surgery that would warrant the assignment of a separate rating under another DC. Moreover, for a knee disability rated under DC 5257 to warrant a separate arthritis rating based on X ray evidence and limitation of motion, limitation of motion would need to be compensable under either DC 5260 or 5261. See VAOPGCPREC 9-98 (August 14, 1998). As already explained, CUE exists when either the correct facts, as they were known at the time, were not before the decision maker, or the statutory and regulatory provisions that existed at the time were incorrectly applied. See 38 C.F.R. § 20.1403. Here, careful review of the record indicates the correct facts were before the adjudicator at the time of the initial June 2008 rating decision. In addition, there is no indication that the statutory and regulatory provisions existing at the time were incorrectly applied. In short, the decision was not fatally flawed or egregious. Thus, the Veteran's petition to vitiate the finality (res judicata) of that decision based on CUE is denied. 2. Entitlement to a rating higher than 20 percent for the right shoulder disability prior to June 30, 2016 and higher than 30 percent since is denied. The Veteran's right shoulder disability is rated under 38 C.F.R. § 4.71a, hyphenated DC 5003-5201, meaning for arthritis (DC 5003) causing limitation of motion (DC 5201). According to DC 5201, limitation of motion of the arm at shoulder level warrants a 20 percent rating for both the major and minor extremity. Limitation of motion of the arm to midway between the side and shoulder level warrants a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity. Limitation of motion of the arm to 25 degrees from the side warrants a maximum 30 percent rating for the minor shoulder and a maximum 40 percent rating for the major shoulder. 38 C.F.R. § 4.71a, DC 5201. DC 5201 "does not provide separate ratings for limitation of motion in the flexion and abduction planes, but rather is addressed generically to limitation of motion of the arm." See Yonek v. Shinseki, 722 F.3d 1355, 1358 (Fed. Cir. 2013). Effective February 7, 2021, VA amended DC 5201 to reflect that limitation of motion may be shown by flexion and/or abduction and clarified the degrees of limitation of motion that correspond to each rating. Now, limitation of motion at the shoulder level (flexion and/or abduction limited to 90 degrees) warrants a 20 percent rating for both the major and minor extremity. Limitation of motion of the arm to midway between the side and shoulder level (flexion and/or abduction limited to 45 degrees) warrants a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity. Flexion and/or abduction limited to 25 degrees from the side warrants a maximum 30 percent rating for the minor shoulder and a maximum 40 percent rating for the major shoulder. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. Entitlement to a rating higher than 20 percent prior to June 30, 2016 The Veteran was afforded a VA examination in December 2015. During that evaluation, he did not report experiencing flare-ups. Shoulder ROM was found to be outside the normal range and measured to 90 degrees on flexion with pain on motion noted that resulted in functional loss (normal flexion is to 180 degrees). Abduction measured to 90 degrees (normal abduction is to 180 degrees), external rotation to 45 degrees (normal external rotation is to 90 degrees), and internal rotation to 45 degrees (normal internal rotation is to 90 degrees); all were noted to cause pain and were considered outside of normal range. In effect, he had 12 of normal range of motion in each direction. His AC joint was noted to be tender, and he reported difficulty working with his arms over his head. An X-ray also confirmed there was degenerative arthritis in this shoulder. Entitlement to a rating higher than 30 percent since June 30, 2016 In July 2016, the Veteran underwent another VA examination during which his shoulder motion was again found to be less than normal, with flexion measuring to 100 degrees, abduction measuring to 80 degrees, external rotation measuring to 30 degrees, and internal rotation measuring to 90 degrees. Localized tenderness was again observed in his AC joint and in the anterior portion of his shoulder. Pain, weakness, fatigability and incoordination were noted, as well, further limiting functional ability during flare-ups or when the joint was used repeatedly beyond what was described during the examination. No additional ROM loss, however, was reported during flare-ups beyond what was documented in the examination. The Veteran also reported interference with lifting objects and reaching overhead. A reduction in strength was also noted in his forward flexion and his abduction. A rotator cuff condition was also noted, accompanied by a positive "empty can test" (used to ascertain rotator cuff pathology). The examiner also noted the Veteran underwent a rotator cuff repair on June 16, 2016, so the month prior to that examination. Additionally, favorable ankylosis in abduction up to 60 degrees was noted. Consequently, the Veteran was awarded a higher 30 percent rating under DC 5200 beginning June 30, 2016 due to his favorable ankylosis in a December 2016 rating decision. That apparently was when VA had received his private treatment records reporting his rotator cuff repair surgery. As noted in the report of the July 2016 VA examination, however, his surgery was performed on June 16, 2016. Therefore, the Board finds that he is entitled to a higher 30 percent rating for his right shoulder disability beginning on the slightly earlier date of June 16, 2016. The Veteran was then provided another examination in September 2020 to comply with the requirements of Correia v. McDonald, 28 Vet. App. 158, 168-70 (2016). He reported that his shoulder had become more painful, with weakness and a constant dull ache. During flare-ups, he indicated his pain is worse and his mobility is limited, which occurs several times a month. With regards to functional loss, he again reported difficulty lifting items overhead and reaching overhead. His ROM measurements were considered abnormal or outside the normal range. Specifically, flexion was measured at 100 degrees, abduction measured to 95 degrees, external rotation to 80 degrees, and internal rotation to 30 degrees. No additional loss of ROM was noted with passive ROM. The Board interprets the Veteran's reports of increased shoulder pain and difficulty lifting objects overhead during his most recent September 2020 VA examination to be indicative of his limited ROM to midway between his side and shoulder level (i.e., to 45 degrees since shoulder level is 90 degrees). See 38 C.F.R. § 4.71, Plate I. The Board finds that the preponderance of the evidence is against a rating greater than 30 percent for his right shoulder disability. The evidence of record shows that he is right-handed, and the Board acknowledges his lay reports of symptoms and that there was functional loss due to pain, weakness, fatigability and incoordination during flare-ups, and pain during repetitive use over time. However, even considering his lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements that he has additional pain and difficulty lifting and reaching overhead would not result in symptoms more nearly approximating limitation of motion of his arm to just 25 degrees from his side of the major extremity or unfavorable ankylosis with abduction limited to 25 degrees from his side. He still has greater ROM than that. The Board also has considered whether any other DCs concerning disabilities of the shoulder would provide for a higher or additional rating. But the evidence does not reflect that the symptoms would warrant any higher rating under a different DC. See 38 C.F.R. § 4.71a. For example, he was previously noted to have favorable ankylosis with abduction to 60 degrees, which at most warrants a 30 percent under DC 5200 (so the rating he now has). In conclusion, then, the preponderance of the evidence is against the Veteran's claim for a rating higher than 20 percent for his right shoulder disability prior to the earlier date of June 16, 2016 or to a rating higher than 30 percent since. In denying any greater ratings, the Board finds the benefit of the doubt doctrine is not applicable because the preponderance of the evidence is against the claim, not instead supportive of the claim or even in relative balance (equipoise). 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 3. Entitlement to a compensable rating for recurrent corneal erosion syndrome is denied. The Veteran contends he is entitled to a compensable rating for his recurrent corneal erosion syndrome. Specifically, he indicates he must wear hats and sunglasses when going outside because he experiences photophobia (light sensitivity) that results in significant pain. In November 2017 correspondence, he also indicates he must modify other aspects of his daily life because of his photophobia; for example, he indicates he has tinted the windows on his car and utilizes privacy screens on his computer monitors to reduce brightness and glare. The Veteran, however, already is being compensated for his photophobia in the rating assigned for his service-connected migraines. For example, he listed "sensitivity to light" during both his December 2015 and November 2016 VA examinations for headaches and migraines. So, this impairment is rated as parcel and parcel of this other service-connected disability. With regards to the Veteran's eye condition, specifically, the Board sees that he has a diagnosis of recurrent corneal erosion syndrome that is currently rated under DC 6066. DC 6066 provides ratings where vision in one eye (the poorer eye) is 10/200 or better. For a higher evaluation, the Veteran would need to demonstrate more severe visual impairment. Other DCs, such as DC 6009, which provide ratings for unhealed eye injuries, also have been considered; however, to receive a higher rating, as explained below, the Veteran would need to have experienced incapacitating episodes, a visual field defect, or impairment of muscle function none of which he has demonstrated in either treatment records or during his VA compensation examinations. DC 6009 is for unhealed eye injury and is among the eye disabilities for which the General Rating Formula for Diseases of the Eye is to be used. The General Rating Formula directs that the disability be rated based on either visual impairment or on incapacitating episodes, whichever results in a higher rating. 38 C.F.R. § 4.79, DC 6009. During the pendency of this appeal, VA issued a final rule revising the portion of the VA Schedule for Rating Disabilities that addresses the organs of special sense and schedule of ratings-eye. 89 Fed. Reg. 15316 (Apr. 10, 2018). The final rule went into effect May 13, 2018. Where there is a change in the rating criteria during the appeal period, the Board will consider the claim in light of both the former and revised schedular rating criteria, although an increased evaluation based on the revised criteria cannot predate the effective date of the amendments. Under the former criteria, DC 6009 instructed to evaluate pursuant to the General Rating Formula for Diagnostic Codes 6000 through 6009. The General Rating Formula for DCs 6000 through 6009 instructs to evaluate on the basis of either visual impairment due to the particular condition or on incapacitating episodes, whichever results in a higher evaluation. Where incapacitating episodes have a total duration of at least 1 week, but less than 2 weeks, during the past 12 months, a 10 percent rating is warranted. Where incapacitating episodes have a total duration of at least 2 weeks, but less than 4 weeks, during the past 12 months, a 20 percent rating is warranted. Where incapacitating episodes have a total duration of at least 4 weeks, but less than 6 weeks, during the past 12 months, a 40 percent rating is warranted. Where incapacitating episodes have a total duration of at least 6 weeks during the past 12 months, a 60 percent rating is warranted. A Note following the General Rating Formula indicates that, for VA purposes, an incapacitating episode is a period of acute symptoms severe enough to require prescribed bed rest and treatment by a physician or other healthcare provider. Under the revised criteria, DC 6009 instructs to evaluate pursuant to the General Rating Formula for Diseases of the Eye. The General Rating Formal for Diseases of the Eye instructs to evaluate on the basis of either visual impairment due to a particular condition or on incapacitating episodes, whichever results in a higher evaluation. Where there are documented incapacitating episodes requiring at least 1 but less than 3 treatment visits for an eye condition during the past 12 months, a 10 percent rating is warranted. Where there are documented incapacitating episodes requiring at least 3 but less than 5 treatment visits for an eye condition during the past 12 months, a 20 percent rating is warranted. Where there are documented incapacitating episodes requiring at least 5 but less than 7 treatment visits for an eye condition during the past 12 months, a 40 percent rating is warranted. Where there are documented incapacitating episodes requiring 7 or more treatment visits for an eye condition during the past 12 months, a 60 percent rating is warranted. Note (1) indicates that, for the purposes of evaluations under 38 C.F.R. § 4.79, an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes. Note (2) indicates that examples of treatment may include but are not limited to: systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions. Note (3) indicates that, for the purposes of evaluating visual impairment due to a particular condition, refer to 38 C.F.R. § 4.75-4.78 and to § 4.79, DCs 6061-6091. Both the former and revised criteria provide for consideration of visual impairment. The amendments made no substantive changes to how visual acuity is rated. With regard to visual field and muscle function examinations, the use of a Goldmann chart is no longer required. There are otherwise no substantive changes to how those types of visual impairment are rated. The evaluation of visual impairment is based on impairment of visual acuity (excluding developmental errors of refraction), visual field, and muscle function. 38 C.F.R. § 4.75(a). Examinations of visual impairment must be conducted by a licensed optometrist or ophthalmologist, and the examiner must identify the disease, injury, or other pathologic process for any visual impairment found. Id. § 4.75(b). Examinations of visual field or muscle function will be conducted only when medically indicated. Id. Evaluation of visual acuity is based on corrected distance vision with central fixation. 38 C.F.R. § 4.76(b)(1). The measurements for each eye are applied to the table for Impairment of Central Visual Acuity. Generally, the table is divided into steps corresponding to different levels of visual acuity for one eye, and each step is further divided into subsections of visual acuity for the other eye, with corresponding ratings. The rater will first locate the step that matches the visual acuity of the poorer eye. Within that step, the rater will then locate the subsection that matches the visual acuity of the better eye, which will produce the corresponding rating. Where a reported visual acuity is between two sequentially listed visual acuities, the visual acuity which permits the higher evaluation will be used. 38 C.F.R. § 4.76(c). Notably, under the new regs effective May 13, 2018, there were no substantive changes to §§ 4.75, 4.76, or the table of Impairment of Central Visual Acuity TABLE FOR VISUAL ACUITY The table of Impairment of Central Visual Acuity encompasses DCs 6061-66. Under DC 6061, a 100 percent rating is warranted for anatomical loss of both eyes. Under DC 6062, a 100 percent rating is warranted for no more than light perception in both eyes. DC 6063 provides ratings where there is anatomical loss of one eye (the poorer eye). A 40 percent rating is warranted where visual acuity of the other eye is 20/40. A 50 percent rating is warranted where visual acuity of the other eye is 20/50. A 60 percent rating is warranted where visual acuity of the other eye is 20/100 or 20/70. A 70 percent rating is warranted where visual acuity of the other eye is 20/200. An 80 percent rating is warranted where visual acuity of the other eye is 15/200. A 90 percent rating is warranted where visual acuity of the other eye is 10/200. A 100 percent rating is warranted where visual acuity of the other eye is 5/200. DC 6064 provides ratings where there is no more than light perception in one eye (the poorer eye). A 30 percent rating is warranted where visual acuity in the other eye is 20/40. A 40 percent rating is warranted where visual acuity in the other eye is 20/50. A 50 percent rating is warranted where visual acuity in the other eye is 20/70. A 60 percent rating is warranted where visual acuity in the other eye is 20/100. A 70 percent rating is warranted where visual acuity in the other eye is 20/200. An 80 percent rating is warranted where visual acuity in the other eye is 15/200. A 90 percent rating is warranted where visual acuity in the other eye is 10/200. A 100 percent rating is warranted where visual acuity in the other eye is 5/200. DC 6065 provides ratings where vision in one eye (the poorer eye) is 5/200. A 30 percent rating is warranted where vision in the other eye is 20/40. A 40 percent rating is warranted where vision in the other eye is 20/50. A 50 percent rating is warranted where vision in the other eye is20/70. A 60 percent rating is warranted where vision in the other eye is 20/100. A 70 percent rating is warranted where vision in the other eye is 20/200. An 80 percent rating is warranted where vision in the other eye is 15/200. A 90 percent rating is warranted where vision in the other eye is 10/200. A 100 percent rating is warranted where vision in the other eye is also 5/200. DC 6066 provides ratings where vision in one eye (the poorer eye) is 10/200 or better. Where the visual acuity in both eyes is 20/40, a 0 percent rating is warranted. Where the visual acuity in one eye (the poorer eye) is 20/50, the following ratings apply. A 10 percent rating is warranted where vision in the other eye is either 20/50 or 20/40. Where the visual acuity in one eye (the poorer eye) is 20/70, the following ratings apply. A 30 percent rating is warranted where vision in the other eye is also 20/70. A 20 percent rating is warranted where vision in the other eye is 20/50. A 10 percent rating is warranted where vision in the other eye is 20/40. Where the visual acuity in one eye (the poorer eye) is 20/100, the following ratings apply. A 50 percent rating is warranted where vision in the other eye is also 20/100. A 30 percent rating is warranted where vision in the other eye is 20/70. A 20 percent rating is warranted where vision in the other eye is 20/50. A 10 percent rating is warranted where vision in the other eye is 20/40. Where visual acuity in one eye (the poorer eye) is 20/200, the following ratings apply. A 70 percent rating is warranted where vision in the other eye is also 20/200. A 60 percent rating is warranted where vision in the other eye is 20/100. A 40 percent rating is warranted where vision in the other eye is 20/70. A 30 percent rating is warranted where vision in the other eye is 20/50. A 20 percent rating is warranted where vision in the other eye is 20/40. Where visual acuity in one eye (the poorer eye) is 15/200, the following ratings apply. An 80 percent rating is warranted where vision in the other eye is also 15/200. A 70 percent rating is warranted where vision in the other eye is 20/200. A 60 percent rating is warranted where vision in the other eye is 20/100. A 40 percent rating is warranted where vision in the other eye is 20/70. A 30 percent rating is warranted where vision in the other eye is 20/50. A 20 percent rating is warranted where vision in the other eye is 20/40. Where visual acuity in one eye (the poorer eye) is 10/200, the following ratings apply. A 90 percent rating is warranted where vision in the other eye is also 10/200. An 80 percent rating is warranted where vision in the other eye is 15/200. A 70 percent rating is warranted where vision in the other eye is 20/200. A 60 percent rating is warranted where vision in the other eye is 20/100. A 50 percent rating is warranted where vision in the other eye is 20/70. A 40 percent rating is warranted where vision in the other eye is 20/50. A 30 percent rating is warranted where vision in the other eye is 20/40. Analysis The Veteran was provided VA examinations in April 2016 and January 2017, both of which measured his visual acuity at 20/40 or better in each eye. With regards to visual field testing, the April 2016 VA examiner noted that the Veteran's visual field was slightly contracted superiorly in each eye. The examiner, however, explained that this was more likely due to the Veteran's photophobia and squinting during the test rather than due to a visual field loss. The examiner noted there was no current pathology or etiology of visual field loss at that time. This same observation was made during the following January 2017 VA eye examination. Consequently, the Board finds there to be no visual field defects reported during the review period. The evidence of record indicates the Veteran has neither experienced incapacitating episodes nor decreased visual acuity; meaning, his eye condition is considered noncompensable under both the former rating criteria as well as the post-2018 rating criteria. Consequently, the Board finds that a compensable initial rating is not warranted. The probative evidence of record, to include the April 2016 and January 2017 VA examinations, and post-service VA treatment records, do not reflect corrected distance vision of 20/50 in one eye and 20/40 in the other eye, which would be necessary for a higher evaluation. On the contrary, the medical evidence reflects corrected distance vision measuring no more than 20/40 in each eye, which equates to a noncompensable rating based on impairment of visual acuity. The Board has considered whether a higher rating or any additional ratings are warranted under an alternative diagnostic code but finds that there is no indication that the Veteran has a visual field defect, impairment of muscle function, or incapacitating episodes to warrant any higher or additional ratings. Here, the Veteran's bilateral eye disability is manifested by corrected distance vision of 20/40 or better in the right eye and 20/40 or better in the left eye, which warrants a noncompensable rating under DC 6066. As the Veteran's bilateral eye disability is not productive of any visual impairment or incapacitating episodes, the currently assigned noncompensable initial rating for recurrent corneal erosion syndrome under DC 6066 is appropriate. The Board acknowledges the Veteran's assertions that his eye condition is more severe than the assigned disability rating reflects, especially when considering his photophobia, which, as explained, has been considered as a symptom associated with his migraine headache rating. The Veteran is competent to report observable symptoms. Laynov. Brown, 6 Vet. App. 465 (1994). However, in this case, the competent medical evidence offering specific specialized determinations relevant to the rating criteria are the most probative evidence with regard to evaluating the pertinent symptoms of the Veteran's bilateral eye disability. In conclusion, as the Board finds that the preponderance of the evidence is against the Veteran's claim for a compensable initial rating for recurrent corneal erosion syndrome, the claim must be denied. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. REASONS FOR REMAND Entitlement to a rating higher than 10 percent for left knee ACL tear with arthritis is remanded. This claim previously was remanded since "inextricably intertwined" with the now-decided CUE claim. In the prior remand directives, the Board instructed the RO (AOJ) to "ensure that all necessary development is complete and readjudicate the claim of entitlement to a disability rating in excess of 10 percent for left knee anterior cruciate ligament tear with arthritis." The necessary development includes the scheduling of an additional VA examination reassessing the severity of this service-connected disability. Because there is no indication this needed additional VA examination was scheduled or completed, this still needs to be done before deciding the appeal of this claim especially since the Veteran alleges an appreciable worsening of this disability since his last VA examination for it in December 2015. In addition, pursuant to Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." This inquiry was not performed during the Veteran's prior December 2015 VA examination, therefore, must be addressed during this additional examination. All that said, records show the Veteran failed to report to a scheduled examination in November 2017, so in the interim, which could have provided additional information pertinent to evaluating the severity of his left knee disability and corrected the deficiencies in his prior December 2015 examination. He was notified of this failure to report in a March 2018 rating decision. In a subsequent October 2018 Notice of Disagreement (NOD), he acknowledged missing that intervening examination, but without giving any reason or explanation (good cause) for his failure to attend that appointment. He then nonetheless requested an additional examination, and the Board agrees he should be given this additional opportunity before deciding his appeal of this claim. There is a presumption of administrative regularity supporting the official acts of public officers and, in the absence of clear evidence to the contrary, Courts presume they have properly discharged their official duties. Clear evidence to the contrary is required to rebut this presumption. Ashley v. Derwinski, 2 Vet. App. 307 (1992) (quoting United States v. Chemical Foundation, 272 U.S. 1, 14-15 (1926)). But, in this regard, the Board has found clear evidence in the claims file that the Veteran was not properly notified of that intervening 2017 VA examination. Namely, the claims file does not contain a copy of the notification letter confirming the scheduling of that examination. Moreover, a VA Form 21-2507a, Request for Physical Examination, in the claims file from November 2017 indicates a discrepancy in the Veteran's current address between the Veterans Benefits Administration (VBA) and Veterans Health Administration (VHA) databases. There is no indication an address was verified prior to mailing any examination notification letter. The Board additionally sees there is an open examination request from January 2019 that does not appear to have been fulfilled. Therefore, on this issue, because there is clear evidence to the contrary, it cannot be presumed that VA properly mailed notice of the examination scheduled in November 2017 to the Veteran's then current address in the normal course of business. See, e.g., Kuo v. Derwinski, 2 Vet. App. 662, 665 (1992). Consequently, the examination must be rescheduled. The Board emphasizes, however, that the duty to assist by providing him this VA examination is a two-way street, and his failure to complete any future scheduled VA examination does not create an additional duty for VA to provide any additional examinations relating to this claim. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Accordingly, this claim is again REMANDED for the following still additional development and consideration: Again schedule the Veteran for an examination by an appropriate clinician to reassess the severity of his service-connected left knee ACL tear with arthritis. To this end, the examiner must provide a full description of this disability and report all signs and symptoms necessary for evaluating it under the applicable rating criteria. In so doing, the examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing. Also indicate whether there is instability and, if there is, whether it is slight, moderate, or severe. If it is not possible to provide a specific measurement or finding without speculating, such as because the Veteran is not experiencing the symptom during the evaluation, determine whether a response can be gleaned from other evidence in the file, including by considering his self-recounted lay history of this disability, or indicate whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training), or specify whatever other reason precludes responding. KEITH W. ALLEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. B. Kucera 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.