Citation Nr: 21071448 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 15-04 528 DATE: November 30, 2021 ORDER Entitlement to a disability rating in excess of 10 percent for right knee degenerative arthritis based on painful motion or limitation of motion is denied. Entitlement to a disability rating of 20 percent, but no higher, for right knee meniscal and anterior cruciate ligament (ACL) tear, post-operative repair, is granted. FINDINGS OF FACT 1. The Veteran's right knee degenerative arthritis was manifested by limitation of extension with painful motion. 2. The Veteran's right knee meniscal and anterior cruciate ligament (ACL) tear, post-operative repair, was manifested by moderate instability. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for right knee degenerative arthritis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5261. 2. The criteria for a rating of 20 percent, but no higher, for right knee meniscal and anterior cruciate ligament (ACL) tear, post-operative repair, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5257. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1987 to August 1990. These matters come to the Board of Veterans' Appeals (Board) on appeal from a January 2013 rating decision which, in pertinent part, continued a 10 percent evaluation for right knee degenerative changes based on painful motion, continued a 10 percent evaluation for right knee traumatic osteoarthropathy based on instability, and denied service connection for a left knee disability. In April 2018, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a Board videoconference. A copy of the transcript is of record. In July 2018, June 2019, and May 2020, the Board remanded the matters for further development. In an August 2021 rating decision, VA granted service connection for a left knee disability. As the grant of service connection for a left knee disability represents a complete grant of the benefit sought on appeal, the claim is no longer before the Board. Increased Ratings Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3. Where entitlement to compensation has already been established and an increase in disability rating is at issue, the present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Within that context, VA must assess the level of disability from the date of initial application and determine whether the level of disability warrants the assignment of different disability ratings at different times over the life of the claim, a practice known as a "staged rating." See Fenderson v. West, 12 Vet. App. 119 (1999). The relevant temporal focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Generally, the Board has been directed to consider only those factors contained wholly in the rating criteria. See Massey v. Brown, 7 Vet. App. 204, 208 (1994); but see Mauerhan v. Principi, 16 Vet. App. 436 (2002) (finding it appropriate to consider factors outside the specific rating criteria in determining level of occupational and social impairment). The standard of proof to be applied in decisions on claims for veteran's benefits is set forth in 38 U.S.C. § 5107. A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 C.F.R. § 3.102. When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). 1. Entitlement to a disability rating in excess of 10 percent for right knee degenerative arthritis. 2. Entitlement to a disability rating in excess of 10 percent for right knee meniscal and anterior cruciate ligament (ACL) tear, post-operative repair (previously diagnosed as traumatic osteoarthropathy with instability). The Veteran contends that increased ratings are warranted for his right knee disability. The decision on appeal stems from the Veteran's June 2011 claim for increased ratings for his right knee. The Board notes that the relevant temporal focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed. However, in a September 2010 decision, the Board denied an evaluation in excess of 10 percent for the Veteran's right knee disability based on instability and granted service connection for right knee degenerative arthritis. In a November 2010 rating decision, VA effectuated the Board's grant of service connection for right knee degenerative arthritis and assigned an initial disability rating of 10 percent, effective December 7, 2006, under DC 5010-5260 for painful motion. The Veteran did not file a motion for reconsideration or appeal the Board's September 2010 decision or the November 2010 rating decision. As such, those decisions became final, and the Board will consider the Veteran's right knee instability from September 22, 2010 and his right knee degenerative arthritis from November 10, 2010. The Veteran's right knee degenerative arthritis is rated at 10 percent under Diagnostic Code (DC) 5010-5260 prior to August 16, 2021 for painful motion and under DC 5003-5261 thereafter for compensable limitation of extension. His right knee meniscal and ACL condition is rated under DC 5257 prior to March 8, 2019 for slight lateral instability and under DC 5259 thereafter for symptomatic post-meniscectomy residuals. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the rating assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. DC 5010, arthritis due to trauma and substantiated by x-ray findings, is rated under degenerative arthritis. Under DC 5003, degenerative arthritis is rated on the basis of limitation of motion of the specific joint or joints involved. When limitation of motion at the joint involved is noncompensable, a 10 percent rating is warranted for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added, under DC 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Knee disabilities are rated under Diagnostic Codes (DC) 5256-5263. 38 C.F.R. § 4.71a. DC 5256 provides a 40 percent rating for ankylosis of a knee in flexion between 10 degrees and 20 degrees. A 50 percent rating is assigned for ankylosis of a knee between 20 degrees and 45 degrees and maximum 60 percent rating is assigned for extremely unfavorable ankylosis, in flexion at an angle of 45 degrees or more. DC 5257 provides a 10 percent rating for slight recurrent subluxation or lateral instability, 20 percent for moderate recurrent subluxation or lateral instability, and 30 percent for severe recurrent subluxation or lateral instability. Neither the Rating Schedule nor the regulations provide definitions for descriptive words such as "slight," "mild," "moderate," "moderately severe," and "severe." Sellers v. Wilkie, 30 Vet. App. 157 (2018) ("DC 5257 does not define 'mild,' 'moderate,' or 'severe,' or generally associate those terms with specific symptoms"). Rather than applying a mechanical formula, the Board must instead evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. DC 5258 provides that a 20 percent rating may be assigned for dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint. DC 5259 provides a 10 percent rating for symptomatic semilunar removal of the cartilage. DC 5260 provides for the evaluation of limitation of flexion of the knee. A non-compensable rating is warranted when flexion is limited to 60 degrees. A 10 percent rating is warranted when flexion is limited to 45 degrees, a 20 percent rating is warranted when flexion is limited to 30 degrees, and a 30 percent rating is warranted where flexion is limited to 15 degrees. DC 5261 provides for the evaluation of limitation of extension of the knee. Extension limited to 5 degrees warrants a 0 percent rating, extension limited to 10 degrees warrants a 10 percent rating, extension limited to 15 degrees warrants a 20 percent rating, extension limited to 20 degrees warrants a 30 percent rating, extension limited to 30 degrees warrants a 40 percent rating, and extension limited to 45 degrees warrants a 50 percent rating. Normal range of motion of the knee is to 140 degrees when considering flexion, and to 0 degrees when considering extension. See 38 C.F.R. § 4.71, Plate II. DC 5262 for impairment of the tibia and fibula provides for a 10 percent rating for malunion with slight knee or ankle disability, a 20 percent rating for malunion with moderate knee or ankle disability, a 30 percent rating for malunion with marked knee or ankle disability, and a 40 percent rating for nonunion with loose motion requiring a brace. DC 5263 provides for a 10 percent rating for genu recurvatum, acquired, traumatic, with weakness and insecurity in weight-bearing objectively demonstrated. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. 38 C.F.R. § 4.40. It is important that when evaluating disabilities of the musculoskeletal system, functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements must be considered. See 38 C.F.R. § 4.40; DeLuca v. Brown, 8 Vet. App. 202 (1995). Consideration must also be given to weakened movement, excess fatigability, and incoordination. 38 C.F.R. § 4.45. It is the intent of the schedule to recognize painful motion with joint or periarticular pathology as productive of disability. It is also the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. In general, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. See 38 C.F.R. § 4.14. The critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See, e.g., Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. The Board notes that, effective February 7, 2021, the applicable rating criteria for the knee were revised. 85 Fed. Reg. 76453 (Nov. 30, 2020). When regulations are revised during the course of an appeal, the Board is generally required to consider the claim in light of both the former and revised schedular criteria and to apply the regulation more favorable to the Veteran. The new rating criteria, however, may be applied only prospectively from the effective date of the change forward, unless the regulatory change specifically permits retroactive application. VAOPGCPREC 3-2000 (Apr. 10, 2000); Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). The final rule did not specifically permit retroactivity of the changes. Relevant to this case, under the new criteria for DC 5257 for patellar instability, a 10 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: a brace, cane, or walker. A 30 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or walker. Under the new criteria for DC 5257 for recurrent subluxation or instability, a 10 percent rating is warranted for sprain, incomplete ligament tear or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability without a prescription from a medical provider for an assistive device (e.g., cane(s), crutches(es), walker) or brace for ambulation. A 20 percent rating is warranted for one of the following: a) a sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive devices (e.g., cane(s), crutch(es), walker) for ambulation. b) Unrepaired or failed repair of complete ligament tear causing persistent instability and medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), or a walker) or bracing for ambulation. A 30 percent rating is warranted for unrepaired or failed repair of complete ligament tear causing persistent instability and a medical provider prescribe both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation. Turning to the evidence of record, in a January 2012 VA Form 21-4138 (Statement in Support of Claim), the Veteran reported a torn ACL in his right knee with severe pain and instability resulting in several falls a week. An April 2012 VA knee examination report reflects diagnoses of right knee strain/ligament tear and patella dislocation. The Veteran reported a medial and lateral meniscectomy in 2008 and that his patella dislocated afterwards. He reported daily flare-ups depending on activity. Upon examination, flexion was to 125 degrees with pain beginning at 120. Extension was to zero. Range of motion was not reduced after repetitive use testing. The examiner indicated that the Veteran had functional loss or impairment of the right knee, including less movement than normal, weakened movement, pain on movement, swelling, instability of station, disturbance of locomotion, and interference with sitting, standing, and weight-bearing. There was pain on palpation and muscle strength was reduced to 4/5 in flexion and extension. Anterior, posterior, and medial-lateral instability were all 1+. The examiner indicated a history of meniscal tear with meniscectomy in 1988 and 2008 with residual symptoms of pain and weakness. There was no evidence or history of recurrent patellar subluxation or dislocation. The examiner noted constant use of a brace and occasional use of a cane. A September 2014 VA orthopedic consultation reflects the Veteran reported episodes of his right knee catching and giving out. An MRI revealed prior meniscectomies and meniscus tearing with chronic ALC disruption. Upon examination, anterior instability was 1+ but it was difficult to determine due to locking. There was no medial-lateral instability and the patella tracked well. There was mild tenderness to palpation but no effusion. The Veteran was able to fully extend the knee and he had good flexion. The Veteran was diagnosed with right knee ACL deficiency with medial meniscus tear and lateral compartment degenerative changes. In October 2014, the Veteran underwent a right knee arthroscopy with partial medial meniscectomy. An October 2014 VA physical therapy assessment reflects the Veteran was wearing a right knee brace and ambulated with minimal gait deviations. Flexion was to 115 degrees and extension was to 5 degrees. The clinician noted the Veteran was doing well following a medial meniscectomy and recommended a cane until gait was fully normalized. A December 2014 VA knee examination report reflects a diagnosis of right knee strain. The Veteran reported that his right knee had worsened over the years and he had flare-ups one to two times a month lasting for several hours which caused his knee give out or lock up and him to fall. He reported he could not walk or stand for long periods of time. Upon examination, flexion was to 120 degrees with pain causing functional loss. Extension was to zero degrees. Range of motion was not reduced after repetitive use testing or repeated use over time. The examiner was not able to say without speculation whether pain, weakness, fatigability, or incoordination significantly limited function ability during flare-ups as the examiner was unable to observe the Veteran during a flare-up. Muscle strength and instability tests were normal. The examiner indicated a history of meniscal tear with meniscectomy with residual symptoms of pain and the joint locking up or giving out. There was no evidence or history of recurrent patellar subluxation or dislocation. The examiner noted that the Veteran walked with a limp and regularly used a brace and occasionally used a cane. The examiner further noted that while the Veteran worked in an office, he could miss some work due to flare-ups, and while he could not do sports, he could vacuum and do other normal daily activities around the home. A VA treatment record dated in July 2015 for the Veteran's left knee reflects the Veteran reported his right knee felt better. However, treatment records dated in December 2017 and July 2018 reflect the Veteran reported that his right knee would give out on him and he occasionally fell. During the April 2018 Board hearing, the Veteran testified that his right knee had worsened and that he was experiencing pain and front-to-back and side-to-side instability resulting in falls. Based on the Veteran's contention that his right knee had worsened since his December 2014 VA examination, the Board remanded the matters in July 2018 so that the Veteran could be afforded a VA examination to assess the severity of his right knee disability. A January 2019 VA orthopedic consultation reflects the Veteran reported progressively worsening right knee pain that had worsened over the past year. He reported pain all over the knee, that he sometimes felt a popping sensation and that his knee wanted to give out, and rarely there were some locking symptoms. Upon examination, flexion was to 120 degrees and extension was to zero degrees. There was no obvious effusion or crepitation, but the knee was tender to palpation. The knee was stable to varus and valgus stress testing and anterior-posterior drawer tests were normal. The clinician recommended continued conservative treatment but noted that knee replacement may be needed in the future. A March 2019 VA examination report reflects diagnoses of right knee meniscal tear, ACL tear, and osteoarthritis. The Veteran reported flare-ups such that his knee locked up causing falls and that he would have to use a cane for two or three days. The Veteran reported he could walk, climb stairs, and ride a stationary bike, but could not run or play sports. Upon examination, flexion was to 130 degrees with pain noted but not causing functional loss. Extension was to zero degrees. Range of motion was not reduced after repetitive use testing or repeated use over time, but the Veteran reported pain limited functional ability with repeated use over time such that walking or standing for long periods of time was painful and he had been prescribed an offloading brace to help with this. The examiner was not able to say without speculation whether pain, weakness, fatigability, or incoordination significantly limited function ability during flare-ups. Muscle strength and instability tests were normal. The examiner indicated a history of meniscal tear with residual symptoms of pain and the joint locking up or giving out. There was no evidence or history of recurrent patellar subluxation or dislocation. The examiner noted that the Veteran walked with a limp and regularly used a brace. The examiner further noted that the Veteran could walk short distances without a brace or cane and was able to tie his shoes without difficulty, but that the Veteran reported he could not walk or stand for long periods of time and engage in sports. In June 2019, the Board remanded the matters, finding that the contemporaneous examinations did not comply with the requirements in Correia v. McDonald, 28 Vet. App. 158, 168 (2016) and Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). A February 2020 VA treatment record notes that upon examination, the Veteran had fairly good range of motion of the right knee and there was no significant pain. An August 2021 VA examination report reflects diagnoses of right knee strain, meniscal tear, ACL tear, degenerative arthritis, and chondromalacia patella. The Veteran reported chronic knee pain and instability and that his right knee would sometimes lock up and give out, causing him to fall. The Veteran reported flare-ups several times a month that were moderate to severe, brought on by walking or standing and relieved by sitting down, in which his knee would give out and he would have pain. He reported that right knee instability limited him in all activities. As to a history of instability or recurrent subluxation, the examiner marked yes and noted that the Veteran reported his right knee locked up or gave way. Upon examination, active and passive flexion were to 120 degrees and extension was to zero degrees, with range of motion contributing to functional loss such that it was difficult to walk or stand for prolonged periods. Flexion was reduced to 115 degrees and extension to 10 degrees due to pain after repetitive use testing. Repeated use and flare-ups reduced flexion to 105 degrees. The knee was tender to palpation. The examiner indicated that there was no recurrent subluxation or persistent instability or patellar instability, and that the Veteran's ligament tear was successfully repaired although he was prescribed a cane. The examiner commented that there was a history of moderate lateral instability but upon examination, stability testing was normal. The Veteran's meniscal tear resulted in frequent episodes of joint pain and locking. Upon review of the evidence of record, the Board finds that a disability rating in excess of 10 percent for the Veteran's right knee degenerative arthritis is not warranted at any point during the appeal period. Throughout the appeal period, the Veteran's right knee was manifested by painful motion with motion limited to, at most, 105 degrees of flexion and 10 degrees of extension. Painful motion with extension limited to 10 degrees warrants an evaluation of 10 percent. A higher, 20 percent evaluation, is not warranted, as the evidence of record does not show extension limited to 15 degrees. A separate rating based on limitation of flexion is not warranted, as painful motion is contemplated under the 10 percent evaluation for limitation of extension and flexion was not limited to 45 degrees, the criteria required for a separate compensable rating for limitation of flexion. As it pertains to the Veteran's right knee meniscal and ACL condition, the Board finds that a 20 percent evaluation, but no higher, is warranted throughout the appeal period under DC 5257. Tests during the April 2012 VA examination revealed lateral instability of 1+ and an examination during a September 2014 VA orthopedic consultation revealed anterior instability of 1+ with a note that stability testing was difficult to determine due to locking. While subsequent stability tests were normal, the Veteran continued to report instability in his knee for which he used a brace or cane, and which caused him to fall. During the August 2021 VA examination, the examiner indicated that stability tests were normal, but that there was a history of moderate lateral instability or recurrent subluxation and that the Veteran was prescribed a cane. As such, the Board finds that a 20 percent evaluation, but no higher, is warranted throughout the appeal period under DC 5257 for moderate instability. The record reflects that the Veteran's ACL tear was successfully repaired by surgery. However, the record shows that the Veteran's meniscal condition is manifested by symptoms such as pain, locking, weakness, and giving way or instability. These symptoms are contemplated by the rating criteria under both DC 5257 and 5259, with instability as a symptomatic residual of the meniscectomy. The critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). Assigning separate ratings under both diagnostic codes for the instability associated with the meniscal condition would violate the rules prohibiting pyramiding as it would compensate the Veteran twice for the same symptomatology, here, instability. 38 C.F.R. § 4.14. As discussed above, the Veteran's right knee meniscal and ACL condition has been rated under DC 5257 or DC 5259 depending on the predominant symptoms at the time. While the Veteran's is currently in receipt of a 10 percent rating under DC 5259 for symptomatic post-meniscectomy residuals, DC 5257 allows for higher disability ratings for impairment of the knee due to recurrent subluxation or lateral instability. The assignment of a particular diagnostic code is "completely dependent on the facts of a particular case" and the Board can choose the diagnostic code to apply so long as it is supported by reasons and bases as well as the evidence. Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors such as an individual's relevant medical history, diagnosis, and demonstrated symptomatology. Any change in diagnostic code by a VA adjudicator must be specifically explained. See Pernorio v. Derwinski, 2 Vet. App. 635, 639 (1992). It is permissible to switch diagnostic codes to reflect more accurately a claimant's current symptoms. See also Read v. Shinseki, 651 F. 3d 1296, 1302 (Fed. Cir. 2011) (holding that service connection for a disability is not severed when the Diagnostic Code associated with it is changed to determine more accurately the benefit to which a veteran may be entitled). As such, the Board finds that, as higher potential and actual ratings are available under DC 5257, it is more advantageous to the Veteran to be rated under these rating criteria. As noted above, separate ratings may not be assigned under DCs 5257 and 5259, as to do so would constitute pyramiding; therefore, because the Board is grating the higher 20 percent rating under DC 5257, the 10 percent rating under DC 5259 will be discontinued. However, this change in Diagnostic Code does not amount to a reduction, as the rating of the Veteran's knee disability increases from 10 to 20 percent as a result of this decision. The Board has considered whether higher ratings are warranted under the revised rating criteria from February 7, 2021. However, the revised rating criteria do not allow for a higher rating. Under DC 5257 for recurrent subluxation or instability, a 30 percent rating is warranted for unrepaired or failed repair of complete ligament tear causing persistent instability and a medical provider prescribe both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation. Here, the August 2021 VA examiner indicated that while the Veteran had a complete ligament tear of the ACL in 1990, the tear was successfully repaired. Thus, the criteria required for a 30 percent evaluation under the new rating criteria are not met. The Board has considered whether separate or higher ratings are warranted for the Veteran's right knee disability during the appeal period under another diagnostic code for the knee. However, the evidence of record does not show ankylosis of the knee, functional or otherwise, impairment of the tibia and fibula, or genu recurvatum such that a separate or higher rating is warranted under DCs 5256, 5262, or 5263. The Board has also considered whether a separate rating is warranted for a muscle injury. While the April 2012 VA examination report notes reduced muscle strength of 4/5 in flexion and extension, muscle strength since the April 2012 VA examination has been normal. Under the diagnostic codes relevant to muscle injuries of the foot and leg, slight muscle injuries are noncompensable. While "slight," "mild," "moderate," "moderately severe," and "severe" are not defined, the Board finds that upon review of the overall evidence of record, reduced muscle strength of 4/5, with normal muscle strength since, is more closely approximated by a slight muscle injury and would warrant a noncompensable evaluation. Thus, a separate or higher rating under the diagnostic codes for muscle injuries is not warranted. As it relates to the Board's June 2019 finding that finding that the contemporaneous examinations of record did not comply with the requirements in Correia v. McDonald, 28 Vet. App. 158, 168 (2016) and Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017), the Board notes that such examinations retain some probative value as they relate to initial ranges of motions, symptoms such as instability, and the Veteran's lay statements regarding the severity of his knee disability. Additionally, to the extent that any evidentiary deficiency was previously noted, the Board finds that such deficiencies were cured on remand and that the August 2021 VA examination complies with the requirements set forth in Correia v. McDonald, 28 Vet. App. 158 (2016) and Sharp Shulkin, 29 Vet. App. 26 (2017). The Board acknowledges that the Veteran believes that the disability on appeal has been more severe than the assigned disability ratings reflect and that he is competent to report observable symptoms. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, the Veteran has not shown that he has the training or medical expertise to competently report on the degree of his right knee disability as it pertains to the ratings criteria. As such, the Board finds the Veteran's representations in this regard to be of extremely limited probative value and outweighed by the medical evidence concerning the severity of the Veteran's right knee disability as discussed above. In sum, and resolving all reasonable doubt in his favor, the Board finds that a 20 percent rating, but no higher, based on instability is warranted for right knee meniscal and anterior cruciate ligament (ACL) tear, post-operative repair, throughout the appeal period. To the extent that the Veteran contends that a rating in excess of 10 percent is warranted for painful motion, in excess of 20 percent for instability, the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application, and the Veteran's claim is denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Owen, 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.