Citation Nr: 21072769 Decision Date: 12/06/21 Archive Date: 12/06/21 DOCKET NO. 15-22 924 DATE: December 6, 2021 ORDER Entitlement to a rating in excess of 10 percent for a left knee disability characterized as arthritis of the left knee is denied. Entitlement to a rating in excess of 20 percent for a meniscus condition of the left knee is denied. FINDINGS OF FACT 1. The probative evidence of record reflects the Veteran's left knee degenerative arthritis, is not productive of compensable limitation of motion or ankylosis, or involving 2 or more minor joint groups, with occasional incapacitating exacerbations. 2. The Veteran's left knee disability has been shown to be manifested by no more than pain, flare-ups, crepitus, frequent episodes of locking, weakness, weekly flare-ups, a meniscus condition with decreased, noncompensable range of motion. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for arthritis of the left knee have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.71a, Diagnostic Code (DC) 5003. 2. The criteria for a rating in excess of 20 percent for a meniscus condition of the left knee have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.71a, DC 5258. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from February 1988 to February 1992. In August 2018, the Veteran presented sworn testimony during a Travel Board hearing in San Juan, Puerto Rico. A transcript of the hearing has been associated with the claims file. The Board previously remanded this claim in February 2019, November 2020, and March 2021. Increased Rating The Veteran is seeking entitlement to higher ratings for his left knee disability, which is presently rated at 10 percent pursuant to DC 5003, and a separate rating of 20 percent pursuant to DC 5003-5257. For the sake of brevity, the Board will provide all the legal criteria before addressing the factual evidence of record. Then, the Board will provide an analysis of any and all diagnostic code that may pertain to the left knee disability. Legal Criteria Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155 (West 2012); 38 C.F.R. § 4.1 (2020). A claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Thus, separate ratings can be assigned for separate periods of time based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). 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. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In determining the appropriate evaluation for musculoskeletal disabilities, particular attention is focused on functional loss of use of the affected part. Under 38 C.F.R. § 4.40, functional loss may be due to pain, supported by adequate pathology and evidenced by visible behavior on motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Under 38 C.F.R. § 4.45, factors of joint disability include increased or limited motion, weakness, fatigability, or painful movement, swelling, deformity or disuse atrophy. A Veteran may be entitled to a higher disability evaluation for a musculoskeletal disability than that supported by mechanical application of the rating schedule where there is evidence that his or her disability causes additional functional loss, such as the inability... to perform the normal working movements of the body with normal excursion, strength, speed, coordination[,] and endurance, including as due to pain. 38 C.F.R. § 4.40 (2020); see Lyles v. Shulkin, 29 Vet. App. 107, 117 (2017). A higher disability evaluation may also be awarded where there is a reduction of a joint's normal excursion of movement in different planes, including changes in the joint's range of movement, strength, fatigability, or coordination. 38 C.F.R. § 4.45 (2020). However, the veteran's functional loss must result in limitation of motion sufficient to satisfy the next disability rating allowable for that particular disorder to be entitled to a higher disability rating under §§ 4.40 and 4.45. See Thompson v. McDonald, 815 F.3d 781, 785-86 (Fed. Cir. 2016). Under 38 C.F.R. § 4.59, painful motion is an important factor of joint disability and actually painful joints are entitled to at least the minimum compensable rating for the joint. This regulation also requires that, whenever possible, the joints involved are tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint. See Correia v. McDonald, 28 Vet. App. 158, 168 (2016). Where functional loss is alleged due to pain upon motion, the provisions of 38 C.F.R. § 4.40 and § 4.45 must be considered. DeLuca v. Brown, 8 Vet. App. 202, 207-08 (1995). Within this context, a finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the claimant. Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Pain itself does not rise to the level of functional loss as contemplated by § 4.40 and § 4.45, but may result in functional loss only if it limits the ability to perform the normal working movements of the body with normal excursion, strength, coordination or endurance. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). A United States Court of Appeals for Veterans Claims (Court) decision addressed what constitutes an adequate explanation for an examiner's inability to estimate motion loss in terms of degrees during periods of flare-ups. Sharp v. Shulkin, 29 Vet. App. 26 (2017). In Sharp, the Court held that a VA examiner must attempt to elicit information from the record and the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups before determining that an estimate of motion loss in terms of degrees could not be given. It also held that any inability to furnish such an estimate must be predicated on a lack of medical knowledge among the medical community at large, rather than insufficient knowledge by the individual examiner. Id. Effective February 7, 2021, VA's Schedule, 38 C.F.R. Part 4, was amended with regard to rating musculoskeletal disorders. Fed. Reg. 76453 (November 30, 2020) (codified at 38 C.F.R. § 4.71a ). When a law or regulation changes during the course of a claim or an appeal, the version more favorable to the veteran will apply, to the extent permitted by any stated effective date in the amendment in question. VAOPGCPREC 3-2000 ; Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). The revised musculoskeletal regulations do not provide for retroactive application; thus, the amendments may be applied as of, but not prior to, February 7, 2021. Hence, VA has made clear that its intent is that the 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. For applications filed on or after the effective date, only the new criteria will be applied. As the Veteran's claim was pending prior to February 7, 2021, the Board will consider entitlement under the prior regulations as well as the revised regulations beginning February 7, 2021, applying the most favorable criteria for the Veteran. The schedular criteria for evaluating disabilities of the musculoskeletal system, including the knee, have undergone revision during the pendency of this appeal. Specifically, and as relevant to this case, revisions to Diagnostic Codes 5003, 5010, and 5257 were made effective February 7, 2021. See 85 Fed. Reg. 76460, 76457 (Feb 7, 2021). When a law or regulation changes during the course of a claim or an appeal, the version more favorable to the veteran will apply, to the extent permitted by any stated effective date in the amendment in question. VAOPGCPREC 3-2000 ; Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). The revised musculoskeletal regulations do not provide for retroactive application; thus, the amendments may be applied as of, but not prior to, February 7, 2021. Hence, VA has made clear that its intent is that the 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. For applications filed on or after the effective date, only the new criteria will be applied. As the Veteran's claim was pending prior to February 7, 2021, the Board will consider entitlement under the prior regulations as well as the updated regulations from February 7, 2021 forward, applying the most favorable criteria for the Veteran. Prior to February 7, 2021, Diagnostic Code 5010, instructed the rater to rate traumatic arthritis as degenerative arthritis under Diagnostic Code 5003. Under the revised criteria, Diagnostic Code 5010 applies only to post-traumatic arthritis, which is to be rated as limitation of motion, dislocation, or other specified instability under the affected joint. If there are 2 or more joints affected, each rating shall be combined in accordance with § 4.25. Under both the earlier and revised rating criteria, degenerative arthritis is rated under Diagnostic Code 5003. Under this code, arthritis established by X-ray findings is 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, to be combined and not added, under Diagnostic Code 5003. For purpose of rating disability from arthritis, the knee is considered a major joint. 38 C.F.R. § 4.45 (f). For rating purposes, normal range of motion in a knee joint is from 0 to 140 degrees. 38 C.F.R. § 4.71, Plate II. The Rating Schedule provides for ratings of 0, 10, 20, or 30 percent where there is limitation of flexion of the leg to 60, 45, 30, or 15 degrees, respectively, and for ratings of 0, 10, 20, 30, 40, or 50 percent for limitation of extension of the leg to 5, 10, 15, 20, 30, or 45 degrees, respectively. 38 C.F.R. § 4.71a, Diagnostic Codes 5260, 5261. VA's General Counsel has held that separate ratings are available for limitation of flexion and limitation of extension under Diagnostic Codes 5260 and 5261. VAOPGCPREC 9-2004 (2004). As it pertains to recurrent subluxation or instability of the knee, revisions to Diagnostic Code 5257 were made effective February 7, 2021. See 85 Fed. Reg. 76457 (Feb 7, 2021). As these changes took effect during the pendency of the Veteran's appeal, both the former and revised criteria will be considered, however, application of the new criteria prior to the effective date of the amended regulation is not allowed. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Prior to February 7, 2021, instability of the knee was rated under Diagnostic Code 5257, which provided ratings of 10, 20, and 30 percent for recurrent subluxation or lateral instability of the knee, which is slight, moderate, or severe, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5257. Effective February 7, 2021, Diagnostic Code 5257 provides ratings for both recurrent subluxation or instability of the knee and for patellar instability. As it pertains to recurrent subluxation or instability of the knee, Diagnostic Code 5257 provides a 10 percent rating for a sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 20 percent rating is warranted for either (a) sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device, or (b) unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device 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 prescribes both an assistive device and bracing for ambulation. As it pertains to patellar instability of the knee, Diagnostic Code 5257 provides a 10 percent rating 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 assigned 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 a walker. Note (1): For patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. Note (2): 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). See DC 5257 (Effective February 7, 2021). Diagnostic Code 5258 provides a 20 percent rating may be assigned for dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint. Diagnostic Code 5259 provides for a 10 percent rating for symptomatic removal of the semilunar cartilage. In the present case, the Board notes that consideration of other Diagnostic Codes for rating knee disabilities (5256, 5262, 5263) is inappropriate as the Veteran's bilateral knee disabilities do not include the pathology required in the criteria for those Diagnostic Codes (ankylosis, malunion or nonunion of tibia or fibula, or genu recurvatum). 38 C.F.R. § 4.71a. Factual Evidence The Veteran filed his claim for an increased rating for the left knee disability for the right and left knee disabilities in May 2011. Therefore, the relevant temporal focus pertaining to the right and left knee disabilities is from May 2010 to the present. See 38 C.F.R. § 3.400. During the pendency of the appeal, the Veteran was scheduled for VA examinations to assess the severity of his left knee disability in May 2014, May 2016, September 2016, January 2017, November 2019, November 2020, and finally in March 2021. Turning first to the May 2014 VA Knee Conditions Disability Benefits Questionnaire (DBQ), left knee degenerative joint disease (confirmed by x-ray findings) with anterior cruciate lesion, and anterior cruciate ligament reconstruction was confirmed as the diagnosis. The Veteran reported severe weekly flare-ups, precipitated by walking, prolonged standing, climbing stairs, and kneeling. Range of motion testing revealed flexion to 75 degrees or greater, with pain at 70 degrees; and extension to 0 degrees, with no evidence of pain. The Veteran was able to perform repetitive-use testing, with no additional limitation of motion. Functional loss was noted as pain on movement and crepitance. There was pain on palpation. Muscle strength testing was normal and there was no evidence of instability. There was also no evidence of patellar subluxation or dislocation. The examiner noted that the Veteran suffers from frequent episodes of locking and joint pain due to a meniscus condition. It was also noted the Veteran requires the constant use of a brace. The examiner indicated that pain could significantly limit functional ability during flare-ups or over a period of time; however, there was no evidence of fatigability, incoordination, muscle weakness or pain during the examination. Further, the examiner stated it was not possible to express additional limitation due to pain in terms of degrees of range of motion because it should be documented during a flare-up, not during a regular medical examination. To do so not during a flare-up would be speculative. No other objective findings were noted. The Veteran was next examined by VA in a May 2016 Knee Conditions DBQ. The Veteran reported flare-ups, which required him to limit ambulation and rest. He also reported functional limitations of inability to walk distances and run or jog. Range of motion testing revealed flexion to 100 degree, and extension to 0. It was noted pain was present on flexion but did not result in/ cause functional loss. There was evidence of pain on weight-bearing, and pain at the peripatellar area, but no evidence of crepitus. The Veteran was able to perform repetitive-use testing, with no additional limitation of motion. Over a period of time and during flare-ups, the examiner indicated that the examination was medically consistent with the Veteran's statements describing functional loss with repetitive use over time, but was unable to state whether pain, weakness, fatiguability, or incoordination significantly limited function ability without resort to speculation because of the individual nature of musculoskeletal disorders that could potentially cause functional limitations. Muscle strength testing showed a 4/5 for both flexion and extension, but no muscle atrophy or ankylosis. There was no evidence of recurrent subluxation, instability, effusion, or any other conditions. The examiner also found arthralgia due to the left knee meniscectomy. No other objective findings were noted. The September 2016 VA Knee Conditions DBQ also noted the Veteran's report of daily flare-ups, lasting hours and resulting in the loss of tolerance for standing and ambulation. Range of motion testing revealed flexion to 100 degree, and extension to 0. It was noted pain was present on flexion but did not result in/ cause functional loss. There was evidence of pain on weight-bearing, and pain at the peripatellar area, but no evidence of crepitus. The Veteran was able to perform repetitive-use testing, with no additional limitation of motion. Over a period of time and during flare-ups, the examiner indicated that the examination was medically consistent with the Veteran's statements describing functional loss with repetitive use over time, but was unable to state whether pain, weakness, fatiguability, or incoordination significantly limited function ability without resort to speculation because of the individual nature of musculoskeletal disorders that could potentially cause functional limitations. Muscle strength testing showed a 4/5 for both flexion and extension, but no muscle atrophy or ankylosis. There was no evidence of recurrent subluxation, instability, effusion, or any other conditions. The examiner also found pain and weakness due the left knee meniscectomy. No other objective findings were noted. In September 2016, VA obtained an addendum opinion to the September 2016 VA Knee Conditions DBQ. This addendum opinion referred only to a claimed right knee disorder that is not presently on appeal before the Board. The Veteran was next examined by VA in January 2017. The January 2017 VA Knee Conditions DBQ examiner noted the Veteran's report of flare-ups, resulting in limitations to walking and the use of pain medications. Range of motion testing revealed flexion to 120 degree, and extension to 0. It was noted pain was present on flexion but did not result in/ cause functional loss. There was evidence of pain on palpation, but no evidence of crepitus or pain on weight-bearing. The Veteran was able to perform repetitive-use testing, with no additional limitation of motion. Over a period of time and during flare-ups, the examiner indicated that the examination was medically consistent with the Veteran's statements describing functional loss with repetitive use over time, but was unable to state whether pain, weakness, fatiguability, or incoordination significantly limited function ability without resort to speculation because of the individual nature of musculoskeletal disorders that could potentially cause functional limitations. Muscle strength testing was normal, and there was no evidence of muscle atrophy or ankylosis. There was no evidence of recurrent subluxation, instability, effusion, or any other conditions. The examiner also found evidence of tendinitis and arthralgia due to the meniscectomy. Further, it was noted that stress valgus examination was positive at the left knee due to pain at the medial collateral ligament. The examiner concluded that the MCL tendinitis is at least as likely as not secondary to the left knee disability due to compensatory ambulation to avoid pain at the joint. No other objective findings were noted. The November 2019 VA Knee Conditions DBQ examiner noted the report of pain and stiffness in the left knee, which is worse after climbing the stairs or sitting for a while. The Veteran denied flare-ups but reported functional limitations of walking with a limp, causing his left leg to lag behind. The examiner also noted, however, that at end of examination, the examiner accompanied the Veteran to the waiting room and no limp was noted. Range of motion testing revealed flexion to 130 degree, and extension to 0. It was noted pain was present on flexion and extension but did not result in/ cause functional loss. There was no evidence of pain on palpation, crepitus, or pain on weight-bearing or non-weightbearing. The Veteran was able to perform repetitive-use testing, with no additional limitation of motion. Over a period of time and during flare-ups, the examiner indicated that the examination was medically consistent with the Veteran's statements describing functional loss with repetitive use over time, and identified that pain significantly limited functional ability with range of motion of 120 degrees for flexion and 0 degrees for extension. Muscle strength testing was normal, and there was no evidence of muscle atrophy or ankylosis. There was no evidence of recurrent subluxation, instability, effusion, or any other conditions. The examiner also found evidence of pain, scars, and reduced range of motion due to the meniscectomy. No other objective findings were noted. The Veteran was reexamined by VA in a November 2020 VA Knee Conditions DBQ. The Veteran reported flare-ups occurring 2 to 3 times per week, lasting hours each time and resulting in limitation of ambulation and standing. Range of motion testing revealed flexion to 115 degree, and extension to 0. It was noted pain was present on flexion and extension but did not result in/ cause functional loss. There was evidence of pain on palpation, crepitus, and pain on weight-bearing and with passive motion. There was no evidence of pain on non-weightbearing motion. The Veteran was able to perform repetitive-use testing, with no additional limitation of motion. Over a period of time and during flare-ups, the examiner indicated that the examination was medically consistent with the Veteran's statements describing functional loss with repetitive use over time, and identified that pain significantly limited functional ability with range of motion of 90 degrees for flexion and 0 degrees for extension. Muscle strength testing was 4/5, but there was no evidence of muscle atrophy or ankylosis. There was no evidence of recurrent subluxation, instability, effusion, or any other conditions. The examiner also found evidence of pain and decreased range of motion due to the meniscectomy. It was noted the Veteran requires the regular use of a brace and occasional use of a cane. No other objective findings were noted. A November 2020 VA Addendum Opinion to the November 2020 VA Knee Conditions DBQ was asked to consider the Veteran's subjective reports of instability of the left knee. The VA examiner explained that a medical opinion regarding the subjective symptoms cannot be reproduced by objective evidence. Further, the examiner noted the last 3 examinations did not find objective evidence of instability. Finally, a March 2021 VA Addendum Opinion was obtained in light of the update to the musculoskeletal regulations, effective February 7, 2021. The examiner noted that the Veteran's use of the brace and cane do not specify persistent knee instability, and most of the time, is due to pain. The examiner specifically noted the Veteran was still employed as a mail-man, which is a job that requires constant ambulation and standing for prolonged periods of time. The examiner reiterated that the last four VA DBQs dated in May 2016, September 2016, January 2017, and November 2019, did not find objective evidence of instability. The examiner stated that after reviewing the evidence of record, the Veteran's occupation, and prior evaluation from November 2020, he finds it less likely than not that the cane and brace are used for "persistent knee instability," as the Veteran has other medical conditions for which the use of a cane is possible. Also of record are significant VA and private treatment records that show the Veteran's continuous treatment for left knee disability. However, these treatment records do not contain any objective evidence not already discussed or materially different from that contained in the multiple VA examination reports of record conducted during the course of this appeals period. Additionally, the Board notes the Veteran's reports of pain associated with his left knee and instability. Specifically during his April 2018 Board hearing, he testified to experiencing limping, dragging his leg, feeling as though his knee is "loose," and that it moves from to top to bottom and side to side. He also reported stiffness. Legal Analysis As noted above, the Veteran is seeking entitlement to higher ratings for his left knee disability, which is presently rated at 10 percent pursuant to DC 5003, and a separate rating of 20 percent pursuant to DC 5003-5257. The assignment of a particular Diagnostic Code is "completely dependent on the facts of a particular case." 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, diagnosis, and demonstrated symptomatology. Any change in Diagnostic Code by a VA adjudicator must be specifically explained. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). The Board finds that the assignation of DC 5003-5257 is inappropriate given the Veteran's disability, which has been consistently diagnosed as residuals pertaining to his prior meniscectomy of the left knee. In this respect, Diagnostic Code 5257 requires recurrent subluxation or lateral instability of the left knee, which has not been shown. Conversely, the x-rays of record do confirm the presence of arthritis resulting in painful motion and noncompensable motion, which warrants a separate 10 percent rating under DC 5003, which is the current rating assigned. Therefore, the Board finds that the appropriate diagnostic codes for this disability are 5003 and 5258 and will be discussed below. 1. Entitlement to a rating in excess of 10 percent pursuant to DC 5003 The Veteran is currently rated at 10 percent pursuant to DC 5003. Here, the Board notes that x-ray evidence of degenerative arthritis of the left knee was identified during the May 2014 VA Knee Conditions DBQ. See 38 C.F.R. § 4.71a , DC 5003 ("[when] limitation of motion of the specific joint or joints involves 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"). As discussed in detail below, the Board is not entitled to separate compensable ratings of the left knee pursuant to DC 5260 or 5261 on the basis of limitation of motion, as there has been consistent reports of pain in the left knee. Thus, based on the foregoing, the Board finds a 10 percent disability rating under DC 5003 is warranted as the record demonstrates evidence of findings of degenerative arthritis confirmed by X-ray and objective evidence of limitation of motion for the Veteran's left knee disability. The Board also concludes that despite the consistent findings of arthritis in the left knee, a 20 percent disability rating under DC 5003 (which requires involvement of two or more minor joint groups) is not warranted as only the knee joint is implicated. The remaining diagnostic codes and considerations pertaining to the ratings of the knee are discussed below. 2. Entitlement to a rating in excess of 20 percent pursuant to DC 5258 Pertaining specifically to the meniscus, DC 5258 provides that a 20 percent rating is assigned when the cartilage or semilunar (which is synonymous with the meniscus) is dislocated with frequent episodes of "locking," pain, and effusion into the joint. In addition, DC 5259 also evaluates impairment of the semilunar cartilage (meniscus) and allows a maximum rating of 10 percent rating. Here, the May 2014 VA Knee Conditions DBQ noted that the Veteran suffers from frequent episodes of locking and joint pain due to a meniscus condition. In fact, the subsequent May 2016, September 2016, January 2017, November 2019, and November 2020 VA Knee Conditions DBQs all note pain and decreased range of motion attributable to the meniscectomy of the left knee. As such, the Board finds a 20 percent rating is warranted under DC 5258 for the entire period on appeal. Other Considerations As 20 percent is the highest rating available under DC 5258, the Board has also considered whether the Veteran is entitled to separate ratings under other potentially relevant diagnostic codes. Of note, DC 5259, impairment of the meniscus, only provides a 10 percent rating and is not more advantageous to the Veteran. The Board also notes that there is no evidence of ankylosis of the left knee (Diagnostic Code 5256), or genu recurvatum (Diagnostic Code 5263). See again May 2014, May 2016, September 2016, January 2017, November 2019, and November 2020 VA Knee Conditions DBQs; see also September 2016, November 2020, and March 2021 VA Addendum Opinions. As such, those codes need not be discussed further. Concerning instability or subluxation (Diagnostic Code 5257), the Board notes that the VA examinations all consistently reported normal testing with respective to the objective findings on examination. Concerning the regulations in effect since February 7, 2021, the March 2021 VA addendum opinion concluded that it was less likely than not that the cane and brace are used for "persistent knee instability," as the Veteran has other medical conditions for which the use of a cane is possible. Pursuant to limitation of flexion under Diagnostic Code 5260, the Board finds that a separate compensable rating is not warranted, as his flexion has been limited to, at most, 90 degrees, even during a flare-up. See November 2020 VA Knee Conditions DBQ. In order to warrant a 10 percent rating, flexion must be limited to 45 degrees. The treatment records similarly do not include any range of motion findings that would support the assignation of separate rating based on limitation of flexion. The Board has also considered whether a separate rating based on limitation of extension pursuant to Diagnostic Code 5261 is warranted. However, the record shows the Veteran's extension has been 0 degrees for the left knee throughout the pendency of the appeal. Therefore, a separate 10 percent rating is also not warranted. 38 C.F.R. § 4.71a , Diagnostic Code 5261. Additionally, whether the Veteran's left knee disability has resulted in a level of functional loss in range of motion such that a separate 10 percent rating may be assigned has also been considered. DeLuca v. Brown, 8 Vet. App. 202, 206 (1995); 38 C.F.R. §§ 4.40, 4.45, 4.59. Here, the left knee has been characterized by pain and some limitation of flexion. In fact, the November 2019 VA examiner also noted that pain significantly limited functional ability with repeated use over time in left knee. However, again, the Veteran's flexion was found to be to, at worse, 70 degrees, even considering the pain and functional ability. See May 2014 VA Knee Conditions DBQ. While the rating schedule is intended to allow for compensation for painful motion of a joint, the evidence does not reflect functional loss that is not already contemplated by the assigned rating of 20 percent for the left knee meniscal disability, which specifically contemplates pain. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011). Moreover, even considering his reports of pain, his flexion has been limited to, at most, 70 degrees as noted in the May 2014 VA Knee Conditions DBQ, which is well in excess of the 30-degree limitation as required for the next higher 20 percent rating. Therefore, tis functional loss does not result in limitation of motion sufficient to satisfy the next disability rating allowable for the left knee to be entitled to a higher disability rating under §§ 4.40 and 4.45. See Thompson v. McDonald, 815 F.3d 781, 785-86 (Fed. Cir. 2016). In reaching the above conclusions, the Board has not overlooked the Veteran's statements submitted in support of his claim attesting to the presence of pain due to his left knee disability. In this regard, the Veteran is competent to report on factual matters of which he has firsthand knowledge, e.g., experiencing chronic pain and limitations due to that pain in the knee and the observations of the impact of that pain on the Veteran. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). The Veteran is competent to provide such statements, and the Board finds the statements to be credible. Nevertheless, the objective medical findings provided by the Veteran's VA examination reports have been accorded greater probative weight. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). Accordingly, as the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule is not for application, and the claim must be denied. 38 U.S.C. § 5107 (b). (Continued on the next page) YVETTE R. WHITE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Berry, 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.