Citation Nr: 21075959 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 17-50 477 DATE: December 22, 2021 ORDER Prior to October 7, 2021, a rating greater than 10 percent for chondromalacia patella and osteoarthritis, left knee, is denied. After October 7, 2021, a rating greater than 30 percent for chondromalacia patella and osteoarthritis, left knee, is denied. Prior to April 14, 2015, a rating of 20 percent, but no higher, for chondromalacia patella and osteoarthritis, right knee, postoperative, is granted. A temporary total disability rating for convalescence following April 2015 right knee surgery is denied. From April 14, 2015 to October 7, 2021, a rating greater than 20 percent for chondromalacia patella and osteoarthritis, right knee, postoperative, is denied on an extraschedular basis. After October 7, 2021, a rating greater than 40 percent for chondromalacia patella and osteoarthritis, right knee, postoperative, is denied. FINDINGS OF FACT 1. Prior to October 7, 2021, the left knee disability manifested by subjective reports of pain; objective testing did not show flexion limited to 45 degrees or extension limited to 15 degrees. 2. After October 7, 2021, the left knee disability manifested by subjective reports of pain; objective testing did not show flexion limited to 45 degrees or extension limited to 30 degrees. 3. Prior to April 14, 2015, the right knee disability manifested by subjective reports of pain, fatigue, weakness, and lack of endurance commensurate with extension limited to 15 degrees. 4. The Veteran's April 2015 right knee surgery did not result in one month of convalescence, severe post-operative residuals, or immobilization by cast, without surgery, of one major joint or more. 5. From April 14, 2015 to October 7, 2021, the Veteran is in receipt of the maximum schedular rating for his right knee disability under the applicable DC; this disability was not productive of an exceptional or unusual disability picture, marked interference with employment, or frequent periods of hospitalization. 6. After October 7, 2021, the right knee disability manifested by subjective reports of pain; objective testing did not show flexion or extension limited to 45 degrees. CONCLUSIONS OF LAW 1. Prior to October 7, 2021, , the criteria for a rating greater than 10 percent for chondromalacia patella and osteoarthritis, left knee, have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, DC 5010-5261. 2. After October 7, 2021, the criteria for a rating greater than 30 percent for chondromalacia patella and osteoarthritis, left knee, have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, DC 5010-5261. 3. Prior to April 14, 2015, the criteria for a rating of 20 percent, but no higher, for chondromalacia patella and osteoarthritis, right knee, postoperative, have been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, DC 5010-5261. 4. The criteria for the assignment of a temporary total disability rating following April 2015 right knee surgery have not been met. 38 U.S.C. § 5107; 38 C.F.R. § 4.30. 5. From April 14, 2015 to October 7, 2021, the criteria for a rating greater than 20 percent for chondromalacia patella and osteoarthritis, right knee, postoperative, have not been met on an extraschedular basis. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, DC 5010-5258. 6. After October 7, 2021, the criteria for a rating greater than 40 percent for chondromalacia patella and osteoarthritis, right knee, postoperative, have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a, DC 5010-5261. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from July 1989 to July 1993, including foreign service in Southwest Asia. For his meritorious service, the Veteran was awarded (among other decorations) the Southwest Asia Service Medal with Bronze Service Star and the Army Achievement Medal. He testified during a May 2021 virtual hearing. A transcript of this proceeding has been associated with the record, in two separate documents. These appeals were then remanded by the Board in June 2021 for additional development which has since been completed, including the provision of VA examinations and obtainment of various treatment records. See Stegall v. West, 11 Vet. App. 268, 271 (1998). At that time, the Board also remanded an appeal seeking service connection for a back disorder. Service connection for such was awarded in an October 2021 rating decision, and the Veteran has not expressed disagreement with any portion of this award as assigned. Accordingly, this matter is no longer before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) (noting that a grant of service connection extinguishes appeals before the Board). In the same October 2021 rating decision, the Veteran was awarded a noncompensable initial rating for right knee limitation of flexion, effective October 7, 2021, under DC 5260. The Board will thus limit the matter on appeal as appropriate. Increased Ratings The Veteran is pursuing higher ratings for his left and right knee disabilities, including a temporary total evaluation due to convalescence following right knee surgery. Disability ratings are determined by the applications of the VA's Schedule for Rating Disabilities. 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. If 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. 38 U.S.C. § 5110(g); see also Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110; Kuzma, 341 F. 3d 1327. Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. In assessing the merits of the following appeals, the Board will consider all DCs pertaining to the knees. The Schedule provides that the normal range of motion of the knee is from zero degrees of extension to 140 degrees of flexion. 38 C.F.R. § 4.71, Plate II. Additionally, a total rating will be granted following hospital discharge, effective from the date of hospital admission and continuing for a period of one, two, or three months from the first day of the month following such hospital discharge if the hospital treatment of the service-connected disability resulted in: (1) Surgery necessitating at least one month of convalescence; (2) surgery with severe post-operative residuals such as incompletely healed surgical wounds, stumps or recent amputations, therapeutic immobilization of one major joint or more, application of a body cast, or the necessity for house confinement, or the necessity for continued use of a wheelchair or crutches (regular weight-bearing prohibited); or (3) immobilization by cast, without surgery, of one major joint or more. 38 C.F.R. § 4.30(a). This rating will be assigned without regard to other provisions of the rating schedule. Left Knee (Prior to October 7, 2021) The Veteran is currently in receipt of a 10 percent rating for his left knee disability prior to October 7, 2021. He was rated under multiple DCs during both periods on appeal, including 5024, 5260-5010, and 5261. See rating codesheets dated November 2014, June 2015, and October 2021. At this time, the Board finds that assessment under DC 5010-5261 is proper for both periods. For the Veteran's own understanding, DCs 5024 and 5010 mandate that the service-connected disability be rated as degenerative arthritis under DC 5003. In turn, DC 5003 holds that the disability shall be rated based on limitation of motion, unless doing so results in a noncompensable evaluation. Accordingly, the Veteran shall hereby be rated under DC 5010-5261 to reflect his arthritis diagnosis and related, compensable limited motion. Such a finding does not result in any negative impact to the Veteran. Rather, a higher rating or the assignment of a separate, compensable service-connected disability is warranted upon evidence of the following: Flexion limited to 45 degrees (10 percent under DC 5260); or Extension limited to 15 degrees (20 percent under DC 5261). The criteria for DCs 5260 and 5261 were unchanged by the February 2021 amendments. Other DCs pertaining to the knee include DC 5256 (ankylosis), DC 5257 (recurrent subluxation or lateral instability), DC 5258 (dislocation of semilunar cartilage), DC 5259 (removal of the semilunar cartilage), DC 5262 (impairment of the tibia and fibula), and DC 5263 (genu recurvatum). These disorders are not shown in the record for the period on appeal (whether under the old or new regulations), such that application of these DCs is not warranted. See, e.g., VA examinations dated November 2014 and June 2015. With respect to DC 5262, the Board acknowledges that a November 2014 VA examiner reported impairment caused by a leg length discrepancy. However, there is no evidence that this condition resulted in nonunion or malunion of the tibia or fibula, whether as defined under the old or new regulations. Accordingly, the mere existence of this discrepancy does not warrant a separate disability rating under DC 5262, as the requisite disability picture is not shown. As to the remaining criteria, the Veteran underwent two VA examinations during the period on appeal. In November 2014, he reported left knee pain with flares. By his own estimation, these flares onset following "prolonged sitting at 90 degrees while riding in a car," and would last up to one day. During flares, the Veteran could not climb the stairs or walk more than a few yards. Initial range of motion testing showed flexion from zero to 115 degrees and extension from 115 to zero degrees. Pain was noted on flexion but did not result in functional loss. There was also evidence of pain with weight-bearing. The Veteran was able to perform repetitive-use testing, with resulting flexion to 105 degrees. Although the examiner recorded extension from "150 to 0 degrees" following repetitive-use, the Board reasonably interprets this as a typographical error, as it is highly unlikely that the Veteran would show improved range of motion following repetitive use. Pain, weakness, and lack of endurance were said to contribute to functional loss following repetitive use. However, the examiner could not estimate if pain, weakness, fatigability, or incoordination would significantly limit functional ability with repeated use over time or during flares, as this would require resorting to mere speculation. Accordingly, the Veteran's primary impairments were described as disturbance of locomotion, interference with sitting, and interference with standing. The Veteran next underwent VA examination in June 2015. At that time, he described ongoing pain but denied a history of flare-ups. The Veteran reported severe difficulty with stairs and the inability to stand for more than five minutes, but did not expressly attribute these difficulties to his left knee. He showed a severely antalgic gait, and was able to walk one block. Initial range of motion testing showed flexion from zero to 110 degrees and extension from 110 to zero degrees. There was evidence of pain on weight-bearing, but no objective evidence of pain on palpation. The Veteran was able to perform repetitive-use testing, with flexion from zero to 100 degrees and extension from 100 to zero degrees. Pain was said to contribute to functional loss, but this could not be estimated in terms of loss of motion. Accordingly, the Veteran's primary impairments were described as disturbance of locomotion and interference with sitting. The remaining evidence, including treatment records and the Veteran's lay testimony, do not deviate from the above disability pictures to any notable degree. Collectively, this evidence speaks to the Veteran's history of chronic pain, weakness, and limited mobility due to his left knee disability. See, e.g., May 2015 lay statement; May 2021 hearing transcript. However, there are no objective test results which show greater limitation of motion than that reported by the Veteran's VA examiners. Accordingly, the Veteran did not demonstrate such limitation of motion as to warrant a higher rating under DC 5261 or a separate service-connected disability under DC 5260 at any time. Rather, he demonstrated initial range of motion far greater than that enunciated in the criteria for a higher rating; even with the presence of pain or with repetitive use, the Veteran's flexion and extension were not so limited as to grant the appeal on this basis. Moreover, the Veteran did not report such additional symptoms as fatigability or incoordination during VA evaluation, particularly that productive of additional functional loss; while he noted instability and weakness during the October 2021 hearing, this is the only report of such symptoms in the record and does not equate the requisite limitation of motion upon which to grant this appeal. DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). The Board is mindful that objective evidence is not required to show instability under the previous version of DC 5257; however, the regulation still requires that such subluxation or instability be "recurrent." Absent the identification of such stability concerns in the examinations and treatment records, the Board cannot find that any claimed instability rises to the level of recurrent. Rather, the nature and severity of the Veteran's symptoms are fully contemplated in the criteria for a 10 percent rating, and the appeal seeking a higher rating prior to October 7, 2021 is hereby denied. Left Knee (After October 7, 2021) The Veteran is currently in receipt of a 30 percent rating under DC 5261 for his left knee disability after October 7, 2021. As discussed in the section above, the Board finds application of DC 5010-5261 to be proper here. Thus, this appeal may be granted upon evidence of the following: Flexion of the knee limited to 45 degrees (10 percent under DC 5260); or Extension of the knee limited to 30 degrees (40 percent under DC 5261). While the Board has considered the application of all other DCs pertaining to the knees, the related conditions are again not shown by the record during the period on appeal. See, e.g., October 2021 VA examination. As to the remaining criteria, the Veteran underwent VA examination in October 2021. At that time, he reported chronic left knee pain with flares that required treatment via steroid injections. Initial range of motion testing showed flexion to 110 degrees and extension to 5 degrees. Pain was noted on flexion. The Veteran's range of motion and pain were said to contribute to functional loss "by limiting his ability to fully squat/bend at the knee." The Veteran reported pain on weight-bearing and with repetitive use, and "opted to defer any repetitive testing." The examiner did not estimate loss of motion with repetitive use. However, pain was said to contribute to functional loss with repeated use over a period of time and during flare-ups, estimated as flexion to 80 degrees and extension to 20 degrees. Accordingly, the Veteran's primary impairments were described as disturbance of locomotion, interference with sitting, interference with standing, and less movement than normal. Notably, there is no additional evidence for consideration during the limited period on appeal, to include treatment records or lay statements. As such, there is no evidence which contradicts or undermines the October 2021 findings. Thus, the appeal is hereby denied. At its most severe, the Veteran's left knee disability was not productive of such limitation of flexion or extension as to grant the appeal on this basis. Even with the presence of pain or upon estimated repetitive use, the Veteran consistently demonstrated range of motion greater than that embodied in the criteria for a higher rating or a separate service-connected disability. While the collective evidence speaks to his primary symptom of chronic left knee pain which results in moderate functional impairment, it is not known to be accompanied by such additional symptoms as weakness, incoordination, or fatigability, particularly that resulting in further loss of mobility. DeLuca, 8 Vet. App. at 206-07. Rather, his disability picture is fully contemplated in the rating as assigned, and the appeal is hereby denied. Right Knee (Prior to April 14, 2015) The Veteran is currently in receipt of a 10 percent rating under DC 5010 for his right knee disability prior to April 14, 2015. See November 2014 rating codesheet. The criteria of DC 5010 remain as discussed in the left knee section above. Accordingly, the Veteran is to be rated based on limitation of motion for the period prior to April 14, 2015. Here, the current 10 percent rating appears to be based upon the criteria of DC 5261 for limitation of extension. See November 2014 rating decision. As such, the Board instructs that the Veteran shall hereinafter be rated under DC 5010-5261 for this period, to avoid any confusion as to the nature and symptoms of his disability. Accordingly, a higher rating or the assignment of a separate, compensable service-connected disability is warranted upon evidence of the following: Flexion limited to 45 degrees (10 percent under DC 5260); or Extension limited to 15 degrees (20 percent under DC 5261). These criteria were unchanged by the February 2021 amendments. The Board has again considered the application of all other DCs pertaining to the knee, but finds that the related conditions are not established by the record during the period on appeal, whether under the old or amended regulations See, e.g., November 2014 VA examination. In offering this finding, the Board reiterates its assessment as to meaning of the Veteran's leg discrepancy, discussed above. Rather, the Veteran underwent one VA examination during the period on appeal. In November 2014, he reported chronic pain requiring treatment with steroids, physical therapy, bracing, and over-the-counter medication, with minimal relief. Initial range of motion testing showed flexion from 10 to 95 degrees and extension from 95 to 10 degrees. Pain was noted on both movements and resulted in functional loss. The Veteran was able to perform repetitive-use testing, with functional loss caused by pain, fatigue, weakness, and lack of endurance. Resulting flexion was from 10 to 85 degrees and extension from 85 to 10 degrees. The examiner could not estimate additional loss of motion following repetitive use over time or during flares without resorting to speculation. Rather, the Veteran's primary symptoms were identified as swelling, disturbance of locomotion, and interference with sitting and standing. VA treatment records spanning the period on appeal corroborate the Veteran's reports of chronic right knee pain resulting in limited mobility, particularly during flares. Notably, there are no objective test results which show more severe limitation of motion than that shown in November 2014. Nonetheless, a positive disposition is offered in this instance. In so finding, the Board acknowledges that objective testing does not show such limitation of flexion or extension as to directly align with the criteria set forth herein. However, the Veteran has also offered competent and credible testimony that his right knee experienced pain with any movement, in addition to symptoms of fatigue, weakness, and lack of endurance with repetitive-use. Layno v. Brown, 6 Vet. App. 465, 469 (1994); Miller v. Wilkie, 32 Vet. App. 249 (2020). Combined, these symptoms resulted in moderate functional impairment, including an altered gait, difficulty climbing stairs, or the inability to walk more than a few yards at a time during flares. DeLuca, 8 Vet. App. at 206-07. Such functional impairment reasonably corresponds with extension limited to 15 degrees, and a 20 percent rating is hereby awarded on this basis. Briefly, the Board has considered whether a higher evaluation (or separate service-connected disability) is also warranted prior to April 14, 2015. A positive finding is not offered in this respect, as the Veteran generally remained capable of greater range of motion than that enunciated in the criteria for such, even with repeated use or during flares. Moreover, the Veteran did not require assistance with the activities of daily living despite his symptoms, even at their most severe. Id. Thus, the Veteran's disability picture is contemplated in the 20 percent rating as assigned herein, but is not of such severity as to warrant additional awards on this basis. Right Knee (April 14, 2015 to October 7, 2021) The Veteran is currently in receipt of a 20 percent rating for his right knee disability under DC 5010-5258 from April 14, 2015 to October 7, 2021. Adjudication of this matter is twofold, as the Veteran seeks both a temporary total evaluation and a higher rating during the period on appeal. With respect to the temporary total evaluation, the evidence shows that the Veteran underwent right knee arthroscopy with partial medial meniscectomy and debridement on April 14, 2015. The procedure required two incisional portals, after which the Veteran was instructed to "[bear weight] as tolerated" on the right lower extremity. During April 28 evaluation, the Veteran was "ambulating well" and showed a small effusion at the knee. There was no warmth of erythema, scope portals were healed, and the surgical sutures were removed. The Veteran showed "good" range of motion at that time, and was instructed to "pace his activities and to avoid ambulating on hills and inclines." He was also provided with instructions for using a treadmill, elliptical trainer, or exercise bike. The Veteran continued to show steady improvement thereafter. It is readily apparent from these records that the Veteran does not meet the criteria for a temporary total evaluation following his right knee surgery. He was capable of ambulating and even moderate exercise two weeks after surgery, and there is no evidence that this procedure resulted in severe post-operative residuals or immobilization by cast. Rather, the Veteran endured two incisional portals with sutures that were removed within two weeks, and was instructed to bear weight as tolerated immediately following his procedure. Per his own testimony, the Veteran returned to work as soon as he was able and did not require short-term disability status. See May 2021 hearing transcript. Although the Veteran did encounter some mobility impairment following surgery, this is primarily attributed to an unrelated May 2015 back surgery. Thus, the Veteran's recovery period with specific respect to the right knee did not require one month of convalescence. See Felden v. West, 11 Vet. App. 427, 430 (1998) (defining "convalescence" as the stage of recovery following an attack of disease, a surgical operation, or an injury, and "recovery" as the act of regaining or returning toward a normal or healthy state). Accordingly, a temporary total disability rating is not warranted for the Veteran's April 2015 right knee surgery, and this appeal is denied. Next, the Board observes that the Veteran is already in receipt of the maximum 20 percent rating available under DC 5258 during the period on appeal. Accordingly, his appeal may be granted if entitlement to a higher rating is established on an extraschedular basis. The record does not support such a finding in this case. Rather, the Veteran underwent VA examination in June 2015, at which time he reported chronic and severe knee pain which limited his ability to use stairs. Flare-ups were also reported, which caused additional difficulty with stairs and limited the Veteran's ability to walk more than one block or stand for more than five minutes. The examiner also documented that the Veteran showed a "severely antalgic gait." At that time, the Veteran reported ongoing employment in security/law enforcement, primarily "watching monitors." He missed approximately one week of work due to his prior surgery, and no additional hospitalizations were reported or are otherwise noted in the record. Importantly, neither the Veteran nor his representative have presented any specific argument as to why an increased rating is warranted on an extraschedular basis in this case. Thus, the evidence does not reflect that the Veteran's service-connected right knee disability was so exceptional in nature as to not be fully contemplated by the rating schedule from April 14, 2015 to October 7, 2021. Rather, there are no unusual clinical pictures presented, nor is there any other factor which takes the disability outside the usual rating criteria. Instead, the Veteran's complete disability picture, inclusive of chronic right knee pain with episodes of locking, is embodied in the criteria as established. Thus, even with the favorable resolution of doubt, the Veteran has not carried the burden of demonstrating that his disability is of such a nature that referral for extraschedular evaluation is warranted. 38 C.F.R. § 3.321(b)(1); Thun v. Peake, 22 Vet. App. 111 (2008). Finally, the Board has contemplated whether the assignment of a separate service-connected disability is warranted under the remaining DCs pertaining to the knees. In this respect, the June 2015 VA examiner either denied or did not report right knee ankylosis (DC 5256), subluxation or instability (DC 5257), cartilage removal (DC 5259), tibial or fibular impairment (DC 5262), or genu recurvatum (DC 5263). Accordingly, awards are not warranted on this basis. Also during the June 2015 examination, initial range of motion testing showed flexion from zero to 80 degrees and extension from 80 to zero degrees. There was evidence of pain on weight-bearing. The Veteran was unable to tolerate repetitive-use testing due to pain, which was also estimated to contribute to functional loss with repeated use over a period of time. The examiner could not estimate the related loss of motion in terms of degrees, and a response as to flare-ups was not provided. VA treatment records spanning the period on appeal do not deviate from the above findings to any notable degree, particularly with respect to loss of motion. During the May 2021 hearing, the Veteran instead reported weakness, pain, instability, and locking due to his disability. DeLuca, 8 Vet. App. at 206-07. However, the record is absent of competent evidence which shows that the Veteran was so limited as to equate a separate and compensable evaluation under DC 5260 or 5261 due to his flexion or extension. Rather, the Veteran's disability picture is best embodied in the criteria under DC 5258 and a separate award is not otherwise warranted. For the preceding reasons, this appeal is denied. Right Knee (After October 7, 2021) Finally, the Veteran is currently in receipt of a 40 percent rating for his right knee disability under DC 5261 after October 7, 2021. Given the nature of his disability, the Board again finds that evaluation under DC 5010-5261 is most appropriate during the period on appeal. Accordingly, a higher rating is warranted upon evidence of the following: Extension limited to 45 degrees (50 percent under DC 5261). The Board has expressly considered the application of all other DCs pertaining to the knee, but finds that the related conditions are not shown by the record during the period on appeal, whether under the old or amended regulations See, e.g., October 2021 VA examination. In this respect, the Board acknowledges the Veteran's history of a meniscal tear which was treated by the April 2015 surgery, but finds that this does not constitute dislocation or removal of the semilunar cartilage sufficient for a rating under DC 5258 or 5259 during the period on appeal. As noted in the Board's introduction, the Veteran is also in receipt of a separate award under DC 5260 during the period on appeal. As he has not expressed dissatisfaction with this award as assigned, this DC is not for further consideration herein. Rather, the Veteran underwent one VA examination for review. In October 2021, initial range of motion testing showed flexion to 90 degrees and extension to 30 degrees. The Veteran showed pain on movement and on weight-bearing, which limited his ability to fully squat or bend at the knee. He was unable to perform repetitive-use testing due to reported pain. However, pain was said to contribute to functional loss following repeated use over time and during flare-ups, estimated as flexion to 60 degrees with no change to extension. Accordingly, the Veteran's primary impairments were described as disturbance of locomotion, interference with sitting, interference with standing, and less movement than normal. Notably, there is no additional evidence for consideration during the limited period on appeal, to include treatment records or lay statements. As such, there is no evidence which contradicts or undermines the October 2021 findings. Thus, the appeal is hereby denied. At its most severe, the Veteran's right knee disability was not productive of such limitation of extension as to grant the appeal on this basis. Even with the presence of pain or upon estimated repetitive use, the Veteran consistently demonstrated range of motion greater than that embodied in the criteria for a higher rating. While the collective evidence speaks to his primary symptom of chronic right knee pain which results in moderate functional impairment, it is not known to be accompanied by such additional symptoms as weakness, incoordination, or fatigability, particularly that resulting in further loss of mobility. DeLuca, 8 Vet. App. at 206-07. Rather, his disability picture is fully contemplated in the rating as assigned, and the appeal is hereby denied. With respect to each of the above appeals, the Board has considered the Veteran's position that higher ratings are warranted, including his testimony regarding the nature and severity of his symptoms. Layno, 6 Vet. App. at 469. However, he lacks the medical expertise to competently identify a specific level of disability according to the applicable DCs. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Instead, greater probative value has been offered to the medical evidence in assessing the severity of the Veteran's disabilities during the periods on appeal, as the examiners possess the requisite expertise to render opinions regarding the degree of impairment caused by the Veteran's disabilities and had sufficient facts and data on which to base their conclusions. In this respect, the Board finds that the medical evidence supports the determinations offered herein. Of final note, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Evan M. Deichert Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Kovarovic, 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.