Citation Nr: 21076122 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 15-04 160A DATE: December 22, 2021 ORDER The July 20, 2021 Board denial of the claim of service connection for allergic urticaria is vacated. The July 20, 2021 Board denial of VA compensation pursuant to 38 U.S.C. § 1151 for an additional right hydrocele disorder is vacated. The July 20, 2021 Board denial of an initial rating higher than 50 percent from February 18, 2010 for obstructive sleep apnea is vacated. The July 20, 2021 Board denial of a compensable increased rating from January 23, 2017 for eczema is vacated. The July 20, 2021 Board denial of an increased rating higher than 10 percent from March 12, 2013 for right knee limitation of flexion is vacated. The July 20, 2021 Board denial of an increased rating higher than 10 percent from March 12, 2013 for left knee limitation of flexion is vacated. The July 20, 2021 Board denial of an initial rating higher than 10 percent from March 12, 2013 for right knee instability is vacated. The July 20, 2021 Board denial of an initial rating higher than 10 percent from March 12, 2013 for left knee instability is vacated. The July 20, 2021 Board denial of an effective date earlier than March 12, 2013 for the assignment of a 10 percent increased rating for right knee limitation of flexion is vacated. The July 20, 2021 Board denial of an effective date earlier than March 12, 2013 for the assignment of a 10 percent increased rating for left knee limitation of flexion is vacated. Service connection for allergic urticaria is denied. VA compensation pursuant to 38 U.S.C. § 1151 for an additional right hydrocele disorder is denied. From February 18, 2010, an initial rating higher than 50 percent for obstructive sleep apnea is denied. From March 12, 2013, an increased rating higher than 10 percent for right knee limitation of flexion is denied. From March 12, 2013, an increased rating higher than 10 percent for left knee limitation of flexion is denied. From March 12, 2013, an initial rating higher than 10 percent for right knee instability is denied. From March 12, 2013, an initial rating higher than 10 percent for left knee instability is denied. A total disability rating based on individual unemployability (TDIU) due to service-connected disorders prior to April 19, 2019 is denied. An effective date earlier than March 12, 2013 for the assignment of a 10 percent increased rating for right knee limitation of flexion is denied. An effective date earlier than March 12, 2013 for the assignment of a 10 percent increased rating for left knee limitation of flexion is denied. FINDINGS OF FACT 1. The July 20, 2021 Board denial as to the claim of service connection for allergic urticaria, VA compensation pursuant to 38 U.S.C. § 1151 for an additional right hydrocele disorder, an initial rating higher than 50 percent from February 18, 2010 for obstructive sleep apnea, a compensable increased rating from January 23, 2017 for eczema, an increased rating higher than 10 percent from March 12, 2013 for right knee limitation of flexion, an increased rating higher than 10 percent from March 12, 2013 for left knee limitation of flexion, a separate rating higher than 10 percent from March 12, 2013 for right knee instability, a separate rating higher than 10 percent from March 12, 2013 for left knee instability, an effective date earlier than March 12, 2013 for the assignment of a 10 percent increased rating for right knee limitation of flexion, and effective date earlier than March 12, 2013 for the assignment of a 10 percent increased rating for left knee limitation of flexion was erroneously issued. 2. The Veteran does not have a current diagnosis of allergic urticaria. 3. The Veteran's additional right hydrocele disorder was reasonably foreseeable and not caused by any claimed carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA in furnishing surgical treatment. 4. From February 18, 2010, the Veteran's obstructive sleep apnea did not require a tracheostomy or result in chronic respiratory failure with carbon dioxide retention or cor pulmonale. 5. From March 12, 2013, the severity of the Veteran's right knee disorder manifested as painful motion, and at worst, 100 degrees flexion and 0 degrees extension. 6. From March 12, 2013, the severity of the Veteran's left knee disorder manifested as painful motion, and at worst, 90 degrees flexion and 0 degrees extension. 7. From March 12, 2013, the Veteran's right knee lateral instability manifested as slight impairment. 8. From March 12, 2013 the Veteran's left knee lateral instability manifested as slight impairment. 9. Prior to April 19, 2019, the Veteran's service-connected disorders did not preclude him from securing or following a substantially gainful occupation. 10. The Veteran submitted and VA received an increased rating claim for a right knee disorder on March 12, 2013. 11. The Veteran submitted and VA received an increased rating claim for a left knee disorder on March 12, 2013. CONCLUSIONS OF LAW 1. The criteria to vacate the July 20, 2021 Board denial as to the claim of service connection for allergic urticaria, VA compensation pursuant to 38 U.S.C. § 1151 for an additional right hydrocele disorder, an initial rating higher than 50 percent from February 18, 2010 for obstructive sleep apnea, a compensable increased rating from January 23, 2017 for eczema, an increased rating higher than 10 percent from March 12, 2013 for right knee limitation of flexion, an increased rating higher than 10 percent from March 12, 2013 for left knee limitation of flexion, a separate rating higher than 10 percent from March 12, 2013 for right knee instability, a separate rating higher than 10 percent from March 12, 2013 for left knee instability, an effective date earlier than March 12, 2013 for the assignment of a 10 percent increased rating for right knee limitation of flexion, and effective date earlier than March 12, 2013 for the assignment of a 10 percent increased rating for left knee limitation of flexion have been met. 38 U.S.C. § 7104(a); 38 C.F.R. § 20.1000. 2. The criteria to establish service connection for allergic urticaria have not been met. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(d). 3. The criteria to establish compensation for an additional right hydrocele disorder have not been met. 38 U.S.C. § 1151; 38 C.F.R. § 3.361. 4. From February 18, 2010, the criteria to establish an initial rating higher than 50 percent for obstructive sleep apnea have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.97, Diagnostic Code (DC) 6847. 5. From March 12, 2013, the criteria to establish an increased rating higher than 10 percent for a right knee disorder have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.71a, DC 5003-5260. 6. From March 12, 2013, the criteria to establish an increased rating higher than 10 percent for a left knee disorder have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.71a, DC 5003-5260. 7. From March 12, 2013 the criteria to establish an initial rating higher than 10 percent for right knee lateral instability have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.71a, DC 5257. 8. From March 12, 2013, the criteria to establish an initial rating higher than 10 percent for left knee lateral instability have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.71a, DC 5257. 9. The criteria to establish a TDIU prior to April 19, 2019 have not been met. 38 U.S.C. § 1155; 38 C.F.R. § 4.16(a). 10. The criteria to establish an effective date earlier than March 12, 2013 for the assignment of a 10 percent increased rating for a right knee disorder have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 11. The criteria to establish an effective date earlier than March 12, 2013 for the assignment of a 10 percent increased rating for a left knee disorder have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army National Guard from September 1985 to March 1986 and in the U.S. Army from July 1987 to September 2007. These matters come before the Board of Veterans' Appeals (Board) on appeal from rating decisions dated November 2013, December 2013, and June 2016 of the Jackson, Mississippi Regional Office (RO). On October 17, 2019 and May 2020, the Board remanded the appeals to the RO for additional action. There was substantial compliance with the Board's remand directives. Stegall v. West, 11 Vet. App. 268 (1998). The Veteran is in receipt of a TDIU from April 19, 2019, special monthly compensation under 38 U.S.C. § 1114(k) and 38 C.F.R. § 3.350(a) on account of loss of use of a creative organ from October 9, 2012, and special monthly compensation under 38 U.S.C. § 1114(s) and 38 C.F.R. § 3.350(i) from June 15, 2020 to August 31, 2020. Vacatur An appellate decision may be vacated by the Board at any time upon request of the appellant or his or her representative, or on the Board's own motion, based on a denial of due process (1) when the appellant was denied his or her right to representation through action or inaction by VA or Board personnel, (2) when there was a prejudicial error to afford the appellant a personal hearing, and (3) for a legacy appeal, as defined in § 19.2 of this chapter, when a statement of the case (SOC) or required supplemental statement of the case (SSOC) was not provided. 38 C.F.R. § 20.1000. On October 17, 2019, the Board denied the claim for a compensable increased rating from January 23, 2017 for eczema. The Veteran chose not to pursue the appeal of the issue before the Court; therefore, the Board's decision became final. The July 20, 2021 Board decision readjudicating the claim for a compensable increased rating from January 23, 2017 for eczema was erroneously issued because the Board did not have a basis on which to readjudicate the issue. On October 17, 2019, the Board remanded the claims of service connection for allergic urticaria, VA compensation pursuant to 38 U.S.C. § 1151 for an additional right hydrocele disorder, increased rating higher than 10 percent from March 12, 2013 for right knee limitation of flexion, increased rating higher than 10 percent from March 12, 2013 for left knee limitation of flexion, separate rating higher than 10 percent from March 12, 2013 for right knee instability, separate rating higher than 10 percent from March 12, 2013 for left knee instability, an effective date earlier than March 12, 2013 for the assignment of a 10 percent increased rating for right knee limitation of flexion, and an effective date earlier than March 12, 2013 for the assignment of a 10 percent increased rating for left knee limitation of flexion. At the time of the July 2021 Board decision, these issues remained in remand status with the RO because the RO had not yet issued an SSOC or returned the issues to the Board. 38 C.F.R. § 19.38. The July 2021 Board decision as to these issues was erroneously issued. On October 17, 2019 and May 14, 2020, the Board remanded the claim for initial rating higher than 50 percent from February 18, 2010 for obstructive sleep apnea. At the time of the July 2021 Board decision, this issue also remained in remand status with the RO because the RO had not yet issued an SSOC or returned the issue to the Board. 38 C.F.R. § 19.38. The July 2021 Board decision as to this issue was erroneously issued. Therefore, the July 20, 2021 Board decision as to the above-noted claims is vacated. In August 2021, the RO issued an SSOC as to the pertinent claims and in September 2021, the RO notified the Veteran that the pertinent claims were returned to the Board. Service Connection Allergic Urticaria Service connection may be granted for a current disability arising from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of an in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Veteran asserts that his allergic urticaria, described as red-colored skin welts approximately eight to nine inches located on his neck, back, arms, legs, and chest, began during service in 2004. The claim will be denied because the Veteran does have a current diagnosis of allergic urticaria. The Board notes that service connection is in effect for eczema. In an April 2006 service treatment record (STR) titled "Post-Deployment Health Assessment," the Veteran reported a rash as a health concern. An April 2006 post-deployment progress note reflects an assessment of hives; however, there was no indication that the Veteran's skin complaints were related to allergic urticaria. In his July 2007 service medical history report, the Veteran answered "yes" to the question of whether he then had, or once had skin diseases but the service medical examiner noted dry skin and not allergic urticaria. In the Veteran's July 2007 service medical examination report, the examiner noted skin abnormalities described as dry skin but no allergic urticaria. A June 2008 VA treatment record reflects the Veteran's report of experiencing a rash on his chest and arms. During the September 2008 VA examination, the examiner noted eczema but no other skin disorder. In a July 2009 VA treatment record, the Veteran denied rashes. During the February 2012 VA examination, the Veteran was diagnosed with eczema and no other skin disorder. During the November 2013 VA examination, the Veteran was diagnosed with eczema and no other skin disorder. The Veteran revealed pictures of lesions on his lower extremities, trunk, and neck but the examiner noted that the lesions were not consistent with eczema and appeared to be related to an allergic process. The Veteran was advised to follow-up with his primary care physician. A January 2018 non-VA treatment record reflects the Veteran's report of experiencing hives over the last ten years. During the April 2018 VA examination, the Veteran was diagnosed with allergic urticaria; however, the examiner indicated that the diagnosis of allergic urticaria was an incidental finding and not related to the Veteran's service-connected eczema. The examiner noted that there was no physical finding of hives/urticaria during the examination. The November 2020 VA examiner indicated that the Veteran's allergic urticaria had resolved. The law is well settled that in the absence of proof of a current disability, there can be no valid claim. Boyer v. West, 210 F.3d 1351 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223 (1992). The Veteran does not have medical training or relevant experience to attribute his hives and/or other non-eczema skin symptoms to a diagnosis of allergic urticaria. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). A preponderance of the evidence is against a finding that the Veteran has a current disability of allergic urticaria. The Veteran is not competent to relate his skin symptoms to a diagnosis of allergic urticaria. The April 2018 VA examiner indicated that the diagnosis of allergic urticaria was an incidental finding and not related to the Veteran's service-connected eczema, and the examiner noted that there was no physical finding of hives/urticaria during the examination. Significantly, the November 2020 VA examiner indicated that the Veteran's allergic urticaria had resolved. Therefore, service connection is not warranted, and the claim is denied. VA Compensation for an Additional Disability Right Hydrocele VA compensation benefits are warranted for a qualifying additional disability or a qualifying death of a veteran in the same manner as if such additional disability or death were service-connected. 38 C.F.R. § 3.361; 38 U.S.C. § 1151(a). An additional disability or death is qualifying if it was not the result of the veteran's willful misconduct and: (1) the disability ot death was caused by hospital care, medical, or surgical treatment, or examination furnished the veteran under any law administered by the Secretary, either by a Department employee or in a Department facility as defined in section 1701(3)(A) of this title, and the proximate cause of the disability or death was: (A) carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of the Department in furnishing the hospital care, medical or surgical treatment, or examination; or (B) an event not reasonably foreseeable. 38 U.S.C. §§ 1151(a)(1)(A), (B); 38 C.F.R. § 3.361. In a November 2010 VA treatment record, a review of systems revealed palpated right inguinal hernia and no penile lesion, discharge, testicular mass, or tenderness. The Veteran was diagnosed with recurring right inguinal hernia. In an early December 2010 VA treatment record, the Veteran reported experiencing right groin hernia. A physical abdomen examination revealed bilateral hernia and no umbilical hernia. The Veteran was diagnosed with bilateral hernia and elected to undergo laparoscopic bilateral hernia repair surgery in late December 2010. On December 28, 2010, the Veteran underwent laparoscopic right inguinal hernia repair at a VA hospital. The pre- and post-operative diagnosis was bilateral inguinal hernias and right inguinal hernia, respectively. The surgery report indicated no complications during surgery. On December 29, 2010, the Veteran reported experiencing acute abdominal pain and urinary retention. A foley catheter was placed to drain urine. A VA treatment record dated December 30, 2010 noted that the Veteran's abdominal pain resolved, and scrotal edema decreased after the foley catheter was placed. The Veteran did not report nausea, vomiting, abdominal pain, or distension. He was diagnosed with acute urinary retention status-post laparoscopic inguinal hernia repair and discharged from the VA hospital. A VA treatment record dated February 24, 2011 reflects the Veteran's report of pain and scrotal swelling. A VA abdomen and pelvis radiograph revealed right inguinal soft tissue thickening and a three-centimeter right hydrocele. The Veteran was assessed with right hydrocele status-post laparoscopic right inguinal hernia repair. A VA treatment record dated March 11, 2011 reflects the Veteran's report of right scrotum pain, swelling, and trouble urinating. A physical examination revealed a swollen, tense, and tender right scrotum. On April 1, 2011, the Veteran reported experiencing right scrotum enlargement. The Veteran was assessed with a right hydrocele. The October 2013 VA examiner opined that the Veteran's residuals of right inguinal hernia repair, to include pain and urinary retention, as an additional disability, were not caused by the December 2010 laparoscopic right inguinal hernia repair. In October 2019, the Board remanded the claim for an addendum opinion because the November 2013 VA negative etiology opinion did not consider the Veteran's contention that his hydrocele, not urinary retention, was the additional disability caused by the VA right inguinal hernia repair surgery. Therefore, the November 2013 VA opinion is inadequate. In July 2015, a non-VA examiner opined that the Veteran's testicular hydrocele was caused by the VA right inguinal hernia repair because the right hydrocele did not exist prior to the surgery, VA medical records reflect that the Veteran developed a right hydrocele after the surgery, and medical literature indicated that a right hydrocele "normally occurs when the closure of the internal inguinal ring is excessively tight around the spermatic cord." The non-VA examiner relied, in part, on a January 1998 article titled "Laparoscopic Hernia Repair Complications" indicating that "testicular edema normally occurs when the closure of the internal inguinal ring is excessively tight around the spermatic cord" and that "hydroceles are a result of serous fluid collected in the scrotum, especially after correction of indirect inguinal hernias, where the inguinal canal is explored to release the sac." The non-VA medical opinion is of low probative value because the examiner did not consider the December 2010 surgery report showing no complications during surgery and did not indicate excessive tightening around the spermatic cord. In the November 2020 VA addendum, the examiner opined that the Veteran's right hydrocele was not caused by any carelessness, negligence, lack of proper skill, error in judgment, or an event not reasonably foreseeable by the December 2010 VA laparoscopic right inguinal hernia repair because the Veteran's intestines, as a normal procedure in hernia repair, were pushed back and abdominal fluid slowly flowed in the scrotal sac resulting in a hydrocele. The VA addendum opinion is highly probative because the examiner reviewed the Veteran's December 2010 surgery operation report and noted that intestinal pushing was a normal part of the procedure, and therefore, reasonably foreseeable that abdominal fluid would slowly build in the scrotal sac. A preponderance of the evidence is against a finding that the Veteran's additional right hydrocele was not reasonably foreseeable or caused by any claimed carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA in furnishing the December 2010 laparoscopic right inguinal hernia repair. The November 2020 VA examiner opined that the Veteran's right hydrocele was not caused by any carelessness, negligence, lack of proper skill, error in judgment, or an event not reasonably foreseeable by the December 2010 VA laparoscopic right inguinal hernia repair because the Veteran's intestines, as a normal procedure in hernia repair, were pushed back and abdominal fluid slowly flowed in the scrotal sac resulting in a hydrocele. Therefore, entitlement under 38 U.S.C. § 1151 for an additional right hydrocele disorder is not warranted and the claim is denied. Initial and Increased Ratings Disability evaluations are determined by comparing the Veteran's current symptomatology with the criteria set forth in the Schedule for Rating Disabilities. 38 U.S.C. § 1155. When there is a question as to which of two disability evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. Obstructive Sleep Apnea A 50 percent rating is assigned if obstructive sleep apnea requires use of a breathing assistance device such as continuous airway pressure (CPAP) machine. 38 C.F.R. § 4.97, DC 6847. A 100 percent rating is warranted if obstructive sleep apnea results in chronic respiratory failure with carbon dioxide retention or cor pulmonale, or; requires tracheostomy. Id. The Veteran's obstructive sleep apnea (OSA) is rated 50 percent disabling from February 18, 2010 and continuing thereafter under DC 6847. The appellate period is from February 18, 2010. The claim for a higher initial rating will be denied. In February 2010, the Veteran underwent a non-VA sleep study and CPAP titration. The Veteran slept for 410 minutes out of 446.5 minutes with a sleep efficiency of 91.8 percent. The sleep study revealed 53 arousals and no snoring. The non-VA examiner indicated that CPAP titration was effective at treating the Veteran's OSA. The Veteran's respiratory events included an arousal as an abrupt shift for a minimum of three seconds, an absence of airflow for a minimum of ten seconds, and a reduction in air flow for a minimum of ten seconds. In statements dated May 2010 and September 2010, the Veteran reported that his CPAP machine may have malfunctioned and experienced trouble sleeping, respectively. In September 2011, the Veteran underwent a VA sleep study. The sleep study revealed hypopnea index of 12.5 per hour with three obstructive apneas, two central apneas, six missed apneas, and ninety-five hypopnea events observed during the total sleep period. There was 65.7 minutes of supine sleep and the hypopnea index was 20.1 per hour during that time. Oxygen saturation baseline was 92 percent with a nadir of 84 percent. The examiner noted mild to moderate OSA while in a supine position and nadir oxygen saturation at 84 percent. The examiner advised the Veteran to continue CPAP treatment, lose weight, avoid alcohol and other sedatives prior to sleep. In a September 2011 VA sleep lab morning questionnaire, the Veteran reported falling asleep in 30 minutes, feeling that he slept 5 hours, awoke twice, felt awake but not alert, no morning discomfort, no dreams, and that he was awakened by the VA technician. The July 2012 VA examiner diagnosed the Veteran with OSA. The Veteran required continuous medication Ambien to control his OSA and required the use of a CPAP machine for breathing assistance. The Veteran's symptoms attributable to OSA were persistent daytime hypersomnolence and excessive snoring. Other significant diagnostic findings noted the September 2011 sleep study results. In October 2012, the Veteran submitted an April 1998 article titled "PTSD and OSA" and a December 2008 article titled "Sleep Problems, PTSD widespread following September 2011." The articles discussed the relationship between OSA and PTSD but did not pertain to the Veteran's then-current symptoms of his OSA. Therefore, the articles are of low probative value. Several statements dated October 2012 from the Veteran's family and friends reflect having observed the Veteran experience snoring and trouble breathing during sleep. A January 2015 VA treatment record reflects the Veteran's report of trouble falling and staying asleep. It was noted that the Veteran showed an "excellent clinical response" to the CPAP machine. In a November 2015 VA treatment record, the Veteran reported experiencing trouble tolerating different CPAP masks and that it was easier to sleep with an oral appliance. The November 2020 VA examiner indicated that continuous medication was not required for the Veteran's OSA and that a CPAP machine was not required. There were no then-current findings, signs, or symptoms attributable to OSA. The examiner noted that the Veteran's OSA had resolved. A preponderance of the evidence is against the assigment of an initial rating higher than 50 percent for the entirety of the rating period on appeal for the Veteran's OSA under DC 6847. The February 2010 non-VA sleep study, September 2011 VA sleep study, July 2012 and November 2020 VA examinations did not reflect that the Veteran's obstructive sleep apnea required tracheostomy or resulted in chronic respiratory failure with carbon dioxide retention, or cor pulmonale. Significantly, no competent medical evidence reflects otherwise. Therefore, a higher initial rating is not warranted, and the claim is denied. Right and Left Knee Disorders Changes to the rating schedule for musculoskeletal disabilities became effective on February 7, 2021. The amended criteria, if favorable to the Veteran's claim, can only be applied for the period from the effective date of the regulatory change; however, the old regulations will be considered for the periods both before and after the change was made. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Prior to February 7, 2021, DC 5003 provides that degenerative arthritis established by X-ray findings will be rated based on limitation of motion under the appropriate DCs for the specific joint or joints involved. 38 C.F.R. § 4.71a, DC 5003. Under DC 5003, when limitation of motion would be noncompensable, i.e., zero percent, under a limitation-of-motion code, but there is at least some limitation of motion, VA assigns a 10 percent disability rating for each major joint so affected, to be combined, not added. Id. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Id. In the absence of any limitation of motion, involvement of 2 or more major joints or 2 or more minor joint groups warrants a 10 percent evaluation, and the same with occasional incapacitating exacerbations warrants a 20 percent evaluation. Id. The knee is considered a major joint. 38 C.F.R. § 4.45(f). Effective February 7, 2021, the diagnostic criteria under DC 5003 remain unchanged but the description of the rating code changed to "Degenerative arthritis, other than post-traumatic." 38 C.F.R. § 4.71a, DC 5003. The diagnostic criteria under DCs 5260 and 5261 remain unchanged. Under DC 5260, limitation of flexion to 60 degrees warrants a noncompensable rating; limitation of flexion to 45 degrees warrants a 10 percent rating; limitation of flexion to 30 degrees warrants a 20 percent rating and limitation of flexion to 15 degrees warrants a 30 percent rating. 38 C.F.R. § 4.71a, DC 5260. Under DC 5261, extension limited to 5 degrees warrants a noncompensable rating, 10 degrees warrants a 10 percent rating, 15 degrees warrants a 20 percent rating, 20 degrees warrants a 30 percent rating, 30 degrees warrants a 40 percent rating, and 45 degrees warrants a 50 percent rating. 38 C.F.R. § 4.71a, DC 5261. Separate ratings may be assigned under DCs 5260 and 5261 for disability of the same knee joint. See VAOPGCPREC 9-2004. Additionally, VAOPGCPREC 23-97 held that a claimant who has both arthritis and instability of the knee may receive two separate disability ratings under DCs 5003-5010 and DC 5257 (or under DCs 5258 or 5259) without violating the prohibition of pyramiding of ratings. It was specified that, for a knee disorder already rated under DC 5257, a claimant would have additional disability justifying a separate rating if there is limitation of motion under DC 5260 or DC 5261. Prior to February 7, 2021, under DC 5257, slight recurrent subluxation or lateral instability warrants a 10 percent rating, moderate recurrent subluxation or lateral instability warrants a 20 percent rating, and severe recurrent subluxation or lateral instability warrants a 30 percent rating. 38 C.F.R. § 4.71a, DC 5257. The words "slight," "moderate" and "severe" are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all the evidence to the end that its decisions are "equitable and just," under 38 C.F.R. § 4.6. Effective February 7, 2021, DC 5257 provides ratings for "recurrent subluxation or instability" or "patellar instability." For recurrent subluxation or instability, a 10 percent rating is assigned 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. 38 C.F.R. § 4.71a, DC 5257. A 20 percent rating is assigned for one of the following: (a) sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation; or (b) unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribed either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. Id. A 30 percent rating is assigned for unrepaired or failed repair of complete ligament tear causing persistent instability and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation. Id. For patellar instability, a 10 percent rating is assigned 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. Id. A 20 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 one of the following: a brace, cane, or walker. Id. 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 walker. Id. The Veteran's right knee disorder is rated noncompensable from October 1, 2007 to March 11, 2013; 10 percent disabling from March 12, 2013 to June 14, 2020; 100 percent disabling from June 15, 2020 to August 31, 2020 under 38 C.F.R. § 4.30; and 10 percent disabling from September 1, 2020 and continuing thereafter under DC 5260-5003. The Veteran's left knee disorder is rated noncompensable from October 1, 2007 to March 11, 2013 and 10 percent disabling from March 12, 2013 and continuing thereafter under DC 5260-5003. The appellate period for both knee disorders is from March 12, 2013. A March 2013 statement reflects the Veteran's report of experiencing bilateral knee instability. A July 2013 VA treatment record reflects the Veteran's report of experiencing bilateral knee pain and temporary relief from a left knee brace, physical therapy, and steroid shots. A physical left knee examination revealed no edema. The Veteran was prescribed medication for pain. The Veteran denied experiencing falls and it was noted that no ambulatory aids, such as a wheelchair, cane, or walker were issued. During the November 2013 VA examination, the Veteran was diagnosed with bilateral knee chondromalacia and chondrocalcinosis. The Veteran reported experiencing bilateral knee pain, swelling, and popping. He treated with medication, wearing a knee brace, physical therapy, and cortisone injections. The Veteran described bilateral knee flare-ups as bilateral knee pain aggravated by prolonged standing and walking. Initial range of motion for both knees was flexion at 120 degrees and extension at 0 degrees with no painful motion. The Veteran performed repetitive-use testing with at least three repetitions with additional limitation in functional loss and without additional limitation in range of motion. Pain on movement for both knees was the additional limitation in functional loss after repetitive-use testing. The examiner noted bilateral knee pain on palpation. Muscle strength and joint stability testing were normal. There was no evidence or history of recurrent patellar subluxation. The examiner noted no tibial or fibular impairment, meniscal conditions, surgical procedures, or other pertinent physical findings. The Veteran regularly used knee braces as a normal mode of transportation. In his January 2014 notice of disagreement, the Veteran reported experiencing bilateral knee instability, limited flexion, pain, throbbing, popping, and trouble with walking. A July 2014 VA treatment record reflects the Veteran's report of experiencing bilateral knee pain unimproved with knee braces. In an August 2014 VA treatment record, a bilateral knee examination revealed no swelling, palpable effusion, or instability. Range of motion for both knees was flexion at 110 degrees and extension at 0 degrees with painful motion, mild patellofemoral crepitus, and grinding. The examiner noted bilateral knee normal muscle strength, gait, and alignment. In a September 2014 VA treatment record, a right knee examination revealed no swelling, palpable effusion, locking, or ligamental laxity. Range of motion for the right knee was flexion at 110 degrees and extension at 0 degrees with mild patellofemoral crepitus, grinding, and joint line tenderness. The examiner noted right knee normal muscle strength and alignment. During the December 2014 VA examination, the Veteran was diagnosed with bilateral knee osteoarthritis, patellofemoral pain syndrome, degenerative arthritis, and left knee chondromalacia patella. The Veteran described bilateral knee flare-ups as throbbing pain aggravated by cold weather and functional loss as bilateral knee pain and trouble with climbing stairs and prolonged walking. Initial range of motion for both knees was flexion at 110 degrees and extension at 0 degrees. The range of motion did not contribute to functional loss and pain on motion did not cause functional loss. There was no pain with weight-bearing. The examiner noted localized tenderness along the patellar tendon and with pressure on the patella. The Veteran performed repetitive-use testing with at least three repetitions with no additional loss of function or range of motion. The Veteran was not examined immediately after repetitive-use but the examination neither supported nor contradicted the Veteran's statements describing functional loss with repetitive-use. The examiner was unable to state without mere speculation as to whether any pain, weakness, fatigability, or incoordination significantly limited functional ability with repetitive-use because the Veteran was not examined beyond four repetitions. The examination was not conducted during a flare-up but the examination neither supported nor contradicted the Veteran's statements describing functional loss during flare-ups. The examiner was unable to state without mere speculation as to whether any pain, weakness, fatigability, or incoordination significantly limited functional ability with repetitive-use because the Veteran was not examined during a flare-up. There were no additional factors contributing to the Veteran's bilateral knee disorder. Muscle strength and joint stability testing were normal. There was no muscle atrophy, ankylosis, tibial or fibular impairment, meniscal conditions, or other pertinent physical findings. The examiner noted no history of recurrent subluxation, lateral instability, or recurrent effusion. The Veteran occasionally used knee braces. A January 2015 VA treatment record reflects the Veteran's report of experiencing bilateral knee pain. During the March 2017 VA examination, the Veteran was diagnosed with bilateral knee chondromalacia and degenerative arthritis. The Veteran reported experiencing bilateral knee pain, locking, popping, and swelling. The Veteran described flare-ups as bilateral knee stiffness due to weather change and functional loss as bilateral knee pain exacerbated by prolonged sitting and walking. Initial range of motion for the right knee was flexion at 100 degrees and extension at 0 degrees and the left knee was flexion at 90 degrees and extension at 0 degrees. As to both knees, the range of motion did not contribute to functional loss but pain on motion caused functional loss. The examiner noted pain with weight-bearing, pain with palpation, and crepitus. The Veteran performed repetitive-use testing with at least three repetitions with no additional loss of function or range of motion. The Veteran was not examined immediately after repetitive-use but the examination was neither medically consistent nor inconsistent with the Veteran's statements describing functional loss with repetitive-use. The examiner could not state without mere speculation as to whether any pain, weakness, fatigability, or incoordination significantly limited functional ability with repetitive-use and describing in terms of range of motion because there was no conceptual or empirical basis for making such a determination without directly observing function under such conditions. The examination was not conducted during a flare-up but the examination was neither medically consistent nor inconsistent with the Veteran's statements describing functional loss during flare-ups. The examiner could not state without mere speculation as to whether any pain, weakness, fatigability, or incoordination significantly limited functional ability with flare-ups and describing in terms of range of motion because there was no conceptual or empirical basis for making such a determination without directly observing function under such conditions. The examiner noted interference with sitting as an additional factor that contributed to the Veteran's bilateral knee disorders. Muscle strength testing revealed abnormal findings. Joint stability testing revealed abnormal findings. There was no muscle atrophy, ankylosis, tibial or fibular impairment, meniscal conditions, or other pertinent physical findings. There was no history of recurrent subluxation, lateral instability, or recurrent effusion. The Veteran occasionally used a brace and cane for support and stability. In a May 2017 VA treatment record, the Veteran reported experiencing bilateral knee pain but denied locking or buckling. A bilateral knee physical examination revealed no swelling, palpable effusion, ligamental laxity, or locking. Range of motion for both knees was flexion at 110 degrees and extension at 0 degrees with patellofemoral crepitus, grinding, and joint line tenderness. Muscle strength and alignment were normal. A March 2018 VA treatment record reflects the Veteran's report of experiencing bilateral knee pain. In a January 2019 VA treatment record, the Veteran reported experiencing bilateral knee pain and popping but denied locking or buckling. A bilateral knee physical examination revealed no swelling, palpable effusion, or locking. Range of motion for both knees was flexion at 110 degrees and extension at 0 degrees with patellofemoral crepitus and joint line tenderness. The examiner noted normal strength and alignment. During the June 2019 VA examination, the Veteran was diagnosed with bilateral knee chondromalacia and degenerative arthritis. The Veteran reported experiencing bilateral knee popping, locking, stiffness, and pain with prolonged standing and walking. The Veteran did not report experiencing flare-ups or functional loss. Initial range of motion for both knees was flexion at 100 degrees and extension at 0 degrees with no pain on motion. The range of motion contributes to functional loss because the Veteran could not fully bend down. There was no localized tenderness, pain on palpation, or pain with weight-bearing. Crepitus was noted. The Veteran performed repetitive-use testing with at least three repetitions with no additional loss of function or range of motion. The Veteran was not examined immediately after repetitive-use but the examination was neither medically consistent nor inconsistent with the Veteran's statements describing functional loss with repetitive-use. Pain, fatigue, and weakness significantly limited functional ability with repetitive-use. The examiner was unable to describe in terms of range of motion because there was no additional loss in range of motion. The examination was not conducted during flare-ups but the examination was neither medically consistent nor inconsistent with the Veteran's statements describing functional loss during flare-ups. Any pain, weakness, fatigability, or incoordination had not significantly limited functional ability with flare-ups. The examiner noted that disturbance of locomotion, interference with standing, pain, fatigue, weakness, prolonged standing, and walking were additional factors that contributed to the Veteran's bilateral knee disorder. Muscle strength and joint stability testing were normal. There was no muscle atrophy, ankylosis, tibial or fibular impairment, meniscal conditions, history of recurrent subluxation, lateral instability, recurrent effusion, or other pertinent physical findings. The Veteran regularly used a brace and occasionally used a cane. There was no pain on non-weight bearing and the examiner noted the same in active range of motion. An August 2019 VA treatment record reflects the Veteran's report of experiencing right knee pain. A right knee physical examination revealed medial tenderness but no swelling. A May 2020 VA treatment reflects the Veteran's report of experiencing right knee aching and pain. A May 2020 right knee radiograph revealed medial compartment spurring, patellofemoral spurring but no joint effusion or fracture. A May 2020 left knee radiograph revealed maintained compartment spaces, patellofemoral spurring, but no joint effusion or fracture. On June 15, 2020, the Veteran underwent a right knee arthroscopy. During the November 2020 VA examination, the Veteran was diagnosed with bilateral knee chondromalacia and degenerative arthritis. The Veteran did not report experiencing flare-ups or functional loss. Initial range of motion for both knees was flexion at 130 degrees and extension at 0 degrees with no painful motion. The range of motion did not contribute to functional loss. There was no localized tenderness, pain on palpation, pain with weight-bearing, or crepitus. The Veteran performed repetitive-use testing with at least three repetitions with no additional loss of function or range of motion. The Veteran was not examined immediately after repetitive-use but the examination was medically consistent with the Veteran's statements describing functional loss with repetitive-use. Pain significantly limited functional ability with repetitive-use and the examiner described in terms of range of motion as flexion at 125 and extension at 0 degrees for the right knee only. The examination was not conducted during a flare-up because the Veteran denied experiencing flare-ups. No additional factors contributed to the Veteran's bilateral knee disorder. Muscle strength and joint stability testing were normal. There was no muscle atrophy, ankylosis, tibial or fibular impairment, meniscal conditions, history of recurrent subluxation, lateral instability, or recurrent effusion. The Veteran underwent a right knee arthroscopy in June 2015 with residuals of pain from prolonged activity. The Veteran regularly used a brace and occasionally used a cane. There was no pain on passive range and non-weight bearing testing. The diagnostic criteria under DC 5257 prior to February 7, 2021 are more favorable to the Veteran's bilateral knee instability. The Court held that DC 5257, as effective prior to February 7, 2021, does not require objective medical evidence of lateral instability for a rating to be assigned. English v. Wilkie, 30 Vet. App. 347 (2018). The Court found that DC 5257 does not indicate medical evidence of instability is required and that the Board cannot require objective medical evidence or find that objective medical evidence is automatically more probative than lay evidence. Petitti v. McDonald, 27 Vet. App. 415 (2015) (holding that if a regulation does not speak to the evidence required, objective evidence is not required). DC 5257, as effective on February 7, 2021, is less favorable to the Veteran's claim because the diagnostic criteria, as to recurrent subluxation or instability, speak to either a "sprain, incomplete ligament tear, or complete ligament tear ... causing persistent instability." The diagnostic criteria, as to patellar instability, speak to "a diagnosed condition involving the patellofemoral complex with recurrent instability ...." A sprain, torn ligament, and patellofemoral instability is a medical diagnosis, and the Veteran did not submit competent evidence of such diagnoses and the Veteran does not have the education, training, or experience to provide a self-diagnosis of a sprain, torn ligament, or patellar instability. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). A preponderance of the evidence is against the assignment of increased ratings higher than 10 percent for the entirety of the rating period on appeal for both knees under DC 5003-5260. Right knee range of motion, at worst, was 100 degrees flexion and 0 degrees extension with painful motion. Left knee range of motion, at worst, was 90 degrees flexion and 0 degrees extension with painful motion. Therefore, higher increased ratings are not warranted, and the claims are denied. A preponderance of the evidence is against the assignment of initial ratings higher than 10 percent for the entirety of the entirety of the rating period on appeal for the Veteran's right and left knee instability under DC 5257. Although five VA examinations revealed no bilateral knee instability, as noted above, DC 5257, as effective prior to February 7, 2021, does not require objective medical evidence of lateral instability for a rating to be assigned, and the Veteran has consistently reported experiencing bilateral knee instability, weakness, and trouble with walking. However, the evidence does not show moderate recurrent subluxation or lateral instability as evidenced by five VA examinations reflecting normal findings for joint stability testing. Therefore, higher initial ratings are not warranted, and the claims are denied. A separate rating under DC 5256 is not warranted because the evidence shows that the Veteran does not have right or left knee ankylosis. A separate rating under DC 5258 is not warranted because the evidence does not reflect that the Veteran underwent a dislocated semilunar cartilage. A separate rating under DC 5259 is not warranted because the evidence does not indicate that the Veteran underwent removal of semilunar cartilage. A separate rating under DC 5261 is not warranted because the Veteran's right and left knee extension, at worst, was 0 degrees. A separate rating under DC 5262 is not warranted because the evidence does not show an impairment of the Veteran's tibia and fibula. A separate rating is not warranted under DC 5263 because the evidence does not show that the Veteran has genu recurvatum. TDIU In June 2021, the RO granted a TDIU effective April 19, 2019. However, the grant of TDIU did not encompass the entire appellate period, and therefore, the grant of TDIU was a partial grant and the remaining period prior to April 19, 2019 remained in appellate status. Harper v. Wilkie, 30 Vet. App. 356 (2018). TDIU may be assigned, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more, and sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). The Veteran's service connected disorders include posttraumatic stress disorder (PTSD) rated 30 percent disabling from October 1, 2007 to March 11, 2013 and 70 percent disabling from March 12, 2013; OSA rated 50 percent disabling from February 18, 2010; irritable bowel syndrome rated 30 percent disabling from October 9, 2012; tension headaches rated noncompensable from October 1, 2007 to August 12, 2014 and 30 percent disabling from August 13, 2014; lumbosacral strain rated 20 percent disabling from October 17, 2019; right knee instability rated 10 percent disabling from March 12, 2013; left knee instability rated 10 percent disabling from March 12, 2013; left knee chondromalacia rated 10 percent disabling from March 12, 2013; right knee chondromalacia rated 10 percent disabling from March 12, 2013 to June 14, 2020, 100 percent disabling under 38 C.F.R. § 4.30 from June 15, 2020 to August 31, 2020, and 10 percent disabling from September 1, 2020; eczema rated noncompensable from October 1, 2007; erectile dysfunction rated noncompensable from October 9, 2012; and right knee scar rated noncompensable from November 19, 2020. The Veteran has met the schedular criteria under § 4.16(a) effective February 18, 2010. The remaining question concerns whether the Veteran is unable to secure or follow a substantially gainful occupation due to his service-connected disabilities. 38 C.F.R. § 4.16(a). The fact that a veteran is unemployed or has difficulty finding employment does not warrant assignment of a TDIU alone as a high rating itself establishes that his disability makes it difficult for him to obtain and maintain employment. Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). Rather, the evidence must show that he is incapable "of performing the physical and mental acts required" to be employed. Id. Thus, the central question is "whether the veteran's service-connected disabilities alone are of sufficient severity to produce unemployability," and not whether the Veteran could find employment. Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). In a social security administration (SSA) record titled "Work History Report," the Veteran reported working in transportation from October 2010 to May 2012, attending school from October 2012 to May 2012, and working as a travel pay clerk from April 2013 to April 2019. The Veteran indicated working at his previous jobs ranging from 8 hours per day 5 days per week, 8 to 10 hours per day 6 to 7 days per week, and 12 hours per day 6 days per week. The Veteran reported that his disorders became severe enough to keep him from working on April 19, 2019. In his June 2019 VA Form 21-8940, Application For Increased Compensation Based On Unemployability, the Veteran reported that his disabilities affected full time employment in January 2019, he last worked full time in April 2019, and became too disabled to work in May 2017. VA examinations prior to April 2019 reflect examiners indicating that the Veteran's service-connected disorders did not impact his ability to work, especially in sedentary occupations as evidenced by the Veteran's work history in sedentary occupations. A preponderance of the evidence is against a finding that the Veteran's service-connected disorders precluded him from securing or following a substantially gainful occupation prior to April 19, 2019. Although the Veteran has met the schedular criteria under § 4.16(a) effective February 18, 2010, SSA records reflect the Veteran working at least 8 hours per day, 5 days per week prior to April 19, 2019. Additionally, VA examiners have indicated that the Veteran was capable of performing the physical and mental acts required to be employed prior to April 19, 2019. Therefore, a TDIU is not warranted, and the claim is denied. Effective Date Right and Left Knee Disorder The applicable law and regulations concerning effective dates state that, except as otherwise provided, the effective date of an evaluation and award of compensation based on an original claim or a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 C.F.R. § 3.400. The effective date of an award of service connection shall be the day following the date of discharge or release if the application is received within one year from such date of discharge or release. Otherwise, the effective date is the date of receipt of claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(b)(2)(i). The Court has interpreted "date entitlement arose" as the date when the claimant met the requirements for the benefits sought. This is determined on a "facts found" basis. 38 U.S.C. § 5110(a); Mcgrath v. Gober, 14 Vet. App. 28, 35 (2000). It is important to note that an effective date generally can be no earlier than the "facts found." DeLisio v. Shinseki, 25 Vet. App. 45 (2011). These "facts found" include the date the disability first manifested and the date entitlement to benefits was authorized by law and regulation. 38 C.F.R. § 3.400. For instance, if a claimant filed a claim for benefits for a disability before he had the disability, the effective date for benefits can be no earlier than the date the disability first manifested. Ellington v. Peake, 541 F.3d 1364, 1369-70 (Fed. Cir. 2008). However, the date entitlement arose is not the date that the RO receives the evidence, but the date to which that evidence refers. Mcgrath v. Gober, 14 Vet. App. 28, 35 (2000). When medical records indicate an increase in a disability, receipt of such medical records may be used to establish effective dates for retroactive benefits based on facts found of an increase in a disability only if a complete claim or intent to file a claim for an increase is received within 1 year of the date of the report of examination, hospitalization, or medical treatment. Id. The terms "claim" and "application" refer to formal or informal communication, in writing, requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p). Generally, the date of receipt of a claim is the date on which a claim, information, or evidence is received by VA. 38 C.F.R. § 3.1(r). A specific claim in the form prescribed by VA must be filed for benefits to be paid or furnished to any individual under the law administered by VA. 38 U.S.C. § 5101(a); 38 C.F.R. § 3.151(a). Any communication or action indicating intent to apply for one or more benefits under the laws administered by VA, from a claimant, his duly authorized representative, a Member of Congress, or a person acting as next friend of the claimant who is not sui juris, may be considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. 38 C.F.R. § 3.155(a). The Court has held that an informal claim must be (1) a communication in writing that (2) expresses intent to apply for benefits, and (3) identifies the benefits sought. Brokowski v. Shinseki, 23 Vet. App. 79, 84 (2009); Brannon v. West, 12 Vet. App. 32, 25 (1998) (holding that before VA can adjudicate an original claim for benefits, the claimant must submit a written document identifying the benefit and expressing some intent to seek it). The Veteran contends that he is entitled to an effective date earlier than March 12, 2013 as to the assignment of 10 percent increased ratings for his right and left right knee disorder. The claims will be denied. On August 18, 2011, the Veteran submitted an increased rating claim as to his noncompensable ratings for his right and left knee disorder. In a March 2012 rating decision, the RO denied compensable ratings for both knees. The Veteran did not submit a NOD, and therefore, the decision became final. On March 12, 2013, the Veteran submitted an increased rating claim as to his noncompensable ratings for his right and left knee disorder. In a December 2013 rating decision, the RO granted 10 percent ratings effective March 12, 2013 for the Veteran's right and left knee disorders. The evidence does not reflect any informal or formal communications that constitutes a claim or application prior to March 12, 2013 for the Veteran's bilateral knee disorders. The Veteran submitted and VA received an increased rating claim for the Veteran's bilateral knee disorder on March 12, 2013. An intent to file a claim was not submitted within one year of the March 12, 2013 increased rating claim. A preponderance of the evidence is against the claims. Therefore, earlier effective dates are not warranted and the claims are denied. M.W. KREINDLER Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Cohen, 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.