Citation Nr: 21077199 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 14-28 133 DATE: December 28, 2021 ORDER A separate rating of 10 percent for a right knee meniscal condition from May 26, 2012, through March 22, 2015, is granted. A rating in excess of 10 percent for right knee loss of flexion status post medial meniscal tear from December 1, 2012, through March 22, 2015, is denied. A rating of 60 percent for status post right knee replacement from May 1, 2016, to December 23, 2020 is granted. A rating in excess of 60 percent for status post right knee replacement is denied. A separate rating of 10 percent for a left knee meniscal condition prior to May 4, 2017, and from July 1, 2017, through January 30, 2018, is granted. A rating in excess of 10 percent for left knee loss of flexion status post meniscectomy prior to May 5, 2017, and from July 1, 2017, through January 30, 2018, is denied. A rating of 60 percent for status post total left knee arthroplasty from April 1, 2019, is granted. A compensable rating for bilateral lower extremity surgical scars is denied. FINDINGS OF FACT 1. The Veteran's right knee meniscal condition resulted in frequent pain and effusion into the joint from May 26, 2012, through March 22, 2015. 2. From December 1, 2012, through March 22, 2015, the Veteran's right knee limitation of flexion was not manifested by flexion limited to 30 degrees or less. 3. The Veterans right total knee replacement has resulted in chronic residuals consisting of severe painful motion or weakness from May 1, 2016; this is the maximum schedular rating for this disability. 4. The Veteran's left knee meniscal condition resulted in frequent pain and effusion into the joint prior to May 4, 2017, and from July 1, 2017, through January 30, 2018. 5. Prior to May 5, 2017, and from July 1, 2017, through January 30, 2018, the Veteran's left knee limitation of flexion was not manifested by flexion limited to 30 degrees or less. 6. From April 1, 2019, the Veteran's left total knee replacement results in chronic residuals consisting of severe painful motion or weakness. 7. During the entirety of the claim, the Veteran's bilateral lower extremity surgical scars have not been painful or unstable and have not been shown to cover an area of 144 square inches or greater (929 sq. cm.). CONCLUSIONS OF LAW 1. The criteria for a separate rating of 10 percent for a right knee meniscal condition from May 26, 2012, through March 22, 2015, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5259. 2. The criteria for a rating in excess of 10 percent for right knee loss of flexion status post medial meniscal tear from December 1, 2012, through March 22, 2015, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5260. 3. The criteria for a rating of 60 percent for status post right knee replacement from May 1, 2016, to December 23, 2020, have been met; this is the maximum schedular rating. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5055. 4. The criteria for a separate rating of 10 percent for a left knee meniscal condition prior to May 5, 2017, and from July 1, 2017, through January 30, 2018, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5259. 5. The criteria for a rating in excess of 10 percent for left knee loss of flexion status post meniscectomy prior to May 4, 2017, and from July 1, 2017, through January 30, 2018, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5260. 6. The criteria for a rating of 60 percent for status post total left knee arthroplasty from April 1, 2019, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5055. 7. The criteria for a compensable rating for bilateral lower extremity surgical scars have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 7805. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from September 1994 to January 1999 and May 1999 to May 2001. The Board sincerely thanks the Veteran for his service to our country. This matter comes before the Board of Veterans' Appeals (Board) from a February 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board acknowledges the time that the Veteran has devoted to this appeals process and appreciates his patience. This claim was previously before the Board in April 2018 and September 2020, when it was remanded for further development. The Board has attempted multiple times to obtain a retrospective opinion as to the severity of the Veteran's flare-ups from 2012. In a March 2021 clarification addendum, the December 2020 VA examiner explained that she is not able to speculate active/passive ROM, weight-bearing, and non-weight-bearing respectively from 2012 based on the evidence of record. The clinician noted the Veteran's reports and knee surgeries. The reasonable implication is that the evidence of record is inadequate to allow for such assessment. As a result, the Board finds that there has been substantial compliance with its remand directives. In July 2017, the Veteran testified at a video-conference hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing is associated with the record. In the June 2020 Written Brief presentation, the Veteran's representative asserted that the qualifications of the VA examiner in October 2019 to give a medical opinion on a complex and progressive degenerative condition such as the Veteran's right and left knee disabilities are "suspect", and that the examination was otherwise inadequate. In other words, the representative has challenged the VA examiner's competence to perform the VA knee examination. If a challenge to the competency of a medical examiner is raised, the Board must make a factual finding as to whether the medical examiner is competent. The challenge must be more than a general assertion that an examination or opinion is inadequate and must be raised by a claimant in the first instance. Francway v. Wilkie, 940 F.3d 1304 (Fed. Cir. 2019) (en banc). Although the Veteran has challenged the competency of the October 2019 examiner, he has not requested any specific information about the examiner's qualifications or made more than a general assertion. Nonetheless, the Board requested that examiner's curriculum vitae and any other information be associated with the record. In a December 2020 memorandum, the evidence intake center was informed that such information is not available. The Board points out that the October 2019 VA examiner was a medical doctor, a medical professional who is qualified to provide information as to the nature and severity of a knee disability. While the examiner did not provide a retrospective opinion as to the severity of the Veteran's flare-ups to 2012, the October 2019 examination report otherwise provides the findings necessary to properly rate the Veteran's knee disability based upon an in-person examination, a complete review of his claims file, and consideration of his reported symptoms and history. The Board also notes that the October 2019 examiner provided the appropriate objective data in order for the severity at the time of examination of the Veteran to be properly rated. Accordingly, the Board finds that the October 2019 examiner was competent to conduct the VA examination. Moreover, the Board finds that, aside from the retrospective opinion, which was not provided, the October 2019 examination report is adequate, and that this report, along with the other evidence of record, provides sufficient information for resolution of the rating issues addressed in this decision. In July 2021, a rating decision awarded an increased 60 percent rating for the right knee from December 24, 2020. Increased Rating Disability ratings are determined by comparing a Veteran's symptomatology during the pertinent period on appeal with criteria set forth in VA's Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings shall be applied under a particular diagnostic code, the higher rating will be assigned if the disability picture more nearly approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. An exception to this rule applies when the rating criteria are successive. In such a case, all the requirements of the lower levels must be met before a higher level is awarded, and 38 C.F.R. §§ 4.7 and 4.21 do not apply. Johnson v. Wilkie, 30 Vet. App. 245 (2018). After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. In every instance where the schedule does not provide a zero percent evaluation for a Diagnostic Code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. With a claim for an increased initial rating, separate staged ratings may be assigned based on facts found. Fenderson v. West, 12 Vet. App. 119 (1999). In a claim for increase in a previously established rating, the present level of disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, where the evidence contains factual findings that demonstrate distinct time periods when the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, staged ratings are to be considered. See Hart v. Mansfield, 21 Vet. App. 505 (2007). In determining whether a claimed benefit is warranted, VA must determine whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107 (a); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case with all reasonable doubt to be resolved in favor of the claimant; however, the reasonable doubt rule is not a means for reconciling actual conflict or a contradiction in the evidence. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Lay evidence may be competent to address any matter not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a layperson. 38 C.F.R. § 3.159 (a)(2). However, competent medical evidence is necessary where the determinative question is one requiring medical knowledge. Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also mean statements conveying sound medical principles found in medical treatises or statements contained in authoritative writings, such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159 (a)(1). The Board has reviewed all of the evidence in the Veteran's claims file, with an emphasis on the evidence pertinent to the issue on appeal. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, all contents of the extensive evidence of record. Indeed, the Federal Circuit has held that the Board must review the entire record but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis below will focus specifically on what the evidence shows, or fails to show, as to the claim. In McGrath v. Gober, 14 Vet. App. 28 (2000), the Court held that when evidence is created is irrelevant compared to when the Veteran was actually experiencing the symptoms. Thus, the Board will consider whether the evidence of record suggests that the severity of pertinent symptoms increased sometime prior to the date of the examination reports noting pertinent findings. The Board has also considered the history of the Veteran's disabilities prior to the rating period on appeal to see if the history supports a higher rating during the rating period on appeal. Generally, in evaluating musculoskeletal disabilities, consideration must be given to additional functional limitation due to factors such as pain, weakness, fatigability, and incoordination. See 38 C.F.R. §§ 4.40 and 4.45; DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). The Court has held that diagnostic codes predicated on limitation of motion do not prohibit consideration of a higher rating based on functional loss due to pain on use or due to flare-ups under 38 C.F.R. §§ 4.40, 4.45, and 4.59. See Johnson v. Brown, 9 Vet. App. 7 (1996); DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). Pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance, as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing. Nonetheless, even when the background factors listed in § 4.40 or § 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). Pain may be taken into consideration when rating functional loss. However, pain on motion is not, itself, functional loss, but may result in functional loss only if it limits the ability "to perform the normal working movements of the body with normal excursion, strength, speed, coordination[, or] endurance." 38 C.F.R. § 4.40. Mitchell v. Shinseki, 25 Vet. App. 32, 38 (2011). A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the claimant. Johnston v. Brown, 10 Vet. App. 80, 85 (1997) (citing 38 C.F.R. § 4.40). 38 C.F.R. § 4.40 (functional loss due to pain is to be rated at the same level as the functional loss when flexion is impeded); see Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991). Thus, in evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 creates a requirement that certain range of motion testing be conducted whenever possible in cases of joint disabilities. The final sentence provides that "[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with the range of the opposite undamaged joint." The Court found that, to be adequate, a VA examination of the joints must, wherever possible, include the results of the range of motion testing described in the final sentence of § 4.59. Correia, 28 Vet. App. at 169-170. In Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017), the Court addressed the adequacy of medical opinions that decline to present clear estimations by citing that such estimations would be mere speculation. The Court explained that case law and VA guidelines do not require direct observation of functional impairment after repetitive use or during a flare-up as a prerequisite to offering a DeLuca opinion. DeLuca v. Brown, 8 Vet. App. 202 (1995). Indeed, it is not expected that such observation will usually occur; therefore, VA examiners should offer opinions based on estimates derived from information procured from all relevant sources, including the lay statements of Veterans. VA examiners have a duty to elicit information from the Veteran when attempting to describe functional loss associated with pain during unobserved exacerbations. If a non-speculative opinion still cannot be offered, the VA examiner must explain the basis for this conclusion. It must be apparent that the inability to provide an opinion without resorting to speculation reflects the limitation of knowledge in the medical community at large and not a limitation (whether based on lack of expertise, insufficient information, or unprocured testing) of the individual examiner. Finally, it is the intention of the VA rating schedule to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. Crepitation either in the soft tissues such as the tendons or ligaments, or crepitation within the joint structures should be noted carefully as points of contact which are diseased. Flexion elicits such manifestations. The joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint. 38 C.F.R. § 4.59. Consideration of 38 C.F.R. § 4.59 is not limited to cases involving arthritis, thereby providing for the possibility of a rating based on painful motion of a joint, regardless of whether the painful motion stemmed from joint or periarticular pathology. Burton v. Shinseki, 25 Vet. App. 1 (2011). The Veteran contends that he is entitled to a higher rating for his bilateral knee disabilities, asserting that the impairment has been more severe than the assigned ratings reflect. This appeal arises from the Veteran's disagreement with the rating determinations associated with August 2012 and September 2012 increased rating claims for the left and right knee disabilities. The Board will consider whether any worsening of the disability within one year prior to the claim warranted an increased rating. The Board furthermore notes that the rating period includes multiple short periods during which the Veteran has already been awarded a maximum 100 percent rating on a temporary basis for periods of convalescence and/or rating provisions for the Veteran's recent total knee replacement surgery. Those periods for which a 100 percent rating for the right and left knee disabilities are already in effect are not the subject of this appeal. Those periods are March 23, 2015 to May 1, 2016, for the right knee, and (1) May 5, 2017 to July 1, 2017 and (2) January 31, 2018 to April 1, 2019 for the left knee. During the pendency of the instant appeal, VA promulgated new regulations governing ratings for musculoskeletal system and muscle disabilities, effective February 7, 2021. See 85 Fed. Reg. 76,453 (Nov. 30, 2020). When a law or regulation changes during the pendency of a Veteran's appeal, the version most favorable to the Veteran applies, absent congressional intent to the contrary. The amended rating criteria, if favorable to the claim, can be applied only for periods 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. See 38 U.S.C. § 5110 (g); 38 C.F.R. § 3.114; VAOPGCPREC 3-2000, 65 Fed. Reg. 33,422 (2000); Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Thus, the Veteran is entitled to application of the criteria that are most favorable to his claim, except that an award based on the amended regulations may not be made effective before the effective date of the change. For the rating periods for consideration in this case, the Veteran's right knee disability has been rated under 38 C.F.R. § 4.71a, Diagnostic Code 5260-5024 for disability manifested by impairment expressed in terms of limitation of extension of the leg, and under Diagnostic Code 5055 for knee replacement. The Veteran's left knee disability has been rated under 38 C.F.R. § 4.71a, Diagnostic Code 5003-5260 for disability manifested by impairment expressed in terms of limitation of extension of the leg, and under Diagnostic Code 5055 for knee replacement. The Board notes that 38 C.F.R. § 4.59 allows consideration of functional loss due to painful motion to be rated to at least the minimum compensable rating for a particular joint, and the Veteran is already in receipt of a greater than minimum compensable rating for his knee disabilities throughout the rating period for consideration. Hyphenated diagnostic codes are used when a rating for a particular disability under one diagnostic code is based upon rating of the residuals of that disability under another diagnostic code. 38 C.F.R. § 4.27. Under Diagnostic Code 5260 flexion of the leg limited to 60 degrees warrants a 0 percent rating, flexion limited to 45 degrees warrants a 10 percent rating, flexion limited to 30 degrees warrants a 20 percent rating, and flexion limited to 15 degrees warrants a 30 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Extension limited to 5 degrees warrants a 0 percent rating, extension limited to 10 degrees warrants a 10 percent rating, extension limited to 15 degrees warrants a 20 percent rating, extension limited to 20 degrees warrants a 30 percent rating, extension limited to 30 degrees warrants a 40 percent rating, and extension limited to 45 degrees warrants a 50 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5261. Flexion of the knee to 140 degrees is considered full and extension to 0 degrees is considered full. 38 C.F.R. § 4.71, Plate II. Diagnostic Code 5024 for "Tenosynovitis, tendinitis, tendinosis or tendinopathy" provides that the joint is to be rated as degenerative arthritis, based on limitation of motion of affected parts. Under Diagnostic Code 5003, degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved (Diagnostic Code 5200, etc.). 38 C.F.R. § 4.71a, Diagnostic Code 5003. Diagnostic Code 5055 (for prosthetic replacement, defined as total replacement of the joint), which provides for a 100 percent rating for 1 year following implantation of prosthesis, a 60 percent rating for chronic residuals of severe painful motion or weakness in the joint, and ratings by analogy to Codes 5256, 5261 or 5262 for intermediate degrees of weakness, pain, or limitation of motion (with a 30 percent minimum rating). 38 C.F.R. § 4.71a. Diagnostic Code 5259 contemplates a 10 percent rating for cartilage, semilunar, removal of, symptomatic. Under Diagnostic Code 5259 5258, a 20 percent rating is assigned for dislocated semilunar cartilage with frequent episodes of 'locking,' pain, and effusion into the joint. 38 C.F.R. § 4.71a, Diagnostic Code 5259 5258. These criteria are conjunctive, not disjunctive; all criteria must be met. See Melson v. Derwinski, 1 Vet. App. 334 (1991)(use of the conjunctive "and" in a statutory provision meant that all of the conditions listed in the provision must be met); see also Middleton v. Shinseki, 727 F.3d 1172 (Fed. Cir. 2013)(if disability rating criteria are written in the conjunctive, "a veteran must demonstrate all of the required elements in order to be entitled to that higher evaluation" and 38 C.F.R. § 4.7 cannot be used to circumvent the need to demonstrate all required criteria). These provisions are substantially unchanged by the new regulations effective February 7, 2021. Factual Background A May 2012 MRI shows moderate effusion with synovitis of the right knee, and a treatment record dated May 26, 2016, shows the Veteran reported that he was walking when he felt a "pop" in his right knee followed by pain. The September 2012 VA examiner diagnosed the Veteran with status post medial meniscus tear right knee and degenerative joint disease of the bilateral knees. The Veteran reported intermittent, intense deep knee pain, audible crepitus and popping, and occasions when the knees will feel weak and "give out". The Veteran reported flare-ups resulting in difficulty bending, walking for long periods, trouble sleeping, getting dressed, going up and down stairs, attempting to stand from sitting, and squatting. Initial range of motion testing showed right knee flexion limited to 90 degrees and full extension to 0 degrees as well as left knee flexion limited to 110 degrees and full extension to 0 degrees. Repetitive use testing was performed without additional loss of range of motion. The examiner noted that the Veteran had bilateral meniscal tears with frequent episodes of pain and effusion. Frequent episodes of locking were not noted. The examiner indicated that the Veteran had not had a total knee replacement but noted an in-service right ACL repair, an in-service left knee surgery, and an August 2012 meniscectomy. The Veteran was noted to experience residual signs and/or symptoms of bilateral knee surgeries, consisting of pain, stiffness, swelling, crepitus, popping, and buckling. The examiner considered a May 2012 x-ray that showed mild to moderate osteoarthritis bilaterally and small joint effusions and a May 2012 right knee MRI that showed (among other observations) extensive tricompartmental osteoarthritic change and degeneration of the posterior horn and root of the medial meniscus. The December 2012 VA examiner diagnosed the Veteran with residuals of left medical meniscectomy with post-traumatic arthritis and residuals of right ACL tear status post reconstruction. The Veteran reported of flare ups consisting of increasing pain and swelling. Initial range of motion testing showed right knee flexion limited to 110 degrees, with painful motion beginning at 100 degrees, and extension to 10 degrees. Left knee flexion was limited to 120 degrees, with painful motion beginning at 100 degrees, and full extension to 0 degrees. Repetitive use testing was performed without additional loss of range of motion. The examiner noted that the Veteran had bilateral meniscal tears and noted residual symptoms of persistent pain and stiffness. At the November 2016 VA examination, initial range of motion testing showed bilateral flexion limited to 110 degrees and full extension to 0 degrees. Pain was noted with flexion. The right knee showed no evidence of pain with weight bearing, objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue, or objective evidence of crepitus. There was objective evidence of left knee crepitus. The examiner indicated that the Veteran did not report flare-ups and repetitive use testing was performed without additional loss of range of motion. No meniscal conditions were noted. At the July 2017 VA examination, the Veteran reported a worsening of the left knee. He described burning, a feeling that the kneecap is slipping to the right, and an inability to fully straighten the knee. The Veteran reported flare-ups of the knees consisting of increased pain, and reported functional loss of difficulty climbing stairs, pushing down, and squatting. Initial range of motion testing showed right knee flexion limited to 100 degrees and full extension to 0 degrees, as well as flexion limited to 115 degrees and full extension to 0 degrees. Repetitive use testing was performed without additional loss of range of motion, and the Veteran was examined immediately after repetitive use over time, not resulting in additional functional loss over initial range of motion measurement. The examination was not performed during a flare-up, however the examiner stated that pain and lack of endurance significantly limit functional ability with flare-ups. The examiner was not able to describe functional loss in terms of range of motion, noting that the Veteran has "more difficulty climbing stairs, pushing down and squatting." The Veteran experienced a reduction of strength (4/5) on flexion. Regarding a meniscal condition, the examiner diagnosed the veteran with bilateral meniscal tears, without frequent episodes of joint "locking," pain, or effusion. The examiner described that the Veteran had a right knee 2013 arthroscopy with residuals of pain and decreased range of motion, and a 2015 total knee replacement with chronic residuals consisting of severe painful motion or weakness. The examiner also described that the Veteran had a March 2017 left knee arthroscopy/meniscus repair resulting in pain and decreased motion. The Board notes that a May 2017 private physical therapy note also shows left knee active range of motion limited to 115 degrees. The October 2019 VA examiner described that the Veteran is status post total knee replacement for the bilateral knees with scars. The Veteran reported bilateral knee pain that is worse with prolonged standing and walking. Initial range of motion testing showed right knee flexion limited to 120 degrees and full extension to 0 degrees, as well as left knee flexion limited to 110 degrees and full extension to 0 degrees. Repetitive use testing was performed without additional loss of range of motion, and the Veteran was examined immediately after repetitive use over time, not resulting in additional functional loss over initial range of motion measurement although pain was noted to significantly limit functional ability. The examiner noted bilateral meniscal tears. The examiner described that the Veteran had a 2015 right total knee replacement with intermediate degrees of residual weakness, pain or limitation of motion and a 2018 left total knee replacement with intermediate degrees of residual weakness, pain or limitation of motion. At the December 2020 VA examination, the Veteran reported that his pain has gotten progressively worse in the bilateral knee over the years, and current symptoms include constant aching bilateral knee pain 7/10. He reported treating his knees with physical therapy, ibuprofen, ice, and use of a cane as needed. The Veteran described severe daily flare-ups of increased pain with activity and weather changes, lasting hours, and described difficulty ambulating up and down stairs, crawling, bending, squatting, and running. Initial range of motion testing showed right knee flexion limited to 90 degrees and extension to 25 degrees, as well as left leg flexion limited to 80 degrees and extension to 10 degrees. Repetitive use testing was performed without additional loss of range of motion. While the examination was not performed immediately after repeated use over a period of time, the examiner estimated right knee flexion to be limited to 80 degrees and extension to 30, as well as left knee flexion limited to 80 degrees and extension to 15. During flare-ups, the examiner estimated that the Veteran's right knee flexion would be limited to 90 degrees and extension to 30, as well as left knee flexion limited to 80 degrees and extension to 15. The examiner indicated that the Veteran had bilateral meniscal tears with repair. The examiner described that the Veteran had a 2015 right total knee replacement with chronic residuals consisting of severe painful motion or weakness. The examiner described that the Veteran had a 2018 left total knee replacement with intermediate degrees of residual weakness, pain or limitation of motion. 1. A rating in excess of 10 percent for status post right knee medial meniscal tear from December 1, 2012, through March 22, 2015, in excess of 30 percent for status post right knee replacement from May 1, 2016 to December 23, 2020, and in excess of 60 percent from December 24, 2020 In relevant part, from December 1, 2012, through March 22, 2015, the Veteran's right knee is rated 10 percent disabling under Diagnostic Code 5260-5024. From May 1, 2016 to December 23, 2020, the Veteran's right knee is rated as 30 percent disabling under Diagnostic Code 5055. From December 24, 2020 the right knee has been rated 60 percent disabling. Based on the May 2012 VA treatment record showing a worsening of the Veteran's right knee meniscal condition, the September 2012 VA examination describing bilateral meniscal tears with frequent episodes of pain and effusion, and the December 2012 VA examination describing bilateral meniscal tears and noting residual symptoms of persistent pain and stiffness, the Board finds that a separate 10 percent rating is warranted for each the right knee under Diagnostic Code 5259 for the Veteran's right meniscal condition from May 26, 2012, the date of the record shows a worsening of the Veteran's right knee condition within the year prior to the Veteran's claim for an increased rating, until March 22, 2015. The Veteran had a right knee meniscal repair in 1998 with recurring episodes of joint pain and effusion noted at the time of the September 2012 and December 2012 examinations. While the 2012 examiners indicated that the Veteran has a meniscal tear with intermittent pain and effusion, "locking" of the joint was not noted, thus a higher rating of 20 percent under DC 5258 is not warranted. The Board has considered whether the Veteran is entitled to a higher rating under Diagnostic Code 5260, however the medical evidence of record does not show that the Veteran's right knee flexion was manifested by flexion limited to 30 degrees or less. Thus, a higher rating of 20 percent or higher is not warranted. The October 2019 VA examination describes the Veteran's 2015 right knee total knee replacement as having only intermediate degrees of residual weakness, pain or limitation of motion. Both the July 2017 and December 2020 VA examinations describing the Veteran's 2015 right total knee replacement with chronic residuals consisting of severe painful motion or weakness. Affording the Veteran the benefit of the doubt, the Board finds the evidence is at least in equipoise that the Veteran's right total knee replacement with chronic residuals consists of severe painful motion or weakness. Therefore, a 60 percent rating for the Veteran's right total knee replacement under Diagnostic Code 5055 is granted from May 1, 2016, to December 23, 2020. For the period from December 24, 2020, the Veteran has been in receipt of the maximum schedular rating for this disability. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (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). The Board notes that under the amputation rule, the maximum rating for the Veteran's lower extremity for the knee and below is 60 percent; thus, the Veteran is in receipt of the highest schedular rating available. 2. A rating in excess of 10 percent for status post left knee meniscectomy prior to May 4, 2017 and from July 1, 2017 through January 30, 2018, and in excess of 30 percent for status post total left knee arthroplasty from April 1, 2019 In relevant part, from prior to May 4, 2017 and from July 1, 2017 through January 30, 2018, the Veteran's left knee is rated 10 percent disabling under Diagnostic Code 5260-5024. From April 1, 2019 the Veteran's left knee is rated as 30 percent disabling under Diagnostic Code 5055. Based on the September 2012 VA examination describing bilateral meniscal tears with frequent episodes of pain and effusion, and the December 2012 VA examination describing bilateral meniscal tears and noting residual symptoms of persistent pain and stiffness, the Board finds that a separate 10 percent rating is warranted for the left knee under Diagnostic Code 5259 for the Veteran's meniscal condition from the date of the Veteran's claim for an increased rating, through the time of his left total knee replacement. The Veteran had a left knee meniscal repair in 2012, and a meniscal tear with recurring episodes of joint pain and effusion noted at the time of the September 2012 and December 2012 examinations. While the 2012 examiners indicated that the Veteran has a meniscal tear with intermittent pain and effusion, "locking" of the joint was not noted, thus a higher rating of 20 percent under DC 5258 is not warranted. The Board has considered whether the Veteran is entitled to a higher rating under Diagnostic Code 5260, however the medical evidence of record does not show that the Veteran has left knee flexion was manifested by flexion limited to 30 degrees or less. Thus, a higher rating of 20 percent is not warranted. As discussed above, the October 2019 VA examination report shows the Veteran had left knee flexion to 110 degrees, and extension to 0 degrees, including with repetitive motion testing, after repeated use over time, and due to pain, fatigue, weakness, lack of endurance, and incoordination. Pain was noted on flexion, with weight bearing, and with passive range of motion testing, but not when used in non-weight bearing. There was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue nor crepitus. The Veteran had full strength, no muscle atrophy, and no joint instability. The Veteran was noted to occasionally use a brace and cane. The examiner in October 2019 indicated that the Veteran has intermediate degrees of residual weakness, pain, or limitation of motion due to his left knee replacement, rather than chronic residuals consisting of severe painful motion or weakness. The December 2020 VA examination report shows that he has left knee flexion to at least 80 degrees, and extension to 15 degrees during daily flare-ups lasting hours. There was objective evidence of 3/10 pain on palpation of the medial and lateral knee. His muscle strength is 4/5. He has no atrophy, but he complained of constant aching knee pain of 7/10, with daily flare-ups of increased pain 9/10. The examiner in December 2020 indicated that he has intermediate degrees of residual weakness, pain, or limitation of motion due to his left knee replacement While the examiners indicated that the Veteran has intermediate degrees of residual weakness, pain, or limitation of motion due to his left knee replacement, rather than chronic residuals consisting of severe painful motion or weakness, the Board observes that the Veteran's functional limitations, range of motion, and reports of pain and flare-ups are similar to those of his right knee, which the examiner described as chronic residuals consisting of severe painful motion or weakness. Reading the examinations in the light most favorable to the Veteran and providing the benefit of the doubt, the Board finds that the Veteran's left knee status post total knee replacement more nearly approximated chronic residuals consisting of severe painful motion or weakness. The Board acknowledges that the October 2019 examiner indicated that the Veteran has intermediate degrees of residual weakness, pain, or limitation of motion bilaterally and yet, as discussed above, the Board granted the Veteran a 60 percent rating for the right knee during the period covered by the October 2019 examination. However, the October 2019 examination notes that in addition to pain on flexion and with weight-bearing, the Veteran's right knee also demonstrated pain on extension. An increased 60 percent rating is warranted from April 1, 2019. 3. A compensable rating for bilateral lower extremity surgical scars The Veteran's scars are rated as noncompensable under Diagnostic Code 7805 for other scars (including linear scars) and other effects of scars evaluated under Diagnostic Codes 7800, 7801, 7802, and 7804. The Board notes that VA amended the criteria for rating skin disabilities effective from August 13, 2018. However, Diagnostic Code 7805 was not changed by the August 13, 2018, amendments. Diagnostic Code 7805 instructs that any disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-04 should be evaluated under an appropriate Diagnostic Code. The Board finds that the preponderance of the evidence is against the assignment of a compensable rating for the Veteran's bilateral knee scars under Diagnostic Codes 7800 through 7805. The Veteran's scars are not on the head, face, or neck, but on his bilateral knees. Moreover, they are not deep and nonlinear and are not associated with underlying soft tissue damage but are superficial. Although they are superficial and not associated with underlying soft tissue damage, they have not been shown to cover an area of 144 square inches or greater (929 sq. cm.). While measurements by the VA examiners have varied (for instance, prior to the Veteran's total left knee replacement, the November 2016 examiner provided measurements totalling an area of 9.75 sq. cm., while the July 2017 examiner provided measurements totalling an area of 7.6 sq. cm; after the Veteran's total left knee replacement, the October 2019 examiner provided measurements totalling an area of 20.95 sq. cm., while the December 2020 examiner provided measurements totalling an area of 13 sq. cm), even while affording the Veteran the benefit of the doubt and totalling the most generous of each scar measurement, the Veteran's bilateral lower extremity scars have not been shown to cover an area of 144 square inches or greater (929 sq. cm.). Therefore, Diagnostic Codes 7800, 7801, 7802, and 7804, both prior to and from August 13, 2018, are inapplicable. Finally, the evidence does not show that there are any other effects not considered under Diagnostic Codes 7801-04 that would be ratable under another applicable Diagnostic Code. Because the preponderance of the evidence is against the claim, the "benefit-of-the-doubt" doctrine is not applicable; and the claim must be denied. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). M. C. GRAHAM Veterans Law Judge Board of Veterans' Appeals Attorney for the Board O. Halpern 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.