Citation Nr: 21005754 Decision Date: 02/02/21 Archive Date: 02/02/21 DOCKET NO. 16-44 492 DATE: February 2, 2021 ORDER Entitlement to a disability rating higher than 50 percent for the service-connected mental disability, is denied. Entitlement to a disability rating higher than 0 percent for the service-connected low back disability is denied. Entitlement to a disability rating higher than 0 percent for lateral instability or recurrent subluxation left knee is denied. Entitlement to a disability rating higher than 0 percent for lateral instability or recurrent subluxation right knee is denied. Entitlement to a separate rating of 10 percent, but not higher, for left knee painful motion, is granted. Entitlement to a separate rating of 10 percent, but not higher, for right knee painful motion, is granted. FINDINGS OF FACT 1. The service-connected mental disability is manifested by occupational and social impairment with reduced reliability and productivity, but is not manifested by occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, or by total occupational and social impairment. 2. The service-connected back disability has essentially resolved. 3. The service-connected left knee disability is manifested by no lateral instability or recurrent subluxation. 4. The service-connected right knee disability is manifested by no lateral instability or recurrent subluxation. 5. The Veteran’s left knee disability is manifested by painful motion. 6. The Veteran’s right knee disability is manifested by painful motion. CONCLUSIONS OF LAW 1. The criteria for entitlement to a disability rating higher than 50 percent for the service-connected mental disability are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.126, 4.130, Diagnostic Code 9411 (2019). 2. The criteria for a disability rating higher than 0 percent for the service-connected low back disability are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5237 (2019). 3. The criteria for a disability rating higher than 0 percent for left knee lateral instability or subluxation are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5257 (2019). 4. The criteria for a disability rating higher than 0 percent for right knee lateral instability or subluxation are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5257 (2019). 5. The criteria for a rating of 10 percent for left knee limitation of motion are met; the criteria for any higher ratings are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260 (2019). 6. The criteria for a rating of 10 percent for right knee limitation of motion are met; the criteria for any higher ratings are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a veteran (the Veteran) who had active duty service from January 2011 to May 2014. This appeal comes before the Board of Veterans’ Appeals (Board) from a December 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In September 2020, the Veteran presented testimony at a Board hearing, chaired virtually, via videoconference, by the undersigned Veterans Law Judge. The Veteran accepted such hearing in lieu of an in-person hearing before a Member of the Board. See 38 C.F.R. § 20.700(e). At the Board hearing, the Veteran was informed of the basis for the RO’s denial of his claims and he was informed of the information and evidence necessary to substantiate each claim. 38 C.F.R. § 3.103. A transcript of the hearing is associated with the claims file. The issue of TDIU entitlement was not separately appealed. The Board has considered whether such a claim is a component of the increased rating claims in accordance with Rice v. Shinseki, 22 Vet. App. 447 (2009) (where there is evidence of unemployability raised by the record during a rating appeal period, the TDIU is an element of an initial rating or increased rating). However, the Veteran does not contend, and the evidence does not otherwise show, that he is unemployable, or in fact, that he is unemployed. Accordingly, such a claim is not reasonably raised. Increased Ratings—Law and Regulations Disability ratings are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. See 38 C.F.R. § 4.3. A disability rating may require re-evaluation in accordance with changes in a veteran’s condition. Thus, it is essential that the disability be considered in the context of the entire recorded history when determining the level of current impairment. See 38 C.F.R. § 4.1. See also Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Nevertheless, where a veteran is appealing the rating for an already established service-connected condition, his present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, when an appeal is based on the assignment of an initial rating for a disability, following an initial award of service connection for this disability, the rule articulated in Francisco does not apply. Fenderson v. West, 12 Vet. App. 119 (1999). Instead, the evaluation must be based on the overall recorded history of a disability, giving equal weight to past and present medical reports. Id. Staged ratings are appropriate for an increased-rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). Generally, lay evidence is competent with regard to identification of a disease with unique and readily identifiable features which are capable of lay observation. A lay person may speak to etiology in some limited circumstances in which nexus is obvious merely through observation, such as sustaining a fall leading to a broken leg. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir 2007). Lay persons may also provide competent evidence regarding a contemporaneous medical diagnosis or a description of symptoms in service which supports a later diagnosis by a medical professional. However, a lay person is not competent to provide evidence as to more complex medical questions, i.e., those which are not capable of lay observation. Lay statements are not competent evidence regarding diagnosis or etiology in such cases. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever); Jandreau, at 1377, n. 4 (‘sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer’); 38 C.F.R. § 3.159(a)(2). After the evidence has been assembled, it is the Board’s responsibility to evaluate the entire record. 38 U.S.C. § 7104(a) (West 2014). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (West 2014); 38 C.F.R. §§ 3.102, 4.3 (2019). A VA claimant need only demonstrate that there is an approximate balance of positive and negative evidence in order to prevail. Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996); Gilbert at 54. Entitlement to a disability rating higher than 50 percent for the service-connected mental disability. The current appeal arises from a service connection claim received at VA on June 20, 2015. In a December 2015 rating decision, VA granted service connection for PTSD and alcohol use disorder and assigned an initial disability rating of 50 percent under Diagnostic Code 9411, effective June 30, 2014. In the process of evaluating a psychiatric/mental disorder, VA is required to consider a number of pertinent factors, such as the frequency, severity, and duration of a veteran’s psychiatric symptoms and the veteran’s capacity for adjustment during periods of remission. After consideration of these factors, and based on all the evidence of record that bears on occupational and social impairment, VA must assign a disability rating that most closely reflects the level of social and occupational impairment a veteran is suffering rather than based solely on the examiner’s assessment of the level of disability at the moment of examination. When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment. See 38 C.F.R. § 4.126. The VA Secretary, acting within his authority to adopt and apply a schedule of ratings, chose to create one General Rating Formula for Mental Disorders. 38 U.S.C. § 1155; see 38 U.S.C. § 501; 38 C.F.R. § 4.130. By establishing one general formula to be used in rating more than 30 mental disorders, the VA Secretary anticipated that any list of symptoms justifying a particular rating would, in many situations, be either under- or over-inclusive. The use of the phrase “such symptoms as,” followed by a list of examples, provides guidance as to the severity of symptoms contemplated for each rating, in addition to permitting consideration of other symptoms, particular to each veteran and disorder, and the effect of those symptoms on the claimant’s social and work situation. This construction is consistent with Cohen v. Brown, 10 Vet. App. 128 (1997). See Mauerhan v. Principi, 16 Vet. App. 436, 442 (1992). The schedular criteria incorporate the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). 38 C.F.R. §§ 4.125, 4.130. Since August 4, 2014, VA has required a diagnosis of a mental disorder that conforms with the DSM–5. For claims prior to that date, VA required a diagnosis that conformed with the DSM–IV–TR. See Schedule for Rating Disabilities: Mental Disorders and Definition of Psychosis for Certain VA Purposes, 79 Fed. Reg. 45,093, 45,093 –94 (Aug. 4, 2014 (amending 38 C.F.R. § 4.125)). The evidence considered in determining the level of impairment under § 4.130 is not restricted to the symptoms provided in the diagnostic code. Instead, the rating specialist is to consider all symptoms of a claimant’s condition that affect the level of occupational and social impairment, including, if applicable, those identified in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. See 38 C.F.R. § 4.126. If the evidence demonstrates that a claimant suffers symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the diagnostic code, the appropriate, equivalent rating will be assigned. Mauerhan, 16 Vet. App. at 443. The Court of Appeals for the Federal Circuit has embraced the Mauerhan interpretation of the criteria for rating psychiatric disabilities. Sellers v. Principi, 372 F.3d 1318, 1326 (Fed. Cir. 2004). Psychiatric disorders are to be rated on the severity, frequency, and duration their respective signs and symptoms. See Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); Vazquez-Claudio v. Shinseki, 713 F.3d 112, 115 (Fed. Cir. 2013). Pertinent to the claim on appeal, the General Rating Formula for Mental Disorders at 38 C.F.R. § 4.130 provides the following ratings for psychiatric disabilities: A 0 percent rating is warranted where a mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication. A 10 percent rating is warranted for PTSD if there is occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication. A 30 percent rating is warranted for PTSD if there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, recent events). A 50 percent rating is warranted if it is productive of occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to compete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating, may be assigned for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. The criteria for a 70 percent rating are met if there are deficiencies in most of the areas of work, school, family relations, judgment, thinking, and mood. Bowling v. Principi, 15 Vet. App. 1, 11-14 (2001). A 100 percent rating contemplates total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130, Diagnostic Code 9411. An August 2015 VA Mental Health Examination reveals a diagnosis of PTSD and alcohol use disorder, mild, found to be very likely directly linked to his PTSD. The Veteran reported that he is currently dating. He reported that his girlfriend is supportive and understanding. He reported that he continues to be close with his family. He reported that his family recently sat him down and asked him to get help noting major changes in his behavior and attitude since he has returned home from the service. The Veteran attempted to attend college at a local junior college. He reported that he failed all his classes. He reported irritation at his peers and some struggle with being in the crowds as his barriers to success in school. He is currently employed. He reported that he has informed his boss that he is looking for new work. He has been there a few months part time. He reported struggles with handling the customers and the crowds as his motivation to find a new job. He is also working part time for a dog training group. He reported that he loves this work and is hoping to increase his part time role to train animals to be service animals. The examiner found the most appropriate criteria were occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal). Symptoms included a depressed mood, anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, mild memory loss, such as forgetting names, directions or recent events, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. The Veteran was highly anxious in the examination. It was though his degree of anxiety could cause impairments in the workplace such as dealing with coworkers or customers. He struggled some with remaining focused and was easily distracted by noise in a quiet office setting, it was reasonable to assume that noise in a regular workplace could lead to distractions that would decrease overall work performance and meeting of work goals. His speech was fluent, and he was pleasant with office staff and the examiner. He was leaving his current employment due to some of the above concerns. He reported success with his part time position working with animals, this could lead to a possible positive work setting (Record 08/15/2015 at 75). VA outpatient treatment records can be summarized by showing that the Veteran was significantly impacted by substance abuse. He reported anger, but denied suicidal ideation or homicidal ideation. His mood was occasionally normal, but was impacted by depression and anxiety, which were responsive to medication. He was consistently interactive, answered questions appropriately, had normal speech, congruent affect, and linear thought processes. He denied hallucinations, obsessions, compulsions, or cravings. He was alert and oriented, with intact memory, fair insight, and fair judgment. He had good grooming and hygiene. In a June 30, 2015, VA Mental Health Note, the Veteran described his girlfriend as his “best friend” (Record 07/25/2016 at 69). At the Board hearing, the Veteran reported that he had seen a private provider for counseling but was having a hard time finding some that he could connect with. He agreed to provide records of his treatment and was provided additional time to obtain (Record 09/25/2020 at 7). He has not provided any additional records. The Veteran testified that his primary problem was anxiety, particularly social anxiety. He believes that this is affecting his memory. He reported that his anxiety is constant (Record 09/25/2020 at 3). The Veteran testified that, while his anxiety affects his work performance, he never misses any work because of it.(Record 09/25/2020 at 4). The Veteran testified that he has a group of friends who make him feel less anxious, and these are the people he feels comfortable going out with (Record 09/25/2020 at 5). After a review of all of the evidence, the Board finds that the criteria for a rating higher than 50 percent for the service-connected mental disability are not met. While the record clearly demonstrates that the Veteran has a deficiency in his mood, which is demonstrated by constant anxiety and occasional periods of panic; and these symptoms also cause a depressed mood, this appears to be his main area of deficiency. The Board acknowledges that the Veteran attributes his irritation with peers and struggle being in crowds as barriers to school success. However, the Board finds that there are no true deficiencies in thinking, judgment, or family relations. As noted above, the Veteran’s thinking has been found on examination to be essentially normal. His judgment has been at least “fair.” He has reported good and supported family relations. Regarding work, the Veteran’s mental symptomatology certainly impacts his work to some degree, in particular when working in a noisy or crowded environment; however, it is difficult to see how this amounts to a true deficiency. He has apparently maintained employment throughout the time of the appeal and was actively seeking work more compatible with his symptoms. Some interference with occupational function is anticipated at all rating levels above 0 percent. The Veteran’s ability to maintain employment, and seek more compatible employment, is probative evidence that there is no true deficiency in work function. However, even if a work deficiency were found to exist, this would still not demonstrate deficiencies in most areas. Accordingly, the Board finds that there are not deficiencies in most areas, as required for a 70 percent rating. In addition, the Board finds that the Veteran’s disability picture does not substantiate symptoms of the type and degree contemplated by the examples provided for the 70 percent rating. While the precise examples listed need not be present, his symptoms must of the same type and degree. These include suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. The picture presented here is of a lower severity, primarily anxiety with occasional panic, and depression. These symptoms certainly affect his social function, as he has reported social anxiety, but they do not approach the level of impairment contemplated in a 70 percent rating. Finally, the Board finds that none of the symptomatology associated with a total rating are present here. There is neither total social impairment nor total occupational impairment. In short, the gross impairment of behavior resulting in severe disorientation of the individual, which is contemplated by the 100 percent rating criteria, is simply not evident in this case at any time. For these reasons, the Board finds that the evidence does not more nearly approximate the criteria for a 70 percent rating than those for a 50 percent rating. 38 C.F.R. § 4.7. In summary, the Board finds that the service-connected mental disability is manifested by occupational and social impairment with reduced reliability and productivity, but is not manifested by occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, or total occupational and social impairment. In light of these findings of fact, the Board concludes that a disability rating higher than 50 percent for the service-connected mental disability is not warranted. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. 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, 371 (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). Entitlement to a disability rating higher than 0 percent for the service-connected low back disability. Disability of the musculoskeletal system is primarily the inability, due to damage or infection of parts of the musculoskeletal system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. The functional loss may be due to absence of part, or all, of the necessary bones, joints, and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca, 8 Vet. App. 202; see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). 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 (musculoskeletal system) or § 4.73 (muscle injury); 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). The current appeal arises from a service connection claim received at VA on June 20, 2015. In a December 2015 rating decision, VA granted service connection for lumbosacral strain and assigned initial disability ratings of 0 percent under Diagnostic Code 5237, effective June 30, 2014. The General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula) encompasses such disabling symptoms as pain, ankylosis, limitation of motion, muscle spasm, and tenderness. Diagnostic codes 5235-5243 are included. Pertinent to the lumbar spine, under the General Rating Formula for diseases and injuries of the thoracolumbar spine, a rating of 100 percent requires unfavorable ankylosis of the entire spine. A rating of 10 percent requires forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour. A rating of 20 percent requires forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A rating of 40 percent requires forward flexion of the thoracolumbar spine limited to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A rating of 50 percent requires unfavorable ankylosis of the entire thoracolumbar spine. The Veteran initially testified at the Board hearing that his back has gotten better. He had gotten in a lot better shape. He had been going to the gym probably on a daily basis for quite some time. There was not much pain in his back anymore. He did not see it as much of an issue anymore. He had been going to a chiropractor, but that was mostly for his neck. He had not had back issues for quite some time. The Veteran initially indicated that he would withdraw his appeal as to that issue, but was afforded additional time to submit any private records that might support an increased rating. He has not done so (Record 09/25/2020 at 8). An August 2015 VA Back Examination reveals a diagnosis of lumbar spine strain in 2011. On examination, range of motion in all excursions—forward flexion, extension, lateral flexion, and lateral rotation—were fully normal, even after 3 repetitions. There was no objective evidence of painful motion with any excursion. There was no functional impairment. There was no pain or spasm on palpation. There was no guarding noted. Muscle strength was full, reflexes were normal, sensation was normal, there was no radiculopathy. There was no intervertebral disc syndrome or other neurologic abnormalities. The impact on work was a limitation in the number of time he could stand (Record 08/15/2015 at 68). VA outpatient treatment records can be summarized as showing possible, but unconfirmed, spasm; normal range of motion; full strength globally; and normal imaging of lumbosacral spine. After a review of all of the evidence, the Board finds that the criteria for a rating higher than 0 percent for the service-connected low back disability are not met. The Veteran’s range of motion on examination has been normal. The evidence does not substantiate forward flexion limited to 85 degrees, combined range of motion limited to 235 degrees, muscle spasm, guarding, or localized tenderness. These are the minimum criteria for a compensable rating. While there was a notation of possible muscle spasm in one record, this was not confirmed. The Board has considered whether a compensable rating may be assigned under 38 C.F.R. § 4.71, Diagnostic Code 5010, or 38 C.F.R. § 4.59. There is no X-ray evidence of arthritis, as would be required under Diagnostic Code 5010; and, the Veteran has essentially disavowed any current symptomatology of the low back. Accordingly, the Board finds that the evidence is insufficient to award a rating on those bases. The Board also notes that there is no medical evidence or assertion of intervertebral disc syndrome or associated neurological abnormalities. Accordingly, the Board concludes that no higher or separate ratings are warranted. In reaching these conclusions, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, 28 Vet. App. 366, 371. Entitlement to a disability rating higher than 0 percent for left knee instability. Entitlement to a disability rating higher than 0 percent for right knee instability. Entitlement to a separate compensable rating for left knee limitation of motion. Entitlement to a separate compensable rating for right knee limitation of motion. The current appeal arises from a service connection claim received at VA on June 20, 2015. In a December 2015 rating decision, VA granted service connection for left and right knee strain and assigned initial disability ratings of 0 percent under Diagnostic Code 5257, effective June 30, 2014. Ratings for limitation of knee motion are addressed by Diagnostic Codes 5260 and 5261. Diagnostic Code 5260 addresses limitation of flexion of the knee. Under that code, a 30 percent rating is for application were flexion is limited to 15 degrees; a 20 percent rating is for application where flexion is limited to 30 degrees; a 10 percent rating is for application where flexion is limited to 45 degrees; a 0 percent rating is for application where flexion limited to 60 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Diagnostic Code 5261 addresses limitation of extension of the knee. Under that code, a 50 percent rating is for application where extension is limited to 45 degrees; a 40 percent rating is for application where extension is limited to 30 degrees; a 30 percent rating is for application where extension is limited to 20 degrees; a 20 percent rating is for application where extension is limited to 15 degrees; a 10 percent rating is for application where extension is limited to 10 degrees; a 0 percent rating is for application where extension is limited to 5 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261. Diagnostic Code 5256 governs ankylosis (complete bony fixation) of the knee, which is neither asserted nor shown here with respect to either knee. Diagnostic Code 5257 addresses recurrent subluxation or lateral instability of the knee. Under that code, a 30 percent rating is for application where subluxation or lateral instability is severe. A 20 percent rating is for application where subluxation or lateral instability is moderate. A 10 percent rating is for application where subluxation or lateral instability is slight. 38 C.F.R. § 4.71a, Diagnostic Code 5257. The Board notes that the criteria under Diagnostic Codes 5257, 5260, and 5261 are not considered to be overlapping, and therefore separate ratings can be assigned where appropriate symptomatology is shown. Diagnostic Code 5258 rates on the basis of dislocation of the semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint. A 20 percent rating is the only rating available. Diagnostic Code 5259 provides a 10 percent rating for symptomatic removal of the semilunar cartilage. The current 0 percent rating for the knees is assigned under Diagnostic Code 5257, which rates in accordance with lateral instability and recurrent subluxation. The term “knee strain,” for which service connection has been granted, is an ambiguous term, referring to the initial injury, and not to a current disability. Nevertheless, the RO chose to rate it in accordance with Diagnostic Code 5257. An August 2015 VA Knees Examination reveals the diagnosis of left knee strain. Arthritis was not found. Flares of knee pain were noted to consist of pain with standing, walking, and taking stairs. On examination, range of motion was all normal, from 0 degrees extension to 140 degrees flexion. The Veteran was able to complete 3 repetitions with no degradation in range of motion. There was no pain with weight bearing, no crepitus, there was no functional loss. The examiner found that pain, weakness, fatigability, or incoordination would not significantly limit functional ability with repeated use over a period time or during flares. Additional factors included interference with standing. Muscle strength testing was full, with no muscle atrophy. There was no ankylosis to any degree. There was no lateral instability or recurrent subluxation. Anterior instability, posterior instability, medial instability, and lateral instability, were all normal. There were no meniscal conditions found. The Veteran was using no assistive devices for his knees. There was no impact of the condition on the ability to work (Record 08/15/2015 at 21). VA outpatient treatment records can be summarized as showing diagnosis of patellofemoral stress/pain syndrome, with negative stability testing and normal range of motion. X-rays have been normal. There are no effusions, locking, or findings consistent with meniscal tear. MRI was not indicated. The Veteran repeatedly complained of pain, catching, and trouble navigating stairs. After a review of all of the evidence, the Board finds that higher ratings are not warranted on the basis of lateral instability or recurrent subluxation of either knee. However, a separate rating of 10 percent rating is warranted for each knee on the basis of painful motion. At the Board hearing, the Veteran testified that his knees are constantly aching, especially in the morning. This does not affect him when he goes to the gym, but does affect him when he sits and then rises (Record 09/25/2020 at 11). The Veteran reported popping and clicking and a sensation of giving way (Record 09/25/2020 at 12). He reported that he will wear braces when doing squats at the gym or when surfing or wake boarding (Record 09/25/2020 at 13). Regarding the rating for lateral instability or recurrent subluxation under Diagnostic Code 5257, there is no persuasive evidence of either condition. The medical evidence is decidedly against any such instability. Moreover, the Veteran has not described any such instability of his knees for the Board to weigh against the medical evidence. See English v. Wilkie, 30 Vet. App. 347 (2018). The wearing of knee braces during strenuous physical activity is not probative of knee instability. Accordingly, the Board finds there is not at least slight lateral instability or recurrent subluxation of either knee. The Board must also consider other potentially applicable diagnostic codes. While the criteria for a rating of 10 percent are not met under the provisions of Diagnostic Code 5003 or 5010, as there is no evidence of arthritis, 38 C.F.R. § 4.59 has been interpreted as applying to painful motion of any joint, not requiring arthritis or other specific condition. It provides a minimum compensable rating for painful motion of a joint, as long as there is a minimum compensable rating provided for that joint. See Burton v. Shinseki, 25 Vet. App. 1 (2011) (the term “Painful motion” reflects the subject matter of the regulation in general and implies no limitation to arthritis claims); cf Sowers v. McDonald, 27 Vet. App. 472 (2016) (where that diagnostic code does not provide for any compensable rating for limited motion of the joint, 38 C.F.R. § 4.59 does not require or permit a compensable rating to be assigned). As the minimum compensable rating under Diagnostic Code 5260 is 10 percent. The Board finds that a 10 percent rating is warranted for each knee under Diagnostic Code 5260. The Board has considered whether any rating is warranted on the basis of meniscal involvement under Diagnostic Codes 5258, 5259; however, there is no indication of meniscal involvement in this case. Indeed, the August 2015 VA Examination reveals that no meniscal conditions were found. While the Veteran has complained of “catching,” the criteria under Diagnostic Code 5258 call for “locking,” which appears to be a more serious symptom than catching, as it implies that all motion is prevented at a certain point. Moreover, the criteria require effusion into the joint, which is not shown here. As the criteria are conjunctive, all criteria must be met to support a rating at that level. A rating under Diagnostic Code 5259 would not provide any higher rating than would 38 C.F.R. § 4.59. Also, such a rating requires symptomatic removal of semilunar/meniscal material. There is no evidence or assertion of this. The Veteran has a diagnosis of iliotibial band friction syndrome; however, such diagnosis does not pertain to the meniscus. In sum, the Board finds that the service-connected knee disabilities are not manifest by even slight lateral instability or recurrent subluxation, but are manifest by painful motion. In light of these findings of fact, the Board concludes that a disability rating higher than 0 percent for the service-connected knee disabilities on the basis of lateral instability or recurrent subluxation is not warranted for either knee; however a separate disability rating of 10 percent on the basis of painful motion is warranted for each knee. The Board has considered the applicability of the benefit-of-the-doubt doctrine. However, to the extent of any denial of additional benefits, the preponderance of the evidence is against each claim. Therefore, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 53-56. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, 28 Vet. App. 366, 371. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Cramp 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.