Citation Nr: 21006831 Decision Date: 02/05/21 Archive Date: 02/05/21 DOCKET NO. 07-09 614 DATE: February 5, 2021 ORDER Entitlement to an initial disability rating in excess of 20 percent for a myofascial back pain is denied. Prior to June 23, 2009 (entire period of appeal), a 10 percent rating but no higher for patellofemoral syndrome of the right knee is granted. Entitlement to a rating in excess of 10 percent for patellofemoral syndrome of the right knee is denied. FINDINGS OF FACT 1. Throughout the period on appeal, the Veteran’s myofascial pain syndrome has manifested in forward flexion of the thoracolumbar spine of greater than 30 degrees. There is no spinal ankylosis or Intervertebral Disc Syndrome (IVDS) with incapacitating episodes. 2. Prior to June 23, 2009 (entire period on appeal), the patellofemoral syndrome of the right knee manifested in pain and limited range of motion. Remaining flexion was greater than 45 degrees and extension better than 5 degrees. There was no instability or subluxation. 3. The patellofemoral syndrome of the right knee manifested in pain and limited range of motion. Remaining flexion was greater than 45 degrees and extension better than 5 degrees. There was no instability or subluxation. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 20 percent for myofascial back pain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5237. 2. Prior to June 23, 2009, the criteria for a 10 percent rating for patellofemoral syndrome of the right knee have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260. 3. For the entire period on appeal the criteria for a rating in excess of 10 percent for patellofemoral syndrome of the right knee have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1995 to July 2004. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2006 rating decision. In October 2012, the Board remanded the case for further development, to include scheduling the Veteran for a DRO hearing. The record shows that the Veteran did not report for a hearing scheduled in May 2013. The Board remanded these issues in December 2017 to obtain new VA examinations that complied with the requirements of Correia v. McDonald, 28 Vet. App. 158 (2016), and Sharp v. Shulkin, 29 Vet. App. 26 (2017). These examinations were obtained in January 2018. The Board remanded these issues again in January 2019 to obtain new VA examinations that complied with the requirements of Sharp. These examinations were obtained in November 2019. 1. Adequacy of the October 2019 VA examinations. Prior to addressing the issues on appeal, the Board will address its prior December 2017 and January 2019 actions. In both, the Board remanded the instant matters in part because none of the relevant VA examinations complied with Sharp v. Shulkin, 29 Vet. App. 26 (2017). In Sharp, the Court of Appeals for Veterans’ Claims held that a VA examiner must attempt to elicit information from the record and the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups before determining that an estimate of motion loss in terms of degrees could not be given. The Court also held that any inability to furnish such an estimate must be predicated on a lack of medical knowledge among the medical community at large, rather than insufficient knowledge by the individual examiner. Id. We first remanded these matters to obtain VA examinations for the Veteran’s back and right knee that complied with Sharp in December 2017. The requested examinations were obtained in January 2018 and the claims thereafter returned to the Board. In January 2019 we determined the January 2018 examinations did not comply with Sharp because the examiner concluded he was unable to say without mere speculation whether pain, weakness, fatigability, or incoordination significantly limit functional ability with repeated use over a period of time because he was not able to observe the Veteran during a flare-up or after repeated use over time. As such, the Board remanded the instant claims to obtain a new VA examination. The Board instructed the VA examiner to include an estimate of the Veteran’s functional loss due to flare-ups or repeated use over a period of time or provide an explanation as to why an estimate is not possible. New VA examinations for the Veteran’s back and knee were obtained in October 2019. The Board concludes that these examinations provide sufficient evidence in compliance with the controlling law. Remand for new examinations is not required to comply with Sharp. Regarding both the Veteran’s low back and right knee disabilities, the examiner determined she was unable to say without mere speculation whether pain, weakness, fatigability, or incoordination significantly limit functional ability with repeated use over a period of time or with flareups. She explained that she could not reliably determine and demonstrate ROM loss during a flare up or after repetitive usage as no flare present on exam. The reports of pain, weakness, fatigability, or incoordination significantly limiting functional ability with repeated use over a period of time and loss of ROM during flares were subjective, and the examination noted objective findings only. Furthermore, she explained that additional functional loss during flare-ups or after repeated use over time cannot be accurately reported as a ROM estimate with any degree of medical certainty due to the lack of documentation in the medical records regarding measurements during a flare or following repeated use. After reviewing the Veteran’s history, the current examination findings, the relevant evidence of record, and utilizing her own clinical judgment and medical expertise, the examiner determined she was unable to determine a range of motion. The Veteran was not examined during repeated use over a period of time and could not describe or demonstrate the decreased range of motion with repeated use over time or during flare ups. As the Court noted in Sharp, the critical question in assessing the adequacy of an examination not conducted during a flare is whether the examiner was sufficiently informed of and conveyed any additional or increased symptoms and limitations experienced during flares. Sharp, 29 Vet. App. at 34 (citing Mitchell v Shinseki, 25 Vet. App. 32, 44 (2011). It must also be clear that an examiner has “considered all procurable and assembled data” before stating that an opinion cannot be reached. Sharp, 29 Vet. App. at 33 (citing Jones v. Shinseki, 32 Vet. App. 382, 390 (2010). The October 2019 examination reports show the examiner elicited statements from the Veteran relevant to the nature, frequency, duration, and severity of his flareups and limitations with repeated use. The examiner reviewed the claims file for additional evidence before reaching her conclusion that she could not say without mere speculation whether pain, weakness, fatigability, or incoordination significantly limit functional ability with repeated use over a period of time or with flareups. The October 2019 VA examiner was sufficiently informed of, and adequately conveyed, additional and increased symptoms and limitations the Veteran experienced with repeated use and during flareups. She considered the Veteran’s electronic claims file, which included the procurable medical records available at the time of examination and elicited relevant lay statements from the Veteran during the examination. The examiner’s conclusion that she was unable to say without mere speculation whether pain, weakness, fatigability, or incoordination significantly limit functional ability with repeated use over a period of time or with flareups was not predicated on the examiner’s own insufficient knowledge. Further, she considered all procurable and assembled data in support of the Veteran’s claims. Rating Disability evaluations are determined by the application of a schedule of ratings that is based on average impairment of earning capacity. 38 U.S.C. § 1155. Percentage evaluations are determined by comparing the manifestations of a particular disorder with the requirements contained in the VA’s Schedule for Rating Disabilities. 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can practically be determined, the average impairment in earning capacity resulting from such disease or injury and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. VA regulations set forth at 38 C.F.R. §§ 4.40, 4.45, and 4.59 provide for consideration of functional impairment due to pain on motion when evaluating the severity of a musculoskeletal disability. When evaluating disabilities of the musculoskeletal system, functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements must be considered. 38 C.F.R. § 4.40; DeLuca v. Brown, 8 Vet. App. 202 (1995). Consideration must also be given to weakened movement, excess fatigability, and incoordination. 38 C.F.R. § 4.45. Joint testing is to be conducted on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. Correia v. McDonald, 28 Vet. App. 158, 170 (2016). The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. See 38 C.F.R. § 4.59. Although the first sentence of 38 C.F.R. § 4.59 refers only to arthritis, the regulation applies to joint conditions other than arthritis. Burton v. Shinseki, 25 Vet. App. 1, 3-5 (2011). VA has a duty to acknowledge and consider all regulations which are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusion. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Separate ratings may be assigned for separate periods of time based on the facts found. This practice is known as “staged” ratings.” Fenderson v. West, 12 Vet. App. 119, 126-127 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). If the evidence for and against a claim is in equipoise, the claim will be granted. 38 C.F.R. § 4.3. A claim will be denied only if the preponderance of the evidence is against the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. 2. Myofascial back pain. The Veteran seeks an initial rating in excess of 20 percent for myofascial back pain. Disabilities of the spine are rated using the General Rating Formula for Diseases and Injuries of the Spine (General Formula) under Diagnostic Codes 5235 through 5243, unless code 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. The Veteran’s myofascial back pain is currently rated under Diagnostic Code 5237, which pertains to lumbosacral or cervical strain. According to the General Formula, a 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or 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 contour such as scoliosis. A 40 percent rating is warranted when there is forward flexion of the thoracolumbar spine to 30 degrees or less, or with favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is assigned for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, Diagnostic Code 5237. Note (2) states that, for VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. The Board previously determined that VA back examinations that were provided to the Veteran in August 2005, May 2007, June 2009, February 2011, June 2012, and January 2018 were inadequate for disability rating purposes. In our December 2017 remand, the Board concluded that none of the VA examinations of record had complied with the requirements of Correia v. McDonald, 28 Vet. App. 158 (2016) and Sharp v. Shulkin, 29 Vet. App. 26 (2017). Regarding Correa, the Board instructed a VA examiner to conduct range of motion testing with active and passive motion, and weight-bearing and non-weightbearing conditions. Regarding Sharp, the Board instructed a VA examiner to provide an estimate of the Veteran’s functional loss due to flares and repeated use over a period of time expressed in terms of the degree of additional range of motion lost or in the alternative explain why the examiner cannot do so. The Veteran was provided a new examination in January 2018 and claim returned to the Board in January 2019, when we determined the January 2018 examination did not comply with Sharp and again remanded for a new examination. A new VA examination was provided in October 2019, and it is the only knee examination of record that complies with both Correia and Sharp. The six prior VA examinations are insufficient, and the range of motion measurements taken at these examinations will not be relied upon to rate the Veteran’s back disability. For the following reasons, the preponderance of the evidence is against a rating in excess of 20 percent for myofascial back pain. At the October 2019 examination, the Veteran reported daily flareups consisting of increased pain that last from several hours to all day. Flareups were caused by prolonged movement, bending, stooping, and sitting for long periods. Range of motion testing showed forward flexion to 45 degrees, extension to 5 degrees, right and left lateral rotation to 30 degrees, and right and left lateral flexion to 30 degrees. Total range of motion was 170 degrees. Flexion and extension exhibited pain. There was pain with weightbearing. Guarding resulted in an abnormal gait or abnormal spinal contour. Regarding Correia, there was pain on passive range of motion testing and with weightbearing. There was no evidence of pain on non-weightbearing. The Veteran did not have IVDS. The Veteran described his functional loss as being unable to sit long periods of time or play with kids, difficulty bending and stooping, and difficulty with daily activities. Back pain also affected his sleep and caused inability to perform on the job. The examiner noted that limited range of motion of the back with guarding contributed to the Veteran’s altered gait and created difficulty with sitting and standing for greater than 30-45 minutes due to increased pain and spasm. The Veteran has right lower extremity radiculopathy associated with his myofascial back pain. The Regional Office has assigned a separate 10 percent rating for incomplete paralysis of the right sciatic nerve effective October 1, 2019, the date of the examination. That rating is not on appeal. Here, the Veteran’s measured range of motion of the lumbar spine fits within the criteria for a 20 percent evaluation. At worst, forward flexion has been limited to 45 degrees, which is well within the requirement that forward flexion be limited to between 30 and 60 degrees for a 20 percent rating. The combined range of the lumbar spine has consistently been greater than 120 degrees. There is no ankylosis of the spine. The October 2019 examination was accomplished consistent with 38 C.F.R. § 4.59. The Veteran described his pain and the resulting functional impact of the lumbar spine. However, the functional impact does not warrant a higher rating based on the current record. The documented ranges of motion fit squarely within the criteria for a 20 percent rating. Although the Veteran’s lumbar spine disability has been documented as causing an abnormal gait or spinal contour, such is contemplated by a 20 percent rating. Pertinently, a higher rating would require either forward flexion of the thoracolumbar spine be limited to 30 degrees or less, or ankylosis of the spine. Neither have been show. There is no information in available in VA and private treatment records which would warrant a rating in excess of 20 percent based on limitation of motion. As to the Veteran’s low back symptoms and their effect on function, the Board finds that the current rating sufficiently compensates the Veteran for this disability. The October 2019 examination was accomplished consistent with 38 C.F.R. § 4.59. The examination report shows range of motion that is not changed with repeated testing. Although the Veteran reported that his symptoms increased in severity during daily flareups, the October 2019 examiner determined she was unable to determine whether pain, weakness, fatigability, or incoordination significantly limited functional ability with repeated use or flareups without resorting to speculation. She reached this conclusion after reviewing the entire claims file and eliciting relevant information from the Veteran. There is no atrophy, swelling, deformity, or instability. The Veteran’s symptoms, to include during flareups, do not approximate a higher rating, nor does the treatment record support such a finding. There is painful, limited motion consistent with a 20 percent rating. The Board has considered the Veteran’s functional impairment in assessing the limitation of motion in this claim, but even considering his reports of flareups, there is little indication of additional disability beyond that assigned. The current evaluation contemplates pain on motion and flexion greater than 30 degrees but not greater than 60 degrees, and muscle spasm or guarding severe enough to result in an abnormal gait and/or spinal curve. Nothing in the record reflects that flexion is functionally limited to less than 30 degrees. The 20 percent evaluation also contemplates total range of motion of the thoracolumbar spine not greater than 120 degrees; the October 2019 VA examination shows total range of motion was 170 degrees. No ankylosis of the spine has been shown. No other factors warranting a higher evaluation are present. The Board acknowledges that the six VA examinations prior to October 2019 do not comply with Correia or Sharp. Although we will not use the invalid range of motion measurements to rate the Veteran’s back, the examination reports do not otherwise contain information that would warrant a higher evaluation. The Veteran’s complaints and description of his symptoms have remained generally consistent throughout the period on appeal. The Veteran has previously reported incapacitating episodes of back pain necessitating bed rest, which implicates rating the Veteran’s disability as intervertebral disc syndrome (IVDS) under Diagnostic Code 5243. However, review of the record shows the Veteran has never been diagnosed with IVDS. Furthermore, for the period on appeal the Veteran has reported incapacitating episodes of low back pain lasting at most one week during the preceding 12 months. However, there is no proof of doctor prescribed bed rest. As such, his report does not provide a basis for a higher evaluation. The Board concludes a 20 percent rating adequately represents any functional impairment attributable to the Veteran’s myofascial back pain disability throughout the appeal period. See 38 C.F.R. §§ 4.41, 4.10. We find that the observations of skilled examiner are more probative and more credible as to the degree of disability than the lay evidence, to the extent that he argues there is a higher level of impairment. The October 2019 examination was based on his reports as well as the remainder of the evidence of record. For the foregoing reasons, the preponderance of the evidence is against a rating in excess of 10 percent for the Veteran’s myofascial back pain. 3. Right knee patellofemoral syndrome prior to June 23, 2009. 4. Right knee patellofemoral syndrome from June 23, 2009. The Veteran seeks a compensable initial rating for right knee patellofemoral syndrome prior to June 23, 2009, and a 10 percent rating thereafter under 38 C.F.R. § 4.71a, Diagnostic Code 5260 (leg, limitation of flexion). Pursuant to Diagnostic Code 5260, when flexion is limited to 45 degrees, a 10 percent rating is warranted. Flexion limited to 30 degrees warrants a 20 percent rating, while flexion limited to 15 degrees warrants the maximum 30 percent rating. For rating purposes, normal range of motion in a knee joint is from 0 to 140 degrees. 38 C.F.R. § 4.71, Plate II. After considering the evidence, the Board concludes that a uniform 10 percent evaluation, but no higher, is warranted for the entire period on appeal. The Board previously determined that VA knee examinations provided to the Veteran in August 2005, May 2007, June 2009, February 2011, February 2013, and January 2018 were inadequate. In our December 2017 remand, the Board concluded that none of the VA examinations of record had complied with the requirements of Correia v. McDonald, 28 Vet. App. 158 (2016) and Sharp v. Shulkin, 29 Vet. App. 26 (2017). Regarding Correa, the Board instructed a VA examiner to conduct range of motion testing with active and passive motion, and weight-bearing and non-weightbearing conditions. Regarding Sharp, the Board instructed a VA examiner to provide an estimate of the Veteran’s functional loss due to flares and repeated use over a period of time expressed in terms of the degree of additional range of motion lost or in the alternative explain why the examiner cannot do so. The Veteran was provided a new examination in January 2018 and claim returned to the Board in January 2019, when we determined the January 2018 examination did not comply with Sharp and again remanded for a new examination. The new knee examination was provided in October 2019, and it is the only knee examination of record that complies with both Correia and Sharp. The six prior VA examinations are insufficient, and the range of motion measurements taken at these examinations will not be relied upon to rate the Veteran’s right knee disability. At the October 2019 examination, the Veteran reported popping, soreness, and swelling, and that he occasionally falls when the knee gives out. Flareups were daily and were precipitated by prolonged standing, walking, bending, kneeling, and lifting. He could not walk or stand for prolonged periods and reported the right knee was very weak. Range of motion was 0 to 140 degrees with pain on flexion. Right knee strength was 5/5 with no muscle atrophy or ankylosis of the knee. Instability testing was normal. No history of recurrent subluxation, lateral instability, or meniscus conditions was recorded. Recurrent effusion of the right knee was noted, and the Veteran regularly used a knee brace. He reported being restricted to standing for less than 30 minutes at a time due to knee pain. No pain was noted on weightbearing, non-weightbearing, or on passive range of motion testing. As noted above, the Veteran seeks a compensable initial rating for right knee patellofemoral syndrome prior to June 23, 2009. Although the prior VA examinations do not fully comply with the Correia and Sharp requirements, a review of these examinations reports reveals that the Veteran’s complaints and lay statements have remained consistent throughout the period on appeal regarding the nature and severity of his right knee symptoms and the resulting functional impact. Prior to June 23, 2009, the Veteran regularly reported pain in his right knee and that his knee occasionally buckled. There was tenderness on palpation at the three examinations provided prior to June 23, 2009. At the 2007 and 2009 examinations, the Veteran reported flareups consisting of increased pain that were caused by increased activity, walking, and standing. The Board notes that the Regional Office (RO) increased the rating for the Veteran’s right knee to 10 percent effective June 23, 2009. The RO assigned the 10 percent evaluation for painful flexion of the right knee pursuant to 38 C.F.R. § 4.59. In light of the Veteran’s consistent reports of increased pain in the right knee with prolonged activity, the severity and frequency of his flareups, and the insufficiency of most of the VA examinations of record, the Board resolves the benefit of doubt in the Veteran’s favor and concludes that a 10 percent rating for painful motion is warranted prior to June 23, 2009. The Board also concludes that a rating in excess of 10 percent for limited flexion is not warranted at any point during the period on appeal. The October 2019 examination shows flexion of the right knee to 140 degrees with pain. There is no competent evidence during the period under consideration that right knee flexion has been limited to substantially greater than what was show at the October 2019 examination. As noted, the examinations prior to October 2019 are all not fully adequate, and the range of motion results contained in those examination reports should not be used to rate the Veteran’s right knee disability. We note that the February 2013 examination shows right knee flexion limited to 90 degrees following three repetitions. There is no evidence of record otherwise indicating a greater limitation of extension. The 10 percent rating has been assigned consistent with 38 C.F.R. § 4.59, providing for a compensable rating for painful motion that does not otherwise meet the criteria for a higher compensable rating based on limitation of motion under Diagnostic Code 5260. The current evaluation for the right knee contemplates pain on motion and would be consistent with limitation of flexion to 45 degrees. To warrant a higher evaluation for the right knee, the disability must approximate the functional equivalent of limitation of flexion to 30 degrees. See 38 C.F.R. § 4.7. Nothing in the record reflects that flexion of the right knee is functionally limited to 30 degrees or less. Rather, the October 2019 VA examination shows flexion to 140 degrees with pain. The lowest degree of flexion documented during the period on appeal was 90 degrees after repetitive use, as documented in the inadequate February 2013 examination, which is well above the 45-degree threshold for a 20 percent rating. No factors warranting a higher evaluation under Diagnostic Code 5260 are present. Accordingly, a disability rating in excess of 10 percent is not warranted for the Veterans’ right knee patellofemoral syndrome under Diagnostic Code 5260. The Board has also considered whether higher ratings are warranted based on functional loss due to pain, weakness, fatigability, or incoordination. We have considered the Veteran’s reports of functional impairment in assessing the limitation of motion in this claim, including his reports of flareups. However, pain, weakness, fatigability, and incoordination do not result in additional disability beyond the uniform 10 percent rating the Board has assigned in this claim. The flareups as described are found to be consistent with and accurately compensated by his rating based on painful flexion. DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995); see also 38 C.F.R. §§ 4.40, 4.45, 4.59. We find that the observations of skilled examiner are far more probative and more credible as to the degree of disability than the lay evidence, to the extent that he argues there is a higher level of impairment. The evidence of record more closely approximates the criteria for a 10 percent rating, but no higher, for limitation of flexion of the right knee. Furthermore, as explained in detail above, the October 2019 VA examination complied with Sharp v. Shulkin. The examiner determined she was unable to determine whether pain, weakness, fatigability, or incoordination significantly limited functional ability with repeated use or flareups without resorting to speculation. She reached this conclusion after reviewing the entire claims file and eliciting relevant information from the Veteran. The Veteran’s symptoms, to include during flareups, do not approximate a higher rating, nor does the treatment record support such a finding. There is painful motion consistent with a 10 percent rating pursuant to 38 C.F.R. § 4.59. The Board has considered the Veteran’s functional impairment in assessing the limitation of motion in this claim, but even considering his reports of flareups, there is little indication of additional disability beyond that assigned. We have also considered whether separate ratings or higher ratings are warranted under any other Diagnostic Codes. Diagnostic Code 5256 is inapplicable as the Veteran does not have ankylosis of the right knee. The record does not suggest impairment of the tibia and fibula or genu recurvatum, and as such, separate disability ratings under Diagnostic Codes 5262 and 5263 are also not warranted. The evidence is absent that either recurrent subluxation or lateral instability of the Veteran’s right knee exists such that a separate rating under Diagnostic Code 5257 is warranted. The Board acknowledges the Veteran’s report of a need to wear a brace on his right knee, and that he has reported that his right knee gives out. However, the October 2019 VA examiner specifically noted the absence of recurrent subluxation and lateral instability, and stability testing was normal for the right knee. There are no objective findings otherwise contrary to these examination findings. We have considered the lay evidence and find the objective findings, which are negative for subluxation or instability of the right knee, to be more probative and more credible. Rating under Diagnostic Code 5257 is not warranted. Although the Veteran is competent to report giving out or instability, his reports are far less credible than the objective medical record. Diagnostic Code 5258 provides a 20 percent evaluation for dislocated semilunar cartilage with frequent episodes of “locking,” pain, and effusion into the joint. Diagnostic Code 5259 provides a 10 percent evaluation for symptomatic removal of the semilunar cartilage. See 38 C.F.R. § 4.71a, Diagnostic Codes 5258, 5259. The October 2019 examiner found no history of meniscus or semilunar cartilage pathology, including dislocations and removal, and there is otherwise no evidence to the contrary. Diagnostic Codes 5258 and 5259 are inapplicable. A separate rating under Diagnostic Code 5261 would only be permitted where limitation of extension was compensable, which is not the case here. The October 2019 VA examination shows extension to a full 0 degrees without pain. there is little to no credible, competent evidence of record suggesting that extension of the right knee has ever been limited to 5 degrees, as required for even a noncompensable rating for limited extension. Rating the right knee for limitation of extension is not warranted. For the foregoing reasons, a uniform 10 percent evaluation is warranted for the Veteran’s right knee patellofemoral syndrome. The preponderance of the evidence is against a rating in excess of 10 percent. H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Morse 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.