Citation Nr: 21007025 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 09-14 056 DATE: February 8, 2021 ORDER Entitlement to an increased rating for a lumbosacral strain prior to August 3, 2010, currently evaluated as 20 percent disabling, is denied. Entitlement to a 40 percent evaluation for a lumbosacral strain for the period from August 3, 2010, to February 24, 2014, is granted. Entitlement to an increased rating for a lumbosacral strain on or after February 24, 2014, currently evaluated as 20 percent disabling, is denied. Entitlement to an increased rating for degenerative joint disease of the left knee, currently evaluated as 20 percent disabling, is denied. Entitlement to an increased rating for degenerative joint disease of the right knee, currently evaluated as 10 percent disabling, is denied. FINDINGS OF FACT 1. For the period from August 3, 2010, to February 24, 2014, the Veteran had forward flexion of the thoracolumbar spine limited to 30 degrees. He has not otherwise had forward flexion of the thoracolumbar spine limited to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. He also does not have incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. 2. The Veteran’s service-connected left knee disability is not productive of actual or functional flexion limited to 15 degrees; actual or functional extension limited to 10 degrees; lateral instability or recurrent subluxation; dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint; symptomatic removal of semilunar cartilage; ankylosis; impairment of the tibia and fibula; or genu recurvatum. 3. The Veteran’s service-connected right knee disability is not productive of actual or functional flexion limited to 30 degrees; actual or functional extension limited to 10 degrees; lateral instability or recurrent subluxation; dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint; symptomatic removal of semilunar cartilage; ankylosis; impairment of the tibia and fibula; or genu recurvatum. CONCLUSIONS OF LAW 1. The criteria for a 40 percent evaluation for a lumbosacral strain from the period from August 3, 2010, to February 24, 2014, have been met. §§ 3.102, 3.321, 4.1-4.14, 4.40-4.45, 4.59, 4.71a, Diagnostic Code 5237. 2. The criteria for an evaluation in excess of 20 percent for a lumbosacral strain prior to August 3, 2010, and on or after February 24, 2014, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.14, 4.40-4.45, 4.59, 4.71a, Diagnostic Code 5237. 3. The criteria for an evaluation in excess of 20 percent for degenerative joint disease of the left knee have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.14, 4.40-4.45, 4.71a, Diagnostic Code 5299-5260. 4. The criteria for an evaluation in excess of 10 percent for degenerative joint disease of the right knee have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.14, 4.40-4.45, 4.71a, Diagnostic Code 5260. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from April 1978 to April 1988. This case initially came before the Board of Veterans’ Appeals (Board) on appeal from a June 2010 rating decision. In May 2012, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the record. In September 2011 and September 2013, the Board remanded the case to the Agency of Original Jurisdiction (AOJ) for further development. The case was subsequently returned to the Board for appellate review. In a March 2015 decision, the Board, in pertinent part, denied the Veteran’s claims for increased ratings for his service-connected lumbosacral strain and right and left knee degenerative joint disease. The Veteran appealed the Board’s decision to the United States Court of Appeals for Veterans Claims (Court). In April 2016, the Veteran’s representative and VA’s Office of General Counsel, representing the Secretary of VA, filed a joint motion for partial remand (Joint Motion) requesting that the Court vacate the Board’s decision and remand the matter for readjudication in compliance with the directives specified. The Court issued an order in April 2016 granting the Joint Motion and returned the case to the Board. In June 2016 and May 2019, the Board remanded the case for further development. That development was completed, and the case has subsequently been returned to the Board for appellate review. In a September 2020 rating decision, the AOJ granted service connection for right knee limitation of flexion and assigned a noncompensable evaluation, effective from January 23, 2020. However, in a subsequent rating decision dated in September 2020, the AOJ proposed severing service connection for right knee limitation of flexion. In an attached notification letter, the AOJ informed the Veteran that the grant of service connection for right knee limitation of flexion in the previous rating decision was clearly and unmistakably erroneous because the findings of the left knee were mistakenly applied to the right knee disability. The Veteran was also notified that severing service connection for right knee limitation of flexion would not change his overall combined evaluation or affect his monthly compensation payments because he was assigned a noncompensable evaluation for right knee limitation of flexion. Thereafter, in a January 2021 rating decision, the AOJ effectuated the severance. The Veteran has not appealed that decision; therefore, the severance issue is not on appeal. Law and Analysis Neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist with regard to the issues decided herein. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). As noted above, this case was appealed to the Court, yet no additional arguments have been made regarding the duty to notify and assist. See Carter v. Shinseki, 26 Vet. App. 534, 542-43 (2014) (where an attorney-represented appellant enters into a Joint Motion for Remand identifying specific Board errors, the terms of that remand can be considered a factor when determining the scope of the Board’s duty to search the record for other issues that are reasonably raised by that record). Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. 38 C.F.R. § 4.7. In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, where the question for consideration is the propriety of the initial rating assigned, evaluation of the evidence since the effective date of the grant of service connection is required. Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). Where VA’s adjudication of the claim for increase is lengthy and factual findings show distinct time periods where the service-connected disability exhibits symptoms which would warrant different ratings, different or “staged” ratings may be assigned for such different periods of time. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007); Fenderson, 12 Vet. App. at 126-27. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage and the functional loss with respect to all of these elements. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated innervation, or other 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. Pain on movement, swelling, deformity or atrophy of disuse as well as instability of station, disturbance of locomotion, interference with sitting, standing and weight bearing are relevant considerations for determination of joint disabilities. 38 C.F.R. § 4.45. Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59. Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the weight of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Lumbosacral Strain In this case, the Veteran’s service-connected lumbar spine disability is currently assigned a 20 percent evaluation pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5237. Diagnostic Code 5237 indicates that lumbosacral strain should be evaluated under either the General Rating Formula for Diseases and Injuries to the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher evaluation. Under the General Rating Formula for Diseases and Injuries to the Spine, with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease, a 20 percent evaluation is warranted when there is forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; the combined range of motion of the thoracolumbar spine is 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 40 percent evaluation is warranted for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be rated separately, under an appropriate diagnostic code. 38 C.F.R. § 4.71a, General Rating Formula, Note (1). For VA compensation purposes, normal range of motion for the thoracolumbar spine is 90 degrees of forward flexion, 30 degrees of extension, 30 degrees of left and right lateral flexion, and 30 degrees of left and right lateral rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees, consisting of the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right lateral rotation. See 38 C.F.R. § 4.71a, General Rating Formula, Note (2) and Plate V. Under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, a 20 percent evaluation is warranted for incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent evaluation is warranted for incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent evaluation is warranted for incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. An incapacitating episode is defined as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, Note (1). If intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, evaluate each segment on the basis of chronic orthopedic and neurologic manifestations or incapacitating episodes, whichever method results in a higher evaluation for that segment. Id., Note (2). In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to an evaluation in excess of 20 percent for his service-connected lumbar spine disability prior to August 3, 2010, or on or after February 24, 2014. However, he is entitled to a 40 percent evaluation from August 3, 2010, to February 24, 2014. For the majority of the appeal period, the Veteran has not been shown to have forward flexion of the thoracolumbar spine limited to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. During a February 2010 VA examination, he had forward flexion to 60 degrees, and during a February 2014 VA examination, he had forward flexion to 70 degrees. During a September 2016 VA examination, the Veteran demonstrated forward flexion to 45 degrees, and a January 2020 VA examination revealed forward flexion to 40 degrees. Ankylosis is defined as “immobility and consolidation of a joint due to disease, injury, surgical procedure.” Lewis v. Derwinski, 3 Vet. App. 259 (1992) (internal medical dictionary citation omitted). Based on the aforementioned range of motion findings, the record shows that the Veteran’s thoracolumbar spine is not fixated or immobile even with repetitive use, flare-ups, fatigue, and lack of endurance. In fact, the February 2014, September 2016, and January 2020 VA examiners specifically stated that there was no ankylosis of the spine. While the noted ranges of motion were limited, these findings are consistent with and fully contemplated by the 20 percent rating currently assigned. Nevertheless, the Board does acknowledge that a Social Security Administration (SSA) functional capacity assessment showed that, on August 3, 2010, the Veteran had lumbar spine flexion to 30 degrees with pain. However, the February 2010 VA examination had previously found him to have forward flexion to 60 degrees that same year, and the subsequent February 2014 VA examination showed even greater forward flexion to 70 degrees. Therefore, resolving any reasonable doubt in favor of the Veteran, the Board finds that he is entitled to a 40 percent evaluation for the period from August 3, 2010, to February 24, 2014 (date of VA examination). Moreover, the evidence does not show that the Veteran has had incapacitating episodes meeting the durational requirements to warrant an increased evaluation. In this regard, the February 2014 and January 2020 VA examiners indicated that the Veteran did not have intervertebral disc syndrome. The September 2016 VA examiner indicated that the Veteran did have intervertebral disc syndrome, but he stated that the Veteran has not had any episodes of acute signs and symptoms due to intervertebral disc syndrome that required bed rest prescribed by a physician and treatment by a physician in the previous 12 months. There are also no treatment records associated with the claims file showing that the Veteran was prescribed bed rest by any physician for his service-connected lumbar spine disability, as required under the rating criteria. As such, the Veteran has not been shown to have met the criteria for an increased evaluation under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. Moreover, the weight of the evidence does not show that the Veteran has a neurological disability associated with his service-connected lumbar spine disability. The Board acknowledges that the parties to the April 2016 Joint Motion identified a September 2009 private medical record reflecting an assessment of stenosis L4-S1 and a mixture of low back pain and left sciatica; a February 2010 VA examination report reflecting low back and hip radiating pain in the left leg with numbness; a December 2010 VA medical problem list reflecting chronic low-back pain with lumbar radiculopathy; a May 2010 VA treatment record reflecting that the Veteran has left sciatica symptoms and occasional tingling and numbness of the left leg. There is also other evidence indicating that the Veteran has radiating pain and numbness in his lower extremities. See, e.g., June 2013 electromyography/nerve conduction study (EMG/NCS); December 2013 VA examination. However, the December 2013 VA examiner opined that “peripheral neuropathy is not caused by lumbar strain which is a musculoskeletal condition.” Moreover, the February 2014 and January 2020 VA examiners specifically stated that there are no other neurologic abnormalities or findings related to a thoracolumbar spine (back) condition (such as bowel or bladder problems/pathologic reflexes). In addition, during the September 2016 VA examination, the Veteran specifically denied having any radicular symptoms, and the January 2020 VA examiner reported that the Veteran did not have radicular pain or any other signs or symptoms due to radiculopathy. Therefore, the Board finds that a separate disability rating is not warranted because the preponderance evidence does not demonstrate that the Veteran suffered from a separate neurological disability associated with his already service-connected lumbar spine disability. See Bierman v. Brown, 6 Vet. App. 125, at 129-32 (1994). The Board has also considered the provisions of 38 C.F.R. §§ 4.40, 4.45, 4.59, and the holdings in DeLuca. However, an increased evaluation for the Veteran’s service-connected lumbar spine disability is not warranted on the basis of functional loss due to pain or weakness in this case, as the Veteran’s symptoms are supported by pathology consistent with the assigned 20 and 40 percent ratings, and no higher. In this regard, the Board observes that the Veteran has complained of pain. However, the effect of the pain in the Veteran’s lumbar spine is contemplated in the currently assigned evaluation. The Veteran’s complaints do not, when viewed in conjunction with the medical evidence, tend to establish weakened movement, excess fatigability, or incoordination to the degree that would warrant an evaluation in excess of the 20 percent assigned. In fact, during the February 2010 VA examination, the examiner noted that there was no additional limitation with repetitive motion and that there was no objective evidence of pain following repetitive motion. During the February 2014 VA examination, the examiner indicated that there was no additional limitation following repetitive motion. The examiner did note that the Veteran had functional impairment, including less movement than normal, weakened movement, pain on movement, and interference with sitting, standing, and/or weight bearing. However, the Veteran also reported that flare-ups “made pretty much no difference” in the severity of his back pain. The September 2016 VA examiner indicated that, although the Veteran’s range of motion of his lumbar spine was abnormal, his range of motion itself did not contribute to a functional loss. He specifically reported that pain was noted on examination, but that it did not result in or cause functional loss. The examiner further related that pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over a period of time. Further, the examiner indicated that he believed that the Veteran’s limited range of motion was an over-exaggeration. The January 2020 VA examiner noted pain on examination that caused functional loss. Nevertheless, the examiner noted that there was no additional loss of function or range of motion after repetitive use testing and that pain, weakness, fatigability or incoordination did not significantly limit functional ability with repeated use over a period of time. The January 2020 VA examiner did note that pain limited the Veteran’s functional ability with flare-ups, but he was unable to estimate additional losses of function during a flare-up. The Board has considered the most restricted range of motion measurements recorded in the January 2020 VA examination based on pain, fatigue, lack of endurance, and flare-ups to ensure the highest evaluation is assigned, but such findings are commensurate with a 20 percent rating. Based on the foregoing, the Board finds that the weight of the evidence is against an evaluation in excess of 20 percent for the Veteran’s service-connected lumbar spine disability. As such, the benefit-of-the-doubt rule does not apply, and the claim is denied. Gilbert, 1 Vet. App. 49 (1990). Right and Left Knees In this case, the Veteran’s service-connected degenerative joint disease of the left knee has been assigned a 20 percent evaluation, pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5299-5260. His service-connected degenerative joint disease of the right knee has been assigned a 10 percent evaluation, pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5260. Hyphenated diagnostic codes, including a diagnostic code ending in the digits “99,” are used when there is no specifically applicable diagnostic code and the disability is rated by analogy. 38 C.F.R. § 4.27. Here, the Veteran’s left knee disability is rated by analogy using the criteria for limitation of flexion under Diagnostic Code 5260. Under Diagnostic Code 5260, a 10 percent disability evaluation is assigned when flexion is limited to 45 degrees, and a 20 percent disability evaluation is warranted when flexion is limited to 30 degrees. A 30 percent disability evaluation is assigned when flexion is limited to 15 degrees, which is the maximum evaluation available under Diagnostic Code 5260. Under Diagnostic Code 5261, a 10 percent disability evaluation is contemplated for extension limited to 10 degrees. When there is limitation of extension to 15 degrees, a 20 percent disability evaluation is warranted. A 30 percent rating will be assigned for extension limited to 20 degrees, and a 40 percent rating is contemplated for limitation of extension to 30 degrees. A 50 percent disability evaluation is warranted for extension limited to 45 degrees. Under Diagnostic Code 5258, dislocated semilunar cartilage, with frequent episodes of locking, pain, and effusion into the joint, warrants a 20 percent disability rating. 38 C.F.R. § 4.71a, Diagnostic Code 5258. Semilunar cartilage is the meniscus lateralis articulationis genus (lateral meniscus) and the meniscus medialis articulationis genus (medial meniscus). See DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 273, 1013 (28th ed. 1994). A 20 percent rating is the maximum schedular evaluation available under Diagnostic Code 5258. Under Diagnostic Code 5259, a 10 percent disability evaluation is assigned for the symptomatic removal of semilunar cartilage. Under Diagnostic Code 5262, pertaining to impairment of the tibia and fibula, a 10 percent disability rating is assigned for malunion with slight knee or ankle disability, and a 20 percent disability rating is warranted for malunion with moderate knee or ankle disability. A 40 percent disability rating is appropriate where there is nonunion of the tibia and fibula with loose motion requiring a brace. 38 C.F.R. § 4.71a, Diagnostic Code 5262. Under Diagnostic Code 5263, a 10 percent disability rating is assigned for acquired, traumatic genu recurvatum with weakness and insecurity in weight-bearing objectively demonstrated. 38 C.F.R. § 4.71a, Diagnostic Code 5263. Diagnostic Code 5010 states that traumatic arthritis is to be rated as degenerative arthritis under Diagnostic Code 5003, which in turn, states that the severity of degenerative arthritis, established by X-ray findings, is to be rated on the basis of limitation of motion under the appropriate diagnostic code for the specific joint or joints affected. When there is arthritis with at least some limitation of motion, but to a degree which would be noncompensable under a limitation-of-motion code, a 10 percent rating will be assigned for each affected major joint or group of minor joints. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, a 10 percent evaluation is warranted if there is X-ray evidence of involvement of two or more major joints or two or more minor joint groups and a 20 percent evaluation is authorized if there is X-ray evidence of involvement of two or more major joints or two or more minor joint groups and there are occasional incapacitating exacerbations. 38 C.F.R. § 4.71a, Diagnostic Code 5003. VA Office of General Counsel has provided guidance concerning increased rating claims for knee disorders. Separate disability ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition was not “duplicative of or overlapping with the symptomatology” of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 262 (1994). VA General Counsel has stated that compensating a claimant for separate functional impairment under Diagnostic Code 5257 and 5003 does not constitute pyramiding. See VAOPGCPREC 23-97 (July 1, 1997). VA General Counsel held in VAOPGCPREC 23-97 that a veteran who has arthritis and instability of the knee may be rated separately under Diagnostic Codes 5003 and 5257, provided that a separate rating must be based upon additional disability. When a knee disorder is already rated under Diagnostic Code 5257, the veteran must also have limitation of motion under Diagnostic Code 5260 or 5261 in order to obtain a separate rating for arthritis. If the veteran does not at least meet the criteria for a zero percent rating under either of those codes, there is no additional disability for which a rating may be assigned. In VAOPGCPREC 9-98, General Counsel also held that if a veteran has a disability rating under Diagnostic Code 5257 for instability of the knee, and there is also x-ray evidence of arthritis, a separate rating for arthritis could also be based on painful motion under 38 C.F.R. § 4.59. In addition, General Counsel considered a hypothetical situation in which a knee disability was evaluated under Diagnostic Code 5259 that was productive of pain, tenderness, friction, osteoarthritis established by x-rays, and a slight loss of motion. For the purposes of the hypothetical, it was assumed that Diagnostic Code 5259 did not involve limitation of motion. Given the findings of osteoarthritis, the General Counsel stated that the availability of a separate evaluation under Diagnostic Code 5003 in light of sections 4.40, 4.45, 4.59 must be considered. See Lichtenfels v. Derwinski, 1 Vet. App. 484, 488 (1991). Absent x-ray findings of arthritis, limitation of motion should be considered under Diagnostic Codes 5260 and 5261. The claimant’s painful motion may add to the actual limitation of motion so as to warrant a rating under Diagnostic Codes 5260 or 5261. The General Counsel further noted in VAOPGCPREC 9-98 that the removal of the semilunar cartilage may involve restriction of movement caused by tears and displacements of the menisci, but that the procedure may result in complications such as reflex sympathetic dystrophy, which can produce loss of motion. Therefore, limitation of motion is a relevant consideration under Diagnostic Code 5259, and the provisions of 4.40, 4.45, and 4.59 must be considered. In addition, the VA General Counsel has held that separate ratings may be assigned under Diagnostic Code 5260 and Diagnostic Code 5261 for disability of the same joint. VAOPGCPREC 9-2004 (September 17, 2004). The regulations provide that the normal range of motion of the knee is zero degrees on extension to 140 degrees on flexion. 38 C.F.R. § 4.71, Plate II. In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to increased ratings for his service-connected left and right knee disabilities. Initially, the Board finds that the Veteran is not entitled to an increased evaluation under Diagnostic Code 5260 for limitation of flexion for the left knee during the period on appeal. In this regard, the record does not show that the Veteran’s left knee flexion was limited to 15 degrees or less to warrant a higher evaluation. In fact, during a February 2014 VA examination, the Veteran demonstrated left knee flexion to 110 degrees, and during a January 2020 VA examination, testing revealed left knee flexion to 75 degrees. As such, an increased evaluation is not warranted under Diagnostic Code 5260 for the left knee. The Board also finds that the Veteran is not entitled to an increased evaluation under Diagnostic Code 5260 for limitation of flexion for the right knee during the period on appeal. In this regard, the record does not show that the Veteran’s right knee flexion was limited to 30 degrees or less to warrant a higher evaluation. In fact, during the February 2014 VA examination, the Veteran demonstrated right knee flexion to 115 degrees, and during the January 2020 VA examination, testing revealed right knee flexion to 90 degrees. As such, an increased evaluation is not warranted under Diagnostic Code 5260 for the right knee. The Board also finds that the Veteran is not entitled to higher or separate ratings under Diagnostic Code 5261 for limitation of extension for his left or right knee. The record does not show that left or right knee extension was limited to 10 degrees or more to warrant separate 10 percent evaluations or higher. In fact, during the February 2014 and January 2020 VA examinations, the Veteran demonstrated left and right knee extension to 0 degrees. As such, increased or separate evaluations under Diagnostic Code 5261 are not warranted for either the left or right knees. In an effort to afford the Veteran the highest possible ratings, the Board has also considered whether any other rating criteria are applicable. The assignment of a particular diagnostic code is “completely dependent on the facts of a particular case.” Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual’s relevant medical history, the current diagnosis, and demonstrated symptomatology. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). Thus, the Board has considered the propriety of assigning higher, or separate, ratings under other diagnostic codes. See Tedeschi v. Brown, 7 Vet. App. 411, 414 (1995). Nevertheless, the Board finds that the Veteran is not entitled to separate or higher evaluations for lateral instability or recurrent subluxation under Diagnostic Code 5257 for either knee. The Board notes that the Veteran reported that his left and right knees were unstable and that his left knee gave way during a February 2010 VA examination; however, the February 2014 and January 2020 VA examiners found no instability on testing. In fact, anterior, posterior, and medial-lateral stability tests were normal, and the January 2020 VA examiner specifically reported that there was no left and right knee joint instability. Further, during the January 2020 VA examination, the Veteran denied any symptoms of locking, subluxation, or instability. Thus, the preponderance of the evidence weighs against entitlement to higher or separate evaluations under Diagnostic Code 5257 for the left and right knees. In addition, the Board finds that higher evaluations are not warranted for the left and right knees under Diagnostic Code 5258 for dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint, or under Diagnostic Code 5259 for the symptomatic removal of semilunar cartilage. Semilunar cartilage is the meniscus lateralis articulationis genus (lateral meniscus) and the meniscus medialis articulationis genus (medial meniscus). See DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 273, 1013 (28th ed. 1994). The February 2014 and January 2020 VA examiners both specifically noted that the Veteran did not have any meniscal conditions or surgical procedures for a meniscal condition in either knee. Thus, higher or separate evaluations cannot be granted. The Board has also considered whether a higher or separate evaluation is warranted under any other diagnostic code. However, as the evidence of record does not demonstrate that the Veteran has ankylosis, impairment of the tibia and fibula, or genu recurvatum, he is not entitled to higher evaluations under Diagnostic Codes 5256 (ankylosis), 5262 (impairment of the tibia and fibula), and 5263 (genu recurvatum). There is simply no evidence of such manifestations. Indeed, based on the aforementioned range of motion findings, the record shows that the Veteran’s left and right knees are not fixated or immobile. Ankylosis is defined as “immobility and consolidation of a joint due to disease, injury, surgical procedure.” Lewis v. Derwinski, 3 Vet. App. 259 (1992) (internal medical dictionary citation omitted). Moreover, the January 2020 VA examiner specifically reported that the Veteran had no ankylosis of the left and right knees. Therefore, separate or higher evaluations are not warranted under Diagnostic Codes 5256, 5262, and 5263. In addition, the Board notes that the Veteran has been assigned 10 and 20 percent ratings for his left and right knee disabilities which contemplate painful motion. There is no x-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations. Thus, increased or separate evaluations are not warranted under Diagnostic Code 5010. The Board has also considered the provisions of 38 C.F.R. §§ 4.40, 4.45, 4.59, and the holdings in DeLuca. However, increased evaluations for the Veteran’s left and right knee disabilities are not warranted on the basis of functional loss due to pain or weakness in this case, as the Veteran’s symptoms are supported by pathology consistent with the assigned evaluations, and no higher. In this regard, the Board observes that the Veteran complained of pain and decreased range of motion throughout the appeal period. However, the effect of the pain in the Veteran’s left and right knees and his limitation of motion are already contemplated in the assigned evaluations. The Veteran’s complaints do not, when viewed in conjunction with the medical evidence, tend to establish weakened movement, excess fatigability, or incoordination to the degree that would warrant increased evaluations beyond those already assigned. During the February 2014 VA examination, the Veteran reported that he had flare-ups that impacted the function of his knees. Specifically, he stated that he was unable to bear weight on his left knee on occasion for three to four hours at a time when it flared, but that he had increased pain in his right knee that did not impact most of his functioning. Nevertheless, during the February 2014 and January 2020 VA examinations, the Veteran was also able to perform repetitive use testing with at least three repetitions for the left and right knees, and there was no additional functional loss or range of motion after three repetitions. In addition, the January 2020 VA examiner indicated that the Veteran had normal muscle strength of the left and right knees and that he had no muscle atrophy of the left and right legs. Thus, even taking into account the Veteran’s reports, the evidence does not show that he more nearly approximates the criteria for higher evaluations. Indeed, he has still maintained flexion greater than required by the rating criteria for increased evaluations in both knees. Accordingly, the Board concludes that increased or separate evaluations are not warranted for the Veteran’s service-connected left and right knee disabilities under DeLuca. Extraschedular Consideration The Board notes that, in the April 2016 Joint Motion, the parties agreed that the Board should consider referral for extraschedular consideration. In reaching this decision, the potential application of various provisions of Title 38 Code of Federal Regulations have been considered, whether or not they were raised by the Veteran. Schafrath v. Derwinski, 1 Vet. App. 589 (1991); Barringer v. Peake, 22 Vet. App. 242, 243-44 (2008). In particular, the Board has considered the provisions of 38 C.F.R. § 3.321(b)(1). However, in this case, the Board finds that the record does not show that the Veteran’s lumbosacral strain and degenerative joint disease of the right and left knees are so exceptional or unusual as to warrant the assignment of a higher rating on an extraschedular basis. See 38 C.F.R. § 3.321(b)(1). The threshold factor for extraschedular consideration is a finding that the evidence before VA presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. See Thun v. Peake, 22 Vet. App. 111 (2008). In this regard, there must be a comparison between the level of severity and symptomatology of the claimant’s service- connected disability with the established criteria found in the rating schedule for that disability. If the criteria reasonably describe the claimant’s disability level and symptomatology, then the claimant’s disability picture is contemplated by the rating schedule and the assigned schedular evaluation is therefore adequate, and no extraschedular referral is required. Id; see also VAOGCPREC 6-96 (Aug. 16, 1996). Otherwise, if the schedular evaluation does not contemplate the claimant’s level of disability and symptomatology and is found inadequate, VA must determine whether the claimant’s exceptional disability picture exhibits other related factors, such as those provided by the extraschedular regulation (38 C.F.R. § 3.321(b)(1)) as “governing norms” (which include marked interference with employment and frequent periods of hospitalization). The evidence in this case does not show such an exceptional disability picture that the available schedular evaluations for the service-connected disabilities are inadequate. A comparison between the level of severity and symptomatology of the Veteran’s assigned evaluations with the established criteria found in the rating schedule shows that the rating criteria reasonably describe the Veteran’s disability levels and symptomatology. As such, it cannot be said that the available schedular evaluations for these disabilities are inadequate. In making this determination, the Board notes that, for all musculoskeletal disabilities, the rating schedule contemplates functional loss, which may be manifested by, for example, decreased or abnormal excursion, strength, speed, coordination, or endurance. 38 C.F.R. § 4.40; Mitchell, 25 Vet. App. at 37. For disabilities of the joints in particular, the rating schedule specifically contemplates factors such as weakened movement; excess fatigability; pain on movement; disturbance of locomotion; and interference with sitting, standing, and weight bearing. 38 C.F.R. §§ 4.45, 4.59; Mitchell, 25 Vet. App. at 37. Given the variety of ways in which the rating schedule contemplates functional loss for musculoskeletal disabilities, the Board finds that the schedular criteria reasonably describe the Veteran’s disability picture in this case. Moreover, the Veteran and his representative have not identified any symptomatology not contemplated in the rating schedule, and the Board further notes that the Court has held that the amended version of 38 C.F.R. § 3.321(b), eliminating the possibility of extraschedular consideration based on the collective impact of multiple service-connected disabilities, applies retroactively to all cases pending before VA. See Thurlow v. Wilkie, 30 Vet. App. 231 (2018). Based on the foregoing, the Board finds that the requirements for an extraschedular evaluation for the Veteran’s service-connected disabilities under the provisions of 38 C.F.R. § 3.321 (b)(1) have not been met. Bagwell v. Brown, 9 Vet. App. 337 (1996); Shipwash v. Brown, 8 Vet. App. 218 (1995); Thun, supra. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Osegueda, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.