Citation Nr: 21007121 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 16-32 141 DATE: February 8, 2021 ORDER Entitlement to a rating in excess of 10 percent prior to March 18, 2016, and a rating in excess of 10 percent from to May 1, 2016, for service-connected left foot strain of fifth metatarsophalangeal joint foot injury is denied. Entitlement to a rating in excess of 10 percent for service-connected left hamstring tendonitis with left knee strain is denied. Entitlement to a rating in excess of 10 percent for service-connected right knee strain with limitation of flexion with hamstring tendonitis is denied. FINDINGS OF FACT 1. The Veteran’s service-connected left foot strain of fifth metatarsophalangeal joint foot injury is manifested by symptoms of moderate severity during the period on appeal. 2. The Veteran’s service-connected left hamstring tendonitis with left knee strain is manifested by symptoms of stiffness, aches, pain, and moderate muscle injury. 3. The Veteran’s service-connected right knee strain with limitation of flexion with hamstring tendonitis is manifested by symptoms of stiffness, aches, pain, and limitation of flexion limited to greater than 60 degrees. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating in excess of 10 percent prior to March 18, 2016, and a rating in excess of 10 percent from May 1, 2016, for service-connected left foot strain of fifth metatarsophalangeal joint foot injury have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-14, 4.40, 4.45, 4.59, 4.71(a), Diagnostic Code 5284. 2. The criteria for entitlement to a rating in excess of 10 percent for service-connected left hamstring tendonitis with left knee strain have not been met. left hamstring tendonitis with left knee strain. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-14, 4.40, 4.45, 4.55, 4.56, 4.59, 4.73, 4.71(a), Diagnostic Codes 5313-5260. 3. The criteria for entitlement to a rating in excess of 10 percent for service-connected right knee strain with limitation of flexion with hamstring tendonitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-14, 4.40, 4.45, 4.55, 4.56, 4.59, 4.73, 4.71(a), Diagnostic Code 5260. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the United States Air Force from November 1987 to September 1998, to include service in Southwest Asia during the Persian Gulf War from August 1990 to March 1991. For his meritorious service, the Veteran was awarded (among other decorations) the Southwest Asia Service Medal, the Air Force Achievement Medal, the Air Force Commendation Medal, and the Kuwait Liberation Medal. This appeal comes to the Board of Veterans’ Appeals (Board) from a July 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. In a June 2012 rating decision, the RO denied service connection for a right knee disability. In July 2012, the RO confirmed and continued this denial. In April 2016, the RO granted a temporary evaluation of 100 percent based on surgical or other treatment necessitating convalescence for the Veteran’s service-connected left foot strain of fifth metatarsophalangeal joint foot injury from March 18, 2016 to May 1, 2016. Since this is the highest possible rating that the Veteran is able to receive for his service-connected left foot condition, the period from March 18, 2016 to May 1, 2016 will not be considered on appeal. In April 2019, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. In October 2019, the Board remanded the issues for further development. As reflected in the analysis section, there has been substantial compliance with the Board’s remand instructions (to include records development and obtaining new examinations) such that the case may move to a decision. In an August 2020 rating decision, the RO granted: (1) an evaluation of 10 percent from November 3, 2011, for the Veteran’s service-connected left foot strain; (2) an evaluation of 10 percent from April 6, 2011, for service-connected left hamstring tendonitis with left knee strain; (3) service connection for surgical scar of the left fifth digit with an evaluation of 0 percent from March 18, 2016; and (4) service connection for left knee strain with an effective date of April 6, 2011. The RO combined the rating for the left knee strain with the rating for the Veteran’s left hamstring tendonitis. As the Veteran was granted service connection for left knee strain, this issue is no longer on appeal. In a subsequent August 2020 rating decision the RO granted: (1) service connection for right knee strain with instability with hamstring tendonitis with an evaluation of 10 percent from January 16, 2020; and (2) an evaluation of 10 percent for right knee strain limitation of flexion with hamstring tendonitis from April 26, 2011. The RO combined the rating for the Veteran’s right knee with the rating for the Veteran’s right hamstring tendonitis. As the Veteran was granted service connection for his right knee disability, this issue of service connection is no longer on appeal. Based on the grants in the August 2020 rating decisions, the Board has recharacterized the issues to reflect such grants. Also, the issues of service connection for irritable bowel syndrome, lumbosacral strain, and cough variant asthma are on appeal, but will be addressed in a separate decision as the Veteran has requested a hearing on these issues. Increased Rating Disability ratings are determined by applying the criteria set forth in the VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran’s disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as “staging the ratings.” See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2008). In rating 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 maligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that 38 C.F.R. § 4.59 applies to disabilities other than arthritis). However, painful motion alone is not a functional loss without some restriction of the normal working movements of the body. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). 1. Entitlement to a rating in excess of 10 percent prior to March 18, 2016, and a rating in excess of 10 percent from May 1, 2016, for service-connected left foot strain of fifth metatarsophalangeal joint foot injury. The Veteran’s service-connected left foot strain is rated at 10 percent prior to March 18, 2016, and 10 percent from May 1, 2016, under 38 C.F.R. § 4.71(a), Diagnostic Code 5284. Under Diagnostic Code 5284, other foot injuries, a 10 percent is assigned for moderate foot injuries, 20 percent for moderately severe foot injuries, 30 percent for severe foot injuries, and 40 percent for actual loss of use of the foot. In April 2012, the Veteran was afforded a VA examination for his service-connected left foot strain on fifth metatarsophalangeal joint foot injury. However, the VA examiner diagnosed the Veteran with right foot 5th metatarsophalangeal joint strain. The Veteran did not have Morton’s neuroma, metatarsalgia, hammer toes, hallux valgus, hallux rigidus, or pes cavus (claw foot). The Veteran did not have malunion or nonunion of tarsal or metatarsal bones. In July 2018, the Veteran was afforded a VA examination for his service-connected left foot condition. The VA examiner noted that the Veteran had surgical resection of the distal portions of the left 4th and 5th proximal phalanges. It affected the left side with moderate severity. The foot condition chronically compromised weight bearing. However, the Veteran’s foot condition did not require arch supports, custom orthotic inserts or shoe modifications. Contributing factors of the Veteran’s left foot disability included weakened movement, excess fatigability, pain on movement, pain on weight-bearing, pain on non-weight-bearing, pain on weight-bearing, deformity, disturbance of locomotion, interference with standing, and lack of endurance. The Veteran preferred not to walk more than 50 yards at a time. The Veteran had a scar related to his condition; however, it was not painful or unstable, nor did it have a total area equal to or greater than 39 square centimeters (6 square inches). The VA examiner noted that the Veteran’s scar was well healed causing no disability. The examiner noted that the Veteran’s foot disability affected his employment, but clerical as well as non-physical occupations were not limited or precluded. In January 2020, the Veteran was afforded a VA examination for his foot disability. The Veteran was diagnosed with left foot strain. He was diagnosed with metatarsalgia and hammer toes of the left foot. The Veteran had left foot pain in the 4th and 5th digit. The pain level was 6/10 when he applied weight to the foot. Pushing or pulling caused pain in the left foot also. It caused the Veteran to walk on the inner medial aspect of his foot in order to prevent weight on the fourth and fifth digit of the left toes. He had to take a break and rest his left foot at least hourly. The Veteran had to wear shoes with a soft toe box to prevent pressure on the fourth and fifth toe. The Veteran had metatarsalgia in his left foot. He had numbness and tingling in the left foot metatarsal and toes. The Veteran’s symptoms also included pain on movement, pain on weight-bearing, pain on non-weight-bearing, interference with sitting, interference with standing, and disturbance of locomotion. The Veteran did not have pes planus, Morton’s neuroma, hallux valgus, hallux rigidus, acquired pes cavus (claw foot), or malunion/nonunion of tarsal/metatarsal bones. The Board finds the April 2012, July 2018, and January 2020 VA examinations to be competent, credible, and highly probative, as they are supported by in-person examinations, medical expertise, adequate findings, sufficient rationales, and proper consideration of the Veteran’s lay statements. Based on these examinations, the Board finds that a rating in excess of 10 percent for the Veteran’s service-connected left foot disability is not warranted. The competent medical evidence of record shows that the Veteran’s left foot strain is manifested by left foot pain in the 4th and 5th digit, numbness and tingling, and pain on movement. It caused the Veteran to walk on the inner medial aspect of his foot in order to prevent weight on the fourth and fifth digit of the left toes. He had to take a break and rest his left foot at least hourly. The Veteran had to wear shoes with a soft toe box to prevent pressure on the fourth and fifth toe. This evidence shows that the Veteran’s left foot strain is moderate in severity. Absent more severe symptoms, the Board cannot find that the Veteran’s disability more closely approximates a moderately severe injury as required for a 20 percent rating. Additionally, there is no competent medical evidence of flat foot, weak foot, claw foot, Morton’s disease, malunion or nonunion of the tarsal or metatarsal bones, hallux valgus, hallux rigidus or hammer toe in order to warrant a compensable disability rating under Diagnostic Codes 5276-5283. See 38 C.F.R. § 4.71 (a), 5276-5283. The Board has considered the Veteran’s lay statements in support of his claim for an increased rating for his service-connected left foot strain. However, the Board concludes that the medical findings are of greater probative value than the Veteran’s allegations regarding the severity of his condition. The nature and extent of the Veteran’s disability have been addressed during the appeal period and the medical findings directly address the criteria under which this disability is evaluated. Accordingly, the Board finds that a rating in excess of 10 percent is not warranted for the appeal period prior to March 18, 2016, and from May 1, 2016. 2. Entitlement to a rating in excess of 10 percent for service-connected left hamstring tendonitis with left knee strain. 3. Entitlement to a rating in excess of 10 percent for service-connected right knee strain with limitation of flexion with hamstring tendonitis. The Veteran’s left hamstring tendonitis with left knee strain is currently rated at 10 percent from April 6, 2011 under 38 C.F.R. §§ 4.73, 4.71(a) Diagnostic Codes 5313-5260. The Veteran’s right knee strain with limitation of flexion with hamstring tendonitis is rated at 10 percent from April 26, 2011, under 38 C.F.R. § 4.71(a), Diagnostic Code 5260. The Veteran’s right knee strain with instability with hamstring tendonitis is also rated at 10 percent from January 16, 2020, under 38 C.F.R. § 4.71(a), Diagnostic Code 5257. Diagnostic Code 5313 provides evaluations for a disability of Muscle Group XIII. 38 C.F.R. § 4.73. This muscle group includes the posterior thigh group, hamstring complex of 2-joint muscles: (1) biceps femoris; (2) semimembranosus; and (3) semitendinosus. 38 C.F.R. § 4.73, Diagnostic Code 5313. The functions of these muscles are as follows: extension of hip and flexion of knee; outward and inward rotation of flexed knee; and acting with rectus femoris and sartorius (see XIV, 1, 2) synchronizing simultaneous flexion of hip and knee and extension of hip and knee by belt-over-pulley action at knee joint. See Id. Under Diagnostic Code 5313, a slight injury warrants a 0 percent rating, a moderate injury warrants a 10 percent rating, a moderately severe injury warrants a 30 percent rating, and a severe injury warrants a 40 percent rating. Id. The factors to be considered in evaluating disabilities residual to healed wounds involving muscle groups are set forth in 38 C.F.R. §§ 4.55 and 4.56. A through-and-through injury with muscle damage shall be evaluated as no less than a moderate injury for each group of muscles damaged. 38 C.F.R. § 4.56(b). For VA rating purposes, the cardinal signs and symptoms of muscle disability are loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination, and uncertainty of movement. 38 C.F.R. § 4.56(c). Under Diagnostics 5301 to 5323, disabilities resulting from muscle injuries shall be classified as slight, moderate, moderately severe, and severe. The type of disability associated with a slight muscle disability is a simple wound of muscle without debridement or infection. A history with regard to this type of injury should include service department record of superficial wound with brief treatment and return to duty, healing with good functional results, and no cardinal signs or symptoms of muscle disability. Objective findings should include minimal scar, no evidence of fascial defect, atrophy, or impaired tonus, no impairment of function or metallic fragments retained in muscle tissue. 38 C.F.R. § 4.56(d)(1). The type of injury associated with a moderate muscle disability is a through-and-through or deep penetrating wound of short track from a single bullet, small shell or shrapnel fragment, without explosive effect of high velocity missile, residuals of debridement, or prolonged infection. A history with regard to this type of injury should include service department record or other evidence of in-service treatment for the wound and record of consistent complaints of one or more of the cardinal signs and symptoms of muscle disability, particularly lowered threshold of fatigue after average use affecting the particular functions controlled by the injured muscles. Objective findings should include entrance and (if present) exit scars, small or linear, indicating short track of missile through muscle tissue and some loss of deep fascia or muscle substance or impairment of muscle tonus and loss of power or lowered threshold of fatigue when compared to the sound side. 38 C.F.R. § 4.56(d)(2). The type of injury associated with a moderately severe muscle disability is a through-and-through or deep penetrating wound by a small high-velocity missile or large low-velocity missile, with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring. A history with regard to this type of injury should include service medical record or other evidence showing prolonged hospitalization for treatment of wound, record of consistent complaints of cardinal signs and symptoms of muscle disability, and, if present, evidence of inability to keep up with work requirements. Objective findings should include entrance and (if present) exit scars indicating the track of the missile through one or more muscle groups, and indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with the sound side. Tests of strength and endurance compared with sound side should demonstrate positive evidence of impairment. 38 C.F.R. § 4.56(d)(3). The type of injury associated with a severe disability of muscles is a through-and-through or deep penetrating wound due to high-velocity missile, or large or multiple low velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding and scarring. A history consistent with this type of injury would include service department record or other evidence showing hospitalization for a prolonged period for treatment of wound, record of consistent complaint of cardinal signs and symptoms of muscle disability, worse than those shown for moderately severe muscle injuries, and, if present, evidence of inability to keep up with work requirements. Objective findings of a severe disability would include ragged, depressed and adherent scars indicating wide damage to muscle groups in missile track; palpation shows loss of deep fascia or muscle substance, or soft flabby muscles in wound area; muscles swell and harden abnormally in contraction; tests of strength, endurance, or coordinated movements compared with the corresponding muscles of the uninjured side indicate severe impairment of function. If present, a severe injury would also show x-ray evidence of minute multiple scattered foreign bodies indicating intermuscular trauma and explosive effect of the missile; adhesion of scar to one of the long bones, scapula, pelvic bones, sacrum or vertebrae, with epithelial sealing over the bone rather than true skin covering in an area where bone is normally protected by muscle; diminished muscle excitability to pulsed electrical current in electrodiagnostic tests; visible or measurable atrophy; adaptive contraction of an opposing group of muscles; atrophy of muscle groups not in the track of the missile, particularly of the trapezius and serratus in wounds of the shoulder girdle; or induration or atrophy of an entire muscle following simple piercing by a projectile. 38 C.F.R. § 4.56 (d)(4). A muscle injury rating will not be combined with a peripheral nerve paralysis rating of the same body part, unless the injuries affect entirely different functions. 38 C.F.R. § 4.55(a). Diagnostic Code 5256 pertains to ankylosis of the knee. 38 C.F.R. § 4.71(a). Diagnostic Code 5257 provides for assignment of a 10 percent rating when there is slight recurrent subluxation or lateral instability, a 20 percent rating when there is moderate recurrent subluxation or lateral instability, or a 30 percent evaluation for severe knee impairment with recurrent subluxation or lateral instability. 38 C.F.R. § 4.71(a). Diagnostic Code 5258 provides for assignment of a 20 percent rating with semilunar cartilage dislocated with frequent episodes of “locking,” pain, and effusion into the joint. 38 C.F.R. § 4.71(a). Diagnostic Code 5259 provides for assignment of a 10 percent rating for removal of symptomatic semilunar cartilage. 38 C.F.R. § 4.71(a). Diagnostic Code 5260 provides for a 10 percent rating when flexion of the leg is limited to 45 degrees; a 20 percent rating when flexion is limited to 30 degrees; and a 30 percent rating when flexion is limited to 15 degrees. 38 C.F.R. § 4.71(a). Diagnostic Code 5261 provides for a 10 percent rating when extension is limited to 10 degrees; a 20 percent rating with extension limited to 15 degrees; a 30 percent rating with extension limited to 20 degrees; a 40 percent rating with extension limited to 30 degrees; and a 50 percent rating is assigned with extension limited to 45 degrees. 38 C.F.R. § 4.71(a). Diagnostic Code 5262 provides ratings for impairment of the tibia and fibula. A 40 percent rating is assigned for nonunion with loose motion requiring a knee brace; a 30 percent rating is assigned for malunion with marked knee or ankle disability; a 20 percent rating is assigned for malunion with moderate ankle or knee disability; and a 10 percent rating is assigned for malunion with slight knee or ankle disability. 38 C.F.R. § 4.71(a). Diagnostic Code 5263 provides for a 10 percent rating for genu recurvatum, acquired, traumatic, with weakness and insecurity in weight-bearing objectively demonstrated. 38 C.F.R. § 4.71(a). In August 2011, the Veteran was afforded a VA examination for his joints, specifically his right knee. The Veteran reported that he had aches and pain in his right knee upon playing basketball, running, or standing for long periods of time. The Veteran did not have instability, weakness, episodes of dislocation or subluxation, locking episodes, effusion, flare-ups, or arthritis. However, the Veteran did have pain, stiffness, and decreased speed of joint motion in his right knee. He was only able to stand for up to one hour and walk 1 to 3 miles. The Veteran had crepitus, tenderness, and pain at rest. Range of motion testing of the right knee revealed flexion to 120 degrees and extension to 0 degrees (normal). There was objective evidence of pain following repetitive motion; however, there was no additional limitations after three repetitions of range of motion. In February 2012, the Veteran was afforded a VA examination for his service-connected bilateral pulled hamstrings. It was noted that the Veteran had a non-penetrating muscle injury (such as a muscle strain, torn Achilles tendon, or torn quadricep muscle). The Veteran currently had minimal symptoms, unless he was doing physical activity. It limited his ability to run and play basketball, but he had been able to avoid recent injury limiting his activity. When the Veteran exerted himself physically, he reported stiffness and tightness in his hamstring musculature. The Veteran injured muscle group XIII, which involved the posterior thigh/hamstring muscles: biceps femoris, semimembranosus, semitendinosus of both sides. The Veteran’s muscle injury did not cause loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination, or uncertainty of movement. The Veteran did not have muscle atrophy. Muscle strength testing of the right and left knee revealed flexion 5/5 and extension 5/5. In January 2020, the Veteran was afforded a VA examination for his knees. The Veteran was diagnosed with bilateral knee strain, right knee anterior cruciate ligament tear, and right knee instability. The Veteran took Cyclobenzaprine, Methocarbamol, Voltaren gel, and extra strength Tylenol to reduce the knee pain for his bilateral knee pain. He also used rest, ice, heat, and elevation to reduce the knee pain. Pain in the right knee was 3-4/10 with stiffness. Pain increased to 7/10 with standing, walking, and kneeling. The pain was present in the front and back of the knees. There were episodes of swelling in the knees. Initial range of motion testing in the right knee revealed flexion from 0 to140 degrees and extension from 140 to 0 degrees. Pain was noted to have caused functional loss. There was tenderness in the anterior and posterior knee. There was evidence of pain with weight bearing, but no objective evidence of crepitus. The Veteran was able to perform repetitive use testing in his right knee, but there was no additional loss of function or range of motion after three repetitions. For the right knee, the Veteran was not examined after repeated use over time. The VA examiner was able to describe the functional loss in terms of range of motion in the right knee: flexion was 0 to 135 degrees and extension was from 135 to 0 degrees. The Veteran denied flare-ups in his right knee. Initial range of motion testing of the left knee revealed flexion from 0 to 135 degrees and extension was from 135 to 0 degrees. Pain was noted also in his left knee. He had tenderness as well. There was pain on weight bearing, but no objective evidence of crepitus. The Veteran was able to perform repetitive use testing with at least three repetitions in his left knee, but there was no additional loss of function or range of motion. His left knee was immediately examined after repetitive use over time. The examiner was able to describe the functional loss in terms of range of motion: flexion was 0 to 130 degrees and extension was 130 to 0 degrees. The Veteran denied flare-ups in his left knee. Additional contributing factors of the Veteran’s bilateral knee disability included swelling, disturbance of locomotion, interference with sitting, and interference with standing. The Veteran did not have any reduction in muscle strength of the right or left knee. He did not have muscle atrophy or ankylosis. The VA examiner noted that there was no history of lateral instability or recurrent subluxation. However, the Veteran recurrent effusion. Edema occurred in bilateral knees but was treated with rest and elevation. Joint instability testing revealed slight instability in the right knee. The Veteran never had a semilunar cartilage condition or ankylosis in any knee. In January 2020, the Veteran was afforded a VA examination for his service-connected left and right hamstring disability. The VA examiner diagnosed the Veteran with left and right hamstring tendonitis. The examiner also diagnosed the Veteran with quadriceps strain. The Veteran did not have loss of power, weakness, lowered threshold of fatigue, impairment of incoordination, or uncertainty of movement. He did not have any muscle atrophy of the injured muscle group. The Veteran’s bilateral hamstring tendonitis and quadriceps strain caused the Veteran to have pain with bending, walking up and down stairs, and walking greater than 10 to 15 minutes. Lifting or pushing at least 20 to 25 pounds increased the pain in the thighs. The pain caused the Veteran to have to sit and rest. Based on the foregoing evidence, a rating in excess of 10 percent is not warranted for the Veteran’s service-connected left hamstring tendonitis with left knee strain the Veteran’s service-connected right knee strain with limitation of flexion with hamstring tendonitis, or the Veteran’s right knee strain with instability with hamstring tendonitis. The Veteran’s left hamstring/knee and right knee/hamstring disabilities are manifested by pain, aches, and stiffness. The Veteran used rest, ice, heat, and elevation to reduce the knee pain. Furthermore, the Veteran’s muscle injury did not cause loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination, and uncertainty of movement. The Veteran did not have muscle atrophy. Thus, a rating in excess of 10 percent is not assignable under Diagnostic Code 5313 for the Veteran’s service-connected left hamstring/knee or right knee/hamstring disabilities. A rating in excess of 10 percent is not assignable under Diagnostic Codes 5260 or 5261 because the Veteran’s left hamstring/knee and right knee/hamstring did not exhibit flexion limited to less than 45 degrees or exhibit extension limited to greater than 10 degrees. Also, for the Veteran’s right knee strain with instability, a rating is not warranted in excess of 10 percent under Diagnostic Code 5257 because the Veteran’s instability was only slight as shown by the January 2020 VA examination. Beyond that, though, the Veteran does not demonstrate the symptoms or diagnoses required for additional ratings under other Diagnostic Codes. The evidence does not show any ankylosis, symptomatic semilunar cartilage removal, semilunar dislocated cartilage with frequent episodes of locking pain and effusion into the joint, tibial or fibular impairment, or Genu recurvatum. See 38 C.F.R. § 4.71(a), Diagnostic Codes 5256, 5258, 5259, 5262-5263. The Board has considered the Veteran’s lay statements in support of his claim for an increased rating for his service-connected right knee/hamstring and left knee/hamstring disabilities. However, the Board concludes that the medical findings are of greater probative value than the Veteran’s allegations regarding the severity of his condition. The nature and extent of the Veteran’s disability have been addressed during the appeal period and the medical findings directly address the criteria under which this disability is evaluated. Accordingly, the Board finds that a rating in excess of 10 percent is not warranted for his service-connected right knee strain with limitation of flexion with hamstring tendonitis, right knee strain with instability with hamstring tendonitis, or left hamstring tendonitis with left knee strain. The claims for increased ratings are denied. Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Crawford, Associate 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.