Citation Nr: 21007285 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 14-37 806 DATE: February 9, 2021 ORDER A disability rating in excess of 30 percent for right knee osteoarthritis, status post total knee replacement, from April 30, 2013 is denied. FINDING OF FACT For the rating period on appeal from April 30, 2013, the right knee osteoarthritis, status post total knee replacement, has not been manifested by chronic residuals consisting of severe painful motion or weakness. CONCLUSION OF LAW For the entire rating period on appeal from April 30, 2013, the criteria for a disability rating in excess of 30 percent for the right knee osteoarthritis, status post total knee replacement, 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, 4,71, 4,71a, Diagnostic Code 5055. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the Army during the Vietnam Era and Peacetime from June 1964 to December 1964. A disability of the musculoskeletal system is primarily the inability to perform the normal working movements of the body. The inability to perform normal movements is shown by the anatomical damage and the functional loss. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. A little used part of the musculoskeletal system may be expected to show evidence of disuse, either through atrophy, the condition of the skin, absence of normal callosity or the like. 38 C.F.R. § 4.40. A joint disability can be determined by examining whether there is (a) less movement than normal (due to ankylosis, limitation or blocking, adhesions, tendon-tie-up, contracted scars, etc.); (b) more movement than normal (from flail joint, resections, nonunion of fracture, relaxation of ligaments, etc.); (c) weakened movement (due to muscle injury, disease or injury of peripheral nerves, divided or lengthened tendons, etc.); (d) excess fatigability; (e) incoordination (impaired ability to execute skilled movements smoothly); or (f) pain on movement, swelling, deformity or atrophy of disuse. Instability of station, disturbance of locomotion, interference with sitting, standing and weight-bearing are related considerations. For the purpose of rating disability from arthritis, the shoulder, elbow, wrist, hip, knee, and ankle are considered major joints; multiple involvements of the interphalangeal, metacarpal and carpal joints of the upper extremities, the interphalangeal, metatarsal and tarsal joints of the lower extremities, the cervical vertebrae, the dorsal vertebrae, and the lumbar vertebrae, are considered groups of minor joints, ratable on a parity with major joints. The lumbosacral articulation and both sacroiliac joints are considered to be a group of minor joints, ratable on disturbance of lumbar spine functions. 38 C.F.R. § 4.45. With any form of arthritis, painful motion is an important factor of disability: 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. Crepitation either in the soft tissues such as the tendons or ligaments, or crepitation within the joint structures should be noted carefully as points of contact which are diseased. Flexion elicits such manifestations. The joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint. 38 C.F.R. § 4.59. VA must consider whether a higher rating is necessary based on a greater limitation of motion due to pain on use or during flare-ups. Deluca v. Brown, 8 Vet. App. 202 (1995). Functional limitations are applied to the schedular rating criteria to ascertain whether a higher schedular rating can be assigned based on limitation of motion due to pain and during flare-ups, and should be expressed in schedular rating terms of degree of range-of-motion loss. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011); Deluca v. Brown, 8 Vet. App. 202 (1995). For the entire rating period on appeal from April 30, 2013, the Veteran is in receipt of a 30 percent rating for the service-connected right knee osteoarthritis, status post total knee replacement, under Diagnostic Code (DC) 5055. Under DC 5055, the next highest rating of 60 percent rating is warranted where the prosthetic replacement of the knee joint results in chronic residuals consisting of severe painful motion or weakness in the affected extremity. After a review of all the evidence, lay and medical, the Board finds that the weight of the evidence shows that, for the rating period on appeal from April 30, 2013, the right knee osteoarthritis, status post total knee replacement, has not been manifested by chronic residuals consisting of severe painful motion or weakness as required for a higher rating of 60 percent under DC 5055. At a VA examination in October 2019, the Veteran reported intermittent knee pain of 4 out of 10, which is treated with naproxen. The Veteran reported that the pain is manageable; the pain increases when standing for longer than 3-4 minutes increases pain; and the Veteran is unable to move rapidly or squat. Examination in October 2019 revealed crepitus, arthritis, pain on flexion and extension, pain on weight-bearing, functional loss from pain, and no noted tenderness with palpation. The range of motion of the right knee was limited to 100 degrees on flexion, and to 0 degrees on extension. With repeated use over time, pain decreased the range of motion on flexion to 20 degrees. Range of motion on extension was still noted as limited to 0 degrees. The examiner assessed intermediate degrees of residual weakness, pain, or limitation of motion as a consequence of the knee replacement. There was no evidence of ankylosis, subluxation or instability; and no muscle atrophy or loss of muscle strength. The examiner had the option to assess chronic residuals consisting of severe painful motion or weakness, as required for a 60 percent rating, but expressly noted the lesser amount of weakness and pain. As directed by DC 5055, the Board has also considered whether the criteria for a higher rating than 30 percent are met for intermediate degrees of residual weakness, pain, or limitation of motion. Under DC 5055, where residuals of knee replacement are determined to consist of intermediate degrees of residual weakness, pain or limitation of motion, a rating in excess of 30 percent may be granted by analogy to DC 5256, 5261, or 5262. Under DC 5256, a 40 percent rating may be granted where there is ankylosis of the knee in flexion between 10 degrees and 20 degrees. As noted above, the VA examiner found no evidence of ankylosis, and the other lay and medical evidence of record does not describe or show ankylosis, so a 40 percent rating is not warranted. Under DC 5261, a 40 percent rating may be granted where extension is limited to 30 degrees. As noted above, the VA examiner determined that, with pain, extension was limited to 0 degrees, not the 30 degrees required for the higher rating. A 40 percent rating is thus not warranted under DC 5261. (Continued on the next page)   Under DC 5262, a 40 percent rating may be granted where there is nonunion of the tibia and fibula, with loose motion, requiring a brace. The lay and medical evidence of record does not show a nonunion of the tibia and fibula. As such, a 40 percent rating under DC 5262 is not warranted. Accordingly, the Board finds that, for the entire rating period on appeal from April 30, 2013, the criteria for an increased disability rating in excess of 30 percent for right knee osteoarthritis are not met. 38 C.F.R. §§ 4.3, 4.7, 4.71a. J. PARKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Plambeck, Charles 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.