Citation Nr: 21007390 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 19-02 063 DATE: February 9, 2021 ORDER An initial rating in excess of 10 percent prior to September 18, 1998, for a right knee disability is denied. A rating of 20 percent, but no higher, from September 18, 1998, to June 20, 2016, for a right knee disability is granted. A rating in excess of 20 percent from September 1, 2016, to July 18, 2017, for a right knee disability is denied. A rating in excess of 30 percent as of September 1, 2018, for a right knee disability is denied. An initial rating in excess of 10 percent prior to December 22, 2011, for a left knee disability is denied. A rating of 20 percent, but no higher, from December 22, 2011, to October 1, 2015, for the dislocated semilunar cartilage of the left knee pursuant to Diagnostic Code (DC) 5258 is granted. A separate rating of 10 percent, but no higher, from December 28, 2011, to October 1, 2015, for left knee arthritis pursuant to DC 5003 is granted. A rating in excess of 10 percent, from December 1, 2015, to April 9, 2019, for left knee arthritis pursuant to DC 5003 is denied. A separate rating of 10 percent, but no higher, from December 1, 2015, to April 9, 2019, for the symptomatic left knee meniscal disorder pursuant to DC 5259 is granted. A one-month temporary rating of 100 percent under 38 C.F.R. § 4.30 for the total arthroscopy of the left knee performed on April 10, 2019, is granted. A rating in excess of 10 percent, as of June 1, 2019, for left knee arthritis pursuant to DC 5003 is denied. A separate rating of 10 percent, but no higher, as of June 1, 2019, for the symptomatic left knee meniscal disorder pursuant to DC 5259 is granted. REMANDED The issue of a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The competent and probative evidence shows that during the entire period on appeal prior to September 18, 1998, the Veteran had right knee functional loss due to painful motion, and the evidence is against a finding of right knee flexion limited to 45 degrees or less or extension limited to more than zero or other more severe symptoms affecting the right knee. 2. The evidence is at least in equipoise as to whether from September 18, 1998 to June 20, 2016, the Veteran had a symptomatic right knee meniscal disorder with frequent episodes of joint locking, pain, and effusion; and the evidence is against a finding of right knee flexion limited to 45 degrees or less or extension limited to more than zero degrees. 3. The competent and probative evidence is against a finding that from September 1, 2016, to July 18, 2017, the Veteran’s post-arthroscopy right knee disability resulted in severe symptoms such as flexion limited to 30 degrees. 4. The evidence shows right knee replacement with intermittent degrees of pain, weakness, or limitation of motion but the weight of the competent and probative evidence is against a finding of severe painful motion or weakness, limitation of extension, limitation of flexion to 45 degrees or less, ankylosis, or tibia or fibula impairment. 5. The competent and probative evidence shows that during the entire period on appeal prior to December 22, 2011, the Veteran had left knee functional loss due to painful motion, and the evidence is against a finding of left knee flexion limited to 45 degrees or less or extension limited to more than zero or other more severe symptoms affecting the left knee. 6. The evidence is at least in equipoise as to whether from December 22, 2011, to October 2, 2015, the Veteran had a symptomatic left knee meniscal disorder with frequent episodes of joint locking, pain, and effusion. 7. The competent and probative evidence is against a finding of left knee flexion limited to 45 degrees or less or extension limited to more than zero degrees from December 22, 2011, to October 2, 2015. 8. On December 28, 2011, left knee arthritis was diagnosed. 9. The competent and probative evidence is at least in equipoise as to whether from December 1, 2015, to April 9, 2019, the Veteran’s left knee arthroscopy results in symptomatic residuals. 10. The Veteran underwent a left knee arthroscopy with partial meniscectomy on April 10, 2019. 11. The competent and probative evidence is at least in equipoise as to whether, as of June 1, 2019, the left knee arthroscopy with partial meniscectomy results in symptomatic residuals. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 10 percent prior to September 18, 1998, for a right knee disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.59, 4.71a. 2. The criteria for a rating of 20 percent, but no higher, from September 18, 1998, to June 20, 2016, for a right knee disability are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.71a, DC 5258. 3. The criteria for a rating of in excess of 20 percent from September 1, 2016, to July 18, 2017, for a right knee disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.71a, DC 5260. 4. The criteria for a rating in excess of 30 percent for the residuals of a right knee replacement as of September 1, 2018, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.71a, DC 5055. 5. The criteria for an initial rating in excess of 10 percent prior to December 22, 2011, for a left knee disability are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.59, 4.71a, DC 5260. 6. The criteria for a rating of 20 percent, but no higher, from December 22, 2011, to October 2, 2015, for a left knee meniscus disability are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.71a, DC 5258. 7. The criteria for a separate rating of 10 percent, but no higher, from December 28, 2011, to October 2, 2015, for left knee arthritis are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.71a, DC 5003. 8. The criteria for a rating in excess of 10 percent from December 1, 2015, to April 9, 2019, for left knee arthritis are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.71a, DC 5003. 9. The criteria for a separate rating of 10 percent, but no higher, from December 1, 2015, to April 9, 2019, for the symptomatic left knee meniscal disorder are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.71a, DC 5259. 10. The criteria for a temporary rating of 100 percent under 38 C.F.R. § 4.30 for left knee arthroscopy performed on April 10, 2019, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.30. 11. The criteria for a rating in excess of 10 percent as of June 1, 2019, for left knee arthritis are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.71a, DC 5003. 12. The criteria for a separate rating of 10 percent, but no higher, as of June 1, 2019, for the symptomatic left knee meniscal disorder, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.71a, DC 5259. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1983 to August 1985. This case is before the Board of Veterans’ Appeals (Board) on appeal from a December 2016 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded this case for further development in March 2019. As the requested development has been completed, no further action to ensure compliance with the remand directives is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Increased Rating Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. Where there is a question as to which of two evaluations shall be applied, VA will assign the higher evaluation if the disability picture more nearly approximates the criteria required for that rating. Otherwise, it will assign the lower rating. 38 C.F.R. § 4.7. VA resolves any reasonable doubt regarding the degree of disability in favor of the Veteran. 38 C.F.R. § 4.3. The standard of proof to be applied in decisions on claims for VA benefits is set forth in 38 U.S.C. § 5107(b). Under that provision, VA shall consider all information, including lay and medical evidence of record, in a case before the Secretary concerning benefits under laws the Secretary administers. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); see also Gilbert v. Derwinski, 1 Vet. App. 49, 57-58 (1990). In the case of an initial rating, the entire evidentiary record from the time of a veteran’s claim for service connection to the present is important in determining the proper evaluation of the disability. Fenderson v. West, 12 Vet. App. 119 (1999). Nevertheless, where the evidence contains factual findings that show a change in the severity of symptoms during the rating period on appeal, the Board can assign different or “staged” ratings for such different periods. See Hart v. Mansfield, 21 Vet. App. 505, 509-510 (2007). In evaluating a disability, the current examination reports are considered in light of the whole recorded history to ensure that the current rating accurately reflects the disorder’s severity. The medical, as well as industrial history, is to be considered, and a full description of the effects of the disability upon ordinary activity is also required. 38 C.F.R. §§ 4.1, 4.2, 4.10. The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one disorder is not duplicative of the symptomatology of the other disorder. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). Veterans are competent to report observable symptoms in the realm of their personal knowledge. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (2007); 38 C.F.R. § 3.159(a). DC 5003 provides that degenerative arthritis will be rated based on limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. 38 C.F.R. § 4.71a, DC 5003. A rating of 10 percent is applicable, to be combined, not added under DC 5003, for each major joint or group of minor joints limitation of motion effects when it is noncompensable under the appropriate diagnostic codes. Findings such as swelling, muscle spasm, or satisfactory evidence of painful motion must objectively confirm the limitation of motion. A knee replacement (prosthesis) will be assigned a 100 percent rating for one year following the implantation of the prosthesis and a minimum rating of 30 percent thereafter. A 60 percent rating is warranted where there are chronic residuals consisting of severe painful motion or weakness in the affected extremity. Intermediate degrees of residual weakness, pain, or limitation of motion will be rated by analogy to DCs 5256 (ankylosis of the knee), 5261 (limitation of extension), or 5262 (impairment of the tibia and fibula). 38 C.F.R. § 4.71a, DC 5055. The standard motion of a knee joint is from zero degrees extension to 140 degrees flexion. 38 C.F.R. § 4.71, Plate II. DCs 5260 and 5261 govern the limitation of leg motion. DC 5260 concerns limitation of leg flexion. Under DC 5260, flexion limited to 45 degrees warrants a 10 percent rating, flexion limited to 30 degrees warrants a 20 percent rating, and flexion limited to 15 degrees warrants a 30 percent rating. 38 C.F.R. § 4.71a. DC 5261 pertains to the limitation of leg extension. Under DC 5261, extension limited to 10 degrees warrants a 10 percent rating, extension limited to 15 degrees warrants a 20 percent rating, extension limited to 20 degrees warrants a 30 percent rating, extension limited to 30 degrees warrants a 40 percent rating, and extension limited to 45 degrees warrants a 50 percent rating. 38 C.F.R. § 4.71a. Under DC 5256, a 30 percent rating is warranted for favorable ankylosis with the knee fixed in full extension or slight flexion between zero and 10 degrees. Ankylosis of the knee fixed in flexion between 10 and 20 degrees warrants a 40 percent rating, and the knee fixed in flexion between 20 and 45 degrees warrants a 50 percent rating. Extremely unfavorable ankylosis in flexion at an angle of 45 degrees or more warrants a 60 percent rating, which is the maximum schedular rating. 38 C.F.R. § 4.71a, DC 5256. Under DC 5257, slight subluxation or lateral instability warrants a 10 percent rating. Moderate subluxation or lateral instability warrants a 20 percent rating. A maximum 30 percent rating is warranted for severe recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, DC 5257. Under DC 5258, evidence of dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the knee joint warrants a 20 percent rating. 38 C.F.R. § 4.71a, DC 5258. Symptomatic removal of semilunar cartilage warrants a 10 percent rating under DC 5259. 38 C.F.R. § 4.71a, DC 5259. Under DC 5262, malunion of the tibia and fibula with slight knee or ankle disability warrants a 10 percent rating; moderate knee or ankle disability warrants a 20 percent rating; and marked knee or ankle disability warrants a 30 percent rating. A 40 percent rating is warranted for nonunion of the tibia and fibula with a loose motion that requires a brace. 38 C.F.R. § 4.71a, DC 5262. For disabilities evaluated based on limitation of motion, VA must apply the provisions of sections 4.40 and 4.45 on functional impairment. 38 C.F.R. §§ 4.40, 4.45. When applying these regulations, the VA must obtain examinations in which the examiner determined whether the disability manifests through weakened movement, excess fatigability, incoordination, or pain. Such inquiry is not to be limited to muscles or nerves. The examiner, if possible, should express these determinations in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, or pain during flare-ups and after repetitive use over time. See Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011); DeLuca v. Brown, 8 Vet. App. 202, 208 (1995); 38 C.F.R. § 4.59. Notably, 38 C.F.R. § 4.59, entitled “Painful motion,” states, in pertinent part, “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.” The scope of § 4.59 is not limited to arthritis claims. Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one disorder is not duplicative of the symptomatology of the other disorder. 38 C.F.R. § 4.14; Esteban, 6 Vet. App. at 262. For example, a claimant who has arthritis and instability of the knee may be rated separately under DCs 5003 and 5257, but separate ratings require separate compensable symptomatology. VAOPGCPREC 9-98, 63 Fed. Reg. 56,704 (Oct. 22, 1998); VAOPGCPREC 23-9, 62 Fed. Reg. 63,604 (Dec. 1, 1997); see also Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). The record demonstrates a diagnosis of bilateral status-post arthroscopy, bilateral chronic knee pain, status-post total right knee replacement, and left knee degenerative joint disease. An October 1985 VA examiner diagnosed arthralgia in both knees and found flexion of both knees limited to 150 degrees. 10/04/1985, VA Examination. A December 1994 private treatment note states the Veteran’s left knee started to hurt a lot that morning, and he could not straighten his leg out. The note did not specify the degree of the limitation. On September 18, 1998, a private physician noted continuing bilateral knee pain and observed the right knee strain had marked effusion and meniscal laxity. See 05/07/2012, Medical Treatment Record (MTR)–Non-Government Facility (NGF). An April 2004 private treatment note contains a finding of right knee joint effusion, and records from February 2006 describe continuing pain in both knees with swelling in the right knee and stiffness and tenderness in the left knee. See MTR–Furnished by SSA. On December 22, 2011, the Veteran sought care after twisting his knee. A private physician noted complaints of left knee pain, swelling, knee locking, knee-buckling, tingling, numbness; the physician observed large left knee effusion, no swelling, minimal tenderness, no instability but noted the examination was not adequate due to the large effusion. 04/06/2012 VA 21-4142. A December 2011 MRI of the left knee showed moderate-to-large joint effusion, edema, a Baker’s cyst, arthritic changes, and a prominent tear to the anterior horn of the lateral meniscus. 12/29/2011, MTR–NGF. An August 2012 VA examination recorded right knee flexion limited to 130 degrees with no change after repetitions and left knee flexion limited to 100 degrees with limitation improved to 120 degrees after three repetitions. A left knee meniscal tear was noted, and the examiner found frequent episodes of joint effusion bilaterally. See 08/04/2012, VA Examination. In October 2015, the Veteran underwent a left knee arthroscopy, lateral meniscectomy right steroid injection. 11/12/2015, Third Party Correspondence. The Veteran’s private physician provided a November 2015 letter stating the Veteran’s left knee had a full extension, flexion limited to about 120 degrees, and some wear and tear under the patella, including meniscal tears. 12/09/2015, Correspondence. A June 2016 private evaluation of the Veteran’s right knee demonstrated a derangement of the posterior and anterior horn of the meniscus. In July 2016, the Veteran underwent a right knee arthroscopy. 07/22/2016, MTR–NGF. The Veteran’s private physician provided a July 2016 statement noting the Veteran has degenerative early arthritis and degenerative meniscal tears. 08/15/2016, MTR–NGF. An October 2016 VA examination notes the bilateral meniscal tear diagnosis. Range of motion testing demonstrated right knee flexion limited to 30 degrees, left knee flexion limited to 60 degrees, no additional loss after repetitive use testing nut pain significantly limited functional ability with repeated use over time. The Veteran reported pain, swelling, and stiffness with use over time, but the examiner did not observe this during the examination. Based on the Veteran’s reports of pain, stiffness, and pain significantly limiting functional ability during flare-ups, the examiner estimated at least a 5-degree decrease in the loss of range of motion during a flare-up. 10/10/2016, C&P Exam. In July 2017, the Veteran underwent a right total knee arthroplasty (TKA). 08/16/2017, MTR–NGF. In a May 2018 VA examination, the Veteran’s right knee flexion was limited to 120 degrees, and left knee flexion was limited to 120 degrees. After repetitive use, the Veteran’s right knee flexion was limited to 110 degrees, and left knee flexion was limited to 115 degrees. The residuals of the total right knee replacement included intermediate degrees of residual weakness, pain, or limitation of motion. 05/02/2018, C&P Exam. In March 2019, the Veteran underwent an arthroscopy of the left knee. 03/30/2019, CAPRI. VA treatment notes from April 2019 indicate evaluations and issuance of supportive brace for the treatment of the Veteran’s bilateral knee instability and pain. The Veteran complained of his left knee popping despite his use of a brace in August 2019. See 12/19/2019, CAPRI. An August 2019 VA examination determined right knee flexion was limited to 140 degrees and left knee flexion was limited to 90 degrees. The examiner observed pain, including with weight-bearing, but did not find that the pain caused functional loss. The Veteran did not participate in active range of motion testing; thus, the examiner was unable to say without mere speculation if pain, weakness, fatigability, or incoordination significantly limit functional ability with repeated use over a period. The examiner noted the Veteran’s regular brace use bilaterally. 08/26/2019, C&P Exam. The August 2019 VA examiner provided an addendum opinion in August 2020, reviewing a private orthopedic examination dated August 23, 2019, which recorded the Veteran’s left knee range of motion from 1 degree to 120 degrees. At the VA examination a few days later, the range of motion was from 0 degrees to 90 degrees. The VA examiner explained that the VA examination was conducted after the Veteran’s 3-hour car ride. This discrepancy would be considered a flare from the 3-hour car ride. However, the VA examination marked no flares as the Veteran reported a high level of pain all the time. 08/11/2020, C&P Exam. In December 2019, the Veteran requested his VA physician for new knee braces, as his were worn, and a sturdier cane. 12/19/2019, CAPRI. In April 2020, the Veteran reported balance changes, and that pain causes his right knee to buckle. 05/14/2020, MTR–NGF. The Veteran underwent a VA examination in August 2020. His right and left knee flexion were limited to 140 degrees. The pain was exhibited with flexion, extension, and weight-bearing. The Veteran was not examined immediately after repetitive use over time, but the examiner found the examination is medically consistent with the Veteran’s statements describing functional loss with repetitive use over time. Pain, weakness, and lack of endurance limit the Veteran’s functional ability with repeated use over a period significantly. With flare-ups, bilaterally, the examiner predicted flexion limited to 140 degrees after repetitive use and during flare-ups. 08/05/2020, C&P Exam. The August 2020 VA examiner found objective evidence bilaterally of crepitus, reduction of strength limited to active movement against some resistance, and a history of recurrent effusion as increased activity level causes swelling. The Veteran states that he had lumbar surgery in June 2020, which causes him to need a walker; he did use the walker before his lumbar surgery. The Veteran states that he needs a walker, in part for his lumbar pain and part for his knee pain. The Veteran has an antalgic gait because of his knee pain and uses a bilateral knee brace and a rolling walker. Both assistive devices are used for his bilateral knee pain. The bilateral knee conditions cause the Veteran to have limitations with prolonged standing and with walking, climbing, bending, and lifting. Id. The Veteran has no bilateral signs of atrophy, ankylosis, or a history of recurrent subluxation or lateral instability. Joint stability testing was performed and is negative for a finding of joint instability bilaterally. Anterior instability (Lachman test), posterior instability (Posterior drawer test), medial instability (valgus pressure applied to knee in extension and with 30 degrees of flexion), and lateral instability (varus pressure applied to knee in extension and with 30 degrees of flexion) were all normal bilaterally. Id. The August 2020 VA examiner found no current symptoms of right knee meniscus condition and no residuals of 2017 right knee total knee joint replacement or 2016 arthroscopy. The left knee had mild localized tenderness on palpation of the medial parapatellar. The examiner noted the Veteran has a left meniscal tear history and joint pain, joint swelling, and frequent episodes of his knee locking in hyper-extension. Id. 1. Right knee. The Veteran was initially assigned a 10 percent rating under DC 5260 for his right knee disability effective August 10, 1985; a temporary total evaluation was granted from June 20, 2016; a 20 percent rating was granted from September 1, 2016; a temporary total evaluation was granted under DC 5055 from July 19, 2017; and a 30 percent rating is effective as of September 1, 2018. a. Prior to September 19, 1998. The preponderance of the evidence is against a rating in excess of 10 percent for a right knee disability prior to September 18, 1998. The record contains no evidence of limitation of motion, more nearly approximating flexion limited to 30 degrees, ankylosis, subluxation, lateral instability, arthritis, or disorders of the semilunar cartilage, tibia, or fibula prior to September 18, 1998. The preponderance of the evidence is against the Veteran’s claim for a rating in excess of 10 percent for a right knee disability prior to September 18, 1998. In denying such a rating, the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. b. From September 19, 1998, to June 20, 2016. The competent and probative evidence is at least in equipoise as to whether from September 19, 1998, to June 20, 2016, the Veteran’s right knee meniscus disorder should be rated under 38 C.F.R. § 4.71a, DC 5258. A private physician note from September 18, 1998, reports right knee strain had marked effusion and meniscal laxity. Right knee joint effusion is also noted in medical records the Social Security Administration furnished and the August 2012 VA examination during this period. Under DCs 5260 and 5261, the Veteran’s right knee disability would be noncompensable from September 19, 1998, to June 20, 2016, because the extension was not typically limited, and flexion was at most limited to 130 degrees. Separate ratings are not warranted under DCs 5003, 5256, 5257, or 5262, as the weight of the competent and probative evidence is against finding arthritis, ankylosis, recurrent subluxation or lateral instability, or tibial or fibular impairment. The competent and probative evidence is at least in equipoise as to whether the Veteran’s right knee meniscus disorder manifests in frequent episodes of locking, pain, and effusion. As 20 percent is the highest schedular rating for dislocation of semilunar cartilage under DC 5258, there is no basis to award a higher evaluation. c. From September 1, 2016, to July 18, 2017. The preponderance of the evidence is against a rating in excess of 20 percent for a right knee disability under 38 C.F.R. § 4.71a, DC 5260 from September 1, 2016, to July 18, 2017. The Veteran’s lay reports of additional functional loss due to pain, swelling, and stiffness with use over time have been considered. However, even considering the Veteran’s lay reports of symptoms and noted functional loss, the degree of additional limitation would not result in limitation of motion, more nearly approximating flexion limited to 15 degrees. All diagnostic codes regarding the knee and leg have been considered. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban, 6 Vet. App. at 261-62; Lyles, 29 Vet. App. 107. A rating under DC 5259 would also be appropriate in this case. The Veteran had an arthroscopy in his right knee and continues to suffer functional loss. Under DC 5259, symptomatic removal of semilunar cartilage, which was partially done in the arthroscopy, warrants a 10 percent rating under DC 5259. 38 C.F.R. § 4.71a, DC 5259. However, because the Veteran has no other diagnosed knee disability contributing to the functional loss or other arthroscopy residuals, both diagnostic codes cannot be applied as it would result in pyramiding. See Esteban, 6 Vet. App. at 261-62; 38 C.F.R. § 4.14. Separate ratings are not warranted under DCs 5003, 5256, 5257, or 5262, as the weight of the competent and probative evidence is against finding arthritis, ankylosis, recurrent subluxation or lateral instability, or tibial or fibular impairment. The preponderance of the evidence is against the Veteran’s claim for a rating in excess of 20 percent for a right knee disability from September 1, 2016, to July 18, 2017. In denying such a rating, the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. d. As of September 1, 2018. The preponderance of the evidence is against a rating in excess of 30 percent for residuals of a right knee replacement under 38 C.F.R. § 4.71a, DC 5055 as of September 1, 2018. The Veteran’s lay reports of pain, instability, and buckling of the right knee have been considered. However, the weight of the competent and probative evidence is against finding the residuals of a right knee replacement as of September 1, 2018, result in ankylosis, limitation of extension, flexion limited to 15 degrees or less, tibia or fibula impairment, or severe painful motion or weakness. Stability testing conducted in the August 2020 VA examination revealed normal stability. The Veteran requires the use of a knee brace and a walker for his knee pain. The probative and competent evidence weighs against a finding of a rating in excess of 30 percent for the right knee disability. See 38 C.F.R. § 4.71a, DC 5055. A May 2018 VA examiner classified the Veteran’s disability as having intermediate degrees of weakness, pain, and limitation of motion rather than the severe painful motion or weakness considered by the 60 percent rating under DC 5055. The Veteran’s functionality supports this conclusion. VA examinations from August 2019 and August 2020 demonstrate flexion limited to 140 degrees and no limitation to the knee extension. The August 2020 VA examination noted a reduction of strength limited to the active movement against some resistance. Separate ratings are not warranted under DCs 5003, 5256, 5257, 5258, 5259, or 5262, as the weight of the competent and probative evidence is against finding arthritis, ankylosis, a current dislocated semilunar cartilage, symptomatic removal of semilunar cartilage, recurrent subluxation or lateral instability, or tibial or fibular impairment. The preponderance of the evidence is against the Veteran’s claim for a rating in excess of 30 percent for a right knee disability as of September 1, 2018. In denying such a rating, the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. All possibly applicable diagnostic codes have been considered in compliance with Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991), but the Veteran could not receive a higher disability rating for his right knee during this period based on the evidence. See 38 C.F.R. § 4.71a. 2. Left knee. The Veteran was initially assigned a 10 percent rating under DC 5260 for his left knee disability effective August 10, 1985; a temporary total evaluation was granted from October 2, 2015, to November 30, 2015, and the 10 percent rating resumed as of December 1, 2015. a. Prior to December 22, 2011. The preponderance of the evidence is against a rating in excess of 10 percent for a left knee disability prior to December 22, 2011. The record contains no evidence of limitation of motion more nearly approximating flexion limited to 30 degrees or less, ankylosis, subluxation, lateral instability, arthritis, or disorders of the semilunar cartilage, tibia, or fibula prior to December 22, 2011. The preponderance of the evidence is against the Veteran’s claim for a rating in excess of 10 percent for a left knee disability prior to December 22, 2011. In denying such a rating, the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. b. From December 22, 2011, to October 2, 2015. A review of the record demonstrates the criteria for a rating of 20 percent, but no higher, from December 22, 2011, to October 2, 2015, for a left knee meniscus disability are met. 38 C.F.R. § 4.71a, DC 5258. A separate rating of 10 percent, but no higher, from December 28, 2011, to October 2, 2015, for left knee arthritis are met. See 38 C.F.R. § 4.71a, DC 5003. The Veteran’s left knee disability progressed to a meniscus tear by December 22, 2011, and he experienced locking, pain, and effusion in his left knee. Under DC 5258, a 20 percent rating is warranted for dislocation of semilunar cartilage, which encompasses a meniscus tear, with frequent episodes of joint locking, pain, and effusion. 38 C.F.R. § 4.71a, DC 5258. As 20 percent is the highest schedular rating for dislocation of semilunar cartilage under DC 5258, there is no basis to award a higher evaluation from December 22, 2011, to October 2, 2015. A separate rating under DC 5003 is also warranted in this case. Left knee degenerative arthritis was diagnosed on December 28, 2011. Under DC 5003, a 10 percent evaluation is appropriate because the left knee is noncompensable under the applicable diagnostic codes; therefore, 38 C.F.R. § 4.59 allows consideration of functional loss for the joint due to painful motion to be rated to at the minimum compensable evaluation of 10 percent. Under DC 5260, the Veteran’s knee disability would be noncompensable because the extension is not typically limited, and the Veteran’s flexion was, at most, limited to 100 degrees. Under DC 5260, evaluations of 10 percent are only warranted for flexion limited to 31-45 degrees; thus, only in the instance that the flexion limitation had been limited to 45 degrees would a 10 percent evaluation have been warranted under DC 5260 from December 28, 2011, to October 2, 2015. c. From December 1, 2015 to April 9, 2019. A review of the evidence demonstrates a 10 percent evaluation is appropriate for the left knee disability from December 1, 2015, to April 9, 2019, because the left knee degenerative arthritis is noncompensable under the relevant diagnostic codes; therefore, 38 C.F.R. § 4.59 allows consideration of functional loss for the joint due to painful motion to be rated to at the minimum compensable evaluation of 10 percent. A separate rating under DC 5259 is also warranted in this case. In October 2015, the Veteran had a left knee arthroscopy and continued to have wear and tear under the patella, including meniscal tears and suffer from swelling and stiffness. Under DC 5259, symptomatic removal of semilunar cartilage, which was partially done in the arthroscopy, warrants a 10 percent rating under DC 5259. 38 C.F.R. § 4.71a, DC 5259. Separate ratings are not warranted under DCs 5256, 5257, or 5262, as the weight of the competent and probative evidence is against finding ankylosis, recurrent subluxation or lateral instability, or tibial or fibular impairment. Under DC 5260, the Veteran’s knee disability would be noncompensable because the extension is not typically limited, and the Veteran’s left knee flexion was at worst limited to 55 degrees based on lay reports of flare-ups in October 2016. Under DC 5260, evaluations of 10 percent are only warranted for flexion limited to 31-45 degrees; thus, only in the instance that the flexion limitation reached 45 degrees would a 10 percent evaluation have been warranted under DC 5260 for the appeals period. The preponderance of the evidence is against a rating in excess of 10 percent for left knee degenerative arthritis but is at least in equipoise as to whether a separate rating of 10 percent, but no higher, is warranted under DC 5259 for the left knee meniscal disorder from December 1, 2015, to April 9, 2019. As 10 percent is the highest schedular rating for the symptomatic removal of semilunar cartilage under DC 5259, there is no basis to award a higher evaluation. d. From April 10, 2019, to May 31, 2019. VA treatment records show that the Veteran underwent a left knee arthroscopy on April 10, 2019, which required the use of a knee immobilizer after the procedure. 12/19/2019, CAPRI. The Veteran is entitled to a one-month temporary rating of 100 percent under 38 C.F.R. § 4.30(a)(3). e. As of June 1, 2019. A review of the evidence demonstrates that a 10 percent evaluation is appropriate because the left knee degenerative arthritis is noncompensable under the applicable diagnostic codes; therefore, 38 C.F.R. § 4.59 allows consideration of functional loss for the joint due to painful motion to be rated to at the minimum compensable evaluation of 10 percent. A separate rating under DC 5259 is also warranted in this case. As of June 1, 2019, the Veteran continues to have meniscus disorder symptoms such as mild localized tenderness on palpation of the medial parapatellar. Under DC 5259, symptomatic removal of semilunar cartilage, which was partially done in the arthroscopy, warrants a 10 percent rating under DC 5259. 38 C.F.R. § 4.71a, DC 5259. A rating under DC 5257 is not warranted. The Veteran’s lay reports of pain and balance changes have been considered. However, the weight of the competent and probative evidence is against finding the left knee disability manifests in symptoms of instability. Stability testing conducted in the August 2020 VA examination was negative for subluxation or lateral instability and revealed knee pain to be the reason the Veteran requires a knee brace and a walker. Separate ratings are not warranted under DCs 5256 or 5262, as the weight of the competent and probative evidence is against finding ankylosis or a tibial or fibular impairment. Under DC 5260, the Veteran’s knee disability would be noncompensable because the extension is not typically limited, and the Veteran’s left knee flexion was at worst limited to 90 degrees as of June 1, 2019. Under DC 5260, evaluations of 10 percent are only warranted for flexion limited to 31-45 degrees; thus, only in the instance that the flexion limitation reached 45 degrees would a 10 percent evaluation have been warranted under DC 5260 for the appeals period. The preponderance of the evidence is against a rating in excess of 10 percent for left knee degenerative arthritis but is at least in equipoise as to whether a separate rating of 10 percent, but no higher, is warranted under DC 5259 for the left knee meniscal disorder as of June 1, 2019. As 10 percent is the highest schedular rating for the symptomatic removal of semilunar cartilage under DC 5259, there is no basis to award a higher evaluation. All possibly applicable diagnostic codes have been considered in compliance with Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991), but the Veteran could not receive a higher disability rating for his left knee as of June 1, 2019, based on the evidence. See 38 C.F.R. § 4.71a. REASONS FOR REMAND The Board deems TDIU to be a component of the claim for an increased rating for the bilateral knee disability. See Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). A December 2019 VA Form 21-8940, Application for Increased Compensation Based on Unemployability, raised the TDIU issue. The Board will remand the TDIU claim for appropriate development. The matters are REMANDED for the following action: Complete any necessary development, and send appropriate notice to the Veteran regarding TDIU, advising the Veteran of the necessity of notifying the RO of his employment history and educational background for proper adjudication of this claim. JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Costa, 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.