Citation Nr: 21007450 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 11-19 370 DATE: February 9, 2021 ORDER Entitlement to an initial disability evaluation in excess of 10 percent prior to September 28, 2020 and an increased evaluation in excess of 20 percent thereafter for lumbar-spine disorder is denied. Entitlement to and increased disability evaluation in excess of 10 percent for right-knee disorder is denied. Entitlement to and increased disability evaluation in excess of 10 percent for left-knee disorder is denied. FINDINGS OF FACT 1. The objective medical evidence shows at no time during the appeal period did lumbar-spine disorder more closely approximate forward flexion of the thoracolumbar spine of 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine, unfavorable ankylosis of the entire thoracolumbar spine, or unfavorable ankylosis of the entire spine. Prior to September 28, 2020, findings revealed back flexion from 75-90 degrees, without significant limitation of extension. 2. The objective medical evidence shows at no time during the appeal period did right-knee disorder more closely approximate flexion limited to less than 45 degrees or less; right-knee subluxation or lateral instability; ankylosis; dislocation of semilunar cartilage with frequent episodes of “locking,” pain and effusion into the joint; extension limited to more than 10 degrees; removal of semilunar cartilage; malunion of the tibia and fibula with any knee or ankle disability; or a reverse or backward-bending knee joint indicating genu recurvatum. 3. The objective medical evidence shows at no time during the appeal period did left-knee disorder more closely approximate flexion limited to less than 45 degrees or less; left-knee subluxation or lateral instability; ankylosis; dislocation of semilunar cartilage with frequent episodes of “locking,” pain and effusion into the joint; extension limited to more than 10 degrees; removal of semilunar cartilage; malunion of the tibia and fibula with any knee or ankle disability; or a reverse or backward-bending knee joint indicating genu recurvatum. CONCLUSIONS OF LAW 1. The criteria for an initial disability evaluation in excess of 10 percent prior to September 28, 2020 and an increased evaluation in excess of 20 percent thereafter for lumbar-spine disorder have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5237 (2019). 2. The criteria for an initial disability evaluation in excess of 10 percent right-knee disorder have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.71a Diagnostic Codes 5260, 5256, 5257, 5258, 5259, 5261, 5262, 5263 (2019). 3. The criteria for an initial disability evaluation in excess of 10 percent left-knee disorder have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.14, 4.40, 4.45, 4.59, 4.71a Diagnostic Codes 5260, 5256, 5257, 5258, 5259, 5261, 5262, 5263 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the United States Marine Corps from November 2005 to November 2009. In May 2015, the Veteran testified at a video conference hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. The Board notes here that its May 2020 Remand included the remand of the claim for lumbar-spine disorder, to include right-lower-extremity radiculopathy and left-lower-extremity radiculopathy, for a VA examination and opinion for resolution of conflicting medical evidence and whether the medical evidence as a whole supports separate disability evaluations for the radiculopathy claims. After the VA examination was conducted, a November 2020 rating decision granted service connection for right-lower-extremity radiculopathy and left-lower-extremity radiculopathy effective November 8, 2009. There has been no disagreement with that action and the matter is not currently before the Board. Increased Schedular Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (rating schedule), found in 38 C.F.R. Part 4. When a reasonable doubt arises regarding the degree of disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. 38 C.F.R. § 4.7 (2019). 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; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Additionally, it is possible for a veteran to be awarded separate percentage evaluations for separate periods (staged ratings), based on the facts. See Fenderson v. West, 12 Vet. App. 119, 126–27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). 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 (2012); 38 C.F.R. § 4.1 (2018). 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; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). 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). Where an increase in the disability rating is at issue, the present level of the veteran’s disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, the relevant overall temporal focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. Hart v. Mansfield, 21 Vet. App. 505 (2007). 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 condition is not duplicative of or overlapping with the symptomatology of the other condition. 38 C.F.R. § 4.14 (2019). When evaluating musculoskeletal disabilities, VA may, in addition to applying the schedular criteria, assign a higher disability rating when the evidence demonstrates functional loss due to limited or excessive movement, pain, weakness, excessive fatigability, or incoordination, to include during flare-ups and with repeated use, if those factors are not considered in the rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; see also DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1995); Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). Nonetheless, a disability rating higher than the minimum compensable rating is not assignable under any diagnostic code relating to range of motion where pain does not cause a compensable functional loss. Rather, the “pain must affect some aspect of ‘the normal working movements of the body’ such as ‘excursion, strength, speed, coordination, and endurance,’” as defined in 38 C.F.R. § 4.40, before a higher rating may be assigned. See Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011) (noting that while “pain may cause a functional loss, pain itself does not constitute a functional loss,” and, is therefore, not grounds for entitlement to a higher disability rating). Additionally, the intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. Thus, with or without degenerative arthritis, actually painful, unstable or malaligned joints, due to a healed injury, are recognized as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59; see also Burton v. Shinseki at 5 (holding that the provisions of 38 C.F.R. § 4.59 are not limited to disabilities involving arthritis). 1. Entitlement to an initial disability evaluation in excess of 10 percent prior to September 28, 2020 and an increased evaluation in excess of 20 percent thereafter for lumbar-spine disorder is denied. Lumbar-spine disorder is evaluated under Diagnostic Code 5237, which in turn defers to the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula), under which a 10 percent rating is assigned when forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. 38 C.F.R. § 4.71a. A 20 percent rating is assigned for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Id. A 40 percent rating is assigned when forward flexion of the thoracolumbar spine of 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is assigned for unfavorable ankylosis of the entire spine. Id. Note (2) of the General Rating Formula provides that, for VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of motion of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Id. Although Note 4 of the General Rating Formula offers the choice of alternatively rating lumbar spine disorder under the Formula for Rating Intervertebral Disc Syndrome for whichever criteria of the two rating formulae provides a higher evaluation, the latter rating formula must be based on incapacitating episodes in the last 12 months, defined as a period of acute signs and symptoms due to intervertebral disc syndrome which requires bed rest prescribed by a physician and treatment by a physician. Turning to the record, a December 2009 rating decision granted service connection for lumbar-spine disorder at a 10 percent rating. VA received the Veteran’s Notice of Disagreement (NOD) with this decision on July 19, 2010, thereby beginning the appeal period. The Board’s consideration of the evidence starts in the period of one year before that date. A September 2009 VA examination for low-back disorder shows range of motion measurements of forward flexion at 75 degrees (90 degrees, normal) and extension at 26 degrees (30 degrees, normal ). The findings for repetitive use were the same. Adding together the measurements for the 4 other range of motion maneuvers (right-lateral flexion, left-lateral flexion, right-lateral rotation, and left-lateral rotation), the combined range of motion was at 217 degrees. The September 2009 VA examiner found pain is the major functional impact, but no incoordination. He found a normal gait, no muscle spasm, no tenderness, no guarding, no weakness, normal musculature, normal spinal curvature, normal symmetry of spinal motion, and no ankylosis. He diagnosed lumbar strain. In September 2012 private treatment notes, the Veteran reported he injured his back during active service when swimming at a North Carolina beach. Range of motion measurements show forward flexion of the spine was at 90 degrees without pain (normal). The treatment provider found extension induced pain, but gave no range of motion measurement. December 2014 VA physical therapy notes contain descriptions by the therapist of lumbar range of motion, but no goniometric measurements. For example, forward flexion was described as “fingertips to 3 [inches] past knee.” The Veteran submitted a May 2015 private Disability Benefits Questionnaire (DBQ) for thoracolumbar spine conditions, in which Dr. T.D. stated a May 2011 diagnosis of mechanical back pain syndrome. In this examination, the Veteran reported his lumbar-spine injury occurred in 2008 or 2009 when jumping from a tank. Range of motion measurements showed forward flexion, apparently in 3 successive maneuvers, at 75, 76 and 75 degrees. Extension was recorded at 25, 28 and 28 degrees. With the lowest of the above measurements combined with the 4 other range of motion measurements made that day, the combined total was 220 degrees. After repetitive use testing, forward flexion was at 75 degrees and extension at 30 degrees. The other range of motion measurements were the same as above. The combined measurement was 225 degrees. Dr. T.D. characterized the Veteran’s range of motion overall as “demonstrat[ing] normal motion [with] mild loss of forward flexion.” He noted the Veteran’s reports of mild pain with repeated forward bending. He further found no guarding or muscle spasm, a normal gait, normal spinal contour, no ankylosis, no intervertebral disc syndrome (IVDS), and available imaging studies did not document arthritis. In November 2015, the Veteran was afforded a VA examination for thoracolumbar spine conditions, in which the VA examiner stated September 2012 diagnoses of lumbar disc disease and lumbar foraminal stenosis. He noted the Veteran’s reports in this examination of having injured his back “after jumping up then coming down.” Range of motion measurements showed forward flexion at 0 to 80 degrees (90 degrees, normal) and extension at 0 to 25 degrees (30 degrees, normal). Combined with the 4 other range of motion measurements, the total was 250 degrees. The November 2015 VA examiner further found no objective evidence of localized tenderness or pain on palpation of the joints or associated soft tissue of the thoracolumbar spine, no guarding or muscle spasm of the thoracolumbar spine, no ankylosis, no IVDS, and no thoracic vertebral fracture with loss of 50 percent or more of height. He found available imaging studies documented arthritis. In the September 2020 VA examination for thoracolumbar spine conditions, the VA examiner stated 2009 through 2012 diagnoses of lumbosacral strain, degenerative arthritis of the spine and IVDS. Range of motion measurements show forward flexion at 0 to 60 degrees, extension at 0 to 20 degrees and, when combined with the 4 other range of motion measurements, the total was 200 degrees. The September 2020 VA examiner further found pain and lack of endurance significantly limit functional ability with both repeated use over a period of time and during flare-ups and she estimated the further decreased range of motion in both instances to be forward flexion at 0 to 55 degrees, extension at 0 to 15 degrees and when combined with the 4 other range of motion measurements, which she estimated would remained undiminished, the total was now 190 degrees. Although she found the Veteran has IVDS, she further found he had not had any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. She found no guarding or muscle spasm in the thoracolumbar spine, no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of the thoracolumbar spine, no thoracic vertebral fracture with loss of 50 percent or more of height, and no ankylosis. She found available imaging studies documented arthritis. The Board notes that, as set forth in each of the summaries for the above examinations, based on the Veteran’s own reports, functional loss due to relevant lumbar-spine symptoms was noted, as well as changes affecting normal working movements, which were sufficiently reviewed, included in the examination findings and considered in the assignment of the Veteran’s current disability evaluation, but they have not presented a basis for a higher evaluation. See 38 C.F.R. §§ 4.40, 4.45, 4.59; See DeLuca v. Brown, 8 Vet. App. at 204-07; Mitchell v. Shinseki, 25 Vet. App. at 37; Burton v. Shinseki, 25 Vet. App. at 5. In short, the 10 and 20 percent ratings in different periods provide for the effects of limitation of motion, whether due to pain on movement or restricted movement due to the orthopedic injury itself. Additionally, the Board has carefully considered the Veteran’s May 2015 Board hearing testimony. The Board is well aware that lay persons are competent to report on matters observed or within their personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Therefore, the Veteran is competent to provide statements of symptoms which are observable to his senses and there is no reason to doubt his credibility. However, the Veteran’s lay evidence must in turn be weighed against other evidence, as all relevant evidence of varying kinds must be considered. Although the Veteran reported in the statement accompanying his July 2020 NOD that back pain impairs his ability to perform work duties, the 10 percent evaluation prior to September 28, 2020 and the 20 percent evaluation thereafter are for limited motion, as stated above. Whether due to limitation by pain or orthopedic injury, the evaluations represent the impaired performance the Veteran reported. The Board therefore assigns more probative value to the 4 examination reports between September 2009 and September 2020, to include the Veteran’s own submission of Dr. T.D.’s May 2015 private DBQ, as they were conducted by medical professionals after objective examinations and assessments of the Veteran, they indicate review of the Veteran’s medical history and their orthopedic findings, for the reasons stated above, have exhibited undeniable consistency. See generally Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (noting that the central issue in assessing the adequacy of an opinion is whether the examiner was informed of the relevant facts in rendering a medical opinion). The summary of the record in the period prior to September 28, 2020, the date of the last VA examination, shows in 3 VA examinations at no time did forward flexion range of motion measurements fall below 60 degrees or below a combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Nor did any examiner find ankylosis of the spine of any kind. Without such findings in this period, the Veteran cannot attain a disability evaluation higher than the 10 percent assigned to him under the General Rating Formula. On examination in the September 2020 VA examination, the Veteran’s disorder had worsened to the point where forward flexion was no greater than 60 degrees. This finding alone warranted an increased rating to 20 percent. However, the September 2020 VA examiner found no ankylosis whatsoever and the record offers no further medical evidence showing such a finding, as required under the General Rating Formula, which would support any evaluation above 20 percent. For these reasons and based on the objective medical evidence, the Board finds the preponderance of the evidence is against a rating in excess of 10 percent prior to September 28, 2020 and a rating in excess of 20 percent thereafter. 2. Entitlement to and increased disability evaluation in excess of 10 percent for right-knee disorder. 3. Entitlement to and increased disability evaluation in excess of 10 percent for left-knee disorder. The December 2009 rating decision also granted service connection for right-knee disorder and left-knee disorder, each at a noncompensable disability evaluation. The NOD received by VA on July 19, 2010 began the appeal period and, as in the preceding section, the Board will consider evidence in the period of one year prior to that date. Both service-connected knee claims are rated under Diagnostic Code 5260, pertaining to limitation of motion, which provides a 10 percent rating when flexion is limited to 45 degrees. A 20 percent rating is warranted when flexion is limited to 30 degrees. A 30 percent rating will be assigned when flexion is limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Normal flexion is from 0 to 140 degrees. 38 C.F.R. § 4.71, Plate II. The Board will briefly note here that the current evaluations for each knee at 10 percent were directed to be assigned by the United States Court of Appeals for Veterans Claims (the Court) in its July 2018 Remand to the Board, because the record indicated painful limitation of motion and, as the intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability, actually painful, unstable or malaligned joints, due to a healed injury, with or without arthritis, are recognized as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. The question then is whether there is any basis demonstrated for further increase, other than that assigned for painful motion. The September 2009 VA examination for lumbar spine, summarized in the preceding section, also includes an examination of the knees, in which the VA examiner noted the Veteran’s reports of weakness, stiffness, swelling, and pain in the knee, as well as his knees “giv[ing] way and tenderness.” The Veteran further reported he has pain in the knee about once or twice a day, depending on physical activity, and lasting for about an hour, with pain severity being 8 out of 10. He added he can function with limitation of motion of the knee joints and also “moving around” induces pain. Range of motion measurements for the right knee show flexion at 140 degrees (normal) and left knee at 138 degrees. Both measurements were the same with repetitive use. Findings for extension were at “0,” being the reversed direction of the flexion measurements, indicating no limitation of motion and noted as normal on the examination report template. The September 2009 VA examiner found no pain, fatigue, weakness, lack of endurance, or incoordination in the knees after repetitive use. He further found no instability and no ankylosis. As it is, the above range of motion measurements for each knee are well beyond any limitation of motion measurements set forth under Diagnostic Code 5260. However, in order to afford the Veteran every possible opportunity to attain the highest evaluation allowed under the regulations, the Board will also look to related or analogous diagnostic codes pertaining to the knee to determine if a higher evaluation might be available under those codes. Therefore, Diagnostic Code 5256 provides ratings from 30 to 60 percent for varying degrees of ankylosis of the knee. Specifically, favorable ankylosis of the knee, in full extension or in slight flexion between 0 degrees and 10 degrees warrants a 30 percent disability rating; ankylosis in flexion between 10 degrees and 20 degrees warrants a 40 percent disability rating; ankylosis in flexion between 20 degrees and 45 degrees warrants a 50 percent disability rating; and extremely unfavorable ankylosis in flexion at an angle of 45 degrees or more warrants a 60 percent disability rating. 38 C.F.R. § 4.71a, Diagnostic Code 5256. However, the September 2009 VA examiner found there was no right or left-knee ankylosis. Diagnostic Code 5257 provides a 10 percent rating for slight recurrent subluxation (a partial dislocation) or lateral instability, a 20 percent rating with evidence of moderate recurrent subluxation or lateral instability and a 30 percent rating will be assigned with evidence of severe recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, Diagnostic Code 5257. The Board will note at this point that descriptive words, such as “moderate” and “severe,” as used in Diagnostic Code 5257, are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. The use of descriptive terminology by medical examiners, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision. 38 U.S.C. § 7104 (a); 38 C.F.R. §§ 4.2, 4.6. There has been no showing of surgery to the ligaments of either knee. However, the September 2009 VA examiner specifically stated he conducted collateral stability and cruciate stability tests, as well as further ligament rupture tests, each of which were “negative on both sides.” Under Diagnostic Code 5258, a sole 20 percent rating is warranted for dislocation of semilunar cartilage “with frequent episodes of ‘locking,’ pain and effusion into the joint.” Although the Veteran reported that he experienced left-knee swelling, the September 2009 VA examiner on examination found no edema and he made no finding of left or right-knee locking or “catching.” The highest rating under Diagnostic Code 5259 for being symptomatic for removal of semilunar cartilage is 10 percent and, as already stated above, as the Veteran at this time is already rated at 10 percent, this diagnostic code is not applicable, as an “extra” 10 percent added on for identical or similar symptoms is impermissible “pyramiding” of one diagnosis upon another. See 38 C.F.R. § 4.14. As it is, the September 2009 VA examiner made no finding of symptoms associated with removal of semilunar cartilage. Diagnostic Code 5261 provides a 10 percent rating when extension is limited to 10 degrees. A 20 percent rating is assigned when extension is limited to 15 degrees. A 30 percent rating is warranted where extension is limited to 20 degrees. A 40 percent rating will be assigned for limitation of extension of the leg to 30 degrees. A 50 percent rating is available for limitation of extension of the leg to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261. Normal extension is from 140 to 0 degrees. 38 C.F.R. § 4.71, Plate II. As stated above, the September 2009 VA examiner specifically found no limitation of motion in knee extension. No higher evaluation is available to the Veteran under this diagnostic code. Under Diagnostic Code 5262, a 10 percent rating is warranted for malunion of the tibia and fibula with slight knee or ankle disability. A 20 percent rating is warranted for malunion of the tibia and fibula with moderate knee or ankle disability. A 30 percent rating is warranted for malunion of the tibia and fibula with marked knee or ankle disability. A maximum 40 percent rating is warranted with nonunion of the tibia and fibula, with loose motion, requiring a brace. 38 C.F.R. § 4.71a, Diagnostic Code 5262. On examination, the September 2009 VA examiner made no findings of tibial or fibular impairment, with any nonunion with loss motion requiring a brace, or malunion of an ankle disability. Therefore, Diagnostic Code 5262, too, is not applicable. Diagnostic Code 5263 allows one evaluation at 10 percent for genu recurvatum, i.e., a reverse or backward-bending knee joint, “acquired, traumatic, with weakness and insecurity in weight-bearing objectively demonstrated.” As already stated, the Veteran at this time is already rated at 10 percent and the September 2009 VA examiner made no such finding. In a November 2015 VA examination for knee and lower-leg conditions, the VA examiner diagnosed patellofemoral pain syndrome for both knees. He noted the Veteran’s reports of pain after running, physical training and trying to drive a car, as well as worsening pain follows with running, squatting and sitting for a prolonged period of time. He described his functional loss as, “I don’t get to do hiking, bike riding, working out as much as I’d like to.” Range of motion measurements for both knees were flexion at 0 to 120 degrees (0 to 140 degrees, normal) and extension at 120 to 0 degrees (140 to 0 degrees, normal). For both knees, the November 2015 VA examiner found no loss of range of motion on repetitive use. (Diagnostic Code (DC) 5260). He further found no ankylosis in either knee (DC 5256) and no history of recurrent subluxation, no lateral instability and no recurrent patellar dislocation (DC 5256). He made no finding of “shin splints” (medial tibial stress syndrome), stress fractures, chronic exertional compartment syndrome, or any other tibial and/or fibular impairment (DC 5262), he found no current or past history of a meniscus (semilunar cartilage) condition (DC 5259) and he made no finding of genu recurvatum (DC 5263). Available imaging studies did not document arthritis. A September 2019 VA primary care note shows on general examination, the Veteran’s range of motion for the knees was found to be “normal,” with no range of motion measurements included. In the September 2020 VA examination for knee and lower-leg conditions, the VA examiner stated the 2009 diagnosis of patellofemoral pain syndrome for both knees, as well as her own diagnosis of degenerative arthritis for both knees. She noted the Veteran’s reports of worsening knee pain, popping, pain and stiffness in the knees with sitting, and leg-cramping during long periods of driving and air travel. Right-knee range of motion for flexion was 0 to 130 degrees and extension was 130 to 0 degrees, with no pain noted on examination. Left-knee flexion was 0 to 135 degrees and extension at 135 to 0 degrees. There were no changes with repetitive use testing. The September 2020 VA examiner found no ankylosis in either knee (DC 5256) and no history of recurrent subluxation, no lateral instability and no recurrent patellar dislocation (DC 5256). She made no finding of “shin splints” (medial tibial stress syndrome), stress fractures, chronic exertional compartment syndrome, or any other tibial and/or fibular impairment (DC 5262), she found no current or past history of a meniscus (semilunar cartilage) condition (DC 5259) and she made no finding of genu recurvatum (DC 5263). Available imaging studies documented arthritis in both knees. The Board once again notes, based on the Veteran’s own reports in the above examinations, functional loss due to relevant right and left-knee symptoms was noted, as well as changes affecting normal working movements, which were sufficiently reviewed, included in the examination findings and considered in the assignment of the Veteran’s current disability evaluation, but they have not presented a basis for a higher evaluation. See 38 C.F.R. §§ 4.40, 4.45, 4.59; See DeLuca v. Brown, 8 Vet. App. at 204-07; Mitchell v. Shinseki, 25 Vet. App. at 37; Burton v. Shinseki, 25 Vet. App. at 5. The 10 percent ratings for each knee provide for the effects of limitation of motion, due to the Veteran’s reported pain on movement. The Board has reviewed the Veteran’s testimony in the May 2015 Board hearing and his statement accompanying the July 2020 NOD. However, the Board first notes that at the time of the hearing, the Veteran had not yet received his current 10 percent rating for each knee due to painful limitation of motion. Moreover, although the Veteran reported his left-knee can be unstable after bicycle-riding and both knees “wobbly” after running and walking far, no findings of instability were made in the November 2015 VA examination, approximately 6 months after the hearing, as well as no examiner having made such a finding throughout the appeal period. As already stated, the Veteran is competent to reported what he feels and observes, but without medical education, training and clinical experience, he is not competent to distinguish various orthopedic disorder symptoms. The Board has further noted in the July 2020 NOD that the Veteran states his knees impair his ability to perform normal work duties. However, as already stated, the current evaluation for painful limitation of motion included consideration of such limitation of motion which would affect the movements expected in the ordinary performance of tasks and duties when employed. The Board again assigns more probative value to the 3 examination reports between September 2009 and September 2020, as they were conducted by medical professionals after objective examinations and assessments of the Veteran, they indicate review of the Veteran’s medical history and their orthopedic findings are consistent. The foregoing summary of the record of examination does not show any finding throughout the appeal period which warrants a disability evaluation higher than the current evaluation of 10 percent. The Board has reviewed and considered the findings of 3 VA examinations over the course of the appeal period and looked to the criteria of not just the assigned Diagnostic Code 5260, but to the criteria of 7 additional related or analogous diagnostic codes for knee disorders for any possibility of an applicable higher disability evaluation. Nonetheless, the findings on examination do not satisfy the numerous and varied evaluative criteria in Diagnostic Codes 5256 through 5263. For these reasons and based on the objective medical evidence, the Board finds the preponderance of the evidence does not support an increased disability evaluation in excess of 10 percent for right or left-knee disorders. The Board has considered the benefit-of-the-doubt doctrine; however, the Board does not perceive an approximate balance of positive and negative evidence. As the preponderance of the evidence is against the claims, the doctrine is not applicable and the claims must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. MICHAEL D. LYON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P. Franke, 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.