Citation Nr: 21008513 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 17-37 128 DATE: February 17, 2021 ORDER Service connection for residuals of vasectomy is denied. Service connection for left foot toenail fungus is denied. Service connection for right toenail fungus is denied. Service connection for carpal tunnel syndrome of the left wrist is denied. Service connection for carpal tunnel syndrome of the right wrist is denied. Service connection for a left upper arm disability is denied. Service connection for a left elbow disability is denied. Service connection for a right elbow disability is denied. Prior to December 19, 2018, a separate 10 percent rating for service-connected right knee disability based on instability is granted, subject to the regulations governing the payment of monetary awards. Prior to December 19, 2018, an initial rating in excess of 10 percent for service-connected right knee disability based on limitation of motion is denied. From February 1, 2020, a rating in excess of 30 percent for service-connected right knee disability is denied. FINDINGS OF FACT 1. The most probative evidence of record demonstrates that the Veteran’s erectile dysfunction and urinary frequency are not related to his service, to include residuals of vasectomy. 2. The preponderance of the competent evidence of record is against finding that the Veteran has had left foot toenail fungus at any time during the pendency of the claim. 3. The preponderance of the competent evidence of record is against finding that the Veteran has had right foot toenail fungus at any time during the pendency of the claim. 4. The most probative evidence of record demonstrates that current carpal tunnel syndrome of the left wrist did not have its onset during service and is not otherwise related to service. 5. The most probative evidence of record demonstrates that current carpal tunnel syndrome of the right wrist did not have its onset during service and is not otherwise related to service. 6. The preponderance of the competent evidence of record is against finding that the Veteran has had a left upper arm disability at any time during the pendency of the claim. 7. The most probative evidence of record demonstrates that a current left elbow disability did not have its onset during service and is not otherwise related to service. 8. The most probative evidence of record demonstrates that a current right elbow disability did not have its onset during service and is not otherwise related to service. 9. Resolving reasonable doubt in his favor, for the period prior to December 19, 2018, the Veteran’s service-connected right knee disability was productive of no more than slight instability. 10. For the period prior to December 19, 2018, the Veteran’s service-connected right knee disability was manifested by limitation of flexion in excess of 45 degrees, even when considering additional functional loss; but not a meniscal condition, ankyloses, impairment of the tibia or fibula, genu recurvatum, or incapacitating exacerbations. 11. For the period beginning February 1, 2020, the Veteran’s service-connected right knee disability, status post right total knee replacement, has been manifested primarily by pain and range of motion from 0 degrees extension to 110 degrees flexion. CONCLUSIONS OF LAW 1. The criteria for service connection for residuals of vasectomy have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for left foot toenail fungus have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for right foot toenail fungus have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for carpal tunnel syndrome of the left wrist have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for carpal tunnel syndrome of the right wrist have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for a left upper arm disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. The criteria for service connection for a left elbow disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 8. The criteria for service connection for a right elbow disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 9. Prior to December 19, 2018, the criteria for a separate 10 percent rating for service-connected right knee disability based on instability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5257. 10. Prior to December 19, 2018, the criteria for a rating in excess of 10 percent for service-connected right knee disability based on limitation of motion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260. 11. For the period beginning February 1, 2020, the criteria for entitlement to a disability rating in excess of 30 percent for service-connected right knee disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5055. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1983 to May 1997. He testified at a Travel Board hearing before the undersigned in February 2020. These matters were before the Board in May 2020 when they were remanded for additional development. An additional issue of entitlement to service connection for a low back disability was remanded by the Board in May 2020. A November 2020 rating decision granted service connection for this disability. As this claim has been granted in full, it is no longer before the Board for appellate consideration. Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). Regulations also provide that service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303 (d). After considering all information including the lay and medical evidence of record in a case with respect to benefits under laws administered by the Secretary, when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be given to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. The benefit of the doubt rule is inapplicable when the evidence preponderates against the claim. Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). Residuals of Vasectomy The Veteran reports having erectile dysfunction (ED) and an overactive bladder that began after an in-service vasectomy and have continued since that time. See February 2020 hearing transcript. Service treatment records (STRs) show that the Veteran underwent a vasectomy in service, in 1991. Private treatment records dated in 2006 note a diagnosis of ED and records dated in 2008 note the Veteran’s complaints of urinary frequency and urgency. In a letter received in March 2020, the Veteran’s private physician, Dr. P.S.K., opined that the Veteran’s ED, bladder and prostate issues were secondary to his in-service vasectomy. No rationale for these opinions was provided and there is no indication that Dr. P.S.K. reviewed any records in forming the basis for these opinions. The Veteran was afforded a VA examination in October 2020. The examiner reviewed the claims file and noted the Veteran’s history of vasectomy in service, as well as current findings of erectile dysfunction and overactive bladder. The examiner reviewed the claims file and opined that Veteran’s voiding dysfunction (overactive bladder) was not related to any incident from his service, including his vasectomy, but rather was due to benign prostatic hypertrophy. The examiner noted that STRs showed the Veteran had recovered well from the in-service vasectomy, with no complications noted in his medical chart. Moreover, the examiner stated “it [was] well established” that vasectomy did not cause erectile dysfunction, bladder issues, or benign prostatic hypertrophy. The examiner further noted that the Veteran’s erectile dysfunction occurred several years after the vasectomy, and pointed out that if it were a complication of the vasectomy it would have occurred immediately after the procedure. Based on the aforementioned evidence, the Veteran is not shown to have any current residuals of vasectomy related to his active service. Weighing the evidence as to a medical nexus between the Veteran’s current erectile dysfunction and overactive bladder and his military service, the Board finds that the March 2020 private opinion supporting a nexus is of less probative value than the October 2020 VA examiner’s opinion that determined no relationship existed. The private examiner did not review the claims file, cite to the STRs, or provide a rationale for the conclusion that there was a relationship. The physician merely restated the Veteran’s contentions. Conversely, the VA opinion is based upon a complete review of the Veteran’s entire claims file and examination of the Veteran and supports its conclusions with an explanation for the rationale. The VA examiner also considered the Veteran’s stated contentions and the medical evidence of record. After considering evidence of record, the VA examiner opined that any current disability was less likely than not incurred in or caused by service, to include as a result of the vasectomy. As for the Veteran’s contentions, although he believes he has residuals from his in-service vasectomy, he is not competent to provide a nexus opinion regarding this issue. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body, anatomical relationships, and the ability to interpret complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the October 2020 VA examiner’s opinion. As the preponderance of the evidence is against the claim, it is denied. Left Toenail Fungus, Right Toenail Fungus, Left Upper Arm Disability The Veteran seeks service connection for left foot toenail fungus and right foot toenail fungus, which he maintains are related to wearing wet boots and socks in service. See February 2020 hearing transcript. He also seeks service connection for a left upper arm disability, which he contends was caused by heavy lifting in service. Id. The question for the Board is whether the Veteran has current disabilities that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that the Veteran does not have current diagnoses of left foot toenail fungus, right foot toenail fungus, or a left upper arm disability, and has not had such diagnoses at any time during the pendency of the claims. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). In this regard, the Veteran’s STRs show that he was treated in May 1996 for complaints of athlete’s foot on the bottom of the right small toe. He was prescribed an antifungal cream and instructed to return in a week if he had further symptoms. Subsequent STRs, including a February 1997 separation examination report, are silent for any further complaints, findings or treatment related to right foot toenail fungus. The Veteran’s STRs are also silent for complaints, findings, or treatment related to left foot toenail fungus, or a left upper arm disability. In September 2016, the Veteran submitted a claim seeking service connection for right foot toenail fungus and left foot toenail fungus. In July 2017, the Veteran submitted a claim seeking service connection for a left upper arm disability. The post-service medical evidence, including February 2017 VA skin, and elbow and forearm, examination reports, is silent for any findings of toenail fungus of either foot, or a left upper arm disability. In a letter received in March 2020, Dr. P.S.K. indicated that he had been treating the Veteran for right and left foot toe fungus, which he opined was a result of extended exposure to wet footwear in service. He further indicated that he had been treating the Veteran for left upper arm problems and opined that this disability was a result of the Veteran’s heavy lifting as a supply specialist in service. In June 2020, the Board obtained the Veteran’s treatment records from Dr. P.S.K. These records do not show any diagnoses of toenail fungus, or left upper arm disability. Moreover, the Veteran specifically denied any rash in May 2015 and April 2016 treatment records. Although the Veteran was treated for a right foot fungus in service, this skin disability resolved prior to his separation from service, as noted above. Post-service treatment records and examination reports are all silent for any diagnoses of any of these claimed disabilities, with the Veteran specifically denying having any rashes in May 2015 and April 2016 treatment records. Although Dr. P.S.K. stated in March 2020 that he had been treating the Veteran for right and left foot toe fungus, as well as a left upper arm problem, these statements are not supported by his treatment records. In conclusion, the Board finds that the weight of the competent and credible evidence establishes that the Veteran has not been shown to have right foot toenail fungus, left foot toenail fungus, or a left upper arm disability at any time during the period of the appeal. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Thus, the Board must conclude that the preponderance of the evidence is against the claims, the benefit-of-the-doubt rule does not apply, and the claims must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Ortiz, supra. Left and Right Carpal Tunnel Syndrome, Left and Right Elbow Disabilities The Veteran reports having had problems with his hands in service and thereafter, that were ultimately diagnosed as CTS. He also maintains that he has right and left elbow disabilities that were caused by heavy lifting in service. See February 2020 hearing transcript. VA treatment records show a current diagnosis of bilateral CTS. See VA treatment records dated in 2016. A July 2016 private treatment record also notes a diagnosis of right lateral epicondylitis and an October 2020 VA examination report shows diagnoses of right and left elbow strain. In a letter received in March 2020, the Veteran’s private physician, Dr. P.S.K., opined that the Veteran’s bilateral CTS was due to his military service, to include heavy lifting in his capacity as a supply specialist. No rationale for this opinion was provided and there is no indication that Dr. P.S.K. reviewed any records in forming the basis for this opinion. Dr. P.S.K. further opined that the Veteran’s elbow disabilities were related to his military service; no diagnosis was provided and no rationale for the opinion was noted. An October 2020 VA Peripheral Nerves Conditions Disability Benefits Questionnaire (DBQ) notes current findings of bilateral carpal tunnel syndrome and the Veteran’s contentions that heavy lifting in service caused his disability. The examiner reviewed the claims file and opined that Veteran’s bilateral carpal tunnel syndrome was not related to any incident from his service. The examiner explained for rationale that there were no STRs showing any complaint, diagnosis or treatment related to carpal tunnel syndrome or any other hand issues. An October 2020 VA Elbow and Forearm DBQ notes current findings of right and left elbow strain and the Veteran’s contentions that heavy lifting in service caused his disability. The examiner reviewed the claims file and opined that Veteran’s elbow disabilities were not related to any incident from his service. The examiner explained for rationale that there were no STRs showing any complaint, diagnosis or treatment related to elbow disabilities. Based on the aforementioned evidence, the Veteran is not shown to have carpal tunnel syndrome of either wrist or a disability of either elbow during his period of active service. Weighing the evidence as to a medical nexus between the Veteran’s current carpal tunnel syndrome and his military service, as well as between the Veteran’s right and left elbow disabilities and his military service, the Board finds that the March 2020 private opinion supporting a nexus is of less probative value than the October 2020 VA examiner’s opinions that determined no relationship existed. The private examiner did not review the claims file, cite to the STRs, or provide a rationale for the conclusions that there is a relationship. The physician merely restated the Veteran’s contentions. Conversely, the VA opinions are based upon a complete review of the Veteran’s entire claims file and examination of the Veteran and supports their conclusions with an explanation for the rationale. The VA examiners also considered the Veteran’s stated contentions and the medical evidence of record. After considering evidence of record, the VA examiner opined that any current disability was less likely than not incurred in or caused by service. As for the Veteran’s contentions, although he believes he bilateral CTS and elbow problems related to his service, he is not competent to provide a nexus opinion regarding this issue. The questions involved are medically complex and, thus, outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the October 2020 VA examiner’s opinions. As the preponderance of the evidence is against the claims, they are denied. Ratings for Right Knee Disability The Veteran was awarded service connection for right knee osteoarthritis, and appealed the initial rating assigned. He then underwent a total knee replacement in December 2018. His service-connected right knee disability is assigned the following disability ratings: 10 percent under Diagnostic Code 5260 from June 15, 2015, through December 18, 2018; 100 percent (temporary total rating) from December 19, 2018, through January 31, 2020; and 30 percent under Diagnostic Code 5055 beginning February 1, 2020. Disability evaluations are determined by application of the VA Schedule for Rating Disabilities, which is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Each disability must be viewed in relation to its history and there must be emphasis upon the limitation of activity imposed by the disabling condition. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the appellant working or seeking work. 38 C.F.R. § 4.2. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Where entitlement to compensation has been established and a higher initial disability rating is at issue, the level of disability at the time entitlement arose is of primary concern. Consideration must also be given to a longitudinal picture of the veteran’s disability to determine if the assignment of separate ratings for separate periods of time, a practice known as “staged” ratings, is warranted. See Fenderson v. West, 12 Vet. App. 119 (1999). Staged ratings are appropriate in any increased rating claim in which distinct time periods with different ratable symptoms can be identified. Hart v. Mansfield, 21 Vet. App. 505 (2007). Normal range of motion of the knee is from 0 degrees of extension (leg in straight line from hip to heel) to 140 degrees of flexion (leg bent with heel near posterior thigh). See 38 C.F.R. § 4.71a, Plate II. Functional loss contemplates the inability of the body to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance, and must be manifested by adequate evidence of disabling pathology, especially when it is due to pain. 38 C.F.R. § 4.40. Additionally, painful motion is an important factor of disability; and joints that are actually painful, unstable, or malaligned, due to healed injury, should be entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. Under 38 C.F.R. § 4.45, consideration must also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the United States Court of Appeals for Veterans Claims (Court) held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing “for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint.” In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. Under 38 C.F.R. § 4.71a, Diagnostic Code 5260, a noncompensable rating is warranted where knee flexion is limited to 60 degrees, a 10 percent rating is warranted where knee flexion is limited to 45 degrees, a 20 percent rating is warranted where knee flexion is limited to 30 degrees, and a 30 percent rating is warranted where knee flexion is limited to 15 degrees. Under 38 C.F.R. § 4.71a, Diagnostic Code 5261 a noncompensable rating is warranted where knee extension is limited to 5 degrees. A 10 percent rating is warranted where knee extension is limited to 10 degrees. A 20 percent rating is warranted where knee extension is limited to 15 degrees. A 30 percent rating is warranted where knee extension is limited to 20 degrees. A 40 percent rating is warranted where knee extension is limited to 30 degrees, and a 50 percent rating is warranted where knee extension is limited to 45 degrees. Under 38 C.F.R. § 4.71a, Diagnostic Code 5256, a 30 percent rating (and even higher ratings) is warranted for ankyloses of a knee in a favorable angle in full extension, or in slight flexion between 0 degrees and 10 degrees. Ankylosis is immobility and consolidation of a joint due to disease, injury, surgical procedure. Nix v. Brown, 4 Vet. App. 462, 465 (1993); and Shipwash v. Brown, 8 Vet. App. 218, 221 (1995). Diagnostic Code 5257 rates impairment resulting from other impairment of the knee, to include recurrent subluxation or lateral instability. A 10 percent rating is assigned with evidence of slight recurrent subluxation or lateral instability of a knee; 20 percent rating is assigned with evidence of moderate recurrent subluxation or lateral instability; and 30 percent rating is assigned with evidence of severe recurrent subluxation or lateral instability. Pursuant to 38 C.F.R. §§ 4.40 and 4.45, pain is inapplicable to ratings under Diagnostic Code 5257 because it is not predicated on loss of range of motion. See Johnson v. Brown, 9 Vet. App. 7, 11 (1996). Under 38 C.F.R. § 4.71a, Diagnostic Code 5258, a 20 percent rating is warranted for a dislocated semilunar cartilage with frequent episodes of “locking,” pain, and effusion into the knee joint. Under 38 C.F.R. § 4.71a, Diagnostic Code 5259, a 10 percent rating is warranted for symptomatic residuals of removal of a semilunar cartilage. Ratings under this Code require consideration of 38 C.F.R. §§ 4.40 and 4.45 because removal of a semilunar cartilage may result in complications producing loss of motion. VAOGCPREC 9-98. Finally, pursuant to Diagnostic Code 5055, prosthetic replacement of a knee joint is rated 100 percent for one year following implantation of the prosthesis. The one-year total rating commences after a one-month convalescent rating under 38 C.F.R. § 4.30. Thereafter, chronic residuals consisting of severe painful motion or weakness in the affected extremity warrant a 60 percent rating. Intermediate degrees of residual weakness, pain, or limitation of motion are rated by analogy to Diagnostic Codes 5256, 5260, 5261, or 5262. The minimum rating following replacement of a knee joint is 30 percent. 38 C.F.R. § 4.71a, Diagnostic Code 5055. Prior to December 19, 2018 For the initial rating period from June 15, 2015, through December 18, 2018, the Veteran is in receipt of a 10 percent rating for his right knee disability under Diagnostic Code 5260 for limitation of flexion. A September 2015 VA Knee and Lower Leg Conditions DBQ notes the Veteran’s complaints of right knee stiffness, soreness, pain and locking. He said he was unable to sit, stand, or walk for prolonged periods of time. He denied flare-ups. Range of motion was from 0 degrees extension to 80 degrees flexion. Pain was noted on weight bearing. The Veteran was able to complete repetitive use testing; no additional functional loss was shown. Muscle strength was 5/5 and there was no muscle atrophy. Anterior, posterior, medial and lateral instability (all +1) was shown on examination. A September 2016 VA treatment record shows right knee osteoarthritis, with normal range of motion and no instability on examination, but the Veteran noted he had instability with overuse of the joint. A March 2017 VA treatment record shows right knee range of motion from 0 degrees extension to 120 degrees flexion with mild pain and crepitus. There was no swelling, redness, atrophy, or ligamentous laxity shown. A June 2017 VA Knee and Lower Leg DBQ notes the Veteran’s history of right knee osteoarthritis. On examination, range of motion of the right knee was from 0 degrees extension to 130 degrees flexion with pain and crepitus. The Veteran was able to complete repetitive use testing; no additional functional loss was shown. Muscle strength was 5/5 and there was no muscle atrophy. There was no ankylosis. There was no instability on examination. The examiner noted that there was pain on passive range of motion testing and nonweight-bearing testing of the right knee. The Veteran reported using a knee brace. In a July 2017 notice of disagreement, the Veteran reported that his right knee was very unstable, very painful and always swollen. He used a hinged brace and pain medication. After reviewing the record for this period, the Board concludes that the Veteran is entitled to a separate 10 percent rating under Diagnostic Code 5257 for instability. In this regard, the Board notes that the Veteran consistently reported episodes of instability during this period. Although instability was not found on the VA examination in 2017, it was noted in 2015. Moreover, the Veteran wore a brace on his knee regularly. The Board finds that these symptoms approximate slight recurrent subluxation or lateral instability, and a separate 10 percent rating is warranted for the period prior to December 19, 2018. The Board has considered a higher rating for the Veteran’s right knee instability; however, the competent evidence of record does not show his right knee instability approximated a degree of severity higher than slight for this period. As noted above, stability testing was shown to be normal without any objective evidence of laxity or instability on testing, except for one occasion. Thus, a separate 10 percent rating, but no higher, for right knee instability is warranted, for the period of the appeal prior to December 19, 2018. However, the Board finds that a rating in excess of 10 percent would not be warranted under Diagnostic Code 5260 because while the Veteran has repeatedly complained of chronic knee pain, the limitation of motion findings for flexion recorded in the VA examinations (80 degrees and 130 degrees) and VA treatment records (120 degrees) do not meet the requirements for the next higher rating under Diagnostic Code 5260 (limitation to 30 degrees), even considering related functional impairment. In addition, the Board has considered whether a separate rating is warranted for limitation of extension under Diagnostic Code 5261. As noted above, however, there are no findings that would warrant a separate rating for limitation of extension. For the above reasons, for the period of the appeal prior to December 19, 2018, a separate 10 percent rating under Diagnostic Code 5257 is warranted; and a rating higher than 10 percent under Diagnostic Code 5260 is not warranted. A preponderance of the evidence is against the assignment of any further higher or separate ratings; hence, the benefit of the doubt doctrine is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3, 4.7. From February 1, 2020 Since February 1, 2020, the Veteran’s service-connected right knee disability, status post-total knee replacement, has been rated 30 percent disabling under Diagnostic Code 5055. An October 2020 VA Knee and Lower Leg Conditions DBQ notes that range of motion was 0 degrees extension to 85 degrees flexion with pain, to include on weight bearing. The Veteran was able to complete repetitive use testing; this did not cause additional functional loss. Muscle strength was full with no atrophy. There was no ankylosis, joint instability, or recurrent dislocation. The Veteran reported effusion on a weekly basis. The examiner noted that there was no evidence of pain on nonweight bearing. In addition, the examiner opined that that the Veteran was unable to stand for long periods of time, walking long distances, easily climb steps, or carry heavy items. A November 2020 VA Knee notes the Veteran’s history of right knee replacement. Range of motion was 0 degrees extension to 110 degrees flexion with pain and lack of endurance, to include on weight bearing. The Veteran was able to complete repetitive use testing; this did not cause additional functional loss. The examiner opined that pain, weakness, fatigability, and incoordination did not significantly limit functional ability with repeated use over a period of time or with flare-ups. Muscle strength was full with no atrophy. There was no ankylosis, joint instability, or recurrent dislocation. The Veteran complained of daily flare-ups precipitated by prolonged standing, walking, driving sitting, climbing stairs, bending, and kneeling. The examiner stated that the Veteran had difficulty walking and standing, as well as with swelling in the knee. The examiner also characterized the residuals of the knee replacement as intermediate degrees of residual weakness, pain or limitation of motion in the right knee. (It was also noted that the left knee replacement residuals were more severe, characterized as chronic residuals with severe painful motion or weakness, and that the Veteran used a cane to walk.) Based on the November 2020 VA examination, the Veteran’s knee has been manifested by range of motion limited to no worse than 85 degrees of flexion with normal extension and pain on motion. The examiner did not describe chronic residuals consisting of severe painful motion or weakness such that a 60 percent rating is warranted under Diagnostic Code 5055. That code provides that a minimum rating of 30 percent will be assigned with a rating in excess of 30 percent based on residual weakness, pain, or limitation of motion rated by analogy to Diagnostic Codes 5256, 5260, 5261, or 5262. The Board has considered whether a higher disability evaluation is warranted on the basis of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45. See also DeLuca, 8 Vet. App. 202. (Continued on the next page)   Here, the Veteran is compensated by a compensable rating for his consistent reports of pain. However, additional compensation for functional loss is not warranted. Indeed, as discussed above, the Veteran has shown normal stability on the right knee, and muscle strength testing was also normal. While the Veteran used a cane, he also has a left knee disability which limits his walking. Therefore, even though it is acknowledged that there has been functional loss indicated on examination, including the Veteran’s limitations in walking, prolonged standing, and more, the Board finds such functional loss is adequately compensated by the 30 percent disability rating assigned for this period. Therefore, there is no demonstrated functional loss in which to assign a higher rating. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. R. Fletcher, 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.