Citation Nr: 21012208 Decision Date: 03/03/21 Archive Date: 03/03/21 DOCKET NO. 14-17 554 DATE: March 3, 2021 ORDER A rating in excess of 10 percent for left knee osteoarthritis prior to January 29, 2020, is denied. A rating in excess of 20 percent for left knee osteoarthritis since January 29, 2020, is denied. FINDINGS OF FACT 1. The Veteran had National Guard service from October 1971 to May 1992, with active service from February to July 1972 and November 1990 to April 1991. 2. Prior to January 29, 2020, a left knee disability was manifested by subjective complaints of pain and instability; objective findings included flexion, at worst, to 50 degrees, extension, at worst, to 0 degrees, no locking of the knee joint or semilunar cartilage condition, no surgery, and no medial tibial stress syndrome (MTSS). 3. Since January 29, 2020, a left knee disability has been manifested by subjective complaints of pain; objective findings include flexion, at worst, to 30 degrees, extension, at worst, to 0 degrees, but no surgery and no MTSS. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for left knee osteoarthritis prior to January 29, 2020, have not been met. 38 U.S.C. §§ 1110, 1131, 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.130, Diagnostic Codes (DCs) 5003-5260 (2020). 2. The criteria for a rating in excess of 20 percent for left knee osteoarthritis since January 29, 2020, have not been met. 38 U.S.C. §§ 1110, 1131, 1155, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.130, DCs 5003-5260 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. §§ 4.1. Separate diagnostic codes identify the various disabilities. The Veteran is in receipt of a 10 percent rating for a left knee disability prior to January 29, 2020, and a 20 percent rating for a left knee disability since January 29, 2020, under DCs 5003-5260. The applicable rating criteria for a left knee disability were revised effective February 7, 2021. The Board will designate the regulations in effect prior to the respective changes as the pre-amended regulations and the subsequent regulations as the amended regulations. The timing of this change requires the Board to first consider the claim under the appropriate pre-amended regulations for any period prior to the effective date of the amended diagnostic codes. Thereafter, the Board must analyze the evidence dated after the effective date of the new regulations and consider whether a rating higher than the previous rating is warranted. See VAOPGCPREC 7-2003; Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003).   In Excess of 10 Percent Prior to January 29, 2020 Under the pre-amended regulations, a 20 percent rating is warranted when the objective medical evidence shows: • moderate recurrent subluxation or lateral instability; • dislocated semilunar cartilage with frequent episodes of “locking,” pain, and effusion into the joint; • flexion of the leg limited to 30 degrees; • extension of the leg limited to 15 degrees; or • malunion of the tibia or fibula with moderate knee or ankle disability. Under the revised criteria, a 20 percent rating is warranted when the objective medical evidence shows: • a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: a brace, cane, or walker • dislocated semilunar cartilage with frequent episodes of “locking,” pain, and effusion into the joint; • one of the following: - sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation; or - unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation • flexion of the leg limited to 30 degrees; • extension of the leg limited to 15 degrees; or • MTSS, or shin splints requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment, one lower extremity. Turning to the medical evidence, while the Veteran reported locking of the left knee, there is no evidence of a semilunar cartilage condition. Specifically, in an October 2010 clinical record, there was no evidence of left knee effusion or dislocation. Further, in a September 2011 clinical record, the examiner wrote that the Veteran complained of recurrent episodes of locking of the left kneel; however, a semilunar cartilage condition was not noted. In addition, in a September 2012 VA examination, he complained of frequent knee buckling during ambulation; however, there was no evidence of a semilunar cartilage condition. In a January 2019 VA examination, the Veteran reported flareups of left knee pain during prolonged walking and standing. While effusion was noted, there was no evidence of a semilunar cartilage condition. As to flexion, it is not limited to 30 degrees. Specifically, in an October 2012 clinical record, it was reported to 150 degrees. Further, in a September 2012 VA examination, it was reported to 140 degrees with painful motion at 105 degrees. In addition, in a January 2019 VA examination, it was limited to 50 degrees. As to extension, it has not been limited to 15 degrees. Specifically, in September 2012 and January 2019 VA examinations, it was reported to 0 degrees (anatomically normal). Further, there is no evidence of tibial or fibular impairment, MTSS, or shin splints. Specifically, in September 2012 and January 2019 VA examinations, tibial or fibular impairment, MTSS, and/or shin splints were not shown. While the Veteran has reported using a knee brace and crutches, there is no evidence of a left knee sprain or ligament tear. Specifically, in March 2012 and September VA examinations, he reported regular use of a knee brace; however, a left knee sprain or ligament tear was not noted. Further, in a December 2013 clinical record, the Veteran stated that he walked with two crutches; however, a left knee sprain or ligament tear was not noted. In addition, in a January 2019 VA examination, he reported constant use of a crutch and brace; however, a left knee sprain or ligament tear was not noted. Further, while the Veteran has been diagnosed with a condition involving the patellofemoral complex, specifically left knee osteoarthritis, and has reported use of a knee brace, there is no evidence that this disability required surgery, as is needed for a higher rating under the revised criteria. Specifically, the medical evidence is absent of reports of left knee surgery. In addition, while the Veteran reported left knee instability on multiple occasions, recurrent subluxation and lateral instability have not been shown on examination. Specifically, in an October 2010 clinical record, he complained of left knee instability; however, upon examination, there was no evidence of swelling, redness, heat tenderness, or decreased mobility. Further, in a January 2011 VA examination, he complained of left knee instability; however, upon examination, there was no evidence of swelling, effusion, tenderness, or laxity. In September 2012 and January 2019 VA examinations, there was no evidence of recurrent subluxation or lateral instability. Based on the above, the medical evidence does not support a rating in excess of 10 percent for a left knee disability prior to January 29, 2020. In this regard, the medical evidence shows flexion to be, at worst, 50 degrees, extension to be, at worst, 0 degrees, and no evidence of tibial or fibular impairment, MTSS, and/or shin splints. Further, while the Veteran has been diagnosed with a condition involving the patellofemoral complex and has reported using a knee brace and crutches, there is no evidence of a left knee sprain, ligament tear, or knee surgery. In addition, while he reported left knee instability, the medical evidence is absent of objective findings of recurrent subluxation or lateral instability. Finally, while the Veteran complained of the left knee locking, there was no evidence of a semilunar cartilage condition. Therefore, the medical evidence does not support a rating in excess of 10 percent for a left knee disability prior to January 29, 2020. In Excess of 20 Percent Since January 29, 2020 Under the pre-amended regulations, a 30 percent rating is warranted when the objective medical evidence shows: • ankylosis of the knee with favorable angle in full extension, or in slight flexion between 0 and 10 degrees; • severe recurrent subluxation or lateral instability; • flexion of the leg limited to 15 degrees; • extension of the leg limited to 20 degrees; or • malunion of the tibia or fibula with marked knee or ankle disability. Under the revised criteria, a 30 percent rating is warranted when the objective medical evidence shows: • ankylosis of the knee with favorable angle in full extension, or in slight flexion between 0 and 10 degrees; • unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation; • flexion of the leg limited to 15 degrees; • extension of the leg limited to 20 degrees; or • MTSS or shin splints requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment, both lower extremities. Turning to the medical evidence, ankylosis is not shown. Specifically, in a January 2020 VA examination, the Veteran complained of weekly knee pain and flareups that lasted all day. He reported that these flareups occurred after prolonged walking, sitting, and standing; however, upon examination, ankylosis was not noted. Next, the medical evidence does not show recurrent subluxation or lateral instability. Specifically, in a January 2020 VA examination, there was no evidence of recurrent subluxation or lateral instability. As to flexion, it has not been limited to 15 degrees. Specifically, in a January 2020 VA examination, it was reported to 50 degrees with functional loss at 30 degrees. As to extension, it has not been limited to 20 degrees. Specifically, in a January 2020 VA examination, it was reported to 0 degrees with functional loss at 0 degrees. Further, there is no evidence of tibial or fibular impairment, MTSS, or shin splints. Specifically, in a January 2020 VA examination, tibial or fibular impairment, MTSS, or shin splints were not shown. In addition, while the Veteran reported constant brace and crutch use, there was no evidence of an unrepaired or failed repair of a complete ligament tear. Specifically, in a January 2020 VA examination, the examiner marked that the Veteran used a brace and crutch; however, an unrepaired or failed repair of a complete ligament tear was not noted. Based on the above, the medical evidence does not support a rating in excess of 20 percent since January 29, 2020. In this regard, the medical evidence shows no ankylosis, recurrent subluxation, lateral instability, tibial or fibular impairment, MTSS, or shin splints. Further, flexion has been limited to be, at worst, 30 degrees, and extension has been limited to be, at worst, 0 degrees. In addition, while the Veteran reported constant brace and crutch use, there is no evidence of an unrepaired or failed repaired complete ligament tear. Clinical records do not contradict these findings. Therefore, the medical evidence does not support a rating in excess of 20 percent for a left knee disability since January 29, 2020. The Board has also considered the Veteran’s lay statements that his disability is worse. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of this disorder according to the appropriate diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran’s left knee disability has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings directly address the criteria under which a left knee disability is evaluated. Moreover, as the examiners have the requisite medical expertise to render medical opinions regarding the degree of impairment caused by a left knee disability and had sufficient facts and data on which to base the conclusion, the Board affords the medical opinions great probative value. As such, these records are more probative than the Veteran’s subjective complaints of increased symptomatology. In sum, after a careful review of the evidence of record, the benefit of the doubt rule is not applicable, and the appeals are denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board’s consideration. See Doucette v. Shulkin, 28. Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). L. HOWELL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Ragofsky, Attorney Advisor 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.