Citation Nr: 21012324 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 13-11 991 DATE: March 4, 2021 ORDER An evaluation in excess of 10 percent for painful limitation of motion of the left knee is denied. An evaluation in excess of 10 percent for painful limitation of motion of the right knee is denied. A separate 10 percent evaluation, but no higher, for instability of the left knee, for the period beginning on November 16, 2009, is granted. A separate compensable evaluation for instability of the right knee for the period prior to September 22, 2020, is denied. A separate 10 percent evaluation, but no higher, for instability of the right knee, for the period beginning on September 22, 2020, is granted. A separate 10 percent evaluation, but no higher, for a meniscus disability of the left knee for the period prior to December 27, 2015, is granted. A separate 20 percent evaluation for a meniscus disability of the left knee for the period beginning on December 28, 2015, is granted. A separate compensable evaluation for a meniscus disability of the right knee, for the period prior to April 5, 2018, is denied. A separate 20 percent evaluation for a meniscus disability of the right knee, beginning on April 5, 2018, is granted. FINDINGS OF FACT 1. The Veteran’s bilateral knees were evaluated as 10 percent disabling from July 1, 1995 through April 11, 2011, under Diagnostic Code 5257 for painful motion of her knees, not instability of her knee joints. 2. Throughout the appeal period, the Veteran’s left knee was demonstrable of painful motion with some loss of motion on flexion and extension, but she did not have limitation of extension to 10 degrees or more, or limitation of flexion to 45 degrees or less. 3. Throughout the appeal period, the Veteran’s right knee was demonstrable of painful motion with some loss of motion on flexion and extension, but she did not have limitation of extension to 10 degrees or more, or limitation of flexion to 45 degrees or less. 4. Throughout the appeal period, the Veteran’s left knee was shown to have symptomatology more closely approximate to slight instability manifested by buckling, giving way, etc., but not moderate lateral instability or recurrent subluxation. 5. For the period prior to September 22, 2020, the Veteran’s right knee is not shown to have recurrent subluxation or instability. 6. Beginning on September 22, 2020, the Veteran’s right knee was shown to have symptomatology more closely approximate to slight instability manifested by giving way and limping, but not moderate lateral instability or recurrent subluxation. 7. For the period prior to December 27, 2015, the Veteran’s left knee is shown to have a symptomatic meniscal disability manifested by stiffness and occasional swelling, although locking is not shown. 8. Beginning on December 28, 2015, the Veteran’s left knee was shown to have a meniscus disability with frequent episodes of locking and effusion/swelling. 9. For the period of prior to April 5, 2018, the Veteran’s right knee was not shown to have symptomatic residuals of a meniscus disability. 10. Beginning on April 5, 2018, the Veteran’s right knee was shown to have a meniscus disability with joint locking and effusion. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 10 percent for painful limitation of motion of the left knee throughout the appeal period are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1-4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5260, and 5261. 2. The criteria for an evaluation in excess of 10 percent for painful limitation motion of the right knee throughout the appeal period are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1-4.14, 4.40, 4.59, 4.71a, Diagnostic Codes 5003, 5260, and 5261. 3. The criteria for a 10 percent evaluation, but no higher, for instability of the left knee for the period beginning November 16, 2009, are met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5257. 4. The criteria for a compensable evaluation for instability of the right knee for the period prior to September 22, 2020 are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5257. 5. The criteria for a 10 percent evaluation, but no higher, for instability of the right knee for the period beginning on September 22, 2020, are met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5257. 6. The criteria for a 10 percent evaluation, but no higher, for a meniscus disability of the left knee for the period prior to December 27, 2015, are met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5259. 7. The criteria for a 20 percent evaluation for a meniscus disability of the left knee for the period beginning on December 28, 2015, are met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5258. 8. The criteria for a compensable evaluation for a meniscus disability of the right knee for the period prior to April 5, 2018, are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5258, 5259. 9. The criteria for a 20 percent evaluation for a meniscus disability of the right knee for the period beginning on April 5, 2018, are met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5258. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from June 1980 to June 1995. This matter comes to the Board of Veterans’ Appeals (Board) from an April 2011 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board in March 2015, November 2017, and October 2019, at which point the claim was remanded for additional development. The most recent VA examination was performed in September 2020 and adequately addresses the directives from the October 2019 Board remand. Accordingly, the Board finds that there has been substantial compliance with the most recent Board remand. See Stegall v. West, 11 Vet. App. 268 (1998). Disability evaluations are determined by the application of a schedule of ratings that 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. See 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. Where there is a question as to which of two separate evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that particular rating. 38 C.F.R. § 4.7. When a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective enervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.10, 4.40, 4.45; see also DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions of 38 C.F.R. § 4.14 (avoidance of pyramiding) do not forbid consideration of a higher rating based on greater limitation of motion due to pain on use, including during flareups. Where entitlement to compensation has already been established, and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, where the evidence contains factual findings that show a change in the severity of symptoms during the course of the rating period on appeal, assignment of staged ratings would be permissible. See Hart v. Mansfield, 21 Vet. App. 505 (2007). Regarding knee claims, a claimant who has arthritis and instability of the knee may be rated separately under Diagnostic Codes 5003, 5260, 5261, and 5257. See VAOPGCPREC 23-97. For example, when a knee disability is already rated under DC 5257 (addressing lateral instability), a separate rating may be warranted if the Veteran’s knee also shows limitation of motion that at least meets the criteria for a zero-percent rating under DC 5260 (flexion limited to 60 degrees or less) or 5261 (extension limited to 5 degrees or more). See VAOPGCPREC 09-04. Moreover, a separate rating could be warranted under 38 C.F.R. § 4.59, based on X-ray findings of arthritis with painful motion. In this case, the Veteran filed her claim for increased evaluation on November 16, 2009. Throughout the appeal period, the Veteran’s bilateral knees have been evaluated as 10 percent disabling under Diagnostic Code 5260. The Veteran has additionally been awarded a separate 10 percent evaluation for instability of the left knee since December 15, 2015, under Diagnostic Code 5257. The Board does acknowledge that the ratings criteria for the musculoskeletal system was updated during the appeal period, effective February 7, 2021; that new criteria will be address in a separate section below. Limitation of motion of the knee is contemplated in 38 C.F.R. § 4.71a, Diagnostic Codes 5260 and 5261. Normal range of knee motion is 140 degrees of flexion and zero degrees of extension. 38 C.F.R. § 4.71, Plate II. Diagnostic Code 5260 provides for a zero percent evaluation where flexion of the leg is only limited to 60 degrees. For a 10 percent evaluation, flexion must be limited to 45 degrees. A 20 percent evaluation is warranted where flexion is limited to 30 degrees. A 30 percent evaluation may be assigned where flexion is limited to 15 degrees. Diagnostic Code 5261 provides for a zero percent evaluation where extension of the leg is limited to five degrees. A 10 percent evaluation requires extension limited to 10 degrees. A 20 percent evaluation is warranted where extension is limited to 15 degrees. A 30 percent evaluation may be assigned where the evidence shows extension limited to 20 degrees. For a 40 percent evaluation, extension must be limited to 30 degrees. And finally, where extension is limited to 45 degrees a 50 percent evaluation may be assigned. Under 38 C.F.R. § 4.71a, Diagnostic Code 5257, a 10 percent rating is assigned when there is slight recurrent subluxation or lateral instability, a 20 percent rating when there is moderate recurrent subluxation or lateral instability, and a 30 percent evaluation for severe recurrent subluxation or lateral instability. Under 38 C.F.R. § 4.71a, Diagnostic Code 5258 provides for a 20 percent rating for a dislocated semilunar cartilage with frequent episodes of “locking,” pain, and effusion into the knee joint. 38 C.F.R. § 4.71a, Diagnostic Code 5259 provides for a maximum 10 percent rating for symptomatic residuals of removal of a semilunar cartilage. Factual Background Turning to the evidence, the Veteran was initially seen for a VA examination on September 22, 2010. At that time, the examiner provided a diagnosis of patellar femoral syndrome of the right knee and degenerative joint disease with remote lateral meniscus tear status post arthroscopic partial resection and debridement of the lateral meniscus of the left knee. With respect to her right knee, the Veteran indicated that she had pain with difficulty kneeling, using stairs, and standing or walking for prolonged periods. She denied having any swelling, locking, or giving way sensation. With respect to her left knee, the Veteran reported worsening pain with a buckling sensation when walking, stiffness, and occasional swelling. On initial range of motion testing, the Veteran’s right knee flexion was 0 to 119 degrees and her right knee extension was to normal. Her left knee flexion was 0 to 115 degrees and her left knee extension was normal. The examiner documented pain on flexion of the bilateral knees. With respect to the left knee, there was no evidence of crepitus, instability, or other abnormality on examination. With respect to the right knee, there was evidence of crepitus, but no evidence of effusion, instability, or other abnormality on examination. The Veteran did not present with ankylosis and the examiner made no mention of an impairment of the tibia or fibula or genu recurvatum. The examiner noted an August 1995 radiological report showing a spur formation of the left knee, but otherwise the bilateral knees were unremarkable. This examination did not provide an estimate of additional loss of range of motion due to flareups or with repeated use over time. The Veteran was next seen for a VA examination on December 28, 2015. At that time, the examiner provided a diagnosis of patellofemoral pain syndrome and degenerative arthritis of the right knee and degenerative joint disease with patellar tendinosis status post multiple arthroscopic surgeries of the left knee. The examiner noted that the Veteran reported pain in both knees with difficulty bending or stooping and flareups with prolonged standing or walking. The Veteran also reported intermittent buckling of her left knee and denied buckling or unsteadiness in the right knee. On initial range of motion testing, the Veteran’s right knee flexion was 0 to 110 degrees and her right knee extension was 110 to 0 degrees. Her left knee flexion was 0 to 90 degrees and her left knee extension was 90 to 0 degrees. Pain on flexion was noted of the bilateral knees. The examiner noted that abnormal range of motion, fatigue, and pain with range of motion testing of both knees, as well as weakness of the left knee, contributed to functional loss. The examiner also noted the presence of pain with weightbearing in the knees bilaterally and crepitus of the left knee. Muscle strength testing was normal bilaterally. Joint stability testing that was performed on the left knee showed anterior instability of 1+ (0-5 millimeters). The Veteran did not present with ankylosis, an impairment of the tibia or fibula, or genu recurvatum. However, the examiner did note that the Veteran has a meniscus disability of the left knee with frequent episodes of joint pain and locking. The examiner also cited to a September 2012 radiological report showing mild tricompartmental arthritis of the right knee and a November 2003 radiological report showing mild proliferative and probably early degenerative changes of the left knee. The examiner concluded that there was no functional loss with repetitive testing, but she did conclude that pain and fatigue of the knees bilaterally and weakness of the left knee limit the Veteran’s functional ability during flareups. Despite these findings, the examiner indicated that she was unable to offer an opinion as to the estimate of additional loss of range of motion due to pain during flareups or repetitive use because the examination was not performed during a flareup and repetitive use testing was not performed. The Veteran was seen again for an April 5, 2018 VA examination. At that time, the VA examiner provided a diagnosis of bilateral patellofemoral syndrome of the right knee and degenerative joint disease of the left knee with patellar tendinosis status post multiple arthroscopic surgeries. The Veteran reported that she experiences pain and swelling in the knees bilaterally. She also reported that she experiences flareups two to three times a week from prolonged standing with painful joints and swelling. On initial range of motion testing, the Veteran’s right knee flexion was 0 to 85 degrees and her right knee extension was 85 to 0 degrees. Her left knee flexion was 0 to 75 degrees and her left knee extension was 75 to 0 degrees. Pain with flexion of the left knee was noted by the examiner. Additionally, the examiner noted that pain, fatigue, weakness, and lack of endurance with repeated use and during flareups contributes to functional loss of both knees. Nevertheless, the examiner indicated that she was unable to offer an opinion as to the estimate of additional loss of range of motion due to pain during flareups or repetitive use because the examination was not performed during a flareup and repetitive use testing was not performed. Muscle strength testing was normal bilaterally and all instability testing was normal bilaterally. The examiner indicated there was a history of patellar dislocation of the left knee, which affects the Veteran’s range of motion. The examiner also noted that the Veteran had a current meniscal tear of the right knee with joint locking, pain, and effusion and status post meniscectomy of the left knee with residual symptoms of joint pain and effusion. The examiner further noted that there is objective evidence of pain on passive range of motion testing and non-weightbearing testing of the bilateral knees. The Veteran did not complain of instability and the examiner noted that there was no joint instability on testing. The examiner also noted that there was no evidence of ankylosis, an impairment of the tibia or fibula, or genu recurvatum. Finally, the Veteran was seen for a September 22, 2020 VA examination for her bilateral knee conditions. The examiner provided diagnoses left knee degenerative joint disease with patellar tendonitis status post multiple arthroscopic surgeries and right knee patellofemoral syndrome. The Veteran reported pain and decreased strength in both knees. The Veteran also reported locking, giving way, and limping in the right knee. Additionally, the Veteran reported having severe flareups in both knees three times a week with throbbing pain, difficulty bending, and inability to get comfortable. On initial range of motion testing, the Veteran’s right knee flexion was 0 to 85 degrees and her right knee extension was 85 to 0 degrees. Her left knee flexion was 0 to 90 degrees and her left knee extension was 90 to 0 degrees. Pain was noted by the examiner with flexion of the bilateral knees. The examiner noted that pain with repeated use and during flareups contributes to functional loss of both knees. The examiner offered an opinion that pain from repeated use reduces the Veteran’s range of motion to 0 to 80 degrees on flexion and 80 to 0 degrees on extension for the left knee, and 0 to 75 degrees on flexion and 75 to 0 degrees on extension for the right knee. Muscle strength testing was decreased on flexion in the bilateral knees. The examiner further noted that there is objective evidence of pain on passive range of motion testing, weight bearing, and non-weightbearing testing of the bilateral knees. The examiner also indicated there was a history of meniscal tear and dislocation of the left knee with residual symptoms of difficulty standing or sitting for prolonged periods, using stairs, bending, and squatting. The examiner noted that there was no evidence of ankylosis, an impairment of the tibia or fibula, or genu recurvatum. Analysis for Increased Evaluation of Bilateral Knee Disabilities The Veteran’s claim for increased ratings was received on November 16, 2009. Therefore, the period for consideration on appeal began on November 16, 2008, one year prior to the date of receipt of her increased rating claim. 38 C.F.R. § 3.400(o)(2). Initially, the Board notes that the Veteran was evaluated as 10 percent disabling in both knees, beginning July 1, 1995. As noted in an August 1995 rating decision, the Veteran’s 10 percent evaluation was assigned at that time based on painful motion of the knees. The decision did not refer to recurrent subluxation or lateral instability. Nevertheless, the Veteran was assigned a 10 percent evaluation under Diagnostic Code 5257 rather than as analogous to Diagnostic Code 5003, 5010, 5260 or 5261. The Veteran continued to be rated under Diagnostic Code 5257 until April 19, 2011, when the assigned Diagnostic Code was changed to 5260 for limitation of motion. The Board acknowledges that the changing of a Diagnostic Code to a more appropriate Diagnostic Code can be warranted under some circumstances and does not necessarily result in a de facto reduction of disability rating. See Read v. Shinseki, 651 F.3d 1296 (Fed. Cir. 2011); Murray v. Shinseki, 24 Vet. App. 420 (2011). The Board finds that the change in diagnostic code from 5257 to 5260 was not improper in this case. In so finding, the Board has considered the Court’s and the United States Court of Appeals for the Federal Circuit’s (Federal Circuit) holdings in Murray v. Shinseki, 24 Vet. App. 420 (2011), and Read v. Shinseki, 651 F. 3d 1296 (Fed. Cir. 2011), respectively. The specific holding in Murray was that a change of diagnostic code from 5257 to 5010 based on evidence that there was knee arthritis but no evidence of what had previously been rated as knee laxity, when the rating under 5257 had been in effect for over 20 years (and thus was protected pursuant to 38 C.F.R. § 3.951), “effectively reduced [claimant Murray’s] protected disability rating to 0% and assigned a new, separate 10% disability rating” for arthritis. According to the holding in Murray, such a reduction warranted reversal. In Read, the Federal Circuit identified the issue on appeal as whether service connection for a disability protected under 38 U.S.C. § 1159 is severed when VA assigns to an injury a different Diagnostic Code than originally noted. In reaching its conclusion that the protected disability is not severed, the Federal Circuit considered the rationale behind 38 U.S.C. § 1159, as well as other relevant statutory definitions, and determined that 38 U.S.C. § 1159 only protects service connection of the disability, not the specific Diagnostic Code. Upon review of the definition of service connection under 38 U.S.C. § 101(16), the Federal Circuit determined that “to sever service connection is to conclude that a particular disability previously determined to have been incurred in the line of duty was incurred otherwise.” See Read, supra. The Federal Circuit noted that § 1159 “does not protect the fact of a disability, and therefore, the change in the determination of the applicable Diagnostic Code likewise is unprotected.” Id. Specifically regarding the facts in Read, the Federal Circuit agreed with the government’s argument that, because the same disability was involved in both the initial disability determination and the later specific identification of the particular muscle group that was affected, the change in the Diagnostic Code did not sever anything. Her disability was still service connected even though the Diagnostic Code may have changed. Id. In the present case, service connection for the Veteran’s knee disabilities have remained in effect for 25 years. Here, as in Read, when the Veteran’s knee disabilities were initially granted service connection, no subluxation or instability was actually addressed in the rating decision and the knees were rated for painful motion. The Board thus finds that the change in diagnostic code here was an attempt to more accurately reflect the symptomatology for which the Veteran was receiving compensation, which is analogous to the facts in Read. Neither the RO nor the Board has concluded that the Veteran’s knee disabilities previously determined to have been incurred in the line of duty were incurred otherwise. Based on the holding in Read that service connection for a disability is protected and not the particular Diagnostic Code, the Board finds that any change in the Diagnostic Code in this case did not result in a severance, but rather such diagnostic code switch was made to more accurately reflect the disability for which the Veteran was already being compensated. Meanwhile, the RO rated the left knee for slight lateral instability under Diagnostic Code 5257 in January 2016 at 10 percent for the period beginning on December 15, 2015. This decision was based on the Veteran’s report of instability of the left knee and clinical findings of instability during the December 2015 VA examination. However, the record demonstrates that the Veteran reported instability and giving way of the left knee when she was first evaluated for her increased rating claim in September 2010. The Board notes that medical evidence is not categorically more probative than lay evidence under Diagnostic Code 5257. See English v. Wilkie, 30 Vet. App. 347, 352-54 (2018). Thus, it is reasonable to conclude that the Veteran has had slight lateral instability for the entire period on appeal, beginning on November 16, 2009. A rating in excess of 10 percent for instability of the left knee is not warranted because there is no objective evidence of moderate recurrent subluxation or lateral instability from any of the VA examinations performed during the period on appeal. The Board further finds that a date prior to November 16, 2009 is not warranted as there is no evidence that a factually ascertainable increase occurred in the one year prior to that date. See 38 C.F.R. § 3.400(o)(2). Furthermore, a separate rating for recurrent subluxation or lateral instability of the right knee is not warranted until September 22, 2020. Prior to this date, the Veteran denied having instability, buckling, or give way sensations in the VA examinations performed in connection with her appeal. Beginning on September 22, 2020, a separate rating of 10 percent is warranted because the Veteran presented with complaints of giving way and limping in the right knee. A rating in excess of 10 percent for instability of the right knee is not warranted because there is no objective evidence of moderate recurrent subluxation or lateral instability from this or any of the VA examinations performed during the period on appeal. With respect to increased ratings under Diagnostic Codes 5260 and 5261, a rating in excess of 10 percent is not warranted because the evidence does not demonstrate that the Veteran’s flexion, bilaterally, is limited to 30 degrees or less, or that extension, bilaterally, is limited to 15 degrees or more. Likewise, a 20 percent evaluation under Diagnostic Code 5003 is not warranted for either knee as each knee is a single major joint. See 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5260, 5261. The Board has also considered separate ratings under Diagnostic Code 5258 and 5259. See Lyles v. Shulkin, 29 Vet. App. 107 (2017). With respect to the left knee, a separate 10 percent evaluation for the period prior to December 28, 2015, and a 20 percent evaluation for the period beginning December 28, 2015, is warranted. Prior to the December 28, 2015, the Veteran is shown to have a meniscal disability with evidence of stiffness and occasional swelling. The Veteran’s left knee, however, is not shown to have any locking symptoms during that period. Accordingly, the Board finds that the criteria for a symptomatic meniscal disability under Diagnostic Code 5259 is met for the period prior to December 28, 2015, although the criteria for a higher 20 percent evaluation is not met during that time. Such criteria—for evaluation under Diagnostic Code 5258—is not met until the December 28, 2015 VA examination, at which time the Veteran’s left knee is shown to have locking symptoms; subsequent records demonstrate continued locking and/or effusion throughout the record. With respect to the right knee, a separate rating for a meniscus disability is not warranted until April 5, 2018, because there is no evidence of a meniscus disability prior to this date. Beginning on April 5, 2018, a separate rating of 20 percent is warranted because a VA examiner concluded that the Veteran had a current meniscal tear with joint locking and effusion. Finally, as the evidence of record fails to demonstrate ankylosis, impairment of the tibia or fibula, or genu recurvatum, the Veteran is not entitled to a higher or separate rating under Diagnostic Codes 5256, 5262 or 5263, respectively. In conclusion, the Board finds that a rating in excess of 10 percent for painful limitation of motion of her bilateral knees is not warranted. However, the Board finds that a separate 10 percent rating is warranted under Diagnostic Code 5257 beginning on November 16, 2009, for the left knee and September 22, 2020, for the right knee. A separate 10 percent rating is also warranted under Diagnostic Code 5259 beginning on November 16, 2009, and a 20 percent evaluation under Diagnostic Code 5258, is warranted beginning December 15, 2015, for the left knee. Additionally, a separate 20 percent rating is warranted under Diagnostic Code 5258 beginning on April 5, 2018, for the right knee, but no earlier. In so reaching the above conclusions, the Board has appropriately applied the benefit of the doubt doctrine in this case. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. New Regulations Effective February 7, 2020 The Board notes that the criteria for knee disabilities have changed during the period covered by this appeal, effective February 7, 2021. See 85 Fed. Reg. 75453 (November 30, 2020). When a law or regulation changes during the pendency of a Veteran’s appeal, the version most favorable to the Veteran applies, absent congressional intent to the contrary. The amended rating criteria, if favorable to the claim, can be applied only for periods from the effective date of the regulatory change. However, the old regulations will be considered for the periods both before and after the change was made. See 38 U.S.C. § 5110(g); 38 C.F.R. § 3.114; VAOPGCPREC 3-2000, 65 Fed. Reg. 33422 (2000); Kuzma v. Principi, 3541 F.3d 1327 (Fed. Cir. 2003). Thus, the Veteran is entitled to application of the criteria that are most favorable to her claim, except that an award based on the amended regulations may not be made effective before the effective date of the change. The Board has considered these changes and finds that the new criteria respecting evaluations of knee disabilities are not as advantageous to the Veteran in this case, and that the Veteran does not meet the criteria for a higher evaluation. Specifically, the significant changes related to knee disabilities were to add Diagnostic Code 5002 for active arthritic process, which the Veteran does not have; change the total replacement and resurfacing criteria under Diagnostic Code 5055, again, which the Veteran does not have in this case; and, finally, to add to Diagnostic Code 5257, the requirement of either (1) sprain of or tear (either complete or incomplete) of a knee ligament causing persistent instability, or (2) a diagnosed condition of the patellofemoral complex with recurrent instability (with or without surgical repair); and (3) assistive devices or bracing (either by prescription or not) to the criteria, which were not present in the old pre-February 7, 2021 criteria. Because the new criteria require more specific criteria than the old criteria, it is less advantageous to the Veteran. In any event, the Veteran is not shown to have any ligament injury or a diagnosed patellar instability condition of either knee, nor is she shown to use a brace or any other assistive device (cane, crutches or a walker) throughout the appeal period. She also has not had any surgical repair for any patellar instability throughout the appeal period. The Board, therefore, does not find that a higher evaluation for the period beginning February 7, 2021, for the Veteran’s bilateral knee disabilities, when contemplating the new Rating Schedule criteria effective that date. Further, neither the Veteran nor her representative have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the initial rating claims addressed herein. See Doucette v. Shulkin, 28 Vet. App. 366 (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). MARTIN B. PETERS Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Beech, 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.