Citation Nr: 21012900 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 14-26 079 DATE: March 5, 2021 ORDER Entitlement to service connection for tinnitus is dismissed. Entitlement to service connection for left ring finger hyperextension is granted. Entitlement to service connection for gastroesophageal reflux disease (GERD), also claimed as acid reflux, is denied. Entitlement to an initial rating of 10 percent for left knee chondromalacia is granted from July 1, 2000. Entitlement to a separate initial rating of 30 percent for left knee chondromalacia based on limited extension is granted for the period from September 28, 2018, to August 7, 2019. Entitlement to a separate initial rating of 10 percent for left knee chondromalacia based on instability is granted from March 10, 2005. Entitlement to an initial rating in excess of 10 percent for right knee degenerative joint disease is denied. Entitlement to a separate initial rating of 10 percent for right knee degenerative joint disease based on instability is granted from November 18, 2008. REMANDED Entitlement to service connection for hearing loss is remanded. Entitlement to service connection for right foot pes planus is remanded. Entitlement to service connection for irritable bowel syndrome (IBS) is remanded. Entitlement to service connection for an eye disorder, to include scar, uveitis, and iritis, is remanded. Entitlement to an initial rating in excess of 10 percent for left foot pes planus is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. An April 2020 rating decision granted the Veteran entitlement to service connection for tinnitus and, thus, there remains no error of fact or law for appellate consideration with respect to that issue. 2. The Veteran’s left ring finger hyperextension began during his active service. 3. The preponderance of the evidence is against finding that the Veteran’s current GERD began during his active service, or is otherwise related to an in-service event, injury, or disease. 4. The Veteran had painful motion of the left knee from July 1, 2000, that was not compensable under the relevant criteria for rating based on limited motion. 5. The Veteran’s extension of the left knee was limited to 25 degrees from September 28, 2018, to August 7, 2019. 6. The Veteran had slight instability of the left knee from March 10, 2005. 7. Throughout the relevant period, the Veteran had painful motion of the right knee that was not compensable under the relevant criteria for rating based on limited motion. 8. The Veteran had slight instability of the right knee throughout the relevant period. CONCLUSIONS OF LAW 1. The issue of entitlement to service connection for tinnitus is dismissed. 38 U.S.C. §§ 511, 7105(d). 2. The criteria for entitlement to service connection for left ring finger hyperextension are met. 38 U.S.C. §§ 1110, 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303. 3. The criteria for entitlement to service connection for GERD, also claimed as acid reflux, are not met. 38 U.S.C. §§ 1110, 1131, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303. 4. The criteria for entitlement to an initial rating of 10 percent for left knee chondromalacia are met from July 1, 2000. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.71a, Diagnostic Code 5099-5014. 5. The criteria for entitlement to a separate initial rating of 30 percent for left knee chondromalacia based on limited extension are met for the period from September 28, 2018, to August 7, 2019. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.71a, Diagnostic Code 5261. 6. The criteria for entitlement to a separate initial rating of 10 percent for left knee chondromalacia based on instability are met from March 10, 2005. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.71a, Diagnostic Code 5257 (2020). 7. The criteria for entitlement to an initial rating in excess of 10 percent for right knee degenerative joint disease are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.71a, Diagnostic Code 5010. 8. The criteria for entitlement to a separate initial rating of 10 percent for right knee degenerative joint disease based on instability are met from November 18, 2008. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.400, 4.3, 4.7, 4.14, 4.21, 4.71a, Diagnostic Code 5257 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from October 1979 to October 2000. In November 2018, the Board issued a decision denying entitlement to service connection for tinnitus, entitlement to service connection for IBS, and entitlement to a higher initial rating for left foot pes planus. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In November 2019, the Court vacated the November 2018 Board decision and remanded those issues for further consideration consistent with a Joint Motion for Partial Remand (JMPR) filed by counsel for the Veteran and the VA Secretary. The November 2018 Board decision also remanded the other issues listed on the first page of this decision. Relevant to the issues decided herein, the remand portion of the November 2018 Board decision directed the Agency of Original Jurisdiction (AOJ) to obtain the Veteran’s updated VA treatment records; schedule the Veteran for a VA examination to determine the current severity of his service-connected left and right knee disabilities; schedule the Veteran for a VA examination in regard to his claimed left ring finger disability; and schedule the Veteran for a VA examination in regard to his claimed GERD. The Board finds that VA has substantially complied with the November 2018 remand directives. Specifically, following the remand, the AOJ obtained the Veteran’s updated VA treatment records and scheduled him for the requested VA examinations. The Veteran attended the VA examinations in August 2019. The examinations are responsive to and consistent with the November 2018 Board remand directives and are otherwise adequate for decision-making purposes. See 38 U.S.C. § 5103A(b); Stegall v. West, 11 Vet. App. 268, 271 (1998); D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). An August 2019 VA knee and lower leg conditions examiner stated that, due to the Veteran’s service-connected disabilities, “ambulation, sitting is so uncomfortable that he is incapable of meaningful employment”. Therefore, the issue of entitlement to a TDIU has been raised by the record as part of the increased rating issues on appeal and is properly before the Board at this time as part of those issues. See Rice v. Shinseki, 22 Vet. App. 447 (2009). In an October 2020 statement, the Veteran’s representative asserted that “critical medical evidence [is] missing from the file (including, but not limited to, up-to-date treatment records).” In a January 2021 statement, the representative asserted that “other evidence still needs to be developed in order for [the Board] to be able to issue a fair and accurate decision in this case.” The October 2020 and January 2021 statements do not provide any description of the reported outstanding evidence, such as the person, company, agency, or other custodian holding non-Federal records or the custodian or agency holding Federal records. Therefore, the Veteran and his representative have not provided enough information to identify and locate the reported outstanding evidence. The representative’s general assertions that there is outstanding relevant evidence is not sufficient to trigger VA’s duty to assist in obtaining evidence has existing records. See 38 C.F.R. § 3.159(c)(1)(i) and (2)(i). The Board notes that the October 2020 and January 2021 each contain a request for an extension of time before the Board adjudicates this case. The Board granted the October 2020 request in a December 2020 letter, and allowed an extension of time through January 17, 2021. However, as explained in a February 2021 letter sent to the representative, the Board has denied the January 2021 request for an extension of time. That letter informed the representative that the Board would revisit the request if it were submitted with argument pertaining to this case. However, to date, no such further request has been made. Accordingly, the Board will proceed with appellate consideration of this case. Neither the Veteran nor his representative has otherwise raised any issues with regard to the duty to notify or duty to assist as they pertain to the issues denied in this decision. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). The analysis in this decision focuses on the most relevant evidence and on what the evidence shows or does not show with respect to the issues denied in this decision. The Veteran should not assume that evidence that is not explicitly discussed in the decision has been overlooked. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (noting that the law requires only that reasons for rejecting evidence favorable to the claimant be addressed). 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). 1. Entitlement to service connection for tinnitus Pursuant to applicable law and regulation, the Secretary shall decide all questions of law and fact necessary to a decision by the Secretary under a law which affects the provision of benefits by the Secretary to veterans. 38 U.S.C. § 511(a). All questions in a matter which under 38 U.S.C. § 511(a) is subject to decision by the Secretary shall be subject to one review on appeal to the Secretary. Final decisions on such appeals are to be made by the Board. The Board may dismiss any appeal which fails to allege error of fact or law in the determination being appealed. 38 U.S.C. § 7105(d). In the April 2020 rating decision, the AOJ granted entitlement to service connection for tinnitus. Thus, the current appeal for entitlement to service connection for tinnitus was contemplated and granted in full by the April 2020 rating decision. As such, there remains no allegation of error of fact or law for appellate consideration with regard to the claim for entitlement to service connection for tinnitus. Therefore, the Board finds that the appeal for entitlement to service connection tinnitus should be dismissed. See 38 U.S.C. §§ 511, 7105(d). 2. Entitlement to service connection for left ring finger hyperextension The Veteran contends that he has a left ring finger disability due to an in-service injury where the finger was hyperextended during a game of basketball. The Board concludes that the Veteran has a current disability that began during active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). The service treatment records show that the Veteran jammed his left ring finger while playing basketball in August 1992. He was treated with immobilization of the left ring finger. X-rays taken at the time were negative for fracture or dislocation. At an April 2009 VA examination, the Veteran reported that his left ring finger has occasionally ached and become stiff since the in-service injury, although it was not causing problems at the time of the examination. In consideration of the in-service injury and the Veteran’s reported current left ring finger symptoms, the examiner diagnosed the Veteran with hyperextension of the left 4th digit. The Veteran is competent in his reports of continuous pain and swelling in the left ring finger since the in-service injury documented in the service treatment records. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board also finds him credible in that regard, as there is nothing in the record that impugns his reports. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current left ring finger hyperextension arose during his active service. Accordingly, after resolving all doubt in the Veteran’s favor, the Board finds that service connection for left ring finger hyperextension is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. Entitlement to service connection for GERD, also claimed as acid reflux The Veteran seeks entitlement to service connection for GERD, which he also claimed as acid reflux. He has stated that the “condition comes and goes and has been recurring since his military service.” The question for the Board is whether the Veteran has a current disability 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, although the Veteran has a current diagnosis of GERD, and evidence shows that in November 1988 the Veteran reported a history of pain, belching, and sour taste in the mouth, the preponderance of the evidence weighs against finding that the Veteran’s current GERD began during service or is otherwise related to an in-service injury, event, or disease. The service treatment records show that the Veteran denied frequent indigestion and stomach trouble on reports of medical history dated in June 1993, October 1993, November 1997, and March 2000. He also had normal clinical evaluations of the mouth, throat, and abdomen at medical examinations in June 1993, November 1997, and March 2000. They do not show that the Veteran was diagnosed with acid reflux, GERD, or any other upper gastrointestinal system condition during his active service. The medical treatment records do not show that the Veteran was diagnosed with GERD until many years after his separation from active service. The August 2019 VA examiner noted the in-service complaints of pain, belching, and sour taste in the mouth in November 1988 and the Veteran’s reports of experiencing upper gastrointestinal system symptoms on a chronic basis since service. He opined that the Veteran’s current GERD was less likely as not incurred in service or caused by an in-service injury, event, or disease. As a rationale for that opinion, he explained that here is no evidence that GERD occurred during the Veteran’s active service. The gastrointestinal illnesses documented in the evidence were temporary and resolved, and they did not predispose the Veteran to chronic esophageal disease. The Board finds the examiner’s opinion to be probative because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). It is consistent with the service treatment records, which show that the Veteran denied current or prior gastrointestinal symptoms on multiple occasions and had multiple normal evaluations of the upper gastrointestinal system subsequent to the November 1988 complaints. The Board accepts the examiner’s opinion as probative evidence that the in-service symptoms do not indicate that the Veteran had GERD and that the currently diagnosed GERD is not etiologically related to the in-service symptoms. The Board acknowledges the Veteran’s assertions that he has had upper gastrointestinal symptoms since his active service. The Veteran is competent to report the onset and recurrence of such symptoms. See Layno, 6 Vet. App. at 469. However, the Veteran in this case is not considered competent to diagnose the in-service upper gastrointestinal symptoms as GERD or to etiologically link the currently diagnosed GERD to the in-service symptoms. The issue is medically complex, as it requires knowledge of the pathology of GERD as a specific gastrointestinal disability and knowledge of complicated diagnostic medical testing. Therefore, it is outside the competence of the Veteran, as 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, his assertions in that regard are not entitled to probative value, and they do not weigh against the probative value of the August 2019 VA examiner’s opinion. In summary, the preponderance of the evidence is against finding that the Veteran’s current GERD began during his active service or is otherwise related to an in-service event, injury, or disease. In view of the foregoing, the Board concludes that the preponderance of the evidence is against the claim for entitlement to service connection for GERD. Because the preponderance of the evidence is against the claim, the doctrine of reasonable doubt is not for application, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Increased Ratings 4. Entitlement to higher initial ratings for left knee chondromalacia, currently rated as noncompensable prior to November 18, 2008, and at 10 percent from that date 5. Entitlement to an initial rating in excess of 10 percent for right knee degenerative joint disease The Veteran seeks higher initial ratings for left knee chondromalacia and for right knee degenerative joint disease. The applicable rating period for the left knee chondromalacia is from July 1, 2000, the effective date for the award of service connection for that disability, through the present. The applicable rating period for the right knee degenerative joint disease is from November 18, 2008, the effective date for the award of service connection for that disability, through the present. See 38 C.F.R. § 3.400. Disability ratings are determined by the application of VA’s Schedule for Rating Disabilities (Schedule), which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Pertinent regulations do not require that all cases show all findings specified by the Schedule, but that findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings,” in all claims for increased ratings. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999). The Veteran’s left knee chondromalacia is currently rated as noncompensable prior to November 18, 2008, and at 10 percent from that date under 38 C.F.R. § 4.71a, Diagnostic Code 5099-5014. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating assigned. 38 C.F.R. § 4.27. In this case, the use of Diagnostic Code 5099-5014 reflects that the Veteran’s specific service-connected disability is not listed in the Schedule and that a diagnostic code was therefore “built-up” using 50, the two digits used for musculoskeletal disabilities, and 99. Id. The Veteran’s left knee chondromalacia has been rated using the criteria listed under Diagnostic Code 5014, which pertains to osteomalacia. The note following Diagnostic Code 5014 states that diseases considered under that diagnostic code should be rated as degenerative arthritis, based on limitation of motion of the affected parts. Degenerative arthritis is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5003. The Veteran’s right knee degenerative joint disease is currently rated at 10 percent under 38 C.F.R. § 4.71a, Diagnostic Code 5010, which pertains to post-traumatic arthritis. During the pendency of the appeal, the rating criteria for rating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes “to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities.” Id. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board will consider the Veteran’s appeal under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. The regulatory changes reworded the Diagnostic Code 5003 from “Arthritis, degenerative (hypertrophic or osteoarthritis)” to “Degenerative arthritis, other than post-traumatic”, but did not change the criteria for rating disabilities under the diagnostic code. Diagnostic Code 5003 directs that a rating shall be awarded on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. If noncompensable limitation of motion is demonstrated, a 10 percent rating is assigned for each major joint or group of minor joints affected. 38 C.F.R. § 4.71a, Diagnostic Code 5003. The regulatory changes reworded Diagnostic Code 5010 from “Arthritis, due to trauma, substantiated by X-ray findings” to “Post-traumatic arthritis”. Prior to the regulatory change, Diagnostic Code 5010 directed that the disability be rated as degenerative arthritis under Diagnostic Code 5003. As of February 7, 2021, under the amended criteria, Diagnostic Code 5010 directs that the disability be rated as limitation of motion, dislocation, or other specified instability under the affected joint. If there are 2 or more joints affected, each rating shall be combined in accordance with 38 C.F.R. § 4.25. The regulatory changes reworded the Diagnostic Code 5014 from “Osteomalacia” to “Osteomalacia, residuals of”, but did not change the criteria for rating disabilities under the diagnostic code. Further criteria for rating disabilities of the knees applicable in this case are found in 38 C.F.R. § 4.71a, Diagnostic Codes 5257, 5260, and 5261. Prior to the regulatory changes, under Diagnostic Code 5257, a 10 percent rating is warranted for slight recurrent subluxation or lateral instability; a 20 percent rating is warranted for moderate recurrent subluxation or lateral instability; and a 30 percent rating is warranted for severe recurrent subluxation or lateral instability. According to MERRIAM WEBSTER’S COLLEGIATE DICTIONARY 999 (11th Ed. 2007), “slight” means small in amount. “Moderate” means limited in scope or effect. “Severe” means very painful or harmful or of a great degree. Objective medical evidence is not required to establish lateral knee instability under Diagnostic Code 5257 as in effect prior to February 7, 2021. Therefore, objective medical evidence cannot be categorically found more probative than lay evidence with respect to that diagnostic code. See English v. Wilkie, 30 Vet. App. 347, 352-53 (2018). As of February 7, 2021, under Diagnostic Code 5257, a 10 percent rating is warranted when there is a sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation; or where there is a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent rating is warranted when there is a 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; an 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; or 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. A 30 percent rating is warranted when there is an 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; or there is a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. The regulatory changes did not affect Diagnostic Codes 5260 and 5261. Under Diagnostic Code 5260, a noncompensable rating is warranted for flexion limited to 60 degrees. A 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Under Diagnostic Code 5261, a noncompensable rating is warranted for extension limited to 5 degrees. A 10 percent rating is warranted for extension limited to 10 degrees. A 20 percent rating is warranted for extension limited to 15 degrees. A 30 percent rating is warranted for extension limited to 20 degrees. A 40 percent rating is warranted for extension limited to 30 degrees. A 50 percent rating is warranted for extension limited to 45 degrees or greater. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration 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). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a criteria.”). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). Regarding the Veteran’s service-connected left knee disability, the Board finds that an initial rating of 10 percent, and no higher, was warranted from July 1, 2000, based on painful motion of the knee. Specifically, the Veteran indicated on a March 2000 report of medical history for separation from active service that his left knee swells and is painful after running or playing sports. His left knee was noted as abnormal at a March 2000 medical examination for separation from active service, although testing was normal and he did not have swelling or reduced range of motion in the knee at the time of the examination. At a November 2000 VA examination, the Veteran reported that he has swelling in the left knee when he runs greater than a mile. On examination, he had full range of motion and negative instability tests, but he had mild pain on patellofemoral compression. Subsequent treatment records show that he continued to have painful motion of the left knee, but that he was not limited in either extension or flexion of the left knee such that a compensable rating was warranted under Diagnostic Code 5260 or Diagnostic Code 5261. In the medical treatment records, his left knee extension was most limited in December 2015 and January 2016, when it was measured to be 3 degrees, which is noncompensable under Diagnostic Code 5261. His left knee flexion was most limited in June 2011, when it was measured to be 90 degrees, which is noncompensable under Diagnostic Code 5260. At an April 2009 VA examination, he reported that his left knee is painful and unstable and that it swells. On examination, he had left knee extension to 0 degrees and flexion to 90 degrees with no change following repetitive testing. At the August 2019 VA examination, he reported a progression in his knee pain and stiffness since his in-service injuries. He also reported limited range of motion in the knees and a feeling of instability on the right. He stated that he has flare-ups in the left knee symptoms that are moderate in severity, last hours, and are precipitated by immobility, prolonged standing, or walking. On examination, he had left knee extension to 0 degrees and flexion to 110 degrees with pain. He was unable to complete repetitive-use testing for the left knee due to pain. The examiner opined that the Veteran would have pain, fatigue, weakness, lack of endurance, and incoordination on repeated use over time and fatigue and incoordination during flare-ups, but that he would not have additional loss of motion in either instance. The Veteran did not have instability of the left knee on testing. He did not show evidence of pain on passive range of motion or on non-weight bearing range of motion. Thus, the record shows that the Veteran had painful motion of the left knee throughout the relevant period, but that he did not have left knee extension limited to 10 degrees or more or flexion limited to 45 degrees or less such that a compensable rating was warranted under Diagnostic Code 5260 or 5261 during the relevant period. As such, he was entitled to a rating of 10 percent, and no higher, from July 1, 2000, under Diagnostic Codes 5014 and 5003. The Board further finds that a separate rating of 10 percent for the service-connected left knee disability was warranted from March 10, 2005, based on slight instability of the left knee. Specifically, on March 10, 2005, the Veteran reported that he has left knee instability with activity. In April 2005, he reported a history of intermittent knee pain for 7 years. On testing, he had a positive valgus stress test at 30 degrees in the left knee. He reported a feeling of instability in his left knee at the April 2009 VA examination. Later records, to include medical treatment records and the August 2019 VA examination, show that the Veteran was negative for instability in the left knee on testing, but that he complained of a feeling of instability or giving out in the knee from time to time. Thus, in summary, the Veteran reported left knee instability on March 10, 2005, and that instability was later confirmed through objective testing in April 2005. Although later instability testing was negative, he continued to report left knee instability. Objective medical evidence is not required to establish lateral knee instability under Diagnostic Code 5257 as in effect prior to February 7, 2021. See English, 30 Vet. App. at 352-53. The Veteran’s left knee instability is considered slight in severity objective testing has been negative aside from that performed in April 2005 and, more importantly, there is no indication in the record that the instability caused falls or was otherwise moderate or severe in terms of the pain or harm it caused. As such, the left knee instability warrants a 10 percent rating, and no higher, under Diagnostic Code 5257 as in effect prior to February 7, 2021, from March 10, 2005, the date the record first documents the Veteran’s report of left knee instability. The record does not show that the Veteran was entitled to a rating in excess of 10 percent for the service-connected left knee chondromalacia under Diagnostic Code 5257 as in effect beginning February 7, 2021. Specifically, the record does not show that the service-connected left knee disability involves the patellofemoral complex, as defined in Note (1) following Diagnostic Code 5257 as in effect beginning February 7, 2021, or a sprain or ligament tear in the left knee. Regarding the Veteran’s service-connected right knee disability, the Board finds that an initial rating in excess of 10 percent was not warranted during the relevant period under Diagnostic Code 5010 or Diagnostic Code 5260, but that from September 28, 2018, to August 7, 2019, a separate initial rating of 30 percent, and no higher, was warranted under Diagnostic Code 5261. Specifically, the records pertinent to the relevant period prior to September 28, 2018, show that the Veteran reported pain, swelling, and limited motion in the right knee. During that period, the medical treatment records show that his right knee extension was most limited in December 2015 and January 2016, when it was measured to be 3 degrees, which does not warrant a compensable rating under Diagnostic Code 5261. His right knee flexion was most limited in June 2011, when it was measured to be 90 degrees, which does not warrant a compensable rating under Diagnostic Code 5260. At the April 2009 VA examination, he reported that his right knee is painful, feels unstable, and swells. On examination, he had right knee extension to 0 degrees and flexion to 100 degrees with no change following repetitive testing. Thus, the record does not show that the Veteran had right knee flexion limited to 30 degrees or less or right knee extension limited to 15 degrees or less such that an initial rating in excess of 10 percent was warranted under Diagnostic Code 5260 or 5261 prior to September 28, 2018. At a September 28, 2018 VA physical therapy consultation, the Veteran complained of a catching pain in the right knee that feels as though the knee is hyperextending, causing him to almost fall upon standing. On examination, he had right knee extension to 25 degrees and flexion to 45 degrees. Under Diagnostic Code 5260, knee flexion limited to 45 degrees warrants a 10 percent rating. Under Diagnostic Code 5261, knee extension limited to 25 degrees warrants a 30 percent rating. Therefore, findings on that date did not show that an initial rating in excess of 10 percent was warranted under Diagnostic Code 5010 or Diagnostic Code 5260. However, they did show that a separate initial rating of 30 percent, and no higher, was warranted under Diagnostic Code 5261. At the August 2019 VA examination, the Veteran reported a progression in his knee pain and stiffness since his in-service injuries. He also reported limited range of motion in the knees and a feeling of instability on the right. He stated that he has flare-ups in the right knee symptoms that are severe, are constant, and are precipitated by immobility, prolonged standing, or walking. On examination, he had right knee extension to 5 degrees and flexion to 50 degrees with pain. He did not have additional loss of function or range of motion following repetitive-use testing of the right knee. The examiner opined that the Veteran would have pain and weakness on repeated use over time and pain, weakness, and lack of endurance during flare-ups, but that he would not have additional loss of motion in either instance. The Veteran did not have instability of the right knee on testing. He did not show evidence of pain on passive range of motion or on non-weight bearing range of motion. Under Diagnostic Code 5260, knee flexion limited to 50 degrees warrants a noncompensable rating. Under Diagnostic Code 5261, knee extension limited to 5 degrees warrants a noncompensable rating. Therefore, for the period beginning August 8, 2019, the date of the August 2019 VA examination, the criteria for entitlement to an initial rating in excess of 10 percent for right knee degenerative joint disease were not met. The Board further finds that a separate rating of 10 percent was warranted throughout the relevant period based on slight instability of the right knee. As noted above, the Veteran reported at the April 2009 VA examination that his right knee is unstable. Later records, to include medical treatment records and the August 2019 VA examination, show that the Veteran was negative for instability in the right knee on testing, but that he complained of a feeling of instability or giving out in the knee from time to time. Although stability testing was negative, objective medical evidence is not required to establish lateral knee instability under Diagnostic Code 5257 as in effect prior to February 7, 2021. See English, 30 Vet. App. at 352-53. The Veteran’s right knee instability is considered slight in severity because objective testing was negative and, more importantly, there is no indication in the record that the instability caused falls or was otherwise moderate or severe in terms of the pain or harm it caused. As such, the right knee instability warrants a 10 percent rating, and no higher, under Diagnostic Code 5257 as in effect prior to February 7, 2021, throughout the relevant rating period. The record does not show that the Veteran was entitled to a rating in excess of 10 percent for the service-connected right knee degenerative joint disease under Diagnostic Code 5257 as in effect beginning February 7, 2021. Specifically, the record does not show that the service-connected right knee disability involves the patellofemoral complex, as defined in Note (1) following Diagnostic Code 5257 as in effect beginning February 7, 2021, or a sprain or ligament tear in the right knee. The Board notes that the August 2019 VA examination report does not include passive range-of-motion measurements and does not specify range of motion with and without weight-bearing. See Correia v. McDonald, 28 Vet. App. 158 (2016). The fundamental issue in view of Correia is that VA examinations must include adequate joint testing for pain. Generally, active range-of-motion testing produces more restrictive results than passive range-of-motion testing because passive range-of-motion testing requires the physician to force the joint through its motions, which results in measurements beyond what the Veteran could achieve through active motion. There is also no indication that range-of-motion testing was performed at the August 2019 VA examination other than on weight bearing. Therefore, there is no prejudice to the Veteran in relying on a VA examination that involved active range-of-motion testing on weight-bearing because such results tend to produce the most severe scenario for impairment and thus would tend to support the highest possible rating. The Board has also considered the other diagnostic codes pertaining to the knee and leg. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). However, in this case, the record does not show that the Veteran’s service-connected left and right knee disabilities have resulted in ankylosis of the knee or dislocation or removal of the semilunar cartilage. Therefore, higher or additional ratings under Diagnostic Codes 5256, 5258, and 5259 are not warranted. Neither the Veteran nor his representative has raised any other issues with regard to the initial ratings for the service-connected left knee chondromalacia and right knee degenerative joint disease, nor have any other such issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017). In conclusion, the Board finds that, for the service-connected left knee disability, the criteria for an initial rating of 10 percent were met from July 1, 2000; the criteria for a separate initial rating of 30 percent under Diagnostic Code 5261 were met for the period from September 28, 2018, to August 7, 2019; and the criteria for a separate initial rating of 10 percent under Diagnostic Code 5257 were met from March 10, 2005; but that the criteria for higher or additional initial ratings are otherwise not met. For the service-connected right knee disability, the criteria for a separate initial rating of 10 percent under Diagnostic Code 5257 were met for the entire rating period on appeal; but that the criteria for higher or additional initial ratings are otherwise not met. To the extend the Veteran seeks initial ratings higher than or in addition to those previously assigned and those assigned herein, the preponderance of the evidence is against the appeal, the doctrine of reasonable doubt is not for application, and the appeal must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND 1. Entitlement to service connection for hearing loss is remanded. 2. Entitlement to service connection for right foot pes planus is remanded. The November 2018 Board remand directed the AOJ to issue a statement of the case as to the issues of entitlement to service connection for hearing loss and entitlement to service connection for right foot planus pursuant to the holding of Manlincon v. West, 12 Vet. App. 238 (1999). Although the AOJ included the issue of entitlement to service connection for hearing loss in an April 2020 supplemental statement of the case, it has not yet issued a statement of the case as to either issue. The issues must therefore again be remanded so that the AOJ may issue a statement of the case. 3. Entitlement to service connection for IBS is remanded. The parties to the November 2019 JMPR agreed that the Board erred in the November 2018 decision by finding that the service treatment records show no complaints or findings of IBS. The parties noted that service treatment records dated November 26, 1984; May 14, 1990; and May 15, 1990, document gastrointestinal issues. In light of the service treatment records documenting lower gastrointestinal symptoms, the Board finds that the threshold for providing a VA examination as to the claim for entitlement to service connection for IBS have been met, and the issue must be remanded to provide the Veteran such an examination. See 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006).   4. Entitlement to service connection for an eye disorder, to include scar, uveitis, and iritis is remanded. The evidence of record indicates that the Veteran’s recurrent uveitis and iritis may be secondary to his ankylosing spondylitis, which was service connected in the April 2020 rating decision. The Veteran has also asserted that he began having eye problems after getting chemicals into his eyes while washing an airplane. The Board cannot make a fully-informed decision on the issue because no VA examiner has opined whether the Veteran’s recurrent uveitis and/or iritis may be secondary to his service-connected ankylosing spondylitis or may be directly related to in-service chemical exposures. 5. Entitlement to an initial rating in excess of 10 percent for left foot pes planus is remanded. The Veteran underwent a VA foot conditions examination in August 2019 subsequent to the AOJ’s most recent adjudication of the issue. The Veteran has not waived initial consideration by the AOJ of that additional relevant evidence. Therefore, the issue must be remanded so that the AOJ may consider the additional evidence in the first instance and issue a supplemental statement of the case as to the issue. See 38 C.F.R. §§ 19.31, 20.1305(c). 6. Entitlement to a TDIU is remanded. The Veteran’s education and occupational history is unclear from the record. The Board finds that the issue must be remanded so that the Veteran may be informed of the factors pertinent to establishing a TDIU and to afford him an opportunity to complete a VA Form 21-8940, Veteran’s Application for Increased Compensation based on Unemployability, or otherwise provide a summary of his education and work history. The matters are REMANDED for the following action: 1. Send the Veteran and his representative a statement of the case that addresses the issues of entitlement to service connection for hearing loss and entitlement to service connection for right foot planus. If the Veteran perfects an appeal by submitting a timely VA Form 9, the issues should be returned to the Board for further appellate consideration. 2. Provide the Veteran a letter explaining the factors pertinent to establishing entitlement to a TDIU. The letter must be enclosed with a VA Form 21-8940, Veteran’s Application for Increased Compensation based on Unemployability. 3. Schedule the Veteran for a VA examination for his claimed IBS. The examiner must review the claims file. The examiner is asked to provide a response to the following: Is IBS at least as likely as not (50 percent probability or greater) related to service, including the in-service lower gastrointestinal symptoms. The opinion must consider the November 1984 emergency care and treatment note documenting complaints of nausea and vomiting and a diagnosis of gastroenteritis. It must also consider the May 1990 service treatment records documenting the Veteran’s complaints of diarrhea with watery bowels, which were diagnosed as gastroenteritis. 4. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s diagnosed eye disorders, to include scar, uveitis, and iritis, are at least as likely as not (50 percent probability or greater) related to the in-service incident he reported in January 2009 in which chemicals got into his eyes while he was washing an airplane. If not, provide an opinion as to whether it is at least as likely as not that the Veteran’s diagnosed eye disorders, to include scar, uveitis, and iritis, are proximately due to or aggravated beyond their natural progression by a service-connected disability, to include the service-connected ankylosing spondylosis. If the opinion is in the negative, the clinician must reconcile that opinion with the evidence of record indicating that the Veteran’s iritis and uveitis may be caused by or symptoms of his ankylosing spondylitis, to include the statements from P. Rim, M.D., and A. Pasquale, M.D., that were received in May 2010. 5. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal in view of the expanded record, to include the August 2019 VA foot conditions examination. If any benefit sought is not granted to the Veteran’s satisfaction, send the Veteran and his representative a supplemental statement of the case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. J. Anthony, 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.