Citation Nr: 21012926 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 10-06 448 DATE: March 8, 2021 ORDER Entitlement to a rating in excess of 10 percent for left hip degenerative joint disease with limited extension is denied. Entitlement to a compensable rating for left hip degenerative joint disease with limited flexion is denied. Entitlement to a separate rating of 10 percent, but no greater, for left hip limitation of adduction is granted effective April 9, 2019. Entitlement to a 10 percent rating, but no greater, for right knee patellar tendonitis prior to February 29, 2012, is granted. Entitlement to a rating in excess of 40 percent for right knee patellar tendonitis since February 29, 2012, is denied. Entitlement to a rating in excess of 10 percent for right knee instability prior to February 7, 2012, is denied. Entitlement to a rating of 10 percent, but no greater, for right knee instability since February 7, 2012, is granted. REMANDED Entitlement to total disability based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. Throughout the rating period on appeal, the Veteran’s left hip degenerative joint disease has been manifested by, at worst, extension limited to 15 degrees, with no evidence of incapacitating exacerbations due to degenerative arthritis. 2. Throughout the rating period on appeal, the Veteran’s left hip degenerative joint disease has been manifested by, at worst, flexion limited to 65 degrees. 3. Since April 9, 2019, the Veteran’s left hip degenerative arthritis has been manifested by, at worst, adduction limitation such that he could not cross his legs following three repetitions of range of motion, after use repeated over time, and during flare-ups. 4. Prior to February 29, 2012, the Veteran’s right knee patellar tendonitis had been manifested by painful motion off the right knee joint. 5. Since, February 29, 2012, the Veteran’s right knee patellar tendonitis has been manifested by, at worst, flexion limited to 110 degrees and extension limited to 30 degrees. 6. Prior to February 7, 2021, the Veteran’s right knee instability had been manifested by, at worst, slight lateral instability of the medial and lateral ligaments. 7. Since February 7, 2021, the Veteran’s right knee instability has been manifested by impairment of the medial and lateral ligaments causing persistent instability, with daily use of a cane for ambulation. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for left hip degenerative joint disease with limited extension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5003-5251. 2. The criteria for a compensable disability rating for left hip degenerative joint disease with limited flexion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5252-5003. 3. The criteria for a separate disability rating of 10 percent, but no greater, for left hip degenerative joint disease with limited adduction have been met effective April 9, 2019. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5252-5003. 4. Prior to February 29, 2012, the criteria for the minimum compensable disability rating of 10 percent, but no greater, for right knee patellar tendonitis have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Code 5261. 5. Since February 29, 2012, the criteria for a rating in excess of 40 percent for right knee patellar tendonitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5260, 5261. 6. Prior to February 7, 2021, the criteria for a rating in excess of 10 percent for right knee instability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5257. 7. Since February 7, 2021, the criteria for a rating of 20 percent, but no greater, for right knee instability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5257. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1970 to June 1970. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a September 2009 Rating Decision by a Department of Veterans Affairs (VA) Regional Office (RO). On August 23, 2017, the President signed into law the Veterans Appeals Improvement and Modernization Act, Pub. L. No. 115-55 (codified as amended in scattered sections of 38 U.S.C.), 131 Stat. 1105 (2017), also known as the Appeals Modernization Act (AMA). This law creates a new framework for Veterans dissatisfied with VA’s decision on their claim to seek review. Here, the Veteran has not opted-in to VA’s test program, the Rapid Appeals Modernization Program (RAMP). Although the AMA was implemented effective February 19, 2019, the Rating Decision on appeal was issued prior to that date. Accordingly, the Board will review his appeal under the existing Legacy Appeals System. The Veterans Claims Assistance Act of 2000 (VCAA), in part, describes VA’s duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (2014); Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012, Pub. L. No. 112-154, §§ 504, 505, 126 Stat. 1165, 1191-93; 38 C.F.R. § §§ 3.102, 3.156(a), 3.159, 3.326(a) (2019). Here, neither the Veteran nor his representative have raised any issues with regard to the duty to notify or duty to assist. 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). These matters were previously before the Board in July 2020, at which time they were remanded in order to obtain retrospective addendum opinions regarding the Veteran’s left hip and right knee disabilities. These opinions were obtained in September 2020. As such, the Board finds that there has been substantial compliance with its July 2020 remand directives. Stegall v. West, 11 Vet. App. 268 (1998); D'Aries v. Peake, 22 Vet. App. 97 (2008) (holding that only substantial, and not strict, compliance with the terms of a remand request, is required). Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as "staging the ratings." See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2008). 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 (musculoskeletal system) or § 4.73 (muscle injury); 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 [or 4.73] criteria.”). A minimum compensable evaluation for a joint disability is warranted for painful motion under 38 C.F.R. § 4.59. However, a rating in excess of the minimum compensable rating must be based on demonstrated functional loss. Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011). Ankylosis is stiffening or fixation of a joint as the result of a disease process, with fibrous or bony union across the joint. Dinsay v. Brown, 9 Vet. App. 79, 81 (1996). 1. Entitlement to higher disability ratings for the left hip. The Veteran seeks entitlement to higher disability ratings for his service-connected left hip symptomatology. Throughout the period on appeal, the Veteran's left hip degenerative joint disease with limited extension has been rated as 10 percent disabling under Diagnostic Code 5003, later under Diagnostic Codes 5003-5251. In an August 2012 Rating Decision, the RO also granted entitlement to service connection for left hip degenerative joint disease with limited flexion and assigned a noncompensable disability evaluation under Diagnostic Codes 5252-5003 effective February 29, 2012. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. As such, the Board will assess the propriety of both the 10 percent evaluation assigned for the Veteran’s left hip extension throughout the rating period on appeal as well as the noncompensable evaluation assigned for his left hip flexion since February 29, 2012. Degenerative arthritis is evaluated based on the limitation of motion of the affected joint. 38 C.F.R. § 4.71a, Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Id. If the joint is affected by limitation of motion but the limitation of motion is noncompensable under the appropriate diagnostic code, a 10 percent rating applies for each such major joint or group of minor joints affected by limitation of motion. Id. In the absence of limitation of motion, a 10 percent rating applies for X-ray evidence of involvement of two or more minor joint groups. Id. A 20 percent rating applies for X-ray evidence of involvement of two or more minor joint groups, with occasionally incapacitating exacerbations. Id. Diagnostic Code 5251 provides that a 10 percent evaluation is warranted for limitation of extension of the thigh to 5 degrees. Diagnostic Code 5252 provides that the following evaluations are warranted for limitation of flexion of the thigh: 10 percent for flexion limited to 45 degrees; 20 percent for flexion limited to 30 degrees; 30 percent for flexion limited to 20 degrees; and 40 percent for flexion limited to 10 degrees. Diagnostic Code 5253 provides for a 10 percent evaluation for limitation of rotation of the thigh prohibiting toe-out more than 15 degrees for the affected leg, a 10 percent evaluation for limitation of adduction preventing crossing of the legs; and a 20 percent evaluation for limitation of abduction of the thigh with motion lost beyond 10 degrees. Normal ranges of motion of the hip are hip flexion from zero to 125 degrees, and hip abduction from zero to 45 degrees. 38 C.F.R. § 4.71a, Plate II. Here, there is no evidence of hip ankylosis to warrant a disability rating under Diagnostic Code 5250, flail joint to warrant a disability rating under Diagnostic Code 5254, or femur impairment to warrant a disability rating under Diagnostic Code 5255. The Veteran was provided with a VA examination in August 2009, at which time he was diagnosed as having degenerative joint disease of the left hip. Subjectively, the Veteran described moderate pain in the hip which was sharp and occurred primarily with walking in certain positions. Although the Veteran reported using a cane for stability, the examiner indicated that he had no instability of the hip and had no inflammatory joint disease. Upon objective examination, the left hip appeared anatomically normal, with no tenderness or swelling. Range of motion testing revealed flexion to 125 degrees, extension to 30 degrees, adduction to 25 degrees, abduction to 45 degrees, external rotation to 60 degrees, and internal rotation to 40 degrees. Repetitive motion of the hip only showed discomfort in abduction, but no weakness or fatigue, and did not alter range of motion. The examiner indicated that it was very hard to indicate whether the Veteran had significant pain on ambulation because his left knee was so bad. The Veteran indicated that his hip pain was intermittent rather than constant, so the examiner concluded the pain more than likely came with the different positions that he used to balance because of the significant pain in the left knee. X-rays revealed mild degenerative changes in the left hip with narrowing. The Veteran was provided with a VA Hip and Thigh Conditions examination in February 2012, at which time he was diagnosed as having degenerative joint disease of the left hip. Range of motion testing revealed left hip flexion to 100 degrees and extension to zero degrees, with no objective evidence of painful motion. Left hip abduction was not lost beyond 10 degrees, adduction was not limited such that the Veteran could not cross his legs, and rotation was not limited such that the Veteran could not toe-out more than 15 degrees. The Veteran was able to perform repetitive-use testing with three repetitions, and with no loss in range of motion after these repetitions. However, the Veteran exhibited functional loss and/or functional impairment of the hip and thigh manifested by disturbance of locomotion as well as interference with sitting, standing, and/or weight bearing. The Veteran did not exhibit localized tenderness or pain to palpation of the joints/soft tissue of the hip. Muscle strength testing revealed only active movement against some resistance during left hip flexion, extension, and abduction. There was no evidence of ankylosis, malunion or nonunion of the femur, flail hip joint, leg length discrepancy, or joint replacement. The VA examiner indicated that there was no functional impairment of the left hip such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. The Veteran’s left hip disability impacted his ability to work only in the sense that it limited his ability with ambulation. The Veteran was provided with another VA Hip and Thigh Conditions examination in May 2018, at which time he was diagnosed as having left hip degenerative joint disease with limited extension and flexion. Subjectively, the Veteran described left hip pain after sitting for a long period of time then standing up. Range of motion testing revealed left hip flexion to 110 degrees, extension to 15 degrees, abduction to 45 degrees, adduction to 25 degrees, external rotation to 60 degrees, and internal rotation to 40 degrees (with no pain noted upon examination). Adduction was not limited such that the Veteran could not cross his legs. However, the VA examiner noted that although these ranges of motion were outside of "normal" ranges, they were normal for the Veteran due to his age. The Veteran was able to perform repetitive-use testing with at least three repetitions, and with no additional loss of function or range of motion after three repetitions. The examiner indicated that pain, weakness, fatigability, and/or incoordination did not significantly limit functional ability with repeated use over a period of time or during flare-ups. Additional contributing factors of disability included less movement than normal and disturbance of locomotion. Muscle strength testing revealed normal strength during left hip flexion, extension, and abduction, with no evidence of muscle atrophy. There was also no evidence of ankylosis, malunion or nonunion of femur, flail hip joint, or leg length discrepancy. The VA examiner indicated that there was no functional impairment of the left hip such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. The Veteran’s left hip disability did not impact the Veteran’s ability to work. The Veteran was provided with another VA Hip and Thigh Conditions examination in April 2019, at which time he was diagnosed as having left hip degenerative joint disease with limited extension as well as trochanteris pain syndrome. Subjectively, the Veteran described constant, dull, arthritic pain and sharpness with weightbearing and stiffness. Range of motion testing revealed left hip flexion to 85 degrees, extension to 20 degrees, abduction to 30 degrees, adduction to 20 degrees, external rotation to 40 degrees, and internal rotation to 30 degrees (with all ranges of motion exhibiting pain). Adduction was not limited such that the Veteran could not cross his legs. There was evidence of tenderness to palpation of the lateral hip that was reflective of left hip degenerative joint disease with limited extension and left hip trochanteric pain syndrome. The Veteran was able to perform repetitive-use testing with at least three repetitions; however, doing so further limited flexion to 75 degrees, extension to 15 degrees, abduction to 30 degrees, adduction to 15 degrees (with post-test adduction limited such that the Veteran could not cross his legs), external rotation to 35 degrees, and internal rotation to 25 degrees. The examiner indicated that pain, weakness, fatigability, and/or incoordination significantly limited functional ability with repeated use over a period of time, further limiting flexion to 70 degrees, extension to 15 degrees, abduction to 25 degrees, adduction to 15 degrees (with post-test adduction limited such that the Veteran could not cross his legs), external rotation to 35 degrees, and internal rotation to 25 degrees. Similarly, the examiner indicated that pain, weakness, fatigability, and/or incoordination significantly limited functional ability during flare ups, further limiting flexion to 65 degrees, extension to 15 degrees, abduction to 20 degrees, adduction to 15 degrees (with post-test adduction limited such that the Veteran could not cross his legs), external rotation to 30 degrees, and internal rotation to 25 degrees. Additional contributing factors of disability included less movement than normal and weakened movement. Muscle strength testing revealed active movement against some resistance during left hip flexion, extension, and abduction (which constituted a reduction in muscle strength), although there was no evidence of muscle atrophy. There was also no evidence of ankylosis, malunion or nonunion of femur, flail hip joint, or leg length discrepancy. The VA examiner indicated that there was no functional impairment of the left hip such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. The Veteran’s left hip disability did impact his ability to work in that it caused limitations in climbing, running, bending, squatting, and standing for long periods of time, with flare ups requiring increased breaks needed for rest and treatment. The April 2019 VA examiner further explained that: Upon reviewing the Veteran's medical record, the Veteran has had ongoing and chronic left hip pain with degenerative changes as is noted in his service-connected diagnosis left hip degenerative joint disease with limited extension. Current examination findings of weakness, pain and decreased range of motion are still present and ongoing as noted in his last examinations with increased severity and contributing to the degenerative changes noted in the Right hip due to altered biomechanics and load instability. Current examination findings are consistent with limitation in range of motion with active motion, passive motion, pain on weight-bearing and in nonweight-bearing. It can be speculated that loss of functioning would occur due to the degenerative arthritic condition in the Left Hip knee. Medical literature supports that "Joint ROM can depend on factors other than articular deformation. Certain motions may be too painful for the patient to complete, or the patient may lack the muscle strength to maintain the joint action. This results in impaired ROM without a clear articular cause for this impairment" (Steultjens et al, 2000). Considering the multifactorial conditions that affect ROM, variance can be considered to occur in ROM in all settings: active, passive, weight-bearing or nonweight-bearing and the exact degree cannot be speculated. The Veteran was provided with another VA Hip and Thigh Conditions examination in October 2019, at which time he was diagnosed as having left hip degenerative joint disease with limited flexion. Subjectively, the Veteran described nearly constant left hip pain increased with sitting or standing for long periods of time. Range of motion testing revealed left hip flexion to 105 degrees, extension to 20 degrees, abduction to 45 degrees, adduction to 25 degrees, external rotation to 60 degrees, and internal rotation to 40 degrees (with no pain noted upon examination). Adduction was not limited such that the Veteran could not cross his legs. The Veteran was able to perform repetitive-use testing with at least three repetitions, and with no additional loss of function or range of motion after three repetitions. The examiner indicated that pain, weakness, fatigability, and/or incoordination did not significantly limit functional ability with repeated use over a period of time or during flare-ups. Muscle strength testing revealed normal strength during left hip flexion, extension, and abduction, with no evidence of muscle atrophy. There was also no evidence of ankylosis, malunion or nonunion of femur, flail hip joint, or leg length discrepancy. The VA examiner indicated that there was no functional impairment of the left hip such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. The Veteran’s left hip disability did not impact the Veteran’s ability to work. A retrospective VA opinion was obtained in March 2020, at which time the examiner explained that: The veteran was noted to have flexion to 125° and extension to 30°, little or no loss on the other planes of ROM. There was no significant loss on observed motion. The range of motion on initial evaluation on the DBQ 2/29/12 was 100° for flexion, with extension noted to be 0°. However, no pain was noted on active motion and none was noted on observed repetitive use and no loss of function was noted with repetitive use. Thus, the 0° extension is suspect. There was no point tenderness noted. It is unclear as to what was limiting the vet, if pain was not the issue. Based on the best information, active and weight-bearing ROM would be the same, Nonweight-bearing and passive ROM would, more likely than not be the same as for active and weight-bearing. Active and weight-bearing measurements are commonly similar or the same. The same applies for passive and non-weight-bearing. The likely loss due to flares would be 5 to 10° for flexion with no change for the other planes, including extension in 2012. Loss due to flares in 2009, would likely have been 0 to 5° for flexion and extension, with little, if any, change in the other planes of motion. The veteran's ROM on the 2019 DBQ was 105° for flexion and 20° for extension with no reported functional loss and no pain on motion with no observed loss of ROM. Passive and active motion and weight-bearing and nonweight-bearing are likely the same. Though pain is not reported, there is no other explanation for loss of ROM. The veteran denied flares on the 2019 DBQ. In total, there appears to be little change from 2012 to 2019, suggesting a relatively stable condition over that span, with mild - moderate loss from 2009 to 2012. The Board reiterates that the Veteran has been service connected for left hip degenerative joint disease with limited extension and assigned a 10 percent disability rating under Diagnostic Codes 5003-5251 throughout the rating period on appeal. He has also been service connection for left hip degenerative joint disease with limited flexion and assigned a noncompensable rating under Diagnostic Code 5252-5003 since February 29, 2012, the date of a VA examination which first revealed limited left hip flexion. Throughout the rating period on appeal, the Veteran’s left hip extension has, at worst, been limited to 15 degrees, even when considering functional loss after repeated use over time and during flare ups. Although the February 2012 VA examination indicated that his left hip extension was limited to zero degrees, with no evidence of pain upon motion, the retrospective VA opinion obtained in September 2020 indicated that this finding was “suspect” because no pain was noted on active motion and none was noted on observed repetitive use and no loss of function was noted with repetitive use. The Board notes that the Veteran is already in receipt of the maximum schedular 10 percent disability rating under Diagnostic Code 5251. Moreover, although there is X-ray evidence of degenerative arthritis in the left hip, there is no indication of incapacitating exacerbations to warrant a 20 percent disability rating under Diagnostic Code 5003. As such, a higher disability evaluation for limited left hip extension is not warranted at any time during the rating period on appeal. Throughout the rating period on appeal, the Veteran’s left hip flexion has, at worst, been limited to 65 degrees, even when considering functional loss after repeated use over time and during flare ups. These findings do not warrant a compensable disability rating pursuant to Diagnostic Code 5252. Moreover, the Veteran did not demonstrate limitation of left hip flexion until the February 29, 2012, VA examination; indeed, at the prior August 2009 VA examination, the Veteran’s left hip flexion was to 125 degrees, which constitutes normal range of motion for that joint. As such, separate service connection for left hip flexion was not warranted prior to February 29, 2012. Furthermore, although degenerative arthritis is present in the left hip, a separate 10 percent rating for a joint affected by limitation of motion (although the limitation of motion is noncompensable) is not warranted under Diagnostic Code 5003 because the Veteran’s left hip already receives a 10 percent disability evaluation for limitation of extension. However, the April 2019 VA examination report indicated that following three repetitions of range of motion, after use repeated over time, and during flare-ups, the Veteran’s left hip adduction was limited such that he could not cross his legs. This warrants a 10 percent disability rating pursuant to Diagnostic Code 5253. As such, in consideration of this functional loss, the Veteran is entitled to a separate 10 percent rating for limitation of adduction effective April 9, 2019, the date of the VA examination which first showed that the Veteran’s hip adduction was limited to the point that he could not cross his legs. However, the Board finds that the Veteran is not entitled to a disability rating in excess of 10 percent, as the evidence does not reflect limitation of abduction lost beyond 10 degrees at any time during the rating period on appeal, even when considering functional loss after repeated use over time and during flare ups. 2. Entitlement to higher disability ratings for the right knee. The Veteran seeks entitlement to higher disability ratings for his service-connected right knee symptomatology. The Veteran initially filed a claim of entitlement to service connection for a right knee disability in June 2009. In a September 2009 Rating Decision, the RO granted entitlement to service connection for right knee patellar tendonitis under Diagnostic Code 5261 and assigned a noncompensable disability evaluation effective June 16, 2009, the date of his claim. In an August 2012 Rating Decision, the RO increased the Veteran’s disability evaluation for right knee patellar tendonitis to 40 percent effective February 12, 2012, the date of a VA examination demonstrating worsening limitation of right knee extension. As such, the Board will assess the propriety of the noncompensable disability evaluation assigned prior to February 12, 2012, as well as the 40 percent evaluation assigned since February 12, 2012. Additionally, the Board notes that in a January 2017 Rating Decision, the RO also granted entitlement to a separate 10 percent disability evaluation for right knee instability under Diagnostic Code 5257, effective October 14, 2016. The Board will also consider the propriety of this disability evaluation. Prior to February 7, 2021, Diagnostic Code 5257 provided for a 10 percent rating for slight recurrent subluxation or lateral instability. A 20 percent rating was warranted for moderate subluxation or lateral instability. A maximum 30 percent rating was warranted for severe recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, Diagnostic Code 5257. The Board notes that the applicable rating criteria for “other impairment of the knee” under Diagnostic Code 5257 were revised effective February 7, 2021. Under the amended regulations, a 10 percent disability rating is warranted for recurrent subluxation or instability when there is evidence of 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. A 20 percent rating is warranted when there is evidence of either (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; or (b) 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. A 30 percent rating is warranted when there is evidence of 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. Also under the amended version of Diagnostic Code 5257, patellar instability warrants a 10 percent disability rating when 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 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 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. Note (1) to the amended Diagnostic Code 5257 indicates that for patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. Note (2) indicates that a surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration). Pursuant to 38 C.F.R. §§ 4.40 and 4.45, pain is inapplicable to ratings under Diagnostic Code 5257 because it is not predicated on loss of range of motion. See Johnson v. Brown, 9 Vet. App. 7, 11 (1996). Under Diagnostic Code 5260, limitation of flexion of a leg warrants a 10 percent evaluation if flexion is limited to 45 degrees and a 20 percent evaluation is assigned if flexion is limited to 30 degrees. Flexion that is limited to 15 degrees is evaluated as 30 percent disabling. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Limitation of extension of a leg warrants a 10 percent evaluation when it is limited to 10 degrees; a 20 percent evaluation when it is limited to 15 degrees; a 30 percent rating when it is limited to 20 degrees; a 40 percent rating when it is limited to 30 degrees; and a maximum 50 percent rating when it is limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261. Here, there is no evidence of knee resurfacing or replacement to warrant a disability rating under Diagnostic Code 5055, knee ankylosis to warrant a disability rating under Diagnostic Code 5256, dislocated or removed semilunar cartilage to warrant disability ratings under Diagnostic Codes 5258 or 5259, impairment of the tibia and fibula to warrant a disability rating under Diagnostic Code 5262, or genu recurvatum to warrant a disability rating under Diagnostic Code 5263. Generally, in a claim for an increased rating, where the rating criteria are amended during the course of the appeal, the Board considers both the former and the current schedular criteria. Should an increased rating be warranted under the revised criteria, that award may not be made effective before the effective date of the liberalizing change. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003); see also VAOPGCPREC 7-2003. Throughout the period on appeal, the Veteran has utilized a cane for mobility, ambulation, and to alleviate severe pain with weight bearing. The Veteran was provided with a VA examination in August 2009, at which time he was diagnosed as having right knee patellofemoral syndrome or patellar tendinitis due to alteration of the gait. Subjectively, the Veteran described pain with walking, primarily around the quadriceps tendon insertion into the patella. Objective examination demonstrated tenderness along the patellar tendon from the quadriceps muscle, with no swelling. Range of motion revealed flexion to 140 degrees and extension to zero degrees. Repeated flexion and extension of the knee produced no indication of pain, weakness, or fatigue. Lateral and medial stress testing of the knee showed no laxity of the lateral or medial collateral ligaments. Anterior and posterior drawer sign was negative, which indicated intact anterior and posterior cruciate ligaments. The Veteran also exhibited a negative McMurray’s sign and did not appear to have pain upon ambulation. X-rays revealed degenerative changes of the medial tibiofemoral joint and the femoral patella joint. The Veteran was provided with a VA Knee and Lower Leg Conditions examination in February 2012, at which time he was diagnosed as having right knee patellar tendonitis. Subjectively, the Veteran reported pain in cold and damp weather. Range of motion testing revealed right knee flexion limited to 130 degrees (with no objective evidence of painful motion) and extension limited to 30 degrees (with painful motion at 15 degrees). The Veteran was able to perform repetitive-use testing with three repetitions, and with no loss in range of motion after these repetitions and with no functional loss and/or functional impairment of the right knee and lower leg. There was no tenderness or pain to palpation of the joint line or soft tissues of the right knee. Muscle strength testing revealed normal strength during right knee flexion and extension. Joint stability testing produced normal results for anterior instability (Lachman test), posterior instability (posterior drawer test), and medial lateral instability (valgus/varus pressure). There was no evidence of patellar subluxation or dislocation, meniscus (semilunar cartilage) condition, or joint replacement relevant to the right knee. The VA examiner indicated that there was no functional impairment of the right knee such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. The Veteran’s right knee disability impacted his ability to work only in the sense that it limited his ambulation. The Veteran was again provided with a VA Knee and Lower Leg Conditions examination in April 2015, at which time he was diagnosed as having patellar tendonitis, right knee. Subjectively, the Veteran indicated that right knee pain increased when the knee had to support his body weight. Range of motion testing revealed right knee flexion to 115 degrees and extension to zero degrees, with pain exhibited during both motions. However, there was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The Veteran was able to perform repetitive-use testing with at least three repetitions, with no additional loss of function or range of motion after three repetitions. The Veteran was also examined immediately after repetitive use over time, with no evidence of pain, weakness, fatigability and/or incoordination significantly limiting functional ability with repeated use over a period of time. The examiner indicated that the examination was being conducted during a flare-up of knee pain and, although pain, weakness, fatigability or incoordination significantly limited functional ability with flare ups, it did not further reduce the Veteran’s range of motion. Additional contributing factors of the Veteran’s right knee disability included less movement than normal, disturbance of locomotion, and interference with sitting. Muscle strength testing indicated active movement against some resistance during both right knee flexion and extension, although the examiner indicated that this did not constitute a reduction in muscle strength and there was no evidence of muscle atrophy. There was also no evidence of ankylosis, recurrent subluxation, lateral instability, recurrent effusion, recurrent patellar dislocation, or meniscus condition. Joint stability testing was normal, with negative results for anterior instability (Lachman test), posterior instability (posterior drawer test), medial instability, and lateral instability. The VA examiner indicated that there was no functional impairment of the right knee such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. The Veteran’s right knee disability impacted his ability to work only in the sense that it limited his mobility. The Veteran was provided with a VA Knee and Lower Leg Conditions examination in May 2018, at which time he was diagnosed as having right knee patellar tendonitis and instability. Subjectively, the Veteran described constant pain in his right knee. Range of motion testing revealed right knee flexion to 125 degrees and extension to zero degrees, with no pain noted on examination. There was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue, and no evidence of pain with weight bearing. The Veteran was able to perform repetitive-use testing with at least three repetitions, with no additional loss of function or range of motion after three repetitions. There was no evidence of pain, weakness, fatigability and/or incoordination significantly limiting functional ability with repeated use over a period of time or during flare ups. Additional contributing factors of the Veteran’s right knee disability included less movement than normal. Muscle strength testing indicated normal strength during both right knee flexion and extension, with no evidence of muscle atrophy. There was also no evidence of ankylosis, recurrent subluxation, lateral instability, recurrent effusion, recurrent patellar dislocation, or meniscus condition. Joint stability testing was normal, with negative results for anterior instability (Lachman test), posterior instability (posterior drawer test), medial instability, and lateral instability. The VA examiner indicated that there was no functional impairment of the right knee such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. The Veteran’s right knee disability impacted his ability to work in that he would be limited from kneeling or squatting, use of ladders, stairs, working at heights, and would likely require a sedentary (or at most light) work level. The Veteran was provided with a VA Knee and Lower Leg Conditions examination in April 2019, at which time he was diagnosed as having right knee patellar tendonitis, degenerative arthritis, strain, and instability. Subjectively, the Veteran described extreme pain with swelling and stiffening. Range of motion testing revealed right knee flexion to 130 degrees and extension to zero degrees, with pain noted during both flexion and extension of the knee. There was objective evidence of tenderness to palpation of the patella reflective of right knee strain, right knee patellar tendonitis, and right knee degenerative arthritis with knee instability. There was also evidence of pain with weight bearing. The Veteran was able to perform repetitive-use testing with at least three repetitions, with right knee flexion limited to 120 degrees after three repetitions due to pain, fatigue, and weakness. Pain, weakness, and fatigability significantly also limited functional ability with repeated use over a period of time and during flare ups, further limiting right knee flexion to 115 degrees (with repeated use over a period of time) and to 110 degrees (during flare-ups). Additional contributing factors of the Veteran’s right knee disability included less movement than normal, weakened movement, instability of station, disturbance of locomotion, and interference with standing. The examiner explained that unsteadiness/instability, weakness, and decreased range of motion due to pain limited prolonged walking and standing due to right knee strain, right knee patellar tendonitis, and right knee degenerative arthritis with knee instability. Muscle strength testing indicated active movement against some resistance during both right knee flexion and extension, which constituted a reduction in muscle strength, with evidence of muscle atrophy. There was no evidence of ankylosis. However, there was evidence of slight recurrent subluxation as well as slight lateral instability of the right knee. While there was evidence of recurrent episodes of left knee swelling, there was no evidence of recurrent effusion in the right knee. Joint stability revealed negative results for anterior instability (Lachman test), posterior instability (posterior drawer test), and medial instability; however, testing for lateral instability yielded positive results of 1+(0-5 millimeters). There was no evidence of recurrent patellar dislocation or meniscus condition. The VA examiner indicated that there was no functional impairment of the right knee such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. The Veteran’s right knee disability impacted his ability to work in that knee symptomology caused limitations in running, kneeling, prolonged standing, prolonged walking due to flare-ups that required breaks and relief from weight bearing. The April 2019 VA examiner further explained that: Upon reviewing the Veteran's medical record and agreeing with the opinion stated by J Collier, PA-C on 06/30/2009, the Right knee patellar tendonitis does have slight laxity causing instability all of which is due to the severe degenerative state of the left knee. Current examination findings of weakness, atrophy, pain and decreased range of motion led to disease progression with a new diagnosis of Right knee strain, right knee patellar tendonitis, and right knee degenerative arthritis with knee instability. The Range of motion noted for the Right knee from 2009-2019 varied in flexion: 0-(115-140). Current examination findings are consistent with limitation in range of motion with active motion, passive motion, pain on weight-bearing and in nonweight-bearing. It can be speculated that loss of functioning would occur due to the degenerative arthritic condition in the right knee. Medical literature supports that "Joint ROM can depend on factors other than articular deformation. Certain motions may be too painful for the patient to complete, or the patient may lack the muscle strength to maintain the joint action. This results in impaired ROM without a clear articular cause for this impairment" (Steultjens et al, 2000). Considering the multifactorial conditions that affect ROM, variance can be considered to occur in ROM in all settings: active, passive, weight-bearing or nonweight-bearing and the exact degree cannot be speculated. The Veteran was provided with a VA Knee and Lower Leg Conditions examination in October 2019, at which time he was diagnosed as having right knee patellar tendonitis and instability. Subjectively, the Veteran described constant pain in his right knee. Range of motion testing revealed right knee flexion to 125 degrees and extension to zero degrees, with no pain noted on examination. There was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue, and no evidence of pain with weight bearing. The Veteran was able to perform repetitive-use testing with at least three repetitions, with no additional loss of function or range of motion after three repetitions. There was no evidence of pain, weakness, fatigability and/or incoordination significantly limiting functional ability with repeated use over a period of time or during flare ups. Muscle strength testing indicated normal strength during both right knee flexion and extension, with no evidence of muscle atrophy. There was also no evidence of ankylosis, recurrent subluxation, lateral instability, recurrent effusion, recurrent patellar dislocation, or meniscus condition. Joint stability testing was normal, with negative results for anterior instability (Lachman test), posterior instability (posterior drawer test), medial instability, and lateral instability. The VA examiner indicated that there was no functional impairment of the right knee such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. The Veteran’s right knee disability impacted his ability to work in that he would be limited in kneeling and squatting due to his right knee patellar tendonitis. The Veteran was most recently provided with a VA Knee and Lower Leg Conditions examination in March 2020, at which time he was diagnosed as having right knee patellar tendonitis. Subjectively, the Veteran described stiffness, aching, and some swelling. Range of motion testing revealed right knee flexion to 110 degrees and extension to zero degrees, with pain noted on examination that caused functional loss. There was objective evidence of localized tenderness or pain on palpation of the top of the knee, and no evidence of pain with weight bearing. The Veteran was able to perform repetitive-use testing with at least three repetitions, with no additional loss of function or range of motion after three repetitions. Pain and fatigability significantly limited functional ability with repeated use over a period of time and during flare ups, resulting in further limitation of right knee flexion to 105 degrees. Muscle strength testing indicated active movement against some resistance during both right knee flexion and extension, which constituted a reduction in muscle strength, although there was no evidence of muscle atrophy. There was also no evidence of ankylosis, recurrent subluxation, lateral instability, recurrent effusion, recurrent patellar dislocation, or meniscus condition. Joint stability revealed negative results for anterior instability (Lachman test), posterior instability (posterior drawer test), and medial instability; however, testing for lateral instability yielded positive results of 1+ (0-5 mm). The VA examiner indicated that there was no functional impairment of the right knee such that no effective function remained other than that which would be equally well served by an amputation with prosthesis. The Veteran’s right knee disability impacted his ability to work in that it limited running, kneeling, crawling, squatting, prolonged standing, prolonged walking, and high impact activities. A retrospective VA opinion was obtained in March 2020, at which time the examiner explained that: [M]otion in 2009 was normal. Therefore active, passive, weight-bearing and nonweight-bearing would likely be the same. There is no pain noted on motion and repetitive motion was normal. The range of motion on initial evaluation on the DBQ 2/29/12 was 30° to 130°. No loss or pain was reported on observed repetitive motion. Oddly, painful motion was noted at 15° for extension, and no painful motion was noted for flexion. The numbers for extension are contradictory, as the veteran apparently could not extend to 15°. I cannot reconcile the error. It is possible extension was 15°, with pain at 30° of extension. The exam 10/4/16 gives a ROM of 0 to 130 with no loss on observed motion, and no pain on motion. The 2020 DBQ has a ROM of 0 to 110° with 0 to 105° on observed repetitive motion. Passive and active motion are, more likely than not, similar, if not the same. Weight-bearing and nonweight-bearing are also likely to be similar, if not the same. For flares in 2012, an additional 5° loss for extension and 5° for flexion would be reasonable estimates. For current flares, no loss for extension is expected and 5° loss for flexion is a reasonable estimate. There is no clear explanation for the loss of ability to extend on the 2012 exam, with apparent amelioration since that time. Taken as a whole, there appears to be mild loss of flexion overall, with no major change in ability to extend the joint since 2009. The 2016 exam appears to be somewhat of an outlier. These estimates are based on reported symptoms, or lack thereof, documented at the time of the available exams. Practically speaking, pain with weight-bearing commonly is the same as active use of a joint, and passive and nonweight-bearing are often similar. There is no evidence to the contrary in the records. Thus, the baseline change from 2009 is 0° to 140° and 0° to 110° in 2020. The estimated loss due to flares at the time of individual exams are noted and do not vary dramatically. The Board reiterates that the Veteran has been service connected for right knee patellar tendonitis manifested by limitation of flexion pursuant to Diagnostic Code 5261 throughout the rating period on appeal, with a noncompensable rating assigned prior to February 29, 2012, and a 40 percent disability rating assigned since February 29, 2012. He has also been service connection for right knee instability and assigned a 10 percent disability rating under Diagnostic Code 5257 since October 14, 2016, the date of a VA examination which indicated the presence of slight right knee instability. Prior to February 29, 2012, the Veteran’s right knee flexion was limited to 140 degrees while his knee extension was to zero degrees. These findings would not warrant the assignment of a compensable rating based on limitation of motion under either Diagnostic Code 5260 or Diagnostic Code 5261. Subjectively, at the time of his August 2009 VA examination, the Veteran described pain with walking, primarily around the quadriceps tendon insertion into the patella. These complaints of right knee pain were corroborated by contemporaneous VA treatment records dated in 2009. Additionally, X-rays associated with the August 2009 VA examination revealed degenerative changes of the medial tibiofemoral joint and the femoral patella joint. As actually painful joints are entitled to at least the minimum compensable rating for the joint, the Board finds that the Veteran is entitled to the minimum 10 percent disability rating under Diagnostic Code 5261 prior to February 29, 2012. See 38 C.F.R. § 4.59. Since February 29, 2012, the Veteran’s right knee extension, at worst, has been limited to 30 degrees, even when considering functional loss after repeated use over time and during flare ups. This finding does not support the assignment of a disability rating in excess of the currently assigned 40 percent for limitation of extension under Diagnostic Code 5261. Similarly, since February 29, 2012, the Veteran’s right knee flexion, at worst, has been limited to 110 degrees, even when considering functional loss after repeated use over time and during flare ups. This finding does not support the assignment of a compensable disability rating for limitation of flexion under Diagnostic Code 5260. With respect to subluxation and instability, there is no evidence of either symptom prior to October 14, 2016. At his August 2009 examination, the Veteran reported no instability or locking; although the VA examiner suggested instability of station due to unloading of the left knee, lateral and medial stress testing of the right knee showed no laxity of the lateral or medial collateral ligaments, and he had a negative anterior and posterior drawer sign. Similarly, all joint stability tests were within normal limits and there was no evidence of recurrent subluxation on the February 2012 and April 2015 VA examinations. As such, an effective date prior to October 14, 2016, is not warranted for the separate award of service connection for right knee instability. At the time of the October 14, 2016, VA examination, there was evidence of both medial instability and lateral instability of the right knee, both measured as 1+ (0-5 millimeters). Although the May 2018 VA examination found no evidence of right knee instability or recurrent subluxation, the April 2019 VA examination indicated both slight recurrent subluxation as well as slight lateral instability. The April 2019 examination additionally indicated that the Veteran used a cane daily and knee brace daily for his right knee. However, the next VA examination in October 2019 again indicated that there was no evidence of recurrent subluxation or lateral instability. While the most recent VA examination in March 2020 indicated that there was no history of recurrent subluxation, testing for lateral instability of the right knee was again positive at 1+ (0-5 millimeters). Significantly, there has been no evidence of surgical repair of the right knee. Based on this evidence, under the version of Diagnostic Code 5257 in effect prior to February 7, 2021, a disability rating for right knee instability in excess of 10 percent is not warranted because the instability and subluxation have been characterized as “slight” rather than as “moderate” or “severe” in nature. However, as the record reflects that the Veteran must use a cane daily for mobility and ambulation due to his service-connected right knee instability, the Board finds that he is entitled to a 20 percent disability rating under the amended version of Diagnostic Code 5257 in effect since February 7, 2021. As such, the Veteran is entitled to a 20 percent disability rating pursuant to Diagnostic Code 5257 effective February 7, 2021, the effective date of the liberalizing change to Diagnostic Code 5257. However, the Board finds that the Veteran is not entitled to a disability rating in excess of 30 percent for right knee instability at any time during the rating period on appeal, as the evidence does not establish that his right knee symptomatology includes unrepaired or failed repair of complete ligament tear or surgical repair of the right knee, as required for the next higher rating under the amended version of Diagnostic Code 5257. For the foregoing reasons, the weight of the evidence is against awarding disability ratings in excess of those outlined above. Although the Veteran is entitled to the benefit of the doubt where evidence is in approximate balance, the benefit of the doubt doctrine is inapplicable where, the preponderance of the evidence is against awarding ratings higher than those granted herein. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). With respect to all increased ratings claims, the Board has considered whether referral for extraschedular consideration is warranted. Ratings shall be based as far as practicable upon the average impairments of earning capacity with the additional proviso that the Secretary shall from time to time readjust this schedule of ratings in accordance with experience. To accord justice to the exceptional case where the schedular ratings are found to be inadequate, the Under Secretary for Benefits or the Director, Compensation and Pension Service, upon field station submission, is authorized to approve on the basis of the criteria set forth in this paragraph an extraschedular rating commensurate with the average earning capacity impairment due exclusively to the service-connected disability or disabilities. An extraschedular disability rating is warranted based upon a finding that the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization that would render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b)(1). The Court has clarified that there is a three-step inquiry for determining whether a veteran is entitled to an extraschedular rating. Thun v. Peake, 22 Vet. App. 111, 115 (2008). Initially, the Board must determine whether the evidence presents such an exceptional disability picture that the available schedular ratings for the service-connected disability are inadequate. See Yancy v. McDonald, 27 Vet. App. 484 (2016); Doucette v. Shulkin, 28 Vet. App. 366 (2017) (holding that either the veteran must assert that a schedular rating is inadequate or the evidence must present exceptional or unusual circumstances); Sowers v. McDonald, 27 Vet. App. 472, 478 (2016) (“[t]he rating schedule must be deemed inadequate before extraschedular consideration is warranted”). Second, if the schedular rating does not contemplate the veteran’s level of disability and symptomatology and is found inadequate, the Board must determine whether the veteran’s disability picture exhibits other related factors such as marked interference with employment and frequent periods of hospitalization. Thun, 22 Vet. App. at 116. Third, if the first two Thun elements have been satisfied, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the veteran’s disability picture requires the assignment of an extraschedular rating. Thun at 116. In other words, the first element of Thun compares a veteran’s symptoms to the rating criteria, while the second element considers the resulting effects of those symptoms; if either prong is not met, then referral for extraschedular consideration is not appropriate. Yancy, 27 Vet. App. at 494-95. With respect to the first prong of Thun, the Board finds that the symptomatology and impairment caused by the Veteran’s service-connected left hip and right knee disabilities is specifically contemplated by the schedular rating criteria, and no referral for extraschedular consideration is required. These signs and symptoms, and their resulting impairment, are fully contemplated by the rating schedule. The diagnostic codes in the rating schedule corresponding to disabilities of the knee and hip provide disability ratings on the basis of limited motion. For all musculoskeletal disabilities, the rating schedule contemplates functional loss, which may be manifested by, for example, decreased or abnormal excursion, strength, speed, coordination, or endurance. 38 C.F.R. § 4.40; Mitchell, 25 Vet. App. at 37. For disabilities of the joints, the rating schedule specifically contemplates factors such as weakened movement; excess fatigability; pain on movement; disturbance of locomotion; and interference with sitting, standing, and weight bearing. 38 C.F.R. §§ 4.45, 4.59; Mitchell, 25 Vet. App. at 37. Given the variety of ways in which the rating schedule contemplates functional loss for musculoskeletal disabilities, the Board concludes that the schedular rating criteria reasonably describe the Veteran’s disability picture. In short, there is nothing exceptional or unusual about the Veteran’s disability because the rating criteria reasonably describe his disability level and symptomatology. Thun, 22 Vet. App. at 115. Comparing the Veteran’s disability, symptomatology, and functional impairment of the left hip and right knee to the rating schedule, the disability throughout the entire period under consideration is contemplated by the rating schedule and the assigned ratings are adequate. Absent any exceptional factors associated with the service-connected disability, the Board finds that the criteria for submission for assignment of an extraschedular rating pursuant to 38 C.F.R. § 3.321(b)(1) are not met. See Bagwell v. Brown, 9 Vet. App. 337 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). REASONS FOR REMAND The Veteran also seeks entitlement to a TDIU. Unfortunately, the Board finds that additional development must be undertaken before this claim can be adjudicated on the merits. The current period on appeal for the increased rating claims addressed herein dates back to June 2009, when the Veteran initially filed his claims of entitlement to service connection for right knee symptomatology and entitlement to an increased disability rating for his service-connected left hip symptomatology. In May 2012, the Veteran submitted a VA Form 21-527 (Income-Net Worth and Employment Statement), at which time he indicated he was last employed in March 2005 (self-employed in residential home repair). The RO interpreted this submission as a claim for nonservice-connected pension benefits, which were granted in June 2012. However, the Board, in a September 2013 decision, found that the Veteran’s May 2012 submission contained a claim that the Veteran’s bilateral knee disabilities and left hip disability prevented him from working. As such, the Board asserted jurisdiction over the TDIU claim as part and parcel of the Veteran’s increased disability rating claims then before the Board. See Rice v Shinseki, 22 Vet. App. 447 (2009). Social Security Administration (SSA) records received August 2016 note that the Veteran was granted SSA disability benefits due to his inability to gain and sustain substantial gainful employment as of January 9, 2009, due to the primary diagnosis of osteoarthritis of the knee. However, a review of the record suggests that the Veteran never filed a VA Form 21-8940 (Veteran’s Application for Increased Compensation Based on Unemployability). Information gleaned from this application, such as the Veteran’s relevant work and education history, are crucial elements to the Board’s TDIU analysis. On remand, the Veteran should be sent a VA Form 21-8940 and requested to complete and return it. This information is necessary for deciding the claim. See Jernigan v. Shinseki, 25 Vet. App. 220, 229-30 (2012). The matters are REMANDED for the following action: 1. Request that the Veteran submit a VA Form 21-8940 (Application for Increased Compensation Based on Unemployability), in addition to any evidence that is relevant regarding his claim for a TDIU, in particular any evidence regarding his level of education and work history. 2. Following any additional development deemed appropriate based on the evidence received from the Veteran, readjudicate the Veteran’s claim of entitlement to a TDIU. If any benefit sought on appeal is not granted to the Veteran’s satisfaction, then the Veteran and his representative must be provided with a Supplemental Statement of the Case and be given an adequate opportunity to respond. Thereafter, the case should be returned to the Board for further appellate action. D. C. JOHNSON Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Anthony M. Flamini 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.