Citation Nr: 21012993 Decision Date: 03/08/21 Archive Date: 03/08/21 DOCKET NO. 10-48 947 DATE: March 8, 2021 ORDER A rating higher than 30 percent for right knee limitation of flexion, under both schedular and extraschedular criteria, is denied. A separate rating of 10 percent for limited extension of the right knee is granted. FINDINGS OF FACT The Veteran’s right knee had a flexion limitation of 15 degrees, and extension to 10 degrees, with no evidence of instability or recurrent subluxation. CONCLUSIONS OF LAW 1. The criteria for entitlement to a schedular or extraschedular disability rating higher than 30 percent for a right knee limitation of flexion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.71a, Diagnostic Code 5260. 2. The criteria for a separate 10 percent rating, but no higher, for limitation of extension of the right knee have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Codes 5261. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from December 1977 to March 1978. The Veteran appeared at an April 2016 hearing before the undersigned Veterans Law Judge. In July 2016 and September 2017, the appeal was remanded for additional development. In an August 2019 decision, the Board granted the Veteran’s claim for an increased initial rating of 30 percent for a right knee disability, based on limitation of flexion. The Veteran appealed the Board’s for an additional separate compensable rating based on limitation of extension of the right knee to the U.S. Court of Appeals for Veterans Claims (Court). By way of an October 2020 Order, the Court granted a Joint Motion for Partial Remand (JMPR) that vacated, in part, the August 2019 denial of entitlement to an initial disability rating in excess of 30 percent for a right knee disability and remanded the matter for adjudication consistent with its terms. It is valuable to note for the record that the Veteran is in receipt of a total disability rating based on individual unemployability (TDIU) throughout the pendency of this appeal. The Veteran has also received special monthly compensation. Entitlement to an initial rating in excess of 30 percent for a right knee disability Ratings for service-connected disabilities are determined by comparing the Veteran’s symptoms with criteria listed in VA’s Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 C.F.R. Part 4. When rating a service-connected disability, the entire history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). 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 entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2009). The assignment of a particular diagnostic code to evaluate a disability is “completely dependent on the facts of a particular case.” See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual’s relevant medical history, the diagnosis, and demonstrated symptomatology. Traumatic arthritis shown by x-ray studies is rated based on limitation of motion of the affected joint. When limitation of motion would be noncompensable under a limitation-of-motion code, but there is at least some limitation of motion, a 10 percent disability rating may be assigned for each major joint so affected. 38 C.F.R. § 4.71a, Diagnostic Codes 5003 (degenerative arthritis) and 5010 (traumatic arthritis). Diagnostic Code 5003 states that degenerative arthritis established by x-ray findings will be rated on the basis of limitation of motion under the appropriate Diagnostic Codes for the specific joint or joints involved. 38 C.F.R. § 4.71a, Diagnostic Code 5003. When, however, the limitation of motion is noncompensable under the appropriate Diagnostic Codes, a rating of 10 percent may be applied to each such major joint or group of minor joints affected by limitation of motion. The limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a, Diagnostic Code 5003. In the absence of limitation of motion, x-ray evidence of arthritis involving two or more major joints or two or more minor joint groups, will warrant a rating of 10 percent; in the absence of limitation of motion, x-ray evidence of arthritis involving two or more major joint groups with occasional incapacitating exacerbations will warrant a 20 percent rating. The above ratings are to be combined, not added under Diagnostic Code 5003. 38 C.F.R. § 4.71a, Diagnostic Code 5003, Note 1. The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. Thus, with or without degenerative arthritis, it is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. §§ 4.59; see Burton v. Shinseki, 25 Vet. App. 1, 5 (2011) (holding that the provisions of 38 C.F.R. § 4.59 are not limited to disabilities involving arthritis). Moreover, when evaluating musculoskeletal disabilities, VA may, in addition to applying the schedular criteria, assign a higher disability rating when the evidence demonstrates functional loss due to limited or excessive movement, pain, weakness, excessive fatigability, or incoordination, to include during flare-ups and with repeated use, if those factors are not considered in the rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; see also DeLuca v. Brown, 8 Vet. App. 202 (1995); Burton, 25 Vet. App. at 5. The Court also held in Correia v. McDonald, 28 Vet. App. 158 (2016) that the final sentence of 38 C.F.R. §§ 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. Nonetheless, a disability rating higher than the minimum compensable rating is not assignable under any diagnostic code relating to range of motion where pain does not cause a compensable functional loss. Rather, the “pain must affect some aspect of ‘the normal working movements of the body’ such as ‘excursion, strength, speed, coordination, and endurance,” as defined in 38 C.F.R. §§ 4.40, before a higher rating may be assigned. See Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011) (noting that while “pain may cause a functional loss, pain itself does not constitute a functional loss,” and, is therefore, not grounds for entitlement to a higher disability rating). As the Veteran can see from the above, the evaluation of knee problem in VA law is complicated. Notwithstanding the fact that the Veteran has TDIU, the Veteran seeks higher/separate disability ratings for his right knee disability. The Veteran’s service-connected right knee disability has been assigned a 30 percent disability rating for limitation of flexion under Diagnostic Codes 5260. 38 C.F.R. § 4.71a, Diagnostic Code 5260. During the pendency of the appeal, the rating criteria for evaluating 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 claim 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. Flexion of the leg limited to 60 degrees warrants a 0 percent rating, flexion limited to 45 degrees warrants a 10 percent rating, flexion limited to 30 degrees warrants a 20 percent rating, and flexion limited to 15 degrees warrants a 30 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Extension limited to 5 degrees warrants a 0 percent rating, extension limited to 10 degrees warrants a 10 percent rating, extension limited to 15 degrees warrants a 20 percent rating, extension limited to 20 degrees warrants a 30 percent rating, extension limited to 30 degrees warrants a 40 percent rating, and extension limited to 45 degrees warrants a 50 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5261. Flexion of the knee to 140 degrees is considered full and extension to 0 degrees is considered full. See 38 C.F.R. § 4.71, Plate II. VA’s General Counsel has held that separate ratings may be assigned for disability of the same joint under Diagnostic Codes 5260 (for limitation of flexion) and 5261 (for limitation of extension). VAOGCPREC 9-2004 (September 2004). In contrast, an evaluation under Code 5003 may not be combined with one under Code 5260 or Code 5261; Code 5003 does not specify the plane of limited motion considered, and so evaluation under either of the other limitation of motion Codes forecloses the possibility of multiple evaluations. See generally VAOPGCPREC 23-97 and VAOPGCREC 9-98; 38 C.F.R. § 4.14. Prior to the regulatory change, the rating schedule provided for a 10 percent rating for slight recurrent subluxation or lateral instability, a 20 percent rating for moderate recurrent subluxation or lateral instability, and a 30 percent rating for severe recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, Diagnostic Code 5257. As of February 7, 2021, under the amended criteria for recurrent subluxation or lateral instability, a 10 percent rating is warranted for 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 for (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 for 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. 38 C.F.R. § 4.71a, Diagnostic Code 5257. As of February 7, 2021, under the amended criteria for recurrent patellar instability, a 10 percent rating is warranted for 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 for 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 for 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. 38 C.F.R. § 4.71a, Diagnostic Code 5257. For patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. 38 C.F.R. § 4.71a, Diagnostic Code 5257, Note (1). 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). 38 C.F.R. § 4.71a, Diagnostic Code 5257, Note (2). Dislocated semilunar cartilage, with frequent episodes of “locking,” pain, and effusion into the joint will be rated a maximum 20 percent disabling. 38 C.F.R. § 4.71a , Diagnostic Code 5258. Removal of the semilunar cartilage, if symptomatic, will be rated a maximum 10 percent disabling. 38 C.F.R. § 4.71a, Diagnostic Code 5259. The Board has also considered whether separate or increased evaluations are warranted under any other Diagnostic Codes pertaining to knee disabilities that would afford the Veteran higher ratings. Here, there is no evidence of ankylosis of the knee to warrant a rating under Diagnostic Code 5256; there is no evidence of dislocated semilunar cartilage, or removal of the semilunar cartilage under Diagnostic Codes 5258, 5259; no evidence of malunion or nonunion of the tibia and fibula to warrant a rating under Diagnostic Code 5262 for impairment of the tibia, and; no evidence of genu recurvatum to warrant a rating under Diagnostic Code 5263. Hence, the Board will not discuss these Diagnostic Codes any further. On VA examination in August 2013 the Veteran complained of pain in the right knee medially. X-rays revealed medial degenerative changes. The Veteran denied mechanical locking but had pain with motion on inside of the knee. He further denied instability or swelling. He endorsed flare-ups. The Veteran had initial range of motion (ROM) measurements in degrees as follows: right knee flexion of 115, and right knee extension of 0. There were no ROM changes to his right knee after post-repetitive use testing. The VA examiner noted pain on movement, and less movement than normal. The Veteran exhibited normal muscle strength and joint stability. The medial/lateral collateral ligaments stability test, the anterior/posterior cruciate ligaments stability test and the medial/lateral meniscus stability test are all within normal limits. There was no evidence of subluxation/dislocation, or a meniscal condition. The Veteran constantly used braces and crutches for ambulation due to his ankle, foot and knee pain. He denied any disruption with activities of daily living. The examiner determined that the occupationally, the right knee disability interfered with his ability to stand, but he was capable of sedentary employment. A December 2013 VA medical record noted that the Veteran’s right knee had a 15 degree flexion contracture and could not flex the right knee to 90 degrees. A VA physician in June 2014 noted a right knee and medial tibial flare are hyper-sensitive to light touch and manual pressure. Additionally, the VA physician noted that the Veteran had a good ROM. However, the Veteran stated that he still had knee pain, and noted popping and grinding. In July 2014, a VA physician assistant noted a large joint effusion. A November 2014 right knee MRI showed a torn meniscus and trace suprapatellar joint effusion. The Veteran underwent a VA examination in August 2016. The examiner noted a that the Veteran had a prosthetic due to lower leg amputation done in April 2014. The Veteran, who was in a wheelchair, described constant knee pain with flare-ups on standing. He only stood for transfers with home life. His spouse assisted with bathing. The Veteran denied swelling or instability, stating that he only used the knee seldomly for activity. There was decreased motion due to pain. While the Veteran had full extension of the right knee, it was painful at 30 degrees short of extension with the prosthetic on, but it was not limited without the prosthetic. Flexion was to 95 degrees flexion with and without prosthetic. There were no ROM changes to his right knee after post-repetitive use testing. The VA examiner reported that the Veteran’s flare ups, described in terms of ROM, presented a right knee flexion 10 to 90 degrees, and extension 90 to 10 degrees. The Veteran had normal muscle strength and joint stability. The examiner noted mild to moderate pain on palpation of medial joint line. There was evidence of pain on weight bearing. The medial/lateral collateral ligaments stability test, the anterior/posterior cruciate ligaments stability test and the medial/lateral meniscus stability test are all within normal limits. There was no evidence of subluxation/dislocation, or a meniscal condition. There was no ankylosis. The Veteran used a wheelchair, brace, and prosthetic for his right leg to help locomotion. Concerning limitation of function, the examiner opined that the right knee was not the limiting factor for activities of daily living, but rather his multiple issues the below the knee amputation, as well as left knee pain. The right knee only restricted his ability to engage in physical labor work, but not in a sedentary environment. In December 2017, the Veteran underwent a VA examination. He reported limited locomotion despite having a leg prosthesis fitted. He also had pain while standing. The examiner noted that examination of the Veteran’s right knee disability was complicated by the unrelated recent right leg below the knee amputation (stump revision) which meant that at the time he was examined, the Veteran was still on non-weight bearing status for right leg. There was localized tenderness or pain on palpation of the media and lateral joint lines, along with swelling. The Veteran had an initial ROM of right knee flexion to 90 degrees and extension to 10 degrees, with pain. There were no ROM changes to his right knee after post-repetitive use testing. The Veteran’s knee was painful for both on active and passive range of motion. Weight bearing for the right knee was not being done at present but would be expected to be painful if/when prosthesis was fitted. The Veteran had normal muscle strength and joint stability. The medial/lateral collateral ligaments stability test, the anterior/posterior cruciate ligaments stability test and the medial/lateral meniscus stability test are all within normal limits. The Veteran did not require use any assistive device as the result of the right knee disability. The VA examiner denied the presence of ankylosis, noting a right knee meniscal tear. The examiner reported limited ambulation despite having had a leg prosthesis fitted. It was noted that the amputation and opposite left knee pain were major factors in limited ambulation and usage of a motorized wheelchair. As a result of the right knee disability, the Veteran was only capable of sedentary employment. The Board notes that Diagnostic Code 5003 cannot serve as the basis for higher ratings for either knee disability, inasmuch as the knee is a single joint. A maximum rating of 10 percent would be assigned for the knee under Diagnostic Code 5003, therefore a higher rating is not warranted. 38 C.F.R. § 4.71a. Diagnostic Code 5003. Pertaining to limitation of motion of the right knee, the range of motion findings detailed above, throughout the appeal, do not show limitation so severe as to meet the criteria for the next higher ratting under Diagnostic Codes 5260. In this regard, during the course of the claim the Veteran’s right knee flexion has been shown to be limited to, at worst, a 15 degree flexion contracture and inability to flex the right knee to 90 degrees. While in August 2016 a VA examiner noted that the Veteran had full extension of the right knee, it was noted as painful at 30 degrees with the use of the prosthetic, but not without the prosthetic. Other than in August 2013, when the VA examiner noted full extension of the right knee, the Veteran consistently exhibited extension to 10 degrees, including on VA examination in August 2016. Thus, a separate 10 percent rating for the right knee disability based on limitation of right knee extension is warranted. In sum, his range of motion was beyond required extension limited to 15 degrees for the next higher rating, even when considering Deluca factors. 38 C.F.R. §§ 4.40 and 4.45. See DeLuca, 8 Vet. App. at 207; see also Mitchell, 25 Vet. App. at 32; Correia, 28 Vet. App. at 158; Sharp, 29 Vet. App. at 26. Thus, a rating higher than 30 percent for limited right knee flexion is not warranted. A separate rating of 10 percent for limited right knee extension is warranted. Although the Veteran has reported pain associated with his range of motion, the Court has held that “pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system.” See Mitchell, 25 Vet. App. 32. Indeed, the Court found that nothing in its case law supports an appellant’s contentions that he should be given the maximum disability ratings under Diagnostic Codes 5260 and 5261 simply because he experienced pain throughout the range of motion of the knee. Id. While an estimate of loss of motion in degrees was not noted during flare-ups, the examiners reported no additional limitation of motion with repetitive movements. Additionally, a review of the entirety of the evidence of record, including the Veteran’s VA clinical records, does not suggest that the Veteran experiences symptomatology during flare-ups sufficient to justify ratings in excess of 30 and 10 percent. While the Board could remand this matter yet again to request this additional information, such remand would likely result in additional delay and expenditure of resources without any reasonable possibility of assisting the Veteran in demonstrating entitlement to a higher overall rating for the right knee (and may provide evidence against the current evaluations). Given these findings, additional remand is found unwarranted. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991) (strict adherence to requirements of the law does not dictate an unquestioning, blind adherence in the face of overwhelming evidence in support of the result in a particular case; such adherence would result in unnecessarily imposing additional burdens on VA with no benefit flowing to the appellant); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (remands which would only result in unnecessarily imposing additional burdens on VA with no benefit flowing to the Veteran are to be avoided). This appeal has been pending for many years and the Board does not wish to delay the Veteran’s case once again. Another examination considering either Correia or Sharp is simply not warranted in this distinct case and would only delay the adjudication without benefit to the Veteran, particularly because the Veteran already has TDIU. There must be some cogent basis upon which the Board can reasonably, once again, remand this case, delaying the full adjudication of this case once again. Additionally, there is no evidence of right instability at any time during the appeal. There is also no evidence or recurrent subluxation. Accordingly, the Board finds that a rating under Diagnostic Code 5257 is not warranted for the right knee. 38 C.F.R. § 4.71a Diagnostic Code 5257. Finally, while the right knee disability involves surgical scarring, as the scar on the right knee was not painful or unstable, nor covering a total area greater than 39 square cm. Accordingly, compensable rating is not warranted. See 38 C.F.R. § 4.118, Diagnostic Codes 7804, 7805. While the Veteran clearly has problems with his right knee (if he did not, there would be no basis for the current compensation levels) the Board finds the medical evidence of record to be highly probative as to the current nature, extent, and severity of the Veteran’s right knee disorder. The medical reports were based on physical examinations and provided sufficient information to allow the Board to apply the schedular criteria. In this regard, it is important for the Veteran to understand that not all evidence in this case supports the current evaluations. Thus, although the Veteran’s competent and credible reports of symptoms have been considered and are probative, the Board attaches greater probative weight to the clinical findings of skilled, unbiased professionals. See Cartleft v. Derwinski, 2 Vet. App. 24, 25 (1991). As such, the objective medical findings and opinions provided by the VA examiners have been accorded greater probative weight and outweigh the Veteran’s contentions. Extraschedular Consideration Knee Disabilities and 38 C.F.R. § 3.321. Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity resulting from diseases and injuries encountered as a result of or incident to military service and their residual conditions in civil occupations. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. While the Ratings Schedule is designed to be robust and adaptive, there will be occasions where the ratings provisions do not adequately describe and compensate a particular disability. When determining whether a claimant is entitled to an extraschedular rating, the Board must determine whether the evidence “presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate.” Thun v. Peake, 22 Vet. App. 111, 115 (2008), aff’d sub nom. Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009); see 38 C.F.R. § 3.321(b)(1). An extraschedular rating under 38 C.F.R. § 3.321(b)(1) is based on the fact that the schedular ratings are inadequate to compensate for the average impairment of earning capacity due to the veteran’s disability. Exceptional or unusual circumstances, such as frequent hospitalizations or marked interference with employment, are required. However, to accord justice in the exceptional case where the criteria in VA’s Rating Schedule are inadequate to rate a single service-connected disability, the Director of Compensation Service or his or her delegate is authorized to approve an extraschedular evaluation commensurate with the average impairment of earning capacity due exclusively to the disability. The governing norm in these exceptional cases is a finding by the Director of Compensation Service or delegate that application of the regular schedular standards is impractical because the disability is so exceptional or unusual due to such related factors as marked interference with employment or frequent periods of hospitalization. 38 C.F.R. § 3.321(b)(1). The Board must refer the Veteran’s claim to the Under Secretary for Benefits or Director of Compensation Service for this special consideration when the issue is raised either by the Veteran or by the evidence of record. Thun, 22 Vet. App. 111; Barringer v. Peake, 22 Vet. App. 242 (2008). Only after the Director has determined whether an extraschedular evaluation is warranted does the Board have jurisdiction to adjudicate the merits of the extraschedular aspect of the claim. The Director’s decision is not evidence, but, rather, the de facto AOJ decision, and the Board must conduct de novo review of this decision. See Wages v. McDonald, 27 Vet. App. 233, 238-39 (2015) (holding that the Board conducts de novo review of the Director’s decision denying extraschedular consideration); Kuppamala v. McDonald, 27 Vet. App. 447 (2015). Here, the Director, Compensation Service, provided a memorandum opinion dated May 2018 regarding the possibility of extraschedular consideration of the Veteran’s right disability. It was noted that the Veteran reported that he last worked full time in June 2012, when he became too disabled to work. The Veteran remarked he could no longer work due to the use of orthotic shoes and crutches to walk. Here, the Director opined, as of the date of the opinion, May 2018, that the medical evidence failed to show an evaluation higher than the 10 percent disability rating assigned at that time, was warranted for the right knee. The Director’s rationale was that examinations did not show additional limitation in range of motion after repetitive motion nor was there evidence of instability of the knee. Additionally, the condition had remained static since 2013. Accordingly, entitlement to a higher level of compensation for the service connected right knee medial compartment arthritis with meniscal tear on an extra-schedular basis pursuant to the provisions of 38 C.F.R. § 3.321(b) was denied. However, the Board notes and emphasizes that the Director reviewed the record prior to the August 2019 Board decision that granted the Veteran’s claim for an increased initial rating of 30 percent for a right knee disability, based on limitation of flexion, as well as this Board decision, which added a separate 10 percent rating for limitation of extension of the right knee. Continuing, the Board notes the earlier detailed analysis for the Veteran’s right knee, where it compared “the level of severity and symptomatology of the claimant's service-connected disability with the established criteria found in the rating schedule for that disability.” See 38 C.F.R. § 3.321(b)(1). As described above, both (1) the specific symptoms and their severity that have been attributed to the service-connected disability, particularly those symptoms that are not obviously contemplated by the rating criteria and (2) the specific rating criteria involved in explaining why the Board found that the Veteran’s symptoms and their severity are contemplated by the rating criteria. Anderson v. Shinseki, 22 Vet. App. 423, 426 (2009) (citing 38 U.S.C. § 7104(d)(1); Allday v. Brown, 7 Vet. App. 517, 527 (1995); Gilbert, 1 Vet. App. at 55. Having considered the medical and lay evidence of record, the Board finds an increased extraschedular rating is not warranted for the Veteran’s right knee disability at any time during the appeal. As noted earlier, the Board denied increased rating for the Veteran’s right knee flexion, but added a separate 10 percent rating for limitation of extension based on the medical, lay, and testimonial evidence in the Veteran’s claims file. Given the consideration of all the evidence, then, the Board finds that the levels and severity of his right knee symptomatology have been adequately compensated by the schedular rating criteria in Diagnostic Codes 5260 and 5261 given the addition of a separate rating for limited extension of the right knee as of this Board decision. In this case, application of the schedular rating criteria to the Veteran’s right knee disability is not impractical because both the applicable Diagnostic Codes and other regulatory provisions explicitly contemplate the Veteran’s symptomatology and disability level, including special considerations for evaluating factors of disability and functional impairment when evaluating the joints. See 38 C.F.R. §§ 4.40, 4.45, 4.71(a), Diagnostic Codes 5260, 5261; 38 C.F.R. §§ 4.40, 4.45, 4.71(a). In other words, the rating criteria reasonably describe the Veteran’s disability picture. Thun, 22 Vet. App. 111; Anderson, 22 Vet. App. at 428. Therefore, the Board finds that the preponderance of the evidence weighs against the assignment of a rating in excess of 30 percent for limitation of flexion of the right knee disability with an additional separate rating of 10 percent for limitation of extension of the right knee, and a rating on an extraschedular basis pursuant to 38 C.F.R. § 3.321(b)(1) throughout the appeal period, therefore the claim must be denied. See 38 U.S.C. § 5107(b); Gilbert, supra. John J. Crowley Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Azizi, T. 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.