Citation Nr: 21013914 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 16-06 059 DATE: March 10, 2021 ORDER For the entire rating period on appeal from November 1, 2014, a disability rating in excess of 30 percent for residuals of a left knee total replacement is denied. FINDING OF FACT For the rating period on appeal from November 1, 2014, the residuals of a left knee total replacement manifested as pain and noncompensable limitation of motion, and did not more nearly approximate chronic residuals of severe painful motion or weakness of the left knee. CONCLUSION OF LAW For the rating period on appeal from November 1, 2014, the criteria for a disability rating in excess of 30 percent for residuals of a left knee total replacement have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71, 4.71a, Diagnostic Code 5055. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Air Force during the Gulf War Era and Peacetime from March 1981 to March 2003. Rating the residuals of a left knee total replacement For the rating period on appeal from November 1, 2014, the Veteran is in receipt of a 30 percent rating for the service-connected residuals of a left knee total replacement, under Diagnostic Code (DC) 5055. The Veteran appealed for a higher disability rating than 30 percent, contending that there is limitation in flexion between 10 degrees and 20 degrees in the left knee. The Veteran also contends that extension is limited more than 0 degrees, and that the most recent VA examination did not measure the range of motion of the knee. Under Diagnostic Code 5055, a 30 percent rating is the minimum rating after a total knee replacement. A 60 percent rating is warranted where the evidence shows chronic residuals consisting of severe painful motion or weakness in the affected extremity. Possible intermediate degrees of residual weakness, pain, or limitation of motion may be rated by analogy to DCs 5256 (knee ankylosis), 5261 (limitation of extension), and 5262 (tibia and fibula impairment). Under DC 5256, a rating of 40 percent is warranted where there is ankylosis of the knee in flexion between 10 degrees and 20 degrees. Under DC 5261, a 40 percent rating is warranted where extension of the leg is limited to 30 degrees. Under DC 5262, a 40 percent rating is warranted where there is nonunion of the tibia and fibula, with loose motion, requiring a brace. The evidence in this case includes that in November 2014, the Veteran reported some limitation of motion of the left knee, as well as pain if the knee is forced to the full range of motion. In 2015, the Veteran sought treatment with VA for diabetes and for right knee pain. The treatment for diabetes in January 2015 does not include any mention of left knee problems. During the August 2015 treatment for the right knee, the VA examiner noted that motion in the left knee did not elicit any pain. At a VA examination in December 2015, the Veteran reported chronic left knee pain with limited range of motion. During the range of motion exercises, the Veteran reported the pain to be 8 out of 10. The Veteran reported wearing knee braces for exercising. The VA examiner noted that the range of motion was to 90 degrees in flexion, and to 0 degree in extension. Repeated use and loss of motion from pain during flare-ups further reduced flexion to 80 degrees, but extension remained to 0 degrees. The examiner noted no pain with weight-bearing; tenderness on palpation of the lateral joint line; no crepitus; full muscle strength, albeit with some atrophy of the left quadricep; no ankylosis; no instability; no tibial or fibular impairment; and no contemporary meniscal issues. In January 2016, the Veteran reported that flexion was limited to 85 degrees, and that extension of the left knee was not measured during the examination and was in fact limited to 10 degrees. At a VA examination in November 2017, while this examination was primarily for the right knee, the VA examiner also reported on the left knee. Range of motion of the left knee was to 90 degrees in flexion, and to 0 degrees in extension. The examiner noted no crepitus; no pain in weight-bearing; limited strength in flexion, but full strength in extension; no atrophy; no ankylosis; no instability; and no tibia or fibular impairments. The Veteran was examined again in December 2018. The examiner noted that limitation of motion in flexion was to 90 degrees, and in extension to 0 degrees. The examiner noted pain on flexion, and the Veteran reported that motion was further limited during flare-ups: the examiner was unable to estimate the further limitation of motion during flare-ups. The examiner noted full strength of the knee; no pain with weight-bearing; no atrophy; no subluxation or instability; no tibial or fibular impairment; and no meniscal conditions. The examiner also noted that there was objective evidence of pain on passive range of motion testing of the left knee. During treatment with VA in December 2018, the Veteran reported pain in the left knee of 8 out of 10, aching pain, pain in flexion, mild quad tenderness, and tight hamstrings. The examiner noted no atrophy, no erythema, no signs of infection, and no instability. The examiner noted full strength, and record the range of motion of the left knee to 0 degrees in extension, and to around 90 degrees in flexion. Private treatment records from January 2019 show the Veteran reported pain in the left knee of 0 out of 10 at rest, and 4 out of 10 with activity. Flexion was recorded as limited to 100 degrees, with extension to 0 degrees. A private treatment record from March 2019 records the Veteran reporting pain in the left knee at rest of 0 out of 10, with pain in flexion of 6 out of 10. The range of motion is recorded as limited to 105 in flexion and to 0 in extension. After a review of all the evidence, lay and medical, the Board finds that, for the rating period on appeal from November 1, 2014, the residuals of a left knee total replacement manifested as pain and noncompensable limitation of motion, consistent with a 30 percent disability rating under DC 5055, did not meet the criteria for “intermediate” ratings between 30 and 60 percent (DCs 5256, 5261, or 5262), and did not more nearly approximate chronic residuals of severe painful motion or weakness of the left knee for a 60 percent rating under DC 5055. (Continued on the next page)   While there was some pain with motion, treatment records indicate there were periods where the Veteran affirmatively reported feeling no pain during motion of the left knee, or less than severe pain during certain degrees of flexion. The painful motion does not approximate limitations of motion remotely approaching the rating criteria for a rating in excess of 30 percent, and does not show severe painful limitations of motion. For the entire period, the strength of the left knee was reported at either 4 out of 5 or 5 out of 5. The limitations of motion did not warrant higher or “intermediate” ratings under alternative DCs 5256, 5261, or 5262. The evidence does not show ankylosis (DC 5256), extension of the leg limited to 30 degrees (DC 5261), or nonunion of the tibia and fibula, with loose motion, requiring a brace (DC 5262). Accordingly, the Board finds that, for the rating period on appeal from November 1, 2014, the criteria for an increased disability rating in excess of 30 percent for residuals of a left knee total replacement are not met. 38 C.F.R. §§ 4.3, 4.7, 4.71a, Diagnostic Code 5055. J. PARKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Plambeck, Charles 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.