Citation Nr: 21015571 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 14-37 029 DATE: March 17, 2021 ORDER Entitlement to an initial disability rating in excess of 10 percent for thoracolumbar spine degenerative disc disease (DDD) and strain with scoliosis prior to July 24, 2017 is granted. Entitlement to a disability rating in excess of 20 percent for thoracolumbar spine DDD and strain with scoliosis from July 24, 2017 is denied. Entitlement to an initial disability rating in excess of 10 percent for right knee osteoarthritis is denied. Entitlement to an initial compensable disability rating for right knee limitation of flexion is denied. Entitlement to an initial disability rating in excess of 10 percent for left knee strain is denied. Entitlement to a separate 20 percent disability rating for a right knee disability manifested by frequent episodes of joint pain, joint locking, and joint effusion is granted. Entitlement to an initial disability rating in excess of 10 percent for right ankle bursitis is denied. Entitlement to an initial disability rating in excess of 10 percent for left ankle osteoarthritis is denied. FINDINGS OF FACT 1. Resolving reasonable doubt in favor of the Veteran, prior to July 24, 2017, the Veteran’s thoracolumbar spine DDD and strain with scoliosis manifested in forward flexion of thoracolumbar spine to 45 degrees. 2. The Veteran’s thoracolumbar spine DDD and strain with scoliosis has not been manifested by forward flexion of the thoracolumbar spine to 30 degrees or less; favorable ankylosis of the entire thoracolumbar spine, or incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. 3. The Veteran’s right knee has manifested in, at worst, flexion to 60 degrees and extension to 0 degrees. 4. The Veteran’s left knee has manifested in, at worst, flexion to 80 degrees and extension to 0 degrees. 5. The Veteran’s right knee disability is manifested by a meniscal tear with frequent episodes of joint pain, joint locking, and joint effusion. 6. The preponderance of the evidence weighs against finding that the Veteran’s right ankle bursitis more nearly approximates marked limitation of motion and ankylosis is not shown. 7. The preponderance of the evidence weighs against finding that the Veteran’s left ankle osteoarthritis more nearly approximates marked limitation of motion and ankylosis is not shown. CONCLUSIONS OF LAW 1. Prior to July 24, 2017, the criteria for a 20 percent disability rating for thoracolumbar spine DDD and strain with scoliosis have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.71a, Diagnostic Code 5243. 2. The criteria for a disability rating in excess of 20 percent for thoracolumbar spine DDD and strain with scoliosis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.71a, Diagnostic Code 5243. 3. The criteria for a disability rating in excess of 10 percent for right knee osteoarthritis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.71a, Diagnostic Code 5010-5261. 4. The criteria for a compensable disability rating for right knee limitation of flexion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.71a, Diagnostic Code 5010-5260. 5. The criteria for a disability rating in excess of 10 percent for left knee strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.71a, Diagnostic Code 5260. 6. The criteria for a separate 20 percent disability rating for a right knee disability manifested by a meniscal tear with frequent episodes of joint pain, joint locking, and joint effusion have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3159, 4.7, 4.71a, Diagnostic Code 5258. 7. The criteria for a disability rating in excess of 10 percent for right ankle bursitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.71a, Diagnostic Code 5019-5271. 8. The criteria for a disability rating in excess of 10 percent for left ankle osteoarthritis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.7, 4.71a, Diagnostic Code 5010-5271. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1988 to October 2010. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2011 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In June 2018, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that proceeding has been associated with the record. The Board previously remanded the case in April 2019 for further development. The requested development has been completed to the extent possible, and no further action is necessary to comply with the Board’s remand directives. Stegall v. West, 11 Vet. App. 268 (1998). In a July 2020 rating decision, the RO increased the Veteran’s rating for thoracolumbar spine DDD and strain with scoliosis to 20 percent disabling, effective July 24, 2017. As the grant of a 20 percent rating, effective July 24, 2017, did not constitute a full grant of the benefits sought, the increased rating issue remains on appeal. AB v. Brown, 6 Vet. App. 35, 39 (1993). Additionally, during the course of the appeal, a separate rating was awarded for the Veteran’s right knee limitation of flexion in November 2020. This disability is considered part of the Veteran’s underlying claim that his right knee disability has worsened and thus, is considered part of this appeal. Increased Rating A disability rating is determined by the application of VA’s Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings,” whether it is an initial rating case or not. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a criteria.”). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). 1. Entitlement to an initial disability rating in excess of 10 percent for thoracolumbar spine DDD and strain with scoliosis prior to July 24, 2017 is granted. 2. Entitlement to a disability rating in excess of 20 percent for thoracolumbar spine DDD and strain with scoliosis from July 24, 2017 is denied. The Veteran is seeking increased disability ratings for his thoracolumbar spine DDD and strain with scoliosis. He contends the severity of his back disability is not accurately reflected by his assigned disability ratings. The Veteran’s thoracolumbar spine DDD and strain with scoliosis is rated under Diagnostic Code 5243 from November 1, 2010 and under Diagnostic Code 5010-5243 from August 18, 2020. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27. Here, the Veteran’s back disability is rated for intervertebral disc syndrome (IVDS) and IVDS due to traumatic arthritis, respectively. The Board notes that, during the pendency of the appeal, VA revised the rating criteria for Diagnostic Codes 5010, 5242, and 5243 effective February 7, 2021. See 85 Fed. Reg. 76453 (November 30, 2020). When the regulations concerning entitlement to a higher rating are changed during the course of an appeal, the veteran may be entitled to resolution of his claim under the criteria that are to his advantage. The former rating criteria may be applied throughout the period of the appeal, if they are more favorable to him. The revised rating criteria may be applied only prospectively, however, from the effective date of the change forward unless the regulatory change specifically permits retroactive application. 38 U.S.C. § 5110(g); VAOPGCPREC 7-03; VAOPGCPREC 3-00; Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Under the former rating criteria for Diagnostic Code 5010, which evaluates arthritis due to trauma, degenerative arthritis established by x-ray findings will be rated under Diagnostic Code 5003 as degenerative arthritis on the basis of limitation of motion for the specific joint or joints involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. 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. Under the revised criteria, effective February 7, 2021, Diagnostic Code 5010 evaluates post-traumatic arthritis and is rated as limitation of motion, dislocation, or other specified instability under the affected joint. If there are two or more joints affected, each rating shall be combined in accordance with §4.25. Under the former rating criteria for Diagnostic Code 5243, IVDS may be rated under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula), or under the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Rating Formula), whichever results in a higher rating. Under the General Rating Formula, a 20 percent disability rating is assigned for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent disability rating is assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent disability rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent disability rating is assigned for unfavorable ankylosis of entire spine. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-5242. Note 1 to the General Rating Formula provides for a separate evaluation for any associated, objective, neurologic abnormalities. 38 C.F.R. § 4.71a. The Board notes here that the Veteran is separately compensated for bilateral lower extremity radiculopathy and scars, secondary to his service-connected thoracolumbar spine disability. Note 2 to the General Rating Formula provides that, for VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion is zero to 30 degrees, and left and right lateral rotation is zero to 30 degrees. The normal combined range of motion of the thoracolumbar spine is 240 degrees. See also Plate V, 38 C.F.R. § 4.71a. Under the IVDS Rating Formula, a 20 percent rating is warranted for incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent rating is warranted for incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent rating requires incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a, Diagnostic Code 5243. An incapacitating episode is defined as a period of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a. Under the revised criteria, effective February 7, 2021, Diagnostic Code 5243 for IVDS is only assigned when there is disc herniation with compression and/or irritation of the adjacent nerve root. All other disc diagnoses are assigned under Diagnostic Code 5242. Under the former criteria, Diagnostic Code 5242 evaluates degenerative arthritis of the spine (see also Diagnostic Code 5003). Under the revised criteria, effective February 7, 2021, Diagnostic Code 5242 evaluates degenerative disc disease other than IVDS (see, also either Diagnostic Code 5003 or 5010). Turning to the evidence of record, in a June 2010 treatment record, the Veteran reported that his low back pain bothered him a couple times a month. The Veteran was afforded a VA examination in July 2010. The Veteran reported stiffness, fatigue, spasms, and decreased motion of the spine. He noted localized, moderate low back pain that occurred constantly. The Veteran stated his pain was exacerbated by physical activity and was relieved by rest. He endorsed flare-ups and noted he could function during pain without medication. The Veteran indicated that he experienced pain with sitting for long periods and bending over and lifting objects greater than 30 pounds. He reported he could walk without limitation and did not experience falls due to his spine condition. The Veteran denied paresthesia, numbness, weakness, bowel/bladder problems, or erectile dysfunction. He indicated he had not experienced an incapacitating episode in the past 12 months, and he was not receiving treatment for his spine condition. On examination, the VA examiner noted there was no muscle spasm or radiating pain on movement. Tenderness and pain on palpation of the thoracolumbar paraspinal muscles were indicated. The examiner noted spinal contour was preserved but with tenderness. There was no guarding of movement and examination did not reveal weakness. Muscle tone and musculature were normal. Straight leg testing was negative bilaterally. There was no atrophy present in the limb and no ankylosis of the thoracolumbar spine. Range of motion testing revealed flexion to 80 degrees with pain noted at 45 degrees, extension to 30 degrees with pain noted at 30 degrees, right lateral flexion to 30 degrees, left lateral flexion to 30 degrees, right rotation to 30 degrees, and left rotation to 30 degrees with pain noted at 25 degrees. Repetitive range of motion was possible with no additional degree of limitation. The examiner noted that joint function of the spine was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use. X-rays of the thoracic spine and lumbar spine revealed minimal levoscoliosis curvature in the thoracolumbar junction and discogenic degenerative disease at T11-T12. The examiner diagnosed scoliosis and DDD of the thoracic spine and chronic lumbar strain. Subjective factors included pain in the mid/low back region with sitting for long periods of time, and pain with bending over and lifting objects greater than 30 pounds. Objective factors included findings of scoliosis and DDD of the thoracic spine and pain with palpation and range of motion of the thoracolumbar spine on exam. A December 2012 treatment record noted that the Veteran’s lumbar/lumbosacral spine exhibited no abnormalities following examination. The Veteran demonstrated the ability to lift 45 pounds. A July 2014 treatment record noted that the Veteran’s lumbar/lumbosacral spine exhibited no abnormalities following examination. Good range of motion was indicated. The Veteran was afforded a VA examination in November 2016. He reported pain in the back that radiated down to the lower legs. The Veteran endorsed flare-ups of the spine, noting increased pain with standing and walking for long periods, and with lifting and carrying heavy objects. He reported functional loss/impairment of the thoracolumbar spine as an inability to lift heavy objects or stand or walk for long periods of time. The VA examiner confirmed a diagnosis of degenerative arthritis of the spine. On examination, range of motion testing of the thoracolumbar spine revealed forward flexion to 90 degrees, extension to 10 degrees, right lateral flexion to 20 degrees, left lateral flexion to 20 degrees, right lateral rotation to 30 degrees and left lateral rotation to 30 degrees. Range of motion itself did not contribute to functional loss. There was no evidence of pain with weightbearing. There was no objective evidence of localized tenderness of pain on palpation of the joints of associated soft tissue of the thoracolumbar spine. The Veteran was able to perform repetitive use testing with at least three repetitions with no additional loss of function or range of motion. Functional ability was significantly limited by pain following repeated use over a period of time, with forward flexion to 90 degrees, extension to 10 degrees, right lateral flexion to 20 degrees, left lateral flexion to 20 degrees, right lateral rotation to 30 degrees, and left lateral rotation to 30 degrees. Functional ability was significantly limited by pain during flare-ups, with forward flexion to 90 degrees, extension to 10 degrees, right lateral flexion to 20 degrees, left lateral flexion to 20 degrees, right lateral rotation to 30 degrees, and left lateral rotation to 30 degrees. The Veteran did not have guarding or muscle spasm of the thoracolumbar spine. Interference with standing was an additional contributing factor of the Veteran’s spine disability. Muscle strength testing and reflex exam were normal with no muscle atrophy. Sensory exam was normal but for decreased sensation in the left foot/toes. Straight leg testing was negative. The Veteran had pain and other signs/symptoms due to radiculopathy. No ankylosis was noted. The examiner indicated the Veteran had IVDS of the thoracolumbar spine but did not have any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. No assistive devices were used to aid in ambulation. The examiner indicated that the Veteran’s thoracolumbar spine condition impacted his ability to work, noting the Veteran could not lift heavy objects or stand or walk for long periods of time. The Veteran was afforded a VA examination in May 2019. The Veteran reported constant low back pain that worsened with bending over or strenuous physical activities. He denied flare-ups of the thoracolumbar spine. The Veteran endorsed functional loss/impairment, noting stiffness, worse in the morning, and that he was easily fatigued. The VA examiner confirmed a diagnosis of thoracolumbar spine DDD and strain with scoliosis with bilateral lower extremity radiculopathy. On examination, range of motion testing of the thoracolumbar spine revealed normal range of motion, with forward flexion to 90 degrees, extension to 30 degrees, right lateral flexion to 30 degrees, left lateral flexion to 30 degrees, right lateral rotation to 30 degrees and left lateral rotation to 30 degrees. Pain was noted on examination but did not result in or cause functional loss. There was pain with weightbearing but no pain on non-weightbearing or passive range of motion. Tenderness to palpation was noted across the low back. The Veteran was able to perform repetitive use testing with at least three repetitions with no additional loss of function or range of motion. Pain, weakness, fatiguability or incoordination did not significantly limit functional ability with repeated use over a period of time. The Veteran did not have guarding or muscle spasm of the thoracolumbar spine. Muscle strength testing and reflex exam were normal and there was no muscle atrophy. Sensory exam was normal but for decreased sensation in the bilateral foot/toes. Straight leg raising test was negative bilaterally. The Veteran had radicular pain and signs or symptoms related to radiculopathy. No ankylosis was noted. The examiner indicated the Veteran did not have IVDS of the thoracolumbar spine. He did not use assistive devices to aid in ambulation. The examiner indicated that the Veteran’s thoracolumbar spine condition impacted his ability to work, noting that the Veteran could not perform heavy lifting, pushing or pulling. The Veteran was afforded a VA examination in December 2019. The Veteran reported an increase in his back pain and that he recently enrolled in pain management and had received steroid injections and ablations. He noted pain in the low back that radiated down the left leg into the left foot. The Veteran denied flare-ups of the thoracolumbar spine. He indicated he had functional loss/impairment of the thoracolumbar spine with prolonged sitting, standing, and walking. The VA examiner confirmed a diagnosis of thoracolumbar DDD and strain with scoliosis and IVDS. On examination, range of motion testing of the thoracolumbar spine revelated normal range of motion, with forward flexion to 90 degrees, extension to 30 degrees, right lateral flexion to 30 degrees, left lateral flexion to 30 degrees, right lateral rotation to 30 degrees and left lateral rotation to 30 degrees. Pain was noted on examination but did not result in or cause functional loss. There was no evidence of pain with weightbearing, non-weightbearing, or on passive range of motion testing. There was no objective evidence of localized tenderness or pain on palpation of the joints or associated soft tissue of the thoracolumbar spine. The Veteran was able to perform repetitive use testing with at least three repetitions with no additional loss of function or range of motion. Pain, weakness, fatigability or incoordination did not significantly limit functional ability with repeated use over a period of time. The Veteran did not have guarding or muscle spasm of the thoracolumbar spine. Muscle strength testing, reflex exam, and sensory exam were normal and there was no muscle atrophy. Straight leg raising test was negative bilaterally. The Veteran had radicular pain and signs or symptoms related to radiculopathy. No ankylosis was noted. The examiner indicated the Veteran had IVDS of the thoracolumbar spine but did not have any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. He did not use assistive devices to aid in ambulation. The examiner indicated that the Veteran’s thoracolumbar spine condition impacted his ability to work, noting that the Veteran had difficulty with prolonged sitting, standing, and walking. The Veteran was afforded a VA examination in November 2020. The Veteran reported constant low back pain that worsened with bending over or strenuous physical activities. He noted that his condition affected his daily functioning of sitting, standing, prolonged walking, lifting, pushing, pulling, and carrying heavy objects. He required frequent position changes and pain affected his concentration and focus. The Veteran endorsed flare-ups of the thoracolumbar spine that occurred daily and were severe. He indicated that the flare-ups lasted for hours to days and were precipitated by physical activity. They were alleviated by rest and medication. The VA examiner confirmed diagnoses of thoracolumbar DDD and strain with scoliosis, and IVDS. On examination, range of motion testing revealed forward flexion to 55 degrees, extension to 15 degrees, right lateral flexion to 15 degrees, left lateral flexion to 15 degrees, right lateral rotation to 15 degrees, and left lateral rotation to 15 degrees. Range of motion itself contributed to functional loss. The condition affected the Veteran’s daily functioning of sitting, standing, prolonged walking, lifting, pulling, pushing, carrying heavy objects, focus due to pain, and concentration due to pain. Pain was noted on exam but did not result in or cause functional loss. There was evidence of pain with weightbearing, non-weightbearing, and on passive range of motion testing. Moderate pain was noted in the lower mid back. The Veteran was able to perform repetitive use testing with at least three repetitions. There was additional loss of function or range of motion, with forward flexion to 40 degrees, extension to 10 degrees, right lateral flexion to 10 degrees, left lateral flexion to 10 degrees, right lateral rotation to 10 degrees, and left lateral rotation to 10 degrees. Pain and weakness caused functional loss. Pain and weakness significantly limited functional ability with repeated use over a period of time resulting in forward flexion to 40 degrees, extension to 10 degrees, right lateral flexion to 10 degrees, left lateral flexion to 10 degrees, right lateral rotation to 10 degrees, and left lateral rotation to 10 degrees. Pain and weakness significantly limited functional ability during flare-ups resulting in forward flexion to 40 degrees, extension to 10 degrees, right lateral flexion to 10 degrees, left lateral flexion to 10 degrees, right lateral rotation to 10 degrees, and left lateral rotation to 10 degrees. The Veteran had guarding and muscle spasm of the thoracolumbar spine that resulted in abnormal gait and abnormal spine contour. Muscle strength testing revealed active movement against gravity to active movement against some resistance. There was no muscle atrophy. Reflex exam was normal. Sensory exam revealed decreased sensation in the bilateral lower leg/ankle and foot/toes. Straight leg raising test was positive on the left. The Veteran had radicular pain and signs or symptoms due to radiculopathy. There was no ankylosis of the spine. The examiner indicated that the Veteran had IVDS of the thoracolumbar spine but did not have any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. He did not use assistive devices to aid in ambulation. The examiner indicated that the Veteran’s thoracolumbar spine condition impacted his ability to work, noting that the Veteran’s disability affected his daily functioning of sitting, standing, prolonged walking, lifting, pushing, pulling, carrying heavy objects, frequent position changes, and concentration and focus due to pain. Upon review of the record, the Board resolves reasonable doubt in favor of the Veteran and finds that a higher disability rating for thoracolumbar spine DDD and strain with scoliosis prior to July 24, 2017 is warranted. Specifically, the September 2010 VA examination reflected that the Veteran demonstrated additional functional loss due to pain with 45 degrees of flexion of the thoracolumbar spine, meeting the criteria for a 20 percent disability rating under Diagnostic Code 5243 and the General Rating Formula. Accordingly, a 20 percent disability rating prior to July 24, 2017 is granted. The Board finds that a disability rating in excess of 20 percent for the Veteran’s thoracolumbar spine DDD and strain with scoliosis is not warranted, as the criteria for a more severe rating has not been met at any time during the period on appeal. In this regard, there is no evidence in the record demonstrating that the Veteran suffers from forward flexion of the thoracolumbar spine limited to 30 degrees or less or favorable ankyloses of the entire thoracolumbar spine. Favorable ankyloses of the entire thoracolumbar spine is not indicated in treatment records or VA examinations. The September 2010 VA examination noted forward flexion of the thoracolumbar spine to 80 degrees with pain beginning at 45 degrees. The November 2016 VA examination noted forward flexion of the thoracolumbar spine to 90 degrees with no additional loss of range of motion following repeated use with at least three repetitions, repeated use over a period of time, or during flare-ups. The May 2019 VA examination noted forward flexion of the thoracolumbar spine to 90 degrees with no additional loss of range of motion following repeated use with at least three repetitions or repeated use over a period of time. The Veteran denied flare-ups. The December 2019 VA examination noted forward flexion of the thoracolumbar spine to 90 degrees with no additional loss of range of motion following repeated use with at least three repetitions or repeated use over a period of time. The Veteran denied flare-ups. The November 2020 VA examination noted forward flexion of the thoracolumbar spine to 55 degrees with additional limitation of motion following repeated use with at least three repetitions, repeated use over a period of time, and during flare-ups resulting in forward flexion to 40 degrees. The Board has also considered whether a higher disability rating is warranted under 38 C.F.R. §§ 4.40 and 4.45, but finds that the record does not reflect additional functional loss due to pain, weakness, fatigability or incoordination severe enough to meet the criteria for a higher disability rating. Further, the Board does not find that a higher disability rating is warranted under the IVDS Rating Formula. While the November 2016, December 2019, and November 2020 VA examinations noted IVDS of the thoracolumbar spine, it was noted that the Veteran did not have any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. The Board has also considered the Veteran’s statements that describe his pain, discomfort, and limitations. The Veteran is competent to describe his observations and the Board finds that his statements are credible. In this case, however, the Board finds that the objective medical findings by skilled professionals are more persuasive, as their findings were based on the Veteran’s history, his statements, and examination. As indicated above, these medical findings do not support a disability rating higher than 20 percent for the entire period on appeal. In sum, the Board resolves reasonable doubt in favor of the Veteran and finds that a 20 percent disability rating for thoracolumbar spine DDD and strain with scoliosis is warranted from July 24, 2017. For the entire period on appeal, a disability rating in excess of 20 percent for thoracolumbar spine DDD and strain with scoliosis is not warranted. As the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). 3. Entitlement to an initial disability rating in excess of 10 percent for right knee osteoarthritis is denied. 4. Entitlement to an initial compensable disability rating for right knee limitation of flexion is denied. 5. Entitlement to an initial disability rating in excess of 10 percent for left knee strain is denied. 6. Entitlement to a separate 20 percent disability rating for a right knee disability manifested by frequent episodes of joint pain, joint locking, and joint effusion is granted. The Veteran is seeking increased disability ratings for his right knee osteoarthritis, right knee limitation of flexion, and left knee strain. He contends the severity of his bilateral knee disabilities are not accurately reflected by his assigned disability ratings. The Veteran’s right knee osteoarthritis is rated under Diagnostic Code 5010-5260 from November 1, 2010 and then under Diagnostic Code 5010-5261 from August 18, 2020. He was granted a separate 10 percent evaluation for right knee limitation of flexion under Diagnostic Code 5010-5260, effective August 18, 2020. The Veteran’s left knee strain is evaluated under Diagnostic Code 5260. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27. Here, the Veteran is compensated for limitation of flexion (Diagnostic Code 5260) due to traumatic arthritis (Diagnostic Code 5010) of the right knee, limitation of extension (Diagnostic Code 5261) due to traumatic arthritis (Diagnostic Code 5010) of the right knee, and limitation of flexion (Diagnostic Code 5260) of the left knee. Disabilities of the knees are evaluated pursuant to the criteria within 38 C.F.R. § 4.71a, including Diagnostic Code 5256 (ankylosis), Diagnostic Code 5257 (other impairment, including recurrent subluxation or lateral instability), Diagnostic Code 5258 (dislocated semilunar cartilage), Diagnostic Code 5259 (symptomatic removal of semilunar cartilage), Diagnostic Code 5260 (limitation of flexion), Diagnostic Code 5261 (limitation of extension), Diagnostic Code 5262 (impairment of the tibia and fibula), and Diagnostic Code 5263 (genu recurvatum). The Board notes that, during the pendency of the appeal, VA revised the rating criteria for Diagnostic Codes 5257 and 5262, effective February 7, 2021. See 85 Fed. Reg. 76453 (November 30, 2020). When the regulations concerning entitlement to a higher rating are changed during the course of an appeal, the veteran may be entitled to resolution of his claim under the criteria that are to his advantage. The former rating criteria may be applied throughout the period of the appeal, if they are more favorable to him. The revised rating criteria may be applied only prospectively, however, from the effective date of the change forward unless the regulatory change specifically permits retroactive application. 38 U.S.C. § 5110(g); VAOPGCPREC 7-03; VAOPGCPREC 3-00; Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Diagnostic Code 5256, which evaluates ankylosis of the knee, provides for a 30 percent rating for favorable angle in full extension, or in slight flexion between 0 degrees and 10 degrees. A 40 percent rating is assigned when there is ankylosis of the knee in flexion between 10 and 20 degrees. A 50 percent rating is assigned when there is ankylosis of the knee in flexion between 20 and 45 degrees. A 60 percent rating is assigned for extremely unfavorable, in flexion at an angle of 45 degrees or more. 38 C.F.R. § 4.71a. Under the former rating criteria for Diagnostic Code 5257, which evaluates recurrent subluxation or lateral instability of a knee, a 10 percent rating is assigned for slight impairment; a 20 percent rating for moderate impairment; and a 30 percent rating for severe impairment. 38 C.F.R. § 4.71a. The terms “mild,” “moderate,” and “severe” are not defined in the Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6 The revised criteria for Diagnostic Code 5257, effective February 7, 2021, evaluates other impairment of the knee, to include recurrent subluxation or instability and patellar instability. Regarding recurrent subluxation or instability, a 10 percent rating is assigned 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 assigned for 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 a brace and/or assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 30 percent rating is assigned 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. Regarding patellar instability, under the revised criteria for Diagnostic Code 5257, a 10 percent rating is assigned 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 assigned 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 disability rating is assigned 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. Note (1) provides that for patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. See 38 C.F.R. § 4.71a, Diagnostic Code 5257, Note (1). Note (2) provides 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). See 38 C.F.R. § 4.71a, Diagnostic Code 5257, Note (2). Diagnostic Code 5258 provides for a 20 percent rating when semilunar cartilage is dislocated with frequent episodes of “locking,” pain, and effusion into the joint. 38 C.F.R. § 4.71a. Diagnostic Code 5259 provides for a 10 percent rating when semilunar cartilage has been removed but remains symptomatic. 38 C.F.R. § 4.71a. Under Diagnostic Code 5260, which evaluates limitation of flexion, a noncompensable rating is assigned when flexion is limited to 60 degrees; a 10 percent rating is assigned when flexion is limited to 45 degrees; a 20 percent rating is assigned when flexion is limited to 30 degrees; and a 30 percent rating is assigned when flexion is limited to 15 degrees. 38 C.F.R. § 4.71a. Under Diagnostic Code 5261, which evaluates limitation of extension, a noncompensable rating is assigned when extension is limited to 5 degrees; a 10 percent rating is assigned when extension is limited to 10 degrees; a 20 percent rating is assigned when extension is limited to 15 degrees; a 30 percent rating is assigned when extension is limited to 20 degrees; a 40 percent rating is warranted for extension limited to 30 degrees; and a 50 percent rating is assigned when extension is limited to 45 degrees. 38 C.F.R. § 4.71a. Separate ratings under Diagnostic Codes 5260 and 5261 may be assigned for disability of the same knee joint. See VAOPGCPREC 9-2004. Additionally, VAOPGCPREC 23-97 held that a claimant who has both arthritis and instability of the knee may receive two separate disability ratings under Diagnostic Codes 5003-5010 and Diagnostic Code 5257 without violating the prohibition of pyramiding of ratings. It was specified that, for a knee disorder already rated under Diagnostic Code 5257, a claimant would have additional disability justifying a separate rating if there is limitation of motion under Diagnostic Code 5260 or Diagnostic Code 5261. Under the former rating criteria for Diagnostic Code 5262, which evaluates impairment of the tibia and fibula, a 10 percent rating is assigned for slight knee or ankle disability, a 20 percent rating for moderate knee or ankle disability, a 30 percent rating for malunion with marked knee or ankle disability, and a 40 percent rating for nonunion with loose motion, requiring a brace. 38 C.F.R. § 4.71a The revised criteria for Diagnostic Code 5262, effective February 7, 2021, evaluates impairment of the tibia and fibula. A noncompensable rating is assigned for medial tibial stress syndrome (MTSS) or shin splints requiring treatment for less than 12 consecutive months of one of both lower extremities. A 10 percent rating is assigned for MTSS or shin splints requiring treatment for no less than 12 consecutive months, and unresponsive to either show orthotics or other conservative treatment of one or both lower extremities. A 20 percent rating is assigned for MTSS or shin splints requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment for one lower extremity. A 30 percent rating is assigned for MTSS or shin splints requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment of both lower extremities. A 40 percent rating is assigned for nonunion of the tibia and fibula, with loose motion, requiring brace. Malunion of the tibia and fibula must be evaluated under Diagnostic Codes 5256, 5257, 5260, or 5261 for the knee, or 5270 or 5271 for the ankle, whichever results in the highest evaluation. Under Diagnostic Code 5263, acquired traumatic genu recurvatum, with objectively demonstrated weakness and insecurity in weight-bearing, is rated at 10 percent. 38 C.F.R. § 4.71a. When assigning ratings, the combined rating for disabilities of an extremity shall not exceed the rating for the amputation at the elective level, were amputation to be performed. 38 C.F.R. § 4.68. Amputation not improvable by prosthesis controlled by natural knee action warrants a 60 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5165. Turning to the evidence of record, the Veteran was afforded a VA examination in July 2010. The Veteran reported weakness, swelling, giving way, and effusion of the knees. He denied stiffness, heat, redness, lack of endurance, locking, fatigability, deformity, tenderness, drainage, subluxation, pain, and dislocation. The Veteran reported flare-ups of the knee as often as three times per day with each time lasting approximately half an hour. He rated his knee pain a 6 out of 10, with 10 being the worst. Flare-ups of the knees were precipitated by physical activity and were alleviated by rest. During flare-ups, the Veteran experienced pain with kneeling down and running. He denied any problems with standing and walking. The Veteran noted past treatment included right knee arthroscopic surgery and physical therapy. He had residual stiffness. The Veteran denied any incapacitation related to the knees in the past 12 months. The Veteran walked steady and did not require any assistive device for ambulation. On examination, the VA examiner noted tenderness of the bilateral knees. Neither knee showed signs of edema, instability, abnormal movement, effusion, weakness, redness, heat, deformity, guarding of movement, malalignment, subluxation, or drainage. There was no locking pain, genu recurvatum, crepitus, or ankylosis bilaterally. Range of motion testing revealed flexion and extension of both knees were within normal limits, with flexion to 140 degrees and extension to 0 degrees. Repetitive range of motion was possible for both knees with no additional degree of limitation. The examiner noted that the joint function of either knee was not additionally limited by pain, fatigue, weakness, lack of endurance, or incoordination after repetitive use. The medial/lateral collateral ligaments stability test, the anterior/posterior cruciate ligaments stability test, and the medial/lateral meniscus stability test were all within normal limited for both knees. X-rays of the right knee revealed minimal narrowing of the medial compartment. X-rays of the left knee were within normal limits. The examiner diagnosed right knee osteoarthritis and left knee strain. Subjective factors included pain with kneeling down and running. Objective factors included x-ray findings of osteoarthritic changes in the right knee and pain with palpation of both knees on exam. A December 2012 treatment record noted that the appearance of the Veteran’s knees were normal and without tenderness on palpation of the knee. Both knees were noted to demonstrate normal movement. A July 2014 treatment record noted that the Veteran’s knees showed no abnormalities. It was noted that the Veteran’s history of knee scope and left knee meniscal problems did not stop him from running and he was about to participate in an extended run. A May 2016 treatment record noted that the Veteran presented for a follow-up evaluation of right knee pain. The Veteran reported pain in the medial aspect of the knee with a clicking and popping sensation. He denied sensations of locking or a feeling of a foreign body in the knee. The Veteran denied a decrease in range of motion and denied instability. He noted his knee pain increased with running and was alleviated by anti-inflammatories. The Veteran reported he had tried physical therapy in the past for his left knee, but it had not been beneficial in decreasing his knee pain. He noted his left knee pain was in the same location as his right knee pain. Examination of the right knee revealed normal knee station and alignment with no skin breaks or abrasions. Tenderness was noted along the medial joint line. There was no tenderness to palpation over the patellar tendon/tibial tuberosity and no tenderness along the lateral joint line. There was no anterior knee pain with patellar grind. Right knee range of motion was 0 degrees to 130 degrees. The Veteran was noted as stable. He had McMurray pain to the medial joint line. Examination of the left knee revealed normal knee station and alignment with no skin breaks or abrasions. No tenderness was noted along the medial joint line or lateral joint line. There was no anterior knee pain with patellar grind. Left knee range of motion was from 0 degrees to 130 degrees. The Veteran was noted as stable with negative McMurray. The Veteran was assessed with arthritic changes to the right knee with medial meniscal tear and left knee pain. An August 2016 treatment record indicated knee motion was normal. An October 2017 treatment record noted that the Veteran presented for platelet-rich plasm (PRP) injections to both knees due to pain. His knees were noted to show abnormalities, but appearance was normal. There was no swelling, edema, induration, warmth or erythema of the knee. Knee motion was normal. The Veteran was afforded a VA examination in May 2019. The Veteran reported chronic bilateral knee pain, worse on the right side. He denied flare-ups of the knees and/or lower leg. The Veteran endorsed functional loss/impairment, noting stiffness, fatigue, and that his knee locked at times. The VA examiner confirmed diagnoses of left knee strain and right knee joint osteoarthritis status post meniscectomy. On examination, range of motion testing revealed right knee flexion to 120 degrees and extension to 0 degrees. Range of motion itself did not contribute to functional loss. Pain was noted on exam and caused functional loss. There was no pain with weightbearing, non-weightbearing, or on passive range of motion testing. There was no objective evidence of crepitus, or localized tenderness or pain on palpation of the joint or associated soft tissue. Range of motion testing of the left knee revealed normal range of motion, with flexion to 140 degrees and extension to 0 degrees. Pain was noted on exam but did not result in or cause functional loss. There was no evidence of pain with weightbearing, non-weightbearing, or on passive range of motion testing. There was no objective evidence of crepitus, or 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 functional loss or range of motion of both knees. Pain, weakness, fatigability or incoordination did not significantly limit functional ability of either knee with repeated use over a period of time. There were no additional contributing factors of disability. Muscle strength was normal with no reduction in muscle strength and no muscle atrophy. No ankylosis was noted. There was no history of recurrent subluxation, lateral instability, or recurrent effusion. Joint stability was normal for both knees. The examiner indicated that the Veteran had never had recurrent patellar dislocation, shin splints, stress fractures, chronic exertional compartment syndrome or any other tibial and/or fibula impairment. The Veteran was noted to have a meniscus condition with medical tear, frequent episodes of joint locking, and frequent episodes of joint pain. The examiner indicated the Veteran was status post meniscectomy with chronic pain and episodes of right knee locking. There were no other pertinent physical findings, complications, conditions, signs or symptoms related to the bilateral knees. The Veteran did not use assistive devices to aid in ambulation. The examiner indicated that the Veteran’s knee condition affected his ability to work, noting no prolonged standing, walking, kneeling, or heavy lifting. A September 2019 treatment record noted that the Veteran presented with swelling to the right knee. He reported knee pain that was sharp, radiating, and constant. Pain was daily and was a 5 to 6 out of 10, but a 10 at its worst and a 3 at its least. Examination revealed knee joint pain and swelling. There was no stiffness or intermittent knee locking. The knee was noted to suddenly buckle. There was tenderness on palpation of the medial and interior knee. Pain was elicited by motion. There was no effusion, misalignment, or crepitus. The knee was noted to show full range of motion. No instability was seen. No weakness of the right knee was observed. Balance and gait were normal. October 2019 consultation information indicated that the Veteran had injured his right knee in 2007 while on active duty and was told at the time that he had a torn meniscus. In 2010, the Veteran had his knee scoped for the meniscus tear. He noted intermittent knee pain between 2010 and 2017. The Veteran underwent another arthroscopy in 2017 and had intermittent discomfort since then. Over the last month, he reported an increase in pain, swelling, and a sense of popping at times. The Veteran reported his pain was sharp or aching and could be up to a 7 out of 10 in intensity. His knee felt as if it could hyperextend at times. The Veteran noted he was taking ibuprofen occasionally but had not tried any other treatment. Examination revealed joint pain, stiffness, and swelling. The Veteran was able to ambulate without assistance and had normal gait and station. Trace palpable effusion was noted for the right knee and no effusion for the left knee. There was “good motion in the knee with mild discomfort at end range of flexion around the medial side.” Assessment indicated right knee osteoarthritis with recent flare. The Veteran was afforded a VA examination in December 2019. The Veteran reported an increase in pain in both knees and that they cracked and popped with pain. He denied flare-ups of the knees. The Veteran endorsed functional loss/impairment of the knees, noting difficultly with ascending stairs, prolonged walking and prolonged sitting. The VA examiner confirmed diagnoses of left knee strain and bilateral knee degenerative arthritis. The examiner noted that left knee osteoarthritis was unrelated and not a progression of the Veteran’s service-connected left knee strain or his service-connected right knee condition. On examination, range of motion testing revealed right knee flexion to 125 degrees and extension to 0 degrees. Range of motion itself did not contribute to functional loss. Pain was noted on exam but did not result in or cause functional loss. There was no evidence of pain with weightbearing, non-weightbearing, or on passive range of motion testing. Crepitus was noted. There was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. Range of motion testing of the left knee revealed flexion to 125 degrees and extension to 0 degrees. Range of motion itself did not contribute to functional loss. Pain was not noted on exam. There was no evidence of pain with weightbearing, non-weightbearing, or on passive range of motion testing. There was no objective evidence of crepitus or 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 for both knees with no additional functional loss or range of motion. Pain, weakness, fatigability or incoordination did not significantly limit functional ability of either knee with repeated use over a period of time. No additional contributing factors of disability were noted. Muscle strength was normal with no reduction in muscle strength and no muscle atrophy bilaterally. No ankylosis was noted. There was no history of bilateral recurrent subluxation, lateral instability, or recurrent effusion. There was no instability of the bilateral knees. The examiner indicated that the Veteran had never had recurrent patellar dislocation, shin splints, stress fractures, chronic exertional compartment syndrome or any other tibial and/or fibula impairment. The Veteran had a meniscal tear. The examiner indicated there were no other pertinent physical findings, complications, conditions, signs or symptoms related to the Veteran’s knee conditions. The Veteran noted he occasionally used bilateral knee braces to aid in ambulation. The examiner indicated that the Veteran’s knee conditions affected his ability to work, noting difficulty going up stairs, prolonged walking, and prolonged sitting. The Veteran was afforded a VA examination in November 2020. The Veteran reported that in both sedentary and physical labor settings, he was unable to crouch, stoop, sit or stand for more than 15 minutes, and carry weight over five pounds. He required frequent position changes. The Veteran noted his knee conditions affected his daily functioning of sitting, standing, prolonged walking, lifting, pushing, pulling, carrying heavy objects, requiring frequent position changes, and focus and concentration due to pain. The Veteran endorsed flare-ups of the knees, noting that severe flare-ups of the right knee occurred several times a day and lasted minutes to hours. Right knee flare-ups were precipitated by normal daily activity and were alleviated by rest, ice, and medication. Moderate flare-ups of the left knee occurred three to five times a week and lasted minutes. Left knee flare-ups were precipitated by normal activity and alleviated by rest, ice, and medication. The Veteran reported functional loss/impairment of the knees in both sedentary and physical labor settings and daily functioning, as noted above. The VA examiner confirmed diagnoses of right knee meniscal tear and bilateral knee joint osteoarthritis. On examination, range of motion testing revealed right knee flexion from 0 to 80 degrees and extension from 85 to 0 degrees. Range of motion itself contributed to functional loss in both sedentary and physical labor settings and daily functioning. Pain was noted on exam but did not result in or cause functional loss. There was evidence of pain with weightbearing, non-weightbearing, and on passive range of motion testing. There was objective evidence of localized tenderness or pain on palpation of the patella medial with moderate severity. There was objective evidence of crepitus. Range of motion testing of the left knee revealed flexion to 100 degrees and extension to 0 degrees. Range of motion itself contributed to functional loss in both sedentary and physical labor settings and daily functioning. Pain was noted on exam but did not result in or cause functional loss. There was evidence of pain with weightbearing, non-weightbearing, and on passive range of motion testing. There was objective evidence of localized tenderness or pain on palpation below the patella medial with mild severity. There was objective evidence of crepitus. The Veteran was able to perform repetitive use testing of the right knee with at least three repetitions with flexion to 70 degrees and extension to 0 degrees. Pain and weakness caused additional loss of function or range of motion. The Veteran was able to perform repetitive use testing of the left knee with at least three repetitions with flexion to 90 degrees and extension to 0 degrees. Pain and weakness caused additional loss of function or range of motion. Pain and weakness significantly limited functional ability with repeated use over a period of time and during flare-ups with right knee extension to 60 degrees, right knee extension to 0 degrees, left knee flexion to 80 degrees and left knee extension to 0 degrees. There were no other contributing factors of disability. Muscle strength testing revealed right knee flexion and extension with active movement against some gravity and a reduction in muscle strength due entirely to his service-connected right knee condition. Muscle strength testing of the left knee revealed flexion with active movement against some resistance and extension with active movement against gravity. The reduction in muscle strength was not due entirely to his left knee condition and was related to other service-connected conditions. There was no muscle atrophy and no ankylosis. Joint stability of the knees was normal bilaterally and there was no history of recurrent effusion. The examiner indicated that the Veteran had never had recurrent patellar dislocation, shin splints, stress fractures, chronic exertional compartment syndrome or any other tibial and/or fibula impairment. The Veteran had a meniscus condition in the right knee with meniscal tear, and frequent episodes of joint locking, joint pain, and joint effusion. He had a meniscus condition in the left knee with frequent episodes of joint locking and joint pain. The examiner indicated there were no other pertinent physical findings, complications, condition, signs or symptoms related to the Veteran’s bilateral knee conditions. The Veteran did not use assistive devices to aid in ambulation. The examiner indicated that the Veteran’s bilateral knee disabilities affected his ability to work, noting that in both sedentary and physical labor settings, the Veteran was unable to crouch, stoop, sit or stand for more than 15 minutes, carry weight over five pounds, and required frequent position changes. The Veteran’s bilateral knee disabilities affected his daily functioning with sitting, standing, prolonged walking, lifting, pushing, pulling, and carrying heavy objects. He required frequent position changes and pain affected his focus and concentration. A January 2021 treatment record noted right knee flexion as 5 out of 5, right knee extension as 5 out of 5, left knee flexion as 5 out of 5, and left knee extension as 5 out of 5. With regard to the Veteran’s right osteoarthritis, left knee strain, and right knee limitation of flexion, based on the evidence of record, the Board finds that higher disability ratings are not warranted, as the criteria for more severe ratings have not been met. The evidence does not show limitation of extension limited to 15 degrees or limitation of flexion limited to 45 degrees to warrant higher ratings under Diagnostic Code 5261 or 5260, respectively. Specifically, the June 2010 VA examination reflected normal range of motion of both knees, with flexion to 140 degrees and extension to 0 degrees. Although the Veteran reported knee pain, he denied any problems with standing or walking, denied any incapacitation during the past 12 months, and did not require any assistive devices for ambulation. The June 2010 VA examiner noted that the joint function of either knee was not additionally limited by pain, fatigue, weakness, lack of endurance, or incoordination after repetitive use. The May 2019 VA examination reflected right knee flexion to 120 degrees, right knee extension to 0 degrees, and normal range of motion of the left knee with flexion to 140 degrees and extension to 0 degrees. The Veteran was able to perform repetitive use testing with at least three repetitions with no additional functional loss or range of motion of both knees. Pain, weakness, fatigability or incoordination did not significantly limit functional ability of either knee with repeated use over a period of time. The Veteran denied flare-ups and did not use assistive devices for ambulation. The December 2019 VA examination noted flexion to 125 degrees and extension to 0 degrees for both knees. There was no additional loss of function or range of motion following repetitive use testing with at least three repetitions for both knees and pain, weakness, fatigability or incoordination did not significantly limit functional ability of either knee with repeated use over a period of time. The Veteran denied flare-ups of the knees. He occasionally used bilateral knee braces to aid in ambulation. The November 2020 VA examination noted right knee flexion to 85 degrees, right knee extension to 0 degrees, left knee flexion to 100 degrees, and left knee extension to 0 degrees. Repetitive use testing with at least three repetitions resulted in right knee flexion to 70 degrees, right knee extension to 0 degrees, left knee flexion to 90 degrees, and left knee extension to 0 degrees. Pain and weakness significantly limited functional ability with repeated use over a period of time and during flare-ups with right knee extension to 60 degrees, right knee extension to 0 degrees, left knee flexion to 80 degrees and left knee extension to 0 degrees. The Veteran did not use assistive devices to aid in ambulation. Given the results of the VA examinations of record, the Board finds that the Veteran does not meet the criteria for more severe disability ratings under Diagnostic Codes 5260 and 5261. Similarly, treatment records do not reflect disabilities of the bilateral knees manifesting in limitation of extension limited to 15 degrees or limitation of flexion limited to 45 degrees. For example, the Veteran’s knees demonstrated normal movement in December 2012. The July 2014 treatment record noted that the Veteran’s knee problems did not stop him from running and he was preparing to participate in an extended run. The Veteran denied a decrease in range of motion of the knees in May 2016 and testing revealed flexion to 130 degrees and extension to 0 degrees for both knees. August 2016 and October 2017 treatment records noted normal knee motion. Full range of motion of the right knee was noted in September 2019 and an October 2019 record noted good motion in the knee. Finally, a January 2021 treatment record reflected full range of motion of both knees. The Board has considered whether higher disability ratings are warranted under 38 C.F.R. §§ 4.40 and 4.45, but finds that the record does not reflect additional functional loss due to pain, weakness, fatigability or incoordination severe enough to meet the criteria for a higher disability rating under Diagnostic Code 5260 or 5261. While the Board finds the that Veteran is competent and credible in describing his pain and functional loss, the Board places greater probative weight on the objective medical findings by skilled professionals, as their findings were based on the Veteran’s history, his statements, and examination. As indicated above, these medical findings do not support higher disability ratings for the Veteran’s right knee osteoarthritis, right knee limitation of flexion, or left knee strain. In considering whether any other diagnostic codes are applicable, the Board finds that a 20 percent disability rating under Diagnostic Code 5258 is warranted for the Veteran’s right knee, as the November 2020 VA examination reflected right knee meniscal tear with frequent episodes of joint pain, joint locking, and joint effusion. Finally, as there is no evidence of ankylosis, recurrent subluxation or lateral instability, symptomatic removal of semilunar cartilage, impairment of the tibia and fibula, or genu recurvatum, separate or higher ratings under any other diagnostic code applicable to the knees is not warranted. In sum, the Board finds that a compensable disability rating for right knee limitation of flexion and disability ratings in excess of 10 percent for right knee osteoarthritis and left knee strain are not warranted. However, a separate 20 percent disability rating under Diagnostic Code 5258 for the Veteran’s right knee meniscal tear with frequent episodes of joint pain, joint locking, and joint effusion is granted. As the preponderance of the evidence is against the denied claims, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). 7. Entitlement to an initial disability rating in excess of 10 percent for right ankle bursitis is denied. 8. Entitlement to an initial disability rating in excess of 10 percent for left ankle osteoarthritis is denied. The Veteran is seeking increased disability ratings for his right ankle bursitis and left ankle osteoarthritis. He contends the severity of his bilateral ankle disabilities are not accurately reflected by his assigned disability ratings. The Veteran’s right ankle bursitis is rated under Diagnostic Code 5019-5271 and his left ankle osteoarthritis is rated under 5010-5271. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. 38 C.F.R. § 4.27. Here, the Veteran is compensated for right ankle limitation of motion (Diagnostic Code 5271) due to bursitis (Diagnostic Code 5019) and left ankle limitation of motion (Diagnostic Code 5271) due to traumatic arthritis (Diagnostic Code 5010). The Board notes that, during the pendency of the appeal, VA revised the rating criteria for Diagnostic Codes 5010 (discussed above) and 5271, effective February 7, 2021. See 85 Fed. Reg. 76453 (November 30, 2020). When the regulations concerning entitlement to a higher rating are changed during the course of an appeal, the veteran may be entitled to resolution of his claim under the criteria that are to his advantage. The former rating criteria may be applied throughout the period of the appeal, if they are more favorable to him. The revised rating criteria may be applied only prospectively, however, from the effective date of the change forward unless the regulatory change specifically permits retroactive application. 38 U.S.C. § 5110(g); VAOPGCPREC 7-03; VAOPGCPREC 3-00; Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Under the former rating criteria for Diagnostic Code 5271, moderate limited motion of the ankle warrants a 10 percent rating and marked limited motion of the ankle warrants a 20 percent rating. Under the revised rating criteria for Diagnostic Code 5271, effective February 7, 2021, moderate limited motion of the ankle with less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion warrants a 10 percent rating. Marked limited motion of the ankle with less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion warrants a 20 percent rating. Normal ranges of motion of the ankle are dorsiflexion from 0 degrees to 20 degrees, and plantar flexion from 0 degrees to 45 degrees. 38 C.F.R. § 4.71, Plate II. Turning to the evidence of record, the Veteran was afforded a VA examination in July 2010. The Veteran reported weakness, stiffness, and pain. He denied experiencing swelling, heat, redness, giving way, lack of endurance, locking, fatigability, deformity, tenderness, drainage, effusion, subluxation, and dislocation. The Veteran reported flare-ups of the ankles as often as two times per week with each time lasting half an hour. He rated his pain an 8 out of 10. Flare-ups occurred spontaneously and were alleviated spontaneously. During flare-ups, the Veteran experienced pain with walking for long periods of time and running. He denied difficulty with standing or walking. The Veteran noted he was not receiving treatment for his ankle conditions and denied incapacitating episodes in the past 12 months. The Veteran walked steady and did not require any assistive device for ambulation. On examination, the VA examiner noted tenderness of the bilateral ankles. Neither ankle showed signs of edema, instability, abnormal movement, effusion, weakness, redness, heat, deformity, guarding of movement, malalignment, drainage, or subluxation. There was no deformity or ankylosis noted. Range of motion testing revealed dorsiflexion and plantar flexion of both ankles were within normal limits, with dorsiflexion to 20 degrees and plantar flexion to 45 degrees. Repetitive range of motion was possible for both ankles with no additional degree of limitation. The examiner noted that the joint function of either ankle was not additionally limited by pain, fatigue, weakness, lack of endurance, or incoordination after repetitive use. X-rays of the right ankle were within normal limits. X-rays of the left ankle revealed mild osteoarthritic changes involving the tibiotalar joint. The examiner diagnosed right ankle bursitis and left ankle osteoarthritis. The examiner noted subjective factors included pain in the ankles when walking for long periods of time and running. Objective factors included x-ray findings of osteoarthritis of the left ankle and pain with palpation of both ankles on exam. In a January 2017 treatment record, the Veteran presented with intermittent bilateral ankle joint pain, which he rated as a 4 out of 10 at its worst. He noted his left ankle joint was stiff and denied swelling. On examination, no laxity of the ankle was noted. Anterior drawer sign was not observed and talar tilt test and squeeze test for fractures were negative. There was no tenderness on palpation of the right ankle medial aspect, achilles insertion, sinus tarsi, Achilles tendon insertion, or anterior lateral gutter. There was tenderness on palpation of the left ankle anterior aspect, decreasing, and the tibio-crural joint. There was no tenderness on medial aspect, Achilles insertion, sinus tarsi, anterior lateral gutter, or Achilles tendon insertion. The Veteran was afforded a VA examination in May 2019. The Veteran reported chronic bilateral ankle pain and locking, worse on the right side. He denied flare-ups of the ankles. The Veteran endorsed functional loss/impairment of the ankles, noting stiffness that was worse in the mornings and that his ankle felt as if it locked up at times. The VA examiner confirmed diagnoses of left ankle osteoarthritis and right ankle bursitis. On examination, range of motion testing of the ankles revealed normal range of motion of both ankles, with dorsiflexion to 20 degrees and plantar flexion to 45 degrees. Pain was noted bilaterally but did not result in/cause functional loss. There was no evidence of pain on weightbearing, non-weightbearing, or on passive range of motion testing bilaterally. There was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. There was no objective evidence of crepitus. The Veteran was able to perform repetitive use testing with at least three repetitions with no additional loss of function or range of motion in either ankle. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over a period of time in either ankle. The examiner indicated there were no additional contributing factors of disability. Muscle strength was normal and there was no reduction in muscle strength or muscle atrophy. There was no ankyloses of either ankle. Instability or dislocation of both knees was suspected, but anterior drawer tests and talar tilt tests were negative. The examiner indicated that the Veteran had not had shin splints, stress fractures, achilles tendonitis, achilles tendon rupture, malunion of the calcaneus or talus, or a talectomy. There were no other pertinent physical findings, complications, conditions, signs or symptoms related to the bilateral ankles. The Veteran did not use assistive devices to aid in ambulation. The examiner indicated that the Veteran’s ankle conditions impacted his ability to work, noting the Veteran’s difficulty with prolonged standing and walking. The Veteran was afforded a VA examination in December 2019. The Veteran reported his ankle was constantly locking and popping. He denied flare-ups of the ankle. The Veteran endorsed functional loss/impairment of the ankles, noting difficulty with prolonged walking, running, and prolonged standing. The VA examiner confirmed diagnoses of left ankle osteoarthritis, right ankle retrocalcaneal bursitis, and bilateral ankle degenerative arthritis. On examination, range of motion testing of the right ankle revealed right ankle dorsiflexion to 20 degrees and plantar flexion to 35 degrees. Range of motion itself did not contribute to functional loss. No pain was noted on exam and there was no objective evidence of crepitus or localized tenderness or pain on palpation of the joint or associated soft tissue. There was no evidence of pain with weightbearing, non-weightbearing, or on passive range of motion testing. Range of motion testing of the left ankle revealed dorsiflexion to 20 degrees and plantar flexion to 35 degrees. Range of motion itself did not contribute to functional loss. No pain was noted on exam and there was no objective evidence of crepitus or localized tenderness or pain on palpation of the joint or associated soft tissue. There was no evidence of pain with weightbearing, on non-weightbearing, or on passive range of motion testing. The Veteran was able to perform repetitive use testing with at least three repetitions without additional loss of function or range of motion of either ankle. Pain, weakness, fatiguability or incoordination did not significantly limit functional ability of either ankle with repeated use over a period of time. There were no additional contributing factors of disability. Muscle strength was normal bilaterally with no reduction in muscle strength and no muscle atrophy. There was no ankylosis. Bilateral ankle instability or dislocation was not suspected. The examiner indicated that the Veteran had not had shin splints, stress fractures, achilles tendonitis, achilles tendon rupture, malunion of the calcaneus or talus, or a talectomy. There were no other pertinent physical findings, complications, conditions, signs or symptoms related to the bilateral ankles. The Veteran indicated he used a right ankle brace occasionally to aid in ambulation. The examiner indicated that the Veteran’s ankle conditions impacted his ability to work, noting the Veteran’s difficulty with prolonged walking, running, and prolonged standing. Upon review of the record, the Board finds that initial disability ratings in excess of 10 percent for the Veteran’s right ankle bursitis and left ankle osteoarthritis are not warranted, as the criteria for more severe ratings have not been met. In this regard, both the September 2010 and May 2019 VA examinations reflected normal range of motion, with dorsiflexion to 20 degrees and plantar flexion to 45 degrees for both ankles. The May 2019 VA examination noted no loss of range of motion following repetitive use with at least three repetitions or with repetitive use over a period of time. The Veteran denied flare-ups of the ankle. Further, both examinations noted that the Veteran did not require the use of assistive devices for locomotion. The December 2019 VA examination reflected dorsiflexion to 20 degrees and plantar flexion to 35 degrees for both ankles. There was no loss of range of motion following repetitive use with at least three repetitions, with repetitive use over a period of time, or during flare-ups of the ankle. The Veteran occasionally utilized a right knee brace. Both the May 2019 and December 2019 indicated that pain, weakness, fatiguability or incoordination did not significantly limit functional ability of either ankle with repeated use over a period of time or during flare-ups. Additionally, the record reflects normal muscle strength and the absence of ankylosis. For these reasons, the Board finds that while some limitation of motion of the ankles are reflected in VA examinations and, similarly, treatment records, marked limitation of motion has not been shown. The Board has considered whether the Veteran is entitled to higher disability ratings for his bilateral ankle disabilities from February 7, 2021 under the revised rating criteria for Diagnostic Code 5271. However, as the evidence of record does not reflect ankle dorsiflexion less than 5 degrees or plantar flexion less than 10 degrees of either ankle, disability ratings for marked limited motion of the ankles are not warranted. The Board has also considered whether higher disability ratings are warranted under 38 C.F.R. §§ 4.40 and 4.45, but finds that the record does not reflect additional functional loss due to pain, weakness, fatigability or incoordination severe enough to meet the criteria for a higher disability rating. (Continued on the next page)   In sum, the Board finds that disability ratings in excess of 10 percent for the Veteran’s right ankle bursitis and left ankle osteoarthritis are not warranted. As the preponderance of the evidence is against the claims, the benefit of the doubt rule is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 54-56 (1990). KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Silverblatt, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.