Citation Nr: 21016030 Decision Date: 03/19/21 Archive Date: 03/19/21 DOCKET NO. 15-26 912 DATE: March 19, 2021 ORDER Entitlement to an evaluation in excess of 10 percent prior to April 25, 2016, for a left knee disability is denied. Entitlement to an evaluation in excess of 10 percent prior to July 31, 2017, for a right knee disability is denied. Entitlement to an evaluation in excess of 30 percent from June 1, 2017, for a left knee disability status post total knee arthroplasty (TKA) is denied. Entitlement to an evaluation in excess of 30 percent from September 1, 2018, for a right knee disability status post right TKA is denied. FINDINGS OF FACT 1. Prior to April 25, 2016, the Veteran’s left knee disability was manifested by flexion limited to, at worst, 80 degrees and pain in flexion and extension. 2. Prior to July 31, 2017, the Veteran’s right knee disability was manifested by flexion limited to, at worst, 70 degrees and pain in flexion and extension. 3. From June 1, 2017, the Veteran’s left knee disability status post TKA has been productive of no worse than intermediate degrees of weakness, pain, and limitation of motion. 4. From September 1, 2018, the Veteran’s right knee disability status post TKA has been productive of no worse than intermediate degrees of weakness, pain, and limitation of motion. CONCLUSIONS OF LAW 1. Prior to April 25, 2016, the criteria for a rating in excess of 10 percent for a left knee disability have not been met or approximated. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. §§ 4.7, 4.40, 4.45, 4.71a, Diagnostic Codes 5260-5263 (2019). 2. Prior to July 31, 2017, the criteria for a rating in excess of 10 percent for a right knee disability have not been met or approximated. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. §§ 4.7, 4.40, 4.45, 4.71a, Diagnostic Codes 5260-5263 (2019). 3. From June 1, 2017, the criteria for a rating in excess of 30 percent for a left knee disability status post TKA have not been met or approximated. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. §§ 4.7, 4.40, 4.45, 4.71a, Diagnostic Code 5055 (2019). 4. From September 1, 2018, the criteria for a rating in excess of 30 percent for a right knee disability status post TKA have not been met or approximated. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. §§ 4.7, 4.40, 4.45, 4.71a, Diagnostic Code 5055 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active naval service from April 1976 to March 1980 and from October 1981 to August 1994. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). Increased Ratings For historical purposes, the Veteran submitted a claim for an increased rating for his left and right knee disabilities in June 2011. In a May 2013 rating decision, the RO continued 10 percent ratings for the left and right knee degenerative joint disease status post patellofemoral syndrome. In an August 2016 rating decision, the RO discontinued the 10 percent rating for left knee degenerative joint disease status post patellofemoral syndrome and granted a temporary 100 percent rating following left TKA, effective April 25, 2016. A 30 percent rating was thereafter assigned effective June 1, 2017. In an August 2017 rating decision, the RO discontinued the 10 percent rating for right knee degenerative joint disease status post patellofemoral syndrome and granted a temporary100 percent rating following right TKA effective July 31, 2017. A 30 percent rating was thereafter assigned effective September 1, 2018. At an October 2011 VA examination, the Veteran reported weakness, stiffness, swelling, redness, giving way, lack of endurance, locking, tenderness, and pain. He reported flare-ups as often as once per day lasting twenty-four hours precipitated by physical activity and stress and alleviated with rest and pain medication. During flare-ups he reported severe pain and limitation of motion which makes it difficult to walk without pain. Clinical evaluation revealed tenderness of the right and left knee with no edema, instability, abnormal movement, effusion, weakness, redness, heat, deformity, guarding of movement, malalignment or drainage. There was no subluxation, no locking pain, no genu recurvatum, no crepitus, and no ankylosis. Range of motion testing of the knees revealed left and right knee flexion to 140 degrees and 0 degrees of extension with pain. The Veteran was able to perform repetitive motion with no loss of motion. Neither knee was additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use. Joint stability testing was normal for both knees. The examiner diagnosed the Veteran with degenerative arthritis of the left and right knee. At an August 2012 VA examination, the Veteran reported flare-ups of the knees which result in pain with walking and locking. Range of motion testing revealed left knee revealed flexion to 80 degrees and extension to 0 degrees with pain and right knee flexion to 70 degrees and extension to 0 degrees with pain. The Veteran was able to perform three repetitions of motion with no change in ranges of motion but less movement than normal and pain on movement of both knees. There was tenderness to palpation of both knees. There was no history of recurrent subluxation or dislocation. Joint stability testing and muscle strength testing was normal for both knees. The examiner reported that there were no meniscal conditions of either knee. The Veteran underwent various surgical procedures of both knees which resulted in pain with walking. The Veteran ambulated with the constant use of a brace and regular use of crutches for the left knee. The examiner diagnosed the Veteran with degenerative joint disease. Private treatment reports reflect that the Veteran underwent a left knee arthroplasty in April 2016 and a right knee arthroplasty in July 2017. The Veteran was seen for left and right knee complaints at both VA and various private providers. He was treated with pain medications and knee injections. On occasion limited motion was noted but no specific degree of limitation was included at those times. At a May 2019 VA examination, the Veteran reported that he had flare-ups but did not elaborate any further. He had undergone total knee replacements for both knees within the last three years. Range of motion testing of both knees revealed flexion to 100 degrees and extension to 0 degrees with pain noted on the right. The Veteran was able to perform three repetitions of motion with no additional loss of function or range of motion. There was no recurrent subluxation or lateral instability of either knee. Joint stability testing and muscle strength testing was normal. There was no ankylosis. The examiner indicated that there was no meniscal condition of either knee. The Veteran ambulates with the use of a cane on uneven ground or outside his home and knee braces when walking long distances. There was no evidence of pain with weight-bearing or with passive range of motion of either knee. In an addendum, the examiner noted that range of motion testing was unchanged in At a November 2020 VA examination, the Veteran reported that his left and right knee were improved following surgery but the Veteran still has symptoms and limitations including trouble walking long distances for extended periods, inability to run, difficulty with bending, kneeling, or squatting, and difficulty negotiating steps, stairs and inclines due to pain. He denied flare-ups of either knee. Range of motion testing of the left knee revealed 70 degrees of flexion and 0 degrees of extension and for the right knee 85 degrees of flexion and 0 degrees of extension. The Veteran had pain to palpation and with passive range of motion of both knees. There was objective evidence of pain with weight-bearing bilaterally. The Veteran was able to perform three repetitions of motion with no additional loss of function or range of motion. The Veteran’s gait was normal with no limp or antalgic gait. There was no recurrent subluxation or lateral instability. Joint stability testing and muscle strength testing was normal. The examiner indicated that the Veteran did not have a meniscal condition of either knee. The examiner noted that the Veteran underwent left and right knee total joint replacement. He reported residual daily pain and decreased range of motion but improved compared to pre-joint replacement. The examiner reported that there was no additional loss of motion during flare-ups as the Veteran denied flare-ups since his knee replacements. The examiner stated that the Veteran had no additional loss of motion of either knee with repeated use over time. In non-weight bearing, the Veteran had 90+ degrees of flexion bilaterally. With regard to the left knee, for the period prior to April 25, 2016, and for the right knee for the period prior to July 31, 2017, range of motion findings at the October 2011 and August 2012 examinations show that the Veteran demonstrated flexion limited to no worse than 80 degrees for the left knee and 70 degrees for the right knee, with pain. After considering additional limitation of motion due to functional loss, the criteria under Diagnostic Code 5260 for limitation of flexion approximates the currently assigned 10 percent ratings for each the left and right knee disabilities. 38 C.F.R. § 4.71a. With regard to Diagnostic Code 5261, the Veteran has demonstrated left and right knee extension to 0 degrees, which represents normal range of motion on extension with pain. As such, the Veteran is not entitled to a separate, 10 percent, rating under Diagnostic Code 5261 for limitation of extension in either knee. 38 C.F.R. § 4.71a. The Board has also considered whether separate or increased ratings may be assigned under other diagnostic codes but finds no additional bases upon which to assign ratings greater than a 10 percent rating for either the left knee or the right knee. There is no medical evidence of ankylosis, dislocated cartilage, removal of cartilage, malunion or nonunion of the tibia and fibula, or genu recurvatum that would support separate or increased evaluations under the criteria set forth in Diagnostic Codes 5256 (ankylosis), 5258 (dislocated semilunar cartilage), 5259 (removal of semilunar cartilage), 5262 (malunion or nonunion of the tibia and fibula), and 5263 (genu recurvatum). See 38 C.F.R. § 4.71a, Diagnostic Codes 5256-5263. Also, separate ratings are not warranted under Diagnostic Code 5257 in light of the absence of evidence of left or right knee instability or subluxation. In this regard, both the October 2011 and August 2012 examiners found that the Veteran did not have left or right knee instability or subluxation. 38 C.F.R. § 4.71a. In sum, the weight of the evidence preponderates against the award of a rating greater than 10 percent for the left knee disability prior to April 25, 2016, or a rating in excess of 10 percent for the right knee disability prior to July 31, 2017. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. With regard to the left knee disability status post TKA for the period beginning June 1, 2017, and with regard to the right knee disability status post TKA for the period beginning September 1, 2018, the RO assigned 30 percent ratings for each knee under Diagnostic Code 5055 as of the dates identified. 38 C.F.R. § 4.71a. The Board finds that the Veteran does not meet the criteria for a higher 60 percent rating, which requires chronic residuals consisting of severe painful motion or weakness. At the May 2019 and November 2020 VA examinations, range of motion testing revealed flexion of the left knee to no worse than 85 degrees with pain, and right knee flexion to no worse than 70 degrees with pain. There was no other reduction in function found in either knee noted in those examination reports. Further, the examiners did not note any other additional limitation present on examination. (Continued on the next page)   In sum, the Board finds after reviewing all of the relevant evidence, the weight of the evidence preponderates against the award of a rating greater than 30 percent for either the left knee since June 1, 2017 or the right knee since September 1, 2018. 38 U.S.C. § 5107 (b) (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Cryan, 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.