Citation Nr: 21021979 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 11-12 878 DATE: April 14, 2021 ORDER Since July 18, 2008, a rating of 20 percent disabled, but no higher, for the Veteran’s right knee disorder is granted. Since July 18, 2008, a separate rating of 10 percent disabled is warranted for the Veteran’s right knee pain during noncompensable motion loss. Since July 18, 2008, a rating of 20 percent disabled, but no higher, for the Veteran’s left knee disorder is granted. Since July 18, 2008, a separate rating of 10 percent disabled is warranted for the Veteran’s left knee pain during noncompensable motion loss. Entitlement to a rating in excess of 10 percent for the Veteran’s left ankle disorder is denied. REMANDED Entitlement to a separate rating for right and left knee cartilage disorders is remanded. Entitlement to a total disability evaluation based on individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. Since July 18, 2008, it is at least as likely as not that the Veteran’s right knee has manifested moderate lateral instability. 2. Since July 18, 2008, the Veteran’s right knee has manifested pain with noncompensable motion loss. 3. Since July 18, 2008, it is at least as likely as not that the Veteran’s left knee has manifested moderate lateral instability. 4. Since July 18, 2008, the Veteran’s left knee has manifested pain with noncompensable motion loss. 5. During the course of the appeal, the Veteran’s left ankle has manifested at worst moderate limitation of motion. CONCLUSIONS OF LAW 1. Resolving reasonable doubt in the Veteran’s favor, since July 18, 2008, the criteria for a rating of 20 percent disabled, but no higher, for the Veteran’s right knee disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5257. 2. Since July 18, 2008, the criteria for a rating of ten percent disabled for the Veteran’s right knee pain with motion loss have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DCs 5260, 5261. 3. Resolving reasonable doubt in the Veteran’s favor, since July 18, 2008, the criteria for a rating of 20 percent disabled, but no higher, for the Veteran’s left knee disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5257. 4. Since July 18, 2008, the criteria for a rating of ten percent disabled for the Veteran’s left knee pain with motion loss have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DCs 5260, 5261. 5. The criteria for entitlement to a rating in excess of 10 percent for the Veteran’s left ankle disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5271. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1980 to May 1984, from August 1984 to August 1988, and from April 1989 to July 1995. During his December 2020 Board hearing, the Veteran raised the issue of entitlement to a rating for tender scars on his left ankle. He is currently service connected for status post arthroscopy and reconstruction of the left ankle. However, the Agency of Original Jurisdiction (AOJ) has not adjudicated this claim. Therefore, the Board does not have jurisdiction over the claim for entitlement to a compensable rating for left ankle scars, and it is referred to the AOJ for appropriate action. 38 C.F.R. § 19.9(b). Increased Rating Disability evaluations are determined by the application of the facts presented to VA’s Schedule for Rating Disabilities (Rating Schedule) at 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 the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Separate diagnostic codes identify various disabilities and the criteria for specific ratings. Relevant regulations do not require that all cases show all findings specified by the Schedule; however, findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. §§ 4.7, 4.21. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining will be resolved in favor of the veteran. 38 C.F.R. § 4.3. In establishing an appropriate initial assignment of a disability rating, the proper scope of evidence includes all medical evidence submitted in support of the veteran’s claim. Fenderson v. West, 12 Vet. App. 119 (1999). In cases where an assigned disability rating has been challenged or appealed, it is possible for a veteran to receive a staged rating. A staged rating is an award of separate percentage evaluations for separate periods, based on the facts found during the appeal period. Id. at 126-28; see also Hart v. Mansfield, 21 Vet. App. 505 (2007) (in determining the present level of a disability for any increased evaluation claim, the Board must consider staged ratings). If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining will be resolved in favor of the veteran. 38 C.F.R. § 4.3. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In determining the appropriate evaluation for musculoskeletal disabilities, particular attention is focused on functional loss of use of the affected part. Under 38 C.F.R. § 4.40, functional loss may be due to pain, supported by adequate pathology and evidenced by visible behavior on motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Under 38 C.F.R. § 4.45, factors of joint disability include increased or limited motion, weakness, fatigability, or painful movement, swelling, deformity or disuse atrophy. Under 38 C.F.R. § 4.59, painful motion is an important factor of joint disability and actually painful joints are entitled to at least the minimum compensable rating for the joint. This regulation also requires that, whenever possible, the joints involved are tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint. See Correia v. McDonald, 28 Vet. App. 158, 168 (2016). Where functional loss is alleged due to pain upon motion, the provisions of 38 C.F.R. § 4.40 and § 4.45 must be considered. DeLuca v. Brown, 8 Vet. App. 202, 207-08 (1995). Within this context, a finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the claimant. Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Pain itself does not rise to the level of functional loss as contemplated by § 4.40 and § 4.45 but may result in functional loss only if it limits the ability to perform the normal working movements of the body with normal excursion, strength, coordination or endurance. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). In Sharp v. Shulkin, the United States Court of Appeals for Veterans Claims (Court) decision addressed what constitutes an adequate explanation for an examiner’s inability to estimate motion loss in terms of degrees during periods of flare-ups. 29 Vet. App. 26 (2017). The Court held that a VA examiner must attempt to elicit information from the record and the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups before determining that an estimate of motion loss in terms of degrees could not be given. It also held that any inability to furnish such an estimate must be predicated on a lack of medical knowledge among the medical community at large, rather than insufficient knowledge by the individual examiner. Id. The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. 1. Since July 18, 2008, a rating of 20 percent disabled, but no higher, for the Veteran’s right knee disorder 2. Since July 18, 2008, a rating of 20 percent disabled, but no higher, for the Veteran’s left knee disorder For the relevant period on appeal, the Veteran’s right and left knee disorders are each rated as 10 percent disabled from July 18, 2008, to March 12, 2018, and as 20 percent disabled thereafter. Included within 38 C.F.R. § 4.71a are multiple DCs that evaluate impairment resulting from service-connected knee disorders, including DC 5256 (ankylosis), DC 5257 (other impairment, including recurrent subluxation or lateral instability), DC 5258 (dislocated semilunar cartilage), DC 5259 (symptomatic removal of semilunar cartilage), DC 5260 (limitation of flexion), DC 5261 (limitation of extension), DC 5262 (impairment of the tibia and fibula), and DC 5263 (genu recurvatum). Under DC 5260, a noncompensable rating is assigned when flexion of the leg 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, DC 5260. Under DC 5261, a noncompensable rating is assigned when extension of the leg 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, DC 5261. Under DC 5257, which evaluates recurrent subluxation or lateral instability of a knee, and assigns a 10 percent disabling for a slight impairment, 20 percent disabling for a moderate impairment, and 30 percent disabling for a severe impairment. Under DC 5258, a maximum 20 percent rating is warranted for semilunar cartilage, dislocated, with frequent episodes of “locking”, pain, and effusion into the joint. Lastly, under DC 5259, a maximum 10 percent rating is warranted for removal of semilunar cartilage that is symptomatic. Separate ratings under DCs 5260 and 5261 may be assigned for disability of the same knee joint. See VAOPGCPREC 9-2004. Additionally, for a knee disability already rated under DCs 5260 and/or 5261, a claimant would have additional disability justifying a separate rating if there is instability and/or subluxation of the knee joint under DC 5257. See generally VAOPGCPREC 23-97. Furthermore, the rating criteria do not preclude separate ratings for meniscal injury under DCs 5258 and 5259 where there are separate ratings for limitation of motion under DCs 5260 and/or 5261, or instability under DCs 5257. Lyles v. Shulkin, 29 Vet. App. 107 (2017). The normal range of knee motion is 140 degrees of flexion and zero degrees of extension. 38 C.F.R. § 4.71, Plate II. The terms “slight,” “moderate,” “moderately severe,” and “severe” are not defined in the Rating 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 use of terminology such as “slight” or “moderate” by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. For the musculoskeletal system and muscle injuries, the applicable rating criteria, found at 38 C.F.R. § 4.71a, were amended effective February 7, 2021. The old rating criteria applies to rating periods prior to February 7, 2021; however, whichever set of criteria is more favorable applies to periods after February 7, 2021, if the claim was pending prior to this date. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). As the Veteran’s claim was pending prior to this date, the more favorable criteria will apply. Under the new rating criteria for DC 5257, other impairments of the knee are rated under either recurrent subluxation or instability, or patellar instability. Under recurrent subluxation or instability, a 10 percent rating is warranted for sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 20 percent rating is warranted for one of the following: (a) Sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation; or, (b) Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 30 percent rating is warranted for unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation. Under patellar instability, a 10 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: A brace, cane, or walker. A 30 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. Note 1 indicates for patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. Note 2 indicates that a surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration. In the July 2008 claim, the Veteran noted that right and left knee pain had become near constant, was sometimes intolerable, and affected his ability to function. During a September 2008 VA examination, the Veteran described daily pain of 6/10 severity worsened by prolonged standing, sitting and ambulating stairs. He was diagnosed with bilateral patellofemoral pain syndrome. Upon examination, the right knee manifested pain. Right knee active and passive flexion was measured to 140 degrees, and active and passive extension was measured to zero degrees. Left knee active and passive flexion was measured to 140 degrees, and active and passive extension was measured to zero degrees. In his April 2011 substantive appeal, the Veteran noted bilateral knee instability affected his ability to walk while working his mail route and caused his employer to switch him to a mounted mail delivery route. September 2015 VA treatment records reflect bilateral knee extension to zero degrees and flexion to 110 degrees. During an October 2017 Board hearing, the Veteran and his spouse testified that his knees limited his ability to participate in activities. The Veteran submitted an October 2017 disability benefits questionnaire that indicated he had bilateral knee joint osteoarthritis and patellofemoral pain syndrome. The Veteran reported flare-ups of pain and stiffness. Testing reflected bilateral knee extension to zero degrees and flexion to 130 degrees. The Veteran manifested bilateral knee tenderness to palpitation along the medial joint line. The examiner found no history of subluxation or lateral instability, but did note occasional swelling and effusion. The examiner also noted frequent episodes of joint pain related to the meniscus. Additionally, the Veteran required constant use of knee braces. During a March 2018 VA examination, the examiner diagnosed the Veteran with bilateral degenerative arthritis of the knees, bilateral patellofemoral pain syndrome, and bilateral chondromalacia. The Veteran reported knee pain, stiffness, and instability. Testing reflected right knee extension to zero degrees and flexion to 130 degrees, and left knee extension to five degrees and extension to 110 degrees. The examiner noted slight subluxation and instability of the knees bilaterally, with occasional swelling and effusion. During a January 2020 VA examination, the examiner diagnosed the Veteran with bilateral degenerative arthritis of the knees and bilateral patellofemoral pain syndrome. The Veteran reported flare-ups, but reported that these flare-ups did not affect range of motion in either knee. Testing reflected bilateral knee extension to zero degrees and flexion to 100 degrees, with objective evidence of medial tenderness and crepitus. The examiner found no subluxation, instability, effusion, or meniscal conditions. The Veteran’s knees require the occasional use of braces. During his December 2020 Board hearing, the Veteran testified that he had experienced symptoms of bilateral knee locking prior to the March 2018 increase in his bilateral knee disorder ratings, and also noted progressive increase in left knee pain prior to that time. The Veteran has also noted knee pain limiting his ability to function in his July 2008 claim; bilateral knee instability in his April 2011 substantive appeal; and knee pain, stiffness, and instability during his March 2018 VA examination. The Veteran is competent to report his symptomology and progression. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). These statements and testimony are credible and probative of the issue on appeal. Based on the Veteran’s testimony and statements regarding bilateral knee instability and locking throughout the course of the appeal, it is at least as likely as not that he has manifested moderate instability of both the right and left knee during the entire course of the appeal. Resolving reasonable doubt in the Veteran’s favor, a rating of 20 percent disabled, but no higher, is warranted since July 18, 2008. However, under the old rating criteria, neither knee has manifested severe recurrent subluxation or lateral instability during the course of the appeal. While the March 2018 VA examiner noted slight knee instability and subluxation, the September 2008 and January 2020 VA examiners, along with the physician who completed the October 2017 disability benefits questionnaire, did not note any instability or subluxation. Additionally, under the new rating criteria, the Veteran has not manifested recurrent subluxation or instability with unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device and bracing for ambulation; and the Veteran has not manifested patellar instability with 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. Therefore, a rating in excess of 20 percent disabled for either knee is not warranted under the new rating criteria at any time during the period under appeal. The Board has also considered rating the right and left knees under DCs 5260 and 5261 for limitation of motion. During the course of the appeal, the Veteran has demonstrated at worst right knee flexion limited to 100 degrees and extension limited to zero degrees; he has demonstrated left knee flexion limited to 100 degrees and extension limited to five degrees. The lay and medical evidence indicates that flare-ups do not affect range of motion. Thus, even with consideration of 38 C.F.R. §§ 4.40 and 4.45, these ranges of motion are not compensable under the relevant rating criteria. However, treatment records and Veteran statements, including his July 2008 claim, have indicated that the Veteran has experienced pain with right and left knee motion. Entitlement to a separate 10 percent rating for each knee because of pain with noncompensable motion loss is warranted since July 18, 2008. See 38 C.F.R. § 4.59; DCs 5260, 5261. The Board has also considered rating the right and left knees under DCs 5256, DC 5262, and DC 5263. However, the Veteran’s knees do not manifest any symptomology that would receive a compensable rating under the criteria for these DCs. The Board notes that the remand below addresses DCs 5258 and 5259. A rating of 20 percent disabled, but no higher, for instability of each knee is warranted since July 18, 2008, the date of filing for the claim currently before the Board. See DC 5257. A separate ten percent rating for each knee because of pain with noncompensable motion loss is also warranted during this time period. See 38 C.F.R. § 4.59; DCs 5260, 5261. 3. Entitlement to a rating in excess of 10 percent for the Veteran’s left ankle disorder During the entire course of the appeal dating to July 18, 2008, claim, the Veteran’s left ankle disorder is rated as ten percent disabled under DC 5271, which is a rating based on limitation of motion. Under DC 5271, moderate limitation of motion of the ankle warrants a rating of ten percent disabled; marked limitation of motion warrants a rating of 20 percent disabled. 38 C.F.R. § 4.71A. According to 38 C.F.R. § 4.71, Plate II, normal ankle dorsiflexion is zero to 20 degrees; normal ankle plantar flexion is zero to 45 degrees. Descriptive words, such as “slight,” “moderate” and “marked,” are not defined in the Rating 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 use of descriptive terminology by medical examiners, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision. 38 U.S.C. § 7104(a); 38 C.F.R. §§ 4.2, 4.6. For the musculoskeletal system and muscle injuries, the applicable rating criteria, found at 38 C.F.R. § 4.71a, were amended effective February 7, 2021. The old rating criteria applies to rating periods prior to February 7, 2021; however, whichever set of criteria is more favorable applies to periods after February 7, 2021, if the claim was pending prior to this date. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). As the Veteran’s claim was pending prior to this date, the more favorable criteria will apply. Under DC 5271, the new rating criteria, moderate limitation of motion of the ankle is less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion and warrants a rating of ten percent disabled; marked limitation of motion is less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion and warrants a rating of 20 percent disabled. 38 C.F.R. § 4.71a. December 1994 medical board records reflect that the Veteran underwent a left ankle arthroscopy and reconstruction during service. In the July 2008 claim, the Veteran noted that left ankle pain had become near constant, was sometimes intolerable, and affected his ability to function. During a September 2008 VA examination, the Veteran was diagnosed with chronic left ankle sprain. The Veteran reported that the left ankle manifested instability causing near-falls, and had gotten progressively worse since surgery. The examiner noted that a brace was required for the left ankle. Upon examination, the left ankle manifested instability, pain, and locking episodes. Left ankle active and passive dorsiflexion was measured to 20 degrees; active plantar flexion was measured to 40 degrees and passive plantar flexion was measured to 45 degrees. The Veteran submitted an October 2017 disability benefits questionnaire that indicated he had a lateral collateral ligament sprain of the left ankle. Range-of-motion measurements reflected left ankle dorsiflexion to 20 degrees and plantar flexion to 45 degrees. The Veteran reported left ankle pain with prolonged standing that limits his mobility. The left ankle manifested 5-out-of-5 strength testing with no muscle atrophy, ankylosis, or instability. The Veteran occasionally used a brace for his left ankle disorder. During a March 2018 VA examination, the examiner determined that the Veteran had limited left ankle motion due to arthroscopy and reconstruction. The Veteran did not report flare ups but did report soreness and note that the left ankle would occasionally “give out.” Range-of-motion measurements reflected left ankle dorsiflexion to 20 degrees and plantar flexion to 20 degrees with pain. Plantar flexion strength was 5-out-of-5, and dorsiflexion strength was 4-out-of-5. The examiner indicated that the Veteran did not use any assistive devices for his left ankle. During a January 2020 VA examination, the examiner diagnosed the Veteran as status post left ankle arthroscopy and reconstruction. The Veteran reported no left ankle flare-ups. Range-of-motion measurements reflected left ankle dorsiflexion to 15 degrees and plantar flexion to 25 degrees with pain. Plantar flexion strength was 5-out-of-5, and dorsiflexion strength was 5-out-of-5. The examiner noted that left ankle instability is suspected, but testing did not reflect instability. The examiner also indicated that the Veteran did not use any assistive devices for his left ankle. During his December 2020 Board hearing, the Veteran testified that he had increasing pain in his left ankle. He has also reported instability and left ankle pain affecting its function. The Veteran is competent to report his symptomology and progression. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). These statements and testimony are credible and probative of the issue on appeal. The Board notes that DC 5271’s new criteria reflects marked limitation of motion is less than 5 degrees dorsiflexion or less than ten degrees plantar flexion. The Veteran has manifested, at worst, left ankle dorsiflexion limited to 15 degrees and plantar flexion limited to 20 degrees. A rating in excess of ten percent disabled under the new criteria is not warranted. Additionally, strength testing has consistently found 4-out-of-5 or 5-out-of-5 strength when testing dorsiflexion and plantar flexion. While the September 2008 VA examiner noted instability, pain, and locking episodes, the March 2018 and January 2020 VA examiners, along with the physician that completed the October 2017 disability benefits questionnaire, did not find any ankle instability, Based on the medical evidence and Veteran’s testimony, his left ankle has likely manifested pain and occasional instability, along, with, at worst, dorsiflexion limited to 15 degrees, plantar flexion limited to 20 degrees, and strength testing indicating 4-out-of-5. This symptomology more closely reflects moderate limitation of motion under the old criteria for DC 5271. In the absence of reduced strength, greater limitation of motion, and more frequent instability reflected in objective testing, the Board finds that the Veteran’s left ankle does not reflect marked limitation of motion. Entitlement to a rating in excess of ten percent disabled for the left ankle disorder is not warranted. REASONS FOR REMAND 1. Entitlement to a separate rating for right and left knee cartilage disorders is remanded. The Veteran has testified that he experiences “locking” in his knees. The Board notes that both the March 2018 VA examiner and the private physician who completed an October 2017 disability benefits questionnaire indicated that March 2016 MRI records were available for review. The Board further notes that VA treatment records contain a March 2016 addendum indicating an MRI of the knee reflected moderate arthritis. Additionally, June 2012 VA treatment records also reflect an MRI of the Veteran’s knees was completed. However, the actual MRI results for these two diagnostic tests do not appear to be part of the claims file. On remand, the AOJ should obtain those results and associate them with the claims file. 2. Entitlement to a TDIU rating is remanded. During his December 2020 hearing, the Veteran indicated that he is planning to retire, as he can no longer continue working due to service-connected disorders. A remand is needed to provide the Veteran the opportunity to submit the Veteran’s Application for Increased Compensation Based on Unemployability. The matters are REMANDED for the following action: 1. Obtain VA treatment records since June 2020 and associate them with the claims file. Additionally, obtain the actual diagnostic results from right and left knee MRIs completed in or around March 2016 and June 2012 and associate them with the claims file. 2. Send the Veteran a letter advising him of the information and evidence needed to award a TDIU rating. This letter should also request that he complete VA Form 21-8940, Veteran’s Application for Increased Compensation Based on Unemployability, in order to provide the information needed to substantiate the claim of TDIU. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Howell, 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.