Citation Nr: 21022293 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 13-27 592 DATE: April 15, 2021 ORDER Entitlement to service connection for a liver disability, to include cirrhosis of the liver, including as due to a service-connected disability, is denied. Entitlement to service connection for ischemic heart disease, including as due to in-service exposure to an herbicide agent, is denied. Entitlement to a disability rating greater than 40 percent prior to June 1, 2015, greater than 30 percent prior to May 23, 2019, and greater than 10 percent thereafter, for residuals of a left knee medial meniscectomy with traumatic arthritis is denied. FINDINGS OF FACT 1. The record evidence shows that the Veteran’s liver disability, to include cirrhosis of the liver, is not related to active service or any incident of service, including as due to a service-connected disability. 2. The record evidence shows that the Veteran likely was exposed to an herbicide agent while on active service in the official waters offshore of the Republic of Vietnam. 3. The record evidence shows that the Veteran does not experience any current disability due to his claimed ischemic heart disease which could be attributed to active service or any incident of service, including as due to his presumed in-service exposure to an herbicide agent. 4. The record evidence shows that, between December 19, 2011, and June 1, 2015, the service-connected residuals of a left knee medial meniscectomy with traumatic arthritis are manifested by, at worst, complaints of pain, flexion to 60 degrees with pain, extension to 30 degrees with pain, stiffness, and tenderness to palpation. 5. The record evidence shows that, between June 1, 2015, and May 23, 2019, the service-connected residuals of a left knee medial meniscectomy with traumatic arthritis are manifested by, at worst, complaints of pain and tenderness to palpation. 6. The record evidence shows that, effective May 23, 2019, the service-connected residuals of a left knee medial meniscectomy with traumatic arthritis are manifested by, at worst, complaints of frequent episodes of joint pain and locking, swelling on weight bearing, and pain with movement. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a liver disability, to include cirrhosis of the liver, including as due to a service-connected disability, have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309, 3.310 (2019). 2. The criteria for entitlement to service connection for ischemic heart disease, including as due to in-service exposure to an herbicide agent, have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.303, 3.304, 3.307, 3.309 (2019). 3. The criteria for entitlement to a disability rating greater than 40 percent prior to June 1, 2015, greater than 30 percent prior to May 23, 2019, and greater than 10 percent thereafter, for residuals of a left knee medial meniscectomy with traumatic arthritis have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.71a, Diagnostic Codes (DCs) 5003-5260, 5258, and 5261 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the U.S. Marine Corps from March 1971 to March 1973, including in combat in the official waters offshore of the Republic of Vietnam. He also had additional unverified U.S. Marine Corps Reserve service. This case has a long and complicated procedural history. A videoconference Board hearing was held in August 2016 before the undersigned Veterans Law Judge and a copy of the hearing transcript has been added to the record. In December 2017, the Board remanded the currently appealed claims to the Agency of Original Jurisdiction (AOJ) for additional development. The Board also dismissed the Veteran’s service connection claim for liver cancer because he had withdrawn it and denied a claim of entitlement to an earlier effective date than December 19, 2011, for service-connected residuals of a left knee medial meniscectomy with traumatic arthritis. A review of the claims file shows that there has been substantial compliance with the Board’s remand directives. The Board directed that the AOJ obtain updated treatment records for the Veteran and schedule him for examinations to determine the current severity of his service-connected residuals of a left knee medial meniscectomy with traumatic arthritis and the nature and etiology of his liver disability. Additional records subsequently were associated with the claims file. And the requested examinations occurred in May 2019 with additional opinions obtained in May 2020. See Stegall v. West, 11 Vet. App. 268 (1998); see also Dyment v. West, 13 Vet. App. 141 (1999) (holding that another remand is not required under Stegall where the Board’s remand instructions were substantially complied with), aff’d, Dyment v. Principi, 287 F.3d 1377 (2002). Following the Board’s December 2017 remand, the AOJ issued a Supplemental Statement of the Case (SSOC) in January 2021 in which it listed the issues on appeal as including a claim of service connection for liver cancer and a claim of entitlement to an earlier effective date than December 19, 2011, for service-connected residuals of a left knee medial meniscectomy with traumatic arthritis. This was error because, as noted above, the service connection claim was withdrawn by the Veteran and dismissed by the Board in December 2017 and the earlier effective date claim was denied by the Board in December 2017. The Board apologizes to the Veteran and his attorney for the AOJ’s error in promulgating the January 2021 SSOC and leading them to believe erroneously that these claims still were on appeal. Having reviewed the record evidence, the Board finds that the issues on appeal should be characterized as stated above. 1. Entitlement to service connection for a liver disability, to include cirrhosis of the liver, including as due to a service-connected disability The Board finds that the preponderance of the evidence is against granting the Veteran’s claim of service connection for a liver disability, to include cirrhosis of the liver, including as due to a service-connected disability. The Veteran essentially contends that he incurred a liver disability (which he characterized as cirrhosis of the liver) during active service and experienced continuous post-service disability. He alternatively contends that a service-connected disability (specifically, PTSD) caused or aggravated (permanently worsened) his liver disability. The more probative evidence does not support his assertions regarding an etiological link between any current liver disability and active service or any incident of service, including as due to a service-connected disability. It shows instead that, although the Veteran has been diagnosed as having and treated for a variety of liver disabilities since his service separation, including cirrhosis, and received a liver transplant, any current liver disability is not related to active service. For example, the available service treatment records show that he denied any relevant pre-service medical history at a pre-enlistment physical examination in February 1971 prior to his entry on to active service in March 1971. At his separation physical examination in March 1973, clinical evaluation was within normal limits. The Board notes that the absence of contemporaneous records does not preclude granting service connection for a claimed disability. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (finding lack of contemporaneous medical records does not serve as an "absolute bar" to the service connection claim); Barr v. Nicholson, 21 Vet. App. 303 (2007) ("Board may not reject as not credible any uncorroborated statements merely because the contemporaneous medical evidence is silent as to complaints or treatment for the relevant condition or symptoms"). The post-service evidence also does not support granting service connection for a liver disability, to include cirrhosis of the liver, including as due to a service-connected disability. Contrary to the lay assertions and Board hearing testimony, it shows instead that the Veteran’s current liver disability is not related to service. For example, his voluminous post-service VA outpatient treatment records show ongoing complaints of and treatment for a liver disability (variously diagnosed as cirrhosis of the liver). On VA hepatitis, cirrhosis, and other liver conditions Disability Benefits Questionnaire (DBQ) in May 2019, the Veteran stated that he began experiencing “swelling and weight gain around 2006. He states that he was soon diagnosed with cirrhosis of the liver.” He had a liver transplant in March 2005 and “his condition has dramatically improved since his transplant.” The VA examiner reviewed the Veteran’s electronic claims file, including his service treatment records and post-service VA treatment records. He denied experiencing any symptoms since his liver transplant. Continuous medication is required for treatment of the Veteran’s liver condition. He had no signs or symptoms attributable to chronic or infectious liver diseases. An abdominal ultrasound in February 2019 showed an unremarkable pancreas and an enlarged spleen. A liver biopsy showed findings consistent with viral hepatitis and fibrosis suggestive of cirrhosis. The VA examiner opined that it was less likely than not that the Veteran’s liver disability is related to active service. The rationale for this opinion was based on a review of the claims file. The rationale also was that the Veteran was not diagnosed as having hepatitis C until 32 years after his service separation. The rationale further was that he was diagnosed as having cirrhosis of the liver secondary to hepatitis C. The diagnoses were liver transplant, hepatitis C, and cirrhosis of the liver. In a December 2020 medical opinion, a VA clinician opined that it was less likely than not that the Veteran’s liver disability (which was diagnosed as cirrhosis of the liver and hepatitis C) is related to active service or any incident of service, including as due to a service-connected disability. The rationale for this opinion was based on a review of the claims file. The rationale also was that, because there was no evidence of high-risk exposures while on active service, it is less likely than not that the Veteran’s hepatitis C is related to service. With regard to the assertion that a psychiatric disability caused or aggravated the Veteran’s liver disability, the rationale was, “There is no physiologic or anatomic mechanism by which psychological conditions can cause or aggravate cirrhosis.” The Veteran contends that he incurred a liver disability during active service or, alternatively, a service-connected disability (specifically, PTSD) caused or aggravated (permanently worsened) his liver disability. The most probative evidence, though, does not support his assertions regarding an etiological link between a liver disability and active service, including as due to a service-connected disability. It shows that the Veteran’s current liver disability (variously diagnosed as cirrhosis of the liver and hepatitis C) is not related to active service. Multiple VA clinicians opined in May 2019 and in December 2020 that this disability is not related to active service or any incident of service, including as due to a service-connected disability (specifically, PTSD). All of these opinions were fully supported. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (finding that a medical opinion "must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). These opinions are afforded greater probative weight than the Veteran’s statements, as the examiners have expertise that the Veteran is not shown to have. The Veteran otherwise has not identified or submitted any equally probative evidence demonstrating his entitlement to service connection for granting service connection for a liver disability, to include cirrhosis of the liver, including as due to a service-connected disability. In summary, the Board finds that service connection for a liver disability, to include cirrhosis of the liver, including as due to a service-connected disability, is not warranted. 2. Entitlement to service connection for ischemic heart disease, including as due to in-service exposure to an herbicide agent The Board next finds that the preponderance of the evidence is against granting the Veteran’s claim of service connection for ischemic heart disease, including as due to in-service exposure to an herbicide agent. The Veteran essentially contends that he incurred ischemic heart disease during active, specifically as a result of in-service exposure to an herbicide agent while operating in the coastal waterways and other official waters offshore of the Republic of Vietnam, and experienced continuous post-service disability. The more probative evidence does not support his assertions and instead shows that the Veteran does not have ischemic heart disease. The Board already has conceded that the Veteran likely was exposed to an herbicide agent while onboard U.S.S. DULUTH between January and May 1972. Although the Veteran likely was exposed to an herbicide agent while on active service, the record evidence does not support finding that the Veteran has ischemic heart disease or that any heart disorder he does have it related to active service. It shows instead that, although the Veteran has complained of and been treated for a variety of cardiovascular disabilities since his service separation, he does not have any disorder that is considered ischemic heart disease, and none of the heart disorders are attributable to active service or any incident of service, including as due to his presumed in-service exposure to an herbicide agent. The Board again notes that the service treatment records show that he denied any relevant pre-service medical history at a pre-enlistment physical examination in February 1971 prior to his entry on to active service in March 1971. At his separation physical examination in March 1973, clinical evaluation was within normal limits. As noted above, the absence of contemporaneous records does not preclude granting service connection for a claimed disability. See Buchanan, 451 F.3d at 1337, and Barr, 21 Vet. App. at 303. The post-service evidence also does not support granting service connection for ischemic heart disease, including as due to in-service exposure to an herbicide agent. For example, the Veteran’s voluminous VA outpatient treatment records show that he complained of and sought treatment for atrial fibrillation (or an irregular heartbeat) in the decades since his service separation. On VA heart conditions DBQ in May 2019, the Veteran’s complaints included occasional episodes of chest pain which occurred every 1-2 months. His chest pain was dull, aching, rated as 6/10 on a pain scale, and lasted 1½ days. He also complained of shortness of breath on exertion. The VA examiner reviewed the Veteran’s electronic claims file, including his service treatment records and post-service VA treatment records. The Veteran’s heart condition did not qualify within the generally accepted medical condition of ischemic heart disease. He took daily atorvastatin for cholesterol. An EKG had documented more than 4 episodes of intermittent cardiac arrhythmia. Physical examination showed a regular heart rate and rhythm, a heart murmur auscultated at the left mid-sternal border, clear lungs to auscultation, normal peripheral pulses, trace peripheral edema of the bilateral lower extremities, and blood pressure 170/84. A chest x-ray was normal. An EKG showed sinus rhythm and a septal myocardial infarction of undetermined age. An interview-based METs test showed fatigue and dizziness with METs between 3-5. “He has increased activity intolerance and [shortness of breath] with exertion secondary to atrial fibrillation.” The VA examiner concluded that there was no evidence of ischemic heart disease. This examiner also opined that it was less likely than not that the Veteran’s claimed ischemic heart disease is related to active service, including as due to his in-service exposure to an herbicide agent. The rationale for this opinion was based on a review of the claims file. The rationale also was that atrial fibrillation is not considered ischemic heart disease under relevant VA diagnostic criteria. The rationale further was that atrial fibrillation was not a disease “to which presumed exposure to” herbicides was applicable. The diagnosis was atrial fibrillation. In an August 2020 opinion, a VA clinician stated that, based on a review of the claims file, the Veteran had a diagnosis of coronary artery disease. This clinician also stated that the Veteran’s diagnosis of atrial fibrillation and a diagnosis of a myocardial infarction were attributable to coronary artery disease. In an October 2020 clarification addendum to the August 2020 opinion, a different VA clinician stated that the August 2020 opinion should be ignored by VA adjudicators. This clinician also stated that the Veteran had not been diagnosed as having coronary artery disease and only had been diagnosed as having atrial fibrillation. This clinician noted that the Veteran had a medical history of a cerebrovascular accident (or stroke) but not coronary artery disease. “There is no medical evidence to confirm that the Veteran has been diagnosed with [coronary artery disease] nor ever had [a] myocardial infarction.” The Court has held that the Board is free to assess medical evidence and is not compelled to accept a physician's opinion. Wilson v. Derwinski, 2 Vet. App. 614 (1992). A medical opinion based upon an inaccurate factual premise is not probative. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). A bare conclusion, even one reached by a medical professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998). The Court also has held that the value of a physician's statement is dependent, in part, upon the extent to which it reflects "clinical data or other rationale to support his opinion." Bloom v. West, 12 Vet. App. 185, 187 (1999). Thus, a medical opinion is inadequate when it is unsupported by clinical evidence. Black v. Brown, 5 Vet. App. 177, 180 (1995). The Board notes that, in an August 2020 opinion, a VA clinician stated that the Veteran had been diagnosed as having coronary artery disease and his diagnosis of atrial fibrillation and a diagnosis of myocardial infarction were attributable to his diagnosis of coronary artery disease. There is nothing in the record evidence to support the August 2020 opinion (as a different VA clinician noted in October 2020). The August 2020 VA clinician was mistaken in concluding that the Veteran had been diagnosed as having coronary artery disease during or after active service, as the medical treatment records show nothing supportive of this. A different VA clinician noted correctly in October 2020 that the Veteran did not have a diagnosis of coronary artery disease and had never been diagnosed as having this disability. The October 2020 VA clinician also correctly noted that the Veteran had never had a myocardial infarction. Thus, the Board assigns no probative value to the August 2020 medical opinion and, as recommended by a different VA clinician in October 2020, will set aside this opinion in adjudicating the currently appealed claim. The Veteran contends that he incurred ischemic heart disease during active service, specifically as a result of in-service exposure to an herbicide agent, and experienced continuous post-service disability. It is undisputed that the Veteran likely was exposed to an herbicide agent while in Vietnam. Nevertheless, the record evidence shows that he does not experience any current heart disability that can be characterized as ischemic heart disease. VA clinicians in May 2019 and in October 2020 determined that the Veteran does not have ischemic heart disease. These opinions were fully supported. See Stefl, 21 Vet. App. at 124. These opinions are also highly probative in determining that the heart disorder that is attributed to the Veteran is not due to exposure to Agent Orange or any other aspect of service. These opinions are afforded more probative weight than the Veteran’s statements. The Veteran otherwise has not identified or submitted any equally probative evidence demonstrating his entitlement to service connection for ischemic heart disease, including as due to in-service exposure to an herbicide agent. Thus, the Board finds that service connection for ischemic heart disease, including as due to in-service exposure to an herbicide agent, is not warranted.   3. Entitlement to a disability rating greater than 40 percent prior to June 1, 2015, greater than 30 percent prior to May 23, 2019, and greater than 10 percent thereafter, for residuals of a left knee medial meniscectomy with traumatic arthritis The Board finally finds that the preponderance of the evidence is against granting the Veteran’s claim of entitlement to a disability rating greater than 40 percent prior to June 1, 2015, greater than 30 percent prior to May 23, 2019, and greater than 10 percent thereafter, for residuals of a left knee medial meniscectomy with traumatic arthritis. The Veteran essentially contends that his service-connected residuals of a left knee medial meniscectomy with traumatic arthritis is more disabling than currently evaluated during each of the time periods at issue in this appeal. The record evidence does not support his assertions. It shows instead that, prior to June 1, 2015, this disability is manifested by, at worst, complaints of pain, flexion to 60 degrees with pain, extension to 30 degrees with pain, stiffness, and tenderness to palpation. For example, on VA knee and lower leg conditions DBQ in June 2012, the Veteran’s complaints included worsening left knee problems. The VA examiner reviewed the Veteran’s electronic claims file, including his service treatment records and post-service VA treatment records. The Veteran reported that weather changes and activity “cause severe pain in the leg.” Range of motion testing of the left knee showed flexion to 100 degrees with objective evidence of painful motion beginning at 60 degrees, extension to 30 degrees with objective evidence of painful motion beginning at 30 degrees with no additional limitation of motion on repetitive testing. The Veteran experienced functional loss or functional impairment due to less movement than normal and pain on movement. He had a left knee medial meniscectomy in 1972 and experienced residuals of pain and stiffness. Physical examination of the left knee showed tenderness to palpation, 5/5 muscle strength, normal joint stability, no history of recurrent patellar subluxation or dislocation, and frequent episodes of joint pain. The Veteran regularly wore a knee brace. X-rays showed arthritis. He experienced severe pain with joint range of motion testing. In a September 2012 addendum to the June 2012 VA examination, a VA clinician stated that the Veteran’s diagnosis was left knee degenerative joint disease. Because the Board previously found an April 2013 VA examination to be inadequate for VA adjudication purposes in the December 2017 remand, this evidence was not reviewed or relied upon in adjudicating the currently appealed claim. VA x-rays of the left knee taken in November 2013 showed extensive osteoarthritic changes which were stable since June 2013 and joint effusion. On VA outpatient treatment in January 2014, the Veteran’s complaints included left knee pain. A history of osteoarthritis per x-ray was noted. He asked to speak to an orthopedic surgeon about total knee replacement surgery. The VA clinician advised the Veteran on activity modifications to treat his left knee such as “moving [his] knees around a bit before standing up after sitting for long periods and also to try the stationary bike or pool for cardio exercise instead of high impact activities.” Range of motion testing of the left knee was from 0 to 105 degrees “with discomfort.” Physical examination of the left knee showed patellofemoral crepitus, patella grind, an antalgic gait, and a hypertrophied appearance. The diagnosis was left knee pain and osteoarthritis. In June 2014, the Veteran’s complaints included left knee swelling, decreased range of motion, and occasional popping. A history of left knee ligament reconstruction surgery was noted. Physical examination of the left knee showed a healed surgical scar, crepitus, joint stability, and global tenderness to palpation. Range of motion testing of the left knee was from 5 to 75 degrees. X-rays of the left knee showed tricompartmental osteoarthritis. The diagnosis was left knee osteoarthritis. The VA clinician stated that the Veteran likely was not a surgical candidate due to his significant co-morbidities. In a January 2015 Hepatology Note included in the Veteran’s VA outpatient treatment records, a VA hepatologist/gastroenterologist stated that the Veteran “has chronic renal insufficiency. He has atrial fibrillation and has required chronic anticoagulation to prevent cerebrovascular accidents. Due to his multiple medical conditions, he would be of increased risk of severe complications with a knee replacement operation.” In a February 2015 Orthopedic Surgery Attending Note included in the Veteran’s VA outpatient treatment records, a VA physician stated that the Veteran had a severely arthritic left knee. “We have recommended total knee surgery but because of his severe medical problems he is not a surgical candidate. I would recommend that he be evaluated for an electric scooter to aid in everyday activity.” On VA outpatient treatment in March 2015, physical examination showed left knee edema, tenderness, and a stable joint. The diagnoses included left knee pain with “episodes of pain over [the] last few days.” The record evidence shows that, prior to June 1, 2015, the Veteran’s service-connected residuals of a left knee medial meniscectomy with traumatic arthritis are manifested by, at worst, complaints of pain, flexion to 60 degrees with pain, extension to 30 degrees with pain, stiffness, and tenderness to palpation. VA outpatient treatment records and examination reported document his ongoing complaints of left knee pain and stiffness which were attributed to residuals of his left knee medial meniscectomy surgery. X-rays of the left knee consistently showed arthritis. Left knee flexion was limited to 60 degrees with pain. Taken together, the record evidence as whole shows that, prior to June 1, 2015, the symptomatology attributable to this disability supported the assignment of a 40 percent rating under DC 5261. See 38 C.F.R. § 4.71a, DC 5261 (2019). There is no indication that, prior to June 1, 2015, the Veteran’s left knee extension is limited to more than 30 degrees such that a disability rating greater than 40 percent is warranted under DC 5261. Id. He also did not experience left knee ankylosis or tibia and fibular impairment such that a disability rating greater than 40 percent is warranted under other potentially applicable DCs for evaluating knee disabilities. The Veteran finally has not identified or submitted any evidence demonstrating his entitlement to a disability rating greater than 40 percent prior to June 1, 2015, for his service-connected residuals of a left knee medial meniscectomy with traumatic arthritis. Thus, the Board finds that the criteria for disability rating greater than 40 percent prior to June 1, 2015, for residuals of a left knee medial meniscectomy with traumatic arthritis have not been met. The Veteran also is not entitled to a disability rating greater than 30 percent between June 1, 2015, and May 23, 2019, for his service-connected residuals of a left knee medial meniscectomy with traumatic arthritis. Contrary to his lay assertions and Board hearing testimony, the record evidence shows instead that this disability is manifested by, at worst, complaints of pain and tenderness to palpation during this time period. VA outpatient treatment records dated during this time period suggest that the Veteran frequently complained of left knee pain when seen for treatment of his liver disability. For example, on VA outpatient treatment in January 2017, the Veteran’s complaints included chronic left knee pain. He reported slipping and twisting his left knee 2 weeks earlier. Objective examination of the left knee showed tenderness to palpation, no swelling, and old surgical scars. The Veteran testified at his August 2016 Board hearing that he had been provided a scooter, wheelchair, cane, and a walker for his service-connected residuals of a left knee medial meniscectomy with traumatic arthritis. He also testified that he had been advised by his treating clinicians not to undergo total knee arthoplasty because of the risk of a liver infection. See Board hearing transcript dated August 9, 2016, at pp. 5. Although the Veteran frequent complained of left knee pain when seen for treatment of his liver disability during this time period, the record evidence as a whole does not support assigning a disability rating greater than 30 percent between June 1, 2015, and May 23, 2019, for his service-connected residuals of a left knee medial meniscectomy with traumatic arthritis. See 38 C.F.R. § 4.71a, DC 5003-5260 (2019). Because it shows instead that the Veteran experiences, at worst, complaints of pain and tenderness to palpation as a result of his service-connected during this time period, this persuasively suggests to the Board that the Veteran may be overcompensated for the degree of disability which experienced. More importantly, there is no indication that the Veteran’s left knee extension is limited to 30 degrees or less, he experiences left knee ankylosis in flexion between 10 and 20 degrees or between 20 and 45 degrees or extremely unfavorable ankylosis, or nonunion of the tibia and fibula as is required for a disability rating greater than 30 percent under DCs 5256, 5261, or 5262, respectively. See 38 C.F.R. §§ 4.71a, DCs 5256, 5261, and 5262 (2019). The Board acknowledges that the Veteran was issued multiple assistive devices, including a scooter, wheelchair, cane, and a walker to help him cope with the symptomatology attributable to his service-connected residuals of a left knee medial meniscectomy with traumatic arthritis. He otherwise has not identified or submitted any evidence demonstrating his entitlement to a disability rating greater than 30 percent for his service-connected residuals of a left knee medial meniscectomy with traumatic arthritis. Thus, the Board finds that the criteria for a disability rating greater than 30 percent between June 1, 2015, and May 23, 2019, for residuals of a left knee medial meniscectomy with traumatic arthritis have not been met. The Veteran finally is not entitled to a disability rating greater than 10 percent effective May 23, 2019, for his service-connected residuals of a left knee medial meniscectomy with traumatic arthritis. Contrary to his lay assertions and Board hearing testimony, the record evidence shows that this disability is, at worst, minimally disabling during this time period. For example, on VA knee and lower leg conditions DBQ on May 23, 2019, the Veteran’s complaints included continued left knee pain. The VA examiner reviewed the Veteran’s electronic claims file, including his service treatment records and post-service VA treatment records. The Veteran rated his left knee pain as 8/10 on a pain scale (with 10/10 being the worst imaginable pain). “He states that the left knee often swells and pops with movement or prolonged weight bearing. He reports that prolonged walking/standing, walking up/down stairs, or kneeling aggravates symptoms.” He denied experiencing flare-ups. He reported functional loss or impairment which he described as, “I am not able to run anymore due to my knee pain. I have pain walking up stairs or just walking for a prolonged period of time.” Range of motion testing of the left knee showed flexion to 90 degrees, extension to 0 degrees, and “he is unable to fully flex the knee.” There was no pain on range of motion testing and no additional limitation of motion on repetitive testing. The Veteran had an antalgic gait “and used a cane to assist with ambulation.” He also had “difficulty getting up from a seated position to a standing position, putting more weight on the right side.” Physical examination of the left knee on May 23, 2019, showed crepitus, pain significantly limited functional ability with repeated use over time but no additional limitation of motion, no ankylosis or muscle atrophy, no history of recurrent subluxation or lateral instability, a history of prolonged effusion with swelling reported during weight bearing, no joint instability, a meniscal tear, frequent episodes of joint pain and locking, and status-post meniscectomy “with residual swelling and pain.” The Veteran regularly used a brace and a cane for residuals of his left medial meniscectomy. X-rays of the left knee showed arthritis. “He is unable to stand/walk for prolonged periods, walk up stairs, or kneel without pain secondary to residuals, medial meniscectomy with traumatic arthritis.” There was objective evidence of pain on passive range of motion testing and no objective evidence of pain on non-weight bearing. The diagnoses included residuals of a left knee medial meniscectomy with traumatic arthritis. The Veteran reported to the emergency room (ER) at a VA Medical Center (VAMC) in August 2020 with complaints including chronic left knee pain. “He states his left knee has been hurting for the last 1 2 months. He denies any recent trauma or injury.” Physical examination of the left knee showed crepitus, bony hypertrophy, and pain with movement. The diagnoses included chronic left knee pain. He was discharged home. The record evidence shows that, effective May 23, 2019, the Veteran’s service-connected residuals of a left knee medial meniscectomy with traumatic arthritis are manifested by, at worst, complaints of frequent episodes of joint pain and locking, swelling on weight bearing, and pain with movement. VA examination on May 23, 2019, documented the Veteran’s ongoing complaints of chronic left knee pain. Although he lacked full flexion of the left knee, his range of motion on flexion was to 90 degrees. There was no pain on range of motion testing and no additional limitation of motion on repetitive testing. He also experienced functional impairment with reported problems climbing stairs, an inability to run, and documented difficulty getting up from a chair without leaning heavily to the right side and having an antalgic gait. Taken together, the record evidence as a whole dated since May 23, 2019, supports assigning a 10 percent rating for this service-connected under DC 5258. See 38 C.F.R. § 4.71a, DC 5258. The Board acknowledges that pain limited the Veteran’s his functional ability with repeated use of the left knee over time but there was no additional limitation of motion in the left knee on repetitive testing at this VA examination. There was objective evidence of pain on passive range of motion testing and no objective evidence of pain on non-weight bearing. A subsequent VAMC ER visit in August 2020 again documented the Veteran’s ongoing complaints of chronic left knee pain. There is no indication that, effective May 23, 2019, he experienced left knee flexion limited to 30 degrees or less or that x-rays showed the involvement of 2 or more major joints or 2 or more minor joint groups as is required for a disability rating greater than 10 percent under DC 5003-5260. See 38 C.F.R. § 4.71a, DC 5003-5260. The Veteran otherwise has not identified or submitted any evidence demonstrating his entitlement to a disability rating greater than 10 percent effective May 23, 2019, for his service-connected residuals of a left knee medial meniscectomy with traumatic arthritis. While the rating criteria applicable to some musculoskeletal disabilities were revised in February 2021, the criteria relevant to the Veteran’s appeal have not changed and would not result in a higher rating than that already assigned. Thus, the Board finds that the criteria for a disability rating greater than 10 percent effective May 23, 2019, for residuals of a left knee medial meniscectomy with traumatic arthritis have not been met. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Michael T. Osborne, 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.