Citation Nr: 21022833 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 14-01 633 DATE: April 19, 2021 ORDER An initial 30 percent rating prior to May 11, 2015 for a bilateral foot disorder (characterized as bilateral pes planus, plantar fasciitis, degenerative arthritis, Morton’s neuroma and right foot hypermobility) is granted, subject to the rules and regulations governing the award of monetary benefits. An initial rating in excess of 50 percent from May 11, 2015 for bilateral foot disorder is denied. REMANDED Entitlement to an initial rating in excess of 10 percent for a right knee disorder is remanded. FINDINGS OF FACT 1. For the period prior to May 11, 2015, the evidence is at least in equipoise as to whether the Veteran’s bilateral foot disorder has been manifested by severe symptoms of disability with severe arch tenderness, swelling, pronation, inward displacement of the calcaneus, weakness, and pain on use and manipulation. More pronounced symptoms were not shown. 2. For the period from May 11, 2015, the Veteran's bilateral foot disorder is rated as 50 percent disabling, which is the maximum schedular rating permitted for the Veteran’s bilateral foot disorder. CONCLUSIONS OF LAW 1. For the period prior to May 11, 2015, the criteria for an initial 30 percent rating, but no higher, for a bilateral foot disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.40, 4.45, 4.71a, Diagnostic Code (DC) 5276. 2. For the period from May 11, 2015, the criteria for an initial rating in excess of 50 percent for a bilateral foot disorder have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.40, 4.45, 4.71a, DCs 5276 and 5269 (2021). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1983 to February 2003. In February 2020, the Board most recently remanded the current claims for additional development. The Board notes that, in the January 2021 rating decision, during the pending appeal, the Regional Office (RO) granted entitlement to service connection for bilateral pes planus to be combined/evaluated with the Veteran’s already service-connected plantar fasciitis with Morton’s disease and 1st ray hypermobility and assigned a higher 50 percent rating effective May 11, 2015. As this, this does not constitute a full grant of the benefit sought, the claim for a higher rating remains on appeal. See AB v. Brown, 6 Vet. App. 35, 39 (1993). The Board also acknowledges that the Veteran has submitted a timely September 2020 VA Form 10182, Notice of Disagreement (NOD), to the March 2020 denial for a clothing allowance award and a December 2020 VA Form 10182, NOD, to the October 2020 rating decision rating decision that severed entitlement to special monthly compensation (SMC) based on housebound status effective January 1, 2021. These appeals have been assigned separate docket numbers and will be addressed in separate decisions consistent with the Appeals Modernization Act (AMA) framework. Finally, it is noted that in March 2021 correspondence, the Veteran made a request for the Board to accept jurisdiction over an increased rating claim for the left knee and to adjudicate it along with his increased rating claim for the right knee. Specifically, the Veteran asserted that his left knee claim remained pending since 2008; that a December 2016 rating decision had granted service connection for the left knee, effective 2008; and that he had filed a left knee NOD and a VA Form 9 for both the right and left knees, but only the right knee claim remained pending. The Veteran stated that in his 2016 VA Form 9, he had requested that the Board review his left knee along with his right knee. A review of the record shows, however, that the Board does not have jurisdiction over a left knee claim. The Veteran’s claim for service connection for the bilateral knees was received on June 27, 2008. In January 2008, the RO issued a rating decision that, in pertinent part, granted service connection for the right knee. The Veteran responded with a July 2009 NOD that included arguments for both the right and left knees. Notably, although the Veteran stated that he disagreed with the denial of service connection for the left knee, the January 2008 rating decision did not address the left knee. Instead, the left knee was not addressed until a rating decision issued in December 2013. Although service connection was denied initially, after the Veteran filed an April 2014 VA Form 9, which was accepted as an NOD to the December 2013 rating decision, the Veteran was issued a rating decision in December 2016 that granted service connection for the left knee, rated 10 percent, effective from June 27, 2008 (date of original claim). The Veteran was notified of this decision on January 5, 2017, and was also advised that if he disagreed with that decision, he should complete and return a VA Form 21-0958, NOD, in order to initiate an appeal. He was further advised that he had one year from the date of that notice letter to appeal the decision. A review of the file does not show that in the one-year period following the January 2017 notice letter, the Veteran filed a VA Form 21-0958 in response to the December 2016 rating decision. While the Veteran had previously filed a NOD for the left knee, it addressed the matter of service connection. Once service connection is granted, however, a new NOD must be filed in order to initiate an appeal of the initial disability rating or effective date assigned for that award. See Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997) (holding that an NOD concerning service connection cannot initiate appellate review of the compensation level); Holland v. Gober, 10 Vet. App. 433, 436 (1997) (holding that an RO’s award of service connection constitutes a full award of benefits on an appeal initiated by an NOD as to a previous RO decision denying service connection and that, to the extent that a veteran disagrees with the compensation level or effective date assigned in the RO decision granting service connection, “a separate NOD [is required] in order for them to be placed in appellate status for the first time”). Accordingly, although the Veteran did include argument regarding the left knee when he filed his April 2014 VA Form 9, substantive appeal, for the right knee, this document does not give the Board jurisdiction over an increased rating claim for the left knee. Notably, at the time of the filing of the April 2014 VA Form 9, the Veteran was not yet service-connected for the left knee. The left knee was awarded service connection in 2016, effective from June 2008, and the Veteran did not file a NOD to the December 2016 rating decision. In December 2017, the Veteran submitted a VA Form 21-4138, Statement in Support of Claim, and requested “reconsideration” for various disabilities, including the left knee. However, this form does not constitute a valid NOD as to the December 2016 rating decision as it was not received on a VA Form 21-0958. Moreover, although prior to March 24, 2015, the statutory and regulatory provisions in effect required VA to look to all communications from a claimant to determine whether they might be interpreted as applications or formal or informal claims formal for benefits, effective March 24, 2015, a formal claim for benefits must be submitted on the application form prescribed by the Secretary. 38 C.F.R. §§ 3.1(p), 3.155, 3.16. For these reasons, the Board does not find that there is a pending claim or appeal regarding the left knee. If the Veteran wishes to seek an increased rating for his left knee, he is encouraged to file the requisite forms to initiate a claim for such with the RO. Also in separate March 2021 correspondences the Veteran has submitted argument for an earlier effective date for the award of a total disability rating due to individuality (TDIU) and also requests that the Board exercise jurisdiction over multiple other claims as a result of the TDIU claim. These statements appear to have been submitted in response to a March 2021 Statement of the Case (SOC) that addresses the issue of entitlement to an earlier effective date for the award of TDIU. It is noted that at the top of one of these correspondences, the Veteran labeled it with “10182 11B” which suggests that he is attempting to opt the TDIU issue into AMA. If the Veteran would like the Board to address this issue under the AMA framework, he is advised he must file a VA Form 10182. If he would like the Board to address this issue as a Legacy appeal, he should file a VA Form 9. The Veteran is reminded that he has 60 days from the issuance of the March 2021 to complete his appeal by filing a formal appeal. 1. Entitlement to an initial increased rating for the bilateral foot disorder. Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the veteran, as well as the entire history of the veteran's disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). In deciding this appeal, the Board has considered whether separate ratings for different periods of time, based on the facts found, are warranted, a practice of assigning ratings referred to as "staging the ratings." See Fenderson v. West, 12 Vet. App. 119 (1999). 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. 38 C.F.R. § 4.40. It is important that when evaluating disabilities of the musculoskeletal system, functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements must be considered. See 38 C.F.R. § 4.40; DeLuca v. Brown, 8 Vet. App. 202 (1995). Consideration must also be given to weakened movement, excess fatigability and incoordination. 38 C.F.R. § 4.45. It is the intent of the schedule to recognize painful motion with joint or periarticular pathology as productive of disability. It is also the intention 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. During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes “to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities.” Id. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. Prior to the regulatory change and prior to May 11, 2015, the Veteran’s bilateral foot disorder was rated by analogy under Diagnostic Code 5020, synovitis, which is rated the same as arthritis for limitation of motion, and the Veteran was assigned separate 10 percent ratings for each foot. 38 C.F.R. § 4.71a. In spite of this, the Board has recharacterized the diagnostic code for this period to 5276 for flatfoot. Such recharacterization is appropriate as the record reflects that the Veteran has been diagnosed with pes planus with plantar fasciitis. The Board has considered the implications of changing the diagnostic code and recognizes that any such change must be explained. Pernorio v. Derwinski, 2 Vet. App. 625 (1992). Likewise, the Board notes that Diagnostic Code 5276 pertains specifically to the anatomical location of the disability as well as provides compensation for the symptoms predominantly reported by the Veteran. The Board cannot identify any evidence to suggest that another diagnostic code would be more appropriate. Furthermore, as will be explained more fully below, there is no prejudice in changing the Veteran's rating diagnostic code to 5276, as such diagnostic code provides for a higher (combined) disability rating. Prior to the regulatory change, bilateral plantar fasciitis was often rated by analogy under DC 5276 (the diagnostic code for flatfoot (pes planus)), depending on the symptomatology shown. Under DC 5276, a 10 percent rating is warranted for moderate disability characterized by weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet. A rating of 20 percent (unilateral) or 30 percent (bilateral) is warranted for severe disability with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. A rating of 30 percent (unilateral) or 50 percent (bilateral) is warranted for pronounced disability with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. The rating schedule does not define nonspecific words such as "moderate," "severe," or "pronounced." Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decision is "equitable and just." See 38 C.F.R. § 4.6. As of February 7, 2021, under the amended criteria, bilateral plantar fasciitis is rated under DC 5269. Under DC 5269, a 10 percent rating is warranted for unilateral or bilateral plantar fasciitis. A 20 percent rating is warranted for unilateral plantar fasciitis with no relief from non-surgical and surgical treatment. A 30 percent rating is warranted for bilateral plantar fasciitis with no relief from non-surgical and surgical treatment. In October 2009, the Veteran underwent a VA examination to evaluate his bilateral foot disorder. The examiner diagnosed the Veteran with bilateral plantar fasciitis and metatarsophalangeal (MTP) degenerative joint disease (DJD). The examiner documented symptoms of pain, swelling, heat, redness, stiffness, fatigability, weakness, and lack of endurance. There was evidence of painful motion and severe tenderness in the arch. The Veteran utilized orthotic inserts and was unable to stand for more than a few minutes or walk more than a few yards. The Veteran saw a private podiatrist in October 2011 and January 2012, and it was noted the Veteran had pronation, calcaneal valgus (inward displacement of the calcaneus), tight achilles tendon, hypermobility of the first rays, and pain around the first metatarsocuneiform joint. In March 2012, the Veteran underwent another VA examination to evaluate his bilateral foot disorder. The examiner diagnosed the Veteran with metatarsalgia and 1st ray hypermobility. The examiner also documented that the Veteran had arch pain on palpation, weak foot, and regularly used orthotics. VA treatment records from October 2013, June 2014, and February 2015 show continuous plantar fasciitis with achilles insert pain, pain was worse with activity. The Veteran also had lower extremity instability with hypermobile structures, aggravated by excessive foot pronation, bilaterally; bilateral acquired equinus deformity; and difficulty walking and standing. On May 11, 2015, a VA examination was conducted to determine the current severity of the Veteran’s bilateral foot disorder. The examiner diagnosed bilateral flat feet, bilateral plantar fasciitis, and right foot degenerative arthritis. The Veteran reported having flare-up pain that occurred when he walked too long. The examiner documented symptoms consisting of pain accentuated on use, pain accentuated on manipulation, characteristic calluses, orthotics with no relief of pain, objective evidence of marked deformity, marked pronation, and weight bearing line falls over or medial to the great toe. The Veteran had mild or moderate left hallux valgus. The examiner indicated there was pain on physical examination with contributing factors to disability consisting of excess fatigability, pain on movement, pain on weight bearing, disturbance of locomotion, interference with standing, and lack of endurance. The examiner also indicated there was pain, weakness, fatigability, and incoordination that significantly limited functional ability during flare-ups or when the foot was used repeatedly over a period time, but she was unable to say, without resorting to speculation, whether this resulted in additional loss of range of motion. The functional impact of such disability was that he was unable to walk or stand for any length of time, he could only stand/walk for short distances, he could not do impact activities such as running or jumping, and he was limited to performing semi-sedentary or sedentary jobs. The examiner also documented that such disability would affect the Veteran’s ability to be reliable, productive, concentrate, follow instructions, and interact with co-workers and supervisors. In June 2016, the RO conducted another VA examination to assess the severity of the Veteran’s bilateral foot disorder. The examiner diagnosed bilateral flat feet, right foot metatarsalgia, bilateral hallux valgus, bilateral plantar fasciitis, and right foot arthritis. The Veteran reported that he had utilized braces for his ankle and foot conditions for the past 2 years and this was helpful in decreasing mid and forefoot pain. The Veteran also reported constant daily pain and avoiding prolonged ambulation or standing. The examiner documented symptoms consisting of orthotics with no relief, decreased longitudinal arch height, lower extremity deformity of equinovarus caused medial pronation forces, characteristic calluses, right foot tenderness at first metatarsocuneiform junction, and mild pes planus with mild pronation. Hallux valgus was mild or moderate. The examiner indicated there was pain on physical examination with contributing factors to disability consisting of more movement than normal on the right, bilateral pain on movement, left foot deformity, bilateral disturbance of locomotion, and bilateral interference with standing. The examiner indicated there was pain, weakness, fatigability, and incoordination that significantly limited functional ability during flare-ups or when the foot was used repeatedly over a period time. Described in terms of functional loss, for the right foot, there was decreased durability in weight bearing activities due to pain and orthotic foot bracing limited the Veteran’s ability to run or jump or work on uneven ground and, for the left foot, there was increased pain with repetitive weightbearing activity and limited durability and ability to engage in prolonged ambulation. The functional impact of such disability was that the Veteran was unable to perform jobs that would require frequent carrying or lifting, he should avoid stairs and ladders, and he was recommended to perform seated or sedentary activity. In February 2018 and November 2020, the Veteran was evaluated for his bilateral foot disorder by two different VA examiners. The examiners diagnosed the Veteran with bilateral flat foot, Morton’s neuroma, metatarsalgia, hallux valgus, plantar fasciitis, arthritis, and right foot hypermobility. The Veteran reported symptoms of pain with prolonged walking and bilateral numbness/tingling of the feet. The Veteran also reported frequent flare ups with increased pain and limited ability to tolerate weight bearing of any degree. During the November 2020 VA examination, the Veteran further reported that his flare-ups were severe, occurred anytime, and lasted two to three days. The examiners documented symptoms consisting of pain accentuated on use, pain accentuated on manipulation, extreme tenderness of the plantar surfaces, characteristic calluses, swelling on use, orthotics with no relief, marked pronation of one or both feet, decreased longitudinal arch height on weight bearing, weight bearing line falls over or medial to the great toe, inward bowing of the achilles tendon, marked inward displacement and severe spasm of the achilles tendon on manipulation, and lower extremity deformity of equinovarus causes medial pronation forces. The Veteran had mild or moderate hallux valgus. The February 2018 VA examiner noted that the Veteran did not have muscular atrophy or circulatory compromise. The examiners indicated there was pain on physical examination with contributing factors to disability consisting of more movement than normal on the right, weakened movement, excess fatigability, pain on weightbearing/non-weightbearing, disturbance of locomotion, interference with standing, and lack of endurance. The examiners also indicated there was pain, weakness, fatigability, and incoordination that significantly limited functional ability during flare-ups or when the foot was used repeatedly over a period time. Described in terms of functional loss, the Veteran’s was limited in his ability to tolerate weight bearing and could not stand for more than 20 minutes or walk more than 50 feet. The functional impact of such disability was that the Veteran would be limited to sedentary work only. In an addendum opinion, the November 2020 VA examiner attempted to delineate the Veteran’s bilateral foot symptoms as follows: bilateral foot pes planus with decreased arch on both feet with hindfoot valgus; Morton’s neuroma/metatarsalgia with tenderness to palpation of the plantar aspect of the feet and pain reported on the plantar side; left hallux valgus with left great toe pain, stiffness, and curvature inwards; bilateral plantar fasciitis with pain reported from the heel to the front of the foot on the plantar side; left foot arthritis with pain on the top of foot; and right foot hypermobility with metatarsal clicking and moving. The Board finds this opinion to be highly probative as it is based on examination of the Veteran, review of the record, and is consistent with the other evidence of record. Notably, there is no evidence to the contrary. More recent VA treatment record show limited activity with plantar fasciitis, achilles insert pain. See January 2020 VA Treatment records. The Veteran demonstrated considerable difficulty walking, standing, and participating in normal activities of daily living. There was also instability with hypermobile structures aggravated by excessive foot pronation. Based on the foregoing, the Board finds that, for the period prior to May 11, 2015, the evidence is at least in equipoise as to whether the criteria for a higher initial 30 percent rating were met. In pertinent part, for this period, the Veteran’s bilateral foot disorder was manifested by severe arch tenderness, swelling, excessive foot pronation, inward displacement of the calcaneus, and pain on use. These symptoms are at the very least commensurate to the severe symptomatology required to establish a 30 percent rating under DC 5276, for the bilateral feet. Accordingly, for the period prior to May 11, 2015, an initial 30 percent rating is granted. [The Board acknowledges that prior to May 11, 2015 the Veteran’s left and right feet were evaluated separately under DC 5276 for plantar fasciitis and pes planus. However, as indicated above, VA regulation pursuant to DC 5276 provides for a combined rating when evaluating a bilateral foot disability. As such, this decision reflects an award for the Veteran’s bilateral foot disability rated at 30 percent, for a severe bilateral foot disability.] For this period, however, the criteria for a higher 50 percent rating were not met. In that regard, more pronounced symptoms such as marked pronation, extreme tenderness of the plantar surfaces, severe spasm of tendo achilles, not improved by orthopedic shoes or appliances or symptoms of similar severity were not shown. Accordingly, a higher initial 50 percent rating is not warranted for the period prior to May 11, 2015. With regard to whether an initial rating in excess of 50 percent is warranted for the Veteran’s bilateral foot disorder from May 11, 2015, the Board emphasizes that the 50 percent rating currently assigned for this disability under DC 5276 is the highest assignable rating under this provision and no other higher/separate ratings are available under any other diagnostic code. The Board has considered whether separate ratings may be awarded for each foot pursuant to DC 5284, in lieu of the single rating currently assigned under DC 5276, to render a higher overall rating. To that effect, separate disability ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition was not "duplicative of or overlapping with the symptomatology" of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 262 (1994). Under DC 5284, a 10 percent rating is warranted for moderate symptoms, a 20 percent rating is warranted for moderately severe symptoms, and a 30 percent rating is warranted for severe symptoms. With actual loss of use of the foot, a 40 percent rating is assigned under DC 5167. Nevertheless, the Board's reading of VA regulations leads it to conclude that separate ratings under DC 5284 are not warranted in this case. In this regard, VA's Schedule for Rating Disabilities sets forth a specific diagnostic code applicable to acquired flatfoot (i.e., DC 5276) and plantar fasciitis (from February 7, 2021, DC 5269). It is significant in the Board's view that pes planus and plantar fasciitis are expressly addressed by specific diagnostic codes. When a condition is specifically listed in the Schedule, it may not be rated by analogy. Copeland v. McDonald, 27 Vet. App. 333, 338 (2015) (pes planus is specifically rated under Diagnostic Code 5276; hence an analogous rating under DC 5284 was not permitted). Because there are specific diagnostic codes for pes planus and plantar fasciitis (after February 7, 2021), it is not appropriate to rate the Veteran's disability under DC 5284. The Board also finds that, prior to the February 7, 2021 regulation change that added a specific diagnostic code for plantar fasciitis, the Veteran’s bilateral foot symptomatology was otherwise contemplated by the rating criteria for DC 5276. The Veteran’s bilateral foot symptoms included pain accentuated on use, pain accentuated on manipulation, tenderness of the plantar surfaces, characteristic calluses, swelling on use, orthotics with no relief, pronation deformities of the feet, decreased longitudinal arch height on weight bearing, weight bearing line falls over or medial to the great toe, inward bowing/stress of the achilles tendon, achilles tendon displacement/pain, lower extremity deformity of equinovarus causes medial pronation forces, and 1st ray hypermobility with clicking and moving. Such symptoms are contemplated by the rating criteria under DC 5276, which accounts for pronounced and severe symptoms regarding pain, tenderness, characteristic callosities, swelling, deformity, and achilles tendon displacement and spasm. Thus, while DC 5284 may apply to plantar fasciitis (prior to the February 7, 2021 regulatory changes) and other foot disorders, the Veteran is service-connected for a bilateral foot disability characterized as bilateral pes planus, plantar fasciitis, degenerative arthritis, Morton’s neuroma and right foot hypermobility and the Board finds that the Veteran’s overall foot symptomatology is best represented by and compensated for under DC 5276, rather than 5284. The Board has also considered whether a separate rating would be warranted under DC 5284 for other foot injuries, under DC 5269 (2021) for plantar fasciitis, or under DC 5279 for metatarsalgia (Morton’s disease). The Veteran’s attorney specifically contended, by and on his behalf, that DC 5284 should at least apply to the Veteran’s 1st ray hypermobility because DC 5276 does not contemplate this disorder. See December 2017 Correspondence. Nevertheless, assigning separate ratings under these diagnostic codes would constitute impermissible pyramiding because the Veteran’s bilateral foot symptomatology, to include the symptoms attributable to his plantar fasciitis, metatarsalgia, and 1st ray hypermobility, are already adequately contemplated under DC 5276. As indicated above, the Veteran’s Morton’s neuroma/metatarsalgia, plantar fasciitis, and 1st ray hypermobility were manifested by tenderness, pain, and metatarsal clicking and moving. These symptoms are adequately accounted for by the criteria under DC 5276 that contemplates tenderness, pain, and marked deformity, and considered in the rating evaluation assigned. To afford the Veteran a separate rating under these diagnostic codes would result in compensation for duplicative symptomatology. See Esteban, 6 Vet. App. 259. As noted above, this is prohibited. [Parenthetically, the Board acknowledges that the Veteran appears to have been awarded a separate rating for Morton’s disease/hypermobility of the 1st ray. However, in the December 2016 rating decision, the RO found clear and unmistakable error in the July 2016 rating decision that awarded a separate rating for these disorders because 38 C.F.R. § 4.14 provides that the evaluation of the same disability under various diagnoses is to be avoided.] The Board also observes that the Veteran has no foot disability characterized by weak foot (i.e., a foot disability with muscular atrophy and circulatory compromise), claw foot, hallux rigidus, or malunion or nonunion of the tarsal or metatarsal bones. Accordingly, the DCs pertaining to those disabilities are not applicable in the instant case. See 38 C.F.R. § 4.71a, DCs 5277, 5278, 5281, 5283. While the Veteran has diagnoses for hallux valgus, he is already separately rated for his left foot hallux valgus and right foot metatarsalgia. Moreover, the evidence does not otherwise show severe symptomatology for right foot hallux valgus, such that a separate compensable rating would be warranted under DC 5280. Accordingly, a separate compensable rating is not warranted under DC 5280 for right foot hallux valgus. The Veteran’s attorney suggested that an extraschedular rating is warranted under 38 C.F.R. § 3.321(b) because the rating schedule fails to describe the Veteran disability level and symptomatology. See December 2017 Correspondence. Consideration of an extraschedular rating requires a three-step inquiry. The first question is whether the schedular rating criteria adequately contemplate the veteran’s disability picture. If the schedular evaluation does not contemplate the level of disability and symptomatology shown and is found inadequate, then the second inquiry is whether the exceptional disability picture exhibits other related factors, such as marked interference with employment or frequent periods of hospitalization. See Thun v. Peake, 22 Vet. App. 111 (2008). The first Thun element compares a claimant’s symptoms to the rating criteria, while the second addresses the resulting effects of those symptoms. Thus, the first and second Thun elements, although interrelated, involve separate and distinct analyses. Yancy v. McDonald, 27 Vet. App. 484, 495 (2016). If the veteran’s disability picture meets the second inquiry, then the third step is to refer the case to the Director of Compensation Services to determine whether an extraschedular rating is warranted. See Thun, 22 Vet. App. 111. The rating criteria under DC 5276, however, describes impairment or severity level in addition to particular symptoms. As a result, DC 5276 contemplates the entire range of impairment resulting from the Veteran’s bilateral foot disability. For this reason, the Veteran’s specific symptoms and their severity are contemplated by the rating schedule. See, e.g., Spellers v. Wilkie, 30 Vet. App. 211, 219 (2018). Because the Rating Schedule was purposely designed to compensate for such functional effects of the Veteran’s disabilities in all spheres of his daily life, including at work and at home, and given the variety of ways in which the Rating Schedule contemplates functional loss for musculoskeletal disabilities, the Board concludes that the schedular rating criteria reasonably describe the Veteran’s disability picture. The threshold issue under Thun is thus not met, and further consideration of an extraschedular rating is not warranted. In light of the contentions made by the Veteran’s attorney, that the VA examinations of record were inadequate because they do not comply with Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Board has also considered the applicability of Sharp and Correia v. McDonald, 28 Vet. App. 158 (2016). In Correia, the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing “for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint.” In Sharp, the Court also noted that for a joint examination to be adequate, the examiner “must express an opinion on whether pain could significantly limit” a veteran’s functional ability, and that determination “should, if feasible, be portrayed in terms of the degree of additional range-of-motion loss due to pain on use or during flare-ups.” Nevertheless, and as discussed above, to the extent that the examination findings of record relative to the bilateral foot disorder are not completely in compliance with Correia and/or Sharp, the Board finds that remand for additional examination would serve no useful purpose. Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991). In that regard, the Board emphasizes that examination findings pertaining to the feet would not be useful in evaluating the Veteran’s bilateral foot disorder because such evaluation does not require joint testing and/or range of motion testing. Accordingly, a remand to correct any prior examination deficiency of the bilateral foot disorder that complies with Correia and Sharp would not be useful. REASONS FOR REMAND 1. Entitlement to an initial rating in excess of 10 percent for a right knee disorder is remanded. In November 2020, the RO procured a VA examination to evaluate the severity of the Veteran’s right knee disorder. The examiner diagnosed the Veteran with right knee strain, instability, and bilateral knee tendonitis. On range of motion testing the examiner documented flexion at 110 degrees and extension at 0 degrees. The examiner also indicated that there was additional range of motion loss due to flare-up episodes consisting of 90 degrees of flexion and 0 degrees of extension. The examiner later noted that pain limited both flexion and extension. This statement, however, is inconsistent with the examiner’s previous findings showing no loss of range of motion on extension of the right knee. As it is not clear to what extent the Veteran’s pain limited extension of his right knee, the Board finds that remand is warranted for a new VA examination consistent with the directives herein. The Board further notes that the Veteran has documented instability of the right knee. During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). Specifically, the criteria for evaluating knee instability under Diagnostic Code 5257 was changed. Accordingly, the Veteran’s right knee instability must also be considered under the new rating criteria. The matters are REMANDED for the following actions: Schedule the Veteran for a VA examination with an appropriate examiner to determine the nature and severity of the Veteran’s service-connected right knee disorder. The claims folder (including a copy of this remand) must be provided to and reviewed by the examiner as part of the examination. All indicated tests should be accomplished, and all clinical findings should be reported in detail. The examiner is asked to describe fully the current severity of the Veteran’s disorder. In addition, the examiner should address the following: a) The examiner should describe any pain, weakened movement, excess fatigability, instability of station, and lack of coordination present. b) The examiner should state whether the examination is taking place during a flare-up or after repeated use over time. If not, the examiner should ask the Veteran to describe the impairment associated with flare-up episodes or after repetitive use over time, to include: frequency, duration, characteristics, precipitating and alleviating factors, severity and/or the extent of functional limitations. Based on the Veteran’s lay statements and the other evidence of record, the examiner should provide an opinion estimating any additional degrees of limited range of motion caused by functional loss during a flare-up or after repeated use over time. If rendering this opinion is not possible, the clinician must provide an adequate explanation as to why. c) Range of motion testing must include testing in active motion and passive motion. The examiner should also discuss weight-bearing and nonweight-bearing ranges, if possible, obtain range of motion of the opposite undamaged joint. If such are not applicable, the examiner should state such along with an explanation. d) The examiner should indicate whether the Veteran has recurrent subluxation/lateral instability consisting of: i) a sprain, incomplete ligament tear, or complete ligament tear causing persistent instability without prescribed assistive device or bracing for ambulation; ii) a sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, or unrepaired or failed repair of complete ligament tear causing persistent instability; or iii) an unrepaired or failed repair of complete ligament tear causing persistent instability and that a medical provider prescribes both an assistive device and bracing for ambulation (both require a prescribed assistive device or bracing for ambulation) e) The examiner should also indicate whether the Veteran has patellar instability consisting of: i) a diagnosed condition that does not require a prescription from a medical provider for a brace, cane, or walker; ii) a diagnosed condition with one of either a brace, cane, or walker; or iii) 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. f) The examiner should also comment on the functional impairment caused by the Veteran’s service-connected knee disorders. The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, the examiner should provide a reason for doing so. A compete rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Metzner, Paul 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.