Citation Nr: 21024535 Decision Date: 04/23/21 Archive Date: 04/23/21 DOCKET NO. 06-14 999 DATE: April 23, 2021 ORDER A rating in excess of 10 percent for degenerative arthritis of the right knee is denied. A rating in excess of 10 percent for degenerative arthritis of the left knee is denied. A rating in excess of 50 percent for posttraumatic headaches is denied. FINDINGS OF FACT 1. For the entire appeal period, the Veteran’s degenerative arthritis of the right knee is manifested by flexion limited to, at most, 110 degrees and full extension, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without ankylosis, dislocation or removal of semilunar cartilage, impairment of the tibia and fibula, or genu recurvatum. 2. For the entire appeal period, the Veteran’s degenerative arthritis of the left knee is manifested by flexion limited to, at most, 120 degrees and full extension, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without ankylosis, dislocation or removal of semilunar cartilage, impairment of the tibia and fibula, or genu recurvatum. 3. For the entire appeal period, the Veteran is in receipt of the maximum schedular rating for his posttraumatic headaches, and such disability did not result in symptomatology that is not contemplated by the currently assigned rating. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for degenerative arthritis of the right knee have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260. 2. The criteria for a rating in excess of 10 percent for degenerative arthritis of the left knee have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260. 3. The criteria for a rating in excess of 50 percent for posttraumatic headaches have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.124a, Diagnostic Code 8100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1972 to February 1973. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions issued in May 2004 and October 2016 by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2015, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In June 2017, the Board, in pertinent part, granted an earlier effective date of September 22, 2008, for the award of the separate 10 percent ratings for degenerative arthritis of the bilateral knees, denied ratings in excess of 10 percent for such disabilities, denied a rating in excess of 30 percent for posttraumatic headaches, and remanded a claim for a total disability rating based on individual unemployability (TDIU). Thereafter, the Veteran appealed the Board’s decision only to the extent that it denied increased ratings for his degenerative arthritis of the bilateral knees and posttraumatic headaches to the United States Court of Appeals for Veterans Claims (Court). In August 2018, the Court granted the parties’ Joint Motion for Partial Remand, which vacated the Board’s decision as to such increased rating claims and remanded the case for further consideration. Further, while on remand, a June 2017 rating decision awarded a TDIU for the entire appeal period, i.e., as of December 24, 2003, which represents a full grant of the benefit sought on appeal in regard to such issue. Rice v. Shinseki, 22 Vet. App. 447 (2009); Harper v. Wilkie, 30 Vet. App. 345 (2018). In March 2019 and June 2020, the Board remanded the issues on appeal for additional development. While on remand, a November 2020 rating decision granted an increased rating of 50 percent for posttraumatic headaches, effective for the entire appeal period, i.e., as of December 24, 2003. Therein, the RO indicated such constituted a full grant of the benefit sought on appeal. In this respect, although such does represent the highest schedular evaluation available for that disability, a rating in excess of 50 percent is permissible on an extraschedular basis. As the Veteran is presumed to be seeking the maximum benefit available for a disability, and neither he nor his representative has expressed satisfaction with the assignment of the 50 percent rating, the claim for a higher rating remains on appeal. AB v. Brown, 6 Vet. App. 35, 38 (1993). The case now returns for further appellate review. Increased Ratings Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant’s favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found - a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. The basis of disability evaluation 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. With regard to the Veteran’s degenerative arthritis of the right knee and left knee, 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 Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011), the Court held that, although pain may cause a functional loss, “pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system.” Rather, pain may result in functional loss, but only if it limits the ability “to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance.” Id., quoting 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). 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, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that “[t]he joints involved should be 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.” Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the Diagnostic Code under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). 1. Entitlement to a rating in excess of 10 percent for degenerative arthritis of the right knee. 2. Entitlement to a rating in excess of 10 percent for degenerative arthritis of the left knee. The appeal period before the Board begins on September 22, 2008, the effective date for the award of the separate ratings for degenerative arthritis of the bilateral knees. For the entire appeal period, the Veteran’s such disabilities are each evaluated as 10 percent disabling pursuant to Diagnostic Code 5260 based on painful, limited motion. 38 C.F.R. §§ 4.59, 4.71a. Normal range of knee motion is 140 degrees of flexion and zero degrees of extension. 38 C.F.R. § 4.71, Plate II. Diagnostic Code 5260 provides for a zero percent rating where flexion of the leg is limited to 60 degrees. For a 10 percent rating, flexion must be limited to 45 degrees. A 20 percent rating is warranted where flexion is limited to 30 degrees. A 30 percent rating may be assigned where flexion is limited to 15 degrees. Diagnostic Code 5261 provides for a zero percent rating where extension of the leg is limited to five degrees. A 10 percent rating requires extension limited to 10 degrees. A 20 percent rating is warranted where extension is limited to 15 degrees. A 30 percent rating may be assigned where the evidence shows extension limited to 20 degrees. For a 40 percent rating, extension must be limited to 30 degrees. Finally, where extension is limited to 45 degrees, a 50 percent rating may be assigned. General Counsel has also stated that separate ratings under Diagnostic Code 5260 (limitation of flexion of the leg) and Diagnostic Code 5261 (limitation of extension of the leg) may be assigned for disability of the same joint. VAOPGCPREC 9-04 (September 17, 2004), published at 69 Fed. Reg. 59,990 (2004). Turning to the evidence of record, a February 2009 VA joints examination reflects the Veteran’s report of using a wheelchair for the proceeding 21 years while incarcerated. In this regard, he stated that he did not have his knee braces while in prison and, once they were returned to him, he could no longer walk. During the examination, he was able to transfer in and out of the wheelchair and was noted to have the ability to drive without a specially adapted car. Regarding his knee pain, he acknowledged pain all the time that was aggravated by movement such as extending his knees. He reported he experienced dislocation, locking, and 10/10 pain even when sitting in his wheelchair. The dislocation reportedly occurred when he was lying in bed, straightened his legs, or when he moved the wrong way; he reported the ability to “yank” the bones back into alignment. He endorsed swelling on movement of his knees. Neurological and orthopedic testing could not be performed during the examination because the Veteran refused to get out of the wheelchair and made no effort to move either leg. Nevertheless, foot strength testing revealed 5/5 strength against resistance. A review of x-rays indicated the presence of minimal degenerative disease in medial knee joint compartments bilaterally and small bilateral suprapatellar effusions. Ultimately, the examiner stated that the Veteran’s current complaints did not support his diagnosis of chondromalacia, and chondromalacia was not treated with braces and would not necessitate the use of a wheelchair. The examiner further stated that the Veteran’s osteoarthritis of the knees could not be associated with his service-connected knee disability without additional documentation. An April 2011 VA ankle examination report shows the Veteran wore braces to “help his knees from giving out” but had equal weight-bearing on both lower extremities. According to an August 2012 private treatment record, he described hyperextension maneuvers that occurred spontaneously and prevented him from kneeling. Physical examination showed the Veteran hyperextended his knees when he walked, which was actually a more comfortable posture for his gait. Specifically, there were a few degrees of hyperextension to 140 degrees in flexion. Once seated, he could straighten both knees completely with only mild crepitus. A March 2013 VA general medical examination report indicates the Veteran did not have any joint swelling, crepitation, or limitation of motion of the musculoskeletal system. While he was guarded with any weight-bearing, he was able to ambulate with a wide-based, slightly antalgic but steady gait wearing braces. Muscle strength was normal. As relevant to his bilateral knee disabilities, the examiner noted a diagnosis of bilateral chondromalacia and mild degenerative joint disease since 2013. At that time, the Veteran reported wearing knee braces since 1970’s anytime he needed to move. He endorsed bilateral swelling, dislocation, ulceration, discomfort, grinding, and pain. Range of motion testing revealed bilateral flexion to 140 degrees or greater and full extension without objective evidence of painful motion; there was no loss on repeat testing or functional loss. Regarding pain, the examiner noted that, with the first and second range of motion, she saw no signs of grimace, guarding, etc., on the Veteran’s face and he did not verbalize pain until she asked him. He endorsed pain on palpation to both knees. Muscle strength was full bilaterally, and the Veteran did not have shin splints, stress fractures, chronic exertional compartment syndrome, or any other tibial or fibular impairment. Regarding his ability to ambulate, the examiner noted he was guarded and resistive with her request for him to stand or walk without braces. With his braces his gait was strong and steady although somewhat antalgic due to limitations caused by the braces. He only used a cane to ambulate when he was not wearing his braces. The examiner noted that other physicians had not seen the need for braces or a wheelchair, including VA physicians and prison caregivers. Specifically, in December 2008 a VA clinician stated that he saw no orthopedic reason for braces nor any reason for the Veteran’s inability/unwillingness to stand in regard to his knees. The clinician nevertheless wrote a prescription for braces. Ultimately, based upon her review of the record and examination of the Veteran, the examiner stated that the Veteran is limited only by his self-imposed criteria. At the April 2015 hearing, the Veteran described swelling and giving out of the knees. He asserted that his weight-bearing difficulties affected his ability to walk, stand, squat, bend, and drive and, when they locked up during flare-ups, he was prohibited from getting out of bed. However, he also testified that, as a rule, he “pretty much” had full range of motion or “maybe a little less than normal” with his knees, albeit with symptoms of constant pain, grinding, and cracking. Upon VA examination in October 2016, the Veteran denied experiencing flare ups, but reported that activity caused bilateral swelling, crepitus, and locking, and he was no longer able to run, cycle, use stairs, perform squats or kneel due to his service-connected knee disabilities. Range of motion testing revealed flexion to 130 degrees and full extension of the right knee, and flexion to 135 degrees with full extension of the left knee on initial testing. The VA examiner reported the Veteran had no additional functional loss or range of motion after three repetitions. There was evidence of pain with weight-bearing, non-weight bearing, active motion, and passive motion, objective evidence of localized tenderness or pain on palpation, and objective evidence of crepitus. The Veteran described bilateral knee swelling after being on his feet for a prolonged period, but there was no evidence of swelling of either knee on examination. The VA examiner further noted the Veteran underwent a right knee medial meniscectomy at age 12 without residuals. At an October 2019 VA examination, the Veteran again denied flare-ups, but reported bilateral knee pain that increased with standing for greater than 10 minutes or walking more than a block, periodic locking, swelling, and crepitus. He indicated that he was no longer able to run, bicycle, go up or down stairs, do squats, or kneel, and continued to wear braces. Range of motion testing revealed flexion to 130 degrees and full extension of the right knee, and flexion to 135 degrees with full extension of the left knee, with no additional functional loss or range of motion after repetitive-use testing. There was evidence of pain with weight-bearing and increased pain with palpation, but no objective evidence of crepitus. The VA examiner noted that pain, weakness, fatigability, and incoordination did not significant limit functional ability with repeated use over a period of time. The only residuals attributed to his pre-service meniscectomy was a scar. In August 2020, a VA physician reviewed the 2016 and 2019 VA examination reports and noted the Veteran has constant knee pain that increases with standing and walking. X-ray examination, however, revealed objective evidence of only mild knee degenerative joint disease. Based on a review of the available evidence, the VA physician opined it is less likely as not that there would be any additional loss of range of motion during weight-bearing, nonweight-bearing, passive, or active range of motion. See Correia, supra. The VA physician further found any additional functional loss during activity, to include while standing and walking, was likely the result of the Veteran’s nonservice-connected conditions, which he detailed in the associated report. On VA examination in November 2020, the Veteran reported flare-ups of both knees, which result from increased use of the bilateral lower extremities and prolonged activities, and can last days, weeks, or months for the right knee and constantly for the left knee. He also reported buckling, limited motion, and swelling of the knees. Upon range of motion testing, flexion was limited to 120 degrees and extension was normal in both knees. There was pain exhibited on active and passive motion, and on weight-bearing and nonweight-bearing, but there was no objective evidence of crepitus. Id. The VA examiner noted such pain did not result in or cause any functional loss. There was objective evidence of localized pain on the right knee. Although there was no additional loss of function or range of motion of the left knee following three repetitions, the VA examiner found flexion was limited to 110 degrees in the right knee after such testing due to pain and weakness. The VA examiner also determined that functional ability would not be significantly limited with repeated use over a period of time or flare-ups due to pain, weakness, fatigability, or incoordination. There was no evidence of a reduction in muscle strength or muscle atrophy. Residuals of the Veteran’s pre-service meniscal condition were noted as frequent episodes of joint pain. Based on the foregoing, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, the evidence demonstrates flexion limited to, at most, 110 degrees in the right knee and 120 degrees in the left knee for the entire appeal period. Additionally, aside from the August 2012 private physician’s notation of “a few degrees of hyperextension,” which, on its face, does not suggest extension limited to 10 degrees, which is required for a compensable rating under Diagnostic Code 5261, the record does not reflect limitation of extension during the appeal period. Further, the Veteran himself testified at the Board hearing that, as a rule, he “pretty much” had either full range of motion or “maybe a little less than normal”, except when his knees locked up during flare-ups and, upon consideration of such flare-ups, no additional loss of range of motion was noted on examination. Thus, a rating in excess of 10 percent is not warranted under Diagnostic Code 5260, and a higher or separate rating is not warranted under Diagnostic Code 5261 at any time during the appeal period. The Board also finds that a higher or separate rating is not warranted under Diagnostic Code 5003, which pertains to degenerative arthritis, as the evidence does not reflect X-ray evidence of the involvement of two or more major joints or two or more minor joint groups in either knee at any time during the appeal period. The Board also observes that the Veteran is currently in receipt of separate 30 percent ratings for chondromalacia of the right knee and the left knee throughout the appeal period under Diagnostic Code 5257, which addresses recurrent subluxation and lateral instability. Such is the maximum rating available for such impairment and the propriety of such ratings was previously finally adjudicated in the June 2017 Board decision. Thus, further consideration of Diagnostic Code 5257 herein is not warranted. Further, although the evidence shows the Veteran underwent a right knee meniscectomy, such occurred prior to his entrance into service, and the only residuals attributed to such condition during the appeal period were episodes of joint pain, which the Board finds are contemplated by the currently assigned 10 percent rating under Diagnostic Code 5260. Furthermore, there is no evidence of dislocation of semilunar cartilage in either knee, or removed semilunar cartilage in the left knee. Thus, a higher or separate rating is not warranted under Diagnostic Code 5258 or Diagnostic Code 5259. Finally, as the evidence of record does not demonstrate ankylosis, impairment of the tibia or fibula, or genu recurvatum at any time during the appeal period, Diagnostic Codes 5256, 5262, and 5263 are not for application. Consequently, the Board finds that ratings in excess of the 10 percent for the Veteran’s bilateral knee disabilities are not warranted under any potentially applicable Diagnostic Code. 3. Entitlement to a rating in excess of 50 percent for posttraumatic headaches. The appeal period before the Board begins on December 24, 2003, the date VA received the Veteran’s increased rating claim, plus the one-year look-back period. Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). Throughout the appeal period, the Veteran’s service-connected headache disability is evaluated as 50 percent disabling, which is the maximum schedular rating, pursuant to 38 C.F.R. § 4.124a, Diagnostic Code 8100. In this regard, such rating contemplates migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. Thus, the only avenue for the Veteran to obtain a rating in excess of 50 percent for his posttraumatic headaches is on an extra-schedular basis. In this regard, an extra-schedular rating is warranted if the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization that application of the regular schedular standards would be impracticable. 38 C.F.R. § 3.321(b)(1). In Thun v. Peake, 22 Vet. App. 111, 115-16 (2008), the Court stated that the determination of whether a claimant is entitled to an extra-schedular rating under 38 C.F.R. § 3.321 is a three-step inquiry. First, it must be determined whether the evidence presents such an exceptional disability picture that the available schedular evaluations for that service-connected disability are inadequate. In this regard, the Court indicated that there must be a comparison between the level of severity and symptomatology of the claimant’s service-connected disability with the established criteria found in the rating schedule for that disability. Under the approach prescribed by VA, if the criteria reasonably describe the claimant’s disability level and symptomatology, then the claimant’s disability picture is contemplated by the rating schedule, the assigned schedular evaluation is, therefore, adequate, and no referral is required. Second, if the schedular evaluation does not contemplate the claimant’s level of disability and symptomatology and is found inadequate, the RO or Board must determine whether the claimant’s exceptional disability picture exhibits other related factors such as “marked interference with employment” and “frequent periods of hospitalization.” Third, when an analysis of the first two steps reveals that the rating schedule is inadequate to evaluate a claimant’s disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether, to accord justice, the Veteran’s disability picture requires the assignment of an extra-schedular rating. Id. In the instant case, the Veteran has alleged that he has cranial or facial nerve damage, which he appears to relate to his posttraumatic headaches. However, while he is competent to describe his reported symptoms, he is not competent as a lay person, to diagnose a cranial or facial nerve disability or relate it to his service-connected posttraumatic headaches as he does not have the requisite training and experience necessary to address such a complex medical matter. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis). In this regard, the diagnosis and etiology of such alleged disorder involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship and, thus, may not be competently addressed by lay statements. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). Furthermore, no medical professional has related a diagnosed cranial or facial nerve disability to the Veteran’s posttraumatic headaches, and service connection for such claimed disorder has been separately denied in prior rating decisions. Additionally, to the extent that the Veteran alleges that he experiences vision impairment during his headache attacks, the Board finds that such are contemplated by the 50 percent rating assigned under Diagnostic Code 8100 for very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. Furthermore, the probative evidence of record, as discussed below, reflects that the totality of the Veteran’s disability level and symptomatology referable to his headaches are fully contemplated by such rating assigned under the rating schedule. Thus, referral for extra-schedular consideration is not warranted. In this regard, on VA examination in February 2009, the Veteran reported severe headaches that were relieved only with closing his eyes and lying down. On VA examination in October 2011, he reported losing his vision routinely with headaches, and had severe headaches that occurred every other day and precluded him from activity. The VA examiner noted that the Veteran experienced symptoms of pain, nausea, sensitivity to light and sound, and changes in vision associated with headaches. In a September 2012 written statement, the Veteran reported that his headaches were so severe that they prevented concentration at work. In March 2013, he indicated that he sometimes had headaches every day, and sometimes had them every two to three days. However, when asked to report his symptoms beyond pain, the VA examiner found his responses to be vague and unclear. At the Board hearing in April 2015, the Veteran described headaches beginning at 4:00 in the morning, during which he felt as though his “eyeballs are going to pop right out of my head”. He stated that such daily headaches made it almost impossible to function and that he would lose his vision during the day due to headaches. On VA examination in October 2016, the Veteran reported having headaches at least four days per week and sometimes every day. He described a throbbing, pulsating type of pain that typically lasted for the rest of the day. The VA examiner also noted the Veteran experienced sensitivity to light and sound associated with his headaches and found that such would require vocational accommodation as he would need to go to a dark and quiet place during significant ones. An October 2019 VA examination report indicates the Veteran experienced symptoms of pain, sensitivity to light, and occasional bilateral otalgia associated with his headaches. The Veteran stated he was unable to function five to six times per month when he had headaches, which lasted from eight hours up to two or three days. In an April 2020 statement, the Veteran clarified that such would have been more frequent had he not controlled them and that he did not leave the house for days due to his headaches. He also asserted that he could not read, use light, or see “almost at all” during severe migraines. Upon review, the Board finds that, other than his alleged cranial or facial nerve disability previously addressed, the Veteran does not report, and the evidence does not show, symptomatology not contemplated by the rating criteria. Initially, the Board notes Diagnostic Code 8100 does not describe specific symptoms under the rating criteria; rather, the focus therein lies on the resulting functional impairment of all associated symptomatology. In this regard, the Board finds pertinent that the rating criteria under Diagnostic Code 8100 specifically contemplate completely prostrating and prolonged attacks, which would account for the Veteran’s reported symptomatology precluding activity and forcing him to remain inside for days. In addition, Diagnostic Code 8100, and the currently assigned 50 percent rating, particularly considers that such symptomatology produces severe economic inadaptability, which would include the Veteran’s reports of an inability to concentrate and work due to his headache disability. Therefore, the record does not reflect additional symptomatology or resulting functional impairment that is not contemplated by the rating criteria, and referral for consideration of an extra-schedular rating is not warranted. Consequently, a rating in excess of 50 percent for the Veteran’s headache disability is not warranted. 38 C.F.R.§ 3.321(b)(1). Other Considerations In reaching its conclusions in the instant case, the Board acknowledges the Veteran’s belief that his right knee, left knee, and headache disabilities are more severe than as reflected by the currently assigned disability ratings. In this regard, the Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that he is competent to provide statements regarding his observable symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert, supra. Rather, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disabilities in light of the rating criteria to be more persuasive than his own reports regarding the severity of such conditions. The Board has also considered whether staged ratings under Hart, supra, are appropriate for the Veteran’s disabilities; however, the Board finds that his symptomatology has been stable throughout the appeal period. Thus, assigning staged ratings for such is not warranted. Furthermore, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the increased rating claims adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017). Based on the foregoing, the Board finds that increased ratings for the Veteran’s right knee, left knee, and headache disabilities are not warranted. As the preponderance of the evidence is against such claims, the benefit of the doubt doctrine is not applicable and such must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. M. Celli, 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.