Citation Nr: 21025025 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 18-16 462 DATE: April 27, 2021 ORDER Entitlement to an initial compensable rating prior to October 25, 2017 and to a rating in excess of 50 percent beginning October 25, 2017 for tension headaches is denied. Entitlement to an initial 20 percent rating for a right ankle disability is granted. Entitlement to an initial rating in excess of 10 percent for a right knee disability is denied. Entitlement to service connection for chest pain is denied. FINDINGS OF FACT 1. Prior to October 25, 2017, there has been no evidence of prostrating attacks of headaches. 2. Since October 25, 2017, there is no higher rating available for the Veteran’s tension headaches. 3. For the relevant period on appeal, the Veteran’s right ankle disability has been productive of marked limitation of motion. 4. The Veteran’s right knee disability is productive of flexion limited to, at worst, 100 degrees with painful motion. 5. The Veteran’s right knee disability is consistent with dislocated cartilage with frequent episodes of locking, pain, and effusion. 6. The competent and probative evidence does not demonstrate a disability manifested by chest pain. CONCLUSIONS OF LAW 1. Prior to October 25, 2017, the criteria for a compensable rating for tension headaches have not been met. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. §§ 4.7, 4.124a, Diagnostic Code 8100 (2020). 2. From October 25, 2017, the claim for a rating in excess of 50 percent for tension headaches is without legal merit. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a, Diagnostic Code 8100 (2020). 3. The criteria for a 20 percent rating for residuals of a right ankle injury have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2., 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5271 (2020). 4. The criteria for a rating in excess of 10 percent for a right knee disability have not been met. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. §§ 4.1, 4.2., 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5260 (2020). 5. The criteria for a separate 20 percent rating for dislocated cartilage with frequent episodes of pain, locking, and effusion in the right knee have been met. 38 U.S.C. §§ 1155, 5107 (2018); 38 C.F.R. §§ 3.102, 4.3, 4.71a, Diagnostic Code 5258 (2020). 6. The criteria for service connection for chest pain have not been met. 38 U.S.C. § 1110 (2018); 38 C.F.R. §§ 3.303, 3.307 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the United States Marine Corps (USMC) from June 2004 to August 2016, to include service in Southwest Asia. His decorations for his active service include a Combat Action Ribbon. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in December 2018, at which time the issues currently on appeal were remanded for additional development. In a January 2021 rating decision, the RO increased the evaluation for the Veteran’s tension headaches to 50 percent effective October 25, 2017. Because the Veteran is presumed to seek the maximum available benefits, this issue remains on appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993). Increased Rating Disability ratings are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. See 38 C.F.R. § 4.3. Staged ratings are appropriate when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999). Tension Headaches Prior to October 25, 2017 The Veteran has asserted that he is entitled to a compensable rating for his headaches as his symptoms are worse than those contemplated by the currently assigned rating. In January 2016, the Veteran was afforded a VA headaches examination. At that time, the Veteran reported that he had a history of headaches, that he did not take medication for his headaches, and that he did not have sensitivity to light or sound during a headache. He also reported he had to stop working if the headaches became too strong. The examiner diagnosed tension headaches. Symptoms of the Veteran’s headaches included pain on both sides of the head and pain that worsened with physical activity. Typical head pain lasted for less than one day at a time. Notably, the examiner found that the Veteran did not have prostrating attacks of headache pain. A review of the record does not show that the Veteran receives treatment for his disability at the VA Medical Center, or at a private facility prior to October 25, 2017. Indeed, the Veteran has not indicated that he seeks treatment for his headaches. Based on the foregoing, the Board finds that the Veteran is not entitled to a compensable rating for headaches. A compensable rating for the Veteran’s headaches requires characteristic prostrating attacks that occur at least once every two months over a period of several months. See 38 C.F.R. § 4.124a, Diagnostic Code (DC) 8100 (2020). There is no evidence indicating that the headaches he experienced are prostrating. The Veteran specifically reported that his headaches did not cause any sensitivity to light or sound. Further, the evidence does not suggest that the Veteran’s headaches caused “extreme exhaustion or powerlessness” that characterizes prostration. Indeed, the exact opposite appears to be true. The Board acknowledges that the Veteran reported he had to stop work if his headaches became too strong. However, the record did not indicate that the Veteran missed any work because of his headaches. Moreover, the Board observes that no clinician has characterized the severity of the Veteran’s headaches as prostrating. Indeed, the January 2016 VA examiner specifically noted that the Veteran’s headaches were not prostrating. Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to an initial compensable rating for tension headaches is not warranted. 38 U.S.C. § 5107 (b) (2018); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Tension Headaches Beginning October 25, 2017 As noted above, the RO increased the evaluation for the Veteran’s tension headaches to 50 percent effective October 25, 2017. Under DC 8100, a maximum 50 percent schedular rating is warranted for migraines with very frequent completely prostrating and prolonged attacks, productive of severe economic inadaptability. 38 C.F.R. § 4.124a. Since the Veteran’s service-connected tension headaches have been assigned the maximum schedular rating available for tension headaches, there is no legal basis upon which to award a higher schedular evaluation for this disability. As such, entitlement to a rating for tension headaches in excess of 50 percent is not warranted on a schedular basis. See Sabonis v. Brown, 6 Vet. App. 426 (1994). Thus, the claim for a higher schedular evaluation must be denied as a matter of law. Smith v. Nicholson, 451 F.3d. 1344 (Fed. Cir. 2006). Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017). (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Right Ankle The Veteran seeks to establish a disability rating in excess of 10 percent for service-connected residuals of right ankle injury. The Veteran’s right ankle disability has been rated as 10 percent disabling under 38 C.F.R. § 4.71a, DC 5271, which provides that moderate limitation of motion of the ankle warrants a 10 percent rating. Marked limitation of motion of the ankle warrants a 20 percent rating. Id. Normal range of motion of the ankle is from 0 to 20 degrees in dorsiflexion and from 0 to 45 degrees in plantar flexion. 38 C.F.R. § 4.71, Plate II. The Board notes that the words “moderate” and “marked” are not defined in the VA Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just.” See 38 C.F.R. § 4.6. 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. As of February 7, 2021, under the amended criteria, DC 5271 added objective criteria to define “marked” and “moderate” limitation of motion in relating to the severity of an ankle injury. “Marked” limitation of ankle motion is defined as less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion that qualifies for a 20 percent disability rating. “Moderate” limitation of ankle motion is defined as less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion which qualifies for 10 percent disability rating. When assessing the severity of musculoskeletal disabilities that are at least partly rated on the basis of limitation of motion, VA must also consider the extent that the Veteran may have additional functional impairment above and beyond the limitation of motion objectively demonstrated, such as during times when his symptoms are most prevalent (“flare-ups”) due to the extent of his pain (and painful motion), weakness, premature or excess fatigability, and incoordination-assuming these factors are not already contemplated by the governing rating criteria. DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1995); see also 38 C.F.R. §§ 4.40, 4.45, 4.59. The report of a January 2016 VA examination indicated that the Veteran stated he experienced flare-ups of the right ankle which he described as pain with aerobic activity. He further stated that his condition had gotten worse, resulting in pops and pain. The Veteran indicated that he has pain upon walking and standing for long periods of time, which impacted his ability to perform his occupation. Range of motion testing indicated that his right ankle had full range of plantar flexion with pain; dorsiflexion was limited to 15 degrees with pain. There was objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. There was no objective evidence of pain with weight-bearing and crepitus. With repetitive-use testing, there was no additional loss of function or range of motion. The examiner noted that the examination was not being conducted immediately after repetitive use over time and that pain significantly limited functional ability with repeated use over a period of time. The examiner estimated that after repeated use over time, dorsiflexion would be limited to 10 degrees and plantar flexion would be limited to 30 degrees. The examiner noted also that the examination was not being conducted immediately after flare-ups and that pain significantly limited functional ability with flare-ups. The examiner estimated that with flare-ups, dorsiflexion would be limited to 10 degrees and plantar flexion would be limited to 30 degrees. Additional factors that contributed to the ankle disability were disturbance of locomotion and interference with standing. Muscle strength of the right ankle was normal. There was no ankylosis or muscle atrophy. The examiner indicated that no instability or dislocation was suspected. There was no laxity during anterior drawer or talar tilt tests. At a November 2019 VA examination, the Veteran reported constant aching and throbbing of the lateral right ankle pain with activity and movement. On range of motion testing, his right ankle had full range of dorsiflexion with pain; plantar flexion was limited to 40 degrees with pain. There was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. There was no objective evidence of pain with weight-bearing, non-weight bearing, or during passive range of motion. There was no crepitus. The examiner noted that the examination was not being conducted immediately after repetitive use over time. The examiner estimated that after repeated use, dorsiflexion would be limited to 15 degrees and plantar flexion would be limited to 30 degrees. Pain contributed to the functional loss. The examiner indicated that after the review of the Veteran’s records and using his medical expertise, he had no basis to offer additional losses of function or motion with repeated use over time. The examiner noted also that the examination was not being conducted immediately after flare-ups and that the Veteran denied flare-ups. Muscle strength of the right ankle was normal. There was no ankylosis or muscle atrophy. The examiner indicated that instability or dislocation was suspected. However, there was no laxity during anterior drawer and talar tilt tests. The examiner indicated that the Veteran’s right ankle disability did not impact his ability to work. At a December 2020 VA examination, the Veteran reported pain with activity. He indicated that he could not jog or participate in store work or sports activities. The Veteran reported right ankle flare-ups that were moderate, lasting for hours, precipitated by a lot of activity and moderate walking. The right ankle flare-ups were alleviated by ice, rest, and over the counter (OTC) pain medication. Regarding functional loss, the Veteran indicated that he could not fully bend the right ankle joint and there was a loss of motion with the right ankle joint. On range of motion testing, right ankle plantar flexion was limited to 35 degrees with pain and right ankle dorsiflexion was limited to 15 degrees with pain. There was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. There was objective evidence of pain with weight-bearing and on passive range of motion. There was no objective evidence of pain when the joint was used in non-weight bearing. Crepitus was observed. With repetitive-use testing, there was no additional loss of function or range of motion. The examiner noted that the examination was not being conducted immediately after flare-ups or repetitive use over time. Muscle strength of the right ankle was normal. There was no ankylosis or muscle atrophy. The examiner indicated suspicion of instability or dislocation. However, there was no laxity during anterior drawer or talar tilt tests. Regarding functional impact, the Veteran indicated that he avoided walking downstairs and walking over one block due to pain in right ankle. In a January 2021 addendum opinion, the examiner stated that pain with ambulation significantly limited the Veteran’s functional ability with flare-ups. The examiner estimated with flare-ups, dorsiflexion would be limited to 15 degrees and plantar flexion would be limited to 30 degrees. For the reasons discussed below, the Board finds that a 20 percent rating for the Veteran’s right ankle is warranted. In this case, at worst, dorsiflexion of the Veteran’s right ankle was limited to 10 degrees, and plantar flexion was limited to 30 degrees. See January 2016 VA examination. Thus, at that time, about a half the range of motion or more of the right ankle was remaining, which suggests that moderate limitation of right ankle was present. The Board notes that there has also been evidence of popping, grinding, and instability of the right ankle. Based on the foregoing, and after taking into consideration all of the Veteran’s right ankle symptoms and resulting limitation with prolonged standing, prolonged walking and high impact activities, the Board finds that the overall right ankle disability picture is consistent with a 20 percent rating. DC 5271. The Board notes that the previous version of the regulations is more favorable to the Veteran than the revised version. 38 U.S.C. § 5110 (2018). Specifically, the Veteran’s ankle injury under the revised version of DC 5271, in using the objective criteria described above, would result in a 10 percent rating for moderate limitation of right ankle motion. A 20 percent rating is the maximum rating assignable under DC 5271 for limitation of motion. Therefore, a rating higher than 20 percent under DC 5271 is not warranted. The Board has also considered whether a higher rating for the Veteran’s right ankle is warranted under DC 5270, for ankylosis of the ankle. In this case, the Veteran has not had ankylosis of the right ankle at any point during the rating period on appeal. Rather, the evidence indicates that the Veteran has motion, albeit limited, of his right ankle. Furthermore, the January 2016, November 2019 and December 2020 VA examiners specifically noted that ankylosis of the right ankle was not present. In addition, the lay and medical evidence of record does not otherwise indicate that the Veteran’s limitation of motion of the right ankle more closely approximates ankylosis of the right ankle. Accordingly, a higher rating under DC 5270 is not warranted. The Board has also considered other potentially applicable diagnostic codes; however, the Veteran’s right ankle disability is not shown to involve any other factor that would warrant evaluation of the disability under any other provisions of the rating schedule, to specifically include ankylosis of the subastragalar or talar joint, malunion of the os calcis or astragalus, or astragalectomy. As such, a rating under DC 5272, 5273, or 5274 is not appropriate. Consideration has been given to assigning staged ratings. However, at no time during the period in question has the disability warranted a higher schedular rating than that assigned. Fenderson, 12 Vet. App. at 119; Hart, 21 Vet. App. at 505. For these reasons, the Board finds that the right ankle disability more closely approximates the criteria for a 20 percent rating, but no higher, throughout the appeal. To that extent, the claim is granted. Increased Rating-Right Knee The Veteran contends that he should have a higher rating for his right knee disability as his symptoms are worse than those contemplated by the currently assigned rating. At a January 2016 VA examination, the Veteran reported that his right knee had worsened since meniscus surgery in 2013. He reported flare-ups, noting that he could not bend past 90 degrees without significant pain. The Veteran indicated that his right knee hurt all the time. On range of motion testing, his right knee flexion was limited to 0 to 110 degrees with pain and his right knee extension was limited to 110 degrees to 0 without pain. With repetitive-use testing, there was no additional loss of function or range of motion. The examiner noted that the examination was not being conducted after use over time or after flare-ups, but estimated that flexion would be further limited to 0 to 10 degrees and extension to 100 to 0 degrees. There was objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. There was no objective evidence of crepitus or pain with weight-bearing. The additional factors that contributed to the right knee disability were disturbance of locomotion and interference with standing. Muscle strength of the right ankle was normal. There was no ankylosis or muscle atrophy. There is no history of recurrent subluxation, lateral instability or recurrent effusion. Testing revealed no right knee joint instability. The examiner indicated that the Veteran had a meniscal tear and frequent episodes of joint pain. There was no use of assistive devices. Regarding functional impact, the Veteran had pain with running, prolonged walking and standing. A March 2017 VA primary care secure message note indicated that the Veteran complained of daily right knee popping. He reported that he had to pop his knee back in place before he could continue walking. At a February 2018 VA examination, the Veteran reported popping in his right knee. He was currently not seeing any doctors and he took OTC medication. The Veteran reported flare-ups with activity, dependent on how much he worked. He indicated that his right knee flared up a couple of times a week with moderate severity, lasting a couple of hours. The Veteran reported having a functional loss in that he could bend his knees or do any kind of prolonged standing or walking. On range of motion testing, his right knee flexion was limited to 0 to 110 degrees with pain and his right knee extension was 110 to 0 degrees without pain. With repetitive-use testing, there was no additional loss of function or range of motion. The examiner noted that the examination was not being conducted immediately after repetitive use over time or with flare-ups. The examiner was unable to say without mere speculation as to whether pain significantly limited functional ability over a period of time or with flare-ups. The examiner reasoned that there was no conceptual basis or empirical basis for making such determinations without directly observing function under these conditions. There was no objective evidence of crepitus, localized tenderness, or pain on palpation of the joint or associated soft tissue. There was objective evidence of pain with weight-bearing, without weight-bearing, and on passive range of motion. Muscle strength of the right ankle was normal. There was no ankylosis or muscle atrophy. There was no history of recurrent subluxation, lateral instability or recurrent effusion. Testing was negative for right knee joint instability. The examiner indicated that the Veteran had a meniscal tear and frequent episodes of joint pain. There was no use of assistive devices. Regarding functional impact, the Veteran lost one week of work over a year and he had trouble with prolonged sitting. In April 2019, the Veteran presented to the emergency room with ongoing, recurrent right knee pain that had gotten worse over the prior three weeks. He stated that he worked in a loading dock, and by the time he got home the pain was “really quite significant.” He stated pain increased if he had to sit for long periods of time and kept his knee flexed at 90 degrees. Physical examination revealed tenderness but no effusion. There was no laxity or crepitus. Anterior and posterior drawer testing was negative. Lachman’s testing was also negative. The examiner prescribed a hinged knee brace and referred the Veteran for an orthopedic consultation. An April 2019 VA physical medicine rehabilitation consultation noted that the Veteran presented with right knee pain, rated as 6 out of 10. His pain was worse with ambulation and standing. He stated that the pain was worse in the evening and felt like a “burning pain.” He denied any catching, locking, or giving out. He did have some catching earlier but denied any current symptoms. On physical examination, no effusion was noted. There was tenderness to palpation of the lateral and medial joint lines. No laxity was noted with anterior or posterior drawer, varus or valgus. McMurray’s test was negative. An October 9, 2019 VA treatment record noted that x-ray of the right knee was negative for fracture, dislocation, or subluxation. There was lateral and patellofemoral joint space narrowing and moderate joint space effusion. At a December 2020 VA examination, the Veteran reported that he could not participate in certain activities without a lot of pain, including walking downstairs, biking, prolonged walking, quick turns, and long drives. He described flare-ups as moderate to severe, occurring daily or hourly, lasting hours. He stated that his flare-ups were precipitated by turning quick, activity, rotating or bending. His flare-ups were alleviated by ice, OTC medication, prescription pain cream, rest and massage therapy. The Veteran described a functional loss of being unable to walk, run, or bend due to loss of motion. On range of motion testing, his right knee flexion was limited 0 to 110 degrees with pain and his right knee extension was 110 to 0 degrees with pain. There was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. There was objective evidence of pain with weight-bearing, without weight-bearing, and on passive range of motion. With repetitive-use testing, there was no additional loss of function or range of motion. The examiner noted that the examination was not being conducted immediately after repetitive use over time or during flare-ups, and that pain did not significantly limit functional ability with repeated use over a period of time or during flare-ups. Muscle strength of the right ankle was normal. There was no ankylosis or muscle atrophy. There was no history of recurrent subluxation, lateral instability or recurrent effusion. Testing revealed no right knee joint instability. The examiner indicated that the Veteran had a meniscal tear and frequent episodes of joint pain and joint locking including residual pain with walking. There was no use of assistive devices. Regarding functional impact, the Veteran avoids walking downstairs, squatting, and general walking due to immediate pain. In a January 2021 addendum opinion, the examiner stated that pain with ambulation limited the Veteran’s functional ability with flare-ups. The examiner estimated with flare-ups, right knee flexion would be limited to 0 to 100 degrees and right knee extension was 100 to 0 degrees. The Board finds that the Veteran is not entitled to a rating in excess of 10 percent for his right knee disability based on limitation of motion. In this regard, there is no indication from the record that the Veteran had right knee flexion limited to 45 degrees or less, or right knee extension limited to 15 degrees or more. In this case, at worst, the flexion of the right knee had been limited to 100 degrees after repeated use over time. Further, the Veteran has not been limited in extension. The Board acknowledges that the Veteran experiences pain following repeated use and experiences decreased function during a flare-up; the limitations in those circumstances were accounted for by the VA examiners. 38 C.F.R. §§ 4.40, 4.45 (2019); Sharp v. Shulkin, 29 Vet. App. 26, 3436 (2017). However, even with consideration of all pertinent disability factors, there remains no basis for assignment of a higher rating. 38 C.F.R. § 4.71a, DCs 5260, 5261 (2020). Further, while there is evidence that the Veteran experiences limitations on standing and walking due to pain, ultimately a disability rating must be assigned based on the criteria contained in 38 C.F.R. § 4.71a, and therefore any functional loss noted to be present must satisfy the criteria corresponding to a higher rating. Thompson v. McDonald, 815 F.3d 781, 786 (Fed. Cir. 2016). In this case, the evidence of record does not establish that the Veteran’s functional loss warrants an increased rating for his right knee disability under the applicable diagnostic criteria. Id. However, the Board finds that a separate 20 percent rating is warranted for the Veteran’s meniscal tear. When semilunar cartilage (that is, the meniscus) is dislocated with frequent episodes of locking, pain and effusion into the joint a 20 percent rating is assigned. See DC 5258. In this case, an April 2017 treatment record noted that the Veteran complained of daily right knee popping. Additionally, an October 2019 x-ray showed effusion of the right knee. Finally, the December 2020 VA examiner opined that the Veteran’s meniscal tear resulted in joint pain and locking. Therefore, the Board finds that the evidence more nearly approximates the criteria for a separate 20 percent rating under Diagnostic Code 5258 for right knee meniscus tear. When semilunar cartilage has been removed, but remains symptomatic, a 10 percent rating is assigned. 38 C.F.R. § 4.71a, Diagnostic Code 5259. Here, the evidence does not show that any of the Veteran's meniscus was removed during this period, so DC 5259 does not apply. Consideration has been given to assigning additional ratings for the right knee disability under other diagnostic codes pertaining to the knee. There is no evidence of ankylosis, instability, subluxation, impairment of the tibia and/or fibula, or genu recurvatum. In fact, all VA examination reports note that there was no ankylosis, instability upon joint testing or recurrent subluxation. As such, an additional compensable rating under another diagnostic code is not warranted. 38 C.F.R. § 4.71a, DC 5256, 5257, 5262, 5263 (2020). Consideration has been given to assigning staged ratings. However, at no time during the period in question has the disability warranted a higher schedular rating than that assigned. Fenderson, 12 Vet. App. at 119; Hart, 21 Vet. App. at 505. Accordingly, the Board finds that the preponderance of the evidence is against the claim of entitlement to a rating in excess of 10 percent for the right knee disability based on limitation of motion. However, a separate, 20 percent rating is warranted for right knee meniscus tear. To that extent, the appeal is granted. Service Connection Chest pain The Veteran contends that his current chest pain was due to active service. The current symptoms are occasional chest pain with stress. The Veteran states that he has to take it slow and cannot stress or do really strenuous activities. Service connection may be granted directly as a result of disease or injury incurred in service based on nexus using a three-element test: (1) The existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). The January 2016 VA examiner opined that for the Veteran’s claimed condition of chest condition with pain, there is no diagnosis because there is no pathology to render a diagnosis. An August 2018 VA primary care note indicated that the Veteran reported chest tightness with coughing. He felt like he had phlegm in chest and could not get it out. The examiner assessed acute bronchospasm. A February 2019 VA psychiatry note indicated that the Veteran reported intermittent panic attacks. Two days previously, he attended a local emergency department for concerns of cardiac demise, however after full cardiac workup was negative, his chest pain was deemed to be related to anxiety symptoms. At a December 2020 VA examination, the Veteran reported that the condition has been treated with blood pressure medication. The current symptoms are occasional chest pain with stress. The current treatment is none. The Veteran reported that due to his chest pain, he had to leave work “before.” He also went to the emergency room twice in the previous two years. He reportedly had to “take it slow and cannot stress or do really any strenuous activities.” The examiner opined that there are no findings consistent with chest pain or muscle condition, nor medication taken to suggest treatment for chest pain or chest muscular pain. Therefore, there was no present pathology of chest pain (chest disability) or muscular condition revealed with the current physical findings. The examiner noted that the Veteran admitted his chest pain was stress-related only, with no involvement to heart nor muscle. On examination, there was no pathology to support a muscle nor non-muscle injury related to a chest disability as there are were positive findings on examination. Further, the Veteran denied any symptoms that would suggest a chest disability. Finally, the examiner opined that the Veteran’s chest pain was not aggravated by a service-connected disability. The examiner reasoned that there is no baseline to establish, because the Veteran’s examination was not positive for chest pain or muscle pain, and he admitted to stress only. Finally, the examiner opined that the Veteran’s chest pain did not result in any functional impairment. The probative medical opinion evidence of record indicates that the Veteran does not have a diagnosed chest disability. The Board acknowledges that the Federal Circuit held that the term "disability" as used in 38 U.S.C. § 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability." In other words, where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. The Federal Circuit did emphasize that they were not holding a veteran could demonstrate service connection "simply by asserting subjective pain . . . . To establish the presence of a disability, the veteran will need to show that her pain reaches the level of functional impairment of earning capacity." Id. In other words, subjective pain in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain. Here, however, the record does not reflect the Veteran’s complains of chest pain have resulted in functional impairment of earning capacity as to constitute a qualifying disability, to include under the provisions of 38 U.S.C. § 1117 and 38 C.F.R. § 3.317. The December 2020 examiner considered the Veteran’s reports that he has had to leave work previously, and has presented to the emergency room twice in the previous two years, and specifically opined that the Veteran’s chest pain did not result in functional impairment of earning capacity. As noted above, the Veteran has presented to medical providers with complaints of chest pain. However, examinations conducted during the presence of chest pain have shown that the chest pain does not have a cardiac etiology. Instead, the chest pain has been related to the lungs or to his service-connected psychiatric disorder. Moreover, while the Veteran reported treating his claimed chest condition with blood pressure medication, the Board notes that he is already separately service-connected for hypertension. The Board acknowledges the Veteran’s contention that he has a chest disability manifested by chest pain. However, the Veteran lacks the medical expertise to offer a competent opinion on complex medical matters, to include the etiology of a condition. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).  Instead, greater probative value is afforded to the competent medical evidence discussed above. In light of the foregoing, the Board concludes that the Veteran's history of chest pains does not reflect the existence of a current disability, cardiac or otherwise. "In the absence of proof of a present disability there can be no valid claim." See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Here, the record contains no current diagnosis of a chest condition. As there is no evidence of a current disability, a discussion of any in-service incurrence or aggravation of a disease or injury, or nexus, is unnecessary. Because there is no evidence of a current disability for which service connection may be granted, the claim is denied. See 38 U.S.C. § 1110; Rabideau v. Derwinski, 2 Vet. App. 141 (1992). Roya Bahrami Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C.Ivan Franklin 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.