Citation Nr: 21025405 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 12-14 335 DATE: April 28, 2021 ORDER Entitlement to an initial disability rating in excess of 10 percent for right knee residual sprain and strain with degenerative arthritis and osteoarthritis is denied. Entitlement to a separate disability rating of 20 percent, effective January 25, 2016 for right knee locking is granted. Entitlement to an initial disability rating in excess of 10 percent for left knee residual sprain and strain with degenerative arthritis and osteoarthritis is denied. Entitlement to a separate disability rating of 20 percent, effective January 25, 2016 for left knee locking is granted. FINDINGS OF FACT 1. Throughout the appeal period, the Veteran’s right knee residual sprain and strain with degenerative arthritis and osteoarthritis has been manifested by painful motion and limitation of motion to a noncompensable degree. 2. As of January 25, 2016, the Veteran’s right knee residual sprain and strain with degenerative arthritis and osteoarthritis has been manifested by frequent popping and locking. 3. Throughout the appeal period, the Veteran’s left knee residual sprain and strain with degenerative arthritis and osteoarthritis has been manifested by painful motion and limitation of motion to a noncompensable degree. 4. As of January 25, 2016, the Veteran’s left knee residual sprain and strain with degenerative arthritis and osteoarthritis has been manifested by frequent popping and locking. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial disability rating in excess of 10 percent for right knee residual sprain and strain with degenerative arthritis and osteoarthritis have not been met. 2. The criteria for a separate rating of 20 percent for right knee dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion have been met As of January 25, 2016. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.40, 4.45, 4.49, 4.71a, Diagnostic Code 5258. 3. The criteria for entitlement to an initial disability rating in excess of 10 percent for left knee residual sprain and strain with degenerative arthritis and osteoarthritis have not been met. 4. The criteria for a separate rating of 20 percent for left knee dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion have been met As of January 25, 2016. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.40, 4.45, 4.49, 4.71a, Diagnostic Code 5258. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from June 2001 to December 2009, which included service in Iraq from October 2005 to October 2006 and Afghanistan from July 2008 to June 2009. These matters comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2012 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in Jackson, Mississippi. The Veteran presented sworn testimony at a hearing before the undersigned in January 2016. The Board notes that there currently is no evidence that the Veteran is unemployed. The October 2020 VA contract examination report indicates the Veteran was working in maintenance and the January 2021 contains no assertion or argument of unemployability. As such, the issue of entitlement to total disability rating based on individual unemployability (TDIU) is not currently before the Board. 38 U.S.C. § 7105 (b); 38 C.F.R. §§ 3.104, 20.1103. The Board remanded the matters of an increased rating for the Veteran’s left and right knee disabilities in April 2016 and April 2020 for additional development. The Board finds that there has been substantial compliance with its remand directives and will proceed with a decision as to these issues. See, Stegall v. West, 11 Vet. App. 268, 271 (1998). Increased Rating Effective February 7, 2021, VA revised the criteria for evaluating musculoskeletal disorders. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76464 (Nov. 30, 2020); Correction, 86 Fed. Reg. 8142, 8143 (Feb. 4, 2021) (changing new diagnostic code applicable to plantar fasciitis from 5285 to 5269). VA’s General Counsel has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the veteran. In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation. If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. The Board must generally apply both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change. VA thus must consider the claim for a higher rating pursuant to the former and revised regulations during the latter part of this appeal. See VAOPGCPREC 3 2000, 65 Fed. Reg. 33,422 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997). 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. 1. Entitlement to an initial disability rating in excess of 10 percent for right knee residual sprain and strain with degenerative arthritis and osteoarthritis. The Veteran contends that he is entitled to an initial disability rating in excess of 10 percent for his right knee residual sprain and strain with degenerative arthritis and osteoarthritis. The assigned Diagnostic Code 5260 suggests that the right knee disability is rated based on compensable limitation of flexion. 38 C.F.R. § 4.71a. A review of the evidence reflects that the right knee disability has manifested as osteoarthritis and been rated based on painful noncompensable limitation of motion, and that the right knee has not had compensable limitation of motion (i.e. limitation of flexion or extension) at any time during the relevant rating period. Therefore, the Diagnostic Code assigned should have been Diagnostic Code 3003, to show that the right knee disability with osteoarthritis is being rated based on noncompensable limitation of motion that is painful. For this reason, the Board is changing the Diagnostic Code for the right knee disability to 5003 to reflect the actual rating already assigned. 38 C.F.R. § 4.71a. Diagnostic Code 5003 provides that arthritis can be rated at 10 percent for X-ray evidence of degenerative arthritis involving two or more major joints or two or more minor joint groups. A 20 percent rating is provided for degenerative arthritis of two or more major joints or two or more minor joint groups with occasional incapacitating exacerbations. 38 C.F.R. § 4.71a. Under Diagnostic Code 5260, a noncompensable rating is warranted for flexion limited to 60 degrees. A 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (“[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran’s disability, after which a rating is determined based on the § 4.71a criteria.”). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), 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.” The spine has no opposite joint. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination.] The Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for the Veteran’s right knee disability. The Board acknowledges the Veteran’s lay reports of symptoms and that there was functional loss due to pain, weakened movement, excess fatigability, repetitive use, pain during flare-ups, and pain during repetitive use over time. However, even considering the Veteran’s lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements would not result in limitation of motion more nearly approximating flexion limited to 30 degrees. A February 2011 VA treatment record notes the Veteran reported bilateral knee pain with intermittent swelling. Upon physical examination, tenderness of the bilateral patellae and outer aspects was noted. A May 2011 VA treatment record notes the Veteran reported wearing braces for his painful knees. The Veteran was afforded a VA examination in July 2011. The Veteran reported progressively worsening, sharp bilateral knee pain. He further reported daily flares of pain that are provoked by standing or walking and last around 60 minutes, as well being unable to walk more than half a mile or stand more than an hour. He then reported that he “feels weak and stiff in both knees.” Upon physical examination, no evidence of deformity, effusion or crepitus were noted. Initial range of motion was measured as follows: 0 to 130 degrees right knee flexion; and 0 degrees right knee extension. No instability or abnormal movement were noted. Muscle strength testing was normal. It was noted that the Veteran “exhibits a mild degree of pain throughout the range, exhibited by muscle guarding and grunting.” Residual bilateral knee sprain was diagnosed. A May 2012 VA treatment record notes the Veteran reported bilateral knee pain and stiffness, worse in the right knee. He stated that “it always hurts after long trips in [the] car”. Decreased range of motion in in the bilateral lower extremities secondary to pain on extension was noted. A May 2013 VA treatment record notes the Veteran reported pain in both knees. Upon examination, range of motion was noted as restricted. Range of motion was measured as 90 degrees right lateral flexion. An April 2014 VA treatment record notes the Veteran reported chronic knee pain and stiffness. The Veteran testified at the January 2016 Board hearing that his knees get stiff and were now locking. He stated that if he sits for too long, he has to “pop” them. He stated he has pain and has to pull over and walk if he drives for too long. He then stated that the pain occurs four days out of the week. He reported feeling grinding. He further stated that he has instability in the mornings and sometimes in the middle of the night that have led to falls. A July 2016 VA treatment record notes that x-rays of the Veteran's knees notes that “[s]ome mild narrowing of the medial joint compartments is seen in both knees”. The Veteran was afforded a VA knee examination in July 2016. He reported having popping and locking in both knees. He further reported flare-ups of pain, stating that sometimes his knees ache when he is walking at work and feel as though they are going to lock up and give out. He further reported functional limitations with climbing ladders and riding lawn mowers with a clutch. Upon examination, initial range of motion was measured as follows: 0 to 115 degrees right flexion; 115 to 0 degrees right extension. Pain was noted as causing a functional loss on all measurements. Objective evidence of pain upon palpation was noted, but not on weight-bearing. No additional loss of function or range of motion was noted after repetitive use testing. Pain was noted as significantly limiting functional ability after repetitive use over time and during flare-ups. Joint stability testing was normal. Occasional use of knee braces was noted. It was noted that the Veteran’s knee conditions affected his ability to perform his work as a maintenance worker at a steel mill as he had to drive a forklift and golf cart. A January 2018 private treatment record from Total Pain Care notes the Veteran reported bilateral knee pain and stiffness for which he uses a brace. It was noted that the Veteran “report[ed] no falls within the past year.” He further reported that his pain was aggravated by driving and sitting for long periods of time, as well as wearing his duty belt. Upon physical examination, range of motion of the lower extremities was normal with no joint crepitation and no pain on motion. An October 2018 private treatment record from Total Pain Care notes the Veteran “report[ed] no falls within the past year.” Upon physical examination, range of motion of the lower extremities was normal with no joint crepitation and no pain on motion. A July 2019 private treatment record from Total Pain Care notes the Veteran “report[ed] no falls within the past year.” Upon physical examination, range of motion of the lower extremities was normal with no joint crepitation and no pain on motion. Mild tenderness to palpation to the left medial knee, as well as mild left knee edema, were noted. An October 2020 treatment record from Rush Hospital notes x-rays of the Veteran's bilateral knees revealed mild bilateral tricompartmental degenerative changes, but normal alignment of the joints. The Veteran was afforded a VA knee examination in October 2020. The Veteran reported dull, achy pain that is sometimes sharp and with intermittent swelling. Treatment with Ibuprofen, Biofreeze and icy hot were noted. The Veteran reported right knee flare-ups of extreme stiffness and severe throbbing pain 3 to 4 times per month, lasting 1 to 2 days. He further reported left knee flare-ups of stiffness, swelling, and dull achy pain “where he feels he needs to reach inside and pull something out.” He stated that these flare-ups occur 3 to 4 times per month and last 4 to 5 days. He further reported that both of his knees will lock up and he will be unable to walk, stoop, squat or stand due to the limited range of motion. Initial range of motion of the right knee was measured as follows: 0 to 120 degrees flexion; and 120 to 0 degrees extension. It was noted that his limited range of motion causes problems with walking, squatting, and sitting. Pain was noted on flexion, but not causing a functional limitation. Pain upon palpation to the medial and posterior of the right knee were noted. No evidence of pain upon weight bearing or crepitus were noted. No additional loss of function or range of motion were noted after repetitive use testing. Regarding repeated use over time, pain, weakness, and incoordination were noted as significantly limiting functional ability, and range of motion was estimated as follows: 0 to 110 degrees flexion; 110 to 0 degrees extension. Regarding flare-ups, pain, weakness, and incoordination were noted as significantly limiting functional ability, and range of motion was estimated as follows: 0 to 115 degrees flexion; 115 to 0 degrees extension. Reduced muscle strength was noted bilaterally, though without atrophy. Joint stability testing was normal bilateral and noted no history of recurrent subluxation, lateral instability, or recurrent effusion. Occasional use of knee braces was noted. Finally, the examiner stated that “[a]s a maintenance worker, the veteran Is unable to stoop, squat, or stand for prolonged periods of time due to his bilateral knee strain/sprain and bilateral arthritis. Also, the veteran is unable to stand for prolonged periods of time, do activities that require veteran to apply direct pressure to knees; activities that increase weight bearing to his knees due to his bilateral knee osteoarthritis while working. Due to his bilateral knee arthritis he has to alter workflow to accommodate pain.” Here, the evidence of record shows that throughout the appeal period, the Veteran’s right knee disability has been manifested by painful motion and limitation of motion to a noncompensable degree. The Board acknowledges the Veteran’s lay statements of his knee giving out and notes that he is competent to report as such. See, Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). However, the medical evidence of record clearly and repeatedly shows that no evidence of instability was found upon testing. Further, numerous VA and private treatment records show no reports of instability. The Board notes, in particular, that the January 2018 through July 2019 private treatment records from Total Pain Care note the Veteran denied having any falls for a period that would cover 2017, 2018 and through July 20, 2019. Finally, the VA examinations in July 2016 and October 2020 noted only occasional us of a knee brace. As such, the Board finds that a preponderance of the record is against a finding that the Veteran’s reports of his knee giving out more closely approximates recurrent or persistent right knee instability. As such, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 10 percent for his right knee disability. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. The Board has also considered the other Diagnostic Codes pertaining to the knee and leg, under both the prior regulations and the regulations that went into effect on February 7, 2021. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). Under Diagnostic Code 5257, slight recurrent subluxation or lateral instability warrants a 10 percent rating. A 20 percent rating requires moderate recurrent subluxation or lateral instability, and a 30 percent rating is warranted for severe subluxation or lateral instability. 38 C.F.R. § 4.71a, Diagnostic Code 5257. The words "slight," "moderate," and "severe" as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. Under Diagnostic Code 5258, a 20 percent rating is warranted for dislocation of semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint. Under Diagnostic Code 5259, a 10 percent evaluation is warranted for removal of semilunar cartilage that is symptomatic. 38 C.F.R. § 4.71a, Diagnostic Code 5258, 5259. Based on the above evidence, the Board finds that a separate rating for recurrent subluxation or lateral instability under Diagnostic Code 5257 is not warranted. The Veteran testified at the January 2016 Board hearing that he has instability in the mornings and sometimes in the middle of the night that have led to falls and he is certainly competent to report his knee symptoms, such as instability. Jandreau; Buchanan. However, VA examinations in July 2016 and October 2020 did not result in findings of instability. Further, as noted above, January 2018 through July 2019 private treatment records from Total Pain Care note the Veteran denied having any falls for a period that would cover 2017, 2018 and through July 20, 2019. As such, the preponderance of the evidence is against a separate rating under Diagnostic Code 5257 for slight recurrent subluxation or lateral instability of the right knee. In addition, the Veteran has never demonstrated or been diagnosed with ankylosis of the right knee, impairment of the tibia and fibula, or genu recurvatum. Therefore, Diagnostic Codes 5256, 5262, and 5263 are not applicable. Moreover, the evidence does not show the Veteran has undergone surgical removal of his meniscus. Accordingly, Diagnostic Code 5259 is not applicable. Based on the above evidence, the Board finds that as of January 25, 2016, the date it was first reported, separate 20 percent rating is warranted under Diagnostic Code 5258 for right knee popping and locking. The Veteran has consistently reported popping and locking since the January 2016 Board hearing and he is certainly competent to report his knee symptoms, such as pain and locking. Jandreau; Buchanan. Further, the October 2020 VA examiner noted that his limited range of motion causes problems with increased stiffness and locking. See October 2020 VA examination report. 2. Entitlement to an initial disability rating in excess of 10 percent for left knee residual sprain and strain with degenerative arthritis and osteoarthritis. The Veteran contends that he is entitled to an initial disability rating in excess of 10 percent for his left knee residual sprain and strain with degenerative arthritis and osteoarthritis. The assigned Diagnostic Code 5260 suggests that the left knee disability is rated based on compensable limitation of flexion. 38 C.F.R. § 4.71a. A review of the evidence reflects that the left knee disability has manifested as osteoarthritis and been rated based on painful noncompensable limitation of motion, and that the left knee disability has not had compensable limitation of motion (i.e. limitation of flexion or extension) at any time during the relevant rating period. Therefore, the Diagnostic Code assigned should have been Diagnostic Code 5003, to show that the left knee disability with osteoarthritis is being rated based on noncompensable limitation of motion that is painful. For this reason, the Board is changing the Diagnostic Code for the left knee disability to 5003 to reflect the actual rating already assigned. 38 C.F.R. § 4.71a. The Board finds that the preponderance of the evidence is against a rating in excess of 10 percent for the left knee disability. The Board acknowledges the Veteran’s lay reports of symptoms and that there was functional loss due to pain, weakened movement, excess fatigability, pain during flare-ups, and pain during repetitive use over time. However, even considering the Veteran’s lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements would not result in limitation of motion more nearly approximating flexion limited to 30 degrees. A February 2011 VA treatment record notes the Veteran reported bilateral knee pain with intermittent swelling. Upon physical examination, tenderness of the bilateral patellae and outer aspects was noted. A May 2011 VA treatment record notes the Veteran reported wearing braces for his painful knees. The Veteran was afforded a VA examination in July 2011. The Veteran reported progressively worsening, sharp bilateral knee pain. He further reported daily flares of pain that are provoked by standing or walking and last around 60 minutes, as well being unable to walk more than half a mile or stand more than an hour. He then reported that he “feels weak and stiff in both knees.” Upon physical examination, no evidence of deformity, effusion or crepitus were noted. Initial range of motion was measured as follows: 0 to 135 degrees left knee flexion; and 0 degrees left knee extension. No instability or abnormal movement were noted. Muscle strength testing was normal. It was noted that the Veteran “exhibits a mild degree of pain throughout the range, exhibited by muscle guarding and grunting.” Residual bilateral knee sprain was diagnosed. An October 2011 VA treatment record notes the Veteran reported that his left knee is painful and “frequently goes out”. A May 2012 VA treatment record notes the Veteran reported bilateral knee pain and stiffness, worse in the right knee. He stated that “it always hurts after long trips in [the] car”. Decreased range of motion in in the bilateral lower extremities secondary to pain on extension was noted. A May 2013 VA treatment record notes the Veteran reported pain in both knees. Upon examination, range of motion was noted as restricted. Range of motion was measured as 100 degrees left lateral flexion. It was then noted that x-rays revealed mild degenerative narrowing of the medial compartment of the left knee. An April 2014 VA treatment record notes the Veteran reported chronic knee pain and stiffness. The Veteran testified at the January 2016 Board hearing that his knees get stiff and were now locking. He stated that if he sits for too long, he has to “pop” them. He stated he has pain and has to pull over and walk if he drives for too long. He then stated that the pain occurs 4 days out of the week. He reported feeling grinding. He further stated that he has instability in the mornings and sometimes in the middle of the night that have led to falls. A July 2016 VA treatment record notes that x-rays of the Veteran's knees notes that “[s]ome mild narrowing of the medial joint compartments is seen in both knees”. The Veteran was afforded a VA knee examination in July 2016. He reported having popping and locking in both knees. He further reported flare-ups of pain, stating that sometimes his knees ache when he is walking at work and feel as though they are going to lock up and give out. He further reported functional limitations with climbing ladders and riding lawn mowers with a clutch. Upon examination, initial range of motion was measured as follows: 0 to 115 degrees left knee flexion; 115 to 0 degrees left knee extension. Pain was noted as causing a functional loss on all measurements. Objective evidence of pain upon palpation was noted, but not on weight-bearing. No additional loss of function or range of motion was noted after repetitive use testing. Pain was noted as significantly limiting functional ability after repetitive use over time and during flare-ups. Joint stability testing was normal. Occasional use of knee braces was noted. It was noted that the Veteran’s knee conditions affected his ability to perform his work as a maintenance worker at a steel mill as he had to drive a forklift and golf cart. A January 2018 private treatment record from Total Pain Care notes the Veteran reported bilateral knee pain and stiffness for which he uses a brace. It was noted that the Veteran “report[ed] no falls within the past year.” He further reported that his pain was aggravated by driving and sitting for long periods of time, as well as wearing his duty belt. Upon physical examination, range of motion of the lower extremities was normal with no joint crepitation and no pain on motion. An October 2018 private treatment record from Total Pain Care notes the Veteran “report[ed] no falls within the past year.” Upon physical examination, range of motion of the lower extremities was normal with no joint crepitation and no pain on motion. A July 2019 private treatment record from Total Pain Care notes the Veteran “report[ed] no falls within the past year.” Upon physical examination, range of motion of the lower extremities was normal with no joint crepitation and no pain on motion. Mild tenderness to palpation to the left medial knee, as well as mild left knee edema, were noted. An October 2020 treatment record from Rush Hospital notes x-rays of the Veteran's bilateral knees revealed mild bilateral tricompartmental degenerative changes, but normal alignment of the joints. The Veteran was afforded a VA knee examination in October 2020. The Veteran reported dull, achy pain that is sometimes sharp and with intermittent swelling. Treatment with baclofen, Biofreeze and icy hot were noted. The Veteran reported right knee flare-ups of extreme stiffness and severe throbbing pain 3 to 4 times per month, lasting 1 to 2 days. He further reported left knee flare-ups of stiffness, swelling, and dull achy pain “where he feels he needs to reach inside and pull something out.” He stated that these flare-ups occur 3 to 4 times per month and last 4 to 5 days. He further reported that both of his knees will lock up and he will be unable to walk, stoop, squat or stand due to the limited range of motion. Initial range of motion of the left knee was measured as follows: 0 to 130 degrees flexion; and 130 to 0 degrees extension. It was noted that his limited range of motion causes problems with increased stiffness and locking. Pain was noted on flexion, but not causing a functional limitation. Pain upon palpation to the medial and posterior of the right knee were noted. No evidence of pain upon weight bearing or crepitus were noted. No additional loss of function or range of motion were noted after repetitive use testing. Regarding repeated use over time, pain, weakness, and incoordination were noted as significantly limiting functional ability, and range of motion was estimated as follows: 0 to 130 degrees flexion; 130 to 0 degrees extension. Regarding flare-ups, pain, weakness, and incoordination were noted as significantly limiting functional ability, and range of motion was estimated as follows: 0 to 130 degrees flexion; 130 to 0 degrees extension. Reduced muscle strength was noted bilaterally, though without atrophy. Joint stability testing was normal bilateral and noted no history of recurrent subluxation, lateral instability, or recurrent effusion. Occasional use of knee braces was noted. Finally, the examiner stated that “[a]s a maintenance worker, the veteran is unable to stoop, squat, or stand for prolonged periods of time due to his bilateral knee strain/sprain and bilateral arthritis. Also, the Veteran was unable to stand for prolonged periods of time, do activities that require veteran to apply direct pressure to knees; activities that increase weight bearing to his knees due to his bilateral knee osteoarthritis while working. Due to his bilateral knee arthritis he has to alter workflow to accommodate pain.” Here, the evidence of record shows that throughout the appeal period, the Veteran’s left knee disability has been manifested by painful motion and limitation of motion to a noncompensable degree. The Board acknowledges the Veteran’s lay statements of his knee giving out and notes that he is competent to report as such. Jandreau. However, the medical evidence of record clearly and repeatedly shows that no evidence of instability was found upon testing. Further, numerous VA and private treatment records show no reports of instability. The Board notes, in particular, that the January 2018 through July 2019 private treatment records from Total Pain Care note the Veteran denied having any falls for a period that would cover 2017, 2018 and through July 20, 2019. Finally, the VA examinations in July 2016 and October 2020 noted only occasional us of a knee brace. As such, the Board finds that a preponderance of the record is against a finding that the Veteran’s reports of his knee giving out more closely approximates recurrent or persistent left knee instability. The Board has also considered the other Diagnostic Codes pertaining to the knee and leg, under both the prior regulations and the regulations that went into effect on February 7, 2021. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. Esteban; Lyles. Based on the above evidence, the Board finds that no other Diagnostic Codes are applicable here. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran’s claim for a rating in excess of 10 percent for the left knee disability. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. The Board has also considered the other Diagnostic Codes pertaining to the knee and leg, under both the prior regulations and the regulations that went into effect on February 7, 2021. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban; Lyles. Based on the above evidence, the Board finds that a separate rating for recurrent subluxation or lateral instability under Diagnostic Code 5257 is not warranted. The Veteran testified at the January 2016 Board hearing that he has instability in the mornings and sometimes in the middle of the night that have led to falls and he is certainly competent to report his knee symptoms, such as instability. Jandreau; Buchanan. However, VA examinations in July 2016 and October 2020 did not result in findings of instability. Further, as noted above, January 2018 through July 2019 private treatment records from Total Pain Care note the Veteran denied having any falls for a period that would cover 2017, 2018 and through July 20, 2019. In addition, the Veteran has never demonstrated or been diagnosed with ankylosis of the right knee, impairment of the tibia and fibula, or genu recurvatum. Therefore, Diagnostic Codes 5256, 5262, and 5263 are not applicable. Moreover, the evidence does not show the Veteran has undergone surgical removal of his meniscus. Accordingly, Diagnostic Code 5259 is not applicable. Based on the above evidence, the Board finds that as of January 25, 2016, the date it was first reported, separate 20 percent rating is warranted under Diagnostic Code 5258 for left knee popping and locking. The Veteran has consistently reported popping and locking since the January 2016 Board hearing and he is certainly competent to report his knee symptoms, such as pain and locking. Jandreau; Buchanan. Further, the October 2020 VA examiner noted that his limited range of motion causes problems with increased stiffness and locking. See October 2020 VA examination report. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Brian P. Keeley 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.