Citation Nr: 21026504 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 17-00 530 DATE: May 3, 2021 ORDER Entitlement to a rating in excess of 10 percent for right knee patellofemoral pain syndrome based on instability is denied. Entitlement to a rating in excess of 10 percent for left knee patellofemoral pain syndrome based on instability is denied. Entitlement to an initial compensable evaluation prior to February 12, 2021, and a rating in excess of 10 percent thereafter, for degenerative changes of the right knee based on limitation of extension is denied. Entitlement to an initial compensable evaluation prior to February 12, 2021, and a rating in excess of 20 percent thereafter, for degenerative changes of the left knee based on limitation of extension is denied. FINDINGS OF FACT 1. The weight of the probative evidence does not demonstrate that the Veteran's right knee instability was manifested by moderate recurrent subluxation or lateral instability or that a medical provider prescribed a brace and/or assistive device for ambulation. 2. The weight of the probative evidence does not demonstrate that the Veteran's left knee instability was manifested by moderate recurrent subluxation or lateral instability or that a medical provider prescribed a brace and/or assistive device for ambulation. 3. For the period prior to February 12, 2021, the Veteran's bilateral knee disorder was manifested by pain, with full range of motion bilaterally. 4. From February 12, 2021, the Veteran's right knee disability was manifested by limitation of extension no worse than 10 degrees. 5. From February 12, 2021, the Veteran's left knee disability was manifested by limitation of extension no worse than 15 degrees. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for a right knee patellofemoral pain syndrome based on instability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.2, 4.6, 4.10, 4.71a, Diagnostic Code 5257. 2. The criteria for a rating in excess of 10 percent for a left knee patellofemoral pain syndrome based on instability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.2, 4.6, 4.10, 4.71a, Diagnostic Code 5257. 3. The criteria for an initial compensable evaluation prior to February 12, 2021, and a rating in excess of 10 percent thereafter, for degenerative changes of the right knee based on limitation of extension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.2, 4.6, 4.10, 4.71a, Diagnostic Code 5003-5261. 4. The criteria for an initial compensable evaluation prior to February 12, 2021, and a rating in excess of 20 percent thereafter, for degenerative changes of the left knee based on limitation of extension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.2, 4.6, 4.10, 4.71a, Diagnostic Code 5003-5261. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had an initial period of active duty for training from August 1980 to December 1980; he had additional periods of active service from October 2003 to February 2005, September 2005 to September 2014, and from March 1987 to July 1992. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2015 rating decision of the Department of Veterans Affairs (VA) regional Office (RO). In September 2020, the Veteran testified at a videoconference hearing before the undersigned. A transcript of the hearing is of record. The issue of entitlement to an increased evaluation for bilateral patellofemoral pain syndrome was previously before the Board in January 2021, at which time the Board awarded separate, initial 10 percent ratings for each knee based on instability. The Board also remanded these issues for a new VA examination that addressed the current level of severity of his bilateral knee disorder because the Veteran testified at his Board hearing that his knee symptoms had worsened in severity since his last VA examination in July 2015. The RO implemented the Board's decision in a February 2021 rating decision, assigning separate 10 percent disability ratings for right and left knee patellofemoral pain syndrome effective October 1, 2014. The Veteran was then afforded the requested VA examination in February 2021, and a Supplemental Statement of the Case (SSOC) was issued. Thus, the Board finds that there has been substantial compliance with the January 2021 remand. Stegall v. West, 11 Vet. App. 268 (1998). Additionally, based upon the findings of the requested VA examination, in a February 2021 rating decision, the RO granted service connection for degenerative changes of the right and left knee, awarding separate 10 and 20 percent disability ratings, respectively, for limitation of extension. Although these issues were not included in the February 2021 SSOC, the Board finds that these issues were part of the Veteran's claim for an increased rating for his bilateral knee disorder. Thus, the Board will address whether an increased rating is warranted for his bilateral knee degenerative changes. See A.B. v. Brown, 6 Vet. App. 35, 38 (1993). Increased Rating Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability ratings 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. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria required for that particular rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When a reasonable doubt arises regarding the degree of disability, that reasonable doubt will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. When rating musculoskeletal disabilities on the basis of limited motion of a joint, VA must consider functional loss due to limited or excess movement, pain, weakness, excess fatigability, or incoordination. 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions of 38 C.F.R. §§ 4.40 and 4.45 are to be considered only in conjunction with diagnostic codes predicated on limitation of motion. Johnson v. Brown, 9 Vet. App. 7 (1996). Painful motion is an important factor of joint disability and actually painful joints are entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. Where functional loss is alleged due to pain upon motion, the function of the musculoskeletal system and movements of joints must still be analyzed. DeLuca v. Brown, 8 Vet. App. 202 (1995). A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the claimant. Johnston v. Brown, 10 Vet. App. 80 (1997). Similarly, painful motion alone does not constitute limited motion for the purposes of rating under diagnostic codes pertaining to limitation of motion. However, pain may result in functional loss if it limits the ability to perform normal movements with normal excursion, strength, speed, coordination, or endurance. Functional loss due to pain is to be rated at the same level as functional loss caused by some other factor that actually limited motion. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Bilateral Knee Disorder The Veteran is currently in receipt of a 10 percent evaluation for his left knee patellofemoral pain syndrome and a 10 percent evaluation for his right knee patellofemoral pain syndrome pursuant to Diagnostic Code 5257. Diagnostic Code 5257 addresses recurrent subluxation and instability of the knee. 38 C.F.R. § 4.71a, Diagnostic Code 5257. He is additionally in receipt of a 10 percent disability rating for right knee degenerative changes and a 20 percent disability rating for left knee degenerative changes, pursuant to Diagnostic Code 5003-5261. During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. Prior to February 7, 2021, Diagnostic Code 5257 provided that a 10 percent rating was warranted for slight recurrent subluxation or lateral instability; a 20 percent rating was warranted for moderate recurrent subluxation or lateral instability; and a 30 percent rating was warranted for severe recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, Diagnostic Code 5257 (2018). As of February 7, 2021, under the amended criteria, Diagnostic Code 5257 provides that a 10 percent rating is warranted for a sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. 38 C.F.R. § 4.71a, Diagnostic Code 5257 (2021). A 20 percent rating is warranted for (a) Sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation; or (b) Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. Id. A 30 percent rating is warranted for severe unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation. Id. In addition to the above, the amended rating criteria under Diagnostic Code 5257 also provides ratings specific to patellar instability, a diagnosed condition involving the patellofemoral complex with recurrent instability. A 10 percent rating is warranted for patellar instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent rating is warranted for patellar instability after surgical repair that requires a prescription by a medical provider for one of the following: A brace, cane, or walker. A 30 percent rating is warranted for patellar instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. Id. For patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. Id. at Note 1. Diagnostic Code 5260, limitation of flexion of the leg, provides for a noncompensable rating for flexion limited to 60 degrees; a 10 percent rating for flexion limited to 45 degrees; a 20 percent rating for flexion limited to 30 degrees; and a 30 percent rating for flexion limited to 15 degrees. 38 C.F.R. § 4.71a. A 30 percent disability rating is the highest available under Diagnostic Code 5260. 38 C.F.R. § 4.71a. Diagnostic Code 5261, limitation of extension of the leg, provides for a noncompensable rating for extension limited to 5 degrees; a 10 percent rating for extension limited to 10 degrees; a 20 percent rating for extension limited to 15 degrees; a 30 percent rating for extension limited to 20 degrees; a 40 percent rating for extension limited to 30 degrees; and a 50 percent rating for extension limited to 45 degrees. 38 C.F.R.§ 4.71a, Diagnostic Code 5261. Notably, neither Diagnostic Code 5260 nor Diagnostic Code 5261 was affected by the February 7, 2021 musculoskeletal rating criteria changes. An April 2015 VA examination notes that the Veteran had patellofemoral pain syndrome in the bilateral knees. The Veteran reported that he experienced bilateral knee pain going down stairs and with kneeling for the last few years, although walking on flat surfaces or going up stairs was "OK". He also reported experiencing aching in his knees with long car rides. The Veteran endorsed experiencing flare-ups described as bilateral knee aching more in cold and/or damp weather; he indicated that he experienced additional functional loss or functional impairment, including with repeated use over time, which he described as increased pain with kneeling, squatting, and descending stairs. Upon range of motion testing, his right and left knees revealed full range of motion, without pain noted on examination or with weightbearing. There was no objective evidence of crepitus or localized tenderness or pain on palpation of the joint or associated soft tissue. There was no additional loss of range of motion after three repetitions of either knee. The examiner indicated that pain significantly limited functional ability with repeated use over a period of time; however, the examiner was unable to describe this functional loss in terms of range of motion because it would be speculative. The examiner further indicated that it would speculative to indicate whether pain, weakness, fatigability or incoordination significantly limited functional ability with flare-ups because he had a normal knee examination. The Veteran's muscle strength was normal bilaterally, without evidence of atrophy. He did not have ankylosis in either knee. Joint stability testing revealed normal results without any recurrent subluxation or lateral instability bilaterally. Further, the examination indicates that the Veteran did not have any recurrent patellar dislocation, "shin splints" (medial tibial stress syndrome), stress fractures, chronic exertional compartment syndrome, any other tibial and/or fibular impairment, or meniscal conditions. He did not use any assistive devices for ambulation. The examiner indicated that, due to his bilateral knee patellofemoral pain syndrome, the Veteran would be unable to perform activities requiring frequent kneeling or squatting. A June 2015 VA treatment record notes that the Veteran reported chronic bilateral knee pain, worse with descending stairs. He described the pain as an intermittent aching rated as a 4. A July 2015 x-ray report notes an impression of mild bilateral knee osteoarthritis changes. In a September 2015 correspondence, associated with his Notice of Disagreement, the Veteran reported that he had severe pain walking down stairs or down a hill, indicating that he avoided these activities. He additionally indicated that he was unable to stand from a kneeling position or squat due to the pain. His December 2016 VA Form 9 indicates that he had constant throbbing pain in both knees which limited his ability to climb stairs and walk distances, and he could only drive in an automobile for a limited period of time; he noted that if he went on road trips, he had to constantly get out of the car to stretch his knees and walk due to the pain and dull ache in his knees, and he had particular difficulty descending stairs. He also reported that he had edema in his knees and suffered from crepitus. October 2017 and November 2017 private medical records note complaints of left knee pain, which was diagnosed as chondromalacia patellae of the left knee. The Veteran received injections to treat his knee pain. During his September 2020 Board hearing, the Veteran testified that he had received injections in his knees due to flare-ups of pain, which alleviated the pain for approximately three to four months at a time. However, when asked about his flare-ups, the Veteran clarified that he did not experience flare-ups; rather, he experienced a constant pain. He noted that he did not experience pain when standing or walking, except when walking down stairs; he also experienced pain when he sat idle. He indicated that his knees did not give way and he did not use any assistive devices for his knees. A February 2021 VA examination notes diagnoses of bilateral patellofemoral pain syndrome and bilateral degenerative arthritis. The Veteran reported that his bilateral knee disorder had worsened since his last VA examination in 2015, indicating that he had received steroid shots to the left knee with only transient relief. The Veteran endorsed flare-ups, indicating that he had a tolerable constant pain rated as a 5 out of 10, and depending on his level of activity and the weather (cold/damp), the pain level increased to 8 out of 10. He described functional loss or functional impairment as significant limitations in lifting, running, jumping, climbing, squatting, bending, pulling, pushing, distance walking, and prolonged standing and sitting. He reported that he had or has had instability or recurrent subluxation of the knee, indicating that the knee gave out on him while walking in the woods; he also reported that both knees felt unstable particularly when descending stairs. He also indicated that both knees swelled almost daily and felt tight; he applied cold packs and elevated both knees in an effort to alleviate the swelling. Range of motion testing revealed the Veteran had decreased range of motion in the bilateral knees impacting his mobility, balance, and activity. Right knee flexion was measured to 125 degrees and extension was noted as 5 degrees; left knee flexion was measured to 120 degrees and extension to 5 degrees. Passive range of motion measurements were the same as active range of motion bilaterally. The Veteran had pain with weightbearing, non-weightbearing, active motion, passive motion, and on rest/non-movement, which resulted in functional loss bilaterally. There was objective evidence of crepitus and mild to moderate tenderness over the anterior knee joint bilaterally and occasionally to the posterior area of the left knee. There was no additional functional loss after three repetitions with either knee; however, evidence suggested that pain and lack of endurance significantly limited functional ability with repeated use over time. The examiner estimated that, with repeated use, the Veteran's right knee flexion was limited to 120 degrees and extension was limited to 10 degrees, and left knee flexion was limited to 115 degrees and extension was limited to 15 degrees. Further the examiner indicated that pain significantly limited functional ability with flare-ups, noting that flare-ups would result in right knee flexion to 120 degrees and extension to 10 degrees and left knee flexion to 115 degrees and extension to 15 degrees. The examination notes that the Veteran's bilateral knee disability resulted in interference with sitting and standing, disturbance of locomotion, and less movement than normal. The Veteran did not have atrophy or ankylosis. The examination indicates that the Veteran had recurrent subluxation or lateral instability bilaterally; he did not have a ligament tear or patellar instability. He was not prescribed any assistive device for ambulation, nor had he undergone any surgical repair for either knee. He did not have recurrent patellar dislocation, shin splints (medial tibial stress syndrome), stress fractures, any other tibial or fibular impairment, or any meniscal conditions to either knee. The examiner indicated that the Veteran's bilateral knee disorder would significantly limit his ability to function in a purely physical work environment and, to some extent, in a sedentary work environment. Initially, with regard to the April 2015 VA examination, the Board notes that the examiner indicated that it would be speculative to describe the functional loss during flare-ups in terms of range of motion. While cognizant of the holding in Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017), the Board finds that the April 2015 VA examiner elicited lay responses from the Veteran describing his flare-ups and additional functional impairment and adequately explained why estimating the degree of functional limitation during flare-ups would be speculative, indicating that the Veteran had a normal knee examination. Nevertheless, the examination notes that the Veteran described his flare-ups in terms of increased pain with certain activities, without identifying additional functional loss, thus sufficiently addressing the functional loss experienced by the Veteran during flare-ups. Furthermore, to the extent that the April 2015 VA examination did not address passive motion and non-weightbearing, the Board notes that all range of motion measurements were performed under active, weight-bearing motion, the Board finds that it is reasonable that any clinician-assisted passive, non-weight bearing motion would reveal greater range of motion. This type of motion would be less beneficial to the Veteran's claim, and thus the absence of these clinician-assisted passive, non-weight bearing motion measurements are harmless errors. Further, range of motion measurements were performed with both knees. Thus, to the extent that there are Correia deficiencies in the examination, such errors are harmless. See Correia v. McDonald, 28 Vet. App. 158 (2016). After a review of the evidence, the Board finds that a rating in excess of 10 percent is not warranted for patellofemoral pain syndrome based on instability for either knee at any time during the period on appeal. The Board acknowledges that the Veteran credibly reported that his bilateral knees felt unstable, particularly when descending stairs, and had given out on him. Further, the February 2021 VA examiner noted that the Veteran had recurrent subluxation or lateral instability bilaterally. However, the medical evidence does not indicate that the Veteran had moderate recurrent subluxation or lateral instability at any time during the period on appeal and the evidence does not otherwise demonstrate a disability picture that more closely approximates moderate recurrent subluxation or lateral instability, pursuant to the pre-amended criteria. Specifically, the Veteran first reported symptoms of instability at his February 2021 VA examination, in which he noted what appears to be one occasion in which he felt his knee give way while walking in the woods and indicated that he experienced feelings of instability when descending stairs. There is otherwise no indication in the record that the Veteran experienced any knee instability or any other evidence describing any additional functional impairment due to his bilateral knee instability. The Board does not find that these occasional feelings of instability in the bilateral knees rise to the level of severity warranting a rating for moderate instability. The Board has also considered whether a higher rating would be warranted from February 7, 2021 pursuant to the amended criteria. However, there is no evidence of record, lay or medical, that a medical provider prescribed a brace and/or assistive device for ambulation at any time from February 7, 2021, as required for a 20 percent rating under the amended criteria. Therefore, the Board finds that a rating in excess of 10 percent for instability is not warranted for either knee under either the pre- or post-amended rating criteria, and the separate 10 percent disability ratings for right and left knee instability contemplates the Veteran's reports of bilateral knee instability. 38 C.F.R. § 4.71a; DC 5257. The Board additionally finds that increased evaluations are not warranted for the Veteran's right and left knee disorder based on limitation of extension. In this regard, the Board notes that there is no evidence of record indicating that the Veteran experienced any limitation of extension at any time prior to February 12, 2021, and thus, a compensable evaluation is not warranted prior to February 12, 2021 for the Veteran's right or left knee based on limitation of extension. Furthermore, for the period from February 12, 2021, the evidence does not reflect that the Veteran experienced extension limited to 15 degrees or greater in the right knee or extension limited to 20 degrees or greater in the left knee at any time during this period, which would warrant a higher rating of 20 percent and 30 percent, respectively. The evidence reflects that the Veteran had full range of motion prior to February 12, 2021, and from February 12, 2021, the evidence reflects extension limited to 5 degrees in the bilateral knees, with an additional 5 degree loss in the right knee and an additional 10 degree loss in the left knee with flare-ups. Therefore, higher ratings are not warranted for the Veteran's bilateral knee disorder based on limitation of extension. 38 C.F.R. § 4.71a, DCs 5261. Nor is there any basis to assign a compensable evaluation pursuant to DC 5260 for limitation of flexion at any time during the period on appeal. In this regard, the medical evidence does not reflect that the Veteran had flexion limited to 45 degrees or less at any time during the period on appeal, which would warrant a 10 percent evaluation under Diagnostic Code 5260 both before and after the February 7, 2021 amendments. See 38 C.F.R. § 4.71a. The record reflects that the Veteran had full range of motion prior to February 12, 2021, and from February 12, 2021, the medical evidence reflects flexion limited to 125 degrees in the right knee and 120 degrees in the left knee, with an additional 5 degree loss bilaterally during flare-ups. Therefore, a separate compensable evaluation is not warranted for limitation of flexion at any time during the period on appeal. Furthermore, the Board finds that a higher rating is not warranted under Diagnostic Code 5010 under either the old or new regulatory provisions. To that end, under the old version of Diagnostic Code 5010, the Veteran is not eligible for a 20 percent rating in the absence of occasional incapacitating exacerbations, which have not been indicated here. The Board notes that although Diagnostic Code 5003 does not define "incapacitating exacerbation," the analogous term, "incapacitating episode," is defined as a period of acute signs and symptoms that requires bed rest prescribed by a physician and treatment by a physician. See 38 C.F.R. § 4.71a, Diagnostic Code 5243, Note 1; 38 C.F.R. § 4.114, Diagnostic Codes 7345, 7354, Note 2. Although the Veteran has reported flare-ups of pain, there is no indication that his knee symptoms required prescribed bed rest and treatment by a physician. Nevertheless, to the extent that he claims that he does experience such incapacitating exacerbations, the Board notes that the Veteran has been awarded a separate 20 percent disability rating for gout affecting his knees and feet based upon two exacerbations a year. Therefore, assigning other ratings based on the same symptoms that are already accounted for would be tantamount to pyramiding. 38 C.F.R. § 4.14. As such, only a maximum 10 percent rating is available under the previous version of Diagnostic Code 5010 and both the pre- and post-amended versions of 5003, which accounted for objective evidence of painful motion in both knees. The result is the same after considering whether a higher rating is available under the new version of diagnostic code 5010 in effect from February 7, 2021, as the Veteran is assigned separate 10 percent ratings for each knee due to instability and separate 20 percent ratings for his bilateral knee limitation of extension. Thus, a higher disability rating is not available pursuant to either the pre- or post-amended criteria for arthritis under Diagnostic Codes 5003 and 5010. The Board acknowledges that the evidence reflects that the Veteran had complained of pain and additional functional loss due to pain, and the Veteran's currently assigned ratings for his bilateral knee disability consider such functional loss due to painful motion. The evidence of record does not reflect that his bilateral knee disability was so disabling as to approximate the level of impairment required for assignment of a higher rating under the limitation of motion criteria during the period on appeal. As noted above, the evidence reflects that, even with flare-ups, the Veteran did not experience any limitation in his right or left knee range of motion prior to February 12, 2021; from February 12, 2021, the Veteran's flexion was limited to 120 degrees in the right knee and 115 degrees in the left knee with flare-ups and extension was limited to 10 degrees in the right knee and 15 degrees in the left knee with flare-ups. The Board thus finds that the current ratings assigned for the bilateral knees during the period on appeal sufficiently compensates the Veteran for the extent of his functional loss due to limited movement and pain. See 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). Finally, there is no basis to assign a separate rating under DCs 5256, 5258, 5259, 5262 or 5263 because there is no evidence of record indicating ankylosis, impairment the cartilage, impairment of the tibia and fibula, or genu recurvatum throughout the period on appeal. 38 C.F.R. § 4.71a. Thus, on this basis, a higher rating is not warranted for the period on appeal for the Veteran's bilateral knee disorder. The Board has considered the statements of the Veteran as to the extent of his bilateral knee symptoms. He is certainly competent to report that his symptoms are worse. Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, in evaluating a claim for an increased schedular rating, VA must weigh his statements against the factors as enumerated in the rating criteria discussed above, which in part, involves the examination of clinical data gathered by competent medical professionals. Based on the foregoing, the Board finds that increased evaluations are not warranted for the Veteran's bilateral knee disorder for any period of the period on appeal. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt rule does not apply, and claims must be denied. See 38 U.S.C. § 5107. Thomas H. O'Shay Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Hite, Associate 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.