Citation Nr: 21027614 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 15-05 404 DATE: May 6, 2021 ORDER A rating in excess of 10 percent for limitation of motion of the right knee is denied. FINDINGS OF FACT 1. The Veteran had active duty from November 1972 to November 1976; he has been 100 percent disabled since September 2019. 2. Limitation of motion of the right knee has been manifested by subjective complaints of cramps, fatigability, flare-ups, pain, stiffness, swelling, weakness, and limited motion; objective findings include full extension to 0 degrees, flexion limited (at worst) to 70 degrees, and no ankylosis, malunion of the tibia and fibula, or shin splints. CONCLUSION OF LAW The criteria for a rating in excess of 10 percent for limitation of motion of the right knee have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 4.14, 4.3, 4.7, 4.20, 4.40, 4.45, 4.59, 4.71a; Diagnostic Codes (DCs) 5010, 5256, 5260, 5261 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Board remanded the appeal in May 2018 and September 2019 for further development. It is now ready for adjudication. As a point of clarification, the Veteran is separately service connected for status/post right knee trauma manifested by locking under DC 5258 and right knee instability under DC 5257. Those issues are not before the Board so only limitation of motion will be addressed. Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. The Veteran currently is rated at 10 percent for limitation of motion of the right knee under DC 5010-5260. 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). While several of the rating criteria applicable to the knee were revised, the diagnostic codes addressing range of motion (DCs 5256, 5260, and 5261) did not change. Although the regulations for an impairment of the tibia and fibula under DC 5262 were amended, the medical evidence does not reflect a diagnosis of nonunion or malunion of the tibia/fibula, medial tibial stress syndrome, or shin splints. Therefore, this regulation will not be addressed. Further, to the extent that the Veteran is also rated under DC 5010 for post-traumatic arthritis, the criteria direct that the rating should be based on limitation of motion, dislocation, or other specified instability of the affected joint under the diagnostic code of that joint. Thus, there is no basis for a rating in excess of 10 percent for limitation of motion under DC 5010 itself. Therefore, as the Veteran is separately rated for instability and dislocation has not been shown, the Board will focus only on the criteria for limitation of motion. Under the pre-amended and amended rating criteria, a rating in excess of 10 percent for right knee limitation of motion will be warranted when the objective medical evidence shows: ankylosis of the knee at a favorable angle in full extension, or in slight flexion between 0 and 10 degrees (30 percent; DC 5256); flexion of the leg limited to 30 degrees (20 percent; DC 5260); or extension of the leg limited to 15 degrees (20 percent; DC 5261). Turning to the medical evidence, as an initial matter, the Veteran contends that an August 2013 VA examination was deficient in that the examiner did not assist him with a leg stand, which he was unable to perform independently. Nonetheless, he has undergone examinations both prior to and since the August 2013 examination, including in January 2011, August 2014, July 2016, May 2019, and November 2020. Thus, the August 2013 examination is assigned less probative value. As to ankylosis, the Veteran has complained of stiffness, pain, fatigable, swelling, weakness, and cramps; however, ankylosis defined as a fixation of the joint has not been shown. Specifically, August 2014, July 2016, and May 2019 VA examiners considered the Veteran's ongoing complaints of functional loss but determined that ankylosis was not shown. Similarly, the most recent November 2020 VA examiner found no signs of ankylosis. The clinical records do not indicate otherwise. Thus, the medical evidence does not support a higher rating for limitation of motion of the right knee based on ankylosis under DC 5256. As to limitation of flexion and extension, as noted above, the Veteran is separately service connected for right knee trauma based on symptoms of locking, pain, and effusion into the knee joint, as well as right knee instability based on the use of a knee brace, persistent pain, and functional loss attributed to pain. As symptoms of pain, instability, and functional loss have already been accounted for, the Board will only consider actual range of motion in assessing flexion and extension. To that end, despite the Veteran's contentions to the contrary, the medical evidence does not support a higher rating based on limitation of motion. Parenthetically, normal flexion is to 140 degrees and normal extension is to 0 degrees. Specifically, an April 2014 VA orthopedist's found right leg flexion to 130 degrees and full extension. The July 2014 VA examiner reported that the Veteran could fully extend his right leg to 0 degrees and, at worst, was limited to 70 degrees of flexion of the right leg. A September 2015 VA clinician found extension to 0 degrees and flexion to 120 degrees. In November 2015, a VA clinician found that, notwithstanding X-rays showing mild degenerative joint disc disease, the Veteran had a full range of motion without pain. Further, a July 2016 VA examiner found flexion to 120 degrees and extension to 0 degrees, and that, though he exhibited signs of pain during flexion and extension testing, this pain did not result in or cause any functional loss. At that time, the Veteran reported that he walked up to three miles per day for exercise. Similarly, an April 2019 VA orthopedist found that range of motion was from 0 degrees of extension to 120 degrees of flexion. More recent, the November 2020 VA examiner found that flexion of the right leg was limited to 100 degrees, with extension of the right leg to 0 degrees, but with a reduction to 80 degrees of flexion during flare-ups of pain. Even considering that the most severe limitation of flexion was to 70 degrees (July 2014) and most recently limited to 100 degrees and to 80 degrees with pain (November 2020), these findings do not support a rating in excess of 10 percent. Further, extension has consistently been reported as anatomically normal and the medical evidence does not support a higher rating on this basis. Consideration has also been given to assigning staged ratings for this disability. But at no time during the period in question has the disability warranted a higher schedular rating than that assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007). The Board has considered the Veteran's lay statements that his disability is worse. While he is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of a disorder according to the pertinent diagnostic codes. Such competent evidence concerning the nature and extent of the Veteran's limitation of motion of the right knee has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which these disabilities are evaluated. Moreover, as the examiners have the requisite medical expertise to render a medical opinion regarding the degree of impairment caused by the disability and had sufficient facts and data on which to base the conclusion, the Board affords the medical opinions great probative value. As such, these records are more probative than the Veteran's subjective complaints of increased symptomatology. In sum, after a careful review of the evidence of record, the benefit of the doubt rule is not applicable, and the appeal is denied. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record for the Board's consideration. See Doucette v. Shulkin, 28 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). L. HOWELL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Associate Counsel Edward P. Vrtis 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.