Citation Nr: 21027643 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 15-20 724 DATE: May 6, 2021 ORDER Entitlement to a rating in excess of 10 percent for degenerative arthritis of the right knee from February 13, 2012 to March 9, 2016 is denied. Entitlement to a rating in excess of 10 percent for osteoarthritis of the right knee limitation of extension from March 9, 2016 is denied. Entitlement to an initial compensable rating for limitation of flexion of the right knee prior to November 16, 2019 is denied. As of November 16, 2019, a rating of 10 percent, but no higher, for limitation of flexion of the right knee is granted, subject to the laws and regulations governing the payment of monetary benefits. Entitlement to a rating in excess of 10 percent for degenerative arthritis of the left knee prior to March 9, 2016 and in excess of 20 percent thereafter is denied. As of November 16, 2019, a rating of 10 percent, but no higher, for limitation of extension of the left knee is granted, subject to the laws and regulations governing the payment of monetary benefits. A 10 percent rating, but no higher, for left knee instability is granted, subject to the laws and regulations governing the payment of monetary benefits. As of November 16, 2019, a rating of 10 percent, but no higher, for right knee instability is granted, subject to the laws and regulations governing the payment of monetary benefits. As of July 22, 2013, a rating of 10 percent for right knee scar is granted, subject to the laws and regulations governing the payment of monetary benefits. FINDINGS OF FACT 1. For the entire appeal period, the Veteran's right knee degenerative arthritis and osteoarthritis is manifested by painful motion without X-ray evidence of involvement of two or more major joints or two or more minor joint groups. 2. Prior to November 16, 2019, the Veteran's right knee limitation of flexion of the right knee was manifested by limitation of flexion to 50 degrees and full extension, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without ankylosis, lateral instability or recurrent subluxation, removal or dislocation of semilunar cartilage, impairment of the tibia or fibula, or genu recurvatum. 3. As of November 16, 2019, the Veteran's right knee limitation of flexion of the right knee was manifested by limitation of flexion to 45 degrees and full extension, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without ankylosis, removal or dislocation of semilunar cartilage, impairment of the tibia or fibula, or genu recurvatum. 4. Prior to March 9, 2016, the Veteran's left knee degenerative arthritis was manifested by limitation of flexion to 80 degrees and full extension, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without ankylosis, removal or dislocation of semilunar cartilage, impairment of the tibia or fibula, or genu recurvatum. 5. As of March 9, 2016, the Veteran's left knee degenerative arthritis was manifested by limitation of flexion to 30 degrees, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without ankylosis, removal or dislocation of semilunar cartilage, impairment of the tibia or fibula, or genu recurvatum. 6. As of November 16, 2019, the Veteran's left knee degenerative arthritis was manifested by limitation of extension to 10 degrees. 7. The Veteran has had slight left knee instability throughout the period on appeal. 8. As of November 16, 2019, the record reflects slight right knee instability or subluxation. 9. As of July 22, 2013, the Veteran's right knee scar was shown to be painful and/or unstable. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for degenerative arthritis of the right knee from February 13, 2012 to March 9, 2016 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.14, 4.27, 4.40, 4.45, 4.59, 4.71a, DC 5003-5260. 2. The criteria for a rating in excess of 10 percent for osteoarthritis of the right knee have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.14, 4.27, 4.40, 4.45, 4.59, 4.71a, DC 5010-5261. 3. The criteria for an initial compensable rating for limitation of flexion of the right knee have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.14, 4.27, 4.40, 4.45, 4.59, 4.71a, DC 5010-5260. 4. As of November 16, 2019, the criteria for a 10 percent rating for limitation of flexion have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.14, 4.27, 4.40, 4.45, 4.59, 4.71a, DC 5010-5260. 5. The criteria for a rating in excess of 10 percent prior to March 9, 2016 and in excess of 20 percent thereafter for degenerative arthritis of the left knee have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.14, 4.27, 4.40, 4.45, 4.59, 4.71a, DC 5010-5260. 6. As of November 16, 2019, the criteria for a separate 10 percent rating for limitation of extension of the left knee have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.14, 4.27, 4.40, 4.45, 4.59, 4.71a, DC 5261. 7. The criteria for a separate 10 percent rating for left knee instability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.14, 4.27, 4.40, 4.45, 4.59, 4.71a, DC 5257. 8. As of November 16, 2019, the criteria for a separate 10 percent rating for right knee instability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.14, 4.27, 4.40, 4.45, 4.59, 4.71a, DC 5257. 9. As of July 22, 2013, the criteria for a 10 percent rating for a right knee scar have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.118, DC 7804. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1962 to June 1965. This matter is on appeal before the Board of Veterans Appeals (Board) from an August 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In August 2019, the Board remanded the case for additional development and it now returns for appellate review. Additionally, the matter developed for appeal involves the rating of residuals of the right knee, which was evaluated by VA examiners in July 2013, August 2016, and December 2019. In this regard, such evaluation revealed a residual surgical scar of the right knee, and such is considered part and parcel of the issue developed for appeal and will be adjudicated by the Board. Increased Rating Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. Separate ratings can be assigned for separate periods based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a Veteran's service-connected disability. 38 C.F.R. § 4.14. It is possible for a Veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. The appeal period before the Board begins on February 13, 2012, the date VA received the Veteran's claims for an increased rating, plus the one-year look-back period. Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). Musculoskeletal System Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011), the U.S Court of Appeals for Veterans Claims held that, although pain may cause a functional loss, "pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system." Rather, pain may result in functional loss, but only if it limits the ability "to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance." Id., quoting 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that "[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint." Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the DC under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016). 1. Entitlement to a rating in excess of 10 percent for degenerative arthritis of the right knee from February 13, 2012 to March 9, 2016. 2. Entitlement to a rating in excess of 10 percent for osteoarthritis of the right knee from March 9, 2016. 3. Entitlement to an initial compensable rating for limitation of flexion of the right knee. 4. Entitlement to a rating in excess of 10 percent prior to March 9, 2016 and in excess of 20 percent from March 9, 2016 to November 16, 2019 for degenerative arthritis of the left knee. 5. Entitlement to a compensable rating for a right knee scar. The Veteran contends that he is entitled to increased ratings for his right and left knee disabilities. From February 13, 2012 to March 9, 2016, the Veteran's right knee degenerative arthritis was evaluated under 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5003-5260 with a 10 percent rating assigned. As of March 9, 2016, the Veteran's right knee osteoarthritis is rated under 5010-5261 with a 10 percent rating assigned and under 5010-5260 for limitation of flexion with a noncompensable rating assigned. The Veteran's left knee degenerative arthritis is rated under DC 5010-5260 with a 10 percent rating assigned from February 13, 2012 to March 9, 2016 and a 20 percent rating assigned as of March 9, 2016. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. Specifically, under Diagnostic Code 5010, traumatic arthritis is evaluated as degenerative arthritis. Degenerative arthritis established by X-ray findings is rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. 38 C.F.R. § 4.71a, Diagnostic Code 5003. Pursuant to DC 5003, arthritis established by x-ray findings will be rated on the basis of limitation of motion of the specific joint involved. When, however, the limitation of motion of the specific joint involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, X-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations warrants a 20 percent evaluation. X-ray evidence of involvement of two or more major joints or two or more minor joints warrants a 10 percent evaluation. 38 C.F.R. § 4.71a, DC 5003. For the purpose of rating disability from arthritis, the knee is considered a major joint. See 38 C.F.R. § 4.45. Normal range of knee motion is 140 degrees of flexion and zero degrees of extension. 38 C.F.R. § 4.71, Plate II. Limitation of motion of the knee is contemplated in 38 C.F.R. § 4.71a, DCs 5260 and 5261. Under DC 5260, a noncompensable rating is warranted where flexion is limited to 60 degrees. A 10 percent rating is warranted where flexion is limited to 45 degrees. A 20 percent rating is warranted where flexion is limited to 30 degrees and a 30 percent rating is warranted where flexion is limited to 15 degrees. DC 5261 provides for a noncompensable rating for extension limited to 5 degrees. A 10 percent rating requires extension limited to 10 degrees. A 20 percent rating is warranted where extension is limited to 15 degrees and a 30 percent rating is warranted where extension is limited to 20 degrees. For a 40 percent rating, extension must be limited to 30 degrees. Finally, where extension is limited to 45 degrees, a 50 percent rating may be assigned. VA's General Counsel has stated that separate ratings under DC 5260 (limitation of flexion of the leg) and DC 5261 (limitation of extension of the leg) may be assigned for disability of the same joint. VAOPGCPREC 9-04 (September 17, 2004), published at 69 Fed. Reg. 59,990 (2004). DC 5257 provides for the assignment of a 10 percent rating when there is slight recurrent subluxation or lateral instability, a 20 percent rating when there is moderate recurrent subluxation or lateral instability, and a 30 percent evaluation for severe recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a. The words slight, moderate, and severe 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. It should also be noted that use of terminology such as severe by VA examiners and others, although an element to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. VA's General Counsel has also stated that when a knee disorder is rated under 38 C.F.R. § 4.71a , DC 5257 and an appellant also has limitation of knee motion which at least meets the criteria for a noncompensable evaluation under 38 C.F.R. § 4.71a , DC 5260 or 5261, separate evaluations may be assigned for arthritis with limitation of motion and for instability. Right Knee Disability The Veteran contends that he is entitled to higher ratings for his right knee disability. The Board acknowledges the Veteran's contentions and complaints expressed on VA examinations. The Veteran is currently assigned a 10 percent rating prior to March 9, 2016 under Diagnostic Code 5003-5260. As of March 9, 2016, he has a 10 percent rating under Diagnostic Code 5010-5261 and a noncompensable rating under Diagnostic Code 5010-5260. The Board finds that a preponderance of the evidence is against a rating in excess of 10 percent prior to March 9, 2016. On VA examination in July 2013, the Veteran's right knee flexion was tested to 80 degrees of flexion with pain at 70 degrees and normal extension. There was no additional loss on repetitive use testing. There is further no other evidence of record supporting that the Veteran had a compensable level of limitation of either right knee flexion or extension prior to March 9, 2016. The Board notes that the AOJ granted a 10 percent rating based on painful motion. Range of motion testing at the Veteran's July 2016 VA examination showed right knee flexion limited to 60 degrees, reduced to 50 degrees on repetitive use testing. The examiner opined that with repeated use over time or during a flare-up flexion would be limited to 50 degrees. Under Diagnostic Code 5260, flexion must be limited to 45 degrees to warrant a 10 percent rating. The July 2016 VA examination did not indicate any reduction in extension. The November 16, 2019 VA examination further indicated that the Veteran had painful extension but no limitation in motion on extension. However, the examiner did opine that with repeated use over time or during a flare-up, the Veteran's right knee flexion would be limited to 45 degrees. Therefore, the Board finds that a 10 percent rating, but no greater, is warranted for impairment of right knee flexion under Diagnostic Code 5260 effective November 16, 2019. The Board finds that 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 45 degrees prior to November 16, 2016. In conclusion, the Board finds that, from February 13, 2012 to March 9, 2016, a rating in excess of 10 percent for right knee degenerative arthritis is not warranted under DC 5003-5260. Additionally, as stated above, as of March 9, 2016, the Veteran's right knee osteoarthritis is rated as 10 percent under 5010-5261; however, a rating in excess of 10 percent is similarly not warranted. Finally, the Veteran also has a noncompensable rating as March 9, 2016, under DC 5010-5260 for limitation of flexion for his right knee. In this regard, as discussed above, the Board finds that, as of November 16, 2019, the Veteran is entitled to a rating of 10 percent, but no higher, for the limitation of flexion. The Board has further considered whether there are other relevant diagnostic codes that would warrant a separate or higher rating. Diagnostic Code 5257 applies to recurrent subluxation or lateral instability. Although joint stability testing done at the Veteran's 2013, 2016, and 2019 VA examinations were normal, the November 16, 2019 VA examiner indicated that the Veteran has a history of slight recurrent subluxation and lateral instability. A review of the Veteran's medical records do not otherwise note a diagnosis or complaint of right knee subluxation or lateral instability, although private treatment records from 2014 and 2016 discuss left knee instability. The Board notes that the Veteran has generally reported knee instability throughout the period on appeal without specific discussion of his right knee. Giving him the benefit of the doubt, the Board finds that based on the November 16, 2019 VA examination report, a 10 percent rating is warranted as of that date. The Board has considered all of the evidence but finds that the record does not support that the Veteran's right knee subluxation or instability more closely approximates moderate severity such that a higher rating would be warranted or that a rating is warranted prior to November 16, 2019. Finally, the Board has considered whether higher or separate ratings are warranted under any other applicable diagnostic codes; however, there is no evidence of ankylosis, dislocated semilunar cartilage, removed semilunar cartilage, tibia/fibula impairment, or genu recurvatum in the right knee. Therefore, higher or separate ratings are not warranted under DCs 5256, 5258, 5259, 5262, and 5263, respectively. Left Knee Disability The Veteran contends that he is entitled to a higher rating for his left knee disability. The Board acknowledges the Veteran's contentions and complaints expressed on VA examinations and in statements submitted to the VA. The Veteran is currently assigned a 10 percent rating for his left knee disability prior to March 9, 2016 and a 20 percent rating thereafter under Diagnostic Code 5010-5260. The Board finds that a preponderance of the evidence is against finding that a rating in excess of 10 percent prior to March 9, 2016 and a rating in excess of 20 percent thereafter is warranted for limitation of flexion. On VA examination in July 2016, range of motion testing showed the Veteran to have flexion to 40 degrees. Range of motion testing conducted on VA examination in November 2019 showed left knee flexion to 60 degrees. Both examination reports indicate that with repeated use over time or during a flare-up, the Veteran's flexion would be limited to 30 degrees. Under Diagnostic Code 5260, flexion limited to 30 degrees warrants a 20 percent rating, which is the rating the Veteran has been assigned effective March 9, 2016. A higher, 30 percent rating, requires flexion be limited to 15 degrees. A review of the record does not reflect any range of motion testing or other evidence supporting that the Veteran's left knee flexion has been limited to 15 degrees or less. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to pain, weakened movement, excess fatigability, incoordination, 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 15 degrees as of March 9, 2016. Therefore, the Board finds that a preponderance of the evidence is against a rating in excess of 20 percent as of March 9, 2016 for limitation of flexion. The Board further finds that a rating in excess of 10 percent is not warranted prior to March 9, 2016. The July 2016 VA examination is the earliest range of motion testing supporting left knee flexion limited to 30 degrees. The prior VA examination, in July 2013, tested left knee flexion to 90 degrees with pain beginning at 80 degrees and no additional loss after repetitive use testing. A review of the record does not reflect any range of motion testing or other evidence supporting that the Veteran's left knee flexion was limited to 30 degrees or less prior to March 9, 2016. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to pain, weakened movement, excess fatigability, incoordination, 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 prior to March 9, 2016. Therefore, the Board finds that a preponderance of the evidence is against a rating in excess of 10 percent prior to March 9, 2016 for limitation of flexion. The Board has further considered whether there are other relevant diagnostic codes that would warrant a separate or higher rating. The Board finds that Diagnostic Code 5261 for limitation of extension is applicable. VA examinations in July 2013, August 2016, and November 2019 each indicated that the Veteran had normal left knee extension. However, an August 2020 addendum clarifying the November 2019 VA examination report stated that the Veteran's extension was limited to 10 degrees after considering flare-ups and repeated motion. Therefore, the Board finds that, as of November 16, 2019, a rating of 10 percent, but no higher, for limitation of extension under DC 5261 is warranted for the Veteran's left knee disability. The Board finds that the November 16, 2019 VA examination is the earliest date on which left knee limitation of extension is supported. The Board has also considered whether a separate rating under Diagnostic Code 5257 for recurrent subluxation or lateral instability is warranted. Here, although joint stability testing done at the Veteran's 2013, 2016, and 2019 VA examinations were normal, he has consistently reported knee instability throughout the period on appeal. His July 2019 VA examination notes a history of slight recurrent subluxation and lateral instability. Private treatment records from 2014 and 2016 further indicate that the Veteran has left knee instability. Therefore, giving the Veteran the benefit of the doubt, the Board finds that a rating under Diagnostic Code 5257 is warranted. Specifically, the Board finds that a 10 percent rating for slight recurrent subluxation or lateral instability is warranted. The Board has considered all of the evidence but finds that the record does not support that the Veteran's instability more closely approximates moderate instability such that a higher rating would be warranted. The Board finds no other applicable diagnostic codes. The Board specifically notes that there is no evidence of ankylosis, dislocated semilunar cartilage, removed semilunar cartilage, tibia/fibula impairment, or genu recurvatum in the left knee. Therefore, higher or separate ratings are not warranted under DCs 5256, 5258, 5259, 5262, and 5263, respectively. In conclusion, the Board finds that a rating in excess of 10 percent prior to March 9, 2016 and in excess of 20 percent from March 9, 2016 to November 16, 2019 for degenerative arthritis of the left knee under DC 5010-5260 is not warranted. However, the Board finds that, as of November 16, 2019, a rating of 10 percent, but no higher, for limitation of extension under DC 5261 is warranted. In addition, the Board finds that a rating of 10 percent, but no higher, for instability under DC 5257 is warranted for the entire period on appeal. Right Knee Scar With regard to the Veteran's right knee scar, it is evaluated pursuant to 38 C.F.R. § 4.118, DC 7899-7801. Scars are rated under 38 C.F.R. § 4.118, DCs 7800 through 7805. Here, the July 2013 VA examiner noted that the Veteran had a right knee scar that he described as painful. The August 2016 and November 2019 VA examiners noted that the Veteran's right knee scar was 12 centimeters by 0.5 centimeters. Although the August 2016 VA examiner noted that the Veteran's scar was not painful or unstable, the November 2019 VA examiner indicated that the scar was painful or unstable. DC 7804 provides that one or two scars that are unstable or painful warrant a 10 percent evaluation. 38 C.F.R. § 4.118. An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Id. at Note (1). If one or more scars are both unstable and painful, the rater is to add 10 percent to the evaluation that is based on the total number of unstable or painful scars. Id. at Note (2). Scars evaluated under DCs 7800, 7801, 7802, or 7805 may also receive an evaluation under DC 7804, when applicable. Id. at Note (3). In this case, the July 2013 and November 2019 VA examiners noted that the Veteran's right knee scar was painful or unstable. Consequently, DC 7804 is applicable, and a rating of 10 percent is warranted for the scar. The Board finds that no other diagnostic codes are applicable. Disfigurement of the head, face, or neck is rated pursuant to DC 7800. As the Veteran's right knee scar does not affect his head, face, or neck, DC 7800 is inapplicable. DC 7801 pertains to burn scars or scars due to other causes, not of the head, face, or neck that are deep and nonlinear. 38 C.F.R. § 4.118. In this case, the VA examiners indicated that the Veteran's right knee scar is not deep and nonlinear. Consequently, a compensable rating under DC 7801 is not warranted for the scar. DC 7802 pertains to burn scars or scars due to other causes not of the head, face, or neck that are superficial and nonlinear. 38 C.F.R. § 4.118. As the Veteran's scar is not nonlinear, DC 7802 does not apply. DC 7805 provides that other scars (including linear scars) and other effects of scars evaluated under DCs 7800, 7801, 7802, and 7804 require the evaluation of any disabling effect(s) not considered in a rating provided under DCs 7800-7804 under an appropriate diagnostic code. 38 C.F.R. § 4.118. Here, the record does not reflect that the Veteran's surgical scar is manifested by any disabling effects. None of the evidence of record supports a consideration of a compensable rating under DC 7805, to include the Veteran's own contentions. Therefore, the Board finds that a rating of 10 percent under DC 7804 for the Veteran's right knee scar is warranted. Amanda Christensen Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Brennae L. Brooks, 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.