Citation Nr: 21027874 Decision Date: 05/07/21 Archive Date: 05/07/21 DOCKET NO. 14-18 893 DATE: May 7, 2021 ORDER Entitlement to a rating in excess of 10 percent prior to May 21, 2019, and in excess of 20 percent thereafter for status post displaced fracture of the left medial malleolus and nondisplaced fracture of the left distal fibula (left ankle condition) is denied. Entitlement to a rating in excess of 10 percent for complex tear of the posterior horn of the lateral meniscus and horizontal tear of the body in the posterior horn of the medial meniscus, right knee (right knee condition) is denied. Entitlement to a rating in excess of 10 percent for status post operative left knee meniscal tear of posterior horn, lateral meniscus (previously rated as meniscal tear of the posterior horn of the lateral meniscus, left knee) is denied. FINDINGS OF FACT 1. Prior to May 21, 2019, the Veteran's left ankle condition was not manifested by marked limitation of motion. 2. From May 21, 2019, the Veteran's left ankle condition is not manifested by ankylosis, and is properly rated at the highest schedular rating available for his orthopedic symptomatology. 3. The Veteran's right knee condition is not manifested by flexion limited to 30 degrees, extension limited to 15 degrees, subluxation or instability, or locking and effusion. 4. The Veteran's left knee condition is not manifested by flexion limited to 30 degrees, extension limited to 15 degrees, subluxation or instability, or locking and effusion. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent prior to May 21, 2019, and in excess of 20 percent thereafter for left ankle condition have not been met. 38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. §§ 4.1, 4.7, 4.71a, Diagnostic Code 5271 (2019) 2. The criteria for a rating in excess of 10 percent for right knee condition have not been met. 38 U.S.C. §§ 1155, 5107 (b); 38 C.F.R. §§ 4.1, 4.7, 4.71a, Diagnostic Code 5299-5259 (2019). 3. The criteria for a rating in excess of 10 percent for left knee condition have not been met. 38 U.S.C. §§ 1155, 5107 (b); 38 C.F.R. §§ 4.1, 4.7, 4.71a, Diagnostic Code 5259 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1978 to March 2005. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The Veteran testified at a Travel Board hearing before the undersigned Veterans Law Judge in May 2017. A transcript of the hearing is of record. The Board remanded this matter in February 2018 and November 2019. The Board finds there has been substantial compliance with its November 2019 remand directives. See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (holding that there was no Stegall (Stegall v. West, 11 Vet. App. 268 (1998)) violation when the examiner made the ultimate determination required by the Board's remand.) Increased Rating Disability ratings are determined by applying the criteria set forth in the VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity resulting from disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The Board has been directed to consider only those factors contained wholly in the rating criteria. Massey v. Brown, 7 Vet. App. 204 (1994). However, the Board has been advised to consider factors outside the specific rating criteria in determining the level of occupational and social impairment. Mauerhan v. Principi, 16 Vet. App. 436 (2002). If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for the higher evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. A Veteran's entire history is to be considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The United States Court of Appeals for Veterans Claims in Correia v. McDonald, 28 Vet. App. 158 (2016), held that the final sentence of 38 C.F.R. § 4.59 (2019) requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and non-weightbearing. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that in addressing the nature of any flare-ups examiners must address the frequency, duration, characteristics, severity, and functional loss due to the flare-up. 1. Entitlement to a rating in excess of 10 percent prior to May 21, 2019, and in excess of 20 percent thereafter for status post displaced fracture of the left medial malleolus and nondisplaced fracture of the left distal fibula (left ankle condition) The Veteran asserts that his left ankle condition is more disabling than 10 percent prior to May 21, 2019, and more disabling than 20 percent thereafter. The Veteran's left ankle condition is currently rated at 10 percent prior to May 21, 2019, and as 20 percent disabling thereafter, under Diagnostic Code 5271. Under Diagnostic Code 5271, limitation of motion of the ankle is rated as either moderate, warranting a 10 percent rating, or marked, warranting a 20 percent rating. 38 C.F.R. § 4.71a. Higher ratings for the ankle are warranted only when the ankle is ankylosed. 38 C.F.R. § 4.71a, Diagnostic Code 5270. Ankylosis of the ankle in plantar flexion between 30 and 40 degrees, or in dorsiflexion between zero and 10 degrees, warrants a 30 percent rating. Ankylosis of the ankle in plantar flexion at more than 40 degrees, in dorsiflexion at more than 10 degrees, or with abduction, adduction, inversion, or eversion deformity warrants a 40 percent rating. The words "moderate" and "marked," as used in the various diagnostic codes applicable to the appeal period prior to February 7, 2021, are not defined in the VA Schedule for Rating Disabilities. The use of these terms by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. 38 C.F.R. §§ 4.2, 4.6. 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. As of February 7, 2021, changes have been implemented to the musculoskeletal rating criteria. The Board notes the only changes to any of the codes relevant to rating ankle disabilities were made to Diagnostic Code 5271. The changes clarify that "moderate" limited motion of the ankle is less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion, and that "marked" limited motion of the ankle is less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion. The Board will apply the new criteria for the period beginning February 7, 2021, if the new criteria are more beneficial to the Veteran than the prior version of the regulation. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003) (regulations may not have retroactive effect unless their language specifies so). Pursuant to VA regulations, normal range of motion for ankle dorsiflexion is 0 to 20 degrees and for plantar flexion is 0 to 45 degrees. See 38 C.F.R. § 4.71a, Plate II. The Board must also consider whether the Veteran is entitled to separate or higher disability ratings under other Diagnostic Codes that relate to the ankle. See 38 C.F.R. 4.71a, Diagnostic Codes 5270 through 5274. In a December 2011 VA examination, the Veteran reported intermittent sharp pains while walking. He described this pain as severe. He said he wore a brace if he was going to be standing for long periods of time. The Veteran reported flare ups and said he had no ability to do any sort of exercise. He felt that the quality of his life was minimal. He played golf his entire life, but in the last 18 months he had not been able to play because of his left ankle and knees. When he walked and the sharp pain came on it would stop him in his tracks and he would have to "get [his] composure back before starting up again." Upon examination, range of motion plantar flexion to 35 degrees with evidence of painful motion to 35 degrees and dorsiflexion to 20 degrees with evidence of painful motion to 20 degrees. There was no evidence of additional loss of range of motion with repetitive use testing. The examiner noted functional loss described as less movement than normal and pain on movement. There was pain on palpation. There was no evidence of ankylosis. Residuals of left ankle surgery performed in 1986 was described as intermediate degrees of residual weakness, pain and/or limitation of motion. In a February 2014 VA examination, the Veteran was mainly examined for his right ankle. Nonetheless, there are some findings pertinent to the left ankle that the Board will discuss. Upon examination, range of motion was plantar flexion to 40 degrees with no evidence of painful motion and plantar dorsiflexion to 20 degrees with no evidence of painful motion. There was no evidence of additional limitation in range of motion following repetitive use testing. Functional loss was described as less movement than normal. The examiner added that medical records supported the Veteran with similar diagnosis and radiographic findings would have a normal range of motion. Decreased range of motion in the left ankle was most likely due to decondition although suboptimal effort could not be entirely ruled out. There was no evidence of localized tenderness or pain on palpation. There was also no evidence of ankylosis. The examiner found that there was some guarding of movement. In the May 2014 VA Form 9, the Veteran stated that his condition was worse and that there was "not a night that goes by" that his ankles, knees, or hips did not wake him up from pain. At the May 2017 Board hearing, the Veteran testified that he used to be able to ride a bicycle but that he was never going to be able to have the same type of movement. He said his ankles swelled when he walked so therefore he did not walk that much. He stated that his ankles were affecting his knees. In a May 2019 VA examination, the Veteran reported flare ups during excessive activity, walking, and almost any exercise. The Veteran also reported functional loss exhibited by activity limitations. Upon examination, range of motion was dorsiflexion to 5 degrees and plantar flexion to 10 degrees. Range of motion itself did not contribute to functional loss. Pain was noted on exam on rest/non-movement. There was no evidence of localized tenderness or pain on palpation. There was also no evidence of pain with weight bearing or crepitus. There was no evidence of additional loss of function or range of motion following repetitive use testing. The Veteran was examined immediately after repetitive use over time. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over a period of time. The examination was not conducted during a flare up and the examiner determined that the examination was medically consistent with the Veteran's statements describing functional loss during flare up. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability with flare ups. The examiner noted interference with standing. There was no evidence of muscle atrophy or ankylosis. There was no evidence of ankle instability or dislocation suspected. The examiner noted shin splints, but it did not affect range of motion of the ankle or knee, and there were no current symptoms. The Veteran used a cane occasionally. The Veteran said that he was unable to walk more than 2 blocks without pain and unable to walk, run, or stand for more than 30 minutes without pain. There was no evidence of pain on passive range of motion testing or non-weight bearing testing. Range of motion showed dorsiflexion to 5 degrees and plantar flexion to 10 degrees. In a January 2021 VA examination, the Veteran reported flare ups and said they occurred occasionally and were moderate lasting seconds to minutes. Flare ups were precipitated by walking, stairs, and bike riding and were alleviated by heating pad, Icy Hot, and an ice pack. The Veteran did not report any functional loss. Range of motion was normal. Pain was noted on exam at dorsiflexion but did not result in/cause functional loss. There was evidence of localized tenderness or pain on palpation. There was no evidence of pain with weight bearing or crepitus. There was no evidence of additional loss of function or range of motion after repetitive use testing. The Veteran was not examined immediately after repetitive use over time and the examiner determined that the examination was neither medically consistent or inconsistent with the Veteran's statements describing functional loss with repetitive use over time. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over a period of time. The Veteran was not examined during a flare up and the examiner determined that the examination was neither medically consistent or inconsistent with the Veteran's statements describing functional loss with flare up. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability with flare up. There was no evidence of muscle atrophy or ankylosis. There was also no evidence of ankle instability or dislocation. The Veteran wore an ankle brace that he bought, but was not issued, for stability. There was no evidence of pain on passive range of motion testing or non-weight bearing testing. Additional post-service treatment records are silent for any evidence warranting an increased rating for the Veteran's left ankle condition prior to May 21, 2019, and thereafter. Overall, the Board finds that the evidence of record does not show symptomatology warranting a rating in excess of 10 percent prior to May 21, 2019, and in excess of 20 percent thereafter. Prior to May 21, 2019, the evidence of record indicated that the Veteran had no worse than dorsiflexion to 20 degrees and plantar flexion to 35 degrees. As noted above, a 20 percent rating contemplates marked limitation of motion. The Veteran's range of motion testing and complaints of pain would suggest that the Veteran had no more than moderate limitation of motion. Specifically, the range of motion testing came out close to normal upon examination. Further, from May 21, 2019, the evidence of record indicated that the Veteran had dorsiflexion to, at worse, 5 degrees, and plantar flexion to, at worse, 10 degrees. The Veteran receives a 20 percent disability rating from May 21, 2019. This is the highest disability rating under Diagnostic Code 5271 for limited motion of ankle. As no ankylosis was noted on any examination, the Board need not analyze the disability under Diagnostic Code 5270, ankylosis of the ankle. Additionally, as there is no evidence of record for ankylosis of the subastragalar or tarsal joint, or malunion of the os calcis or astragalus, or astragalectomy, no further analysis is required for those diagnostic codes (Diagnostic Codes 5272-5274). Finally, the Board notes that at the January 2021 VA examination, the Veteran was shown to have normal range of motion, suggesting full improvement in the Veteran's left ankle condition. Finally, the Board notes the change in the rating criteria effective February 7, 2021, does not render a more beneficial outcome, as the Veteran did not have range of motion findings to suggest anything higher than moderate limited motion prior to May 21, 2019, and from May 21, 2019, the Veteran is assigned the maximum rating under Diagnostic Code 5271, for marked limited motion of the ankle, demonstrated by 5 degrees of dorsiflexion at the May 2019 examination. The Court has held that diagnostic codes predicated on limitation of motion require consideration of a higher rating based on functional loss due to pain on use or due to flare-ups. 38 C.F.R. §§ 4.40, 4.45, 4.59; Johnson v. Brown, 9 Vet. App. 7 (1997); and DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). However, the Veteran's left ankle condition has been assigned the appropriate rating for his symptoms. The evidence shows that the Veteran had close to normal range of motion prior to May 21, 2019, and although there were reports of flare ups and functional loss, overall, the amount of loss in activity involved does not rise to a higher rating. The Veteran reported at times that he still exercised. From May 21, 2019, when the maximum rating for limitation of motion of a joint has already been assigned, a finding of pain on motion cannot result in a higher rating. Johnson v. Brown, 9 Vet. App. 7 (1997). Accordingly, because the Veteran has been assigned the maximum compensable rating for his orthopedic symptoms from May 21, 2019, he cannot be assigned any additional ratings under sections 4.40, 4.45, or 4.59 for any additional functional loss associated with pain on use or due to flare-ups. In sum, from October 24, 2014, the Board finds that the Veteran has received the highest allowable rating under the schedular criteria for his orthopedic symptoms, and an increase is denied. The Board notes that as a lay person, the Veteran is considered to be competent to report what comes to him through his senses, such as experiencing limited motion of his back. Layno, 6 Vet. App. 465. However, to the extent that he was asserting decreased range of motion in his left ankle, his lay description does not adequately rebut the medical evidence, including more recent testing, as discussed above. The Board places more probative value on the objective evidence of record, which is measured in degrees, rather than on his subjective complaints which are less precise. Therefore, the objective evidence does not establish the Veteran met the criteria associated with higher ratings. In conclusion, the Board finds a rating in excess of 10 percent is not warranted for the Veteran's left ankle condition prior to May 21, 2019, and a 20 percent evaluation thereafter. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (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). 2. Entitlement to a rating in excess of 10 percent for complex tear of the posterior horn of the lateral meniscus and horizontal tear of the body in the posterior horn of the medial meniscus, right knee (right knee condition) and entitlement to a rating in excess of 10 percent for status post operative left knee meniscal tear of posterior horn, lateral meniscus (previously rated as meniscal tear of the posterior horn of the lateral meniscus, left knee) (left knee condition) The Veteran asserts that his right and left knee conditions are more severe than 10 percent disabling. The Veteran's right knee is currently assigned a 10 percent rating under Diagnostic Code 5299-5259. The Veteran's left knee is currently assigned a 10 percent rating under Diagnostic Code 5259. Diagnostic Code provides for a single 10 percent rating for symptomatic removal of semilunar cartilage. As stated above, the criteria for rating disabilities of the musculoskeletal system in the VA Schedule for Rating Disabilities was revised effective February 7, 2021. The February 7, 2021 amendments did not result in changes to Diagnostic Codes 5256, 5258, 5259, 5260, 5261, or 5263. However, significant changes were made to Diagnostic Code 5257, as detailed below. Accordingly, there are essentially two sets of criteria, the earlier criteria and the current criteria, applicable to the evaluation of the Veteran's knee conditions. Prior to the February 7, 2021 amendments, Diagnostic Code 5257 provided ratings of 10, 20, and 30 percent for recurrent subluxation or lateral instability of the knee which is slight, moderate, or severe, respectively. 38 C.F.R. § 4.71a. Effective February 7, 2021, Diagnostic Code 5257 provides separate criteria for ratings based on recurrent subluxation or lateral instability and patellar instability. For recurrent subluxation or lateral instability, 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. A 20 percent rating is warranted for either (a) a sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribed either a brace and/or assistive device; 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. A 30 percent rating is warranted for unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device and bracing for ambulation. For patellar instability, a 10 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent 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 a diagnosed condition involving the patellofemoral complex with recurrent 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 a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. Diagnostic Code 5258 provides a single 20 percent rating for dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint. Although a recent VA examination documented a history of a meniscal tear with surgical treatment, the record reflects no complaints of knee locking and no findings of effusion into the knee joint. Therefore, a rating under Diagnostic Code 5258 is not warranted. In a July 2010 MRI, the Veteran's right knee showed complex tear, posterior horn medial meniscus, and tiny Baker's cyst. The Veteran's left knee showed oblique tear, posterior horn medial meniscus, oblique tear, posterior horn lateral meniscus, appearing to extend partially into the anterior horn suggestive of bucket handle injury, otherwise normal left knee MRI. In a June 2011 VA examination, the Veteran was seen for his left knee. The Veteran reported that since his meniscus repair surgery, his condition had improved. The Veteran said that pain was moderate and described stiffness. There was no swelling; however, the Veteran also reported weakness and instability. Flare ups were described as increased pain when climbing stairs. Upon examination, range of motion was flexion to 130 degrees and extension to 0 degrees. Range of motion was limited by recent surgery and fear of injury. Medial and lateral collateral ligament were stable. Anterior and posterior cruciate ligament were stable. There was no evidence of knee instability. There was no evidence of swelling or joint line tenderness. There was also no evidence of deformity, malalignment, drainage, tenderness, edema, redness, heat, spasms, painful motion, abnormal movement, guarding of movement, fatigue, lack of endurance, weakness, atrophy, incoordination, instability, or pertinent abnormal weight bearing. There was no loss of function with repetitive use. Loss of function due to flare ups could not be determined without resorting to mere speculation. In a December 2011 VA examination, the Veteran described his left knee pain as constant and worse at night. The Veteran described his right knee pain as sharp and intermittent, aggravated by walking or climbing stairs. For both knees, the Veteran said twice a week his knees would temporarily "lock up" and he would have to stop and move it around to resume walking. He reported swelling later in the afternoon 4 times per week and treated this with ice and elevation. He took anti-inflammatories for his pain, which he said was helpful "at times." The Veteran reported flare ups and said that he was walking up the stairs he felt his legs would lock up at times and prevent him from continuing to walk up the stairs. He said that his quality of life was significantly less than it was because he could not do things. If he had to sit for long periods of time he would have to get up and stretch frequently to avoid his knees hurting. Upon examination, range of motion was the following: right knee flexion to 120 degrees with no evidence of painful motion and extension to 0 degrees with no evidence of painful motion; left knee flexion to 115 degrees with evidence of painful motion to 115 degrees and extension to 0 degrees with no evidence of painful motion. There was no additional limitation in range of motion following repetitive use testing. Functional loss was described as less movement than normal in both knees and pain on movement in the left knee. There was evidence of tenderness or pain to palpation in both knees. There was no evidence or history of recurrent patellar subluxation/dislocation. The Veteran did not have shin splints, stress fractures, chronic exertional compartment syndrome, or any other tibial and/or fibular impairment. The Veteran had a meniscus condition in both knees described as meniscal tear, frequent episodes of joint "locking," and frequent episodes of joint pain. The Veteran had not had a meniscectomy. The Veteran said that he used a single prong cane for ambulating long distances and for walking up stairs. In a January 2013 VA treatment record, the Veteran reported knee pain on the left. In an April 2014 VA treatment record, the Veteran reported having a lot of pain in his joints at night, mostly the left hip and right knee. Pain was in the right knee with going up stairs; it did not swell. In the May 2014 VA Form 9, the Veteran stated that his condition was worse and that there was "not a night that goes by" that his ankles, knees, or hips did not wake him up from pain. In a February 2015 VA treatment record, left knee pain was noted and described as sharp with movement. The pain would wake him up and his knee hurt when stepping down. In an April 2016 VA treatment record, the Veteran reported having some pain in his right knee. In a January 2017 VA treatment record, the Veteran reported pain in his left knee that he noted at night; when he changed position the pain would resolve. He rode a stationary bike for 30 to 60 minutes. At the May 2017 Board hearing, the Veteran testified that his ankles were affecting his knees and at night they seemed to lock up and there was significant pain. The doctors said he should go back eventually for a right knee replacement. Prior to his knee surgery, the Veteran said that he had fallen down climbing the stairs because his knees would lock up. He reported instability in his knees and that sometimes when going up stairs, his knees would stiffen. He said that he would rather stand than sit at work. In a May 2017 VA treatment record, the Veteran reported pain in his hips and knees at night. The pain would wake him up nightly for several months. In a May 2019 VA examination, the Veteran reported pain, weakness, swollen joints, and an inability to maintain consistent exercise/activity without pain. He treated with ice after activity when needed and pain medicine. The Veteran said he had fallen when climbing stairs at work. He reported flare ups with any activity that should be expected as normal and described increased pain, swelling, and discomfort. He also reported functional loss as inability to perform normal everyday activities as should be expected without discomfort/pain. Upon examination, range of motion was the following: right knee flexion to 120 degrees and extension to 0 degrees; left knee flexion to 120 degrees and extension to 0 degrees. For both knees, range of motion itself contributed to functional loss because the Veteran was unable to walk more than 2 blocks before pain became severe. Pain was noted on exam on rest/non-movement. There was no evidence of localized tenderness or pain on palpation and no evidence of crepitus. There was no evidence of additional loss of function or range of motion after repetitive use testing. The Veteran was examined immediately after repetitive use testing over time. Pain significantly limited functional ability with repeated use over a period of time. Range of motion was flexion to 120 degrees and extension to 0 degrees. The Veteran was not examined during a flare up and the examiner determined that the examination was medically consistent with the Veteran's statements describing functional loss during flare up. Pain significantly limited functional ability with flare ups. Range of motion was flexion to 120 degrees and extension to 0 degrees. The examiner noted disturbance of locomotion. There was no evidence of muscle atrophy or ankylosis. There was no history of recurrent subluxation or effusion. Shin splints were noted but did not affect range of motion of the knee or ankle and there were no current symptoms. Meniscus condition in both knees was also noted and described as meniscal tear. The Veteran used a cane occasionally. There was no evidence of pain on passive range of motion testing or non-weight bearing testing. Range of motion was flexion to 120 degrees and extension to 0 degrees. In a January 2021 VA examination, the Veteran reported flare ups of the right knee that occurred frequently that were moderate to severe and lasted a few minutes. These flare ups were precipitated by walking, riding, kneeling, and stairs. The flare ups were alleviated by heating pad, Icy Hot, ice pack, and wearing a brace. Left knee flare ups occurred less often and were moderate and lasted seconds to minutes. The flare ups were precipitated by walking, kneeling, exercise, and stair climbing. The flare ups were alleviated by heating pad, Icy Hot, ice pack, and wearing a brace. There was no functional loss reported. Upon examination, range of motion for both knees was normal. Pain was noted on exam at flexion and extension but did not result in/cause functional loss. There was evidence of localized tenderness or pain on palpation. There was no evidence of pain with weight bearing or crepitus. There was no evidence of additional loss of function or range of motion with repetitive use testing. The Veteran was not examined immediately after repetitive use over time and the examiner determined that the examination was neither medically consistent or inconsistent with the Veteran's statements describing functional loss with repetitive use over time. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability with repeated use over a period of time. The Veteran was not examined during a flare up and the examiner determined that the examination was neither medically consistent or inconsistent with the Veteran's statements describing functional loss during flare ups. Pain, weakness, fatigability, or incoordination did not significantly limit functional ability with flare ups. There was no evidence of muscle atrophy or ankylosis. There was no history of recurrent subluxation, lateral instability, or recurrent effusion. There was no evidence of joint instability. A meniscus condition in both knees were noted, described as meniscal tear in the right knee and meniscal tear and meniscal tear repair in the left knee. There was no evidence of pain on passive range of motion testing or non-weight bearing testing. Additional post-service treatment records are silent for any evidence warranting an increased rating for the Veteran's right and left knee conditions. Overall, the Board finds that the evidence of record does not show symptomatology warranting a rating in excess of 10 percent. Initially, the Board notes that, as stated above, Diagnostic Code 5259 has a single 10 percent maximum rating. Looking to other evidence to determine if the Veteran would warrant a higher rating under a different Diagnostic Code, the Board finds that the Veteran had, at worse, flexion to 120 degrees for the right knee and 115 degrees for the left knee. Extension was found to be normal. Moreover, at the January 2021 VA examination, range of motion for the Veteran's right and left knee was found to be normal. This would suggest an improvement in the Veteran's bilateral knee condition. As noted above, a 20 percent rating contemplates flexion limited to 30 degrees. There is no indication that the right or left knee had flexion limited to 30 degrees. A higher additional rating is also not available for limitation of extension as testing revealed full extension for both knees and there is no evidence that the Veteran's symptoms manifested in functional impairment comparable to extension limited to 15 degrees. The Board notes that as a lay person, the Veteran is considered to be competent to report what comes to him through his senses, such as experiencing limited motion of his knees. Layno, 6 Vet. App. 465. However, to the extent that he was asserting decreased range of motion in his right and left knees, his lay description does not adequately rebut the medical evidence, including more recent testing, as discussed above. The Board places more probative value on the objective evidence of record, which is measured in degrees, rather than on his subjective complaints which are less precise. Therefore, the objective evidence does not establish the Veteran met the criteria associated with a higher 20 percent rating based on limitation of motion in the right and left knees. The Board has also considered the Court's holdings in Mitchell, 25 Vet. App. 32, DeLuca, 8 Vet. App. 202, and Sharp, 29 Vet. App. 26 with regard to functional impact. However, the examination reports and clinical findings with regard to such factors do not reflect that his symptoms rise to the level to warrant a higher rating. Additionally, the Board finds that a separate compensable rating is not warranted under either the current or former versions of Diagnostic Code 5257, for recurrent subluxation or lateral instability, or patellar instability, for the entire period on appeal. There is no evidence of a sprain, incomplete ligament tear, or complete ligament tear causing persistent instability, or a diagnosed condition involving the patellofemoral complex with recurrent instability, as is required for a compensable rating under the current version of Diagnostic Code 5257 (effective February 7, 2021). Furthermore, the Board notes that joint stability testing appeared to have been normal in both knees, and there was no instability found or recurrent subluxation or effusion. Despite the Veteran using a cane, there is no evidence this was prescribed. For these reasons, the Board finds that a separate compensable rating is not warranted under either the current or former versions of Diagnostic Code 5257, for recurrent subluxation or lateral instability, or patellar instability, for the entire period on appeal. Finally, the Board considered all potentially applicable provisions of 38 C.F.R. Parts 3 and 4, irrespective of whether they have been raised by him, his representative, or otherwise by the record, as required by Schafrath v. Derwinski, 1 Vet. App. 589 (1991). However, there is no evidence of any left or right knee ankylosis, meniscus dislocation or removal, impairment of the tibia and fibula, or genu recurvatum to support higher or separate ratings under Diagnostic Codes 5256, 5257, 5258, 5259, 5262, or 5263. To the extent that the record reflects symptoms of painful motion, stiffness, and difficulty with walking, standing, or squatting and related activities, such symptoms are contemplated by the ratings assigned herein for the right and left knees under Diagnostic Code 5259. In conclusion, the Board finds a rating in excess of 10 percent is not warranted for the Veteran's right and left knee conditions. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette, 28 Vet. App. at 69-70. Total Disability Based on Individual Unemployability (TDIU) Entitlement to total disability rating based upon individual unemployability (TDIU) is an element of all increased rating claims. See Rice v. Shinseki, 22 Vet. App. 447 (2009); Roberson v. Principi, 251 F.3d 1378 (Fed. Cir. 2001). Where a veteran (1) submits evidence of a medical disability; (2) makes a claim for the highest rating possible; and (3) submits evidence of unemployability, the requirements in 38 C.F.R. § 3.155 (a) that an informal claim "identify the benefit sought" has been satisfied and VA must consider whether the veteran is entitled to TDIU. Id. A TDIU claim is not raised unless the Roberson requirements are met. Jackson v. Shinseki, 587 F. 3d 1106 (Fed. Cir. 2009). The Veteran has not submitted evidence of unemployability and has never raised a claim for TDIU. He has thus not raised the question of entitlement to a TDIU and the Board need not consider such a claim. MICHAEL MARTIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Saudiee Brown 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.