Citation Nr: 21028430 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 16-01 734 DATE: May 11, 2021 ORDER Service connection for tuberculosis is denied. Service connection for fibromyalgia is denied. Service connection for erectile dysfunction is denied. A disability rating in excess of 10 percent for left knee osteoarthritis with degenerative joint disease and patellofemoral pain syndrome (left knee disability) is denied. A disability rating in excess of 10 percent for right knee osteoarthritis with degenerative joint disease and patellofemoral pain syndrome (right knee disability) is denied. A disability rating in excess of 10 percent for osteoarthritis of the left ankle with Achilles tendon tear (left ankle disability) is denied. A disability rating in excess of 10 percent for osteoarthritis of the right ankle with Achilles tendon tear (right ankle disability) is denied. FINDINGS OF FACT 1. The preponderance of the evidence of record is against finding that the Veteran has had active nor inactive tuberculosis at any time during or approximate to the pendency of the claim. 2. The preponderance of the evidence of record is against finding that the Veteran has had fibromyalgia at any time during or approximate to the pendency of the claim. 3. None of the competent and credible evidence indicates that the Veteran's erectile dysfunction may be associated with service. 4. The Veteran's for left knee osteoarthritis with degenerative joint disease and patellofemoral pain syndrome has been manifested by flexion limited to, at worst, 120 degrees and pain and full extension to 0 degrees and no pain. 5. The Veteran's for right knee osteoarthritis with degenerative joint disease and patellofemoral pain syndrome has been manifested by flexion limited to, at worst, 130 degrees and pain and full extension to 0 degrees and no pain. 6. The Veteran's osteoarthritis of the left ankle disability has not been productive of marked limited motion of the ankle. 7. The Veteran's osteoarthritis of the right ankle disability has not been productive of marked limited motion of the ankle. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for tuberculosis are not met. 38 U.S.C. § 1110, 1131, 5107; 38 C.F.R. § 3.303, 3.307, 3.309. 2. The criteria for service connection for fibromyalgia have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. 3. The criteria for service connection for erectile dysfunction have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303 (2020). 4. The criteria for an award of a disability rating in excess of 10 percent for left knee osteoarthritis with degenerative joint disease and patellofemoral pain syndrome have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5256-5263. 5. The criteria for an award of a disability rating in excess of 10 percent for right knee osteoarthritis with degenerative joint disease and patellofemoral pain syndrome have not been met or approximated. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5256- 5263. 6. The criteria for an award of a disability rating in excess of 10 percent for osteoarthritis of the left ankle with Achilles tendon tear have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5271. 7. The criteria for an award of disability rating in excess of 10 percent for osteoarthritis of the right ankle with Achilles tendon tear have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5271. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from September 1983 to September 2005. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions dated in September 2013 and August 2018. The Veteran canceled a Board hearing that had been scheduled in July 2017 and has not requested a new hearing date. In September 2018, the Board remanded the claims of entitlement to service connection for tuberculosis and increased ratings for the left and right knee disabilities. Subsequent to June 2020 supplemental statements of the case (SSOCs), additional VA and private treatment reports and additional VA examination reports were associated with the claims file. However, the medical records are cumulative of other evidence considered by the agency of original jurisdiction (AOJ) in the SSOCs and the VA examination reports are unrelated to the issues decided herein. Therefore, the Veteran is not prejudiced by the Board's adjudication of the issues on appeal. Service Connection Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). If a Veteran serves 90 days or more of active, continuous service after December 31, 1946, and manifests active tuberculosis to a degree of 10 percent or more during the three-year period following his separation from that service, service connection for the condition may be established on a presumptive basis, notwithstanding that there is no in-service record of the disorder. See 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. Service connection may also be established under 38 C.F.R. § 3.303(b) by (a) evidence of (i) a chronic disease shown as such in service (or within an applicable presumptive period under 38 C.F.R. § 3.307) and (ii) subsequent manifestations of the same chronic disease, or (b) if the fact of chronicity in service in not adequately supported, by evidence of continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). A layperson is generally incapable of opining on matters requiring medical knowledge. See 38 C.F.R. § 3.159(a)(2); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). However, lay evidence can be competent and sufficient to establish a diagnosis of a condition when: (1) a layperson is competent to identify the medical condition, (e.g., a broken leg, separated shoulder, pes planus (flat feet), varicose veins, tinnitus (ringing in the ears), etc.), (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). In essence, lay testimony is competent when it pertains to the readily observable features or symptoms of injury or illness and "may provide sufficient support for a claim of service connection." Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also 38 C.F.R. § 3.159(a)(2). A determination as to whether medical evidence is needed to demonstrate that a Veteran presently has the same condition he or she had in service or during a presumptive period, or whether lay evidence will suffice, depends on the nature of the Veteran's present condition (e.g., whether the Veteran's present condition is of a type that requires medical expertise to identify it as the same condition as that in service or during a presumption period, or whether it can be so identified by lay observation). See Barr v. Nicholson, 21 Vet. App. 303, 310 (2007). Thus, medical evidence is not always or categorically required when the determinative issue involves either medical diagnosis or etiology, but rather such issue may, depending on the facts of the particular case, be established by competent and credible lay evidence under 38 U.S.C. § 1154(a). See Davidson, supra. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. See also Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 1. Service connection for tuberculosis is denied. The Veteran seeks to establish service connection for tuberculosis. He asserts that he has tuberculosis that started during his active service. Service treatment records (STRs) show that the Veteran had a positive purified protein derivative (PPD) test in October 1996 and August 2003. The Veteran was treated with pyridoxine and underwent isoniazid prophylaxis (INH) therapy for six months beginning in November 1996. Clinical evaluation of the lungs and chest was normal at the Veteran's February 2005 separation examination. Chest X-rays performed at that time were reported to be unremarkable. Although a positive PPD test was documented in service, a positive PPD test result is a laboratory finding used to test for exposure to mycobacterium tuberculosis when exploring a possible diagnosis of tuberculosis. See Dorland's Illustrated Medical Dictionary 1498, 1962 (30th ed. 2003). It does not represent a clinical finding of tuberculosis. Additionally, the Veteran's post-service treatment records do not contain any medical evidence of a positive PPD test or any related complaints, treatment, or diagnosis of active TB. During a VA examination in July 2019, the examiner noted the Veteran's treatment with INH during service but stated that he does not currently have nor has he ever been diagnosed with active or latent TB. The examiner noted the PPD test and indicated that the Veteran has never been diagnosed with active tuberculosis. The Board finds that while the Veteran is competent to report his medical history and knowledge of his test results and treatment, as his reports are based on personal knowledge and confirmed by clinical findings, he is not competent to provide medical conclusions to complex medical questions, such as the presence of active TB, etiology of TB, or any residuals thereof. A diagnosis and an opinion of that nature require medical expertise, clinical testing, and knowledge outside the realm of common knowledge of a layperson. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Accordingly, the Board gives more probative weight to the July 2019 VA examination report. In summary, there is no competent medical evidence of record indicating that the Veteran had active or inactive tuberculosis diagnosed during active duty, within three years of separation from service, or at any time during the appeal period. Without a current disability, more than a mere laboratory finding or exposure to TB, the Veteran is not entitled to service connection. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013). While a diagnosis is not always necessary to establish a current disability, which may be demonstrated by evidence of functional impairment of earning capacity (Saunders v. Wilkie, 886 F.3d 1356 (2018)), the Veteran has not provided any such evidence. Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for tuberculosis is not warranted. 38 U.S.C. § 5107 (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Service connection for fibromyalgia is denied. The Veteran seeks to establish service connection for fibromyalgia. The Veteran's STRs do not reflect any complaints, findings, or treatment for fibromyalgia. Clinical evaluation of all relevant systems was normal at the Veteran's separation from service in February 2005. VA outpatient treatment reports and private treatment reports from various providers do not reflect any complaints of, treatment for, or a diagnosis of fibromyalgia. During a July 2019 VA examination, the examiner reviewed the Veteran's claims file and treatment reports, conducted a clinical evaluation, and determined that there was no diagnosis of fibromyalgia. The examiner noted that the Veteran denied widespread pain and indicated that his joint pain was limited to his knees, ankles, and back. The Veteran has not been treated for fibromyalgia and does not take any medication for fibromyalgia. At a VA Gulf War examination, the same examiner stated that no Gulf War opinion was rendered as there was no diagnosis of fibromyalgia to include undiagnosed illness. In the absence of proof of present disability there can be no successful claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). See also Degmetich v. Brown, 104 F.3d 1328 (1997) (also interpreting 38 U.S.C. § 1131 as requiring the existence of a present disability for VA compensation purposes). To be present as a current disability, there must be evidence of the condition at some time during the claim period. Gilpin v. West, 155 F. 3d 1353, 1356 (Fed. Cir. 1998); see also McClain, 21 Vet. App. at 321 (the Gilpin requirement that there be a current disability is satisfied when the disability is shown at the time of the claim or during the pendency of the claim, even though the disability subsequently resolves). The question for the Board is whether the Veteran has a current disability of fibromyalgia. After considering the evidence in its entirety, the Board finds that the preponderance of the evidence is against finding that the Veteran has or has had such disability at any time since filing his claim for service connection or prior thereto. Cf. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013) (Board erred in failing to address pre-claim evidence in assessing whether a current disability existed, for purposes of service connection, at the time the claim was filed or during its pendency); McClain, at 321. As noted above, fibromyalgia is not shown in the Veteran's STRs or in post service treatment records. Moreover, the Veteran denied that he was being treated for fibromyalgia at a July 2019 VA examination and a diagnosis was not rendered at that time. Similarly, the same examiner reported the Veteran did not meet the diagnostic criteria for fibromyalgia or an undiagnosed illness at a Gulf War examination. The examiner based her opinions on her examination of the Veteran and on her review of the Veteran's claims file, and her opinions constitute probative evidence. Moreover, there is no medical evidence to the contrary. Finally, the record reflects that the Veteran is already service connected for disabilities of the knees and ankles. Accordingly, a grant of service connection for fibromyalgia based on the same knee and ankle symptoms constitutes impermissible pyramiding. See 38 C.F.R. §§ 4.14; Esteban v. Brown, 6 Vet. App. 259, 261- 62 (1994). In short, the only evidence supporting current diagnoses of fibromyalgia is the Veteran's lay statements. These lay statements have evidentiary value inasmuch as the Veteran is competent to report observable symptomatology. Jandreau v. Nicholson, 492 F.3d 1372 (2007). However, the claimed disability is medically complex and requires specialized medical education, and knowledge of the interaction between multiple systems in the body. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). In short, the Board finds that the Veteran is not competent to self-diagnose this disability. Accordingly, the Board finds that the preponderance of the evidence is against the claim and entitlement to service connection for fibromyalgia is not warranted. 38 U.S.C. § 5107; Gilbert, 1 Vet. App. at 49. 3. Service connection for erectile dysfunction is denied. The Veteran seeks to establish service connection for erectile dysfunction. The Veteran's STRs are do not reflect any complaints, findings, or treatment for erectile dysfunction. Private treatment reports from Southside Urology reflect a diagnosis of erectile dysfunction. The Board finds that that none of the competent and probative evidence indicates that the disability may be associated with service, a service-connected disability or a claimed service-connected disability, or any medication he is taking for a service-connected disability or claimed service-connected disability. Therefore, remand for a VA medical examination/opinion is not necessary. 38 C.F.R. § 3.159(c); Waters v. Shinseki, 601 F.3d 1274, 1278 (2010); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Board has also considered the lay evidence of record. The Veteran is competent to describe what he has personally observed or experienced; however, the ultimate question of etiology in this case extends beyond an immediately observable cause-and-effect relationship and is beyond the competence of lay witnesses. In the absence of any competent and probative evidence of record indicating that the Veteran's erectile dysfunction may be associated with a disease or injury in service, the Board must find that the preponderance of the evidence is against his claim. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. Higher Ratings Disability evaluations are determined by the application of a schedule of ratings, which is in turn based on the average impairment of earning capacity caused by a given disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the evaluations to be assigned to the various disabilities. If there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. If different disability ratings are warranted for different periods of time over the life of a claim, "staged" ratings may be assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). With any form of arthritis, painful motion is an important factor of disability; the facial expression, wincing, etc., on pressure or manipulation, should be carefully noted and definitely related to affected joints. The intent of the schedule is to recognize painful motion with joint or particular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. Crepitation either in the soft tissues such as the tendons or ligaments, or crepitation within the joint structures should be noted carefully as points of contact which are diseased. Flexion elicits such manifestations. The joints involved should be tested for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with the range of the opposite undamaged joint. 38 C.F.R. § 4.59. 4. A disability rating in excess of 10 percent for the left knee disability is denied. 5. A disability rating in excess of 10 percent for the right knee disability is denied. By way of background, in the September 2013 rating decision, the Veteran's claims for service connection for left and right knee disabilities were granted effective September 13, 2012, and noncompensable ratings were assigned for each knee. The Veteran disagreed with the ratings for his left and right knee disabilities. In a November 2015 rating decision, the ratings assigned for the left and right knee disabilities were increased to 10 percent each effective September 13, 2012. The private and VA outpatient treatment records contain reports of knee problems. However, the relevant treatment records do not contain findings pertinent to rating the knees. During a VA examination in July 2013, the Veteran reported knee pain and burning in both knees. He endorsed flare-ups which resulted in difficulty walking. Range of motion testing of the left and right knee revealed 140 degrees of flexion with no pain and 0 degrees of extension bilaterally. The Veteran was able to perform repetitive use testing with no change in range of motion of either knee but there was bilateral crepitus. There was no pain to palpation of either knee. Muscle strength testing and joint stability testing of both knees was normal. There was no evidence or history of recurrent patellar subluxation/dislocation. The examiner indicated that the Veteran had meniscal conditions of both knees with frequent episodes of joint "locking" and frequent episodes of joint effusion. The Veteran has not undergone any surgical procedures of either knee. The Veteran ambulates with the constant use of a brace. There was no X-ray evidence of patellar subluxation. The examiner diagnosed the Veteran with chronic bilateral knee strain, osteoarthritis of the bilateral knees, and patellofemoral pain syndrome. During a VA examination in August 2018, the Veteran reported giving out of the left knee when climbing stairs and difficulty climbing a ladder. He stated that pain was aggravated by stair climbing, descending stairs, climbing ladders, and prolonged sitting and driving. The Veteran denied flare-ups of the knees. The Veteran reported that his knees prevented him from working out. Range of motion testing of the left knee revealed flexion to 120 degrees and 0 degrees of extension with pain noted on flexion with no resultant loss of function. There was no evidence of pain with weight-bearing, mild tenderness to palpation over the medial knee and objective evidence of crepitus. Range of motion testing of the right knee revealed flexion to 130 degrees and 0 degrees of extension with no pain noted on examination. There was no evidence of pain with weight-bearing, no objective evidence of localized tenderness, and objective evidence of crepitus. The Veteran was able to perform repetitive use testing of both knees with three repetitions and no additional functional loss or range of motion. Muscle strength testing and joint stability testing of both knees was normal. There was no evidence or history of recurrent patellar subluxation/dislocation or recurrent effusions. The examiner indicated that the Veteran did not have any meniscus (semilunar cartilage) condition of either knee. The Veteran did not have ankylosis of either knee. He ambulated with the regular use of braces. There was evidence of pain on passive motion of the left knee and evidence of pain when the joint was used in non-weight bearing. The examiner diagnosed the Veteran with left knee joint osteoarthritis and patellofemoral pain syndrome of the left knee. During a VA examination in July 2019, the Veteran reported aching pain in both knees worsened with long periods of sitting, stiffness, and burning behind the kneecap. He indicated that he was unable to stand for long periods and has to sit when his knees hurt. The Veteran denied flare-ups of the knee. Range of motion testing of the left knee revealed flexion to 120 degrees and 0 degrees of extension with pain noted with flexion with no resultant loss of function. There was evidence of pain with weight-bearing, mild tenderness to palpation over the medial knee, and no objective evidence of crepitus. Range of motion testing of the right knee revealed flexion to 130 degrees and 0 degrees of extension with pain noted with flexion with no resultant loss of function. There was evidence of pain with weight-bearing, mild tenderness to palpation over the medial knee, and no objective evidence of crepitus. The Veteran was able to perform repetitive use testing of both knees with three repetitions and no additional functional loss or range of motion. The examiner indicated that the Veteran would not have any loss of range of motion of either knee with repeated use over time. Muscle strength testing and joint stability testing of both knees was normal. There was no evidence or history of recurrent patellar subluxation/dislocation or recurrent effusions. The examiner indicated that the Veteran did not have any meniscus (semilunar cartilage) condition of either knee. The Veteran did not have ankylosis of either knee. He ambulated with the regular use of a left knee brace. The examiner indicated that, to the extent possible, range of motion testing was performed in active motion, passive motion, in weight-bearing, and in non-weight bearing and the results were the same. The examiner diagnosed the Veteran with left and right knee joint osteoarthritis and patellofemoral pain syndrome of the left and right knee. Based on the foregoing, the Board finds that a rating in excess of 10 percent for the Veteran's left and right knee disabilities is not warranted. In this regard, there is no evidence of record showing the Veteran to have limitation of flexion to 45 degrees or less. In fact, flexion is limited to, at worst, 120 degrees for the left knee and 130 degrees for the right knee. Moreover, extension was full for both the left and right knees at all examinations of record. In terms of functional loss, although the Veteran has reported left and right knee pain with flexion, such pain is not productive of symptoms that meet or are analogous to the criteria for a higher rating for limitation of motion. Further, the VA examiners took any additional limitation as a result of pain, fatigue, weakness, or incoordination into account when reporting the Veteran's limitation of function. As such, even with consideration of all pertinent disability factors, there remains no reasonable basis for the assignment of a rating in excess of 10 percent for left and right knee osteoarthritis with degenerative joint disease and patellofemoral pain syndrome. Therefore, a higher rating is not warranted. 38 C.F.R. § 4.71a, Diagnostic Codes 5260, 5261 (2020). Consideration has also been given to assigning higher ratings under other diagnostic codes pertaining to the knee. As an initial matter, the Board notes that while the 2013 VA examiner indicated that the Veteran had a condition of the meniscus of both knees with frequent episodes of joint "locking" and frequent episodes of joint effusion, both the 2018 and 2019 examiner's specifically found that there was no evidence of any meniscal condition of either knee and no surgical procedures of either meniscus. Further, there is no other indication from the record that the Veteran has impairment of the left or right knee meniscus or cartilage. Therefore, a higher or separate rating for impairment of left and right knee cartilage is not warranted. 38 C.F.R. § 4.71a, Diagnostic Codes 5258, 5259 (2020). There is also no evidence of record showing the Veteran to have ankylosis of the either knee; recurrent subluxation or lateral instability, tibia or fibula impairment in either leg; or genu recurvatum. In this regard, while the Veteran reported during the August 2018 VA examination that his left knee gave out while climbing stairs, joint stability testing was found to be normal. See also July 2013 and July 2019 VA examination reports. As such, higher or separate ratings are not warranted for the left or right knee under other diagnostic codes. 38 C.F.R. § 4.71a, Diagnostic Codes 5256, 5257, 5262, 5263 (2020). The Board notes that there have been changes to the musculoskeletal regulations effective February 7, 2021. The Board may continue the old rating criteria to rating periods prior to February 7, 2021 but may apply whichever set of criteria is more favorable to periods after February 7, 2021 if the claim was pending prior to that date. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Under the new rating criteria effective February 7, 2021, no changes were made to Diagnostic Code 5256, or Diagnostic Codes 5258-5261. On the other hand, changes were made to Diagnostic Code 5257 and Diagnostic Code 5262. However, in this case, the record does not reflect diagnosed patellar instability, recurrent subluxation or instability, or tibia or fibula impairment. Accordingly, higher or separate ratings under the new rating criteria effective February 7, 2021 are not warranted. The Veteran's belief that he is entitled to a rating higher than 10 percent rating for his left and right knee disabilities is outweighed by the objective medical findings of record. That is, the Board assigns greater probative value to the pertinent objective findings on the VA examination reports and treatment records that were recorded following physical examinations of the Veteran, than to the Veteran's general belief that he is entitled to higher ratings. Accordingly, the Board finds that a preponderance of the evidence is against the left and right knee claims. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Gilbert, 1 Vet. App. at 55-56. However, as the preponderance of the evidence is against the claims, entitlement to ratings in excess of 10 percent for the left and right knee disabilities are not warranted. 6. A disability rating in excess of 10 percent for the left ankle disability is denied. 7. A disability rating in excess of 10 percent for the right ankle disability is denied. By way of background, in the August 2018 rating decision, the Veteran's claims for higher ratings for the left and right ankle disabilities were denied and 10 percent ratings for each ankle were continued. The Veteran disagreed with denial of his claims. The private and VA outpatient treatment records contain reports of ankle problems. However, the relevant treatment records do not contain findings pertinent to rating the ankles. During an August 2018 VA examination, the Veteran reported pain in both ankles, as well as stiffness upon awakening. He stated that he was unable to sit for prolonged periods of time or exercise. The Veteran denied flare-ups of the ankles. Range of motion testing of the left and right ankles revealed 10 degrees of dorsiflexion and 30 degrees of plantar flexion. Pain was noted in plantar flexion for the right ankle and in dorsiflexion and plantar flexion for the left ankle with no resultant loss of function in either ankle. There was no evidence of pain on weight-bearing, there was evidence of mild tenderness of the left and right ankles, and there was no evidence of crepitus. The Veteran was able to perform three repetitions of motion and left ankle dorsiflexion was reduced to 5 degrees and 20 degrees of plantar flexion due to pain and right ankle dorsiflexion was reduced to 10 degrees and plantar flexion was reduced to 25 degrees due to pain. There was normal muscle strength, but no ankylosis of either ankle, or dislocation or instability of either ankle. There was evidence of pain on passive motion of both ankles and evidence pain with weight-bearing. The Veteran was diagnosed with osteoarthritis of the left and right ankles. During a July 2019 VA examination, the Veteran reported that his ankles were stiff and tight in the morning and it was difficult to walk on his ankles. He stated that he did not jump or run and limited his walking to one mile. The Veteran denied flare-ups of the ankles. Range of motion testing of the left ankle revealed dorsiflexion to 10 degrees and plantar flexion to 20 degrees with pain and difficulty walking up and down stairs and for the right ankle dorsiflexion was to 20 degrees and plantar flexion was to 30 degrees with pain and difficulty walking up and down stairs. There was no evidence of pain with weight bearing, no objective evidence of crepitus, and tenderness of the bilateral ankle joints. The Veteran was able to perform repetitive use testing with three repetitions of both ankles with no loss of function or loss of motion. The examiner indicated that the Veteran's left and right ankle range of motion would be unchanged with repetitive use over time. Muscle strength testing was normal with no muscle atrophy, no ankylosis, no instability or dislocation suspected in either ankle. The Veteran ambulated with the regular use of knee braces. There was evidence of pain on passive range of motion of both ankles, there was evidence of pain when the ankle joints were used in non-weight bearing. The Veteran was diagnosed with osteoarthritis of the left and right ankles and residuals of Achilles tendon tear of both knees. Given the aforementioned evidence, the Board finds that the preponderance of the evidence is against the assignment of disability ratings in excess of 10 percent for the left or right ankle disabilities. In this regard, there is no indication from the evidence of record indicating that the Veteran had limitation of motion in the left and right ankles that was more than moderate in severity. At worst, the Veteran has been shown to have left and right ankle dorsiflexion to 10 degrees and left ankle plantar flexion to 20 degrees and right ankle plantar flexion to 30 degrees. Further, the VA examiners took any additional limitation as a result of pain, fatigue, weakness, or incoordination into account when reporting the Veteran's limitation of function. While dorsiflexion was slightly reduced for the left and right ankle with three repetitions of motion at the 2018 examination, there was no loss of motion or function with three repetitions at the 2019 examination. As such, even with consideration of all pertinent disability factors, there remains no reasonable basis for the assignment of a rating in excess of 10 percent. 38 C.F.R. § 4.71, Diagnostic Code 5271 (2020). Consideration has also been given to assigning higher ratings under other diagnostic codes pertaining to the ankle. However, Veteran's left and right ankle disabilities have not been productive of ankylosis of the ankle joints, ankylosis of the subastragalar or tarsal joints, malunion of the os calcis or astragalus, or astragalectomy. As such, higher or separate ratings are not warranted for the left or right ankle disabilities under another relevant diagnostic code. 38 C.F.R. § 4.71a, Diagnostic Codes 5270, 5272, 5273, and 5274 (2020). The Board notes that there have been changes to the musculoskeletal regulations effective February 7, 2021. The Board may continue the old rating criteria to rating periods prior to February 7, 2021 but may apply whichever set of criteria is more favorable to periods after February 7, 2021 if the claim was pending prior to that date. See Kuzma, 341 F.3d 1327. Under the new rating criteria effective February 7, 2021, no changes were made to Diagnostic Code 5270, or Diagnostic Codes 5272-5274. On the other hand, changes were made to Diagnostic Code 5271. Specifically, under the new rating criteria under Diagnostic Code 5271 provide that a 10 percent rating is warranted for moderate limited motion of the ankle (defined as less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion). A 20 percent is warranted for limited motion of the ankle (defines as less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion). At no point during the period from February 7, 2021 has the left or right ankle disabilities manifested in marked limited motion of either ankle as defined under the new rating criteria. Accordingly, higher ratings under the new rating criteria effective February 7, 2021 are not warranted. Accordingly, the Board finds that a preponderance of the evidence is against the left and right ankle higher rating claims. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Gilbert, 1 Vet. App. at 55-56. However, as the preponderance of the evidence is against the claims, entitlement to disability ratings in excess of 10 percent for the left and right ankle disabilities are not warranted. J. Ragheb Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Cryan, 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.