Citation Nr: 21028433 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 16-49 419 DATE: May 11, 2021 ORDER The claim of entitlement to a disability rating higher than 30 percent for headaches prior to November 21, 2020 is denied. The claim of entitlement to a higher disability rating for cervical spine disability, rated as 10 percent disabling prior to November 21, 2020 and as 20 percent disabling since then, is denied. The claim of entitlement to a 30 percent disability rating for left knee instability is granted. The claim of entitlement to a 30 percent disability rating for right knee instability is granted. The claim of entitlement to a disability rating higher than 10 percent for left knee retropatellar pain syndrome with degenerative arthritis is denied. The claim of entitlement to a disability rating higher than 10 percent for right knee retropatellar pain syndrome with degenerative arthritis is denied. FINDINGS OF FACT 1. The evidence dated between February 25, 2013 and November 21, 2020 does not indicate headaches symptoms cause very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 2. The evidence dated between February 25, 2013 and November 21, 2020 does not indicate, with regard to the cervical spine, incapacitating episodes, forward flexion greater than 15 degrees but not greater than 30 degrees, a combined range of motion not greater than 170 degrees, or abnormal gait or abnormal spinal contour. 3. Since November 21, 2020, the evidence regarding the cervical spine does not indicate restriction of forward flexion of 15 degrees or less, ankylosis, or incapacitating episodes. 4. A VA medical examination report states that instability in the left knee is severe. 5. A VA medical examination report states that instability in the right knee is severe. 6. Left knee disability does not cause limitation of flexion in the left knee to 30 degrees, or limitation of extension to 15 degrees. 7. Right knee disability does not cause limitation of flexion in the right knee to 30 degrees, or limitation of extension to 15 degrees. CONCLUSIONS OF LAW 1. The criteria for a rating higher than 30 percent for headache disability prior to November 21, 2020 are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.124a. 2. The criteria for a rating higher than 10 percent for cervical spine disability prior to November 21, 2020 are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a. 3. The criteria for a rating higher than 20 percent for cervical spine disability since November 21, 2020 are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a. 4. The criteria for a 30 percent rating for left knee instability are met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a. 5. The criteria for a 30 percent rating for right knee instability are met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a. 6. The criteria for a rating higher than 10 percent for left knee patellofemoral pain syndrome and degenerative joint disease are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a. 7. The criteria for a rating higher than 10 percent for right knee patellofemoral pain syndrome and degenerative joint disease are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.71a. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The record documents that the Veteran served on active duty from June 1984 until August 1991, and from May 2001 until May 2004. This matter comes to the Board of Veterans' Appeals (Board) on appeal of rating decisions by a U.S. Department of Veterans Affairs (VA) Regional Office (RO). In May 2020, the Veteran testified in a videoconference hearing before the Board. A transcript of the hearing has been included in the electronic claims file and has been reviewed. In July 2020, the Board remanded the claims on appeal for additional development. The case is again before the Board for appellate review. Increased Rating The Veteran has been service connected for headache, neck, and knee disabilities since May 2004. On February 25, 2013, he claimed entitlement to higher ratings for these disorders. In the December 2013 rating decision on appeal, the RO granted entitlement to service connection for bilateral knee instability as 20 percent disabling for each knee effective the date of claim. In this decision, the RO also granted an increased rating to 30 percent for headaches effective the date of claim. In the other rating decision on appeal, dated in February 2014, the RO denied claims of entitlement to ratings higher than 10 percent for bilateral retropatellar pain syndrome and cervical spine degenerative disc disease. Since the appealed rating decisions, the RO has granted higher ratings to 50 percent for headaches and to 20 percent for cervical spine disability, each effective November 21, 2020. The Veteran continues to assert entitlement to higher disability ratings for these disorders. In the decision below, the Board will address whether higher ratings are warranted since February 25, 2012, one year prior to the date of claim. Law and regulations Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes (DCs). 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where 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 for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. "Staged" ratings are appropriate for any rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999). When assessing the severity of a musculoskeletal disability that is rated based on limitation of motion, such as the neck and knee disabilities addressed here, VA must consider the extent that a veteran may have additional functional impairment above and beyond the limitation of motion objectively demonstrated, such as during times when symptoms are most prevalent ("flare-ups") due to the extent of pain (and painful motion), weakness, premature or excess fatigability, and incoordination. See DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995); see also 38 C.F.R. §§ 4.40, 4.45, 4.59. When feasible, evaluation should consider range of motion while weight-bearing and non-weight-bearing, and in passive and active motion. See 38 C.F.R. § 4.59; see also Correia v. McDonald, 28 Vet. App. 158 (2016) and Mitchell v. Shinseki, 25 Vet. App. 32 (2011). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be granted to the claimant. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on the merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). In rating disabilities, VA is precluded from differentiating between symptomatology attributed to a nonservice-connected disability and a service-connected disability in the absence of medical evidence that does so. Mittleider v. West, 11 Vet. App. 181, 182 (1998). In such cases, the reasonable doubt doctrine dictates that all symptoms be attributed to the service-connected disability. Id. The applicable law and regulations concerning effective dates state in relevant part that, except as otherwise provided, the effective date of an evaluation and award of compensation based on a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. An exception to this rule exists under 38 C.F.R. § 3.400 (o)(2). This provision allows VA to assign an effective date for increased rating up to one year prior to the date of claim where medical evidence indicates an increase in disability during that time period. Headaches The RO rated the Veteran's headache disability under DC 8100 of 38 C.F.R. § 4.124a. Thereunder, ratings of 0, 10, 30, and 50 percent are authorized for various levels of disability. The question before the Board is whether a compensable rating was warranted between February 25, 2012 and February 25, 2013, during which time the disorder was rated 0 percent disabling, and whether a 50 percent rating was warranted between February 25, 2013 and November 21. 2020, during which time the disorder was rated 30 percent rating. Under DC 8100, a 0 percent rating is warranted for less frequent attacks, a 10 percent rating for characteristic prostrating attacks averaging one in 2 months over last several months, a 30 percent rating for characteristic prostrating attacks occurring on an average once a month over last several months, and a 50 percent rating for very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. 38 C.F.R. § 4.124a. The term "prostrating" is not defined in the rating criteria. In Dorland's Illustrated Medical Dictionary 1367 (28th ed. 1994) "prostration" is defined as "extreme exhaustion or powerlessness." The RO awarded the maximum 50 percent rating for headaches effective November 21, 2020. As such, the Board will address the evidence dated from the date of claim in February 2013 until November 2020. The evidence addressing this claim consists of lay assertions from the Veteran, VA and private treatment records, and VA compensation examination reports dated in April 2013. With regard to the period between February 25, 2012 and February 25, 2013, a compensable rating is unwarranted under 38 C.F.R. § 3.400(o)(2). The record does not contain a medical report dated during this period detailing the severity of headaches, which were rated 0 percent disabling prior to February 25, 2013. Moreover, the evidence dated between then and November 2020 does not indicate very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability such that would warrant a 50 percent rating. 38 C.F.R. § 4.124a. The April 2013 VA report notes complaints of daily headaches and sensitivity to light for which the Veteran used Advil, aspirin, and tramadol. The examiner diagnosed tension headaches due to neck disability and found that the Veteran experienced characteristic prostrating attacks more frequently than once per month. The examiner stated that headaches affected the Veteran's job because he "has to leave work a couple of days a week." But the examiner found that the headaches were not "very frequent" or "prolonged." Findings in the January 2021 VA report, which is based on a November 2020 examination, led to the increase in rating to 50 percent effective the date of examination. This report does not contain evidence indicating very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability prior to November 2020. 38 C.F.R. § 4.124a. But the report did indicate that the Veteran missed: 2-4 weeks work time lost in last 12 months. [T]ension headaches occur frequently and cause veteran to have to lay down for relief which interrupts any type of productive work. [H]e is unable to focus and concentrate while having a headache due to headache pain and sensitivity to light. [S]ensitivity to light causes him to have to shut his eyes for relief. This evidence suggests that the criteria for a rating higher than 30 percent may have been approximated at some point between the April 2013 VA examination and the November 2020 examination. But the private and VA treatment records dated between 2013 and 2020 indicate otherwise. The records do not contain evidence indicating that a 50 percent rating was warranted prior to November 2020. Rather, this evidence merely notes that the Veteran either had headaches or was service connected for them. The records do not in any way indicate complaints of or treatment for "very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability." 38 C.F.R. § 4.124a, DC 8100. In assessing the claim, the Board has considered the Veteran's lay statements regarding severe headaches. His statements are of probative value because as a layperson he is competent to report observable symptomatology such as head pain. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). However, he is not a medical professional who is competent to determine matters such as the nature and degree of his headaches. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). Moreover, his statements are outweighed by the medical evidence indicating, prior to November 2020, that the Veteran had not experienced significant disability related to headaches. Indeed, the objective medical evidence addressing extensive medical care for multiple health problems between 2013 and 2020 is more credible than his assertions regarding severity. See Smith v. Derwinski, 1 Vet. App. 235 (1991) (credibility is determined by the fact finder). Based on the foregoing evidence, a compensable rating is unwarranted in the year prior to the February 2013 increased rating claim. Further, a rating higher than 30 percent has been unwarranted between then and November 2020. As the preponderance of the evidence is against the claim for a higher rating, the benefit-of-the-doubt doctrine does not apply, and the claim for a higher rating for headaches must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Cervical spine The RO has rated the Veteran's cervical spine degenerative disc disease under DC 5242 of 38 C.F.R. § 4.71a. Cervical spine disability is rated under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-43. When rating under the former formula, VA is directed to evaluate orthopedic disability separately with any associated objective neurologic abnormalities under an appropriate diagnostic code, and then combine the separate ratings under 38 C.F.R. § 4.25. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-43, Note (1). A rating under the latter formula is warranted where incapacitating episodes are present due to intervertebral disc syndrome (IVDS). An incapacitating episode is defined as a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, Diagnostic Code 5243, Note (1). VA should then select whichever formula results in the higher evaluation. Under these formulas, disability ratings of 10, 20, 30, 40, 50, 60, and 100 percent are authorized. 38 C.F.R. § 4.71a, Diagnostic Codes 5235-43. The spine disability at issue here has been rated at least 10 percent disabling throughout the appeal period, so the Board will limit its analysis to whether higher ratings are warranted. Under the General Rating Formula for Diseases and Injuries of the Spine, a 20 percent rating is warranted for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 30 percent rating is warranted for forward flexion of the cervical spine to 15 degrees or less; or, favorable ankylosis of the entire cervical spine. Fifty and 100 percent ratings are warranted under the General Rating Formula for Diseases and Injuries of the Spine for disorders manifested by ankylosis. Ankylosis is defined as "stiffening or fixation of a joint as the result of a disease process, with fibrous or bony union across the joint[.]" Dinsay v. Brown, 9 Vet. App. 79, 81 (1996). The normal combined range of motion of the cervical spine is 340 degrees with 45 degrees flexion, 45 degrees extension, 45 degrees each for left and right lateral flexion, and 80 degrees each for left and right rotation. See 38 C.F.R. § 4.71a, Diagnostic Codes 5235-43, Note (2); Plate V. Under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, a 20 percent rating is warranted for incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months. A 40 percent rating is warranted for incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. A 60 percent rating is warranted for incapacitating episodes having a total duration of at least six weeks during the past 12 months. The evidence addressing this claim consists of lay assertions from the Veteran, private and VA treatment records, and VA compensation examination reports dated in April 2013, January 2014, and January 2021. With regard to the period between February 25, 2012 and February 25, 2013, during which time neck disability was rated 10 percent disabling, a higher rating does not appear warranted under 38 C.F.R. § 3.400(o)(2). The record does not contain a medical report dated during this period detailing the severity of neck disability. The earliest evidence detailing the nature and severity of neck disability is found in the April 2013 VA examination report. That examiner found reduced combined range of motion of 285 degrees due to pain from disc degeneration. The examiner noted functional loss affecting sitting, standing, and weightbearing. The examiner stated that the Veteran would be functionally limited around heavy machinery because of his difficulty moving his neck. The examiner also found evidence of muscle guarding or spasm. But the examiner found no evidence of consequent abnormal gait or abnormal spinal contour. Furthermore, after three repetitions and without pain, the Veteran flexed to 40 degrees, extended to 45 degrees, right lateral flexed to 45 degrees, left lateral flexed to 30 degrees, right lateral rotated to 80 degrees, and left lateral rotated to 45 degrees. Further, the report indicates no flare ups, full muscle strength, no muscle atrophy, normal reflexes, and normal sensation without evidence of radiation or IVDS. The report also indicates no ankylosis and no incapacitating episodes. The results of this report support the assignment of a 10 percent rating prior to November 2020. While the report indicates guarding or spasm, it does not indicate abnormal gait or abnormal spinal contour. Further, while it shows functional loss due to pain associated with motion, the examination results indicate pain-free and repetitive forward flexion beyond 30 degrees and combined range of motion beyond 170 degrees to 40 degrees and to 285 degrees, respectively. A January 2014 VA addendum report did not provide additional information regarding range of motion. Rather, the examiner stated that such information regarding flare ups could not be provided without speculation. The examiner did state that neck disability prevented physical employment, but not sedentary employment. The Board notes that the Veteran has been awarded a total disability rating based on individual unemployability (TDIU) since his February 2013 claim for increase. The Board has reviewed the VA treatment records dated between the April 2013 and November 2020 VA reports, seeking evidence in support of the next-highest rating of 20 percent. However, the records, which address the Veteran's many disorders, are largely silent regarding the severity of neck disability. The records note neck pain and cervical spine degenerative changes. In one record dated in August 2013, the Veteran's complaints of left upper extremity shooting pain and tingling from the neck are noted. But none of the records dated during this period provide detailed information regarding the neck disability, such as range of motion. Further, the records indicate that in the seven-year period between the two examinations the Veteran sought medical treatment for his neck problem in August 2013, but not afterward. The January 2021 VA report of the November 2020 examination indicates a worsening of the disorder since the 2013 examination. The report indicates that the Veteran stopped working due to the pain. The report indicates stiffness and tingling hands along with pain. The report notes the Veteran's complaint that he experiences flare ups three to five times per month, lasting one to three days duration, during which he would apply heat to his neck and lay "for a few days." The report contains several range of motion measurements indicating combined motion well below the normal 340 degrees. At worst, as a result of pain, fatigue, weakness, and lack of endurance during flare ups, the examiner estimated a combined range of motion of 170 degrees flexion limited to 20 degrees, extension to 20 degrees, right lateral flexion to 25 degrees, left lateral flexion to 20 degrees, right lateral rotation to 55 degrees, and left lateral rotation to 20 degrees. Based on these findings, the RO increased the disability rating to 20 percent effective the date of examination. The examiner also found evidence of upper extremity radiculopathy, which the RO found service connected as well. The examiner stated that the "constant" pain makes "looking left to right nearly impossible, lifting heavy objects impossible, and also cause[s] pain into his bilateral upper arms with tingling." Nevertheless, the examiner also found an absence of ankylosis, full muscle strength, no muscle atrophy, normal reflexes, and normal sensation. Lastly, the examiner clarified that the findings were based on active and weight-bearing motion, and that measuring passive and nonweight-bearing motion, or an opposite joint, were not possible for the cervical spine. In sum, the November 2020 examination indicated a worsening disability, and led not only to an increase in rating to 20 percent, but also a separate award of service connection for radiculopathy. However, the examination results would not support the assigment of the next-highest rating of 30 percent. In short, even at his most disabled during flare ups, the Veteran could forward flex beyond 15 degrees (i.e., to 20 degrees). Further the examiner did not find evidence of ankylosis. The private and VA treatment records dated since November 2020 do not indicate, moreover, flexion limited to 15 degrees or less, or ankylosis. Rather, like the treatment records dated prior to November 2020, the records are largely silent regarding neck disability. In assessing this claim, the Board has considered the Veteran's lay statements regarding neck limitation. His statements are of probative value because as a layperson he is competent to report observable symptomatology such as neck pain. See Jandreau, supra. However, he is not a medical professional who is competent to determine matters such the nature and degree of his cervical spine disability. See Woehlaert, supra. He is not competent to determine whether he has ankylosis, abnormal gait, abnormal spinal contour, or limitation of motion of 170 degrees or less. As such, his statements regarding the severity of his disorder are outweighed by the medical evidence indicating that the criteria for higher ratings were not met prior to November 2020 and since then. Indeed, the objective medical evidence addressing extensive medical care for multiple health problems since 2013 is more credible than the assertions regarding severity. See Smith, supra. Based on the foregoing evidence, a rating higher than 10 percent was unwarranted in the year prior to the February 2013 increased rating claim until November 21, 2020, and a rating higher than 20 percent is unwarranted since then. As the preponderance of the evidence is against the claim for a higher rating, the benefit-of-the-doubt doctrine does not apply, and the claim for a higher rating for cervical spine disability must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Knees The RO has rated the Veteran's knee disabilities under DCs 5003, 5257, and 5260 of 38 C.F.R. § 4.71a. Inasmuch as the four separate knee disabilities at issue here are rated 10 percent disabling or more during the appeal period, the Board will limit its discussion to whether higher ratings are warranted. Arthritis is addressed under DC 5003. See 38 C.F.R. § 4.71a. Degenerative arthritis is rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When the limitation of motion of the specific joint or joints 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, to be combined, not added under DC 5003. Inasmuch as the knee disabilities here have been rated 10 percent disabling throughout the appeal period, DC 5003 cannot lead to a higher rating. There are several DCs that specifically address knee disorders other than arthritis (i.e., DCs 5256 through 5263 of 38 C.F.R. § 4.71a). Diagnostic Code 5256 addresses ankylosis of the knee. Diagnostic Code 5257 addresses recurrent subluxation or lateral instability. Diagnostic Code 5258 addresses dislocated semilunar cartilage in the knee manifested by frequent episodes of "locking," pain, and effusion into the joint. Diagnostic Code 5259 addresses symptomatic residuals related to removal of semilunar cartilage. Under DC 5260, limitation of flexion is addressed while limitation of extension is addressed under DC 5261. Diagnostic Code 5262 addresses impairment of the tibia and fibula. And DC 5263 addresses genu recurvatum. See 38 C.F.R. § 4.71a. The RO has awarded 20 percent ratings for bilateral instability under DC 5257, and 10 percent ratings for bilateral limitation of motion under DC 5260. The criteria for rating lateral instability under DC 5257 have been revised during the appeal period. The only rating higher than 20 percent under either set of criteria 30 percent will be addressed here. Under the older criteria, a 30 percent rating is warranted for severe lateral instability or subluxation. 38 C.F.R. § 4.71a. Under the revised criteria, which are effective from February 7, 2021, 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 (e.g., cane(s), crutch(es), walker) and bracing for ambulation. Or for patellar instability, a 30 percent rating is warranted under the revised criteria 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. Note (1) of this provision states that the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon while Note (2) states that surgical procedure which does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration). See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5257). The older criteria under DC 5257 apply prior to February 7, 2021. The more favorable of the older or revised criteria apply from that date. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Under DC 5260, the next-highest rating above the 10 percent assigned throughout the appeal period is 20 percent, which is warranted for limitation of flexion to 30 degrees, while a 20 percent rating is warranted for limitation of extension to 15 degrees under DC 5261. The evidence addressing this claim consists of lay assertions from the Veteran, private and VA treatment records, and VA compensation examination reports dated in April 2013, January 2014, and January 2021. With regard to the period between February 25, 2012 and February 25, 2013, during which time bilateral knee disability was rated for limitation of motion, a higher rating does not appear warranted under 38 C.F.R. § 3.400(o)(2). The record does not contain a medical report dated during this period detailing range of motion or addressing the severity of instability, which has been service connected since the February 2013 claim. A higher rating is warranted, however, based on evidence dated after February 2013. The April 2013 VA report stated that the Veteran reported no flare ups. The examiner noted pain-free bilateral range of motion of 0 degrees extension to 140 degrees flexion after three repetitions. The examiner noted full muscle strength, no atrophy or ankylosis, normal joint stability, and no meniscus disorder. Further, the report does not indicate that the Veteran had undergone surgery for his knee problems. The report also noted, however, that functional loss resulted from weakened movement, incoordination, pain, instability, and disturbance of locomotion, and that the disorders interfered with sitting, standing, weight bearing, climbing, and squatting. The report also indicated recurrent patellar subluxation/dislocation of moderate degree, and that the Veteran used knee braces and a cane for his disability. The examiner diagnosed bilateral degenerative arthritis and bilateral patellofemoral syndrome (anterior compartment pain). The January 2021 VA report of the November 2020 examination indicates severe instability in each knee. The report also noted moderately severe flare ups several times monthly, lasting between several hours and two days, during which the Veteran had 110 degrees flexion and 5 degrees extension. The examiner also noted pain-free 120 degrees flexion and 5 degrees extension following three repetitions during the actual examination and estimated 115 degrees flexion and 5 degrees extension after repeated use. The examiner indicated that findings of pain were found after passive and nonweight-bearing testing as well. The examiner noted that the painful motion during flare ups and after repetitive use caused disturbance of locomotion, interference with sitting, standing, and squatting, and noted that the Veteran used knee braces and a cane for his disorder. The examiner also noted weakened muscle strength in the legs due to the knee problems but found no evidence of atrophy, ankylosis, meniscus disorder, or past surgery. The private and VA treatment records indicate that VA has fitted the Veteran for knee braces throughout the appeal. Further, the records repeatedly note since February 2012 that the Veteran has experienced knee pain, that he has been service connected for knee disability, and that he has experienced instability. However, the records do not detail specific range of motion measurements, and do not refer to the degree of severity of the knee instability. In sum, the November 2020 examination indicated severe instability in each knee. As such, a 30 percent rating has been warranted for each knee under the older rating criteria of DC 5257. The 30 percent rating is the highest rating under DC 5257 so the Board will not discuss the revised rating criteria under DC 5257. The evidence does not indicate that higher ratings have been warranted for limitation of motion, however. The April 2013 and January 2021 VA reports each indicate, after accounting for pain and other limiting factors, at least 110 degrees flexion and at most extension limited 5 degrees. In short, even at his most disabled during flare ups, the criteria for a rating higher than 10 percent for limitation of motion has not been approximated. The Board further notes that the evidence has consistently shown during the appeal period that the Veteran does not have ankylosis in either knee. The Board has considered whether other DCs pertaining to knee disability apply here. However, the evidence does not indicate ankylosis (DC 5256), meniscus dysfunction (DCs 5258-59), genu recurvatum (DC 5262), or tibia-fibula dysfunction (DC 5263). In assessing this claim, the Board has considered the Veteran's lay statements regarding knee pain and limitation. His statements are of probative value because as a layperson he is competent to report observable symptomatology such as pain. See Jandreau, supra. However, he is not a medical professional who is competent to determine matters such the nature and degree of his knee disability. See Woehlaert, supra. He is not competent to determine whether he has ankylosis, what the degree of his instability is, or what the degree of his motion is. As such, his statements regarding the severity of his disability are outweighed by the medical evidence dated throughout the appeal period. Indeed, the objective medical evidence addressing extensive medical care for multiple health problems since 2013 is more credible than the assertions regarding severity. See Smith, supra. Based on the foregoing evidence, separate increased ratings of 30 percent are warranted under DC 5257 for instability in each knee. But higher ratings are not warranted for limitation of motion under DC 5260. As the preponderance of the evidence is against the assignment of ratings higher than those granted here, the benefit-of-the-doubt doctrine does not apply, and the claims for a rating higher than those awarded here must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher McEntee, 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.