Citation Nr: 21032374 Decision Date: 05/26/21 Archive Date: 05/26/21 DOCKET NO. 09-41 282 DATE: May 26, 2021 ORDER Entitlement to a rating in excess of 10 percent prior to June 15, 2012, in excess of 40 percent prior to August 5, 2020, and in excess of 50 percent thereafter for left knee limitation of extension is denied. Restoration of a 50 percent rating from April 1, 2021 is denied. Entitlement to a rating in excess of 20 percent for left knee instability is denied. Entitlement to a compensable rating for left knee limitation of flexion is denied. Entitlement to a compensable rating for a surgical scar, left knee, is denied. FINDINGS OF FACT 1. Prior to June 15, 2012, the Veteran's left knee osteoarthritis was manifest by pain, stiffness, and noncompensable limitation of motion. 2. From June 15, 2012 to August 5, 2020, the Veteran's left knee disability was manifest by extension limited to 30-44 degrees, but no greater. 3. From August 5, 2020 to April 1, 2021, the Veteran's was rated as 50 percent disabling, which is the maximum schedular rating permitted for limitation of extension of the leg, and he did not have extremely unfavorable ankylosis of the left knee. 4. The procedural requirements for a reduction of the disability rating for left knee osteoarthritis from 50 percent to 30 percent were satisfied by a November 2020 letter. 5. At the time the reduction was proposed, the rating had been in effect less than 5 or more years; a January 2021 rating decision effectuated the proposed reduction, effective from April 1, 2021, based on examination findings showing that the Veteran's left knee osteoarthritis was manifest by extension limited to 20 degrees and was not manifest by ankylosis. 6. The Veteran's left knee disability was not manifest by severe recurrent subluxation or lateral instability at any time during the period on appeal. 7. The Veteran's left knee disability was not manifest by compensable limitation of flexion at any time during the period on appeal. 8. The Veteran's left knee surgical scar is not manifest by an area or areas of 144 square inches (929 sq. cm.) or greater and is not associated with underlying soft tissue damage. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating in excess of 10 percent prior to June 15, 2012, in excess of 40 percent prior to August 5, 2020, and in excess of 50 percent thereafter for left knee limitation of extension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes, 5010, 5014, 5261. 2. The criteria for restoration of a 50 percent rating for left knee osteoarthritis from April 1, 2021 have not been met. 38 U.S.C. §§ 5107(b), 5112; 38 C.F.R. §§ 3.105(e), 3.344, 4.3, 4.71a, Diagnostic Codes 5010, 5256-5263. 3. The criteria for entitlement to a rating in excess of 20 percent for left knee instability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5257. 4. The criteria for entitlement to a compensable rating for left knee limitation of flexion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5010, 5260. 5. The criteria for entitlement to a compensable rating for a surgical scar, left knee, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7802. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from November 1969 to February 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2008 rating decision by the Department of Veterans Affairs (VA) Regional Office in Waco, Texas. This matter was previously before the Board in March 2016. At that time, the Board denied the Veteran's claim for an increased rating for his knee disability. The Veteran appealed the denial to the Court of Appeals for Veterans Claims (CAVC). In October 2016, pursuant to a Joint Motion for Remand (JMR) filed by VA and the Veteran, CAVC vacated the Board's March 2016 decision and remanded the matter to the Board for further action consistent with the JMR. Thereafter, in February 2017, the Board issued a decision remanding the matter to obtain an adequate VA examination of the Veteran's left knee disability. The matter was remanded by the Board in July 2017, June 2018, and August 2019 to determine the current severity of the Veteran's left knee disability. There has been at least substantial compliance with the Board's remand directives. See D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268 (1998). Increased Ratings Disability evaluations are determined by the application of a schedule of ratings which is based on the average impairment of earning capacity. 38 U.S.C.§ 1155; 38 C.F.R., Part 4. An evaluation of the level of disability present also includes consideration of the functional impairment of the veteran's ability to engage in ordinary activities, including employment. 38 C.F.R. § 4.10. 38 C.F.R. § 4.7 provides that, where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. In deciding the veteran's increased evaluation claim, the Board has considered the determinations in Fenderson v. West, 12 Vet. App. 119 (1999) and Hart v. Mansfield, 22 Vet. App. 505 (2007), and whether the veteran is entitled to an increased evaluation for separate periods based on the facts found during the appeal period. 1. Entitlement to a rating in excess of 10 percent prior to June 15, 2012, in excess of 40 percent prior to August 5, 2020 and in excess of 50 percent thereafter for left knee limitation of extension is denied. 2. Entitlement to a rating in excess of 20 percent for left knee instability is denied. 3. Entitlement to a compensable rating for left knee limitation of flexion is denied. Issues 1-3: The Veteran seeks a higher rating for his service connection left knee osteoarthritis, also rated as left knee osteomalacia. The Veteran has complained of chronic left knee pain and stiffness which he contends affects his ability to perform his job as a law enforcement officer. See Statement in Support of Claim (October 1, 2008). He also contends he has marked interference with daily activities. See Appellant's Post-Remand Brief (May 3, 2018). The Veteran was initially granted service connection for left knee chondromalacia effective February 9, 1971 and assigned an initial 10 percent rating. In June 2008, he submitted a claim for an increased rating, which is currently on appeal. During the pendency of the appeal, the rating criteria for rating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board will consider the Veteran's appeal under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. The Veteran's left knee osteoarthritis (previously osteomalacia) has been assigned separate ratings under multiple diagnostic codes, including Diagnostic Code 5014, Diagnostic Code 5256, Diagnostic Code 5257, Diagnostic Code 5260, and Diagnostic Code 5261. Prior to June 15, 2012, the Veteran's left knee disability was assigned a 10 percent rating under Diagnostic Code 5014, which rates osteomalacia. Effective June 15, 2012, the rating was increased to 40 percent under Diagnostic Code 5261, which rates limitation of extension. From August 5, 2020, the rating was increased to 50 percent under Diagnostic Code 5256, which rates ankylosis. Effective January 14, 2018, a separate noncompensable evaluation for limitation of flexion of the knee under Diagnostic Code 5260 was assigned, as well as a separate 20 percent rating for instability of the left knee under Diagnostic Code 5257. Diagnostic Code 5014 rates osteomalacia. The note following Diagnostic Code 5014 states that diseases considered under that diagnostic code should be rated as degenerative arthritis, based on limitation of motion of the affected parts. Degenerative arthritis is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5003. Regulatory changes effective February 7, 2021 reworded the Diagnostic Code 5003 from "Arthritis, degenerative (hypertrophic or osteoarthritis)" to "Degenerative arthritis, other than post-traumatic", but did not change the criteria for rating disabilities under the diagnostic code. Diagnostic Code 5003 directs that a rating shall be awarded on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. If noncompensable limitation of motion is demonstrated, a 10 percent rating is assigned for each major joint or group of minor joints affected. 38 C.F.R. § 4.71a, Diagnostic Code 5003. Under Diagnostic Code 5256, a 30 percent rating is warranted for knee ankylosis with a favorable angle in full extension, or in slight flexion between zero and 10 degrees. A 40 percent rating is warranted for knee ankylosis in flexion between 10 degrees and 20 degrees. A 50 percent rating is warranted for knee ankylosis in flexion between 20 degrees and 45 degrees. A 60 percent rating is warranted for extremely unfavorable knee ankylosis, in flexion at an angle of 45 degrees or more. 38 C.F.R. § 4.71a, Diagnostic Code 5256. Under Diagnostic Code 5257, a 10 percent rating is warranted for slight recurrent subluxation or lateral instability. A 20 percent rating is warranted for moderate recurrent subluxation or lateral instability. A 30 percent rating is warranted for severe recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, Diagnostic Code 5257. According to MERRIAM WEBSTER'S COLLEGIATE DICTIONARY 999 (11th Ed. 2007), "slight" means small in amount. "Moderate" means limited in scope or effect. "Severe" means very painful or harmful or of a great degree. Objective medical evidence is not required to establish lateral knee instability under Diagnostic Code 5257 as in effect prior to February 7, 2021. Therefore, objective medical evidence cannot be categorically found more probative than lay evidence with respect to that diagnostic code. See English v. Wilkie, 30 Vet. App. 347, 352-53 (2018). As of February 7, 2021, under Diagnostic Code 5257, a 10 percent rating is warranted when there is 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; or where there is 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 when there is a sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation; an 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; or 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 when there is an 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 there is 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. The regulatory changes did not affect Diagnostic Codes 5260 and 5261. Under Diagnostic Code 5260, a noncompensable rating is warranted for flexion limited to 60 degrees. A 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Under Diagnostic Code 5261, a noncompensable rating is warranted for extension limited to 5 degrees. A 10 percent rating is warranted for extension limited to 10 degrees. A 20 percent rating is warranted for extension limited to 15 degrees. A 30 percent rating is warranted for extension limited to 20 degrees. A 40 percent rating is warranted for extension limited to 30 degrees. A 50 percent rating is warranted for extension limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261. 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 and, therefore, not be reflected on range-of-motion testing. 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); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. Based on the following, the Board finds that the preponderance of the evidence is against a higher rating under any diagnostic code. The Board acknowledges the Veteran's lay reports of symptoms including pain and stiffness and that there was functional loss due to pain, weakened movement, excess fatigability, incoordination, repetitive use, pain during flare-ups, and pain during repetitive use over time. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation that would occur during flare-ups or following repeated use would not result in limitation of motion more nearly approximating compensable limitation of flexion at any time during the period on appeal, compensable extension prior to June 15, 2012, extension limited to 45 degrees or greater after June 15, 2016, or extremely unfavorable ankylosis after August 5, 2020. The Veteran was afforded a VA examination of his left knee disability in October 2008. The Veteran reported subjective complaints of pain, weakness, stiffness, swelling, instability, and locking. He stated that prolonged standing and walking, as well as strenuous exercise, increased pain, stiffness, and swelling. He also reported difficulty bending and squatting do to pain. He did not require any ambulatory aides. He did not have ankylosis of the knee joint. On examination, he had range of motion of the left knee from 0 degrees extension to 120 degrees flexion. There was no additional limitation of motion following repeated tested. The examiner concluded that there was no pain, fatigue, weakness, lck of endurance, incoordination, painful motion, edema, effusion, instability, tenderness, redness, heat, abnormal movement or guarding of movement. Mild crepitus was noted. The knee was stable. No muscle atrophy of the left thigh was observed. The Veteran was diagnosed with mild chondromalacia. At a June 2009 VA examination, the Veteran continued to report left knee pain. He described the pain as normally a mild "achy" feeling, which worsened with prolonged standing, walking, or climbing stairs. The Veteran's gait was observed to be antalgic. Range of motion of the left knee was from 0 degrees extension to 135 degrees flexion. There was objective evidence of painful motion. Following repeated testing, flexion was additionally limited to 130 degrees. There was no joint ankylosis. The Veteran reported that he worked full-time as a police officer (since 1972) and had missed a week of work in the last year. The Veteran was afforded another VA examination in June 2012. The Veteran continued to report left knee pain, with flare-ups with drastic weather changes, particularly cold. He reported difficulty climbing and descending stairs and stated that his work as a police officer was slowed down by his knee pain. He did not use any assistive devices. On examination, the Veteran had flexion to 120 degrees, with pain beginning at 115 degrees. The Veteran had extension limited to 35 degrees, with pain beginning at 35 degrees. There was no additional limitation of motion following repetitive testing. However, the examiner noted that the Veteran would have functional impairment after repeated use, including less movement than normal, excess fatigability, pain on movement, instability of station, disturbance of locomotion, and interference with sitting, standing, and weightbearing. Muscle strength was normal in the left lower extremity. Stability testing of the left knee was normal (no instability). There was no evidence of patellar subluxation or dislocation. The Veteran did not have a meniscus (semilunar cartilage) condition. In December 2014, the Veteran continued to report left knee pain. He also described the occasionally sensation of the knee popping and giving way. He reported flare-ups that were weekly and depend on activity. During flare-ups, the knee can swell. On examination, range of motion was from 0 degrees extension to 120 degrees flexion. Pain with weightbearing was noted. There was no additional functional loss or limitation of motion following repetitive testing. The examiner stated that pain, weakness, fatigability or incoordination would not significantly limit functional ability with repeated use over a period of time. However, pain, weakness, fatigability or incoordination would significantly limit functional ability during flare-ups. The examiner estimated that range of motion would be limited during flare-ups from 5 degrees extension to 110 degrees flexion. There was no reduction of muscle strength or muscle atrophy and no ankylosis of the left knee. The Veteran had no history of recurrent subluxation or lateral instability, but there was a history of recurrent effusion after prolonged activity. Joint stability testing was normal (no instability). The Veteran did not have a meniscus (semilunar cartilage) condition. The Veteran reported the occasional use of a knee brace. While the Veteran reported that he is still able to do his job, activities such as running, deep bending, or prolonged standing cause flare-ups of pain. He reported missing only a few days on one occasion because of his knee condition. The Veteran reported he planned to retire in 2015. In September 2017, the Veteran described pain and stiffness of the left knee. The Veteran had range of motion from 20 degrees extension to 80 degrees flexion. The Veteran complained of pain and stiffness with range of motion. There was evidence of pain with weightbearing, including prolonged standing. There was no additional limitation of motion following repetitive testing. The examiner was unable to determine without resorting to speculation whether pain, weakness, fatigability or incoordination would significantly limit functional ability with repeated use over a period of time or during flare-ups. There was no reduction in muscle strength, muscle atrophy, or ankylosis. The Veteran did not have a history of recurrent subluxation, lateral instability, or recurrent effusion. Joint stability testing was not performed on the left knee. The Veteran did not have a meniscus condition. The examiner stated that the Veteran's condition would not prevent him from performing any occupational task. The Veteran was again afforded a VA examination in November 2018. The Veteran described a long history of left knee pain which increased over time. His pain is worsened by prolonged standing and walking, as well as climbing stairs. He also reported that the knee becomes stiff after long sitting or driving. Flare-ups of pain stiffness and swelling occur with increased activity, rapid weather changes, and cold or rainy weather. He estimated the flare-ups occurred approximately once a week and lasted for a day or two. On examination, he had range of motion from 40 degrees extension to 70 degrees flexion. Pain was noted with range of motion and weightbearing. Following repetitive testing, flexion was further limited to 60 degrees, with no change in extension. The examiner was unable to determine without resorting to speculation whether pain, weakness, fatigability or incoordination would significantly limit functional ability with repeated use over a period of time or during flare-ups. There was no reduction in muscle strength, muscle atrophy, or ankylosis. There was no history of recurrent subluxation, lateral instability, or recurrent effusion. Stability tested noted posterior instability. The examiner noted that there appeared to be no prior history of left joint instability in the Veteran's claims file and that this was a new finding. The examiner also found that the Veteran had a meniscus (semilunar cartilage) condition with frequent episodes of locking, joint pain, and joint effusion. The Veteran did not report any assistive devices. The Veteran was retired at the time of the examination. The examiner opined that the Veteran's new diagnoses of instability and osteoarthritis were a progression of his service connected osteomalacia. The Veteran was most recently afforded a VA examination in August 2020. The Veteran continued to report pain and stiffness of the left knee that was worsened by bending or prolonged walking. He described the occasional sensation of giving way but stated that this has not happened recently. He did not use any assistive devices. He reported not receiving any treatment since his November 2018 VA examination. He was retired and spends his time traveling the country on his motorcycle. He reported having to stop frequently to rest and stretch his legs. On examination, range of motion was from 20 degrees extension to 100 degrees flexion. The Veteran had pain with range of motion and with weightbearing. There was no additional limitation of motion over time. The examiner concluded that pain, weakness, fatigability or incoordination would significantly limit functional ability with repeated use over a period of time and during flare-ups. He estimated flexion would be limited to 80 degrees, with no change in extension. The Veteran had 4/5 muscle strength in the right knee, but no muscle atrophy. The examination indicated that the Veteran had ankylosis of the left knee in flexion between 10 and 20 degrees, but in an October 2020 addendum medical opinion, explained that this finding was in error and that the Veteran did not have ankylosis. The Veteran did not have a history of recurrent subluxation or effusion but did have a history of slight lateral instability. There was no joint instability on testing. The Veteran had a meniscus (semilunar cartilage) condition with frequent locking, joint pain, and joint effusion. The above evidence does not show sufficient limitation of motion to warrant assigning a higher rating based on limitation of extension or flexion at any time during the period on appeal. Additionally, the preponderance of the evidence weighs against finding that the Veteran's left knee instability could be characterized as severe at any time during the period on appeal. Beyond an isolated finding at the Veteran's November 2018 VA examination, there is no objective evidence of knee instability. While the Veteran has reported the subjective sensation of instability or giving way, he has described this occurring only occasionally. The Board finds that such infrequent symptoms cannot be considered to be very painful or harmful or of a great degree. Additionally, the Veteran was not prescribed a knee brace, cane or walker by a physician for his left knee condition. Accordingly, a rating in excess of 20 percent for left knee instability is not warranted. The Board has also considered the other Diagnostic Codes pertaining to the knee and leg. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). The Board notes that the assignment of a rating under Diagnostic Code 5258, 5262, and 5263 when the Veteran is already rated under Diagnostic Code 5260 and/or 5261 constitutes pyramiding. Furthermore, while the November 2018 and August 2020 VA examinations noted a meniscus condition with symptoms of locking, pain, and effusion into the joint, the Veteran was already assigned a 40 percent rating under Diagnostic Code 5261, which is higher than the maximum schedular rating of 20 percent under Diagnostic Code 5258. Thus, there is no benefit to the Veteran in rating him under Diagnostic Code 5258 rather than Diagnostic Code 5261. As there is no evidence that the Veteran's left semilunar cartilage was removed, Diagnostic Code 5259 is not for application. The Board also notes that the Veteran has reported during the pendency of his appeal that his left knee osteoarthritis made it difficult to perform the duties of his job as a law enforcement officer. The Board has considered whether the issue of entitlement to a total disability rating based on individual unemployability (TDIU) has been raised by the record; however, the evidence does not show nor has the Veteran claimed that he is unable to find or maintain all substantially gainful employment due to his service connected disabilities. Rather, the Veteran described difficulties performing a specific, physically demanding job. Further, the Veteran was able to successfully maintain this employment, apparently without any accommodations from his employer, throughout the pendency of the appeal until he retired. There is no evidence of record that since his employment, the Veteran has attempted to find new employment and was unsuccessful because of his service-connected bilateral knee condition. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's claim for a higher rating for his service-connected left knee disability during any period on appeal. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 4. Restoration of a 50 percent rating from April 1, 2021 is denied. Also at issue is the decision of the RO to reduce the disability evaluation for the Veteran's service-connected left knee osteoarthritis from 50 percent to 30 percent, effective April 1, 2021. As noted above, the Veteran has been service connected for a left knee disability since February 9, 1971. A September 2020 rating decision granted a 50 percent rating effective August 5, 2020. An October 2020 rating decision proposed to reduce the Veteran's rating, after an October 2020 addendum medical opinion identified errors in the August 2020 VA examination on which the Veteran's 50 percent evaluation was based. The Veteran was provided notice of this decision in a November 2020 letter. A January 2021 decision reduced the Veteran's rating to 30 percent, effective April 1, 2021, noting that VA examination reports and medical treatment records did not support an evaluation in excess of 30 percent. The Board concludes that the preponderance of the evidence is against restoration of a 50 percent rating for left knee osteoarthritis as the correct procedures for reduction of the rating were followed and because VA examinations and treatment records reflect the absence of symptoms that would warrant assignment of a higher disability rating. 38 U.S.C. §§ 5107(b), 5112; 38 C.F.R. §§ 3.105(e), 3.344, 4.3, 4.71a, Diagnostic Codes 510, 5256-5263. Pursuant to 38 C.F.R. § 3.105(e), where a reduction in the evaluation of a service-connected disability is considered warranted and the lower evaluation would result in a reduction or discontinuance of compensation payments currently being made, a rating proposing the reduction or discontinuance will be prepared setting forth all material facts and reasons. The beneficiary will be notified at his or her latest address of record of the contemplated action and furnished detailed reasons therefore and will be given 60 days for the presentation of additional evidence to show that compensation payments should be continued at their present level. Final rating action will reduce or discontinue the compensation effective the last day of the month in which a 60-day period from the date of notice to the beneficiary of the final rating action expires. 38 C.F.R. § 3.105(e). Here, the RO complied with the procedures required under 38 C.F.R. § 3.105(e) for reducing the Veteran's disability rating. In a November 2020 letter, the RO notified the Veteran of the proposed reduction in benefits and his due process rights to include that no action would be taken on the proposed reduction for 60 days following the date of the notification letter, and that he should provide evidence showing that the proposed reduction is not warranted. A January 2021 rating decision effectuated the proposed reduction by assigning a 30 percent rating for left knee osteoarthritis. The Board finds that the RO complied with the procedural requirements of 38 C.F.R. § 3.105(e) to include the effective date of the reduction. See 38 C.F.R. § 3.105(e) (Final rating action will reduce or discontinue the compensation effective the last day of the month in which a 60-day period from the date of notice to the beneficiary of the final rating action expires). Reducing a rating also brings concurrent substantive requirements that must be followed. The law provides that, when a rating has continued for a long period at the same level (i.e., five years or more), a reduction may be accomplished when the rating agency determines that evidence makes it reasonably certain that the improvement will be maintained under the ordinary conditions of life. 38 C.F.R. § 3.344(a). However, where a rating has been in effect for less than five years, the regulatory requirements under 38 C.F.R. § 3.344(a) and (b) are inapplicable, as set forth in 38 C.F.R. § 3.344(c). In such cases, an adequate reexamination that discloses improvement in the condition will warrant reduction in rating. See 38 C.F.R. § 3.344 (c); 3.343(a). These provisions impose a clear requirement that VA rating reductions be based upon review of the entire history of the veteran's disability. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Such review requires VA to ascertain, based upon review of the entire recorded history of the condition, whether the evidence reflects an actual change in the disability and whether the examination reports reflecting such change are based upon thorough examinations. Thus, in any rating reduction case not only must it be determined that an improvement in a disability has actually occurred but also that that improvement actually reflects an improvement in the veteran's ability to function under the ordinary conditions of life and work. 38 C.F.R. §§ 4.2, 4.10, 4.13; Faust v. West, 13 Vet. App. 342, 350 (2000). In the present case, the Veteran's 50 percent rating had been in effect for less than a five-year period at the time the Veteran's disability was evaluated and the RO proposed to reduce the Veteran's disability rating. Specifically, the Veteran's 50 percent disability rating became effective in August 2020. In October 2020, the RO proposed to reduce the Veteran's rating. As a result, the requirements under 38 C.F.R. § 3.344(a) and (b) do not apply. Nevertheless, as noted above, the Court has held that several general regulations are applicable to all rating reduction cases, without regard for how long a particular rating has been in effect. The Court has stated that certain regulations "impose a clear requirement that VA rating reductions, as with all VA rating decisions, be based upon a review of the entire history of the veteran's disability." Brown v. Brown, 5 Vet. App. 413, 420 (referring to 38 C.F.R. §§ 4.1, 4.2, 4.13). A rating reduction requires an inquiry as to "whether the evidence reflects an actual change in the disability and whether the examination reports reflecting such change are based upon thorough examinations." See Brown, 5 Vet. App. at 421. Significantly, in a rating reduction case, VA has the burden of establishing that the disability has improved. This is in stark contrast to a case involving a claim for an increased (i.e., higher) rating, in which it is the Veteran's responsibility to show the disability has worsened. A rating reduction case focuses on the propriety of the reduction and is not the same as an increased rating issue. See Peyton v. Derwinski, 1 Vet. App. 282, 286 (1991). In considering the propriety of a reduction, the Board must focus on the evidence available to the RO at the time the reduction was effectuated, although post-reduction medical evidence may be considered in the context of evaluating whether the condition had demonstrated actual improvement. Cf. Dofflemyer v. Derwinski, 2 Vet. App. 277, 281-282 (1992). The question of whether a disability has improved naturally involves consideration of the applicable rating criteria. At the time the Veteran's left knee osteoarthritis was increased to 50 percent disabling, he was rated Diagnostic Code 5261, which rates limitation of extension of the knee. Under Diagnostic Code 5261, a noncompensable rating is warranted for extension limited to 5 degrees. A 10 percent rating is warranted for extension limited to 10 degrees. A 20 percent rating is warranted for extension limited to 15 degrees. A 30 percent rating is warranted for extension limited to 20 degrees. A 40 percent rating is warranted for extension limited to 30 degrees. A 50 percent rating is warranted for extension limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261. An August 2020 VA examination report noted that the Veteran had extension limited to 20 degrees. The examiner concluded that the Veteran would not have any additional limitation of extension following repeated use or during flare-ups. However, the examiner also checked a box indicating that the Veteran had ankylosis of the left knee in flexion between 10 and 20 degrees. Based on the finding that the Veteran had ankylosis, in September 2020, the RO increased the Veteran's rating to 50 percent under Diagnostic Code 5256, which rates ankylosis of the knee, although the Board notes that ankylosis of the knee in flexion between 10 and 20 degrees actually warrants assignment of a 40 percent rating under the applicable diagnostic code. Diagnostic Code 5256 provides a 30 percent rating for ankylosis of a knee at a favorable angle in full extension, or in slight flexion between 0 degrees and 10 degrees. A 40 percent rating may be assigned for ankylosis of a knee in flexion between 10 degrees and 20 degrees. A 50 percent rating is available for ankylosis of a knee between 20 degrees and 45 degrees. A 60 percent rating is warranted for extremely unfavorable ankylosis of a knee in flexion at an angle of 45 degrees or more. 38 C.F.R. § 4.71a, Diagnostic Code 5256. However, in an October 2020 addendum, the examiner clarified that the box stating that the Veteran had ankylosis had been checked in error and that the Veteran did not in fact have ankylosis of the left knee. Shorty thereafter, the RO proposed to reduce the Veteran's 50 percent rating for left knee osteoarthritis, since it was based on incorrect data, and assign a 30 percent rating based on the finding that the Veteran's extension was limited to 20 degrees. These records support the RO's decision to reduce the Veteran's rating for left knee osteoarthritis. These records reflect that the 50 percent rating was assigned in error and that the Veteran does not actually have left ankylosis of the left knee. Additionally, VA outpatient treatment records, available through January 2021, do not show any worsening of the Veteran's left knee disability that would suggest the findings of the August 2020 VA examination were transient. Furthermore, while a June 2012 VA examination found extension limited to 35 degrees, at a December 2014 VA exam, no limitation of extension was observed. At a September 2017 VA examination, the Veteran's extension of the left knee was limited to 20 degrees, but no greater. At the August 2020 VA examination, the Veteran's extension was again limited to 20 degrees. Thus, the RO's decision to assign a 30 percent rating is consistent with the Veteran's level of disability not only at the Veteran's August 2020 VA examination, but throughout the period on appeal. Thus, as the preponderance of the evidence weighs against finding that the Veteran meets the criteria for a 50 percent rating for left knee osteoarthritis, the Board finds that the reduction in the Veteran's rating for left knee osteoarthritis was proper and restoration of a 50 percent rating from April 1, 2021 is not warranted. If in the future, the Veteran suffers a remission of his left knee disability or develops new symptoms he believes are related to this condition, he can submit a new claim for a higher rating. Accordingly, the claim is denied. There is no doubt to resolve. 38 U.S.C. § 5107(b). 5. Entitlement to a compensable rating for a surgical scar, left knee, is denied. The Veteran seeks a compensable rating for his service-connected left knee surgical scar. The Veteran's left knee surgical scar is rated under Diagnostic Code 7802. The Board notes that VA amended the criteria for rating skin disabilities effective from August 13, 2018. These new regulations apply to all applications for benefits received by VA or that are pending before the agency of original jurisdiction on or after August 13, 2018. Claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied. The Board may not apply a current regulation prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). However, the Board is not precluded from applying prior versions of the applicable regulation to the period on or after the effective dates of the new regulation if the prior version was in effect during the pendency of the appeal. Prior to August 13, 2018, Diagnostic Code 7802, was for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that were superficial and nonlinear. Under these criteria, a scar with an area or areas of 144 square inches (929 sq. cm.) or greater warrants a 10 percent rating. 38 C.F.R. § 4.118. Note 1 to Diagnostic Code 7802 instructed that a superficial scar was one not associated with underlying soft tissue damage. Id. Since August 13, 2018, Diagnostic Code 7802 is for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. 38 C.F.R. § 4.118. Diagnostic Code 7802 was otherwise unchanged by the August 13, 2018, amendments. The Board finds that the preponderance of the evidence is against the assignment of a compensable evaluation under Diagnostic Code 7802 because the Veteran's left knee surgical scar is not manifest by an area or areas of 144 square inches (929 sq. cm.) or greater and is not associated with underlying soft tissue damage. An October 2008 VA examination described the Veteran's left knee surgical scar as superficial and non-painful, normal in color and texture. It measured 1cm by 1cm. A November 2018 VA examination noted a faded 1cm by 1cm scar that was neither painful nor unstable. An August 2020 VA examination noted a 1cm by 0.1cm scar on the medial aspect of the left leg that was neither painful nor unstable. The Board has also considered the other Diagnostic Codes pertaining to scars. However, the Veteran's left knee surgical scar is not of the head, face, or neck, is not deep and non-linear, and is not associated with underlying soft tissue damage. Moreover, the Veteran's left knee surgical scar is not unstable or painful. Therefore, Diagnostic Codes 7800, 7801, and 7804, both prior to and from August 13, 2018, are inapplicable. Finally, the evidence of record shows there are no other disabling effects not considered in a rating provided under Diagnostic Codes 7800-04 as contemplated under both pre- and post-August 13, 2018, Diagnostic Code 7805. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's claim for a compensable rating for surgical scar, left knee. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. ROBERT N. SCARDUZIO Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E.D. Anderson, 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.