Citation Nr: 21042525 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 16-40 851 DATE: July 13, 2021 ORDER For the period on appeal prior to March 4, 2011, a rating in excess of 20 percent for right lower extremity sciatic radiculopathy is denied. For the period on appeal prior to October 30, 2014, a rating in excess of 20 percent for left lower extremity sciatic radiculopathy is denied. A rating in excess of 30 percent for right knee disability, status post total knee replacement (TKR), is denied. FINDINGS OF FACT 1. Prior March 4, 2011, the Veteran's right lower extremity radiculopathy was productive of no more than moderate incomplete paralysis of the sciatic nerve. 2. Prior October 30, 2014, the Veteran's left lower extremity radiculopathy was productive of no more than moderate incomplete paralysis affecting the sciatic nerve. 3. Throughout the period on appeal, beginning June 1, 2013, the Veteran's right knee disability, status post TKR, has not been manifested by severely limited motion (to include as due to pain), severe weakness, ankylosis in flexion between 10 and 20 degrees, extension limited to 30 degrees, or nonunion of the tibia or fibula with loose motion, requiring a brace, and s instability symptomatology is not separate and distinct from his TKR residuals. CONCLUSIONS OF LAW 1. For the period on appeal prior to March 4, 2011, the criteria for a rating in excess of 20 percent for right lower extremity sciatic radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.124a, Diagnostic Code (DC) 8520. 2. For the period on appeal prior to October 30, 2014, the criteria for a rating in excess of 20 percent for left lower extremity sciatic radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.124a, DC 8520 (2020). 3. The criteria for entitlement to a rating in excess of 30 percent for a right knee disability, status post TKR, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5055 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant in this case, served on active duty from April 1975 to April 1979. This matter comes before the Board of Veterans' Appeals (Board) on appeal from August 2009 and February 2015 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). With regard to the issue of entitlement to an increased rating for the right knee disability, this matter was adjudicated by the Board in a November 2018 decision. In that decision, the Board granted a temporary total (100 percent) rating for the period from August 1, 2010 to May 16, 2011, and a 30 percent rating, beginning May 17, 2011. The Board also denied entitlement to a rating in excess of 30 percent beginning June 1, 2013. The Veteran timely appealed the November 2018 Board decision to the United States Court of Appeals for Veterans Claims (Court). In a July 2019 Order, pursuant to a Joint Motion for Partial Remand (JMPR) submitted by counsel for the Veteran and VA, the Court vacated the November 2018 Board decision as to the issues of whether a rating in excess of 30 percent was warranted for the right knee disability for the period beginning June 1, 2013 and remanded this matter to the Board for action consistent with the JMPR, including consideration of whether a separate rating was warranted for right knee instability under DC 5257. In an April 2020 decision, the Board denied, in relevant part, a rating in excess of 20 percent prior to March 4, 2011 for right lower extremity sciatic radiculopathy; a rating in excess of 20 percent prior to October 30, 2014 for left lower extremity sciatic radiculopathy; and a rating in excess of 30 percent for right total knee replacement, status post arthroscopic partial meniscectomy. The Veteran timely appealed the April 2020 Board decision to the Court. In a January 2021 Order, pursuant to a JMPR submitted by counsel for the Veteran and VA, the Court vacated the April 2020 Board decision as to the issues detailed above and remanded this matter to the Board for action consistent with the JMPR. Increased Ratings Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. A veteran's entire history is to be considered when making disability evaluations (ratings). See generally 38 C.F.R. § 4.1. Staged ratings are appropriate when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). Where there is a question as to which of two evaluations (ratings) 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. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3. 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). 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 (musculoskeletal system) or § 4.73 (muscle injury); 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). Moreover, the provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to arthritis, and must be considered when raised by the claimant or when reasonably raised by the record. Burton v. Shinseki, 25 Vet. App. 1 (2011). The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14. The critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 1. Entitlement to a rating in excess of 20 percent for right lower extremity sciatic radiculopathy for the period on appeal prior to March 4, 2011. 2. Entitlement to a rating in excess of 20 percent for left lower extremity sciatic radiculopathy for the period on appeal prior to October 30, 2014. Here, in pertinent part, the Veteran is in receipt of a 20 percent rating for right lower extremity sciatic radiculopathy for the period on appeal prior to March 14, 2011. He is also in receipt of a separate 20 percent rating for left lower extremity sciatic radiculopathy for the period on appeal prior to October 30, 2014. He contends that higher ratings are warranted. As an initial matter, the Board notes that the period on appeal begins on August 3, 2006, the date the Veteran filed the claim for an increased rating that is at issue in this appeal. DC 8520 provides rating criteria for paralysis of the sciatic nerve. Under DC 8520, an 80 percent disability rating is assigned for complete paralysis of the sciatic nerve, demonstrated by foot drop, no active movement possible of the muscles below the knee, and knee flexion that is weakened or (very rarely) lost. Lower disability ratings are provided for incomplete paralysis, defined by the Rating Schedule as "a degree of lost or impaired function substantially less than the type picture for complete paralysis given." A 60 percent disability rating is assigned for severe, incomplete paralysis, with marked muscular atrophy. A 40 percent disability rating is assigned for moderately severe, incomplete paralysis. A 20 percent disability rating is assigned for moderate, incomplete paralysis. A 10 percent disability rating is assigned for mild, incomplete paralysis. 38 C.F.R. § 4.124a, DC 8520. Neuritis and neuralgia are to be rated as incomplete paralysis. Neuritis, "characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating," shall not be rated higher than severe, incomplete paralysis. 38 C.F.R. § 4.123. The maximum rating which may be assigned for "neuritis not characterized by organic changes referred to in this section" is moderate, or with sciatic nerve involvement, moderately-severe incomplete paralysis. Id. Neuralgia, "characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve," shall not be rated higher than moderate incomplete paralysis. 38 C.F.R. § 4.124. The Rating Schedule further clarifies that "when the [neural] involvement is wholly sensory, the rating should be for [ ] mild, or at most, [ ] moderate" incomplete paralysis. 38 C.F.R. § 4.124a. Neither the Rating Schedule nor the regulations provide definitions for descriptive words such as "mild," "moderate," "moderately severe," and "severe." Sellers v. Wilkie, 30 Vet. App. 157 (2018) ("DC 8520 does not define 'mild,' 'moderate,' 'moderately severe,' or 'severe,' or generally associate those terms with specific symptoms"). It should also be noted that use of terminology such as "mild" and "moderate" by VA examiners or other physicians, although an element of evidence to be considered by the Board, is not dispositive of an issue. Rather than applying a mechanical formula, the Board must instead evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. Turning to the evidence, in August 2006, the Veteran was afforded a VA back examination which included a neurological examination of his bilateral lower extremities. The Veteran reported stiffness with prolonged sitting or sitting and weakness with prolonged standing or walking. He also reported constant pain located in his back and hips that travels to his legs "sometimes" with a pain level of 6. The Veteran reported that the pain is elicited by physical activity and relieved by rest and medication and is combined with back spasms, limited motion, and "at times" numbness in his legs, but does not cause incapacitation. The examiner noted that the Veteran's posture and gait were within normal limits and that he used a corset for ambulation. Physical examination revealed no evidence of radiating pain on movement and muscle spasms are absent. Straight leg testing was positive bilaterally. The examiner indicated intervertebral disc syndrome (IVDS) with findings as follows: motor weakness in right and left knee extension 4/5/5 and 3/5/5, respectively; motor weakness in right and left hip adduction 3/5/5 and 3/5/5, respectively; and motor weakness in right and left hip abduction 3/5/5 and 4/5/5 in the sciatic nerve. These findings show slight to average weakness bilaterally. No bladder or bowel dysfunction was indicated. Reflex resting was normal (2+) in the bilateral knees and ankles. In a June 2007 private treatment record, the examiner reported radicular pain in the bilateral lower extremities. The examiner noted he was "slightly better" than his last visit but he still could not fully ambulate without use of a crutch due to increased pain with weight bearing. Physical examination revealed difficulty with muscle testing in the bilateral lower extremities causing increased back and leg pain especially with right hip flexion and left foot EHL testing and inversion against resistance. Sensation was intact and the examiner noted that the Veteran's toes are down-going with no clonus with Babinski testing. In January 2009, the Veteran was afforded a VA back examination which included a neurological examination of his bilateral lower extremities. The Veteran reported stiffness and numbness with constant pain located in his lumbar area that travels to his buttocks and down his leg with a pain level of 7. The Veteran reported the pain is elicited by physical activity and relieved by rest and medication and that he can function with medication. He also reported additional symptoms of spasms that are very painful where he cannot function for a period of time but denied incapacitation and loss of bladder or bowel control. The examiner noted that the Veteran's posture and gait were within normal limits and he required use of cane for ambulation. Physical examination revealed no evidence of radiating pain on movement, no tenderness, and muscle spasms are absent. Straight leg testing was positive bilaterally. The examiner indicated signs of IVDS with no lumbosacral motor weakness. Sensory deficit to the bilateral back of thighs was indicated. Reflex resting was normal (2+) in the bilateral knees and ankles. The examiner noted the effect of the Veteran's condition is moderately limiting and that he will experience pain and discomfort with prolonged walking, standing, bending at the waist, and lifting more than 20 pounds. In a March 2011 private treatment record, the Veteran complained of back pain that radiates to lateral right hip and right groin down right leg. Straight leg testing was positive bilaterally. Sensation and deep tendon reflex testing were both normal bilaterally. There was decreased strength in the Veteran's quads and hamstrings and with dorsiflexion of right leg. In a subsequent March 2011 private treatment record, two weeks later, the Veteran complained of low back pain and right buttock and right leg pain. Physical examination revealed a positive straight leg test on the right and a negative straight leg test on the left. His neurovascular function was intact. Muscle strength testing was normal (5/5), deep tendon reflexes were intact, and no clonus or spasticity were indicated. During his October 2014 Board Hearing, the Veteran reported constant back pain that radiates down his hips and legs and is temporarily relieved by pain medication. He also complained of difficulty with prolonged standing and sitting. Based on review of the evidence, both lay and medical, the Board finds that a rating in excess of 20 percent for right lower extremity sciatic radiculopathy is not warranted for the period on appeal prior to March 4, 2011. Furthermore, a rating in excess of 20 percent for left lower extremity sciatic radiculopathy is not warranted for the period on appeal prior to October 30, 2014. In support of this finding, the Board notes that the January 2009 VA examiner described the Veteran's condition as "moderately limiting," which is probative, though not dispositive, as it is based on examination of the Veteran and review of the record. The record reflects that that the Veteran experienced some bilateral lower extremity weakness and difficulty with muscle testing, though such symptoms are described as, at worst, "slight to average" and appear to be intermittent. See August 2006 VA examination report (showing slight to average weakness bilaterally), June 2007 private treatment record (noting difficulty with muscle testing in the bilateral lower extremities causing increased back and leg pain), and March 2011 private treatment record (noting decreased strength in the Veteran's quads and hamstrings and with dorsiflexion of the right leg); but see January 2009 VA examination report (reflecting no lumbosacral motor weakness), March 2011 private treatment record (noting normal (5/5) muscle strength testing). Thus, while the Veteran's radicular symptoms were not wholly sensory during the period on appeal, such non-sensory manifestations of the disability were no more than moderate in severity, even when considering the Veteran's reports of stiffness and numbness with constant pain located in his lumbar area that travels to his buttocks and down his leg with a pain level of 7 during the January 2009 VA examination, as cited in the JMPR. The August 2006 VA examination findings were also consistent with moderate. Furthermore, while the January 2009 VA examination indicated that the Veteran reported experiencing painful spasms to the extent that he was unable to function for a period of time, it is not clear from the examination report whether such spasms were of the bilateral lower extremities or the lumbar spine. Moreover, physical examination revealed no evidence of radiating pain on movement, no muscle spasms, no lumbosacral motor weakness, and reflex testing was normal bilaterally. For these reasons, the Board finds that the weight of the evidence supports findings that the Veteran's right lower extremity sciatic radiculopathy was no more than moderate in severity for the period on appeal prior to March 4, 2011, and his left lower extremity radiculopathy was no more than moderate in severity for the period on appeal prior to October 30, 2014. As such, ratings in excess of 20 percent are not warranted for the right lower extremity sciatic radiculopathy for the period on appeal prior to March 4, 2011, or for the left lower extremity radiculopathy for the period on appeal prior to October 30, 2014. Finally, the Board notes that at no point during either of the periods on appeal did the evidence indicate that the Veteran had marked muscular atrophy of either lower extremity or complete paralysis of the sciatic nerve, demonstrated by foot drop, no active movement possible of the muscles below the knee, and knee flexion that is weakened or (very rarely) lost. In summary, the Board herein denies entitlement to a rating in excess of 20 percent for the right lower extremity sciatic radiculopathy for the period on appeal prior to March 4, 2011. The Board also denies entitlement to a rating in excess of 20 percent for the left lower extremity radiculopathy for the period on appeal prior to October 30, 2014. Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017). 3. Entitlement to a rating in excess of 30 percent for right TKR is remanded. In pertinent part, the Veteran is currently in receipt of a 30 percent rating for a right TKR, effective June 1, 2013, under DC 5055, applicable to knee replacement (prosthesis). Prior to his April 2012 right TKR, his right knee disability was rated under DC 5257, applicable to recurrent subluxation or lateral instability, and a 30 percent rating was assigned for the period from May 1, 2006 to April 2, 2012. By way of history, the Veteran underwent a total right knee replacement on April 2, 2012. Prior to this, the Veteran was assigned a separate rating for right knee instability; however, in an October 2013 rating decision, the RO recharacterized the Veteran's disability as right total knee replacement and assigned a 100 percent rating under DC 5055, effective from April 2, 2012 through June 1, 2013, and a 30 percent rating thereafter. In doing so, the RO discontinued the assignment of a separate rating under DC 5257 for instability. Accordingly, a new rating was assigned for total knee replacement, right knee, under DC 5055 effective June 1, 2013. During the pendency of this appeal, the criteria for rating disabilities of the musculoskeletal system in the VA Schedule for Rating Disabilities was revised effective February 7, 2021. Significant changes were made to DCs 5055 and 5257, as detailed below. Accordingly, consideration of both the former and revised criteria is applicable here. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Prior to the February 7, 2021 amendments, DC 5055 provides that for one year following implantation of a knee prosthesis for a service-connected knee disability, a 100 percent rating is assigned. Thereafter, a 60 percent rating is assigned when there are chronic residuals consisting of severe painful motion or weakness in the affected extremity; otherwise, a minimum 30 percent rating is assigned. 38 C.F.R. § 4.71a. Furthermore, the prior version of DC 5055 specifies that a minimum 30 percent rating is assigned, but when there are intermediate degrees of residual weakness, pain, or limitation of motion, the disability is to be rated by analogy under 38 C.F.R. § 4.71a, DCs 5256 (knee ankylosis), 5261 (limitation of extension), or 5262 (impairment of the tibia and fibula) if applicable. However, no such rating by analogy is applied when there is evidence of chronic residuals consisting of severe painful motion or weakness in the affected extremity as that is provided in the maximum 60 percent rating under DC 5055. DCs 5256, 5261, and 5262 do not provide for any higher ratings; the maximum ratings available under these codes are 60 percent, 50 percent, and 40 percent, respectively. Effective February 7, 2021, DC 5055 provides a 100 percent rating for the four months following implantation of a knee prosthesis for a service-connected knee disability. Thereafter, the rating criteria remains the same with the exception that a separate evaluation for resurfacing after the conclusion of the 100 percent evaluation period may be warranted. Here, there is no evidence the Veteran's knees have undergone resurfacing during the appeal period. Thus, as it pertains to this particular Veteran, the old and new rating criteria under DC 5055 are the same. Prior to the February 7, 2021 amendments, DC 5257 provided ratings of 10, 20, and 30 percent for recurrent subluxation or lateral instability of the knee that is slight, moderate, or severe, respectively. 38 C.F.R. § 4.71a. Effective February 7, 2021, DC 5257 provides separate criteria for ratings based on recurrent subluxation or lateral instability and patellar instability. For recurrent subluxation or lateral instability, a 10 percent rating is warranted for a sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 20 percent rating is warranted for either (a) a sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribed either a brace and/or assistive device; or (b) unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 30 percent rating is warranted for unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device and bracing for ambulation. For patellar instability, a 10 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: A brace, cane, or walker. A 30 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. The words "slight", "moderate", and "severe" used in DC 5257 are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. Turning to the evidence, in September 2013, the Veteran was afforded a VA knee examination. He reported having a TKR but noted the condition has stayed the same. Range of motion findings indicated that right knee flexion was limited to 95 degrees, with painful motion beginning at 85 degrees. Extension was limited to 5 degrees, with painful motion beginning at 10 degrees. The Veteran was able to perform repetitive use testing with no change in range of motion. The examiner noted functional loss due to less movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, instability of station, disturbance of locomotion, and interference with sitting, standing, or weight-bearing which caused additional limitation in range of motion of 10 to 15 degrees with repeated use over time and during flare-ups. Muscle strength testing was a 4/5 in right knee flexion and extension, and x-rays showed a small supra-patella effusion of the right knee. There was tenderness or pain on palpation; and anterior, posterior, and medial-lateral instability of right knee (1+), but no subluxation. The examiner noted no use of assistive devices. His ability to work was noted to be impacted due to his inability to sit, stand, or walk for extended periods. In November 2018, the Veteran was afforded another VA knee examination. He reported worsening pain. He denied flareups, but indicated the functional loss of being unable to do any recreational activities and limited yard work. On examination, forward flexion was 90 degrees and extension was zero degrees. There was pain on flexion, pain with weightbearing, pain or tenderness on palpation, and pain that caused functional loss. The Veteran could perform repetitive use testing with no loss in function or range of motion, and there was no functional loss due to pain, fatigue, weakness, incoordination, or lack of endurance; however, the examiner noted other factors disability, including swelling, disturbance of locomotion, and interference with standing. There was no muscle atrophy, ankylosis, subluxation, instability, or effusion. Muscle strength testing was 4/5 in the right knee with flexion and extension. Joint stability testing was normal. The examiner noted the Veteran's occasional use of a cane and that his ability to work is impacted due to limitations with standing and squatting frequently and lifting and carrying 25 pounds. Beginning June 1, 2013, a rating in excess of 30 percent is not warranted under DC 5055 for the right knee, status post TKR. There is no evidence during the period on appeal of ankylosis, limitation of extension to 30 degrees or more, or of nonunion of the tibia and fibula with loose motion requiring a brace or analogous symptomology in either knee. As such, a rating in excess of 30 percent rated by analogy under Diagnostic Codes 5256, 5261, or 5262 is not established. Further, the Veteran's symptom presentation does not rise to the level of severe painful motion or weakness. Although pain on weight bearing was noted in the September 2013 VA examination report, the examiner found that the Veteran had no residuals of the right TKR, flexion was no worse than 85 degrees even with pain, extension was no worse than 10 degrees even with pain, there was no additional functional loss after repetitive use testing, and muscle strength was only mildly decreased (4/5). Weakened movement and instability were noted, but such instability was mild (1+). Even though the examiner noted functional loss due to less movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, instability of station, disturbance of locomotion, and interference with sitting, standing, or weight-bearing which caused additional limitation in range of motion of 10 to 15 degrees with repeated use over time and during flare-ups, this still did not constitute severe or intermediate painful motion or weakness as is required for a rating in excess of 30 percent under DC 5055. Furthermore, the Board notes that even upon consideration of this additional limitation in range of motion with repeated use over time and during flare-ups, a rating in excess of 30 percent is not warranted by analogy to DC 5261. Additionally, during the November 2018 VA examination, the examiner noted pain that causes functional loss with flexion to 90 degrees and again did not indicate even intermediate degrees of residual weakness, pain, or limitation of motion, even when considering Deluca factors with repeated use over time and his use of a cane. The Veteran denied flare-ups and muscle strength testing was only mildly decreased (4/5). Moreover, joint stability testing was normal. As such, the Board finds that the weight of the evidence reflects that the Veteran's right knee disability has not been characterized by either chronic residuals of severe painful motion or weakness, or intermediate degrees of residual weakness, pain, or limitation of motion at any point during the period on appeal. Finally, the Veteran is not entitled to a separate rating under DCs 5256, 5261, or 5262. The record does not reflect the Veteran ever had ankylosis or nonunion of the tibia and fibula during the appeal period. Although the September 2013 VA examiner found the Veteran's right knee extension was limited to 5 degrees, with additional limitation in range of motion of 10 to 15 degrees with repeated use over time and during flare-ups this would provide for a rating of no more than 30 percent under DC 5261. The Board also acknowledges the Veteran's reports of knee instability and giving way during the appeal period as well as the finding of bilateral knee instability by the September 2013 VA examiner. However, the Board finds that this symptom is contemplated in the rating assigned under DC 5055, as this evaluation includes weakness and is intended to compensate for all residuals of a knee replacement. Thus, to assign a separate rating under 38 C.F.R. § 4.71a, DC 5257 under the old or revised criteria, would constitute improper pyramiding. 38 C.F.R. § 4.14. See also Tedesco v. Wilkie, 31 Vet. App. 360, 367, n. 5 (2019) (where the Secretary argued that separate ratings under DC 5257 were prohibited in cases involving DC 5055 due to improper pyramiding, the Court, while remanding the issue for further consideration by the Board, declined to specifically address the question of whether the Board committed legal error when it found that a separate rating for instability under DC 5257 could be granted in addition to a rating for knee replacement under Diagnostic Code 5055 because to allow such a rating would constitute improper pyramiding). Additionally, the Board notes that under both the old and revised criteria, a 30 percent rating is the maximum evaluation under Diagnostic Code 5257, so a change in the applicable Diagnostic Code from DC 5055 to DC 5257 would not be favorable to the Veteran. Finally, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Accordingly, as the preponderance of the evidence is against the claim for a rating in excess of 30 percent for service-connected right knee disability, status post TKR, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Megan R. Thomas Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Asante, Ruby 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.