Citation Nr: 21042589 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 16-50 668 DATE: July 13, 2021 ORDER Entitlement to an increased evaluation in excess of 10 percent for a left knee disability is denied. Entitlement to a compensable rating for left knee residual scars is denied. Entitlement to a compensable rating for right knee residual scars is denied. FINDINGS OF FACT 1. The Veteran's left knee degenerative arthritis disability was manifested by painful motion, limitation of flexion at worst to 100 degrees, limitation of extension at worst to zero degrees, occasional swelling, weakness, and pain on motion; ankylosis has not been shown. 2. The Veteran's left knee scar has not been characterized as deep and nonlinear, and is considered stable and not painful. 3. The Veteran's right knee scar has not been characterized as deep and nonlinear, and is considered stable and not painful. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 10 percent for a left knee degenerative arthritis disability have not been met or approximated. 38 U.S.C. §§ 1155, 5107, 7104 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.20, 4.45, 4.59, 4.71a, Diagnostic Codes 5003-5260 (2020). 2. The criteria for a compensable rating for a left knee scar have not been met or approximated. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.321, 4.1-4.10, 4.118, Diagnostic Code 7805 (2020). 3. The criteria for a compensable rating for a right knee scar have not been met or approximated. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.321, 4.1-4.10, 4.118, Diagnostic Code 7805 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from November 1975 to December 1982, and again from October 1984 to September 1986. These matters come to the Board of Veterans' Appeals (Board) on appeal from August 2016 and June 2017 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office in Newark, New Jersey. In his October 2016 and January 2018 VA Form 9 substantive appeals, the Veteran indicated that he desired a Board hearing. However, he withdrew that request in January 2020, and the Board considers the original hearing requests to now be canceled. 38 C.F.R. § 20.704(e). The Board remanded the issues on appeal for additional development in January 2020. The directives having been substantially complied with, the matter again is before the Board. D'Aries v. Peake, 22 Vet. App. 97, 105 (2008); Stegall v. West, 11 Vet. App. 268 (1998). When a Veteran files a claim for an increased rating, he or she is presumed to be seeking the maximum benefit under any applicable theory, including TDIU. See generally Roberson v. Principi, 251 F.3d 1378 (Fed. Cir. 2001); Rice v. Shinseki, 22 Vet. App. 447 (2009). In light of this principle, entitlement to special monthly compensation (SMC) has been found to be an inferable issue anytime a veteran is requesting increased benefits. Akles v. Derwinski, 1 Vet. App. 118 (1991). Here, both VA and private medical records indicate the Veteran has been employed full time, and he has not asserted that his service-connected disabilities keep him from gaining and maintaining suitable employment. There is no further lay or medical evidence the Veteran is housebound in fact, requires aid and attendance, or that his disabilities result in loss of use of a limb or blindness. 38 U.S.C. §§ 1114(s), (l), (k); 38 C.F.R. § 3.350(a), (b), (i). The Board finds that consideration of TDIU and SMC are not inferred by the record, and as such will not be discussed. Veterans Claims Assistance Act of 2000 (VCAA) The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C. §§ 5102, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2020). The Veteran in this case has not referred to any deficiencies in either the duties to notify or assist; therefore, the Board may proceed to the merits of the claim. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015, cert. denied, U.S.C. Oct. 3, 2016) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board....to search the record and address procedural arguments when the [appellant] fails to raise them before the Board"); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to an appellant's failure to raise a duty to assist argument before the Board). The Board has reviewed all of the evidence in the Veteran's claims file. Although the Board has an obligation to provide adequate reasons and bases supporting this decision, there is no requirement that the evidence submitted by the Veteran or obtained on his behalf be discussed in detail. Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claim and what the evidence in the claims file shows, or fails to show, with respect to the claim. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) and Timberlake v. Gober, 14 Vet. App. 122, 128-130 (2000). Increased Schedular Ratings - General Disability evaluations are determined by the application of the facts presented to VA's Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. § Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § §§ 3.321(a), 4.1. If two disability evaluations are potentially applicable, 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. All reasonable doubt as to the degree of disability will be resolved in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § § 4.3. In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. § § 4.1 (2013); Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). That said, higher evaluations may be assigned for separate periods based on the facts found during the appeal period. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). This practice is known as staged ratings. Id. The determination of whether an increased disability rating is warranted is to be based on a review of the entire evidence of record and the application of all pertinent regulations. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). 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 (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) ("[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 [or 4.73] criteria."). The final sentence of 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. Correia v. McDonald, 28 Vet. App. 158 (2016). Additionally, the United States Court of Appeals for Veterans' Claims (Court) recently addressed what constitutes an adequate explanation for an examiner's inability to estimate motion loss in terms of degrees during periods of flare-ups. Sharp v. Shulkin, 29 Vet. App. 26 (2017). In Sharp, the Court held that a VA examiner must attempt to elicit information from the record and the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups before determining that an estimate of motion loss in terms of degrees could not be given. It also held that any inability to furnish such an estimate must be predicated on a lack of medical knowledge among the medical community at large, rather than insufficient knowledge by the individual examiner. Id. The Board also notes recent case law where the Court held that 38 C.F.R. § 4.59 does not solely condition the evaluation based on range of motion measurements for a particular diagnostic code, but rather "it conditions that award on evidence of an actually painful, unstable, or maligned joint or periarticular region and the presence of a compensable evaluation in the applicable diagnostic code." Southall-Norman v. McDonald, 28 Vet. App. 346, 352 (2016). The Board considers not only the criteria of the currently assigned diagnostic codes, but also the criteria of other potentially applicable diagnostic codes. In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § § 4.25. However, the evaluation of the same "disability" or the same "manifestations" under various diagnoses is not allowed. See 38 C.F.R. § § 4.14. A claimant may not be compensated twice for the same symptomatology as "such a result would overcompensate the claimant for the actual impairment of his [or her] earning capacity." See 38 U.S.C. § 1155 (2012); Brady v. Brown, 4 Vet. App. 203, 206 (1993). This would result in pyramiding, contrary to the provisions of 38 C.F.R. § § 4.14. However, if a veteran has separate and distinct manifestations attributable to the same injury, they should be compensated under different diagnostic codes. See Esteban v. Brown, 6 Vet. App. 259 (1994); Fanning v. Brown, 4 Vet. App. 225, 230 (1993). The assignment of a particular diagnostic code is "completely dependent on the facts of a particular case." See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, the current diagnosis, and the demonstrated symptomatology. Any change in a diagnostic code by VA must be specifically explained. See Pernorio v. Derwinski, 2 Vet. App. 625 (1992). If the evidence for and against a claim is in equipoise, the claim will be granted. 38 C.F.R. § 4.3. A claim will be denied only if the preponderance of the evidence is against the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). Any reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Knee Disabilities: Legal Standards The Veteran is currently rated under two separate diagnostic codes for each knee, under Diagnostic Codes 5260 and 5003 with a 10 percent rating, each effective from February 24, 2016. There are no other ratings for either knee, and in this appeal, only the left knee's evaluation on is on appeal. In assigning hyphenated diagnostic codes, the number assigned to the residual condition on the basis of which the rating is determined will generally represent injuries. Diseases will be identified by the number assigned to the disease itself, with the residual condition added, preceded by a hyphen. 38 C.F.R. § 4.27. Separate disability ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not "duplicative of or overlapping with the symptomatology" of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 262 (1994). See also VAOPGCPREC 9-04, 69 Fed. Reg. 59990 (2004) (holding that separate ratings under Diagnostic Code 5260 for limitation of flexion of the knee and Diagnostic Code 5261 for limitation of extension of the knee may be assigned). The rationale is that limitation of flexion and limitation of extension are two distinct impediments, i.e., the symptomatology upon which the separate ratings would be based is not duplicative or overlapping. VA General Counsel has also held that separate ratings may be assigned in cases where the service-connected knee disability includes both arthritis and instability. VAOPGCPREC 23-97 (July 1, 1997). VA's Office of the General Counsel (OGC) opined that it was not pyramiding to assign ratings under DC 5257 (knee instability) and DC 5260/61 based on additional disability. The opinion explained that DC 5257 addressed instability of the knee without reference to limitation of motion, and DC 5060/61 referenced limitation of motion without instability. Id. at para. 2. In other words, the two diagnostic codes addressed different manifestations or symptoms. In Lyles v. Shulkin, 29 Vet. App. 107 (2017), the Court held that evaluation of a knee disability under Diagnostic Codes 5260 and/or 5261 does not, as a matter of law, preclude separate evaluation of a meniscal disability of the same knee under Diagnostic Code 5258 or 5259, and vice versa. The Court further held that entitlement to a separate evaluation in a given case depends on whether the manifestations of disability for which a separate evaluation is being sought have already been compensated by an assigned evaluation under a different Diagnostic Code. In the context of evaluating musculoskeletal disabilities based on limitation of motion, a manifestation of disability has not been compensated, for separate evaluation and pyramiding purposes, if that manifestation did not result in an elevation of the evaluation under 38 C.F.R. §§ 4.40 and 4.45 pursuant to the principles set forth in DeLuca v. Brown, 8 Vet. App. 202 (1995). Included within 38 C.F.R. § 4.71a are multiple Diagnostic Codes that evaluate impairment resulting from service-connected knee disorders, including Diagnostic Code 5256 (ankylosis), Diagnostic Code 5257 (other impairment, including recurrent subluxation or lateral instability), Diagnostic Code 5258 (dislocated semilunar cartilage), Diagnostic Code 5259 (symptomatic removal of semilunar cartilage), Diagnostic Code 5260 (limitation of flexion), Diagnostic Code 5261 (limitation of extension), Diagnostic Code 5262 (impairment of the tibia and fibula), and Diagnostic Code 5263 (genu recurvatum). However, based on the medical evidence before the Board, ankylosis, impairment of the tibia and fibula, and genu recurvatum have not been found or associated with the Veteran's knee disabilities and thus will not be considered here. VA's schedule of musculoskeletal rating changes, found in 38 C.F.R. § 4.71a, was modified with the changes in effect on February 7, 2021. See 85 Fed. Reg. 76453 (Nov. 30, 2020). A small modification was also made to Diagnostic Code 5003, which was announced in a corrected final rule. See 85 Fed. Reg. 85523 (Dec. 29, 2020). Pertinent to this appeal, Diagnostic Code 5003 was modified in its title to now read "Degenerative arthritis, other than post-traumatic." Id. No other changes pertinent to this claim are applicable for this particular appeal. Absent any Congressional intent or directive with regard to new or revised regulations, when a claim originates prior to the effective date of the new language but is decided after the effective date, VA will use the version that provides the Veteran a greater benefit. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). The remainder of the pertinent diagnostic codes are unchanged and are as follows. Under Diagnostic Code 5260, a non-compensable rating will be assigned for limitation of flexion of the leg to 60 degrees; a 10 percent rating will be assigned for limitation of flexion of the leg to 45 degrees; a 20 percent rating will be assigned for limitation of flexion of the leg to 30 degrees; and a 30 percent rating will be assigned for limitation of flexion of the leg to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Under Diagnostic Code 5261, a non-compensable rating will be assigned for limitation of extension of the leg to 5 degrees; a 10 percent rating will be assigned for limitation of extension of the leg to 20 degrees; a 20 percent rating will be assigned for limitation of extension of the leg to 15 degrees; a 30 percent rating will be assigned for limitation of extension of the leg to 20 degrees, a 40 percent rating will be assigned for limitation of extension to 30 degrees, and a 50 percent rating will be assigned for limitation of extension to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261. Normal range of motion of the knee is to zero degrees extension and to 140 degrees flexion. See 38 C.F.R. § 4.71a, Plate II. For Diagnostic Code 5003, degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved (DC 5200 etc.). When however, 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. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, rate as follows: a 10 percent evaluation is assigned for painful or limited motion of a major joint or group of minor joints and may also be applied once to multiple joints if there is no limited or painful motion. A 20 percent is assigned for X-ray evidence that shows involvement of two or more major joints or two or more minor joint groups with occasional incapacitating exacerbations. Note (1): The 20 percent and 10 percent ratings based on X-ray findings, above, will not be combined with ratings based on limitation of motion. 38 C.F.R. § 4.71a. The terms "slight," "marked," "moderate," and "severe" are not defined in the rating schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to arrive at a just and equitable decision. Additionally, the use of such terminology by VA examiners and others, although an element to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6. Evidence and Analysis Left Knee Increased Evaluation Service connection for both left knee and right knee degenerative arthritis was granted in a June 2016 rating decision, each with a 10 percent evaluation effective from the date of claim of February 24, 2016 under Diagnostic Codes 5260 and 5003. On January 17, 2017, the Veteran filed a claim for an increased evaluation of the left knee only. The Veteran did not appeal the evaluation for the right knee. In a June 12, 2017 rating decision, the Veteran's left knee evaluation was continued at 10 percent under Diagnostic Codes 5260 and 5003, and the RO also granted service connection for both a right knee scar and a left knee scar, each with a noncompensable evaluation effective from February 24, 2016. In December 2017, the Veteran filed a notice of disagreement with the June 2017 rating decision, arguing that his left knee evaluation should be at least 20 percent and each of his scar ratings should be 10 percent. As the Veteran has continuously pursued his claim for his left knee and the bilateral knee scars, the Board will evaluate the disabilities from the original effective date of service connection. Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran received a VA knee examination in June 2016. Bilateral knee degenerative osteoarthritis was diagnosed, and no other condition of the knees. The Veteran reported pain in his knees and flareups were noted after prolonged standing or walking. No functional loss or impact was noted by the examiner. Left knee flexion and extension was 110 to zero degrees, and the abnormal range of motion did not contribute to functional loss. Pain was not noted on weight bearing. Objective evidence of crepitus was noted, but no ankylosis. There was no change in range of motion measurements after three repetitions. Muscle strength was five on a scale of five and there was no muscle atrophy reported. Joint stability testing was accomplished and was normal for each knee joint. There was no history of recurrent patellar dislocation, lateral instability, recurrent effusion, shin splints, stress fractures, compartment syndrome, or any other tibial and/or fibular impairment. The examiner noted no history of any meniscal condition in either knee. The examiner noted the Veteran occasionally used a brace on his knee. X-rays taken as part of this examination indicated degenerative arthritis, characterized as bilateral tricompartmental osteoarthritis. This examiner considered evidence of scars related to the knee disabilities on this June 2016 VA examination. The Veteran reported previous arthroscopies on each knee and the examiner found a "scope scar" on each knee, approximately one centimeter in length. Neither knee scar was considered unstable and painful; each scar was considered superficial and linear. The Veteran received a VA knee examination in February 2017. Bilateral knee degenerative osteoarthritis was diagnosed, and no other condition of the knees. The Veteran reported pain in his knees and flareups were noted after prolonged standing or walking, especially if going up an incline. No functional loss or impact was noted by the examiner. Left knee flexion and extension was 115 to zero degrees, and the abnormal range of motion did not contribute to functional loss. Pain was not noted on weight bearing. Objective evidence of crepitus was noted. There was no change in range of motion measurements after three repetitions. The examiner estimated range of motion during a flareup to be 110 degrees of flexion to zero degrees of extension. Muscle strength was five on a scale of five and there was no muscle atrophy reported. Joint stability testing was accomplished and was normal for each knee joint. There was no history of recurrent patellar dislocation, lateral instability, recurrent effusion, shin splints, stress fractures, compartment syndrome, or any other tibial and/or fibular impairment. The examiner noted no history of any meniscal condition in either knee. The examiner noted the Veteran occasionally used a brace on his knee. X-rays taken as part of this examination indicated degenerative arthritis, characterized as bilateral tricompartmental osteoarthritis. This examiner considered evidence of scars related to the knee disabilities. The Veteran reported previous arthroscopies on each knee but the examiner found no residual scarring with the examination, and postulated that the scars have dissipated with the passage of time. The Veteran received another VA examination for his knees, to include the knee scars so claimed, in March 2020. The examiner diagnosed degenerative arthritis of each knee, and the Veteran reported pain in each knee, and that his left knee had a meniscal tear repaired in a 1995 arthroscopy. The Veteran reported pain in his knees and flareups were noted after prolonged standing or walking, and were unpredictable. No functional loss or impact was noted by the examiner. Left knee flexion and extension was 100 to zero degrees, and the abnormal range of motion did contribute to functional loss, in that increased range of motion increased the level of pain. Pain was noted on weight bearing. Objective evidence of crepitus was not noted, and no ankylosis was noted. There was no change in range of motion measurements after three repetitions. The examiner estimated no change in range of motion during a flareup. Muscle strength was five on a scale of five and there was no muscle atrophy reported. Joint stability testing was accomplished and was normal for each knee joint. There was no history of recurrent patellar dislocation, lateral instability, recurrent effusion, shin splints, stress fractures, compartment syndrome, or any other tibial and/or fibular impairment. The examiner noted the history of the meniscal condition in the left knee. The examiner noted the Veteran occasionally used a brace on his knee. X-rays taken as part of this examination indicated degenerative arthritis, characterized as bilateral tricompartmental osteoarthritis. Functional impact of the current knee disability was described as requiring the Veteran to stop and rest every 20 minutes of walking. This examiner considered evidence of scars related to the knee disabilities. For the right knee, a scar measuring 2.5 centimeters by 0.25 centimeters was noted on the right patella, medial aspect. The left knee had a small surgical scar on the left medial aspect of the patella, 2.0 centimeters by 0.5 centimeters. The examiner characterized both scars as superficial and linear, and as stable and not painful. 1. Entitlement to an increased evaluation in excess of 10 percent for a left knee disability For the Veteran's left knee degenerative arthritis under Diagnostic Codes 5003 and 5260, for the entire period on appeal, the Board finds that a 10 percent evaluation for the left knee, but no higher, is warranted. While the flexion measurements in this period would not warrant a compensable rating for the left knee, a rating of 10 percent is appropriate here due to painful motion of the left knee, where the minimum compensable evaluation is 10 percent because 38 C.F.R. § 4.59 allows for consideration of functional loss due to painful motion to be rated to at least the minimum compensable rating for a particular joint. Painful, unstable, or misaligned joints, due to healed injury, are entitled to at least the minimum compensable rating for the joint, which for the right knee, is 10 percent. 38 C.F.R. § 4.59; see Southall-Norman v. McDonald, 28 Vet. App. 346, 352 (2016); Petitti v. McDonald, 27 Vet. App. 415 (2015). A higher evaluation of 20 percent is not warranted for limitation of flexion unless the evidence shows a limitation of flexion of 16-30 degrees under Diagnostic Code 5260. A higher evaluation of 20 percent under Diagnostic Code 5261 is not warranted for limitation of extension unless the evidence shows a limitation of extension to 15 degrees. This has never been shown, even with consideration of additional loss of motion due to pain and swelling during flare-ups. The Board has also considered but declines to find any additional rating for the left knee for instability. While VA General Counsel has held that separate ratings may be assigned in cases where the service-connected knee disability includes both arthritis and instability, no VA examiner has found instability for the left knee. VAOPGCPREC 23-97 (July 1, 1997). The Board has also considered the findings regarding objective evidence of knee instability versus subjective reporting of instability by the Veteran in this case. See English v. Wilkie, 30 Vet. App. 347, 353 (2018) (holding that the Board cannot categorically favor objective stability test results over lay reports of instability). Here, the Board notes there were no reports of instability by either the Veteran or VA medical examiners pertinent to this period from February 24, 2016, the effective date of the left knee rating. Id.; see also Tedesco v. Wilkie, 31 Vet. App. 360, 367 (2019). Besides instability under Diagnostic Code 5257, the Board has considered other diagnostic codes for the Veteran's left knee disability, to include ankylosis (Diagnostic Code 5256), disabilities involving cartilage, semilunar, dislocated, with frequent episodes of locking, pain, and effusion into the joint (Diagnostic Code 5258), removal of the semilunar cartilage (Diagnostic Code 5259), extension (Diagnostic Code 5261), malunion/nonunion of the tibia and fibula (Diagnostic Code 5262), and genu recurvatum (Diagnostic Code 5263), and found them to not apply to the Veteran's left knee disability picture in this period. 38 C.F.R. § 4.71a, Diagnostic Codes 5256, 5258, 5259, 5260, 5261, 5262, 5263. The Board is cognizant that VA examiners have recorded different ranges of motion, but all examiners have noted the consistent pain and pain on motion of the Veteran's left knee. Furthermore, the Veteran's lay statements are consistent over time and correspond to the medical evaluations and treatment notes in the record. "[O]bjective evidence does not necessarily mean [only] medical evidence." Petitti v. McDonald, 27 Vet. App. 415, 427 (2015); see Southall-Norman v. McDonald, 28 Vet. App. 346, 352 (2016). The Veteran is competent to report pain on motion and limitation of movement. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24 Vet. App. 428 (2011). Moreover, the Board finds him credible, as his reports are internally consistent and there is no evidence to the contrary. Caluza v. Brown, 7 Vet. App. 498 (1995). Additionally, the Board has considered the statements regarding flareups by the Veteran, but based on the medical evidence, even with estimates of motion loss in terms of degrees during periods of flare-ups, the criteria for higher evaluations based on range of motion have not been met or approximated. Sharp v. Shulkin, 29 Vet. App. 26 (2017). All potentially applicable diagnostic codes have been considered, and there is no basis to assign an alternative evaluation for the Veteran's left knee disability other than that discussed above. See Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). Staged ratings are not warranted beyond that discussed, as the Veteran has had a stable level of symptomatology throughout the appeal period. Any increases in severity were not sufficient for a higher rating for the reasons discussed above. See Hart, 21 Vet. App. 505. 2. Entitlement to a compensable rating for left knee residual scars 3. Entitlement to a compensable rating for right knee residual scars The Veteran is seeking an initial compensable evaluation for his service-connected scars of the left knee and the right knee. The Veteran indicated he has had arthroscopies on each knee at varying times to deal with meniscal tears of each knee. The Veteran's bilateral knee scars have been evaluated as noncompensably disabling under Diagnostic Code 7805, which is assignable for scars, other; and other effects of scars evaluated under diagnostic codes 7800, 7801, 7802, or 7804. Given the number, size, and type of the Veteran's scars, Diagnostic Code 7802 covers burn scars or scars due to other causes, not of the head, face, or neck, that are superficial and nonlinear, that are not associated with underlying soft tissue damage. A 10 percent evaluation is provided when the area of the scars is 144 square inches or greater. Note (1) specifies that a superficial scar is one not associated with underlying soft tissue damage. Diagnostic Code 7804 covers scars that unstable or painful. Three or four scars that are unstable or painful merit a 20 percent evaluation; one or two scars that are unstable or painful merit a 10 percent evaluation. 38 C.F.R. § 4.118, Diagnostic Codes 7802, 7804, 7805. The Veteran received examinations of his knee scars as part of his VA knee examinations discussed earlier. The June 2016 VA examiner noted "scope scars' of each knee, about one centimeter in length, and considered them superficial and linear; neither was unstable or painful. The February 2017 VA examination did not note specific scars of either knee, and the March 2020 VA examiner noted the scars on each knee, considering them superficial and linear, and neither was unstable or painful. Based on a preponderance of the medical and other evidence, including the Veteran's lay statements, the Board finds that a compensable evaluation is not warranted for either of the Veteran's service-connected left knee or right knee scars. 38 C.F.R. § 4.118, Diagnostic Code 7805. A compensable rating under Diagnostic Code 7802 is not possible unless the area of the scars is 144 square inches or greater, and that they are superficial and nonlinear. Here the total area of the scar is less than 2 inches square in total for the scar on the left knee or the right knee, and it is deemed superficial and linear. Neither knee scar was considered unstable or painful. A compensable rating under Diagnostic Code 7804 is not possible unless the scars are considered unstable or painful. Here, the medical evidence indicates that none of the scars are considered unstable or painful. 38 C.F.R. § 4.118, Diagnostic Codes 7802, 7804, 7805. After careful review of the clinical findings, the Board finds that during the course of the appeal the Veteran has not had symptoms more nearly approximating the criteria for a compensable rating for scars on either the left knee or the right knee. Accordingly, the Board finds that the preponderance of the evidence is against the claim for a compensable rating for his left knee or right knee scars. To this extent, the appeal is denied. Because the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 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, 369 (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). MICHAEL A. PAPPAS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Setter, 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.