Citation Nr: 22011419 Decision Date: 02/28/22 Archive Date: 02/28/22 DOCKET NO. 10-18 517A DATE: February 28, 2022 ORDER An effective date earlier than April 20, 2009, for the grant of service connection for status post right rotator cuff tear with acromioclavicular joint arthritis (right shoulder disability) is denied. An effective date earlier than April 20, 2009, for the grant of service connection for status post left rotator cuff tear with degenerative arthritis (left shoulder disability) is denied. An effective date earlier than October 22, 2014, for the grant of service connection for radiculopathy in the right lower extremity is denied. An effective date earlier than October 22, 2014, for the grant of service connection for radiculopathy in the left lower extremity is denied. Restoration of a 30 percent rating for chondromalacia, right knee with degenerative joint disease from October 1, 2021, is granted. Restoration of a 30 percent rating for chondromalacia, left knee with degenerative joint disease from October 1, 2021, is granted. A rating in excess of 10 percent for chondromalacia, right knee with degenerative joint disease prior to October 29, 2014, is denied. A rating in excess of 10 percent for chondromalacia, left knee with degenerative joint disease prior to October 29, 2014, is denied. A rating in excess of 30 percent for chondromalacia, right knee with degenerative joint disease since October 29, 2014, is denied. A rating in excess of 30 percent for chondromalacia, left knee with degenerative joint disease since October 29, 2014, is denied. A separate 30 percent rating for limitation of right knee extension associated with chondromalacia with degenerative joint disease, from May 28, 2015, but no earlier, is granted. A separate 30 percent rating for limitation of left knee extension associated with chondromalacia with degenerative joint disease, from May 28, 2015, but no earlier, is granted. A 20 percent rating, but no higher, for right knee instability, prior to October 29, 2014, is granted. A 20 percent rating, but no higher, for left knee instability, prior to October 29, 2014, is granted. A rating in excess of 20 percent for right knee instability, since October 29, 2014, is denied. A rating in excess of 20 percent for left knee instability, since October 29, 2014, is denied. REMANDED The issue of a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. There is no evidence of any unadjudicated formal or informal claim of service connection for right or left shoulder disabilities after a March 2005 final rating decision (denying service connection for right and left shoulder disabilities) and prior to April 20, 2009. 2. The service connection claim for radiculopathy in the right and left lower extremities was part and parcel of the April 20, 2009, initial higher rating claim for a low back disability; the Veteran's radiculopathy in the right and left lower extremities had their onset on October 22, 2014, which is later than the date of claim. 3. The reduction in the disability ratings for chondromalacia with degenerative joint disease of the right and left knees from 30 percent ratings to 10 percent ratings were not based on evidence of sustained material improvement under the ordinary conditions of life. 4. Prior to October 29, 2014, the Veteran's limitation of right and left knee flexion did not more nearly approximate limitation of flexion to 30 degrees even considering pain, flare ups, and other functional factors. 5. Since October 29, 2014, the Veteran is in receipt of the maximum schedular ratings for limitation of right and left knee flexion. 6. Prior to May 28, 2015, there was no limitation of right or left knee extension, even considering pain, flare ups, and other functional factors. 7. Since May 28, 2015, the Veteran's limitation of right and left knee extension manifested by, at most, limitation of extension to 20 degrees. 8. Throughout the appeal period, the Veteran's right and left knee instability manifested by, at most, moderate right and left knee instability; he did not have unrepaired or failed repair of complete ligament tear causing persistent instability or 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. 9. Throughout the appeal period, there was no right or left knee ankylosis, semilunar cartilage dislocation or removal, symptomatic tibia or fibula impairment, or genu recurvatum. CONCLUSIONS OF LAW 1. The criteria for an effective date earlier than April 20, 2009, for the grant of service connection for a right shoulder disability are not met. 38 U.S.C. §§ 5110(a), 7105(d)(3); 38 C.F.R. §§ 3.104, 3.155 (in effect prior to March 24, 2015), 3.156, 3.400, 20.302, 20.1103. 2. The criteria for an effective date earlier than April 20, 2009, for the grant of service connection for a left shoulder disability are not met. 38 U.S.C. §§ 5110(a), 7105(d)(3); 38 C.F.R. §§ 3.104, 3.155 (in effect prior to March 24, 2015), 3.156, 3.400, 20.302, 20.1103. 3. The criteria for an effective date earlier than October 22, 2014, for the grant of service connection for radiculopathy in the right lower extremity are not met. 38 U.S.C. §§ 5110(a), 7105(d)(3); 38 C.F.R. §§ 3.104, 3.155 (in effect prior to March 24, 2015), 3.156, 3.400, 20.302, 20.1103. 4. The criteria for an effective date earlier than October 22, 2014, for the grant of service connection for radiculopathy in the left lower extremity are not met. 38 U.S.C. §§ 5110(a), 7105(d)(3); 38 C.F.R. §§ 3.104, 3.155 (in effect prior to March 24, 2015), 3.156, 3.400, 20.302, 20.1103 5. The criteria for a restoration of a 30 percent rating for chondromalacia, right knee with degenerative joint disease from October 1, 2021, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.105(e), 3.344. 6. The criteria for a restoration of a 30 percent rating for chondromalacia, left knee with degenerative joint disease from October 1, 2021, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.105(e), 3.344. 7. The criteria for a rating in excess of 10 percent for chondromalacia, right knee with degenerative joint disease, prior to October 29, 2014, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.71a, DC 5260. 8. The criteria for a rating in excess of 10 percent for chondromalacia, left knee with degenerative joint disease, prior to October 29, 2014, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.71a, DC 5260. 9. The criteria for a rating in excess of 30 percent for chondromalacia, right knee with degenerative joint disease, since October 29, 2014, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.71a, DC 5260. 10. The criteria for a rating in excess of 30 percent for chondromalacia, left knee with degenerative joint disease, since October 29, 2014, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.71a, DC 5260. 11. The criteria for a separate 30 percent rating for limitation of right knee extension associated with chondromalacia with degenerative joint disease, from May 28, 2015, but no earlier, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.71a, DC 5261. 12. The criteria for a separate 30 percent rating for limitation of left knee extension associated with chondromalacia with degenerative joint disease, from May 28, 2015, but no earlier, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.71a, DC 5261. 13. The criteria for a 20 percent rating, but no higher, for right knee instability prior to October 29, 2014, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.71a, DC 5257. 14. The criteria for a 20 percent rating, but no higher, for left knee instability prior to October 29, 2014, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.71a, DC 5257. 15. The criteria for a rating in excess of 20 percent for right knee instability since October 29, 2014, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.71a, DC 5257. 16. The criteria for a rating in excess of 20 percent for left knee instability since October 29, 2014, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.71a, DC 5257. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1980 to April 1982. This matter comes before the Board of Veterans' Appeals (Board) on appeal from September 2009 and September 2018 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). In November 2017 and February 2021, the Board remanded the issues of higher ratings for the right and left knee disabilities and a TDIU for further development. Specifically, the Board remanded the issues of higher ratings for the right and left knee disabilities to schedule the Veteran for an examination to determine the severity of his service-connected right and left knee disabilities, to include compliance with Correia v. McDonald, 28 Vet. App. 158 (2016). In March 2021, the Veteran was afforded a VA knee examination with an addendum opinion that reflects the current severity of his service-connected right and left knee disabilities. The March 2021 VA knee examination provides sufficient findings that complied with the requirements in Correia, as the examiner provided active and passive motion range of motion measurements. The March 2021 VA examination is sufficient for evaluation purposes, as the examiner rendered findings responsive to the rating criteria. See 38 C.F.R. § 4.2. Therefore, the agency of original jurisdiction (AOJ) complied with the Board's remand instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998). Also, in February 2021, the Board remanded the issues of earlier effective dates for the grants of service connection for a right shoulder disability, left shoulder disability, radiculopathy in the right lower extremity, and radiculopathy in the left lower extremity for an issuance of a Statement of Case (SOC), as a SOC had not been issued following the Veteran's timely November 2018 notice of disagreement (NOD) to the September 2018 rating decision. Following the February 2021 remand, a SOC was issued later that month, in February 2021, and the Veteran submitted a timely VA Form 9 (substantive appeal). In a July 2021 rating decision, while on remand, the Decision Review Officer (DRO) reduced the Veteran's chondromalacia with degenerative joint disease of the right and left knee ratings from a 30 percent rating to a 10 percent rating, effective October 1, 2021. The rating reductions claims are separate from increased ratings claims. Dofflemyer v. Derwinski, 2 Vet. App. 277, 279-80 (1992). Notably, although in August 2021, the Veteran submitted a higher-level review request, indicating that he disagreed with the July 2021 rating decision, he did not check the opt-in box or include a letter specifically withdrawing the higher rating claims for his right and left knee disabilities from the legacy appeal. In this case, the rating reductions resulted from the Veteran's higher rating claims for his right and left knee disabilities and the reduction was effectuated by the RO despite the fact that the Board held jurisdiction over higher rating claims for his right and left knee disabilities. Therefore, both the higher rating claims for the Veteran's right and left knee disabilities and the propriety of the rating reductions are on appeal, as reflected on the title page. Effective Date Generally, the effective date of an evaluation and award of pension, compensation or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. The effective date for an award of disability compensation based on an original claim for direct service connection is the day following separation from active service or the date entitlement arose if a claim is received within one year after separation from service. Otherwise, the effective date is the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(b)(1); 38 C.F.R. § 3.400(b)(2)(i). VA amended its adjudication regulations on March 24, 2015, to require that all claims governed by VA's adjudication regulations be filed on standard forms prescribed by the Secretary, regardless of the type of claim or posture in which the claim arises. See 79 Fed. Reg. 57660 (Sept. 25, 2014). The amendments, however, are only effective for claims and appeals filed on or after March 24, 2015. As the claims of service connection for right and left shoulder disabilities and radiculopathy in the right and left lower extremities (which was part and parcel of the April 20, 2009, initial rating claim for the low back disability) were filed prior to that date, the amendments are not applicable with those issues and the regulations in effect prior to March 24, 2015, will be applied for those issues. Under the former legal authority, any communication or action, indicating an intent to apply for one or more benefits under laws administered by VA, from a veteran or his representative, may be considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within one year from the date it was sent to the veteran, it will be considered filed as of the date of receipt of the informal claim. 38 C.F.R. § 3.155(a) (in effect prior to March 24, 2015). There is no set form that an informal written claim must take. All that is required is that the communication indicates an intent to apply for one or more benefits under the laws administered by VA, and identify the benefits sought. Rodriguez v. West, 189 F.3d 1351 (1999). While a pro se claimant's claim must identify the benefit sought, the identification need not be explicit in the claim-stating documents but can also be found indirectly through examination of evidence to which those documents themselves point when sympathetically read. Shea v. Wilkie, 926 F.3d 1362, 1369 (Fed. Cir. 2019). An informal claim may be raised by language that points to records mentioning a condition in a way that, sympathetically read, is properly understood as seeking benefits for such a condition. Id. at 1370. Where a claimant's filings refer to specific medical records, and those records contain a reasonably ascertainable diagnosis of a disability, the claimant has raised an informal claim for that disability under § 3.155(a). Id. However, a veteran's legally sufficient claim must provide information, even at a high level of generality, to identify the sickness, disease, or injury for which benefits are sought. Sellers v. Wilkie, 965 F.3d 1328, 1337 (Fed. Cir. 2020). 1. An effective date earlier than April 20, 2009, for the grant of service connection for a right shoulder disability. 2. An effective date earlier than April 20, 2009, for the grant of service connection for a left shoulder disability. The current effective date of the grant of service connection for right and left shoulder disabilities is April 20, 2009, the day VA received the Veteran's application to reopen his claims of service connection for right and left shoulder disabilities. The Veteran contends that he is entitled to an effective date earlier than April 20, 2009, for the grant of service connection for right and left shoulder disabilities. See attorney's brief (April 2021). Neither the Veteran nor his attorney have presented any specific argument as to why an earlier effective date is warranted for the grant of service connection for right and left shoulder disabilities. For the following reasons, an effective date earlier than April 20, 2009, for the grant of service connection for right and left shoulder disabilities is not warranted. In a March 2005 rating decision, the RO initially denied service connection for right and left shoulder disabilities. Later that month in March 2005, the Veteran was notified of the March 2005decision. The Veteran did not appeal the March 2005 decision within one year of its issuance, and new and material evidence was not received within that year. In fact, in a June 2006 statement, the Veteran wrote that he was withdrawing his service connection compensation claims. Therefore, the March 2005 decision became final. See 38 U.S.C. § 7105 (d)(3); Bond v. Shinseki, 659 F.3d 1362 (Fed. Cir. 2011); 38 C.F.R. §§ 3.104, 3.156(a)-(b), 20.302, 20.1103. Between the March 2005 rating decision (and its contemporaneous notification letter) and April 20, 2009, that is, the day VA received the Veteran's application to reopen his claims of service connection for right and left shoulder disabilities, there is no formal or informal claims of service connection for right and left shoulder disabilities. Following the Veteran's April 20, 2009, application to reopen his claims of service connection for right and left shoulder disabilities, a rating decision in May 2010 was issued denying service connection for right and left shoulder disabilities on the basis that new and material evidence had not been submitted since the March 2005 rating decision. The Veteran appealed the May 2010 rating decision to the Board. In November 2017, the Board granted service connection for right and left shoulder disabilities. In the September 2018 rating decision, the RO implemented the Board's grants of service connection for right and left shoulder disabilities and assigned an effective date, for both disabilities, of March 14, 2010. In November 2018, the Veteran submitted a timely NOD indicating that he disagreed with the effective date of the grant of service connection for right and left shoulder disabilities. In a May 2020 rating decision, the DRO granted an earlier effective date of April 20, 2009, for the grant of service connection for right and left shoulder disabilities. The DRO reasoned, that on April 20, 2009, the Veteran's submitted statement (where he reported that his service-connected knee disabilities caused shoulder disabilities) was received. The DRO indicated that the April 2009 statement was "sympathetically interpreted" as a claim to reopen the previously denied claims of service connection for right and left shoulder disabilities. There is no evidence of any unadjudicated formal claims of service connection for right and left shoulder disabilities after the March 2005 final rating decision and prior to April 20, 2009, nor is there any prior communication in the record that could be considered an informal claim for VA compensation for the same. In addition, there are no records mentioning right and left shoulder disabilities in a way that, sympathetically read, can be understood as seeking benefits for those disabilities after the March 2005 final rating decision and prior to April 20, 2009. Shea v. Wilkie, 926 F.3d at 1370 ("language that points to records mentioning... a condition in a way that, sympathetically read, is properly understood as seeking benefits for such a condition" can satisfy the "identify the benefit sought" requirement of 38 C.F.R. § 3.155(a)); Sellers, 30 Vet. App. at 163 ("The Secretary is correct that a general statement of intent to seek benefits for unspecified disabilities standing alone is insufficient to constitute a claim. Yet, the Secretary's argument misses a crucial additional factor present here: evidence of reasonably identifiable in-service diagnoses of psychiatric conditions that predate the appellant's claim were in the possession of the RO before it rendered its rating decision"). As the evidence is against the claim, the benefit-of-the-doubt doctrine is not for application. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. An effective date earlier than April 20, 2009, for the grant of service connection for right and left shoulder disabilities is denied. 3. An effective date earlier than October 22, 2014, for the grant of service connection for radiculopathy in the right lower extremity. 4. An effective date earlier than October 22, 2014, for the grant of service connection for radiculopathy in the left lower extremity. The current effective date of the grant of service connection for radiculopathy in the right and left lower extremities is October 22, 2014, the day that treatment records showed a diagnosis of radiculopathy. The Veteran claims, thorough his attorney, that the effective date for the grant of service connection for radiculopathy in the right and left lower extremities should be April 20, 2009, the effective date of the grant of service connection for a low back disability. See attorney's brief (April 2021). In this case, the Veteran did not file a claim of service connection for radiculopathy in the right or left lower extremity. Rather on April 20, 2009, the Veteran submitted a claim service connection for a low back disability. In a September 2009 rating decision, the RO denied service connection for a low back disability. The Veteran appealed that decision to the Board. While the service connection claim for a low back disability was pending, the Veteran was afforded a VA back examination on May 28, 2015. A review of the May 2015 rating decision examination report shows that the Veteran was diagnosed as having right and left lower extremity radiculopathy, associated with his low back disability. In November 2017, the Board granted service connection for a low back disability. In the September 2018 rating decision, the RO implemented the Board's grant of service connection for a low back disability and assigned an effective date of April 20, 2009. In consideration of the Veteran's diagnosed radiculopathy in the right and left lower extremities associated with his low back disability, the RO awarded service connection for radiculopathy in the right and left lower extremities, effective May 28, 2015. Under 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (1) provides that associated objective neurologic abnormalities, are to be evaluated separately, under an appropriate diagnostic code. In November 2018, the Veteran submitted a timely NOD indicating that he disagreed with the effective date of the grant of service connection for radiculopathy in the right and left lower extremities. In a May 2020 rating decision, the DRO granted an earlier effective date of October 22, 2014, for the grant of service connection for radiculopathy in the right and left lower extremities. The DRO explained that an effective date for the grant of service connection for radiculopathy in the right and left lower extremities was warranted from October 22, 2014, because that was the date private treatment records showed a clinical diagnosis of thoracic/lumbar radiculopathy. Indeed, the evidence shows that the Veteran's radiculopathy in the right and left lower extremities had their onset on October 22, 2014. Prior to October 22, 2014, there was no evidence of radiculopathy in the right or left lower extremities. For example, a December 2009 VA treatment record reflects that a VA physician examined the Veteran and indicated that he had no radiculopathy, power loss, or muscle wasting. Also, a December 2009 VA back examination report reflects that the neurological examination was normal. An October 2011 private treatment reflects that motor strength of the lower extremities upon physical examination were normal. Private treatment records dated in 2011 did show an assessment of radiculopathy. In an October 22, 2014, private treatment record, the treatment provider noted that the Veteran had pain radiating to his lower extremities and diagnosed thoracic/lumbar radiculopathy. Notably prior to that treatment visit, the treatment provider that the Veteran had "non radicular facetogenic low back pain." See private treatment record (October 15, 2014). In the attorney's April 2021 brief, the Veteran's attorney indicated that the Veteran was diagnosed as having of radiculopathy in the right and left lower extremities during a May 2015 VA examination and did not assert that the Veteran's radiculopathy in the right and left lower extremities had its onset prior to the May 2015 VA examination. For the following reasons, an effective date earlier than October 22, 2014, for the grant of service connection for radiculopathy in the right and left lower extremities is not warranted. As indicated above, the Veteran did not file a claim of service connection for radiculopathy in the right and left lower extremities, but rather the claim of service connection for radiculopathy in the right and left lower extremities was part and parcel of his April 20, 2009, initial rating claim for the low back disability. Thus, the Veteran's date of claim for service connection for radiculopathy in the right and left lower extremities was April 20, 2009. As indicated above, the evidence shows that the Veteran's radiculopathy in the right and left lower extremities had their onset on October 22, 2014. Thus, the date entitlement arose was October 22, 2014. Notably, there is no regulatory definition of the phrase "date entitlement arose." However, in Wright v. Gober, 10 Vet. App. 343 (1997), the phrase "date entitlement arose" was found to be similar to the phrase "facts found." This case, along with the regulatory context, strongly suggest that the "date entitlement arose" is the date on which the facts in the case demonstrate that the entitling criteria are first met. The entitling criteria for a claim are frequently met on or before the date of claim based on the lay, medical, and other information presented during the entire process of claim development. When applying the general rule, the assignment of an effective date based on date entitlement arose being later than the date of receipt of the claim is only appropriate when the evidence clearly establishes that the entitling criteria were not met as of the date of receipt of the claim. Here, the date entitlement arose for radiculopathy in the right and left lower extremities (October 22, 2014) is later than the date of claim (April 20, 2009); therefore, October 22, 2014, is the proper effective date for the grant of service connection for radiculopathy in the right and left lower extremities. Accordingly, an effective date of earlier than October 22, 2014, for the grant of service connection for radiculopathy in the right and left lower extremities is denied. Rating Reduction Where a reduction in 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 therefor. Additionally, the beneficiary must be given notice that he has 60 days to present additional evidence to show that compensation payments should be continued at the present level, and 30 days to request a predetermination hearing. 38 C.F.R. § 3.105(e), (i). Congress has provided that a veteran's disability will not be reduced unless an improvement in the disability is shown to have occurred. 38 U.S.C. § 1155. In cases where a rating has been in effect for 5 years or more, the rating agency must make reasonably certain that the improvement will be maintained under the conditions of ordinary life even if material improvement in the physical or mental condition is clearly reflected. Kitchens v. Brown, 7 Vet. App. 320, 324 (1995). Moreover, a rating that has been in effect for 5 years or more may not be reduced on the basis of only one examination in cases where the disability is the result of a disease subject to periodic or episodic improvement. 38 C.F.R. § 3.344(a). The 5-year period is calculated from the effective date of the rating to the effective date of the reduction. Brown v. Brown, 5 Vet. App. 413, 419 (1993). A rating becomes entitled to heightened procedural protections under § 3.344(c) only when it has existed at the exact same percentage for at least 5 years. Simon v. Wilkie, 30 Vet. App. 403, 410 (2018). The applicability of § 3.344 is premised on how long a disability rating per VA's rating schedule has been in place, as opposed to how long some baseline symptomatology has existed. Id. at 411. Section 3.344(a) applies when a rating exists for 5 years without changing its degree or position on the rating schedule. Id. These requirements do not apply to ratings that have not continued for long periods at the same level (five years or more) or to disabilities which have not become stabilized and are likely to improve. Rather, in such cases, reexaminations disclosing improvement, physical or mental, in these disabilities will warrant a rating reduction. 38 C.F.R. § 3.344(c). Yet, without regard to whether a rating has been in effect for five years or more, a rating reduction is warranted only where the evidence contains thorough medical examinations demonstrating an actual improvement in disability. See 38 C.F.R. § 4.13. In other words, the provisions of 38 C.F.R. §§ 4.2 and 4.10 require that "in any rating-reduction case not only must it be determined that an improvement in a disability has actually occurred but also that the improvement actually reflects an improvement in the veteran's ability to function under the ordinary conditions of life and work." Brown, 5 Vet. App. at 421. Moreover, reports of examination must be interpreted in the light of the whole evidentiary history and reconciled with the various reports into a consistent picture, so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2. "[T]he Board must 'establish, by a preponderance of the evidence and in compliance [with] 38 C.F.R. § 3.344, that a rating reduction is warranted." Green v. Nicholson, 21 Vet. App. 512 (2006). 1. Whether the reduction in the disability rating for chondromalacia, right knee was proper. 2. Whether the reduction in the disability rating for chondromalacia, left knee was proper. Originally, in a September 1982 rating decision, the RO granted service connection for right and left knee chondromalacia and assigned noncompensable ratings under DC 5257 effective April 30, 1982. A March 2005 rating decision changed the DC to 5260 and granted 10 percent ratings. In April 2009, the Veteran filed an increased rating claim for right and left knee disabilities. In a September 2009 rating decision, the RO continued the Veteran's 10 percent ratings for chondromalacia. The Veteran appealed that decision to the Board. While the appeal was pending, a July 2015 rating decision was issued increasing the ratings for the Veteran's chondromalacia from 10 percent ratings to 30 percent ratings, effective October 29, 2014. The Veteran did not express satisfaction with the increased disability ratings; thus, these issues remained in appellate status. See AB v. Brown, 6 Vet. App. 35, 38 (1993). An April 2021 rating decision proposed to decrease the Veteran's chondromalacia with degenerative joint disease of the right and left knee from 30 percent ratings to 10 percent ratings. The DRO reasoned that the evidence showed "objective improvement" in the ranges of motion of the left and right knees based on November 2018 and March 2021 VA examinations. In a May 2021 letter, the RO advised the Veteran that he had (1) 60 days to present additional evidence to show that compensation payments should be continued at the 30 percent level and (2) that he had 30 days to request a predetermination hearing. The RO also notified the Veteran that this reduction would reduce his overall disability rating (for his combined service-connected disabilities) from a 100 percent rating to a 90 percent rating. In a July 2021 rating decision, the RO reduced the Veteran's chondromalacia with degenerative joint disease of the right and left knees from 30 percent ratings to 10 percent ratings effective October 1, 2021. The DRO reiterated its reasoning from the April 2021 rating decision and indicated that the April 2021 rating decision was "based on evidence confirming sustained improvement in the range of motion" of the right and left knees. The reduction in the Veteran's right and left knee disabilities from 30 percent ratings to 10 percent ratings reduced his overall disability rating (for his combined service-connected disabilities) from a 100 percent rating to a 90 percent rating; therefore, 38 C.F.R. § 3.105 is applicable in this case. The RO's actions here satisfied all procedural requirements under 38 C.F.R. § 3.105. Accordingly, the remaining question is whether a reduction is warranted based on the evidence of record. The Veteran, through his attorney, asserts that reductions for the right and left knee disabilities were improper, as the rating reductions were not supported by material improvement under the ordinary conditions of life. The Veteran, though his attorney, explained that VA treatment records illustrate that he has continued right and left knee pain that required knee injections to treat pain. See attorney's brief (April 2021). For the following reasons, the Board finds that the reduction in the disability ratings was not proper and that, therefore, the 30 percent ratings must be restored. As noted above, although the DRO found that there was "objective" and "sustained" improvement in the Veteran's right and left knees based on the November 2018 and March 2021 VA examinations, there was no discussion as to whether the Veteran's limitation of right and left knee motion demonstrated improvement in his ability to function in the ordinary conditions of work and life. The AOJ likewise did not provide any rationale or discussion regarding improvement in the ordinary conditions of life and work in any subsequent documents. Indeed, as noted by the Veteran's attorney, the Veteran's VA treatment records and the November 2018 and March 2021 VA examination reports reflect that the Veteran had continued right and left knee pain, flare ups, and that he has had functional impairment due to his right and left knee disabilities. Specifically, the Veteran reported during the November 2018 and March 2021 VA examinations that he had pain on movement and that he was unable to sit or stand for prolonged periods due to his right and left knee disabilities. These functional impairments are historically consistent dating back to the grant of the 30 percent ratings in the July 2015 rating decision. In sum, to the extent that there was an improvement in objective findings related to the Veteran's limitation of motion in the right and left knees, those improvements did not actually reflect an improvement in the Veteran's ability to function under the ordinary conditions of work and life. See Faust, 13 Vet. App. at 350. Thus, the reduction in the right and left knee ratings from 30 percent to 10 percent was not proper, and the 30 percent ratings must be restored effective October 1, 2021. Increased Rating Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Rating Schedule. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Where, as here, 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 concern. Francisco v. Brown, 7 Vet. App. 55 (1994). Staged ratings are appropriate for any rating claim 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, 510 (2007). Higher Ratings for Right and Left Knee Disabilities For the reasons set forth above, the Board restored the Veteran's 30 percent ratings from October 1, 2021. Accordingly, the Board will proceed with adjudication of the appeal based on these currently assigned ratings for the right and left knee disabilities. During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71A were amended effective February 7, 2021. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 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 claimant will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110 (g); see also Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). 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; Kuzma, 341 F. 3d 1327. Therefore, the Board will consider the Veteran's claims under the former criteria prior to February 7, 2021 and both the former and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. Disabilities evaluated on the basis of limitation of motion require VA to apply the provisions of 38 C.F.R. §§ 4.40, 4.45, pertaining to functional impairment. The United States Court of Appeals for Veterans Claims (Court) has instructed that in applying these regulations VA should obtain examinations in which the examiner determines whether the disability is manifested by weakened movement, excess fatigability, incoordination, pain, or flare-ups. Such inquiry is not to be limited to muscles or nerves. These determinations, if feasible, are to be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, flare-ups, or pain. The examiner should also determine the point at which such factors cause functional impairment. Moreover, the joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint. Correia v. McDonald, 28 Vet. App. 158 (2016); DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. § 4.59. Further, in claims for higher ratings for musculoskeletal disabilities, where a veteran has a noncompensable rating and complaints of pain on motion, the veteran may be entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011). In Petitti v. McDonald, 27 Vet. App. 415 (2015), the Court held that under 38 C.F.R. § 4.59, "the trigger for a minimum disability rating is an actually painful, unstable, or malaligned joint," and it explained that 38 C.F.R. § 4.59 speaks to both painful motion of joints and actually painful joints. Id. at 425. Moreover, the Court held that 38 C.F.R. § 4.59 does not require "objective" evidence but can be satisfied with lay and other nonmedical evidence. Id. at 429. The provisions of 38 C.F.R. § 4.59 are not limited to arthritis and must be considered when raised by the claimant or when reasonably raised by the record. Id. Moreover, the plain language of § 4.59 indicates that it is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable, or malaligned joints or periarticular regions, regardless of whether the DC under which the disability is being evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346, 354 (2016). A. Chondromalacia with Degenerative Joint Disease of the Right and Left Knees. The appeal period before the Board begins on April 20, 2009, the date VA received the Veteran's increased rating claims for right and left knee disabilities, plus the one year look back period. Gatson v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). The Veteran's right and left knee disabilities have been separately rated as 10 percent disabling prior to October 29, 2014, and 30 percent disabling thereafter under DCs 5299-5260. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating assigned. 38 C.F.R. § 4.27. Here, the use of DCs 5299-5260 reflects that the ratings assigned are based on limitation of knee flexion under DC 5260. Under DC 5260, both prior to and since the regulatory change, limitation of knee flexion is rated as follows: a 10 percent rating is warranted when it is limited to 45 degrees; a 20 percent rating is warranted when it is limited to 30 degrees; and a 30 percent rating is warranted when it is limited to 15 degrees. 38 C.F.R. § 4.71A, DC 5260. VA's General Counsel has held that separate ratings can be provided for limitation of knee extension and flexion. VAOPGCPREC 9-2004; 69 Fed. Reg. 59,990 (2004). Under DC 5261, both prior to and since the regulatory change, limitation of knee extension is rated as follows: a 10 percent rating is warranted when it is limited to 10 degrees; a 20 percent rating is warranted when it is limited to 15 degrees; a 30 percent rating is warranted when it is limited to 20 degrees; a 40 percent rating is warranted when it is limited to 30 degrees; and a 50 percent rating is warranted when it is limited to 45 degrees. 38 C.F.R. § 4.71a, DC 5261. For rating purposes, normal range of motion in a knee joint is from 0 to 140 degrees. 38 C.F.R. § 4.71, Plate II. i. For the period prior to October 29, 2014. For the following reasons, ratings higher than 10 percent for the right and left knee disabilities based upon limitation of flexion, under DC 5260, are not warranted, and a separate compensable rating for limitation of right and left knee extension is not warranted. The Veteran's limitation of right and left knee flexion did not meet or approximate the criteria for a rating higher than 10 percent prior to October 29, 2014, even in contemplation of functional loss caused by symptoms such as pain, swelling, weakness, fatigue, or incoordination as a result of repetitive motion and/or flare-ups. The Veteran's limitation of right and left knee extension did not meet or approximate the criteria for a compensable (10 percent) rating prior to October 29, 2014, even in contemplation of functional loss caused by symptoms such as pain, swelling, weakness, fatigue, or incoordination as a result of repetitive motion and/or flare-ups. For instance, during this period, the evidence includes June 2009 and January 2010 VA examination reports; VA and private treatment records; January 2009 private examination report; and March 2010 pain questionnaire. During examinations and treatment visits, the Veteran's right and left knee complaints included his reports of right and left knee pain, weakness, stiffness, swelling, lack of endurance, fatigability, and flare ups. See VA examination reports (June 2009; January 2010); private examination report (January 2009); pain questionnaire (March 2010); VA treatment record (March 2010). He stated that he had functional impairment. Id. Also, he described the severity of his knee pain on a scale from one to 10, as ten being the worst, as a 9 or 10. See VA examination reports (June 2009; January 2010); private examination report (January 2009). He stated that his pain worsened with physical activity, walking, and driving. He reported that he was unable to walk, stand, or sit for prolonged periods and climb stairs. See VA examination reports (June 2009; January 2010); private examination report (January 2009); pain questionnaire (March 2010). He stated that he was unable to drive due to knee pain. With respect to flare ups, he indicated that he had limitation of motion of the right and left knee, locking, inability to drive, and difficulty moving from a standing to a seated position during flare ups. See VA examination report (January 2010). Upon physical examination during this period, the Veteran's limitation of right and left knee flexion manifested, at worst, with flexion limited to 90 degrees with pain at 70 degrees and extension, bilaterally, was 0 degrees with pain. See, e.g., VA examination report (January 2010). The Veteran's treatment records do not show any different findings than above. The Board has considered whether repetitive motion and/or flare-ups resulted in greater loss of flexion or extension after repetitive testing due to symptoms such as pain, swelling, weakness, fatigue, or incoordination. However, while the Veteran did express knee symptoms, such as pain on motion, there is no evidence that such resulted in a greater loss of flexion or extension after repetitive testing, as he was able to perform repetitive-use testing with at least three repetitions without additional loss in range of motion. See VA examination reports (June 2009; January 2010). The Veteran is competent to report the symptoms associated with his service-connected limitation of right and left knee flexion and the extent of his impairment following repetitive use and during flare ups, and the Board has no reason to challenge the credibility of his contentions. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). Regardless of the competent and credible reports of flare ups, pain, and other functional impairments, and despite the fact that painful motion has been documented, the evidence supports the conclusion that the Veteran's limitation of right and left knee flexion symptoms have most closely approximated the criteria for, at most, a 10 percent rating for painful right and left knee motion under DC 5260 prior to October 29, 2014. Specifically, the above evidence reflects that the Veteran's right and left knee flare ups and other functional impairments have not been so severe, frequent and/or prolonged to warrant the next higher percent ratings at any time prior to October 29, 2014. The evidence shows that even considering pain, flare ups, and other functional factors, the Veteran's limitation of right and left knee flexion symptoms have not been shown to be so disabling to actually or effectively result in limitation of right and left knee flexion more nearly approximating 30 degrees or limitation of knee extension more nearly approximating 10 degrees, which are the requirements for a 20 percent rating for limitation of knee flexion under DC 5260 and a compensable (10 percent) rating for limitation of knee extension under DC 5261, respectively. Furthermore, the manifestations described by the Veteran, examiners, and treatment providers are already contemplated by the currently assigned 10 percent ratings under DC 5260. As such, the Board finds that such factors do not result in functional loss more nearly approximating flexion limited to 30 degrees. See DeLuca, 8 Vet. App. 202; Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011). Overall, the Veteran's limitation of right and left knee flexion has resulted in painful right and left knee motion, flare ups, and functional impairment with noncompensable limitation of motion. Therefore, ratings in excess of 10 percent for limitation of right and left knee flexion is not warranted at any time prior to October 29, 2014, under either the old or the revised regulations. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.7, 4.71a, DCs 5260-5261. ii. For the period since October 29, 2014. As indicated above, in the previous section, the Veteran's 30 percent ratings have been restored. For the following reasons, ratings higher than 30 percent under DC 5260, are not warranted, and separate 30 percent ratings for limitation of right and left knee extension, effective May 28, 2015, are warranted. During this period, the Veteran's right and left knee disabilities were evaluated under DC 5260. In this regard, the Board acknowledges that the July 2015 rating decision granting 30 percent ratings shows that such were warranted for extension limited to 20-29 degrees. The codesheet for this decision shows that the disabilities continued to be rated under DC 5260, which evaluates limitation of flexion. A September 2017 rating decision continued the 30 percent ratings; this decision specifically shows that such ratings were assigned for flexion limited to 15 degrees. The codesheet shows that the disabilities were again rated under DC 5260. Consequently, when affording the Veteran the benefit-of-the-doubt, considering the September 2017 rating decision, the Board considers the 30 percent ratings from October 29, 2014, to be based on limitation of flexion. During this period, the Veteran reported knee pain, flare ups (that occurred three times per week that lasted one to two days and that were moderate to severe), decreased range of motion, functional impairment, and functional loss. See VA examination reports (May 2015; March 2021). He also stated that he had throbbing pain and swelling after walking, driving, and climbing stairs. See, e.g., VA examination report (May 2015). With respect to limitation of right and left knee flexion, the evidence shows that upon physical examination, the Veteran's limitation of right and left knee flexion manifested, at worst, with flexion limited to 85 degrees with pain, to include upon repetitive-use testing and passive range of motion testing. See, e.g., VA examination report (March 2021). The March 2021 VA examiner estimated that the Veteran's flexion would be limited to 80 degrees when considering functional impairment after repeated use and 75 degrees during flare ups. As discussed above, the RO increased the Veteran's knee disability ratings from 10 percent ratings to 30 percent ratings, effective October 29, 2014, the date the DRO found that the Veteran's increased rating claim was received (although the Veteran's increased rating claims for the right and left knee disabilities were already pending). To this extent, the Board will not disturb the RO's favorable finding that 30 percent ratings, under DC 5260, for limitation of right and left knee flexion ratings were warranted. As the Veteran is receiving the maximum schedular rating under DC 5260, a schedular rating higher than 30 percent is not available. As to limitation of right and left knee extension, the evidence shows that on May 28, 2015, the Veteran's limitation of right and left knee extension was limited to 25 degrees upon repetitive-use testing. Thereafter, in a November 2018 VA examination report, the Veteran's right and left knee extension was normal; however, the examiner did not provide estimated range of motion measurements during periods of pain or flare ups, or other symptoms. At a March 2021 VA examination, the Veteran's limitation of right and left knee extension was limited to 5 degrees, to include upon passive range of motion testing. The March 2021 VA examiner estimated that the Veteran's right and left knee extension would be limited to 10 degrees when considering functional impairment after repeated use and 15 degrees during flare ups. Prior to the May 28, 2015, examination report, there is no evidence that the Veteran's right and left knee symptoms were shown to be so disabling to result in limitation of knee extension more nearly approximating 10 degrees actually or effectively, which is the requirement for a compensable (10 percent) rating for limitation of knee extension under DC 5261. As indicated above, at the May 28, 2015, VA examination, the Veteran's right and left knee extension was limited to 25 degrees upon repetitive-use testing, which is the requirement for a 30 percent rating for limitation of knee extension under DC 5261. Although the Veteran's right and left knees were not limited to 25 degrees after the May 2015 VA examination, the Board finds that considering pain, flare ups, and other functional factors his right and left knee disabilities more nearly approximated the criteria for 30 percent ratings, under DC 5261, especially in light of the March 2021 VA examiner's findings that the Veteran's right and left knees would be limited to, at least, 15 degrees during flare ups. A rating higher than 30 percent is not warranted, as the Veteran's right and left knee extension did not more nearly approximate limitation of extension to 30 degrees, even considering pain, flare ups, or other symptoms. As such, the Board finds that the severity, frequency, and duration of his limitation of knee extension symptoms have not been shown to be so disabling to result in limitation of right and left knee flexion more nearly approximating 30 degrees actually or effectively. B. Right and Left Knee Instability The Veteran's right and left knee instability is rated, separately, as 10 percent disabling prior to October 29, 2014, and 20 percent disabling thereafter, under 38 C.F.R. § 4.71a, DC 5257. The rating criteria for knee instability were amended, effective February 7, 2021. Prior to the regulatory change, 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, and a 30 percent rating is warranted for severe recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, DC 5257 (in effect prior to February 7, 2021). Webster's II New College Dictionary definitions for "moderate" include "of average or medium quantity, quality, or extent." at 704 (1995). Definitions for "severe" include "extremely intense." Id. at 1012. As of February 7, 2021, under the amended criteria, a 20 percent rating is warranted for recurrent subluxation or lateral instability with either (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; 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 maximum 30 percent rating is warranted for unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation. 38 C.F.R. § 4.71a, DC 5257 (in effect from February 7, 2021). Under the amended criteria, a 20 percent rating is also warranted for patellar instability if there is 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 maximum 30 percent rating is also warranted for patellar instability if 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. Id. For the following reasons, the Board finds that the Veteran' s right and left knee instability symptoms manifested by the type and extent, frequency, and/or severity, as appropriate, to warrant no more than, separate, 20 percent ratings for right and left knee instability during the entire claim period under either the old or revised version of DC 5257. For instance, the evidence includes June 2009, January 2010, May 2015, November 2018, and March 2021 VA examination reports; VA and private treatment records; January 2009 private examination report; and March 2010 pain questionnaire. During examinations and treatment visits, the Veteran reported instability, buckling, locking, and giving way during the entire claim period. Also, he reported that he had "some bad falls" due his right and left knee instability; he also indicated occasionally required assistive devices for ambulation. See, e.g., VA treatment record (September 2016). The Board acknowledges that DC 5257 does not necessarily require medical evidence of lateral instability for a rating to be assigned. Instead, the Board must address any relevant lay evidence and compare it to the medical evidence to determine which is more probative, keeping in mind that objective medical evidence is not automatically more probative than lay evidence. English v. Wilkie, 30 Vet. App. 347, 349 (2018). The Veteran is competent to report observable symptoms of his bilateral knee disability, such as instability, and the Board has no reason to challenge the credibility of his contentions. See Jandreau, 492 F.3d at 1372; Buchanan, 451 F.3d at 1331. Nevertheless, the Board points out that the Veteran denied a history of any recurrent subluxation of the right and left knees during the January 2010 examination. The Veteran denied right and left knee recurrent subluxation and lateral instability at the November 2018 examination. The June 2009, January 2010, and November 2018 VA examination reports show that joint stability testing of the right and left knee was normal. But, at the May 2015 and March 2021 VA examinations, the examiners indicated that there was joint instability in the right and left knees. At the May 2015 VA examination, the Veteran reported a history of moderate right and left recurrent subluxation and lateral instability. Upon physical examination of the knees in May 2015 and November 2018, the examiners found that there was no recurrent patellar dislocation. Throughout the whole appeal period, the examiners indicted that the Veteran did not have a meniscus condition or require surgery for his knees. The Board finds that a rating higher than 20 percent under DC 5257 under the pre-amended version of DC 5257 is not warranted, as the Veteran's right and left knee instability did not more nearly approximate severe or extremely intense, as the Veteran denied right and left knee recurrent subluxation and lateral instability at the November 2018 examination. Also, he described his history of right and left recurrent subluxation and lateral instability as "moderate" at the November 2018 examination. Also, stability testing of the knee has otherwise consistently been normal throughout the entire claim period, other than the joint instability noted during the May 2015 and March 2021 examinations. In light of these facts, the Board finds that any knee instability has not been so severe or frequent as to more nearly approximate severe instability under the pre-amended version of DC 5257. Moreover, a rating in excess of 20 percent is also not warranted under the revised version of DC 5257. To this extent, although the Veteran has required assistive devices for ambulation, he has not had an unrepaired or failed repair of complete ligament tear causing persistent instability or 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. Overall, the Veteran's right and left knee instability has most closely approximated the criteria for a 20 percent rating for knee instability under DC 5257 during the entire claim period (indicative of moderate knee instability). Accordingly, ratings in excess of 20 percent for right and left knee instability are not warranted at any time during the claim period. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.7, 4.71a, DC 5257 (in effect both prior to and since February 7, 2021). C. Additional Considerations for the Right and Left Knee Disabilities Although the Veteran reported "dislocation" as a symptom during some of his VA examinations, the VA examiners throughout the appeal period indicated that there was no meniscal condition and that he has not required any surgery for his knees. See, e.g., VA examination report (March 2021). As such, throughout the appeal period, there has been no evidence of any knee ankylosis, cartilage dislocation or removal, impairment of the tibia or fibula, or genu recurvatum at any time during the appeal period. Therefore, separate/higher ratings are not warranted under DCs 5256, 5258, 5259, 5262, or 5263 at any time during the claim period. REASONS FOR REMAND The issue of a TDIU remanded. The Veteran asserts that he is unable to maintain employment due to his service-connected disabilities, namely due to his right and left knee disabilities. Notably, in light of the restoration of the 30 percent ratings for the Veteran's knee disabilities, he now has a combined schedular 100 percent rating; however, a grant of a 100 percent rating does not always render the issue of a TDIU moot. See Bradley v. Peake, 22 Vet. App. 280 (2008) (analyzing 38 U.S.C. § 1114(s)); see also 75 Fed. Reg. 11, 229-04 (March 10, 2010) (withdrawing VAOPGCPREC 6-1999). Also, in light of the decision above restoring the 30 percent ratings and the grants of higher rating for right and left knee disabilities, the AOJ should consider the issue of a TDIU in the first instance, after implementing the Board's grants herein. In remanding this issue, the Board makes no credibility determination, expressed or implied, at this juncture. (Continued on the next page) The matter is REMANDED for the following action: After implementing the Board's grants herein, readjudicate the issue of entitlement to a TDIU. L. BARSTOW Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Castillo, 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.