Citation Nr: 22011827 Decision Date: 03/02/22 Archive Date: 03/02/22 DOCKET NO. 14-40 868 DATE: March 2, 2022 ORDER Entitlement to an initial compensable evaluation for tricompartmental degenerative changes of the left knee (limited flexion) before January 29, 2013, is denied. Entitlement to an initial 10 percent evaluation, but no higher, for limitation of extension of the left knee before January 29, 2013, is granted. Entitlement to a rating in excess of 30 percent for total left knee replacement from May 1, 2014 to September 10, 2019, is denied. Entitlement to a rating in excess of 60 percent for total knee replacement from September 10, 2019, is denied. Entitlement to a rating in excess of 10 percent tricompartmental degenerative changes of the right knee with limitation of flexion before September 10, 2019 is denied. Entitlement to a compensable rating for tricompartmental degenerative changes of the right knee with limitation of flexion from September 10, 2019 is denied. Entitlement to a rating in excess of 10 percent for right knee limitation of extension from September 10, 2019 to January 25, 2021 is denied. Entitlement to a 30 percent evaluation, but no higher, for right knee limitation of extension is granted from January 25, 2021. FINDINGS OF FACT 1. For the period before January 29, 2013, for tricompartmental degenerative changes of the left knee manifested in painful flexion limited to 100 degrees at worst. 2. For the period before January 29, 2016, extension of the left knee was limited to 15 degrees at worst with pain. 3. For the ratings period from May 1, 2014 to September 10, 2019, total left knee replacement manifested in painful motion. There is not ankylosis of the left knee, functional extension is not limited to 30 degrees, and there is not nonunion of the tibia and fibula. The residuals of the left knee replacement did not approximate severe residual pain, weakness, or limitation of motion. 4. From September 10, 2019, the Veteran is in receipt of the schedular maximum 60 percent evaluation for total left knee replacement; no higher evaluation is available. 5. For the entire ratings period, right knee flexion has been limited to 50 degrees at worst with pain. 6. For the ratings period from September 10, 2019 to January 25, 2021, right knee extension was to 0 degrees with pain. 7. From January 25, 2021, right knee extension has been limited to 25 degrees at worst with pain. CONCLUSIONS OF LAW 1. Before January 29, 2013, the criteria for a compensable evaluation for tricompartmental degenerative changes of the left knee (limited flexion) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.322, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5010-5260. 2. Before January 29, 2013, the criteria for a 10 percent evaluation, but no higher, for limitation of extension of the left knee have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.322, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5261. 3. From May 1, 2014 to September 10, 2019, the criteria for an evaluation in excess of 30 percent for total left knee replacement have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5055. 4. From September 10, 2019, the criteria for an evaluation in excess of 60 percent for total left knee replacement have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.68, 4.71a, Diagnostic Code 5055. 5. Before September 10, 2019, the criteria for a rating in excess of 10 percent for tricompartmental degenerative changes with limitation of flexion, right knee, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260. 6. From September 10, 2019, the criteria for a compensable evaluation for right knee limitation of flexion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260. 7. From September 10, 2019 to January 25, 2021, the criteria for a rating in excess of 10 percent for limitation of extension of the right knee have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5261. 8. From January 25, 2021, the criteria for a 30 percent rating, but no higher, for limitation of extension of the right knee have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5261. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1971 to October 1972 and February 2006 to June 2006. This matter comes before the Board of Veteran's Appeals (Board) on appeal from multiple rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). In May 2018 the Board remanded this matter for further evidentiary development. In December 2019 and January 2020 statements, the Veteran noted that the Agency of Original Jurisdiction (AOJ), in the October 2019 Supplemental Statement of the Case (SSOC), did not consider pertinent evidence. Following review, the Board remanded this matter again for further evidentiary development in January 2020. In March 2020 the AOJ issued another SSOC. Additional evidence was received, to include statement in disagreement with the SSOC in March 2020. In August 2020 the AOJ issued a rating decision changing the effective date for the Veteran's temporary 100 percent rating following left knee replacement and another SSOC. In October 2020 the Veteran filed a VA Form 20-0995 Supplemental Claim Application, disagreeing with the effective date established by the August 2020 rating decision. The Veteran has also submitted additional lay and medical evidence following the August 2020 SSOC and rating decision. In October 2020 the AOJ requested a VA examination for the left knee. In November 2020 the Board remanded these matters again because the examination for the left knee would by design examine both the Veteran's knees, and information in this examination could directly affect the issues in this appeal. New VA knee examinations were provided in December 2020 and January 2021. In February 2021 the AOJ issued another SSOC denying the Veteran's increased rating claims for bilateral knee disabilities, and the matter was thereafter recertified to the Board for further appellate consideration. Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule), found in 38 C.F.R., Part 4. The ratings are intended to compensate impairment in earning capacity due to a service-connected disease or injury. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. When assessing the severity of musculoskeletal disabilities that are at least partly rated on the basis of limitation of motion, VA must also consider the extent that the Veteran may have additional functional impairment above and beyond the limitation of motion objectively demonstrated, such as during times when his symptoms are most prevalent ("flare-ups") due to the extent of his pain (and painful motion), weakness, premature or excess fatigability, and incoordination-assuming these factors are not already contemplated by the governing rating criteria. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995). Pain, may result in functional loss, but only if it limits the ability "to perform the normal working movements of the body with normal excursion, strength, speed, coordination, [or] endurance." Mitchell v. Shinseki, 25 Vet. App. 32, 38 (2011). Separate ratings may be assigned for knee disabilities when none of the symptomatology overlaps and the separate rating is based on additional disabling symptomatology. The evaluation of the same disability under several Diagnostic Codes, known as pyramiding, must be avoided. However, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one disorder is not duplicative of the symptomatology of the other disorder. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). 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. 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. Left and Right Knee Ratings The Veteran seeks increased ratings for nearly every aspect of his service-connected left and right knee disabilities. The Board will briefly summarize the complicated ratings history of the Veteran's bilateral knee disabilities. From September 20, 2010 through January 28, 2013, the Veteran's left knee disability was service connected as tricompartmental degenerative changes, left knee, and limited extension, left knee. The Agency of Original Jurisdiction (AOJ) assigned noncompensable evaluations for limited flexion and limited extension. From January 29, 2013 to March 1, 2014, the Veteran was in receipt of a temporary total evaluation following the left knee replacement surgery. The Board will not disturb that ratings period in this decision. He is in receipt of a 30 percent evaluation for the total left knee replacement effective March 1, 2014, and a 60 percent evaluation from September 10, 2019. Regarding his right knee, the Veteran was in receipt of a 10 percent initial rating for tricompartmental degenerative changes of the right knee with limitation of flexion from September 20, 2010 to September 10, 2019, and a noncompensable zero percent evaluation from September 10, 2019. Regarding limited extension, the right knee is currently assigned a 10 percent evaluation effective September 10, 2019. The AOJ has also assigned a 30 percent evaluation for right knee instability, effective September 10, 2019. Under Diagnostic Code 5260, flexion limited to 60 degrees or greater warrants a 0 percent rating, flexion limited to 45 degrees warrants a 10 percent rating, flexion limited to 30 degrees warrants a 20 percent rating, and flexion limited to 15 degrees warrants the maximum 30 percent rating. See 38 C.F.R. § 4.71a, Diagnostic Code 5260. 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. Diagnostic Code 5261 rates based on limitation of extension of the leg. A noncompensable rating is assigned when extension is limited to 5 degrees. Extension limited to 10 degrees warrants a 10 percent rating. When limitation of extension is at 15 degrees, a 20 percent rating is warranted. Extension limited to 20 degrees warrants a 30 percent rating. Extension limited to 30 degrees warrants a 40 percent rating. Lastly, extension limited to 45 degrees warrants the maximum, 50 percent rating. VA General Counsel has held that separate evaluations under Diagnostic Code 5260 (limitation of flexion of the leg) and Diagnostic Code 5261 (limitation of extension of the leg) may be assigned for disability of the same joint. See VAOGCPREC 9-2004, 69 Fed. Reg. 59990 September 17, 2004). Additionally, separate evaluations may be assigned for compensable limitation of extension, instability, subluxation, or meniscus impairment of the knees. Residuals of a total knee replacement are evaluated under Diagnostic Code 5055. A 100 percent evaluation is assigned for one year following implantation of prosthesis. A minimum 30 percent evaluation is assigned thereafter. A maximum 60 percent evaluation is warranted when there are chronic residuals consisting of severe painful motion or weakness in the affected extremity. Intermediate degrees of residual weakness, pain, or limitation of motion are evaluated by analogy to diagnostic codes 5256, 5261, or 5262. See 38 C.F.R. § 4.71a, Diagnostic Code 5055. Diagnostic Code 5257 provided a 10, 20, or 30 percent ratings for slight, moderate, or severe recurrent subluxation or lateral instability of the knee. See 38 C.F.R. § 4.71a, Diagnostic Code 5257. Effective February 7, 2021, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended, including Diagnostic Code 5257. As will be explained in further detail below, these new amendments have no impact on the Veteran's claims. Diagnostic Code 5257 provides ratings for other impairment of the knee. 38 C.F.R. § § 4.71a. Recurrent subluxation or lateral instability warrants a 20 percent rating when moderate and a 30 percent rating when severe. Diagnostic Code 5258 provides a 20 percent rating for dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint. Diagnostic Code 5259 provides a 10 percent rating for removal of semilunar cartilage, symptomatic. 1. Left knee before January 29, 2013. The Veteran seeks a compensable evaluation for his left knee disability before January 29, 2013. From September 20, 2010 through January 28, 2013, the Veteran's left knee disability was service connected as tricompartmental degenerative changes, left knee, and limited extension, left knee. The Agency of Original Jurisdiction (AOJ) assigned noncompensable evaluations for limited flexion and limited extension. The AOJ granted service connection for the left knee tricompartmental degenerative changes and limited extension in an April 2012 rating decision. The AOJ determined that service connection was warranted because the disabilities preexisted and were aggravated (permanently worsened) by the Veteran's period of active duty from February 2006 to June 2006. The AOJ noted that prior to aggravation, the Veteran's left knee degenerative changes and limited extension were considered 10 percent disabling each according to evidence showing the range of motion of the left knee was limited to 120 degrees of flexion and 12 degrees of extension before his active duty. Following aggravation, the disabilities were still 10 percent disabling each based on painful flexion and extension of the left knee. The AOJ explained that the pre-aggravation percentage is deducted from the present evaluation percentage unless the disability rating is total. See 38C.F.R. § 3.322 (a). Therefore, the Veteran was assigned noncompensable ratings for his tricompartmental degenerative changes (based on painful limited flexion) and limited extension of the left knee. As such, the currently assigned noncompensable evaluations contemplate limitations of flexion and extension at the level of a 10 percent disability. The assigned evaluation for limited flexion contemplates pain on motion and is consistent with flexion limited to 45 degrees. The assigned evaluation for limited extension contemplates painful motion and extension limited to 10 degrees. To warrant a higher evaluation under Diagnostic Code 5260 for limited flexion, the left knee must approximate the functional equivalent of flexion limited to 30 degrees or less. To warrant a higher evaluation under Diagnostic Code 5261, the left knee must approximate the functional equivalent of extension limited to 15 degrees or more. After considering the evidence, the Board concludes that a higher rating is not warranted for limited flexion of the left knee before January 29, 2013. However, the Veteran's left knee extension was shown during private treatments to be limited to approximately 15 degrees. As such, he met the criteria for a 20 percent evaluation based on limited extension of the left knee before January 29, 2013. Considering 38 C.F.R. § 3.322, a 10 percent evaluation but no higher is warranted for limitation of left knee extension before January 29, 2013. A March 2011 private record shows left knee flexion to 120 degrees and left knee extension limited to 10 to 15 degrees with complaints of increasing pain. The Veteran was provided a VA knee examination in May 2011. He reported constant left knee pain with weakness, stiffness, instability, locking, lack of endurance, effusion, swelling, heat, and redness occurring at various times. The Veteran also reported occasional use of a cane, crutches, and a brace, and that his knee becomes painful with prolonged walking and sitting. There was no additional limitation of motion or functional impairment during a flareup. Physical examination showed flexion of the left knee to 100 degrees and extension to 5 degrees. The Veteran reported excruciating pain throughout the range of motion, and the knee was tender to palpation. There was no left knee instability or subluxation, and the examiner noted the Veteran's knee ligaments and meniscus were normal by testing. There was no additional limitation after repetitive motion. There was guarding during range of motion testing, and the Veteran walked with a limp favoring the left leg. The examiner noted that the Veteran could have further limitation of range of motion and reduced functional capacity during flareups but explained that additional loss could not be estimated without resorting to speculation. March 2012 private records shows left knee flexion to 120 degrees and extension limited to 10 degrees with complaints of persistent discomfort and pain, and an antalgic gait noted. In December 2012 flexion was noted to 110 to 115 degrees and extension limited to 10 to 15 degrees in the left with worsening pain and discomfort. Pain was noted with weightbearing and the Veteran reported the left knee was "locking and catching." Walking and standing made the left knee worse, and not walking made the knee better. Based on the range of motion measurements available, the criteria for a rating in excess of 10 percent for limited flexion of the left knee have not been met or more nearly approximated before January 29, 2013. Left knee flexion was to 100 degrees at worst, which is well above the 30 degrees or less that is required for a rating more than 10 percent. However, the Board finds the Veteran's limitation of extension of the left knee did more nearly approximated the criteria for a 20 percent evaluation before January 29, 2013. A 20 percent evaluation requires extension of the leg be limited to 15 degrees. Pertinently, private treatment records show the Veteran's left knee was limited to 10 to 15 degrees of extension in March 2011 and March 2012. Although extension was only to 5 degrees at the May 2011 VA examination, the Veteran did report that his symptoms occasionally worsen during the examination insofar as he reported occasionally having symptoms that were not always present. 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. 38 C.F.R. § 4.7. The range of motion estimates offered by the Veteran's private physician suggest the Veteran's left knee extension was limited to somewhere between 10 and 15 degrees, with 15 being the limit. Resolving any doubt in the Veteran's favor, the Board finds the Veteran's limitation of extension of the left knee more nearly approximated the criteria for a 20 percent evaluation. Considering 38 C.F.R. § 3.322, a 10 percent evaluation is warranted for limited extension of the left knee before January 29, 2013. However, the criteria for a 30 percent rating or higher for limited extension were not approximated before January 29, 2013. To warrant such an evaluation, extension must be shown to 20 degrees or greater or its functional equivalent. Extension of the left leg has been shown limited to 15 degrees at most with little evidence suggesting the functional equivalent of 20 degrees or higher has been demonstrated. As such, the criteria for an even higher rating for limited extension is not warranted. Higher ratings for limited flexion and extension are not warranted based on functional loss due to pain, weakness, fatigability, or incoordination. We have considered the Veteran's reports of functional impairment in assessing the limitation of motion in this claim, including his reports in the May 2011 VA examination of increased symptoms such as weakness, stiffness, instability, locking, lack of endurance, effusion, swelling, heat, and redness occurring at various times, and that his knee becomes painful with prolonged walking and sitting. Private treatment records show similar reports and complaints. However, repetitive use testing showed no additional functional loss during the examination. The evidence does not suggest that pain, weakness, fatigability, or incoordination result in disability beyond the ratings assigned. The evidence does not establish a higher level of impairment caused by flareups or repetitive use beyond the impairment described in the VA examination and private treatment records. Even accepting the Veteran's reports as true, range of motion measurements show flexion to 100 degrees and extension to 15 degrees. No other objective measurements show a greater level of impairment. The flareups as described on the examinations are found to be consistent with and accurately compensated by the assigned ratings. See De Luca, 8 Vet. App. at, 204-7; 38 C.F.R. §§ 4.40, 4.45, 4.59. We find that the observations of skilled medical professionals are more probative and more credible as to the degree of disability than the lay evidence, to the extent that the Veteran asserts there is a higher level of left knee impairment, to include during flareups. In reaching this decision, we acknowledge that the Board previously found the May 2011 VA inadequate under Correia v. McDonald, 28 Vet. App. 158 (2016), due to the examiner's failure to conduct joint testing for pain on active and passive motion and with weightbearing and non-weightbearing, and inadequate under Sharp v. Shulkin, 29 Vet. App. 26 (2017), due to the examiner's failure to explain why a range of motion estimate as to additional functional loss during flareups could not be offered without speculation. Based on evidence contained in the private treatment records before January 29, 2013, the Veteran had pain with passive and active motion and with weightbearing and non-weightbearing. The Board notes the May 2011 VA examination report does show the Veteran had a limp favoring the left leg, suggesting pain with weightbearing. Furthermore, the May 2011 examiner did elicit information from the Veteran regarding the frequency, duration, characteristics, precipitating and alleviating factors, and the severity of left knee flareups. The Veteran reported intermittent weakness, stiffness, instability, locking, lack of endurance, effusion, swelling, heat, and redness. The Veteran claims of increased pain with prolonged walking and sitting constitute flareups. It is unclear whether the examiner's conclusion that an estimate of additional loss during a flareup could not be made without resorting to speculation is due to a lack of medical knowledge among the medical community at large or insufficient knowledge of the examiner or a lack of knowledge of the medical community at large. See Sharp, 29 Vet. App. at 36. While the May 2011 examination is imperfect, there is no other estimate of additional loss in the record regarding the Veteran's level of impairment during flareups prior to January 29, 2013. The Board remanded to obtain an adequate examination in May 2018, years after the relevant period on appeal, and a new examination providing estimates was finally obtained in September 2019. We note the September 2019 examiner estimated an additional five-degree loss of flexion during flareups, which would not more nearly approximate the criteria for a 20 percent evaluation in this case. In addition, all other left knee range of motion measurements obtained during private assessments before January 29, 2013 show the Veteran's left knee range of motion did not more nearly approximate the criteria for a 20 percent evaluation for limited flexion. Regarding extension, the private records show the left knee met the requirements for a 20 percent evaluation for limited extension. The Veteran's private physicians have offered no estimate regarding flareups. As noted above, separate evaluations may be assigned for instability, subluxation, or meniscus impairment. However, no separate evaluations for the left knee are warranted before January 29, 2013. The version of Diagnostic Code 5257 in effect before January 29, 2013 provided a 10, 20, or 30 percent ratings for slight, moderate, or severe recurrent subluxation or lateral instability of the knee. The private treatment records are silent regarding left knee instability during this period. Most pertinently, the May 2011 VA examination shows no left knee instability, and that all stability tests were normal. None of the objective medical evidence shows left knee instability before January 29, 2013. Objective medical evidence is not required to establish lateral knee instability under Diagnostic Code 5257. See English v. Wilkie, 30 Vet. App. 347, 352-53 (2018). However, despite the Veteran's personal reports of left knee instability, the medical evidence is negative for left knee instability before January 29, 2013. VA and private examinations showed no instability. The Board affords the objective physical examinations results significantly more probative weight than the Veteran's assertions that he had left knee instability. Diagnostic Code 5258 provides a 20 percent evaluation for dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint. Here, the Veteran has reported a history of locking and effusion and has pain in his left knee. Diagnostic Code 5259 provides a 10 percent evaluation for symptomatic removal of the semilunar cartilage. The Veteran has had cartilage removed from his left knee and is symptomatic following the surgery. Although these two codes are potentially applicable, the symptoms related to the Veteran's cartilage, including locking, pain, and effusion, are causing the reduced range of motion of his left knee. Symptoms including pain causing reduced range of motion are already contemplated by the assigned evaluations under Diagnostic Codes 5260 and 5261. Compensating the Veteran pursuant to Diagnostic Code 5258 or 5259 would constitute impermissible pyramiding as he is already being appropriately compensated for pain causing limited flexion and extension, among the symptoms of his cartilage removal and documented meniscus injury. See 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). In sum, for the ratings period before January 29, 2013, at least a preponderance of the evidence is against assigning a compensable initial evaluation for limited flexion of the left knee. The evidence weighs in favor of awarding an initial 10 percent evaluation, but no higher, for limited extension of the left knee, pursuant to the terms of 38 C.F.R. § 3.322. Separate ratings are not for application. 2. Left knee since March 1, 2014. The Veteran is in receipt of a 30 percent evaluation for total left knee replacement effective March 1, 2014, and a 60 percent evaluation from September 10, 2019. Prior to this, from January 29, 2013 to March 1, 2014, he was in receipt of a temporary total evaluation following the left knee replacement surgery. The Board will not address that period. Staged ratings are appropriate when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999). The Veteran is in receipt of staged ratings for his total left knee replacement. As explained below, the currently assigned staged ratings are appropriate. Residuals of a total knee replacement are evaluated under Diagnostic Code 5055. A 100 percent evaluation is assigned for one year following implantation of prosthesis. A minimum 30 percent evaluation is assigned thereafter. A maximum 60 percent evaluation is warranted when there are chronic residuals consisting of severe painful motion or weakness in the affected extremity. Intermediate degrees of residual weakness, pain, or limitation of motion are evaluated by analogy to diagnostic codes 5256, 5261, or 5262. See 38 C.F.R. § 4.71a, Diagnostic Code 5055. Specific to rating intermediate degrees of impairment by analogy, Diagnostic Code 5256 is not applicable here, as there is no evidence of left knee ankylosis or its functional equivalent. Similarly, Diagnostic Code 5262 is not applicable as there is no evidence of impairment of the tibia or fibula. Diagnostic Code 5261 rates based on limitation of extension. It provides two potential ratings in excess of the current 30 percent evaluation. A 40 percent rating is warranted for extension limited to 30 degrees. A 50 percent rating is warranted for extension limited to 45 degrees. 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. 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. Diagnostic Code 5055 was amended to include resurfacing of the knee. In addition, the period of total evaluation following prosthesis was changed to four months. That is not at issue in this appeal and the post temporary total criteria for prosthesis remain the same. After the period of total evaluation following the knee replacement, a 60 percent rating is the maximum schedular rating available. 38 C.F.R. § 4.71a, Diagnostic Code 5055; Copeland v. McDonald, 27 Vet. App. 333 (2015). Regarding the period for which a 60 percent evaluation has already been assigned, we note that this is the schedular maximum rating available under Diagnostic Code 5055 once the one-year period following a total knee replacement has expired. Diagnostic Code 5055 specifically considers the Veteran's left knee replacement, and there is no evidence of another knee replacement. No higher rating is possible from September 10, 2019, the period for which a 60 percent evaluation is already assigned. See 38 C.F.R. § 4.68. Thus, only remaining question for the Board is whether the Veteran is entitled to a rating in excess of 30 percent for his left knee from March 1, 2014 to September 10, 2019. After reviewing the evidence, the Board concludes that a rating in excess of 30 percent for the Veteran's total left knee replacement before September 10, 2019 is not warranted. The Veteran was provided a VA knee examination in April 2014. He reported constant knee pain which he rated an 8 out of 10, with daily flareups of pain he rated a 10 out of 10. Initial range of motion testing showed left knee flexion to 120 degrees with pain and extension to 0 degrees. Repetitive use testing showed no reduction in range of motion. Less movement than normal, pain, and interference with sitting, standing, and weightbearing caused additional functional impairment. The left knee was tender to palpation and muscle strength was 5/5. Left knee stability tests were normal, and a history of joint locking was noted. The Veteran reported occasionally using a cane. A January 2015 treatment records shows the Veteran had no complaints with his left knee, with full extension and flexion to 125 degrees. In January 2016 the Veteran had full left knee extension and flexion to 125 degrees with "no significant complaints of pain." In July 2016 he reported some increased knee pain. There was no significant left knee swelling, with full extension and flexion to 115 to 120 degrees. Left hip arthritis was noted as causing antalgic gait. A December 2016 record shows no pain in the left knee with full extension and flexion to 120 degrees. At a June 2018 appointment for his right knee the treating physician indicated the Veteran's left knee replacement was "doing well" and a knee x-ray showed a stable total left knee replacement. In August 2019 the Veteran reported that pain in his left knee had returned, with pain on daily activities and at rest. Range of motion was 0 degrees of extension and 130 degrees of flexion. There was no erythema, effusion, tenderness, or swelling. He was given an injection in the left knee. The Veteran was provided another VA knee examination on September 10, 2019. He reported swelling, increased pain, reduced range of motion, stiffness, and pain when walking and standing. Flareups occurred with repetitive movement, standing longer than 10 minutes, walking over a block, sitting with the left knee bent, during cold weather, with air conditioning, and with drops in barometric pressure. He described the flareups as severe lasting a minimum of two hours and three days at the longest. The Veteran reported avoiding activities involving extended walking and standing, and that he sits with his knees extended as much as possible. He reported difficulty dressing, kneeling, using stairs, getting in and out of the bathtub, and sleeping due to knee pain. Initial range of motion testing showed left knee flexion to 50 degrees and extension to 0 degrees with pain on both. Repetitive use testing caused left knee flexion to drop to 45 degrees; the examiner estimated flareups would also cause flexion to drop to 45 degrees. The examiner noted pain, fatigue, weakness, lack of endurance, and incoordination would cause the additional impairment. Left knee muscle strength was reduced to 3/5 on flexion and extension. Additional factors consisting of less movement than normal, weakened movement, instability of station, disturbance of locomotion, and interference with sitting and standing contributed to disability. Severe left knee instability was noted on all four stability tests, and a history of severe subluxation was noted. There was pain with weightbearing and non-weightbearing, and pain with active and passive range of motion. The Veteran reported constant use of a knee brace, tape, and a cane for instability and pain. The examiner concluded the Veteran had chronic residuals consisting of severe painful motion or weakness caused by his total left knee replacement. Here, the Board encounters evidence that the Veteran's left knee worsened to an extreme degree by the time he was afforded the September 2019 VA examination. We note that the Agency of Original Jurisdiction increased the evaluation for his left knee replacement to 60 percent based entirely on the September 2019 examination, effective September 10, 2019, the date of the examination. The Veteran's left knee likely did not become drastically worse on the day of the September 2019 VA examination. However, the medical evidence and the Veteran's own lay statements during the period between March 1, 2014 and September 10, 2019 suggest the residual impairment caused by his left knee replacement was much less severe than the impairment demonstrated during the September 2019 examination. Private treatment records show the Veteran routinely reported no problems with the left knee during the period between March 1, 2014 and September 10, 2019. His doctors noted the left knee replacement was stable and doing well, although left knee flexion was limited at times to 120 degrees. Following the April 2014 VA examination, the first documented report of any pain or symptom in his left knee was in July 2016, when extension remained full and flexion was to 115 degrees at the worst. Thereafter pain in the left knee returned in August 2019 when he reported pain had returned. Range of motion was 0 degrees extension to 130 degrees flexion with no erythema, effusion, tenderness, or swelling. While he was given an injection for pain, the physical examination shows a low level of left knee impairment. The Veteran is competent to report the severity of pain and limitation due to his left knee replacement. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, the medical and lay evidence of record does not indicate chronic residuals consistent of severe painful motion or weakness before September 10, 2019. While there is pain, the private treatment records show the Veteran was able to ambulate with little to no trouble caused by the left knee, and his own lay reports regarding the left knee suggest he had no significant or chronic pain or weakness in the left knee. He had pain July 2016 and again in August 2019, when he reported that the pain in his left knee had returned. He otherwise denied significant problems with his left knee. Muscle strength was noted as 5/5 on the April 2014 examination, shortly before the expiration of the temporary 100 percent evaluation. Weakness attributable to the left knee is not documented before the September 10, 2019 VA examination. The Veteran reported severe, daily flareups in the April 2014 examination. However, the subsequent private treatment records and the lay statements contained within show few complaints and that he denied any problems with the left knee. We find the Veteran's reports of his flareups in the April 2014 VA examination are less credible than the subsequent treatment record. When evaluating the credibility of lay statements, the Board may properly consider factors such as internal inconsistency and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498, 511-12 (1995). At least a preponderance of the evidence establishes the pain was not at the level of "severe" as contemplated under Diagnostic Code 5055 for a 60 percent evaluation. The Board does not dispute that the Veteran experienced pain on motion and some functional impairment due to his left knee replacement before September 10, 2019. However, the objective medical evidence of record and the Veteran's own statements made in the course of treatment indicate that he did not experience severe painful motion or weakness, or the functional equivalent of such limitation, prior to being evaluated during the VA examination on September 10, 2019. While he did experience some symptoms, the relevant private treatment records also suggest the symptoms were mild and consisted of reduced flexion and pain in the left knee. These symptoms are contemplated by the currently assigned 30 percent evaluation. With respect to an intermediate evaluation under Diagnostic Code 5261, extension has not been functionally limited to 30 degrees. Instead, the evidence shows the Veteran retained full extension of the left knee following the expiration of the temporary 100 percent evaluation on May 1, 2014 until being evaluated by VA on September 10, 2019. As noted above, intermediate evaluation is not warranted under Diagnostic Codes 5256 or 5262 in this instance. In reaching this finding, the Board considered the factors of functional loss. See 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). The Board acknowledges that the April 2014 VA examination is not adequate regarding functional limitation during flareups. However, the Veteran's statements regarding the severity and nature of his flareups were not credible when weighed against the other evidence of record. In addition, subsequent private treatment records suggest the Veteran had little to no functional loss due to pain, weakness, fatigability, or incoordination caused by his left knee during the relevant period. The private records reflect only pain and otherwise minor problems with the left knee. He retained full extension in the left knee with flexion limited to 115 degrees at worst when he reported pain. No other symptoms were identified. Stated another way, such additional functional loss has not been demonstrated to warrant a higher rating. Flare-ups have not been shown to result in additional limitation consistent with a higher evaluation for the left knee. At least a preponderance of the evidence is against an evaluation more than 30 percent for the period from May 1, 2014 to September 10, 2019. 3. Right knee ratings. The Veteran seeks higher evaluations for his tricompartmental degenerative changes of the right knee with limited flexion and extension. Regarding limited flexion, the disability is currently assigned a 10 percent initial evaluation from September 20, 2010 to September 10, 2019, and a noncompensable zero percent evaluation from September 10, 2019. Regarding limited extension, the disability is assigned a 10 percent evaluation effective September 10, 2019. The Board also notes that the Agency of Original Jurisdiction assigned a 30 percent evaluation for right knee instability in an October 2019 rating decision, effective September 10, 2019. The Board concludes that a rating in excess of 10 percent for limited flexion of the right knee before September 2019, and a compensable rating thereafter, is not warranted. A rating in excess of 10 percent for limited extension of the right knee is not warranted before January 25, 2021. However, a 30 percent rating for limited extension of the right knee is warranted thereafter. No additional separate evaluations are warranted, and the 30 percent evaluation for right knee instability, effective September 10, 2019, is the highest evaluation available. The Veteran was provided a VA knee examination in May 2011. He reported daily constant right knee pain with weakness, stiffness, locking, lack of endurance, effusion, swelling, and giving way. Pain made worse by sitting, walking for a long time, and cold weather. No history of dislocation, subluxation, heat, redness, tenderness, or drainage was noted. No additional limitation of motion or functional impairment was reported during flareups. Physical examination showed flexion of the right knee to 110 degrees and extension to 0 degrees. The Veteran reported excruciating pain throughout the range of motion. There was no objective evidence of right knee instability, effusion, deformity, abnormal movement, malalignment, or weakness. The examiner noted the Veteran's knee ligaments and meniscus were normal by testing. There was no additional limitation after repetitive motion. There was guarding during range of motion testing, and the Veteran walked with a limp favoring the left leg. The examiner noted that the Veteran could have further limitation of range of motion and reduced functional capacity during flareups but explained that additional loss could not be estimated without resorting to speculation. March 2012 private records show right knee flexion to 120 degrees and full extension. In December 2012 right knee extension was noted "close to full" with no right knee flexion measurements recorded. In December 2013 the Veteran reported that his right knee pain during flexion. Extension was noted as full, with flexion to 125 degrees. The Veteran was provided a VA knee examination in April 2014. He reported constant knee pain which he rated an 8 out of 10, with daily flareups of pain he rated a 10 out of 10. Initial range of motion testing showed right knee flexion to 100 degrees with pain and extension to 0 degrees. Repetitive use testing showed no reduction in range of motion. Less movement than normal, pain, and interference with sitting, standing, and weightbearing caused additional functional impairment. The right knee was tender to palpation and muscle strength was 5/5. Right knee stability tests were normal, and a history of joint locking was noted. The Veteran reported occasionally using a cane. A January 2016 private record shows full bilateral knee extension with right knee flexion to 115 to 120 degrees, with no significant complaints of pain on active motion. In December 2016 the Veteran reported his right knee was bothering him; extension was full, and flexion was limited to 120 degrees. He reported that his right knee was getting worse in June 2018, with range of motion testing showing extension to 5 degrees and flexion to 110 degrees with pain. All instability tests for the right knee were negative. In November 2018 range of motion was noted as 5 degrees of extension and 110 degrees of extension with a small effusion and crepitus. Muscle strength testing was 5/5 in the right leg. All stability tests were negative for instability. Range of motion was 0 degrees of extension and 115 degrees of flexion in December 2018, with tenderness on palpation and crepitus. In May 2018 the Board found the May 2011 and April 2014 VA examinations were inadequate under Correia v. McDonald, 28 Vet. App. 158 (2016), due to the examiners' failure to conduct joint testing for pain on active and passive motion and with weightbearing and non-weightbearing, and under Sharp v. Shulkin, 29 Vet. App. 26 (2017), due to the examiners' failure to explain why a range of motion estimate as to additional functional loss during flareups could not be offered without speculation. The Veteran was provided a new VA knee examination on September 10, 2019. He reported severe flareups with repetitive movement, standing longer than 10 minutes, walking over a block, sitting with the knee bent, cold weather, air conditioning, and drops in barometric pressure. The flareups lasted between three hours and five days and were alleviated by injections, Tylenol, heat therapy, carefully monitoring activities, cold compresses, and rest. Initial range of motion testing showed right knee flexion to 55 degrees and extension to 0 degrees with pain on both. Repetitive use testing caused right knee flexion to drop to 50 degrees; the examiner also estimated flareups would also cause flexion to drop to 50 degrees. Extension remained the same. The examiner noted pain, fatigue, weakness, lack of endurance, and incoordination would cause the additional impairment. Right knee muscle strength was reduced to 3/5 on flexion and extension. Additional factors consisting of less movement than normal, weakened movement, instability of station, disturbance of locomotion, and interference with sitting and standing contributed to disability. Severe right knee instability was noted on all four stability tests. A history of joint locking, pain, and effusion was noted regarding his right knee meniscus tears. There was pain with weightbearing and non-weightbearing, and pain with active and passive range of motion. The Veteran reported constant use of a knee brace, tape, and a cane for instability and pain. Following the September 10, 2019 examination, the AOJ issued a rating decision decreasing the evaluation for limited flexion of the right knee from 10 percent to 0 percent, granting service connection for limited extension of the right knee and assigning a 10 percent evaluation and granting service connection for right knee instability with a 30 percent evaluation. All are effective September 10, 2019. The Veteran was provided another VA knee examination in December 2020. He reported right knee pain with bending and that the knee locks up and feels like he is going to fall. During flareups the Veteran reported being unable to walk without extreme pain and he is unable to do any activities such as dress himself or take a shower without the help of his wife. He reported being unable to do any repetitive movements or walk and stand for periods over 10 minutes. Initial range of motion testing showed right knee flexion to 100 degrees and extension to 0 degrees with pain and crepitus. The Veteran did not perform repetitive use testing due to pain and fear the right knee may give way. The examiner noted pain, fatigue, weakness, lack of endurance, and incoordination would cause the additional impairment with repeated use over time and flareups but estimated no further loss of range of motion. Right knee muscle strength was reduced to 4/5 on flexion and extension. Additional factors consisting of less movement than normal, weakened movement, swelling, instability of station, disturbance of locomotion, and interference with sitting and standing contributed to disability. Severe right knee instability was noted on all four stability tests. A history of joint locking and pain were noted regarding his right knee meniscus tears. There was pain with weightbearing but no objective evidence of pain on non-weightbearing, and passive range of motion was the same as active. The Veteran reported constant use of a cane and occasional use of crutches for support and instability. The Veteran was provided another VA knee examination in January 2021. Current right knee symptoms included constant pain that increased in severity twice monthly, weakness, buckling, and limited mobility. He reported that he avoids stairs, could not stand more than 10 minutes, could not bend, had trouble getting dressed, could not walk long, and had difficulty sleeping, getting in and out of the shower, and getting in and out of a vehicle. Initial range of motion testing showed right knee flexion to 110 degrees and extension to 20 degrees with pain. Repetitive use testing showed no additional loss of range of motion. The examiner estimated repeated use over time would cause flexion to fall to 105 degrees and extension be limited to 25 degrees. The examiner noted that the Veteran had denied flareups. Right knee muscle strength was reduced to 4/5 on flexion and extension. Stability testing showed lateral instability only. There was pain with weightbearing and non-weightbearing, and pain on passive and active range of motion. The Veteran reported regular use of a cane. Regarding flexion, the Veteran's right knee disability has not warranted an increased rating during the period on appeal. The September 2019 VA examination is the first fully adequate examination under Correia and Sharp. The examination shows right knee flexion to 55 degrees on initial range of motion testing, with the examiner estimating that flexion would be limited to 50 degrees with repetitive use over time and during flareups. These are by far the worst recorded flexion measurements in the record. The Board notes the subsequent VA examinations in December 2020 and January 2021 show a much greater range of right knee flexion. The evaluation for limited flexion of the right knee before September 10, 2019 was assigned pursuant to 38 C.F.R. § 4.59, contemplates pain on motion, and would be consistent with limitation of flexion to 45 degrees under Diagnostic Code 5260. The current evaluation in effect since September 10, 2019 was reduced to 0 percent because the Veteran now has a compensable degree of limited extension and, as such, is assigned at least the minimum compensable rating for painful limited motion under Diagnostic Code 5261. To warrant a compensable evaluation from September 10, 2019, flexion must be limited to 45 degrees or less. Such limited flexion has never been shown, and the Veteran retained significantly higher flexion at the December 2020 and January 2021 VA examinations. Even considering the Veteran's statements and the reports of pain and flare-up causing decreased range of motion, the reported degree of additional limitation reflected by the statements that would not result in limitation of motion more nearly approximating flexion limited to 45 degrees or less. The probative lay and medical evidence does not establish that flexion is less than 45 degrees at any time, including due to the DeLuca factors. Range of motion testing reflects that the Veteran retains flexion better than that required for a higher rating. The evidence does not include findings that warrant a higher evaluation under Diagnostic Code 5260 at any time during the appeals period. Before September 10, 2019, a separate rating under Diagnostic Code 5261 would only be permitted where limitation of extension of the right knee was compensable. See VAOPGCPREC 9-04 (2004). A compensable evaluation requires extension be limited to 10 degrees or more. Before September 10, 2019, private treatment records and VA examination reports show extension of the right leg was either full or close to full, with no indication that extension was ever limited to 10 degrees or more. At most, private records show right leg extension limited to 5 degrees, which would qualify for a noncompensable evaluation. However, we reiterate that a separate rating under Diagnostic Code 5261 for painful, limited extension would only be permitted where the limitation of extension was compensable. A separate rating for limited extension of the right knee is not warranted before September 10, 2019. Regarding the rating period from September 10, 2019 to January 25, 2021, the Board concludes a rating in excess of 10 percent for limited extension of the right knee is not warranted by the evidence. As noted above, in October 2019 the AOJ granted service connection for limited extension of the right knee and assigned a 10 percent evaluation effective September 10, 2019. The Board notes that, at the time, the Veteran had no compensable limitation of extension of the right leg. The September 2019 VA examination report shows full extension with pain. In addition, the December 2020 VA examination also showed full extension. To warrant a rating in excess of 10 percent, extension must be limited to 15 degrees or more. Such a limitation was not shown before January 25, 2021, and the functional equivalent of extension limited to 15 degrees or more was not more nearly approximated. However, the January 25, 2021 VA examination shows extension of the right knee limited to 20 degrees on initial range of motion testing, and the examiner estimated repeated use over time would cause extension to be limited to 25 degrees. This limitation aligns with the criteria for a 30 percent evaluation for limited extension of the right knee. As such, a 30 percent rating is warranted under Diagnostic Code 5261 for limited extension of the right knee effective January 25, 2021, the date such a limitation was first ascertainable. We acknowledge that the Veteran has routinely reported painful limitation of motion of the right knee and that his complaints have been generally consistent throughout the period on appeal. However, extension was not demonstrably limited to such an extent before January 25, 2021. We reiterate that the December 2020 examination, provided only one month before the January 25, 2021 examination, showed full extension of the right knee. It was not factually ascertainable that the Veteran's right knee flexion was limited to 20 degrees or more prior to the January 25, 2021 examination. Consistent with DeLuca, the Board considered the Veteran's functional impairment in assessing the limitation of motion in this claim, considering flare-ups and painful motion, weakness, premature or excess fatigability, and incoordination. However, these factors do not result in additional disability beyond that assigned in this claim for the right knee. Even considering flareups, repetitive use, and repeated use over time, the limitations noted on the VA examinations, private treatment records, and as described by the Veteran are found to be consistent with and accurately compensated by the evaluations assigned. Credible evidence suggests that flexion has ever been limited to less than 50 degrees. Extension was generally not limited upon private or VA examination until January 25, 2021. The evidence presented through in the Veteran's description of his disability, or more pertinently in the private treatment records or in the observations by medical personnel during the appeal period, does not warrant a higher evaluation than those assigned. DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995); see also 38 C.F.R. § § 4.40, 4.45, 4.59. To the extent the Veteran argues he has a higher level of impairment, we find that the observations of the skilled examiners, in particular the September 2019, December 2020, and January 2021 VA examiners, are significantly more probative and more credible as to the degree of disability than the lay evidence. The private treatment records are also probative evidence showing no greater degree of disability beyond the ratings currently assigned. Separate evaluations for the knee may be assigned for instability, subluxation, or meniscus impairment. Effective September 10, 2019, the Veteran is in receipt of a 30 percent evaluation for right knee instability under Diagnostic Code 5257, effective September 10, 2019. Diagnostic Code 5257 provided a 10, 20, or 30 percent ratings for slight, moderate, or severe recurrent subluxation or lateral instability of the knee. See 38 C.F.R. § 4.71a, Diagnostic Code 5257. Effective February 7, 2021, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended, including Diagnostic Code 5257. If a law or regulation changes during a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by the amendment's effective date. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). Here, we find that neither the new or old criteria is more favorable and the Veteran suffers no prejudice in our consideration of the facts. The new version of Diagnostic Code 5257 provides for a schedular maximum 30 percent evaluation for instability. As the Veteran is already in receipt of the schedular maximum 30 percent rating for right knee since September 10, 2019, consideration of the new criteria is not necessary. A higher rating is not possible and is not warranted for right knee instability from September 10, 2019. The Board concludes that a separate evaluation for right knee instability before September 10, 2019 is not warranted. We acknowledge that the Veteran has reported instability of the right knee as early as the May 2011 VA examination. However, private treatment records do not show right knee instability during the period before September 10, 2019. His private doctors have noted that the right knee was stable, and that instability testing of the right knee was normal. Likewise, all VA examinations before September 2019 reflect normal stability testing and ligaments, and that there was no right knee instability. The objective medical evidence does not show left knee instability before September 10, 2019. Objective medical evidence is not required to establish lateral knee instability under Diagnostic Code 5257. See English v. Wilkie, 30 Vet. App. 347, 352-53 (2018). However, despite the Veteran's personal reports of left knee instability, all medical evidence is negative for right knee instability before the September 10, 2019 VA examination report. The Board affords much more probative weight on the results of these objective physical examinations than the Veteran's assertions as to instability. Diagnostic Code 5258 provides a 20 percent evaluation for dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint. Here, the Veteran has reported a history of locking and effusion and has pain in his right knee. Diagnostic Code 5259 provides a 10 percent evaluation for symptomatic removal of the semilunar cartilage. The Veteran has had cartilage removed from his right knee and is symptomatic. Although these two codes are potentially applicable, the symptoms related to the Veteran's cartilage, including locking, pain, and effusion, are causing the reduced range of motion of his right knee. Symptoms including pain causing reduced range of motion are already contemplated by the assigned evaluations under Diagnostic Codes 5260 and 5261. Compensating the Veteran pursuant to Diagnostic Code 5258 or 5259 would constitute impermissible pyramiding because he is already being expressly compensated for pain causing limited flexion and extension. See 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). Furthermore, rating the Veteran's knee disability under Diagnostic Code 5258 or 5259 would not benefit the Veteran, as it would not result in an evaluation higher than what is already assigned. Diagnostic Code 5256 is inapplicable as the Veteran does not have ankylosis of the right knee, and considering the Veteran retains significant degrees of flexion and extension of the knee, the functional equivalent of ankylosis has not been shown. In addition, the record does not show malunion or nonunion of the tibia and fibula or genu recurvatum, and as such, separate disability ratings under Diagnostic Codes 5262 and 5263 are also not warranted. In sum, at least a preponderance of the probative evidence weighs significantly against assigning a rating more than 10 percent for limited flexion of the right knee before September 10, 2019, and a compensable rating thereafter, under Diagnostic Code 5260. A separate rating for limited extension of the right knee is not warranted before September 10, 2019. A rating in excess of 10 percent for limited extension is not warranted from September 10, 2019 to January 25, 2019. Effective January 25, 2019, a 30 percent evaluation but no higher is warranted for limited extension of the right knee. Separate ratings besides the 30 percent evaluation for instability assigned from September 10, 2019, are not warranted. Furthermore, other Diagnostic Codes would not provide a higher rating than those already assigned. SHAUN S. SPERANZA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Morse 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.