KNEE IMPAIRMENT OF

EVAN M. DEICHERT · 2026 · Case ID: 26003073

MIXED

Summary

The veteran, who served in the U.S. Marine Corps from December 1976 to December 1979 and in the Air National Guard with periods of active duty from October 2001 to November 2017, appeals the denial of an increased disability rating for his right and left knees. The veteran sought service connection for bilateral knee disabilities, specifically for instability, dislocated semilunar cartilage with locking, pain, and effusion, and limitation of flexion. The Board reviewed the evidence, including service treatment records and multiple VA examinations, noting the veteran's history of knee pain, locking, catching, popping, and occasional giving way, along with findings of pain with flexion and weight-bearing. However, objective joint stability and strength testing were generally normal throughout the appeal period. The Board applied the benefit of the doubt doctrine, granting a separate 10 percent rating for slight instability of each knee, based on the veteran's credible subjective reports of giving way. A 20 percent rating was granted for each knee due to dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion, as the evidence supported these symptoms. The Board denied an increased rating for limitation of flexion, finding that the evidence did not support a limitation of 30 degrees or less, and that the veteran's reported stiffness did not equate to ankylosis. The Board also found that other diagnostic codes were not applicable based on the evidence.

Rationale

Veteran reported subjective symptoms of instability; Credible reports of knees giving way; Normal objective joint stability testing

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

5257

Docket No.

17-59 976

Full Decision Text

Citation Nr: 26003073
Decision Date: 03/06/26 Archive Date: 03/06/26

DOCKET NO. 17-59 976
DATE: March 6, 2026

ORDER

Entitlement to a separate initial disability rating of 10 percent for a right knee disability based on recurrent subluxation or instability is granted.

Entitlement to a separate initial disability rating of 10 percent for a left knee disability based on recurrent subluxation or instability is granted.

Entitlement to a separate initial disability rating of 20 percent for a right knee disability based on dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion, is granted.

Entitlement to a separate initial disability rating of 20 percent for a left knee disability based on dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion is granted.

Entitlement to a disability rating in excess of 10 percent for a right knee disability based on limitation of flexion is denied.

Entitlement to a disability rating in excess of 10 percent for a left knee disability based on limitation of flexion is denied.

FINDINGS OF FACT

1. Joint stability testing of the Veteran's right and left knee was reported as normal throughout the appeal period; however, the Veteran credibly reported subjective symptoms of instability and the sensation of his knees giving way.

2. The Veteran's right and left knee disability was manifested by a history of dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion.

3. The Veteran's right and left knee disability was manifested by flexion limited to, at worst, 80 degrees following repeated use over time or during flare-ups due to pain and weakness. Neither the objective medical findings nor the lay descriptions of functional impairment demonstrate the Veteran's flexion of the right and/or left knee was limited to 30 degrees or less.

CONCLUSIONS OF LAW

1. The criteria for a separate initial disability rating of 10 percent for a right knee disability based on instability 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 5257.

2. The criteria for a separate initial disability rating of 10 percent for a left knee disability based on instability 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 5257.

3. The criteria for a separate initial disability rating of 20 percent for a right knee disability based on dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion, 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 5258.

4. The criteria for a separate initial disability rating of 20 percent for a left knee disability based on dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion, 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 5258.

5. The criteria for a disability rating in excess of 10 percent for a right knee disability based on limitation of flexion have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260.

6. The criteria for a disability rating in excess of 10 percent for a left knee disability based on limitation of flexion have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40,
on limitation of flexion have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Marine Corps from December 1976 to December 1979. He also in the Air National Guard from December 1982 to December 2017, with periods of active duty from October 2001 to July 2003, from October 2003 to March 2004, from January 2005 to June 2005, from May 2006 to October 2006, from June 2010 to February 2011, and from February 2011 to November 2017. During his service, he was awarded, among others, the Meritorious Service Medal, Joint Service Commendation Medal, Air Force Commendation and Achievement Medal, Army Commendation and Achievement Medal, Iraq Campaign Medal, and the Afghanistan Campaign Medal.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2016 decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared at a Board hearing before the undersigned Veterans Law Judge in October 2019. A transcript of the hearing is in the Veteran's file.

In relevant part, the Board denied an initial disability rating in excess of 10 percent for each the right and the left knee in an April 2022 decision. The Veteran appealed the April 2022 Board decision to the United States Court of Appeals for Veterans Claims (Court). In a March 2024 Memorandum Decision, the Court set aside only that part of the April 2022 Board decision concerning the initial evaluation of the Veteran's right and left knee disability. This matter has been returned to the Board for readjudication consistent with the Memorandum Decision.

Right and Left Knee Disability

Disability ratings are determined by the criteria set forth in the VA Schedule for Rating Disabilities and are intended to represent the average impairment of earning capacity resulting from the disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. 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 rating. 38 C.F.R. § 4.7. All benefit of the doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3.

Knee disabilities are unique, as they are one of a few orthopedic disabilities in which multiple ratings may be assigned based on separate and distinct manifestations of the same disability. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment).

During the pendency of the current appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a, including Diagnostic Codes 5003, 5010, 5257, and 5262 were amended effective February 7, 2021. 85 Fed. Reg. 76453 (Nov. 3, 2020). The February 7, 2021, amendments did not affect Diagnostic Codes 5256, 5258, 5259, 5260, 5261, or 5263. Prior to February 7, 2021, the Board will consider the old version of the diagnostic code only. For the period on appeal from February 7, 2021, the Board will consider both the old and the amended version of the diagnostic code and rate based on
, including Diagnostic Codes 5003, 5010, 5257, and 5262 were amended effective February 7, 2021. 85 Fed. Reg. 76453 (Nov. 3, 2020). The February 7, 2021, amendments did not affect Diagnostic Codes 5256, 5258, 5259, 5260, 5261, or 5263. Prior to February 7, 2021, the Board will consider the old version of the diagnostic code only. For the period on appeal from February 7, 2021, the Board will consider both the old and the amended version of the diagnostic code and rate based on whichever is more favorable to the Veteran.

Degenerative arthritis established by X-ray findings is rated on the basis of limitation of motion under the appropriate diagnostic code(s) for the specific joint(s) involved. See 38 C.F.R. § 4.71a, Diagnostic Code 5003. When the limitation of motion is noncompensable under the appropriate diagnostic code(s), a 10 percent rating is applied for each major joint affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. Limitation of motion must be objectively confirmed by such findings as swelling, muscle spasm, or satisfactory evidence of painful motion.

Prior to February 7, 2021, the rating for post-traumatic arthritis under Diagnostic Code 5010 was determined under the criteria for Diagnostic Code 5003 pertaining to degenerative arthritis. Since February 7, 2021, Diagnostic Code 5010 provides that post-traumatic arthritis shall be rated as limitation of motion, dislocation, or other specified instability under the affected joint. If there are two or more affected joints, each rating shall be combined in accordance with 38 C.F.R. § 4.25.

Diagnostic Code 5256 pertains to ankylosis of the knee. A 30 percent disability rating is assigned for ankylosis of the knee, favorable angle in full extension, or in slight flexion between 0 degrees and 10 degrees. A 40 percent disability rating is assigned for ankylosis of the knee in flexion between 10 and 20 degrees. A 50 percent disability rating is assigned for ankylosis of the knee in flexion between 20 and 45 degrees. A maximum 60 percent disability rating is assigned for ankylosis of the knee, extremely unfavorable, in flexion at an angle of 45 degrees or more.

Prior to February 7, 2021, Diagnostic Code 5257 provided a 10 percent disability rating for "slight" recurrent subluxation or lateral instability of the knee. A 20 percent rating is assigned for "moderate" recurrent subluxation or lateral instability. A 30 percent rating is assigned for "severe" recurrent subluxation or lateral instability.

The revised criteria for Diagnostic Code 5257, effective February 7, 2021, evaluates other impairment of the knee, to include recurrent subluxation or instability, and added evaluation for patellar instability. Regarding recurrent subluxation or instability, a 10 percent rating is assigned for sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 20 percent rating is assigned for 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 30 percent rating is assigned 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.

Regarding patellar instability, under the revised criteria for Diagnostic Code 5257, a 10 percent rating is assigned for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent rating is assigned for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical
acing for ambulation. A 30 percent rating is assigned 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.

Regarding patellar instability, under the revised criteria for Diagnostic Code 5257, a 10 percent rating is assigned for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent rating is assigned for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: a brace, cane, or walker. A 30 percent disability rating is assigned for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker.

Note (1) provides that for patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. 38 C.F.R. § 4.71a, Diagnostic Code 5257, Note (1). Note (2) provides that a surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration). 38 C.F.R. § 4.71a, Diagnostic Code 5257, Note (2).

Under Diagnostic Code 5258, a maximum 20 percent rating is assigned for dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint. The use of the conjunctive "and" indicates that dislocated semilunar cartilage and all three criteria (frequent episodes of locking, pain, and effusion) must be demonstrated. Camacho v. Nicholson, 21 Vet. App. 360, 366 (2007).

Under Diagnostic Code 5259, a maximum 10 percent rating is assigned for symptomatic removal of semilunar cartilage.

Under Diagnostic Code 5260, a noncompensable disability rating is assigned for limitation of flexion to 60 degrees. A 10 percent rating is warranted for flexion limited to 45 degrees, a 20 percent rating is warranted for flexion limited to 30 degrees, and a maximum 30 percent rating is warranted for flexion limited to 15 degrees.

Under Diagnostic Code 5261, a noncompensable disability rating is assigned for limitation of extension to 5 degrees. A 10 percent rating is warranted for extension limited to 10 degrees, a 20 percent rating is warranted for extension limited to 15 degrees, a 30 percent rating is warranted for extension limited to 20 degrees, a 40 percent rating is warranted for extension limited to 30 degrees, and a 50 percent rating is warranted for extension limited to 45 degrees.

VA's General Counsel has held that separate ratings may be assigned in cases where a service-connected knee disability includes both a compensable limitation of flexion under Diagnostic Code 5260 and a compensable limitation of extension under Diagnostic Code 5261, provided that the degree of disability is compensable under each set of criteria. VAOPGCPREC 9-2004; 69 Fed. Reg. 59990 (2004).

With respect to Diagnostic Code 5262, for impairment of the tibia and fibula, a 10 percent rating is assigned for a "slight" knee or ankle disability prior to February 7, 2021. A 20 percent rating is assigned for a "moderate" knee or ankle disability. A 30 percent rating is assigned for a "marked" knee or ankle disability. A maximum 40 percent rating is assigned for nonunion of the tibia and fibula with loose motion requiring a brace.

The maximum 40 percent rating under Diagnostic Code 5262 for nonunion of the tibia and fibula with loose motion requiring a brace did not change with the February 7, 2021, amendments. However, since February 7, 2021, malunion of the tibia and fibula is rated under the appropriate knee (5256, 5257, 5260, or 5261) or ankle (5270 or 5271) diagnostic codes, whichever results in the highest evaluation.

The February 7, 2021, amendments added criteria under Diagnostic Code 5262 for medial tibial
is assigned for nonunion of the tibia and fibula with loose motion requiring a brace.

The February 7, 2021, amendments added criteria under Diagnostic Code 5262 for medial tibial stress syndrome (MTSS) or shin splints. A noncompensable evaluation is assigned for treatment of MTSS or shin splints less than 12 consecutive months, one or both lower extremities. A 10 percent disability rating is assigned for MTSS or shin splints requiring treatment for no less than 12 consecutive months, and unresponsive to either shoe orthotics or other conservative treatment, one or both lower extremities. A 20 percent disability rating is assigned for MTSS or shin splints requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment, one lower extremity. A maximum 30 percent disability rating is assigned for MTSS or shin splints requiring treatment for no less than 12 consecutive months, and unresponsive to surgery and either shoe orthotics or other conservative treatment, both lower extremities.

Under Diagnostic Code 5263, a maximum 10 percent rating is assigned for genu recurvatum (acquired, traumatic, with weakness and insecurity in weight-bearing objectively demonstrated).

Background

Turning to the relevant evidence of record, service treatment records reflect that the Veteran reported longstanding knee issues. With respect to his right knee, the Veteran reported a history of right knee pain, swelling with increased activity, frequent locking and catching, and popping and crackling. In September 2015, physical examination of the right knee revealed trace effusion, pain with flexion, and tenderness. The provider noted that all ligaments appeared stable, and McMurray's testing was positive on the right. In October 2015, the Veteran underwent right knee arthroscopy, debridement, and partial meniscectomy.

Medical evidence associated with service treatment records show that the Veteran sought treatment for his left knee in December 2015. He reported a history of left knee medial pain, locking and catching, popping and crackling, and an occasional sensation of giving way. He indicated that his left knee symptoms felt exactly the same as his right knee. In January 2016, he underwent a left knee arthroscopy with arthroscopic medial plica band excision, and arthroscopic chondroplasty of patella, trochlea, and medial femoral condyle.

In an original claim received by VA on February 17, 2016, the Veteran sought service connection for a right and left knee disability. He was afforded a VA knee examination in June 2016. In describing his medical history, the Veteran reported bilateral knee pain for many years, and current symptoms that included crepitus and popping. However, the Veteran noted that he was still able to run two to three miles a few times a week. The Veteran described functional impairment due to his bilateral knee disability as needing to use his arms to go from a seated to standing position.

On initial range of motion measurements, right knee flexion was measured to 115 degrees, and extension was measured to 0 degrees. Left knee flexion was measured to 120 degrees, and extension was measured to 0 degrees. On the date of examination in February 2016, the examiner indicated that neither the right nor the left knee demonstrated evidence of pain with weight-bearing, objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue, or crepitus. Strength testing of the right and left knee was reported as normal. The examiner stated the Veteran did not have muscle atrophy, or ankylosis of the right and/or left knee joint. Joint stability testing of the right and left knee was reported as normal.

During the October 2019 Board hearing, the Veteran testified that he used knee braces for his right and left knee when he was having a lot of trouble with his knees and/or pain in his knees. He indicated that his knees had given out on him in the past. The Veteran described current symptoms of sticking, locking, popping, and cracking in his bilateral knees. He testified that he experienced some instability, and limitation of flexion and extension in his knees.
of the right and left knee was reported as normal. The examiner stated the Veteran did not have muscle atrophy, or ankylosis of the right and/or left knee joint. Joint stability testing of the right and left knee was reported as normal.

During the October 2019 Board hearing, the Veteran testified that he used knee braces for his right and left knee when he was having a lot of trouble with his knees and/or pain in his knees. He indicated that his knees had given out on him in the past. The Veteran described current symptoms of sticking, locking, popping, and cracking in his bilateral knees. He testified that he experienced some instability, and limitation of flexion and extension in his knees. Regarding limitation of flexion, the Veteran indicated that he was unable to raise his heel to his buttocks. Regarding limitation of extension, he indicated that he was unable to fully extend his knees to straighten his legs.

In January 2020, the Board remanded the Veteran's increased rating claim to determine the current nature and severity of his bilateral knee disability. Pursuant to the Board remand, the Veteran was afforded another VA knee examination in July 2020. The Veteran reported pain and stiffness in his knees, with difficulty straightening out his legs after being on his feet for a long period of time. He described flare-ups of his bilateral knee disability as increased pain and stiffness the more time that he spent on his feet.

On initial range of motion testing, both right and left knee flexion was measured to 100 degrees, and extension was measured to 0 degrees. The examiner reported that the results of passive range of motion testing were the same as active range of motion testing. The Veteran exhibited pain with right and left knee flexion, as well as evidence of pain with weight-bearing, and evidence of crepitus. The examiner stated that the Veteran did not demonstrate objective evidence of right knee pain on non-weight-bearing. He demonstrated objective evidence of left knee pain on non-weight-bearing.

After repetitive use testing, both right and left knee flexion was measured to 80 degrees, and extension was measured to 0 degrees. The examiner stated the additional functional loss of the right knee following repetitive use testing was due to pain, fatigue, lack of endurance, and incoordination. The additional functional loss of the left knee following repetitive use testing was due to pain, fatigue, weakness, lack of endurance, and incoordination. The examiner estimated that right and left knee flexion would be limited to 80 degrees, and extension to 0 degrees, during flare-ups and following repeated use over time. Strength testing of the right and left knee was reported as normal. The examiner stated the Veteran did not have muscle atrophy, or ankylosis of the right and/or left knee joint. Joint stability testing of the right and left knee was reported as normal. The examiner reported that the Veteran's bilateral knee disability resulted in poor tolerance for prolonged standing, walking, and climbing due to pain and stiffness in his knees.

As noted above, the Board denied an initial disability rating in excess of 10 percent for each the right and the left knee in an April 2022 decision. On remand from the Court, the March 2024 Memorandum Decision directed the Board to reassess whether the Veteran is entitled to a separate disability rating for instability, which is discussed further below in the decision herein.

In addition, the March 2024 Memorandum Decision directed the Board to address the Veteran's argument that the July 2020 VA knee examination was not compliant with Correia v. McDonald, which requires VA joint examinations to include the results of range of motion testing described in 38 C.F.R. § 4.59 in order to be adequate. See Correia v. McDonald, 28 Vet. App. 158, 169-70 (2016) ("examination should record the results of range of motion testing 'for pain on both active and passive motion [and] in weight-bearing and nonweight-bearing"). Here, the Board finds that the July 2020 VA knee examination was adequate with respect to compliance with Correia. The July 2020 VA examination identified the required criteria under 38 C.F.R. § 4.59, and the Board finds that the required elements were adequately recorded when reading the entirety of the report. See 38 C.F.R. 4.2 (concerning interpretation of examination reports).

On examination in July 2020, the examiner reported that the Veteran demonstrated pain with initial (active) range of motion testing for flexion of both the right and left knee, resulting in flexion limited to 100 degrees. The examiner indicated that the Veteran did not have pain with extension on active range of motion testing of either knee, and extension was measured to 0 degrees. The examiner reported that the Veteran demonstrated evidence of pain with weight-bearing for both the right and the left knee, which resulted in flexion limited to 100 degrees. With respect to non-weight-bearing, the examiner stated that the Veteran did not demonstrate evidence of pain in the right knee, but he did demonstrate evidence of pain in the left knee. Regarding range of motion testing for pain on both active and passive motion in non-weight-bearing, the examiner indicated that the results were the same as those results for active and passive range of motion testing for pain with weight-bearing.

Law and Analysis

Initially, the evidence of record does not demonstrate, and the Veteran has not asserted, that he has the following knee conditions: symptomatic removal of semilunar cartilage of right and/or left knee; impairment of the tibia and fibula of the right and/or left knee; or genu recurvatum. Therefore, the Board finds that consideration of separate disability ratings under Diagnostic Codes 5259, 5262, and 5263 is not warranted.

Diagnostic Code 5256: Ankylosis

In this case, the evidence of record does not demonstrate that the Veteran has actual, or the functional equivalent of, ankylosis of the right or the left knee at any time during the appeal period. See Chavis v. McDonough, 34 Vet. App. 1 (2021). While the Veteran testified that he was not able to straighten his legs, the Board finds that his reported "stiffness" of the knees is not consistent with the functional equivalent of ankylosis. In this regard, the competent evidence does not support a finding that either the right or the left knee joint is fused at an angle specified under Diagnostic Code 5256. Here, although the Veteran testified that he was unable to straighten his legs, the evidence of record is more consistent with reduced range of motion due to pain and stiffness of the bilateral knees, rather than either knee joint being in a fixed position (i.e., ankylosis).

As such, the Board finds that a separate evaluation under Diagnostic Code 5256 is not warranted.

Diagnostic Code 5257: Recurrent Subluxation or Instability

As directed by the March 2024 Memorandum Decision, the Board has considered whether the Veteran is entitled to a separate disability rating for instability. In this case, December 2015 medical records document that the Veteran reported he experienced a sensation of his left knee giving way, and he indicated he experienced such symptoms in his right knee as well. 38 C.F.R. § 4.1 (stating that it is essential, both in the examination and in the evaluation of disability, that each disability be viewed in relation to its history). Although the competent medical findings show that joint stability testing of the bilateral knees was normal throughout the evidence of record, the Veteran testified that he had a history of his knees giving out, that he experienced some knee instability, and that he wore braces on his knees occasionally.

Here, the objective medical evidence throughout the appeal period reflects that joint stability testing of the Veteran's right and left knee was normal, and muscle strength testing of the knees was normal. Nevertheless, the Board finds the Veteran's report of subjective symptoms of instability and that his knees sometimes gave way to be credible in this case.

Prior the February 7, 2021, amendments, Diagnostic Code 5257 provided a 10 percent disability rating for "slight" recurrent subluxation or instability. A 20 percent rating was assigned for "moderate" recurrent subluxation or instability, and a 30 percent rating was assigned for "severe" recurrent subluxation or lateral instability. While the terms "slight," "moderate," and "severe" are not defined in the VA Schedule for Rating Disabilities, the Board must evaluate all of the evidence for "equitable and just decisions." 38 C.F.R. § 4.6. Slight may
his knees sometimes gave way to be credible in this case.

Prior the February 7, 2021, amendments, Diagnostic Code 5257 provided a 10 percent disability rating for "slight" recurrent subluxation or instability. A 20 percent rating was assigned for "moderate" recurrent subluxation or instability, and a 30 percent rating was assigned for "severe" recurrent subluxation or lateral instability. While the terms "slight," "moderate," and "severe" are not defined in the VA Schedule for Rating Disabilities, the Board must evaluate all of the evidence for "equitable and just decisions." 38 C.F.R. § 4.6. Slight may generally be defined as small in degree or amount. See Merriam-Webster Dictionary, https://www.merriam-webster.com/dictionary (last viewed February 26, 2026). Moderate may generally be defined as limited in scope or effect. Severe may generally be defined as very harmful.

The Board resolves all reasonable doubt in favor of the Veteran in finding that a separate 10 percent evaluation is warranted for slight instability of each the right and left knee. In reaching this determination, the Board assigns weight to the Veteran's subjective reports that he experienced the sensation of his knees giving way. Given the competent medical evidence demonstrating normal joint stability, the Board finds that any subjective reports of instability of the right and/or left knee is small in degree or amount, warranting a 10 percent evaluation for slight instability. The Board finds that a higher rating of 20 percent for moderate instability or 30 percent for severe instability is not warranted under either the old or the amended criteria. Under the old rating criteria, the Board finds that moderate and severe evaluations for instability contemplate a condition that is demonstrated by objective medical findings, and not solely subjective symptoms. Such is consistent with the amended criteria for Diagnostic Code 5257.

Accordingly, a separate initial disability rating of 10 percent, but no higher, for slight instability of each the right and left knee is granted.

Diagnostic Code 5258: Dislocated Semilunar Cartilage

As directed by the March 2024 Memorandum Decision, the Board has considered the Veteran's reports of his knees popping, sticking, and locking. Here, the VA examinations during the period under review noted the Veteran's history of a right and left knee meniscal condition which is documented in service treatment records. As discussed above, the medical evidence in service treatment records reflect that the Veteran had swelling with increased activity, effusion, frequent locking and catching, and popping and crackling of the right and left knee. 38 C.F.R. § 4.1. During the October 2019 Board hearing, the Veteran testified that he continued to experience sticking, locking, popping, and cracking in his bilateral knees.

With respect to Diagnostic Code 5258 for dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion, the Board resolves reasonable doubt in favor of the Veteran in finding that a separate 20 percent disability rating is warranted for each the right and left knee for the entire appeal period. In reaching this determination, the Board assigns weight to the medical evidence noting a history of a right and left knee meniscal condition. In addition, the Board resolves reasonable doubt in favor of the Veteran in assigning weight to the evidence of record describing frequent episodes of "locking," pain, and swelling/effusion.

Resolving all reasonable doubt in favor of the Veteran, a separate initial disability rating of 20 percent under Diagnostic Code 5258 is granted for each the right and left knee.

Diagnostic Code 5260: Limitation of Flexion

In this case, the Veteran is in receipt of an initial 10 percent disability rating under Diagnostic Code 5260 for each his right and left knee based on limitation of flexion. The April 2022 Board decision determined that the VA examinations, when read together, provided sufficient information for the Board to make an informed decision concerning the Veteran's limitation of flexion due to his right and left knee disability. The medical evidence of record demonstrated that the Veteran's right and left knee flexion was limited to, at worst, 80 degrees. The July 2020 VA examiner considered functional loss due to pain, fatigue, weakness, lack of endurance, and incoordination in estimating that the Veteran's flexion of the right and left knee would be limited to 80 degrees during flare-ups or following repeated use over a period of time.

The March 2024 Memorandum Decision found no error in this part of the Board's April 2022 decision. As discussed in the March 2024 Memorandum Decision, the Veteran's range of motion loss during flare-ups, even if
ion due to his right and left knee disability. The medical evidence of record demonstrated that the Veteran's right and left knee flexion was limited to, at worst, 80 degrees. The July 2020 VA examiner considered functional loss due to pain, fatigue, weakness, lack of endurance, and incoordination in estimating that the Veteran's flexion of the right and left knee would be limited to 80 degrees during flare-ups or following repeated use over a period of time.

The March 2024 Memorandum Decision found no error in this part of the Board's April 2022 decision. As discussed in the March 2024 Memorandum Decision, the Veteran's range of motion loss during flare-ups, even if constant in frequency and duration, does not establish entitlement to a compensable rating under Diagnostic Code 5260 for either knee. Nevertheless, an initial 10 percent rating for each the right and left knee was assigned under Diagnostic Code 5260 based on full consideration of the functional loss exhibited by the Veteran. Neither the objective medical findings nor the lay descriptions of the Veteran's functional impairment demonstrate flexion of the right and/or left knee was limited to 30 degrees or less to warrant a disability rating in excess of 10 percent under Diagnostic Code 5260.

Accordingly, a disability rating in excess of 10 percent for each the right and left knee based on limitation of flexion is denied.

Diagnostic Code 5261: Limitation of Extension

Regarding limitation of extension, the Board notes that VA's General Counsel has held that separate ratings may be assigned in cases where a service-connected knee disability includes both a compensable limitation of flexion under Diagnostic Code 5260 and a compensable limitation of extension under Diagnostic Code 5261, provided that the degree of disability is compensable under each set of criteria. Crucially, the degree of disability must be compensable under each set of rating criteria to warrant separate ratings for both limitation of flexion and limitation of extension.

In this case, the Board acknowledges that the Veteran testified that he experienced "some" limitation of extension in his knees. However, he did not demonstrate pain with extension on either of the VA examinations, and extension of the right and left knee was measured to 0 degrees. In considering the Veteran's medical history, the objective medical evidence pertaining to the severity of his bilateral knee disability, and functional loss due to pain, fatigue, weakness, lack of endurance, and incoordination, the July 2020 VA examiner estimated that the Veteran would still be able to extend his right and left knee to 0 degrees during flare-ups and following repeated use over time.

Under Diagnostic Code 5261, a noncompensable disability rating is assigned for limitation of extension to 5 degrees. A minimum compensable disability rating of 10 percent is warranted for extension limited to 10 degrees. Even considering the Veteran's testimony that he experienced "some" limitation of extension in his right and left knee, the Board finds that the probative evidence of record persuasively weighs against a finding that his right and/or left knee disability was manifested by extension more nearly limited to 10 degrees to warrant a compensable evaluation under Diagnostic Code 5261. As a compensable rating for limitation of extension is not shown during the appeal period, a separate disability rating under Diagnostic Code 5261 is not warranted.

Conclusion

In sum, the evidence persuasively weighs against a finding that separate disability ratings are warranted for ankylosis (Diagnostic Code 5256), symptomatic removal of semilunar cartilage (Diagnostic Code 5259), limitation of extension (Diagnostic Code 5261), impairment of the tibia and fibula (Diagnostic Code 5262), or genu recurvatum (Diagnostic Code 5263). For the reasons discussed above, the Board finds that the evidence of record demonstrates the following: (1) a separate initial disability rating of 10 percent is warranted under Diagnostic Code 5257 for slight instability of each the right and left knee; (2) a separate initial disability rating of 20 percent is warranted under Diagnostic Code 5258 for each the right and left knee based on dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion; and (3) a disability rating in excess of 10 percent is not warranted under Diagnostic Code 5260 for limitation of flexion of each the right and left knee.

Evan M. Deichert

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board B. Mask, 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.

Analyze in VA Law Explorer