PSEUDOFOLLICULITIS BARBAE

NATHANIEL DOAN · 2026 · Case ID: 26004585

MIXED

Summary

The veteran, who served from September 1983 to September 1992, appeals the denial of an increased rating for pseudofolliculitis barbae (PFB) and for residuals of bilateral tibia stress fractures with osteoarthritis, as well as the denial of service connection for a neck scar secondary to PFB. The Board reviewed the evidence, including multiple VA examinations and some private treatment records, noting inconsistencies in the VA examinations regarding scarring and the extent of PFB. The veteran provided statements asserting more significant scarring and symptoms than documented by VA. The Board found the evidence did not support a rating higher than 10 percent for PFB, citing the criteria for characteristic lesions and systemic therapy. However, the Board granted service connection for an unstable neck scar secondary to the service-connected PFB, finding the Veteran's reports of scarring credible and consistent with the PFB diagnosis. For the bilateral knee conditions, the Board reviewed range of motion and stability testing, finding the Veteran's reports of pain and instability credible, but the objective measurements did not meet the criteria for increased ratings beyond 10 percent for painful motion. The Board did, however, grant a separate 10 percent rating for mild left and right knee instability under DC 5257, based on the Veteran's credible reports of the knees giving out, despite objective testing not showing instability. Service connection for the tibia residuals with osteoarthritis remained at 10 percent.

Rationale

Evidence did not meet criteria for increased rating; No characteristic lesions involving 20-40% of body or exposed areas; No systemic therapy required for 6+ weeks

Special Benefit

NO SPECIAL BENEFIT

Docket No.

14-07 019A

Full Decision Text

Citation Nr: 26004585
Decision Date: 04/15/26 Archive Date: 04/15/26

DOCKET NO. 14-07 019A
DATE: April 15, 2026

ORDER

An initial rating in excess of 10 percent for pseudofolliculitis barbae (PFB) is denied.

Service connection for unstable neck scar, secondary to PFB, is granted.

A rating in excess of 10 percent for residuals of stress fracture of the left tibia with osteoarthritis is denied.

A separate 10 percent rating for left knee instability, from April 2, 2014, is granted.

A rating in excess of 10 percent for residuals of stress fracture of the right tibia with osteoarthritis prior to March 15, 2022, and from May 1, 2022, is denied.

A separate 10 percent rating for right knee instability, from April 2, 2014, is granted.

FINDINGS OF FACT

1. Throughout the appeal period, the Veteran's PFB has not more nearly approximated characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period.

2. The Veteran's unstable neck scar is due to his service-connected PFB.

3. During the entire period on appeal, the Veteran's left knee disability has been manifested as limitation of flexion to 120 degrees, at worst.

4. During the entire period on appeal, the Veteran's left knee instability has been manifested by mild instability, at worst.

5. During the entire period on appeal, the Veteran's right knee disability has been manifested as limitation of flexion to 110 degrees, at worst.

6. During the entire period on appeal, the Veteran's right knee instability has been manifested by mild instability, at worst.

CONCLUSIONS OF LAW

1. The criteria are not met for an initial rating higher than 10 percent for PFB. 38 U.S.C. §§ 1155, 5103, 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.118, Diagnostic Criteria (DC) 7806.

2. The criteria for service connection for an unstable neck scar, secondary to PFB, are met. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.310.

3. The criteria for a rating in excess of 10 percent for residuals of stress fracture of the left tibia with osteoarthritis are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5003-5260.

4. The criteria for a separate rating of 10 percent for left knee instability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5257.

5. The criteria for a rating in excess of 10 percent for residuals of stress fracture of the right tibia with osteoarthritis prior to March 15, 2022, and from May 1, 2022, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5003-5260.

6. The criteria for a separate rating of 10 percent for right knee instability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5257.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from September 1983 to September 1992.

These matters come before the Board of Veterans' Appeals (Board) on appeal from

a February 2015 rating decision issued by the Department of Veterans Affairs (VA)

Regional
, 4.71a, DC 5003-5260.

6. The criteria for a separate rating of 10 percent for right knee instability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5257.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from September 1983 to September 1992.

These matters come before the Board of Veterans' Appeals (Board) on appeal from

a February 2015 rating decision issued by the Department of Veterans Affairs (VA)

Regional Office, the agency of original jurisdiction (AOJ).

These matters were remanded in October 2015, November 2017, November 2023, and July 2024. In July 2024, the Board remanded the matter to provide the Veteran the opportunity to provide authorization for VA to obtain his private dermatology records from 2013 to present and for the AOJ to issue an SSOC listing the claims for increased rating for the knee disabilities. The Board finds that there has been substantial compliance with the July 2024 remand instructions; accordingly, the Board will adjudicate the appeal. See Stegall v. West, 11 Vet. App. 268, 271 (1998); see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999) (noting that Stegall requires substantial compliance with remand orders, rather than absolute compliance).

Increased Ratings

Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Each disability must be viewed in relation to its history, and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7.

When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria.").

38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion and in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." Correia v. McDonald, 28 Vet. App. 158 (2016).

VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. Sharp v. Shulkin, 29 Vet. App. 26 (201
on the § 4.71a criteria.").

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); 38 C.F.R. § 3.102.

1. Entitlement to an initial rating in excess of 10 percent for PRB.

2. Entitlement to service connection for an unstable neck scar, secondary to PFB.

The Veteran contends that he is entitled to an increased rating for his PFB.

From service connection, April 2, 2014, the Veteran's PFB has been rated 10 percent disabling, under DC 7813-7806. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating. 38 C.F.R. § 4.27.

Under DC 7806, the criteria in the General Rating Formula for the Skin applies. Under the General Rating Formula, a 10 percent rating is warranted when there are characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body or at least 5 percent, but less than 20 percent, of exposed areas; or, when intermittent systemic therapy including but not limited to corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs is required for a total duration of less than 6 weeks during a 12-month period. A 30 percent rating is warranted when there are characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas; or, when systemic therapy including but not limited to corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs is required for a total duration of 6 weeks or more, but not constantly, during a 12-month period. A 60 percent rating is warranted when there are characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas; or, when constant or near-constant systemic therapy including but not limited to corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs is required during a 12-month period.

A note to the criteria indicates that if rating the skin condition under DC 7800 (disfigurement of the head, face, or neck) or any of the DCs pertaining to scars (DCs 7801, 7802, 7803, 7804, or 7805) would result in a higher disability rating, the rater is directed to those codes. 38 C.F.R. § 4.118, DC 7806.

A note preceding 38 C.F.R. § 4.118 explains that for the purposes of this section, "systemic therapy is treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy is treatment that is administered through the skin."

The criteria for rating skin disabilities under DC 7806 were amended during the pendency of this claim, and the above criteria are effective from August 13, 2018.

The previous version of DC 7806 is essentially the same as the current General Rating Formula for the Skin, and provided a 10 percent rating for at least 5 percent, but less than 20 percent, of the entire body or at least 5 percent, but less than 20 percent, of exposed areas affected; or, when intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs is required for a total duration of less than 6 weeks during a 12-month period. A 30 percent rating is warranted for 20 to 40 percent of the entire body or 20 to 40 percent exposed areas affected; or, systemic therapy such as corticosteroids or other immunosuppressive drugs is required for a total duration of 6 weeks or more, but not constantly, during a 12-month period. A 60 percent rating is warranted for more than 40 percent of the entire body or more than 40 percent exposed areas affected; or, constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during a 12-month period. See 38 C.F.R. § 4.118, DC 7806

Turning to the evidence, in the April 2014 Report of General Information, the Veteran indicated desire to initiate a claim for PFB and reported that he had not been treated for such since service.

The January 2015 VA examination report reflects the Veteran's PFB diagnosis; and he reported papules in the neck area. The Veteran's condition did not cause any scarring, and the Veteran had not been treated with oral or topical medications; or treatments or procedures in the prior 12 months. The examiner indicated that the Veteran's condition affected less than five percent of his body, specifying that such affected his neck and bilateral cheek area. However, the examiner noted that the Veteran has a "very fine skin change of his upper cheeks...from prior episodes of PFB...there are no cosmetically obvious scars." The Board finds such observations to be internally inconsistent.

In a March 2015 written statement, the Veteran asserted that he has "numerous permanent scars and disfiguration of features" and he explained that other areas are affected by the disease and noticeable bumps/welts remain constant. The Board observes that the Veteran is competent to report scarring on his face.

In the June 2016 VA Form 9, the Veteran explained that under his beard is additional scarring keloids, blemishes, razor bumps, and indentations due to his PFB.

In December 2017, the Veteran identified private dermatology records from October 2014 to November 2014 and provided authorization for VA to obtain such records. VA requested the records and received such in January 2018; they consisted of a single page. The private September 2014 treatment record reflects PFB with one follicular papule and acne keloid; the Veteran's hand eczema was also treated at the same visit. The Veteran was prescribed multiple creams and medications, though the record is not clear as to whether prescriptions are for the facial PFB or the hand eczema.

The February 2018 VA skin examination report reflects that the Veteran's PFB causes scarring consisting of painful or unstable scars that have a total area equal to or greater than 6 square inches or are located on the head face or neck. The examiner indicated that the Veteran has been treated with oral or topical medications for PFB in the prior 12 months but not constantly. The examiner indicated that the Veteran has taken oral doxycyline and protopic ointment; and that less than five percent of the Veteran's body area is affected. He explained the skin appearance and location as PFB macules and papules that are too numerous to count on cheeks and neck.

The February 2018 VA scar examination report reflects pseudofolliculitis barbae scarring that of the head, face, or neck. The scars were indicated to be stable, not painful, and not due to burns. The report reflects 1-2 millimeter pitted scars that are too numerous to count.

In an April 2019 written statement, the Veteran explained that he still has "developing keloids and bumping to this date" in addition to permanent scarring "that will never return to normal" in his facial area and neck.

The December 2023 VA skin examination report reflects that the Veteran had no active skin activity and had not been treated with medication or treatments in the prior 12 months for any skin condition. The examiner did not indicate the percentage of the Veteran's body affected by the skin condition. The report indicates that the
neck. The scars were indicated to be stable, not painful, and not due to burns. The report reflects 1-2 millimeter pitted scars that are too numerous to count.

The December 2023 VA skin examination report reflects that the Veteran had no active skin activity and had not been treated with medication or treatments in the prior 12 months for any skin condition. The examiner did not indicate the percentage of the Veteran's body affected by the skin condition. The report indicates that the Veteran's PFB causes scarring or disfigurement of the head, face, or neck.

The December 2023 VA scar examination report reflects PFB scarring of the head, face, or neck. The scars were indicated to not be painful and not due to burns; however, the Veteran had one unstable scar consisting of a hypopigmented area on the neck. The report reflects 1-2 millimeter pitted scars that are too numerous to count in the bearded area of face and neck. The total area of the hypopigmented area of the head, face, and neck is .1 centimeters squared.

In January 2024, the Veteran asserted that his VA examinations "did not go well," that he was not properly examined, and that he would like to be rescheduled. Unfortunately, it is not clear to which examination the Veteran is referring and the specifics of his assertions regarding the examination(s).

In July 2024, the Board remanded the Veteran's claim to allow the Veteran the opportunity to identify and authorize the release of any relevant private treatment records as there are inconsistencies in the record as to whether his condition was being treated with medication from February 2013 to the present; alternatively, the Veteran was informed that he could provide such records. In this regard, the Veteran was provided with the necessary forms by the AOJ and VA received a response in October 2024, but only for records dated September 2024 to current. The record request was rejected as it did not meet the criteria; moreover, the Board finds that even if such was completed, the necessary records would not have been complete as the Veteran limited the authorization to the one year prior to the date of receipt of form. The July 2024 Board remand was clear that private records from the entire period were needed to properly assess the claim; and the Veteran's cooperation was emphasized by the Board as the remand stated, "It is crucial that the Veteran cooperate with VA's efforts to develop his claim, to include authorizing VA to obtain all relevant private medical records, or submitting the records himself." Nevertheless, the AOJ provided the Veteran another opportunity to provide proper authorization in October 2024; and no response was received. The record also does not contain any additional records submitted by the Veteran after the July 2024 remand. While the private treatment records were not received, the Board finds that the AOJ substantially complied with the July 2024 Board remand as the AOJ provided the Veteran ample notice and opportunity to submit his authorization for private treatment records from February 2013 to the present time.

The Board reminds the Veteran that he is obligated to participate in the development of his appeal. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (holding that "(t)he duty to assist is not always a one-way street... [i]f a veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence.").

Based on the foregoing, the Board finds that there is no evidence of record throughout the appeal period that supports a rating in excess of 10 percent for the Veteran's PFB. In this regard, there is no evidence that the Veteran has characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period.

Consequently, the Board finds that a rating in excess of 10 percent for PFB is denied. Moreover, the weight of the evidence is against the Veteran's claim, and the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990);
percent of exposed areas affected; or systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period.

However, in Wilson v. McDonough, the Court held that VA is obligated to identify, develop, and adjudicate claims for secondary service connection that are reasonably raised during the processing of a properly initiated claim as to the primary service-connected disability's evaluation level, which may include complications of the primary service-connected disability and claims that logically relate to the pending claim. 35 Vet. App. 103 (2022).

In this regard, the Board finds that service connection for facial and neck scarring on a secondary basis are warranted as such are due to the Veteran's service-connected PFB. The record contains consistent reporting of such symptoms throughout the appeal period at the majority of the VA examinations as well as written statements from the Veteran. Moreover, throughout the appeal period, multiple VA examiners have indicated that such scarring is due to the PFB, to include the December 2023 VA examiner's finding of an unstable scar. The Board acknowledges that the applicable rating criteria directs the rater to consider other skin ratings if such would provide a higher rating. However, in the instant case, the Board finds that the probative medical evidence of record, particularly in the December 2023 VA examination, supports a basis for secondary service connection for a single unstable scar. In this regard, the medical evidence reflects that such neck scar is persistent in one location, in addition to the generalized PFB scarring that covers the entire neck and facial hair area; and that such has separate symptomatology from the PFB.

Accordingly, service connection for an unstable neck scar is warranted. 38 C.F.R. § 3.310.

3. Entitlement to an initial rating in excess of 10 percent for residuals of stress fracture of the left tibia with osteoarthritis.

4. An initial rating in excess of 10 percent for residuals of stress fracture of the right tibia with osteoarthritis.

The Veteran contends that he is entitled to increased ratings for his left and right knee disabilities. The rating decision on appeal was an adjudication of an April 2, 2014, claim for increase.

From service connection on September 30, 1992, the Veteran's residuals of stress fracture of the left tibia with osteoarthritis (hereafter "left knee") has been rated 10 percent disabling, under DC 5003-5260. His residuals of stress fracture of the right tibia with osteoarthritis (hereafter "right knee") has been rated 10 percent disabling from September 30, 1992, except for a period from March 15, 2022, to April 30, 2022, when he received a total rating for such (following surgery); from May 1, 2022, his right knee rating continued at 10 percent, under DC 5003-5260. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating. 38 C.F.R. § 4.27.

Under DC 5260 for limitation of flexion of the leg, a noncompensable rating is warranted for flexion limited 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 30 percent rating is warranted for flexion limited to 15 degrees. 38 C.F.R. § 4.71a, DC 5260.

DC 5261 provides a noncompensable rating is warranted for extension limited 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 provided for extension limited to 45 degrees. 38 C.F.R. § 4.71a, DC 5261.

Where
30 percent rating is warranted for flexion limited to 15 degrees. 38 C.F.R. § 4.71a, DC 5260.

Where there is painful or limited motion with both flexion and extension, but the compensable criteria are not met for flexion (DC 5260) or extension (DC 5261), only one minimum rating of 10 percent should be assigned. Separate ratings also may not be assigned for painful or noncompensable limitation of motion using DC 5003 or section 4.59 in connection with DC 5260, and for compensable limitation of extension under DC 5261. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011).

In addition to DCs 5260 and 5261, there are other Diagnostic Codes pertaining to the knee.

DC 5256 provides a 30 percent rating for knee ankylosis with a favorable angle in full extension, or in slight flexion between zero and 10 degrees. A 40 percent rating is warranted for knee ankylosis in flexion between 10 degrees and 20 degrees. A 50 percent rating is warranted for knee ankylosis in flexion between 20 degrees and 45 degrees. A 60 percent rating is warranted for extremely unfavorable knee ankylosis, in flexion at an angle of 45 degrees or more. 38 C.F.R. § 4.71a.

DC 5257 provides the criteria required for a rating pertaining to knee subluxation or instability. 38 C.F.R. § 4.71a. During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a, including DC 5257, were amended effective February 7, 2021. 85 Fed. Reg. 76453 (Nov. 30, 2020). Prior to February 27, 2021, the Board will consider the old version of the DCs only (old code); however, for the period beginning February 27, 2021, the Board will consider both the old and amended version (amended code) of the DC and rate based on whichever is most favorable to the Veteran.

Prior to the regulatory change, recurrent subluxation and lateral instability of the knee warranted a 10, 20, or 30 percent rating if slight, moderate, or severe, respectively. 38 C.F.R. § 4.71a, DC 5257 (2020). According to MERRIAM WEBSTER'S COLLEGIATE DICTIONARY 999 (11th Ed. 2007), "slight" means small in amount. "Moderate" means limited in scope or effect. "Severe" means very painful or harmful or of a great degree.

As of February 7, 2021, DC 5257 contains two sections for rating other impairment of the knee. 38 C.F.R. § 4.71a, DC 5257. The first is for recurrent subluxation or instability. The second is for patellar instability. The Board initially observes that, under the old rating criteria, objective medical evidence is not required to establish lateral knee instability under DC 5257, so objective medical evidence cannot be categorically found more probative than lay evidence with respect to this DC. English v. Wilkie, 30 Vet. App. 347, 352-53 (2018). However, under the new rating criteria, objective medical evidence of a diagnosed condition of a sprain, incomplete ligament tear, or complete ligament tear, or condition involving the patellofemoral complex, is required before a compensable rating can be assigned.

DC 5258 provides a 20 percent rating for dislocation of semilunar cartilage with frequent episodes of "locking, pain", and effusion into the joint. 38 C.F.R. § 4.71a.

DC 5259 provides a 10 percent rating for symptomatic removal of semilunar cartilage. 38 C.F.R. § 4.71a.

Accordingly, in order to be entitled to an increased rating, the Veteran's flexion
the new rating criteria, objective medical evidence of a diagnosed condition of a sprain, incomplete ligament tear, or complete ligament tear, or condition involving the patellofemoral complex, is required before a compensable rating can be assigned.

DC 5258 provides a 20 percent rating for dislocation of semilunar cartilage with frequent episodes of "locking, pain", and effusion into the joint. 38 C.F.R. § 4.71a.

DC 5259 provides a 10 percent rating for symptomatic removal of semilunar cartilage. 38 C.F.R. § 4.71a.

Accordingly, in order to be entitled to an increased rating, the Veteran's flexion must be limited 30 degrees. The Board finds that the evidence of record does not support such and a rating in excess of 10 percent for either knee for limited range of motion is not warranted.

Turning to the evidence of record, the January 2015 VA examination report reflects the Veteran's report of intermittent pain in both knees and that the Veteran has to limit his walking to avoid increased knee pain and avoids particular exercises that contribute to knee pain. The Veteran reported no flare-ups. Range of motion testing revealed bilateral flexion limited to 120 degrees and extension to 0. After repetitive use testing, there was no additional loss of range of motion or functional loss. Joint stability testing revealed no bilateral joint instability.

In March and May 2015 written statements, the Veteran explained that he has constant pain and his arthritis has further developed. In June 2016, the Veteran reported his additional symptoms of swelling; increased pain; and the inability to bend or squat without significant pain or "grinding noises."

The February 2018 VA examination report reflects the Veteran's report of increased pain during cold and damp weather; and that there is no change of range of motion during flare-ups. The Veteran reported that he cannot do weight training and has trouble running; climbing steps; squatting; and bending. Range of motion testing revealed bilateral flexion limited to 120 degrees and extension to 0. After repetitive use testing, there was no additional loss of range of motion or functional loss. After repeated use over time and during flare-ups, the Veteran experienced pain but no further range of motion reduction. Joint stability testing revealed no bilateral joint instability.

November 2021 private treatment records reflect the Veteran's left knee range of motion was from 0 to 130 degrees.

The December 2021 VA examination report reflects the Veteran's flexion was limited to 130 degrees and his extension to 0. After repeated use over time and during flare-ups, the Veteran experienced pain but no further range of motion reduction was indicated. Joint stability testing revealed no bilateral joint instability. The Veteran's right knee was noted to have a meniscal tear, but no surgery.

March 2022 private treatment records reflect the Veteran's right knee range of motion was from 0 to 130 degrees.

April 2022 private treatment records reflect the Veteran's right knee range of motion was from 0 to 120 degrees.

In April 2022, the Veteran did not appear for VA examinations to assess the severity of his knee disabilities.

The May 2022 VA examination report reflects the Veteran's report that he is undergoing physical therapy; takes motrin as needed; and uses ice as needed. The Veteran reported no flare-ups but increased pain on weight-bearing, prolonged standing, prolonged walking, prolonged sitting, and pain when going from seated to standing. The Veteran's right knee flexion was limited to 110 degrees and extension limited to 0; his left knee range of motion was not measured. After repetitive use testing, there was no additional loss of range of motion or functional loss. After repeated use over time and during flare-ups, the Veteran did not have additional functional loss. Joint stability testing revealed no bilateral joint instability, and the Veteran was indicated to have no current symptoms of the stress fracture, which was diagnosed in 1992. The Veteran's right knee meniscal tear was treated via right knee arthroscopy on March 15, 2022. The examiner indicated that the residuals of such surgery include increased pain on weight-bearing, prolonged standing, prolonged walking, prolonged sitting, and pain when going from seated to standing.

August 2022 private treatment records reflect the Veteran's right knee range of motion was from 0 to 130 degrees.

The January 2023 VA examination report reflects the Veteran's report that his symptoms have improved but that he still has pain to his right knee periodically, during weather changes, after sitting over an hour, and that his knee feels like it will "give in" when walking. He treated his knees with physical therapy, Tylenol as needed, ice, and elevation. The Veteran did not report flare-ups. The examiner indicated that the Veteran reported a history
examiner indicated that the residuals of such surgery include increased pain on weight-bearing, prolonged standing, prolonged walking, prolonged sitting, and pain when going from seated to standing.

August 2022 private treatment records reflect the Veteran's right knee range of motion was from 0 to 130 degrees.

The January 2023 VA examination report reflects the Veteran's report that his symptoms have improved but that he still has pain to his right knee periodically, during weather changes, after sitting over an hour, and that his knee feels like it will "give in" when walking. He treated his knees with physical therapy, Tylenol as needed, ice, and elevation. The Veteran did not report flare-ups. The examiner indicated that the Veteran reported a history of instability. The Veteran's right knee range of motion was 130 degrees to 0 and his left knee 140 degrees to 0. After repeated use over time, the Veteran's right knee flexion was limited to 125 degrees and during flare-ups, such was limited to 120 degrees. Joint stability testing revealed no bilateral joint instability. The Veteran denied any symptoms attributable to the meniscus condition.

The June 2023 VA examination report reveals the Veteran's reports of pain in the knees that is intermittent associated with activity. He treats such with intermittent use of steroids and gels; as well as Tylenol, meditation, elevation, ice, and topicals for pain. The Veteran's bilateral range of motion reflected his flexion endpoint was 130 degrees and extension endpoint was 0. After repetitive use testing, there was no additional loss of range of motion or functional loss. After repeated use over time, the Veteran did not have additional functional loss or range of motion reduction. The Veteran denied flare-ups. Joint stability testing revealed no bilateral joint instability. The Veteran denied any symptoms attributable to the meniscus condition.

Based on the foregoing, the Veteran's left and right knee disabilities do not warrant a rating in excess of 10 percent each for painful motion. In this regard, the Veteran's extension has full range of motion, and his right knee flexion is limited to 110 degrees, at worst during the appeal period and his left knee flexion is limited to 120 degrees, at worst. In order to receive the next highest rating, 20 percent, his flexion would need to be limited to 30 degrees.

The Board acknowledges that the Veteran has repeatedly asserted that his knee condition has worsened over the years and warrants increased ratings as it affects his life. While the Veteran is competent to report his symptoms, the Veteran is not competent to ascertain whether such warrants an increased rating as such is based on specific criteria as provided in the DC. Moreover, such is based on the range of motion which is measured by physicians upon examination. Therefore, it is outside the competency of the Veteran because the record does not show that he has the medical training or credentials to determine the degree of range of motion reduction and the record contains both VA and private records reflecting the Veteran's range of motion throughout the appeal period. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011).

However, based on the evidence of record, namely the Veteran's report of instability in his knees during the appeal period, the Board finds that a 10 percent initial rating is warranted for left knee instability and a 10 percent rating is warranted for right knee instability under DC 5257. In this regard, the Board notes that the Veteran is competent to report symptoms that he is able to perceive through his senses such as pain, flare-ups, giving way, and difficulty with tasks such as walking, standing, sitting, and squatting. Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Board finds the Veteran's assertion regarding knee instability feeling as though his knees will "give in" as credible. Although objective testing did not identify instability on VA examination or on private examination, the Board finds the Veteran's assertions support a finding of "slight" instability for the right and left knees. See English v. Wilkie, 30 Vet. App. 347, 352-53 (2018). The evidence does not reflect more than slight instability. Thus, the Board assigns a separate 10 percent rating for left knee instability and a separate 10 percent rating for right knee instability pursuant to DC 5257, from April 2, 2014.

There is no evidence supporting a finding of ankylosis; dislocation or removal of semilunar cartilage; or limited extension of either knee. Accordingly, the Board finds that DCs 5256, 5258, 5259, and 5261 are
's assertions support a finding of "slight" instability for the right and left knees. See English v. Wilkie, 30 Vet. App. 347, 352-53 (2018). The evidence does not reflect more than slight instability. Thus, the Board assigns a separate 10 percent rating for left knee instability and a separate 10 percent rating for right knee instability pursuant to DC 5257, from April 2, 2014.

Based on the foregoing, the Board finds that ratings in excess of 10 percent for each the left and right knee painful motion under DC 5260 is warranted; and a separate initial rating of 10 percent for each the left and right knee under DC 5257 is warranted for mild instability from April 2, 2014. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102.

Nathaniel Doan

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board N. M. Younan

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.

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