OTHER SPECIFIED FORMS OF ARTHROPATHY

ROBERT C. SCHARNBERGER · 2026 · Case ID: 26005030

MIXED

Summary

The veteran, who served from March 1965 to February 1967, appeals the denial of higher ratings for his bilateral knee conditions, specifically sarcoid arthropathy and instability. The case has a complex procedural history involving multiple remands from the Board of Veterans' Appeals (BVA) and the U.S. Court of Appeals for Veterans Claims (CAVC) due to inadequate examinations and failure to address all aspects of the veteran's claims. The veteran sought increased ratings for sarcoid arthropathy of the left and right knees, which had previously received zero percent evaluations, and for left and right knee instability. The Board reviewed multiple VA examinations and addendum opinions from 2012 through 2025. While the veteran submitted lay evidence of instability and flare-ups, the objective medical evidence, including stability tests, consistently showed normal ranges of motion and no significant functional loss, even during flare-ups or with repeated use, according to most examinations. Although a 2024 examination and a 2025 addendum opinion acknowledged some pain-related functional loss and limitation of motion during flare-ups, the Board found this did not meet the criteria for ratings higher than 10 percent for limitation of flexion. However, considering the lay evidence of instability and the pre-February 7, 2021, rating criteria, the Board granted 10 percent ratings for slight recurrent subluxation or lateral instability for both knees under Diagnostic Code 5257, finding this level of instability was supported by the evidence, but higher ratings were not warranted due to normal stability testing. The Board denied higher ratings for sarcoid arthropathy based on limitation of flexion, finding the evidence did not support ratings exceeding the current 10 percent.

Rationale

Lay reports of symptoms and functional loss considered.; Objective medical evidence did not support flexion limited to 30 degrees.; Estimated functional loss of 10-15 degrees during flare-ups not sufficient for higher rating.

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

5257

Docket No.

12-17 889

Full Decision Text

Citation Nr: 26005030
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 12-17 889
DATE: April 29, 2026

ORDER

Entitlement to an initial rating in excess of 10 percent for sarcoid arthropathy of the left knee is denied.

Entitlement to an initial rating in excess of 10 percent for sarcoid arthropathy of the right knee is denied.

Entitlement to an initial 10 percent rating, but no higher, for left knee instability is granted.

Entitlement to an initial 10 percent rating, but no higher, for right knee instability is granted.

FINDINGS OF FACT

1. The Veteran's sarcoid arthropathy of the left knee is manifest by flexion to 120 degrees during flare-ups.

2. The Veteran's sarcoid arthropathy of the right knee is manifest by flexion to 120 degrees during flare-ups.

3. The Veteran left knee instability is manifest by slight recurrent subluxation or lateral instability.

4. The Veteran right knee instability is manifest by slight recurrent subluxation or lateral instability.

CONCLUSIONS OF LAW

1. The criteria for an initial rating in excess of 10 percent for sarcoid arthropathy of the left knee are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5009, 5260.

2. The criteria for an initial rating in excess of 10 percent for sarcoid arthropathy of the right knee are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5009, 5260.

3. The criteria for an initial 10 percent rating, but no higher, for left knee instability are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5257.

4. The criteria for an initial 10 percent rating, but no higher, for right knee instability are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5257.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from March 1965 to February 1967. This matter comes before the Board of Veterans' Appeals (Board/BVA) on appeal from a June 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO).

The Veteran testified at an April 2013 Board hearing before the undersigned Veterans Law Judge (VLJ). See Hearing Transcript (June 2013).

This case has a lengthy and complex procedural history before the Board and the U.S. Court of Appeals for Veterans Claims (Court/CAVC) that has been explained in detail in prior Board decisions. See Remand BVA or CAVC (February 2018); BVA Decision (July 2019); BVA Decision (February 2021); BVA Decision (September 2022); BVA Decision (April 2024). Notably, the service-connected disabilities of degenerative arthritis of the shoulders, hands, and knees were initially rated collectively, effective in 2008. See e.g., Rating Decision (June 2012); BVA Decision (December 2014). Separate evaluations for the right and left knee were eventually granted and zero percent evaluations were assigned. See Rating Decision (October 2015). In a February 2018 decision, the Board denied entitlement to compensable evaluations for the right and left knee sarcoid arthropathy. See Remand BVA or CAVC (February 2018). In January 2019, the Court granted a Joint Motion for Partial Remand (JMPR) vacating and remanding the February 2018 Board decision to the extent it denied higher initial ratings for the disabilities on appeal. See CAVC Decision (January 2019). The Court found that the Board erred by not obtaining VA treatment records, by not considering relevant lay evidence, and by not ensuring that the relevant examinations complied with Correia v. McDonald, 28 Vet. App. 158 (2016). See CAVC Decision
to compensable evaluations for the right and left knee sarcoid arthropathy. See Remand BVA or CAVC (February 2018). In January 2019, the Court granted a Joint Motion for Partial Remand (JMPR) vacating and remanding the February 2018 Board decision to the extent it denied higher initial ratings for the disabilities on appeal. See CAVC Decision (January 2019). The Court found that the Board erred by not obtaining VA treatment records, by not considering relevant lay evidence, and by not ensuring that the relevant examinations complied with Correia v. McDonald, 28 Vet. App. 158 (2016). See CAVC Decision at 3-7 (January 2019).

Thus, in July 2019, the Board remanded the issues to obtain medical records and an adequate examination. See BVA Decision at 7-8 (July 2019). In August 2020, the RO granted 10 percent evaluations for the right and left knee disabilities, effective November 26, 2019. See Rating Decision (August 2020). In a February 2021 decision, the Board again denied increased evaluations for the right and left knee. See BVA Decision (February 2021). The Veteran appealed. In April 2022, the Court granted a JMPR vacating and remanding the February 2018 Board decision to the extent it denied higher initial ratings for the disabilities on appeal. See CAVC Decision (April 2022). The Court determined that the Board erred by failing to provide an adequate statement of reasons and bases as to why it found the objective evidence of record more probative that the lay statements as it related to the Veteran's alleged knee instability and failed to fully address alleged functional impairment. See CAVC Decision at 8-10 (April 2022).

Thereafter, the Board's September 2022 decision granted 10 percent ratings for sarcoid arthropathy of the right and left knees prior to November 26, 2019, and denied entitlement to a rating in excess of 10 percent for the entire period on appeal. See BVA Decision at 5 (September 2022). The Veteran appealed the September 2022 Board decision to the Court to the extent that it denied entitlement to a rating in excess for 10 percent for sarcoid arthropathy of the right and left knees. A September 2023 JMPR was granted by the Court, partially vacating the September 2022 Board decision. See CAVC Decision (September 2023).

Ultimately, the September 2023 JMPR noted that the Board failed to address whether the Veteran was entitled to a separate rating for knee instability on and after April 8, 2015. See CAVC Decision at 3-4 (September 2023). The Board also failed to define the subjective terms in its decision, including terms related to instability. See CAVC Decision at 5 (September 2023).

In an April 2024 decision, the Board remanded the issues on appeal to attempt to obtain private medical records and to obtain a VA examination that addressed the ameliorative effects of medication throughout the appeal period and provided findings relevant under the new diagnostic code regarding instability. See BVA Decision at 6-7 (April 2024).

The Board again remanded these issues in August 2025 to ensure compliance with the previous April 2024 remand directives. The Board directed the RO to obtain private medical records and a retrospective medical opinion addressing the ameliorative effects of medication throughout the appeal period, as well as the degrees of range of motion lost due to pain in both weightbearing and non-weight bearing positions, and on both active and passive motion during an April 2015 examination. Review of the record indicates substantial compliance with the Board's August 2025 remand. Stegall v. West, 11 Vet. App. 268, 271 (1998).

Increased Rating

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. In cases in which a claim for a higher initial evaluation stems from an initial grant of service connection for the disability at issue, multiple ("staged") ratings may be assigned for different periods of time during the pendency of the appeal. See generally Fenderson v. West, 12 Vet. App. 119 (1999). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. In every instance where the rating schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31.

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.").

Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011).

In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 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."

In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that 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.

In making these determinations, the Board notes that neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017). Moreover, as the Veteran has not contended, nor does the evidence show that these disabilities render him unemployable, the issue of entitlement to a total disability rating based on individual unemployability has not been raised by the record. Rice v. Shinseki, 22 Vet. App. 447 (2009).

1. Entitlement to an initial rating in excess of 10 percent for sarcoid arthropathy of the left knee

2. Entitlement to an initial rating in excess of 10 percent for sarcoid arthropathy of the right knee

The Veteran seeks higher ratings for his bilateral knee disabilities.

During the pendency of this appeal, VA amended the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. §
contended, nor does the evidence show that these disabilities render him unemployable, the issue of entitlement to a total disability rating based on individual unemployability has not been raised by the record. Rice v. Shinseki, 22 Vet. App. 447 (2009).

1. Entitlement to an initial rating in excess of 10 percent for sarcoid arthropathy of the left knee

2. Entitlement to an initial rating in excess of 10 percent for sarcoid arthropathy of the right knee

The Veteran seeks higher ratings for his bilateral knee disabilities.

During the pendency of this appeal, VA amended the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71(a), effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). If a law or regulation changes during a claim or an appeal, the amended rating criteria, if favorable to the Veteran's claim, can be applied only for periods from the effective date of the regulatory change. However, the old regulations will be considered for the periods both before and after the change was made. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003).

The Veteran's bilateral knee disabilities are rated under hyphenated Diagnostic Code 5009-5260. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires the use of an additional diagnostic code to identify the basis for the rating assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.2.

Prior to February 7, 2021, Diagnostic Code 5009 referred to other types of arthritis and instructed that they are to be rated as rheumatoid arthritis. Diagnostic Code 5002 provides that rheumatoid (atrophic) arthritis will be rated based on either as an active process or for chronic residuals, with the higher rating assigned. 38 C.F.R. § 4.71a.

The current Diagnostic Code 5009 refers to other specified forms of arthropathy (excluding gout). Note (1) under Diagnostic Code 5009 provides that other specified forms of arthropathy include, but are not limited to, Charcot neuropathic, hypertrophic, crystalline, and other autoimmune arthropathies. 38 C.F.R. § 4.71a, Diagnostic Code 5009. Note (2) under Diagnostic Code 5009 provides that with the types of arthritis, diagnostic codes 5004 through 5009, rate the acute phase under diagnostic code 5002; rate any chronic residuals under diagnostic code 5003. Id.

Diagnostic Code 5260, upon which the currently assigned 10 percent ratings are based, refers to limitation of flexion. Under Diagnostic Code 5260, 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. A 30 percent rating is warranted for flexion limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260.

The Board finds that the evidence of record persuasively weighs against ratings in excess of 10 percent for the bilateral knee disabilities based on limitation of flexion. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to pain and fatigability. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements that the Veteran experienced weekly flare-ups lasting minutes to hours would not result in limitation of motion more nearly approximating flexion limited to 30 degrees of either knee. The Veteran was provided VA examinations in February 2012, April 2015, November 2019, and October 2024. Addendum medical opinions regarding the Veteran's ranges of motion were also obtained in October 2025.

The 2012 examination showed that the Veteran reported having pain in both knees. He denied flare-ups. He had flexion to 140 degrees bilaterally without objective evidence of painful motion. There were no changes in motion following repetition. The Veteran did not have any functional loss or functional impairment. There were no additional factors contributing to disability.

The 2015 examination showed that the Veteran reported pain in both knees and occasional swelling. He reported that prolonged sitting caused joint stiffness. He had moderate pain that responded to medication. The Veteran reported flare-ups. He did not have any functional loss or functional impairment. He had flexion to 140 degrees bilaterally without pain. There were no changes in motion following repetition. The examiner reported that pain, weakness, fatigability or incoordination would not significantly limit functional ability with repeated use over a period of time or with flare-ups for either knee. There were no additional factors contributing to disability.

The 2019 examination showed that the Veteran reported taking medication. He reported swelling, popping sensations, and difficulty sitting and standing for long periods of time. The Veteran reported flare-ups occurring once a month that lasted for two to three days with severity of 7/10 for both knees. He had functional impairment of difficulty standing and sitting for long periods of time, and swelling caused him to use a cane for stability. He had flexion to 140 degrees bilaterally without pain. There were no changes in motion following repetition. The examiner reported that pain, weakness, fatigability or incoordination would not significantly limit functional ability with repeated use over a period of time or with flare-ups for either knee. The examiner reported basing their opinion on physical exam, reported history and subjective complaints, relevant evidence of record and using their medical knowledge and expertise. They opined that there remained no basis to offer additional losses of function or motion when it came to repeated use over time and during a flare-up. There were no additional factors contributing to disability.

The 2024 examination showed that the Veteran reported taking medication. He reported that knee pain was aggravated and painful with walking, bending, and going up stairs. He reported not being able to sustain prolonged standing or walking without severe pain. The Veteran reported mild weekly flare-ups that lasted for minutes to hours. He had functional impairment of being unable to pick objects from floor with flare-ups. He had flexion to 135 degrees for active and passive motion with pain on active and passive motion bilaterally. There were no changes in motion following repetition. The examiner reported that pain would limit flexion to 130 bilaterally with repeated use over time. They further reported that pain and fatigability would limit flexion to 120 bilaterally during flare-ups. There were no additional factors contributing to disability.

Addendum medical opinions were obtained in October 2025. Regarding range of motion during the 2015 examination, the examiner reported that the examination documented full and normal bilateral knee motion with flexion to 140 degrees or greater and full extension to 0 degrees bilaterally. They noted that there was no objective evidence of painful motion, weakness, or functional loss, and repetitive use testing did not result in additional limitation. The examiner reported that it was noted during that examination that the Veteran was not experiencing a flare-up. The examiner noted that testing position (weight-bearing vs. nonweight-bearing) and medication status were not specified. The opined that, overall, the 2015 findings represented normal, pain-free knee function. The examiner also discussed the findings from the 2024 examination reported above.

The examiner opined that, when comparing the two examinations, the objective evidence supported an approximate loss of 5 degrees of flexion at rest due to pain, 10 degrees with repeated use over time, and up to 20 degrees during flare-ups, bilaterally. They reported that extension remained full at 0 degrees, even during flare conditions. They opined that there was no indication of a significant difference between weight-bearing and nonweight-bearing positions, as pain and limitation were similar on both active and passive motion. They opined that it was reasonable to estimate an additional 5-degree functional loss in flexion under weight-bearing conditions due to pain-related guarding and discomfort with loading.

The examiner concluded that, based on the evidence of record, it was at least as likely as not that the Veteran now experienced a mild-to-moderate loss of functional range of motion in both knees due to pain, most prominent during repetitive activity and flare-ups. They opined that the estimated total functional loss from baseline was approximately 10 to 15 degrees of
, even during flare conditions. They opined that there was no indication of a significant difference between weight-bearing and nonweight-bearing positions, as pain and limitation were similar on both active and passive motion. They opined that it was reasonable to estimate an additional 5-degree functional loss in flexion under weight-bearing conditions due to pain-related guarding and discomfort with loading.

The examiner concluded that, based on the evidence of record, it was at least as likely as not that the Veteran now experienced a mild-to-moderate loss of functional range of motion in both knees due to pain, most prominent during repetitive activity and flare-ups. They opined that the estimated total functional loss from baseline was approximately 10 to 15 degrees of flexion and 0 degrees of extension during painful use or flare-up conditions. The examiner reported that those findings reflected progression of pain-related limitation since 2015, though the overall motion remains within a functional range for daily activity.

The same examiner further opined that, as regards the 2019 and 2024 examinations, it would be medically speculative to provide an estimate of the Veteran's baseline range of motion or functional capacity without the beneficial effects of medication such as Tramadol and Tylenol. The examiner explained that the evidence of record did not indicate whether the Veteran was medicated on the day of the examinations, and there were no objective findings available for comparison under medicated and unmedicated conditions. They opined that an accurate determination of the degree of functional change attributable to medication would require examination of the Veteran both with and without medication and documentation of those results. They concluded that an estimate of baseline functioning absent the effects of medication could not be provided without resorting to speculation.

The October 2025 examiner's opinions are probative, because they are based on an accurate medical history and provides explanations that contain clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

In this case, at worst, the Veteran would have flexion to 120 degrees bilaterally during flare-ups. The 2024 examination showed such ranges, and the 2025 medical opinion showed that the estimated total functional loss from baseline was approximately 10 to 15 degrees of flexion during painful use or flare-up conditions. Higher 20 percent ratings are warranted for flexion limited to 30 degrees; even with considering functional loss during flare-ups or with repeated use over time, the objective medical evidence of record does not support flexion limited to 30 degrees of either knee.

In finding that higher 20 percent ratings for limitation of flexion are not warranted, the Board acknowledges that VA is required "to discount beneficial medication effects when relevant rating criteria do not specifically contemplate medication use." Ingram v. Collins, 38 Vet. App. 130 (2025). The Board is aware that the Veteran has taken medication to treat his bilateral knee symptoms. This appeal was specifically remanded to obtain a medical opinion as to how medication affects the Veteran's ranges of motion. As described in detail above, the October 2025 examiner was unable to provide an estimate of baseline functioning absent the effects of medication without resorting to speculation. The Board accords this opinion great probative value since the examiner included a detailed rationale for why such an estimate could not be provided.

Consequently, based on the above, the Board finds that the Veteran's symptoms during the appeal period and use of medication, viewed in tandem, are essentially commensurate to the disability picture contemplated by the currently assigned 10 percent ratings for each knee. Therefore, initial ratings in excess of 10 percent for each knee based on limitation of flexion are not warranted.

The Board has also considered the other Diagnostic Codes pertaining to the knee and leg. 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. See 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).

Diagnostic Code 5256 evaluates impairment from ankylosis, which had not been shown. The Veteran had not contended, nor did the evidence show, that his limitation of motion of either knee approximated ankylosis warranting a rating under Diagnostic Code 5256.

Diagnostic Code 5257, evaluates other impairment of the knee. Under Diagnostic Code 5257, a 10 percent rating is warranted for slight recurrent subluxation or lateral instability. A 20 percent rating is warranted for moderate
. 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).

Diagnostic Code 5257, evaluates other impairment of the knee. Under Diagnostic Code 5257, a 10 percent rating is warranted for slight recurrent subluxation or lateral instability. A 20 percent rating is warranted for moderate recurrent subluxation or lateral instability. A 30 percent rating is warranted for severe recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, Diagnostic Code 5257.

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.

Objective medical evidence is not required to establish lateral knee instability under Diagnostic Code 5257, so objective medical evidence cannot be categorically found more probative than lay evidence with respect to this Diagnostic Code. See English v. Wilkie, 30 Vet. App. 347, 352-53 (2018).

Effective February 7, 2021, VA amended the rating criteria for disabilities of the knee and leg. The amended Diagnostic Code 5257 provides ratings for other impairment of the knee based on recurrent subluxation or instability, and patellar instability.

In this case, the Board concludes that separate 10 percent ratings, but no higher, are warranted for slight recurrent subluxation or lateral instability for both knees. Stability tests (anterior, posterior, medial, and lateral) were all normal at the 2012, 2015, and 2019 examinations. Regarding the 2024 examination, in an October 2024 addendum opinion, the examiner opined that the Veteran did not have diagnoses of recurrent subluxation or lateral instability based on examination, interview, and records review.

However, lay evidence from the Veteran, friends, and spouse suggest that the Veteran has experienced instability in both knees throughout this appeal. See, e.g., July 2009 buddy/lay statements. Consequently, the Board concludes that initial 10 percent ratings, but no higher, for slight recurrent subluxation or lateral instability under the pre-February 7, 2021, rating criteria. Even higher ratings are not warranted as the evidence does not show that the Veteran's reported instability is moderate.

As noted above, according to MERRIAM WEBSTER'S COLLEGIATE DICTIONARY 999, "slight" means small in amount while "moderate" means limited in scope or effect. In this case, while the lay evidence shows that the Veteran experiences instability, the Board reiterates that instability tests were normal during the examinations. Considering the normal testing throughout this appeal, the Board is unable to conclude that the Veteran's instability is best characterized as moderate.

Further, as regards the current criteria, the evidence does not show a sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability or a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair. As such, 20 percent ratings under the current criteria are not warranted.

In this case, considering the lay reports of instability, in light of normal stability testing throughout this appeal, the Board concludes that initial 10 percent ratings, but no higher, under Diagnostic Code 5257 for slight recurrent subluxation or lateral instability under the pre-February 7, 2021, rating criteria are warranted.

Diagnostic Code 5258 provides for a 20 percent rating for dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint. All of the examination reports showed that the Veteran did not have any meniscus conditions of either knee.

Similarly, while Diagnostic Code 5259 provides for a 10 percent rating for symptomatic removal of semilunar cartilage, the Veteran does not have a meniscus condition. Therefore, ratings under Diagnostic Codes 5258 and 5259 are not warranted.

Diagnostic Code 5261 evaluates impairment from limitation of extension. A zero percent rating is warranted for extension limited to 5 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261. The examinations all showed normal extension to zero degrees bil
episodes of "locking," pain, and effusion into the joint. All of the examination reports showed that the Veteran did not have any meniscus conditions of either knee.

Diagnostic Code 5261 evaluates impairment from limitation of extension. A zero percent rating is warranted for extension limited to 5 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261. The examinations all showed normal extension to zero degrees bilaterally. The October 2025 VA examiner's opinion showed that, even during flare-ups and with painful use, the Veteran would have normal extension to zero degrees. Therefore, separate ratings under Diagnostic Code 5261 are not warranted.

In conclusion, the Board finds that the evidence of record persuasively weighs in favor of separate 10 percent ratings for bilateral knee instability pursuant to Diagnostic Code 5257. Further, the Board finds that the evidence of record persuasively weighs against the claim for ratings in excess of 10 percent for the bilateral knee limitation of flexion disabilities. As the evidence of record persuasively weighs against ratings in excess of 10 percent for bilateral knee limitation of flexion, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7.

ROBERT C. SCHARNBERGER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board L. Barstow, 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.

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