KNEE IMPAIRMENT OF

KRISTY L. ZADORA · 2026 · Case ID: A26029174

MIXED

Summary

The veteran, who served from January 1979 to January 1995, appeals the denial of increased ratings for bilateral knee patellofemoral syndrome and scars related to compartment syndrome, as well as denials for right hip bursitis and right great toe bunion residuals. The Board granted a 10 percent rating for mild instability in each knee, finding the veteran's testimony regarding instability consistent with treatment records and the examiner's note of occasional brace use, despite the February 2019 VA exam not identifying instability. However, the Board denied increased ratings for patellofemoral syndrome and scars, finding the evidence did not meet the criteria for higher ratings based on limitation of motion or painful/unstable scars. The Board also denied a compensable rating for right hip residuals, as the evidence did not show the required limitation of motion or other disabling factors. The claim for chronic low back strain with degenerative arthritis of the spine was remanded for the agency of original jurisdiction to obtain outstanding private treatment records from the Lexington Brain and Spine Institute, as VA had not made sufficient efforts to obtain these records.

Rationale

Flexion limited to 110 degrees, extension to 0 degrees.; Pain noted on flexion and weight-bearing, but no functional loss.; No evidence of greater limitation of motion or functional loss during flare-ups.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

201209-127350

Full Decision Text

Citation Nr: A26029174
Decision Date: 03/31/26 Archive Date: 03/31/26

DOCKET NO. 201209-127350
DATE: March 31, 2026

ORDER

Entitlement to a rating in excess of 10 percent for left knee patellofemoral syndrome is denied.

Entitlement to a rating in excess of 10 percent for right knee patellofemoral syndrome is denied.

Entitlement to a separate 10 percent rating for mild instability of the left knee is granted.

Entitlement to a separate 10 percent rating for mild instability of the right knee is granted.

Entitlement to a rating in excess of 10 percent for scars, painful, residuals of bilateral lower extremity compartment syndrome, is denied.

Entitlement to a compensable rating for residuals of greater trochanter bursitis, right hip, impairment of flexion, is denied.

Entitlement to a compensable rating for residuals of bunion, right great toe is denied.

REMANDED

Entitlement to a rating in excess of 20 percent for chronic low back strain with degenerative arthritis of the spine is remanded.

FINDINGS OF FACT

1. Throughout the period on appeal, the Veteran's left knee patellofemoral syndrome manifested by flexion limited to 110 degrees and extension limited to zero degrees, both at worst and with pain, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without ankylosis, functional impairment consistent with ankylosis or genu recurvatum.

2. Throughout the period on appeal, the Veteran's right knee patellofemoral syndrome manifested by flexion limited to 90 degrees and extension limited to zero degrees, both at worst and with pain, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without ankylosis, functional impairment consistent with ankylosis or genu recurvatum.

3. Throughout the period on appeal, the Veteran's left knee manifested as slight instability.

4. Throughout the period on appeal, the Veteran's right knee manifested as slight instability.

5. Throughout the period on appeal, the Veteran had two service connected scars that were not burn scars, not located on his head, face, or neck, not associated with underlying soft tissue damage, and did not cover an area of 144 square inches (929 square centimeters) or greater.

6. Throughout the period on appeal, the Veteran's residuals of greater trochanter bursitis, right hip, impairment of flexion, manifested as painful limitation of flexion to 100 degrees, at worst, even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, without flail joint, impairment of the femur, ankylosis or the functional equivalent the ankylosis.

7. Throughout the period on appeal, the Veteran's residuals of bunion, right great toe did not manifest as severe hallux valgus or the equivalent to amputation of the great toe and did not result in resection of the metatarsal head.

CONCLUSIONS OF LAW

1. The criteria for a rating in excess of 10 percent for a left knee patellofemoral syndrome have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.40, 4.59, 4.71a, Diagnostic Code 5260.

2. The criteria for a rating in excess of 10 percent for a right knee patellofemoral syndrome have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.40, 4.59, 4.71a, Diagnostic Code 5260.

3. The criteria for a separate 10 percent rating, but no higher, for left knee instability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.71a, Diagnostic Code 5257.

4. The criteria for a separate 10 percent rating, but no higher, for right knee instability have been met. 38 U.S.C. §§ 1155, 5107;
.R. §§ 3.102, 4.1-4.14, 4.40, 4.59, 4.71a, Diagnostic Code 5260.

3. The criteria for a separate 10 percent rating, but no higher, for left knee instability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.71a, Diagnostic Code 5257.

4. The criteria for a separate 10 percent rating, but no higher, for right knee instability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.71a, Diagnostic Code 5257.

5. The criteria for a rating in excess of 10 percent for scars, painful, residuals of bilateral lower extremity compartment syndrome have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.114, Diagnostic Code 7804.

6. The criteria for a compensable rating for residuals of greater trochanter bursitis, right hip, impairment of flexion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.20, 4.40, 4.45, 4.71a, Diagnostic Code 5252.

7. The criteria for entitlement to a compensable rating for residuals of bunion, right great toe have not been met. 38 U.S.C. §§ 1155, 5017; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5280.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from January 1979 to January 1995.

This matter is before the Board of Veterans' Appeals (Board) on appeal from an October 2020 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The rating decision on appeal constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In May 2020, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of an April 2020 rating decision. In October 2020, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior April 2020 rating decision.

In October 2020, the Veteran submitted VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) and elected the Hearing docket. A Board hearing was held on August 18, 2022; a hearing transcript has been associated with the claims file. Therefore, the Board may only consider the evidence of record at the time of the April 2020 rating decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the April 2020 rating decision, which was subsequently subject to higher-level review and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim(s), considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. However, because the Board is remanding the Veteran's claim for an increased rating for chronic low back strain with degenerative arthritis of the spine, any evidence the Board could not consider will be considered by the AOJ in the adjudication of that claim.
like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim(s), considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. However, because the Board is remanding the Veteran's claim for an increased rating for chronic low back strain with degenerative arthritis of the spine, any evidence the Board could not consider will be considered by the AOJ in the adjudication of that claim. 38 C.F.R. § 3.103(c)(2)(ii).

In a June 2024 decision, the Board denied the claims that are subject to this appeal. The Veteran appealed the June 2024 Board decision to the United States Court of Appeals for Veterans Claims (Court). In a September 2025 Joint Motion for Partial Remand, the parties agreed to vacate the Board's June 2024 decision and remand to the Board for further adjudication. Consistent with the closed record characteristic of the AMA and the structure of its review lanes, the Board's adjudication will be based on the evidence of record as described above. The Veteran did not challenge the Board's decision to the extent that it found entitlement to a rating in excess of 10 percent for right lower extremity peroneal nerve neuropathy an entitlement to a rating greater than 10 percent for left lower extremity had been withdrawn as well as the Board's denial of service connection for obstructive sleep apnea; these decisions are therefore final.

An October 2025 letter informed the Veteran that the Court issued a decision in September 2025 that remanded (sent back) his case to the Board for readjudication, that the Veteran had the opportunity to submit additional argument in support of his appeal before the Board proceeds with readjudication and that the Board will wait to make a decision on his appeal for 90 days from the date of this letter to provide him the opportunity to submit argument.

Increased Rating Criteria

Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3.

Separate evaluations may be assigned for separate periods of time if such distinct periods are shown by the competent evidence of record during the appeal, a practice known as "staged" ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). VA's determination of the present level of a disability may result in a conclusion that the disability has undergone varying and distinct levels of severity throughout the entire time period the increased-rating claim has been pending. Hart v. Nicholson, 21 Vet. App. 505, 509 (2007).

The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that "[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint." Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the Diagnostic Code under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016).

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
-bearing and, if possible, with the range of the opposite undamaged joint." Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the Diagnostic Code under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016).

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. 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 (musculoskeletal system) or § 4.73 (muscle injury); a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. 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 [or 4.73] 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. Burton v. Shinseki, 25 Vet. App. 1 (2011).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

Finally, the Board notes that during his August 2022 Board hearing the Veteran reported that he had been forced to retire as a result of his service connected disabilities. A May 2024 Board decision remanded the issue of entitlement to a total disability rating based on individual unemployability (TDIU) and a November 2024 rating decision found that the claim for entitlement to a TDIU is moot. As such, the Board finds that adjudication of the TDIU claim herein is not necessary. Cf. Rice v. Shinseki, 22 Vet. App. 447 (2009).

1. Entitlement to a rating in excess of 10 percent for left knee patellofemoral syndrome is denied.

2. Entitlement to a rating in excess of 10 percent for right knee patellofemoral syndrome is denied

3. Entitlement to a separate 10 percent rating for mild instability of the left knee is granted.

4. Entitlement to a separate 10 percent rating for mild instability of the right knee is granted.

The Veteran contends that a higher rating is warranted for his left knee and right knee patellofemoral syndrome. See, e.g., January 2019 Application for Disability Compensation and Related Compensation Benefits (VA Form 21-526EZ).

This appeal stems from a claim for an increased rating filed by the Veteran on January 2, 2019. See January 2019 VA Form 21-526EZ. Therefore, the appeal period begins January 2, 2018, which includes the one-year "look back" period provided by 38 U.S.C. § 5110(b)(2), 38 C.F.R. § 3.400(o)(2), and Gaston v. Shinseki, 605 F.3d 979, 984 (Fed. Cir. 2010).

The Veteran's left knee and right knee patellofemoral syndrome are rated under Diagnostic Code 501
21-526EZ).

The Veteran's left knee and right knee patellofemoral syndrome are rated under Diagnostic Code 5010-5260 based on noncompensable limitation of motion that is painful. 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. §4.27.

Prior to February 7, 2021, Diagnostic Code 5010 states that arthritis due to trauma substantiated by x-ray findings is to be rated as degenerative arthritis. In turn, degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003.

Other diagnostic codes applicable to the knee prior to February 7, 2021 include Diagnostic Code 5257, which provides that recurrent subluxation and lateral instability of the knee warrants a 10, 20, or 30 percent rating if slight, moderate, or severe, respectively. 38 C.F.R. § 4.71a. The Court has held that nothing in Diagnostic Code 5257, under the pre-amendment rating criteria, provided that objective medical evidence is required or is to be favored over lay evidence in determining whether to assign a rating for lateral instability of the knee. English v. Wilkie, 30 Vet. App. 347, 349 (2018).

"Slight," as relevant to a physical condition, is defined as "small of its kind or in amount." See Merriam-Webster's Dictionary (merriam-webster.com/dictionary, accessed February 19, 2026). It is similar to "mild," which is defined as "not severe" or temperate; with "temperate" being defined as "keeping or held within limits" and "not extreme or excessive." "Moderate" is defined as "tending toward the mean or average amount," "not violent, severe, or intense," and "limited in scope or effect." Id. "Severe" is defined as "very painful or harmful" or "of a great degree." Id. Within the context of the old version of Diagnostic Code 5257, which established a successive, tiered rating structure, each level of disability is intensified.

Under Diagnostic Code 5258, when the knee disability affects the meniscus, a 20 percent rating is warranted when there is dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint. 38 C.F.R. § 4.71a.

Under Diagnostic Code 5259, a 10 percent rating is warranted when there has been removal of semilunar cartilage (e.g., meniscectomy) and current residual symptoms.

Under Diagnostic Code 5260, flexion of the knee limited to 15 degrees warrants a 30 percent rating; flexion limited to 30 degrees warrants a 20 percent rating; flexion limited to 45 degrees warrants a 10 percent rating; and flexion limited to 60 degrees warrants a zero percent (noncompensable) rating.

Under Diagnostic Code 5261, extension of the knee limited to 45 degrees warrants a 50 percent rating; extension limited to 30 degrees warrants a 40 percent rating; extension limited to 20 degrees warrants a 30 percent rating; extension limited to15 degrees warrants a 20 percent rating; extension limited to 10 degrees warrants a 10 percent rating; and extension limited to 5 degrees warrants a zero percent (noncompensable) rating.

Ratings can also be assigned for impairment of the tibia or fibula, genu recurvatum, or ankylosis of the knee. 38 C.F.R. § 4.71a, Diagnostic Codes 5256, 5262
) rating.

Ratings can also be assigned for impairment of the tibia or fibula, genu recurvatum, or ankylosis of the knee. 38 C.F.R. § 4.71a, Diagnostic Codes 5256, 5262, 5263. Ankylosis is stiffening or fixation of a joint as the result of a disease process, with fibrous or bony union across the joint. Dinsay v. Brown, 9 Vet. App. 79, 81 (1996). Ankylosis is also defined as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." Dorland's Illustrated Medical Dictionary 93 (30th ed. 2003).

Separate ratings can be assigned for knee disabilities when none of the symptomatology overlaps and the separate rating is based on additional disabling symptomatology; this includes separate ratings based on limitation of flexion (Diagnostic Code 5260), limitation of extension (Diagnostic Code 5261), lateral instability or recurrent subluxation (Diagnostic Code 5257), and meniscal conditions (Diagnostic Codes 5258, 5259). See VAOPGCPREC 23-97, 62 Fed. Reg. 63, 603 (1997); VAOPGCPREC 9-98, 63 Fed. Reg. 56, 703 (1998); VAOPGCPREC 9-2004; 69 Fed. Reg. 59, 988 (2004); Lyles v. Shulkin, 29 Vet. App. 107 (2017).

The combined rating for disabilities of any extremity, including the knee and leg, shall not exceed the rating for amputation at the elective level, were amputation to be performed. 38 C.F.R. § 4.68 ("amputation rule"). For a below the knee amputation, the combined disability rating cannot exceed 40 percent; for an above-the-knee amputation, the combined disability rating cannot exceed 60 percent. 38 C.F.R. § 4.71a, Diagnostic Codes 5162-5165.

During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These new regulations apply to all applications for benefits received by VA or that are pending before the AOJ on or after February 7, 2021. Claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied. The Board may not apply a current regulation prior to its effective date unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). However, the Board is not precluded from applying prior versions of the applicable regulation to the period on or after the effective dates of the new regulation if the prior version was in effect during the pendency of the appeal.

VA's General Counsel has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the Veteran. In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation. If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. The Board must generally apply both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change.

VA thus must consider the claim for a higher rating pursuant to the former and revised regulations. See VAOPGCPREC 3-2000, 65 Fed. Reg. 33,422 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997). The criteria that are more favorable to the Veteran will be applied. The Board notes that the rating period under consideration
(g) can be no earlier than the effective date of that change. The Board must generally apply both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change.

As of February 7, 2021, under the revised criteria, Diagnostic Code 5003 assigns a rating for degenerative arthritis, other than post-traumatic. Under both the earlier and revised rating criteria, arthritis established by X-ray findings is rated on the basis of limitation of motion under the appropriate Diagnostic Codes for the specific joint or joints involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined and not added, under Diagnostic Code 5003.

As of February 7, 2021, under the revised criteria, Diagnostic Code 5010 assigns a rating for post-traumatic arthritis based on limitation of motion, dislocation, or other specified instability under the affected joint. If there are two or more joints affected, each rating shall be combined in accordance with 38 C.F.R. § 4.25.

As of February 7, 2021, under the amended criteria, Diagnostic Code 5257 evaluates knee, other impairment of, which may be rated under separate criteria for recurrent subluxation or instability or, alternatively, patellar instability. Under the amended criteria for rating patellar instability, a 10 percent rating is warranted 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 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 warrants a 20 percent rating. A maximum 30 percent rating is warranted 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.

Diagnostic Code 5257, Note (1), as amended, defines the patellofemoral complex as consisting of the quadriceps tendon, the patella, and the patellar tendon. Note (2) instructs 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).

The former and revised criteria under Diagnostic Codes 5258, 5259, 5260, and 5261 are identical.

Turning to the evidence, the Veteran was afforded a VA knee examination in February 2019 and diagnosed with bilateral patellofemoral pain syndrome. The Veteran reported that his symptoms included pain in his left and right knees and that he used a heating pad to alleviate his pain and get to sleep. The Veteran reported flare-ups of pain that made it difficult for him to walk or stand for long periods of time.

On examination, the right knee showed flexion to 90 degrees and extension to 0 degrees. Mild pain was noted on flexion and extension and with weight-bearing but did not result in functional loss. The left knee showed flexion to 130 degrees and extension to 0 degrees. Mild pain was noted on flexion and with weight-bearing but did not result in functional loss. Repetitive use testing with at least three repetitions did not result in additional loss of function.

The Veteran was examined immediately after repeated used over time. The examiner found that pain, fatigue, weakness and lack of endurance significantly limited functional ability with repeated use over time. Flexion was 90 degrees for the right knee and 130 degrees for the left knee and extension was 0 degrees for both knees.

The Veteran was not examined during a flare-up. The examiner found that pain, fatigue, weakness, and lack of endurance significantly limited functional ability with flare-ups. The examiner estimated flexion during a flare-up to be 90 degrees for the right
ion and with weight-bearing but did not result in functional loss. Repetitive use testing with at least three repetitions did not result in additional loss of function.

The Veteran was not examined during a flare-up. The examiner found that pain, fatigue, weakness, and lack of endurance significantly limited functional ability with flare-ups. The examiner estimated flexion during a flare-up to be 90 degrees for the right knee and 130 degrees for the left knee, with extension to 0 degrees for each knee.

Muscle strength testing was normal for each knee and there was no muscle atrophy or ankylosis for either knee. The February 2019 examiner found that there was no history of recurrent subluxation or lateral instability for either knee. Joint stability testing was performed with normal results. The examiner did not identify joint instability for either knee.

The February 2019 examiner noted that the Veteran had a history of chronic exertional compartment syndrome that was asymptomatic as long as the Veteran did not run. Otherwise, no tibial or fibular impairment was noted. The examiner noted that the Veteran occasionally used knee braces when he was more active. The examiner did not identify a meniscal condition or any other pertinent findings. With respect to functional impact, the examiner found that the Veteran's bilateral patellofemoral syndrome would require him to be able to sit and stand at will, with no long periods of standing, walking, or sitting.

Turning to VA treatment records, a July 2018 podiatry notes states that the Veteran walked with a limp but without any assistive devices. See CAPRI Records. An October 2018 VA treatment note states that the Veteran's left knee showed medial effusion, crepitus, and pain. A November 2018 VA treatment note states that the Veteran ambulated without assistive devices and with a normal gait.

An August 2019 VA treatment note observes that the Veteran's knees caused no gait or alignment problems and he had no muscle atrophy. Right and left knee range of motion were from 0 to 110 degrees. The Veteran had a positive McMurray test on the right knee.

A September 2019 VA treatment note states that the Veteran was ambulatory without assistive devices and with a noticeable limp, which the Veteran attributed to hip pain.

A February 2020 VA treatment note observes that the Veteran walked without difficulty. He had no gait or alignment problems and no muscle atrophy. Right and left knee range of motion were from 0 to 110 degrees. The Veteran had a positive McMurray test on the right knee.

A March 2020 VA treatment note states that the Veteran did not have a history of falls and did not use an assistive device.

VA treatment records otherwise document ongoing complaints of bilateral knee pain and treatment that included cortisone shots.

Turning to private treatment records, a note dated October 2018 states that the Veteran's left knee demonstrated medial effusion, crepitus, and pain.

During his August 2022 Board hearing, the Veteran testified that he was receiving physical therapy and cortisone shots for his knees. The Veteran reported instability of the knees despite such treatment, and stated that his knees had given out several times. The Veteran stated that when he performed jobs such as climbing ladders or working on floor tiles, his leg would give out and it would go numb. The Veteran also testified that prior to his compensation and pension examination he had taken Tylenol and Motrin.

In light of the above evidence, the Board finds that entitlement to a rating in excess of 10 percent for left knee patellofemoral syndrome or right knee patellofemoral syndrome is not warranted under Diagnostic Code 5010-5260 based on limitation of flexion or Diagnostic Code 5010-5261 based on limitation of extension.

In this regard, flexion was found to be, at worst, 90 degrees for the Veteran's right knee and 110 for his left knee, and extension was found to zero degrees on all tests. As noted during the February 2019 VA examination, the Veteran had pain on motion but there is no indication that such pain resulted in additional functional loss, to include a greater loss of flexion or extension. The Board finds that such factors do not result in functional loss more nearly approximating flexion limited to 30 degrees or extension limited to 15 degrees as would be needed for the next higher rating of 20 percent. DeLuca v. Brown, supra; Mitchell v. Shinseki, supra. Even in contemplation of functional loss due to symptoms such as pain, fatigue, weakness, lack of endurance, or incoordination, or as a result of repetitive motion and/or flare-ups, the Board finds a rating in excess of 10 percent under Diagnostic Code 5010-5260 or 5010-5261 is not warranted for the Veteran's left knee patellofemoral syndrome or right knee patellofemoral syndrome.

While the Veteran has essentially stated that he has reduced motion in his knees, he did not describe a range of motion less than that found of record. In this regard, the Veteran reported that he experiences chronic daily pain and flare-ups that make it difficult for him to walk or stand for long periods of time The Veteran's statements do not show the requisite limitation of motion necessary for a higher rating based on limitation of motion. Treatment records do not show greater limitation of motion than the above examination findings. Given the above, even when considering the left and right knee pain's impact on physical activities, a higher rating is not warranted under Diagnostic Code 5010 based on limitation of motion under Diagnostic Codes 5260 or 5261.

The Board notes that Diagnostic Codes 5260 and 5261 do not contemplate the use of medication. The Board is cognizant of the recent Court decision in Ingram v. Collins, in which the Court reaffirmed prior holdings that in rating disabilities, the Board must discount the beneficial effects of medication when the relevant rating criteria do not contemplate medication use. Ingram v. Collins, 38 Vet. App. 130 (2025); see also Jones v. Shinseki, 26 Vet. App. 56 (2012); McCarroll v. McDonald, 28 Vet. App. 267 (2016). Here, the Veteran did not report that the use of any medication ameliorated his symptoms in any way, and the Board has thus discounted the ameliorative effects of medication in reaching its determination in this case.

The Board also finds that a separate rating of 10 percent each, but no higher, is warranted for instability of the left knee and right knee under Diagnostic Code 5257. In this regard, the Veteran testified at his August 2022 Board hearing that when he performed jobs such as climbing ladders or working on floor tiles, his knees would give out. The Board notes thar the Veteran's testimony is consistent with reports he made to VA treatment providers in the past regarding his knees buckling. See July 2014 and December 2014 VA treatment notes in CAPRI Records.

The Board acknowledges that the February 2019 VA examination did not identify joint instability. However, the examiner did note that the Veteran wore knee braces when he was more active. In any event, as noted above, the Court has ruled that nothing in the pre-amendment version of Diagnostic Code 5257 provides that objective medical evidence is required or is to be favored over lay evidence in determining whether to assign a rating for lateral instability of the knee. English v. Wilkie, supra. Accordingly, the Board finds that a separate rating of 10 percent, but no higher, is warranted for slight instability of the left knee and the right knee under Diagnostic Code 5257.

The Board has considered the applicability of other potential diagnostic codes. As the evidence of record fails to demonstrate ankylosis, functional impairment consistent with ankylosis, impairment of the tibia or fibula, or genu recurvatum, the Veteran is not entitled to a higher or additional rating under Diagnostic Codes 5256, 5262, or 5263, respectively, for left knee and right knee patellofemoral syndrome.

The Board notes that a July 2018 VA treatment note states that the Veteran was diagnosed with a meniscal tear. See CAPRI Records. However, the record contains no evidence that the Veteran experienced frequent episodes of locking. Also, while the VA treatment notes discussed above
The Board has considered the applicability of other potential diagnostic codes. As the evidence of record fails to demonstrate ankylosis, functional impairment consistent with ankylosis, impairment of the tibia or fibula, or genu recurvatum, the Veteran is not entitled to a higher or additional rating under Diagnostic Codes 5256, 5262, or 5263, respectively, for left knee and right knee patellofemoral syndrome.

The Board notes that a July 2018 VA treatment note states that the Veteran was diagnosed with a meniscal tear. See CAPRI Records. However, the record contains no evidence that the Veteran experienced frequent episodes of locking. Also, while the VA treatment notes discussed above show that the Veteran experienced occasional effusion, the February 2019 VA examination found that the Veteran did not experience frequent episodes of effusion and there is otherwise no evidence of frequent effusion in the record. Therefore, a separate rating under Diagnostic Code 5258 for dislocated semilunar cartilage in either knee is not warranted.

Finally, the Veteran's right and left knee pain is being used to support a 10 percent rating under Diagnostic Code 5010-5260 for noncompensable limitation of motion that is painful. Therefore, such pain may not be used to support a separate rating under Diagnostic Code 5259 for symptomatic removal of semilunar cartilage in either knee.

The Board has considered the effects of repeated use over time and flare-ups along with the adequacy of the VA examinations in light of the Court's holdings in Correia v. McDonald, supra, and Sharp v. Shulkin, 29 Vet. App. 26, 32 (2017). The Board notes that the Veteran has been diagnosed with patellofemoral pain syndrome in both knees; therefore, there is no undamaged knee to test. The February 2019 VA examiner provided measurements for active range of motion, observed repetitive use, and repeated use over time, along with estimates of range of motion during flare-ups in both knees. The examiner also noted pain on passive range of motion and on weight bearing and did not find evidence of pain on non-weight bearing in either knee. The Board notes that active range of motion testing usually results in further limitation than passive range of motion testing. See Massie v. Shinseki, 25 Vet. App. 123, 131(2011); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Scott v. McDonald,789 F.3d 1375, 1381 (Fed. Cir. 2015). The examiner also indicated that the examination was consistent with the Veteran's statements describing functional loss during flare-up. Therefore, although the Board notes that the February 2019 VA examinations did not complete all the testing required under Correia v. McDonald, supra, the range of motion findings are still the most probative evidence concerning the Veteran's functional limitation at such time. The Board finds that the examination report of record is adequate to adjudicate the Veteran's claim for an increased rating for right knee patellofemoral syndrome and left knee patellofemoral syndrome and no further examination is necessary. To the extent that the Veteran's representative has argued that the February 2019 VA examination in inadequate, the Board finds that this argument is without merit.

In reaching its conclusions, the Board acknowledges the Veteran's belief that his right and left knee patellofemoral syndrome is more severe than reflected by the currently assigned ratings. The Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to provide evidence regarding his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Ultimately, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disabilities in light of the rating criteria to be more persuasive than his reports regarding the severity of his right and left knee patellofemoral syndrome.

The Board has considered whether staged ratings under Hart v. Mansfield, supra, are warranted, however, the Board finds that the Veteran's symptomatology has been stable throughout the period on appeal. Therefore, assigning a staged rating is not warranted. Further, neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of
the rating criteria to be more persuasive than his reports regarding the severity of his right and left knee patellofemoral syndrome.

In sum, the Board finds a rating in excess of 10 percent for left knee patellofemoral syndrome and right knee patellofemoral syndrome is not warranted. To that extent, the appeals are denied. The Board further finds that a rating of 10 percent, but no higher, for right knee instability and a rating of 10 percent, but no higher, for left knee instability is warranted. To that extent, the appeals are granted. 38 U.S.C. § 5107; 38 C.F.R. §3.102; Lynch v. McDonough, supra.

5. Entitlement to a rating in excess of 10 percent for scars, painful, residuals of bilateral lower extremity compartment syndrome, is denied

The Veteran contends that a rating in excess of 10 percent is warranted for scars, painful, residuals of bilateral lower extremity compartment syndrome. See, e.g., October 2019 VA Form 21-526EZ.

This appeal stems from a claim for an increased rating filed by the Veteran on October 9, 2019. See October 2019 VA Form 21-526EZ. Therefore, the appeal period begins October 9, 2018, which includes the one-year "look back" period provided by 38 U.S.C. § 5110(b)(2), 38 C.F.R. § 3.400(o)(2), and Gaston v. Shinseki, supra.

Throughout the period on appeal, the Veteran's bilateral lower extremity scars were rated as 10 percent disabling under Diagnostic Code 7804.

By way of further background, an April 2012 rating decision granted service connection and a 10 percent rating for two painful scars on the Veteran's lower extremities. An April 2011 VA examination noted that the Veteran had required an open fasciotomy on each leg during boot camp to relieve swelling. The VA examiner noted further that the scar on the right leg measured 4.5 inches and the scar on the left leg measured 4 inches. Both scars were linear in nature.

Scars are rated under Diagnostic Codes 7800 to 7805, 38 C.F.R. § 4.118.

Diagnostic Code 7800 deals with scars and disfigurement of the head, face, or neck and was not revised by recent regulatory amendments. A 10 percent rating is assigned with one characteristic of disfigurement. A 30 percent rating is assigned with visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with two or three characteristics of disfigurement. A 50 percent rating is assigned with visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features, or; with four or five characteristics of disfigurement. An 80 percent rating is assigned with visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features, or; with six or more characteristics of disfigurement.

Characteristics of disfigurement include: Scar 5 or more inches (13 or more centimeters) in length; Scar at least one-quarter inch (0.6 centimeters) wide at widest part; Surface contour of scar elevated or depressed on palpation; Scar adherent to underlying tissue; Skin hypo-or hyper-pigmented in an area exceeding six square inches (39 square centimeters); Skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 square centimeters); Underlying soft tissue missing in an area exceeding six square inches (39 square centimeters); and, Skin indurated and inflexible in an area exceeding six square inches (39 square centimeters). Id.

Diagnostic Code 7801 contemplates burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage
part; Surface contour of scar elevated or depressed on palpation; Scar adherent to underlying tissue; Skin hypo-or hyper-pigmented in an area exceeding six square inches (39 square centimeters); Skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 square centimeters); Underlying soft tissue missing in an area exceeding six square inches (39 square centimeters); and, Skin indurated and inflexible in an area exceeding six square inches (39 square centimeters). Id.

Diagnostic Code 7801 contemplates burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7801. A 10 percent rating is awarded when the area of the scar(s) covers at least 6 square inches (39 square centimeters) but less than 12 square inches (77 square centimeters). A 20 percent rating is warranted when the area of the scar(s) covers at least 12 square inches (77 square centimeters) but less than 72 square inches (456 square centimeters). A 30 percent rating is warranted when the area of the scar(s) covers at least 72 square inches (456 square centimeters) but less than 144 square inches (929 square centimeters). A 40 percent rating is assigned when the area of the scar(s) covers at least 144 square inches (929 square centimeters) or greater. 38 C.F.R. § 4.118, Diagnostic Code 7801.

Diagnostic Code 7802 is for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. 38 C.F.R. § 4.118. Under these criteria, a scar with an area or areas of 144 square inches (929 square centimeters) or greater warrants a 10 percent rating. 38 C.F.R. § 4.118. Note 2 to Diagnostic Code 7802, in relevant part, instructs, "if a higher evaluation would result from adding the areas affected from multiple zones of the body, a single evaluation may also be assigned under this diagnostic code."

Under Diagnostic Code 7804, one or two scars that are unstable or painful scars warrants a 10 percent rating. Three or four scars that are unstable or painful scars warrants a 20 percent rating. Five or more scars that are unstable or painful warrants a 30 percent rating. 38 C.F.R. § 4.118. Note 1 to Diagnostic Code 7804 instructs that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. If one or more scars are both unstable and painful 10 percent is added to the evaluation.

Pursuant to Diagnostic Code 7805, a scar may be rated on any disabling effect(s) not considered as part of Diagnostic Codes 7800 to 7804.

Turning to the evidence, the Veteran was afforded a VA examination in February 2019. The examiner noted that the Veteran did not have any scars or disfigurement on the head, face, or neck and found that none of the scars on the Veteran's trunk or extremities were painful, unstable, or due to burns.

The examiner noted one scar on the Veteran's right lower extremity that measured 12 centimeters by 0.7 centimeters. The scar was not tender to palpation or unstable upon inspection and had no underlying soft tissue damage.

The examiner noted two scars on the Veteran's left lower extremity, with one scar measuring 10 centimeters by 0.5 centimeters and the other scar measuring 5 centimeters by 0.5 centimeters. Neither of these scars was tender to palpation or unstable upon inspection and neither had underlying soft tissue damage.

The examiner noted that the Veteran's right lower extremity scar had a total area of 8.4 square centimeters and the left lower extremity scars had a total area of 7.5 square centimeters. The examiner found that the Veteran's scars did not affect his ability to work.

At his August 2022 Board hearing, the Veteran stated that his scars were painful and itchy and became red. He stated further that he felt pain and pulling in his skin when he did stretching exercises for his hip, and that he had difficulty putting his socks on and sometimes had difficulty walking due to pain and tightness with his scars.

In light of the above evidence, the Board finds that a rating in excess of 10 percent is not warranted under Diagnostic Code 7804 for the Veteran's scars, painful, residuals of bilateral
square centimeters and the left lower extremity scars had a total area of 7.5 square centimeters. The examiner found that the Veteran's scars did not affect his ability to work.

In light of the above evidence, the Board finds that a rating in excess of 10 percent is not warranted under Diagnostic Code 7804 for the Veteran's scars, painful, residuals of bilateral lower extremity compartment syndrome. In this regard, throughout the period on appeal, there is no evidence that the Veteran had three or four scars that are unstable or painful. As noted above, an April 2012 rating decision granted service connection and a 10 percent rating for two painful scars on the Veteran's lower extremities. Although the February 2019 VA examiner identified a total of three scars, one of the two scars on the Veteran's left lower extremity is not service connected. Therefore, it cannot serve as a basis for an increased rating under Diagnostic Code 7804.

The Board has considered whether separate or higher ratings may be granted under other diagnostic codes. The Veteran does not have a burn scar, nor a scar or other disfigurement of the head, face, or neck, so Diagnostic Code 7800 does not apply. The Veteran's lower extremity scars are not associated with underlying soft tissue damage and do not measure at least six square inches (39 square centimeters) but less than 12 square inches (77 square centimeters), so Diagnostic Code 7801 does not apply. The Veteran has already been granted a separate 50 percent rating under Diagnostic Code 5312-7302. Finally, the record does not warrant the assignment of an additional rating under Diagnostic Code 7805 as there are no other disabling effects not considered in a rating provided under Diagnostic Code 7800 through Diagnostic Code 7804.

In reaching its conclusions, the Board acknowledges the Veteran's belief that his lower extremity scars are more severe than reflected by the currently assigned rating. The Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to provide evidence regarding his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. Woehlaert v. Nicholson, supra. Ultimately, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disabilities in light of the rating criteria to be more persuasive than his reports regarding the severity of his right and left knee disorders.

In sum, the Board finds a rating in excess of 10 percent for scars, painful, residuals of bilateral lower extremity compartment syndrome, is not warranted. The appeal is denied. 38 U.S.C. § 5107; 38 C.F.R. §3.102; Lynch v. McDonough, supra.

6. Entitlement to a compensable rating for residuals of greater trochanter bursitis, right hip, impairment of flexion, is denied.

The Veteran contends that a compensable rating is warranted for residuals of trochanter bursitis, right hip, impairment of flexion. See, e.g., January 2019 VA Form 21-526EZ.

Throughout the period on appeal, the Veteran's greater trochanter bursitis, right hip, impairment of flexion is rated as noncompensable under 38 C.F.R. § 4.71a, Diagnostic Code 5252.

By way of background, in addition to the rating under Diagnostic
, 2019. See January 2019 VA Form 21-526EZ. Therefore, the appeal period begins January 2, 2018, which includes the one-year "look back" period provided by 38 U.S.C. § 5110(b)(2), 38 C.F.R. § 3.400(o)(2), and Gaston v. Shinseki, supra.

Throughout the period on appeal, the Veteran's greater trochanter bursitis, right hip, impairment of flexion is rated as noncompensable under 38 C.F.R. § 4.71a, Diagnostic Code 5252.

By way of background, in addition to the rating under Diagnostic Code 5252, the Veteran was assigned a separate rating under Diagnostic Code 5010-5251 for painful limitation of motion, right hip residual of trochanter bursitis. He was also assigned a separate rating for greater trochanter bursitis of the right hip under Diagnostic Code 5010-5253. These ratings were separately adjudicated in a May 2024 Board decision.

Under Diagnostic Code 5252, limitation of flexion of the thigh, a 10 percent rating is assigned for flexion limited to 45 degrees. A 20 percent rating is assigned for flexion limited to 30 degrees. A 30 percent rating is assigned for flexion limited to 20 degrees. A 40 percent rating is assigned for flexion limited to 10 degrees.

Other diagnostic codes may also be used to rate the hip and thigh. Under Diagnostic Code 5251, limitation of extension of the thigh, a 10 percent rating is assigned for extension limited to 5 degrees.

Diagnostic Code 5250 provides a 60 percent rating for favorable ankylosis of the hip in flexion at an angle between 20 degrees and 40 degrees and slight adduction or abduction; a 70 percent rating for intermediate ankylosis; and a 90 percent rating for extremely unfavorable ankylosis, with the foot not reaching the ground, necessitating crutches.

Under Diagnostic Code 5253, impairment of the thigh, a 10 percent rating is assigned for limitation of rotation of the affected leg with an inability to toe-out more than 15 degrees. A 10 percent rating is also assigned for limitation of adduction where the legs cannot be crossed. A 20 percent rating is assigned for limitation of abduction with motion lost beyond 10 degrees.

Under Diagnostic Code 5254, an 80 percent rating is warranted where there is flail of the hip joint.

Ratings are assignable under Diagnostic Code 5255 when there is fracture of the surgical neck with false joint, fracture of the shaft or anatomical neck of the femur, or malunion of the femur.

The Rating Schedule provides that the normal flexion of the hip is from zero degrees to 125 degrees and normal abduction of the hip is from zero degrees to 45 degrees. 38 C.F.R. § 4.71, Plate II.

Turning to the evidence, the Veteran was afforded a VA examination in February 2019. The Veteran reported flare-ups of sharp right hip pain, particularly in cold weather, that made walking and standing difficult.

On examination, the Veteran's right hip showed flexion to 100 degrees, extension to 30 degrees, abduction to 40 degrees, adduction to 20 degrees, external rotation to 30 degrees, and internal rotation to 20 degrees. Adduction was limited such that the Veteran could not cross his legs. Pain was noted on all motions except for extension, there was evidence of pain with weight-bearing, and there was objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The examiner found that the pain did not result in functional loss. Range of motion findings for the left hip were all normal.

There was no loss of function after repetitive-use testing with at least three repetitions. The examination was conducted immediately after repeated use over time. The examiner found that pain, fatigue, weakness, and lack of endurance significantly limited functional ability after repeated use over time with flexion to 100 degrees, extension to 30 degrees, abduction to 40 degrees, adduction to 20 degrees, external rotation to 30 degrees, and internal rotation to 20 degrees.

The examination was not conducted during a flare-up. The examiner found that pain, fatigue, weakness, and lack of endurance significantly limited functional ability with flare-ups, and estimated range of motion during a flare-up to be flexion to 100 degrees, extension to 30 degrees, abduction to 40 degrees, adduction to 20 degrees, external rotation to 30 degrees, and internal rotation to 20 degrees.

found that pain, fatigue, weakness, and lack of endurance significantly limited functional ability after repeated use over time with flexion to 100 degrees, extension to 30 degrees, abduction to 40 degrees, adduction to 20 degrees, external rotation to 30 degrees, and internal rotation to 20 degrees.

Muscle strength testing was normal. The examiner found no muscle atrophy, ankylosis, malunion or nonunion of the femur, flail hip joint, or leg length discrepancy. The examiner noted that the Veteran occasionally used a back brace when he was more active. With respect to functional impact, the examiner found that the Veteran would need the ability to sit and stand at will, with no long periods of standing, walking, or sitting.

VA treatment notes indicate that the Veteran was seen in February 2018, March 2018, and May 2018 for right hip pain. See CAPRI Records. The VA clinician did not report range of motion findings in degrees of motion. Instead, for each visit, the VA clinician reported that the Veteran's right hip flexion was limited 25 percent. The Board notes that full range of motion for hip flexion is 125 degrees. See 38 C.F.R. § 4.71, Plate II. Therefore, if right hip flexion was limited 25 percent, it indicates that the Veteran retained 75 percent of flexion, or 94 degrees of motion. The Board notes that this finding of 94 degrees flexion is consistent with the finding of the February 2019 VA examiner that the Veteran had 100 degrees of motion for right hip flexion.

A private treatment note from August 2019 states that the Veteran complained of right hip pain that was diffuse, mild, constant, and dull. See Medical Treatment Record - Non-Government Facility.

During his August 2022 Board hearing, the Veteran testified that he had right hip replacement surgery in April 2022. See August 2022 Hearing Transcript. Prior to hip surgery, his doctors told him he had osteoarthritis with bone rubbing on bone. He had used a cane, walker, cortisone injections, and gel for right hip pain. During that time the Veteran had been unable to cross or lift his legs and he had flare-ups that prevented him from walking up more than one flight of stairs.

Within the evidentiary window following the August 2022 Board hearing, the Veteran submitted a report of a private radiology examination conducted in September 2020. See September 2022 Medical Treatment Record - Non-Government Facility. The report stated there was marked joint space narrowing at the right hip joint consistent with severe osteoarthritis with significant progression since 2015.

Based on the foregoing, the Board finds that a compensable rating for the Veteran's residuals of greater trochanter bursitis, right hip, impairment of flexion is not warranted. During the February 2019 VA examination, the examiner found that the Veteran's right hip range of motion was, at worst, flexion to 100 degrees. Similarly, VA treatment records from February 2018, March 2018, and May 2018 indicate right hip flexion to 94 degrees. At no time during the appeal period does the evidence show flexion limited to 45 degrees even in contemplation of pain, fatigue, weakness, lack of endurance, or incoordination for either hip. Therefore, a compensable rating under Diagnostic Code 5252 is not warranted.

The Board has considered whether a higher or separate rating is warranted under alternative diagnostic codes. As noted above, the Veteran has already been granted separate ratings for his right hip under Diagnostic Codes 5251 and 5253. A December 2024 rating decision assigned a separate rating under Diagnostic Code 5054 for the Veteran's right hip replacement surgery. The evidence does not show that the Veteran had ankylosis or the functional ankylosis of the right hip at any time during the appeal period to warrant a separate or higher rating under Diagnostic Code 5250. The evidence did not show a flail joint or impairment of the femur to warrant a separate or higher rating under Diagnostic Code 5254 and 5255. Accordingly, separate or higher ratings for the right hip under these diagnostic codes are not applicable.

The Board has considered the effects of repeated
separate ratings for his right hip under Diagnostic Codes 5251 and 5253. A December 2024 rating decision assigned a separate rating under Diagnostic Code 5054 for the Veteran's right hip replacement surgery. The evidence does not show that the Veteran had ankylosis or the functional ankylosis of the right hip at any time during the appeal period to warrant a separate or higher rating under Diagnostic Code 5250. The evidence did not show a flail joint or impairment of the femur to warrant a separate or higher rating under Diagnostic Code 5254 and 5255. Accordingly, separate or higher ratings for the right hip under these diagnostic codes are not applicable.

The Board has considered the effects of repeated use over time and flare-ups along with the adequacy of the VA examinations in light of the Court's holdings in Correia v. McDonald, supra, and Sharp v. Shulkin, 29 Vet. App. 26, 32 (2017). The February 2019 VA examiner provided measurements for active range of motion, observed repetitive use, and repeated use over time, along with estimates of range of motion during flare-ups. The examiner also noted pain on passive range of motion and on weight bearing, and did not find evidence of pain on non-weight bearing. The Board finds that the examination report of record is adequate to adjudicate the Veteran's claim for an increased rating for residuals of greater trochanter bursitis, right hip, impairment of flexion and no further examination is necessary.

The Board notes that Diagnostic Code 5252 does not contemplate the use of medication. The Board is cognizant of the recent Court decision in Ingram v. Collins, in which the Court reaffirmed prior holdings that in rating disabilities, the Board must discount the beneficial effects of medication when the relevant rating criteria do not contemplate medication use. Ingram v. Collins, supra. Here, the Veteran did not report that the use of any medication ameliorated his symptoms in any way, and the Board has thus discounted the ameliorative effects of medication in reaching its determination in this case.

In reaching its conclusions, the Board acknowledges the Veteran's belief that his residuals of greater trochanter bursitis, right hip, impairment of flexion are more severe than reflected by the currently assigned rating. The Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to provide evidence regarding his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. Woehlaert v. Nicholson, supra. Ultimately, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disabilities in light of the rating criteria to be more persuasive than his reports regarding the severity of his residuals of greater trochanter bursitis, right hip, impairment of flexion.

In sum, the Board finds a compensable rating for the Veteran's residuals of greater trochanter bursitis, right hip, impairment of flexion is not warranted. The appeal is denied. 38 U.S.C. § 5107; 38 C.F.R. §3.102; Lynch v. McDonough, supra.

7. Entitlement to a compensable rating for residuals of bunion, right great toe is denied.

The Veteran contends that a compensable rating is warranted for residuals of bunion, right great toe. See, e.g., January 2019 VA Form 21-526EZ.

Throughout the period on appeal, the Veteran's residuals of bunion, right great toe is rated as noncompensable under 38 C.F.R. § 4.71a, Diagnostic Code 5280.

Under Diagnostic Code 5280, a 10 percent rating is warranted for: (
2, 2019. See January 2019 VA Form 21-526EZ. Therefore, the appeal period begins January 2, 2018, which includes the one-year "look back" period provided by 38 U.S.C. § 5110(b)(2), 38 C.F.R. § 3.400(o)(2), and Gaston v. Shinseki, supra.

Throughout the period on appeal, the Veteran's residuals of bunion, right great toe is rated as noncompensable under 38 C.F.R. § 4.71a, Diagnostic Code 5280.

Under Diagnostic Code 5280, a 10 percent rating is warranted for: (1) hallux valgus that has been operated on with resection of the metatarsal head; or, (2) severe hallux valgus that is equivalent to amputation of the great toe. There is no higher rating available under this Diagnostic Code.

Turning to the evidence of record, the Veteran was afforded a VA examination in February 2019 and diagnosed with hallux valgus. The Veteran stated it was painful to wear shoes or walk and difficult to stand, and that he had a special shoe to accommodate his bunion. The VA examiner found that the Veteran had mild or moderate symptoms of hallux valgus and that surgery for hallux valgus had not been performed. The examiner noted there was pain on physical examination and that there was functional loss due to pain, stiffness, weakness, fatigue, and lack of strength and endurance. The examiner concluded that there was not functional impairment such that no effective functions remain other than that which would be equally well served by an amputation with prosthesis.

A July 2018 VA podiatry note states that the Veteran walked with a limp without assistive devices. See CAPRI Records. A November 2018 VA treatment note states that the Veteran had received an injection for foot pain and walked with a normal gait without assistive devices. A September 2019 VA podiatry note states that the Veteran was ambulatory without assistive devices and walking with a noticeable limp, which the Veteran attributed to hip pain. A February 2020 VA treatment note states that the Veteran walked without difficulty,

At his August 2022 Board hearing, the Veteran stated that he had problems with pain and numbness in his big toe. See August 2022 Hearing Transcript.

Based on the foregoing, the Board finds that a compensable rating for residuals of bunion, right great toe is not warranted. The Veteran has reported, and the medical evidence shows, pain with walking and standing, stiffness, weakness, fatigue, and lack of strength and endurance. However, the record is negative for, and the Veteran has not alleged, hallux valgus that has been operated on with resection of the metatarsal head or severe hallux valgus that is equivalent to amputation of the great toe. Therefore, a compensable rating is not warranted.

The Board has considered whether a higher rating is available under other diagnostic codes but finds that it is not. In this regard, the Veteran is service connected for right foot hallux valgus, which is specifically covered by Diagnostic Code 5280. As such, it would be inappropriate to rate his right foot hallux valgus by analogy to any other diagnostic codes. Copeland v. McDonald, 27 Vet. App. 333, 336-37. Thus, consideration of whether higher ratings may be assigned under alternative diagnostic codes is not warranted in this case.

In reaching its conclusions, the Board acknowledges the Veteran's belief that his residuals of bunion, right great toe are more severe than reflected by the currently assigned rating. The Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to provide evidence regarding his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. Woehlaert v. Nicholson, supra. Ultimately, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disabilities in light of the rating criteria to be more persuasive than his reports regarding the severity of his residuals of bunion, right great toe.

In sum, the Board
. Ultimately, the Board finds the medical evidence in which professionals with medical expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disabilities in light of the rating criteria to be more persuasive than his reports regarding the severity of his residuals of bunion, right great toe.

In sum, the Board finds a compensable rating for the Veteran's residuals of bunion, right great toe, is not warranted. The appeal is denied. 38 U.S.C. § 5107; 38 C.F.R. §3.102; Lynch v. McDonough, supra.

REASONS FOR REMAND

1. Entitlement to a rating in excess of 20 percent for chronic low back strain with degenerative arthritis of the spine is remanded.

The Veteran contends that a rating in excess of 20 percent is warranted for chronic low back strain with degenerative arthritis of the spine. See, e.g., January 2019 VA Form 21-526EZ.

The October 2020 rating decision on appeal states that the evidence reviewed by the AOJ includes private treatment records from the Lexington Brain and Spine Institute dated April 4, 2019 and received by VA on April 11, 2019. These records were submitted by the Veteran. See April 2019 Statement in Support of Claim (VA Form 21-4138).

The April 4, 2019 treatment note from Lexington Brain and Spine Institute states that the physician ordered radiology studies of the Veteran's lumbar spine and that the plan was for the physician to see the Veteran again in approximately six weeks. See April 2019 Medical Treatment Record - Non-Government Facility. It appears that this subsequent visit occurred, as a May 2019 VA treatment note states that the Veteran was being evaluated through community care at the Brain and Spine Institute and that a May 2019 progress note from the Brain and Spine Institute stated that the Veteran had a lumbar spine radiology examination that showed multilevel degenerative changes. See CAPRI Records. However, the only record in the case file from the Lexington Brain and Spine Institute is the April 4, 2019 treatment note submitted by the Veteran.

VA has a duty to assist a claimant in obtaining evidence to substantiate all substantially complete initial and supplemental claims, including records from private medical care providers. 38 C.F.R. § 3.159(c). In this case, the records indicates that additional private treatment records are available regarding the Veteran's lumbar spine condition. The record does not indicate that VA attempted to obtain records from the Lexington Brain and Spine Institute. Failure to do so was a pre-decisional duty to assist error for which remand is warranted.

The matters are REMANDED for the following action:

The AOJ should obtain outstanding private treatment records relevant to the Veteran's claim for an increased rating for chronic low back strain with degenerative arthritis of the spine, namely records from the Lexington Brain and Spine Institute. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained.

For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in his possession.

If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e).

KRISTY L. ZADORA

Veterans

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