SPINAL STENOSIS

JOHN Z. JONES · 2026 · Case ID: A26032313

DENIED

Summary

The veteran, who served from October 1979 to April 1988, appeals the denial of increased disability ratings for his back and bilateral knee conditions. The veteran sought a rating higher than 40 percent for his back disability, currently rated under DC 5010-5238 (post-traumatic arthritis with spinal stenosis), and higher than 20 percent for left and right knee instability (DC 5257), and higher than 10 percent for left and right knee degenerative joint disease (DJD) (DC 5010-5260). The Board reviewed the evidence, including VA examinations from July 2020 and February 2019, and treatment records. For the back, the Board found the evidence weighed against unfavorable ankylosis of the entire thoracolumbar spine, noting limited forward flexion and no significant functional loss beyond that contemplated by the 40 percent rating. The Board also addressed the effective date for the back rating, finding no basis for an earlier date. For the knees, the Board found the evidence weighed against severe recurrent subluxation or lateral instability under pre-February 2021 criteria, and that the new criteria for knee instability and DJD did not yield a more favorable rating. The Board noted that the veteran's lay reports of symptoms and functional loss were considered but did not meet the criteria for higher ratings. The Board also found that the evidence did not support a rating under DC 5258 for meniscus conditions. The Board denied increased ratings for all conditions, finding the evidence weighed persuasively against the veteran's claims and that the benefit-of-the-doubt rule did not apply.

Rationale

Evidence weighed against unfavorable ankylosis of entire thoracolumbar spine; Limited forward flexion and no significant functional loss beyond 40% rating criteria; Benefit-of-the-doubt rule did not apply as evidence weighed against claim

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210409-151575

Full Decision Text

Citation Nr: A26032313
Decision Date: 04/08/26 Archive Date: 04/08/26

DOCKET NO. 210409-151575
DATE: April 8, 2026

ORDER

A rating higher than 40 percent for spinal canal stenosis (previously rated as lumbar strain with degenerative joint disease of lumbar spine) (hereinafter back disability), is denied.

A rating higher than 20 percent for left knee instability is denied.

A rating higher than 20 percent for right knee instability is denied.

A rating higher than 10 percent for left knee degenerative joint disease (DJD) is denied.

A rating higher than 10 percent for right knee DJD is denied.

FINDINGS OF FACT

1. The evidence of record weighs persuasively against finding that the Veteran's back disability is manifested by unfavorable ankylosis of the entire thoracolumbar spine or unfavorable ankylosis of the entire spine.

2. The evidence of record weighs persuasively against finding that the Veteran's left and right knee instability manifest in severe recurrent subluxation or lateral instability.

3. The evidence of record weighs persuasively against finding that the Veteran's left and right knee DJD manifest in flexion limited to less than 45 degrees flexion.

CONCLUSIONS OF LAW

1. The criteria for a rating higher than 40 percent for back disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code (DC) 5238.

2. The criteria for a rating in higher than 20 percent for left and right knee instability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5257.

3. The criteria for a rating higher than 10 percent for left and right knee disabilities have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, (DC) 5260.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from October 1979 to April 1988.

This matter is before the Board of Veterans' Appeals (Board) on appeal from a October 2020 rating decision issued by a Regional Office (RO).

In an April 2021 Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran selected the Hearing docket. An October 2024 notification advised the Veteran that a hearing was scheduled for January 8, 2025. The Veteran did not appear for the scheduled Board hearing.

Therefore, the Board may only consider the evidence of record at the time of the October 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative within 90 days following the date of the scheduled hearing. 38?C.F.R. §?20.302(c). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date of the scheduled Board hearing, or (2) more than 90 days following the date of the scheduled hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(c), 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.

The Veteran's former representative submitted a motion to withdraw as representative; the Board granted the motion in a February 2024 ruling.

Increased Disability Ratings

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155;
, 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.

The Veteran's former representative submitted a motion to withdraw as representative; the Board granted the motion in a February 2024 ruling.

Increased Disability Ratings

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 for that rating. 38 C.F.R. § 4.7. In considering the severity of a disability, it is essential to trace the veteran's medical history. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991).

The effective date of an award of increased disability compensation shall be the earliest date as of which it is factually ascertainable that an increase in disability had occurred, if the claim is received within one year from such date, otherwise, the effective date shall be the date of receipt of claim. 38 C.F.R. § 3.400(o)(2). If the increase occurred more than one year prior to the claim, the increase is effective the date of the claim. 38 C.F.R. § 3.400(o)(1), (2). If the increase occurred after the date of the claim, the effective date is the date of increase. Id.

Back

The Veteran contends that she is entitled to a rating higher than 40 percent for her back disability. The rating decision on appeal was promulgated in response to a September 2019 application for increased compensation based on unemployability (TDIU).

The rating decision on appeal increased the Veteran's rating for her back disability to 40 percent under DC 5010-5238. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. DC 5010 addresses post-traumatic arthritis. DC 5238 addresses spinal stenosis. The Board notes that from August to November 2015, the Veteran had a temporary 100 percent rating for her back disability following treatment necessitating convalescence, followed by a 20 percent rating.

Under the General Rating Formula for Diseases and Injuries of the Spine, a 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine.

Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1.

Unfavorable ankylosis is defined as "a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching." Id. at Note 5. Additionally, fixation of a spinal segment in neutral position (zero degrees) is "always" considered favorable ankylosis. Id.

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
of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching." Id. at Note 5. Additionally, fixation of a spinal segment in neutral position (zero degrees) is "always" considered favorable ankylosis. Id.

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).

The Veteran was afforded a July 2020 VA examination, which noted range of motion endpoints of 70 degrees forward flexion, and 10 degrees extension, right and left lateral flexion, and left and right lateral rotation. Her abnormal range of motion contributed to functional loss of difficulty standing, walking, bending, lifting, and sitting. There was no additional loss of function or range of motion after 3 repetitions. Following repeated use over time, she had functional loss due to pain, fatigue, weakness, and lack of endurance. During flare ups, she had functional loss due to pain, fatigue, weakness, lack of endurance, and incoordination. Her range of motion endpoints during flare ups were described with endpoints of 30 degrees forward flexion and 5 degrees extension, left and right lateral flexion, and left and right lateral rotation. She did not have guarding or muscle spasm. However, the examiner did note less movement than normal due to ankylosis, limitation or blocking, adhesions, etc.; weakened movement due to muscle or of peripheral nerves; instability of station; disturbance of locomotion; interference with sitting; and interference with standing.

January 2018 VA treatment records reported tenderness of the lumbar paraspinal musculature adjacent from L3 and extending to the lumbosacral region; her range of motion was limited, with forward flexion to approximately 60 degrees past the neutral sagittal plane. The Veteran was also noted to have neck pain; her neck pain has not been granted service connection.

Under the General Formula, a higher rating of 50 percent is warranted for unfavorable ankylosis of the entire thoracolumbar spine, and a 100 percent rating is warranted for unfavorable ankylosis of the entire spine. However, the evidence of record does not support finding unfavorable ankylosis of the entire thoracolumbar spine; rather, the Veteran was reported to have, at most restricted, 30 degrees forward flexion and 5 degrees extension, left and right lateral flexion, and left and right lateral rotation. Accordingly, the evidence of record does not support finding that the Veteran's entire thoracolumbar spine is fixed in flexion or extension with associated symptoms.

Regarding the effective date of the assignment of the Veteran's 40 percent rating, the date assigned corresponds to the Veteran's September 2019 application for TDIU. The effective date of an award of increased disability compensation shall be the earliest date as of which
entire spine. However, the evidence of record does not support finding unfavorable ankylosis of the entire thoracolumbar spine; rather, the Veteran was reported to have, at most restricted, 30 degrees forward flexion and 5 degrees extension, left and right lateral flexion, and left and right lateral rotation. Accordingly, the evidence of record does not support finding that the Veteran's entire thoracolumbar spine is fixed in flexion or extension with associated symptoms.

Regarding the effective date of the assignment of the Veteran's 40 percent rating, the date assigned corresponds to the Veteran's September 2019 application for TDIU. The effective date of an award of increased disability compensation shall be the earliest date as of which it is factually ascertainable that an increase in disability had occurred, if the claim is received within one year from such date, otherwise, the effective date shall be the date of receipt of claim. 38 C.F.R. § 3.400(o)(2). Here, the evidence of record does not support an increase in disability in the year prior to the Veteran's claim for TDIU, which did not constitute continuous pursuit of a previous rating disability for the Veteran's back disability. The Board further notes that in the instant appeal, the Veteran did not note a desire to appeal an April 2020 rating decision that addressed lower extremity radiculopathy; the effective dates and assigned ratings of the Veteran's lower extremity radiculopathy were addressed in a December 2021 Board decision.

Finally, in making the above findings, the Board is cognizant of the fact that the Veteran has used medication, including ibuprofen, naproxen, and flexeril, to treat her back pain. The Court has held that in assigning a disability rating, VA may not consider the ameliorative effects of medication where such effects are not explicitly contemplated by the rating criteria. Jones v. Shinseki, 26 Vet. App. 56 (2012). More recently, the Court stated that the "the Board [is] obligated to discount the beneficial effects of the medication taken for each disability and evaluate the baseline severity of those disabilities" and held that "Jones applies in the evaluation of musculoskeletal disabilities where the relevant [diagnostic code] does not reference medication as a factor in evaluation." Ingram v. Shinseki, 2025 U.S. App. Vet. Claims LEXIS 327, *15-19 (March 12, 2025).

The Board notes, however, that neither Jones nor Ingram address how the Board is to discount the beneficial effects of medication, particularly when used as treatment for musculoskeletal symptoms and where examiners do not reasonably have the ability to assess range of motion both with and without use of medication. Remanding this appeal to order an addendum medical opinion based on Jones and Ingram, and in the lens of the rating criteria under § 4.71a, would almost certainly require an examiner to engage in medical speculation and would result in a medical opinion that lacks the degree of certainty to ascertain, even under the benefit-of-the-doubt standard, the impact of the ameliorative effects of medication on the severity of a veteran's musculoskeletal disability in terms of range of motion. See, e.g., Hood v. Shinseki, 23 Vet. App. 295, 298-99 (2005) (medical opinions that are speculative have "little probative value"). Significantly, one of the judges in McCarroll, joined by another judge in concurrence, expressed the same concern as to the implications of the holding in Jones:

The requirement that the Secretary "may not consider the relief afforded by [a veteran's] medication when" applying the rating schedule, as Jones demands...invites medical speculation in trying to guess what a veteran's symptoms might be without the medication, or medical malpractice in the cessation of medication so that the veteran's symptoms without medication might be recorded. The former invites non-helpful guesswork by medical practitioners,...and the latter raises, at a minimum, serious ethical concerns that no court should encourage. That Jones essentially requires the Board to consider whether a medical examination is required to determine how serious a veteran's symptoms would have been in an alternate reality in which he or she was not taking his or her required medication should alone demonstrate the fallacy of the Jones holding.

McCarroll v. McDonald, 28 Vet. App. 267, 278 (2016) (internal citations omitted). Because it is highly unlikely that remand to obtain a medical opinion as to the ameliorative effects of medication on the severity of the Veteran's back disability would result in a probative, non-speculative opinion as to such, the Board does not wish to further delay adjudication of the Veteran's appeal to engage in likely unfruitful
. That Jones essentially requires the Board to consider whether a medical examination is required to determine how serious a veteran's symptoms would have been in an alternate reality in which he or she was not taking his or her required medication should alone demonstrate the fallacy of the Jones holding.

McCarroll v. McDonald, 28 Vet. App. 267, 278 (2016) (internal citations omitted). Because it is highly unlikely that remand to obtain a medical opinion as to the ameliorative effects of medication on the severity of the Veteran's back disability would result in a probative, non-speculative opinion as to such, the Board does not wish to further delay adjudication of the Veteran's appeal to engage in likely unfruitful further development pursuant to Jones and Ingram. Moreover, the Board certainly cannot - and will not - order the Veteran to stop taking medication to undergo an examination that would reflect the severity of her back disability without the use of pain medication. This would not only be cruel and potentially damaging to the Veteran, but the undersigned finds it would be legally unethical to ask such.

Finally, the Board notes that VA compensation does not contemplate hypothetical symptoms or impairment. Instead, the purpose of VA benefits is to compensate for decreased earning capacity - to compensate for actual symptoms or impairment that an individual experiences in the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. The Veteran's manifestations of pain have been considered in rating her back disability, but it remains the Board's obligation to rate the condition based on the application of the rating criteria found in the diagnostic codes to the objective medical evidence.

Left and Right Knees

The Veteran contends that she is entitled to ratings higher than 20 percent for left and right knee instability, and higher than 10 percent for left and right knee DJD.

The Veteran's left and right knees have both been rated under DC 5257 for knee instability at 20 percent from September 2019, and under DC 5010-5260 for DJD at 10 percent from July 2013. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. In this case, DC 5010 indicates post-traumatic arthritis and DC 5260 addresses limitation of flexion.

The Board notes that prior to the rating decision on appeal, the Veteran appealed the left knee rating assigned in a May 2019 rating decision. As such, the Veteran's initial left knee rating was addressed in a March 2024 Board decision, which the Board will not now disturb.

Knee Instability

Under DC 5257, 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, DC 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 DC 5257, so objective medical evidence cannot be categorically found more probative than lay evidence with respect to this DC. 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 DC 5257 provides ratings for other impairment of the knee based on recurrent subluxation or instability, and patellar instability.

For recurrent subluxation or instability, a 10 percent rating is warranted for sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 20 percent rating is warranted for one of the following: (a) Sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation; or (b) Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A maximum 30 percent
from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 20 percent rating is warranted for one of the following: (a) Sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation; or (b) Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A maximum 30 percent rating is warranted for unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation.

For 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 20 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 one of the following: A brace, cane, or walker. 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.

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

Turning to the evidence of record, Lachman testing did not demonstrate one-plane anterior instability on either knee in February 2017 medical treatment records.

The Veteran was afforded a February 2019 VA examination, which reported no history of recurrent subluxation or lateral instability in either knee; joint stability testing was not performed.

The Veteran was subsequently afforded a July 2020 VA examination, which noted knee instability of her left and right knees. The examiner noted no history of recurrent subluxation or lateral instability. Joint stability testing indicated 2+ anterior instability (Lachman test) on a scale of "normal" to 3+ of both the left and right knees. Posterior, medial, and lateral instability tests were normal.

Under the pre-February 7, 2021, rating criteria, the evidence of record does not support finding that the Veteran's left and right knee instability manifested in severe recurrent subluxation or lateral instability. Rather, the Veteran reported tripping "every once in a while," her joint instability testing was noted to be 2+ on a scale of "normal" to 3+, and the examiner noted no history of recurrent subluxation or lateral instability. Therefore, the evidence of record weighs persuasively against finding that the Veteran's knee injury resulted in symptoms more nearly approximating severe recurrent subluxation or lateral instability.

Similarly, the Board finds that the evidence of record persuasively weighs against a rating higher than 20 percent under the new rating criteria for either knee. A maximum 30 percent rating is warranted for unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation or 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. The evidence of record does not support finding an unrepaired or failed repair of a complete ligament tear or recurrent instability after surgical repair. Accordingly, a rating under the new criteria is not more favorable to the Veteran.

Additionally, an earlier effective date for the Veteran's knee instability rating is not warranted. The effective date for an award of increased disability compensation shall be the earliest date as of which it is factually ascertainable that an increase in disability had occurred, if the claim is received within one year from such date, otherwise, the effective date shall be the date of receipt of claim. 38 C.F.R. § 3.400(o)(2). If the increase occurred more than one year prior to the claim, the increase is effective the date of the claim. 38 C.F.R. § 3.400(o)(1), (2). If the increase occurred after the date of the claim, the effective date is the date of increase. Id. Here, there is no ascertainable date regarding when the Veteran's knee disability began; rather, her Lachman test was negative in February 2017 medical records and positive in her July 2020 examination. As there is no ascertainable date within the one year look back period in which the Veteran's knee instability worsened, an effective date earlier than the Veteran's date of claim is not warranted.

In conclusion, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for a rating higher than 20 percent for the Veteran's left and right knee instability. As the evidence of record persuasively weighs against a higher rating, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (2021).

DJD

The Veteran's left and right knee DJD is rated under 38 C.F.R. § 4.71a, DC 5260, for limitation of flexion of the leg. Under DC 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, DC 5260. A 10 percent evaluation can instead be provided for functional loss due to painful motion, to be rated to at least the minimum compensable rating for a particular joint under 38 C.F.R. § 4.59.

Turning to the evidence of record, 2018 treatment records note knee injections and knee pain that had progressively worsened over time. February 2018 VA treatment records note full active range of motion with extension. April 2019 VA records note that the Veteran's left knee had marked decreased flexion with pain. She was
which a rating is determined based on the § 4.71a criteria.").

Turning to the evidence of record, 2018 treatment records note knee injections and knee pain that had progressively worsened over time. February 2018 VA treatment records note full active range of motion with extension. April 2019 VA records note that the Veteran's left knee had marked decreased flexion with pain. She was unable to perform any special tests due to pain limitations - she had pain with patellar grind.

The Veteran was afforded a February 2019 VA examination, in which the Veteran's left knee range of motion endpoints were 120 degrees flexion and 0 degrees extension; her flexion endpoint was decreased to 115 degrees following three repetitions. The examiner was unable to describe additional loss due to repeated use over time or flare ups in terms of range of motion.

The Veteran's right knee range of motion endpoints were 115 degrees flexion and 0 degrees extension; her flexion endpoint was decreased to 110 degrees following three repetitions. The examiner was unable to describe additional loss due to repeated use over time or flare ups in terms of range of motion due to the variability of factors leading to a variability of range of motion loss.

The Veteran was subsequently afforded a July 2020 VA examination, in which the Veteran's left knee range of motion endpoints were 110 degrees flexion and 0 degrees extension. The examiner noted pain on both flexion and extension. Her range of motion was unchanged following repetitive use over time and on passive range of motion. During flare ups, her estimated range of motion endpoints were 80 degrees flexion and 0 degrees extension.

The Veteran's right knee range of motion endpoints were 105 degrees flexion and 0 degrees extension. The examiner noted pain on both flexion and extension. Her range of motion was unchanged following repetitive use over time and on passive range of motion. During flare ups, her estimated range of motion endpoints were 80 degrees flexion and 0 degrees extension.

The Board finds that the evidence of record persuasively weighs against a rating in higher than 10 percent for left and right knee DJD. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation would not result in limitation of motion more nearly approximating flexion limited to 30 degrees.

The Board has also considered the other DCs 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).

The Board specifically notes that in February 2018 private treatment records, the Veteran reported that both of her knees would "pop" and she seemed to trip without falling every once in a while. In a March 2018, physical therapy note, the Veteran reported that the previous evening she felt her left knee "pop" in a "forward/backward" motion. To the extent that her reports raise the issue of a rating under DC 5258 for cartilage, semilunar, dislocated, with frequent episodes of "locking," pain, and effusion into the joint, the Board notes that the Veteran noted tripping without falling "every once in a while," which is not frequently. Additionally, July 2020 and February 2019 examinations indicated that the Veteran did not have a meniscus (semilunar cartilage) condition. Therefore, the evidence of record weighs persuasively against finding that the Veteran had a meniscus condition and rating either of the Veteran's knees under DC 5258 is not warranted.

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In conclusion, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for a rating higher than 10 percent for left and right knee DJD. As the evidence of record persuasively weighs against a rating higher than 10 percent, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch

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