KNEE INSTABILITY

HARVEY P. ROBERTS · 2026 · Case ID: A26036090

MIXED

Summary

The veteran, who served from February 1987 to March 1995 and again from April 2005 to May 2006, appeals the denial of an increased rating for left knee patellofemoral pain syndrome and the denial of a separate rating for left knee instability. The veteran also sought a 10 percent rating for a left knee scar. The Board reviewed evidence including a March 2020 VA knee examination and the veteran's testimony from a July 2024 hearing. The VA examiner diagnosed left knee patellofemoral pain syndrome with residual symptoms of limited range of motion and pain, noting the veteran used a knee brace for ambulation but found no functional impairment for work. The veteran testified to painful motion, instability, knee locking, falling episodes, and the need for a brace, cane, and pain medication. The Board found the veteran's testimony credible regarding instability and pain. For left knee instability, the Board granted a 10 percent rating, citing the veteran's testimony of instability and need for a brace, aligning with Diagnostic Code 5257. For patellofemoral pain syndrome, the Board denied a higher rating, finding the veteran's pain did not result in functional loss beyond what was already compensated, consistent with the VA exam and Diagnostic Code 5260. For the left knee scar, the Board granted a 10 percent rating based on the veteran's credible testimony of pain, consistent with Diagnostic Code 7804, while noting the scar was not unstable or associated with underlying soft tissue damage.

Rationale

Veteran's testimony of instability and need for brace found credible.; March 2020 VA exam noted need for brace, though no objective instability found.; Rating aligns with Diagnostic Code 5257 for slight instability.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

200918-111562

Full Decision Text

Citation Nr: A26036090
Decision Date: 04/17/26 Archive Date: 04/17/26

DOCKET NO. 200918-111562
DATE: April 17, 2026

ORDER

Entitlement to a separate 10 percent initial rating, but not higher, for left knee instability, as of December 3, 2019, but not earlier, is granted.

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

Entitlement to a 10 percent initial rating, but not higher, for a left knee scar, as of December 3, 2019, but not earlier, is granted.

FINDINGS OF FACT

1. Resolving all reasonable doubt in favor of the Veteran, the evidence of record shows the left knee disability was manifested by slight instability during the period under review.

2. During the period under review, the evidence of record shows left knee patellofemoral pain syndrome was manifested by painful motion with normal flexion to 115 degrees, at worst, and normal extension to 0 degrees with no objective evidence of ankylosis, recurrent subluxation or lateral instability, dislocated semilunar cartilage, symptomatic removal of semilunar cartilage, impairment of the tibia and fibular, or genu recurvatum.

3. During the period under review, the single left knee scar was painful, but not unstable; was not located on the head, face, or neck; was not associated with underlying soft tissue damage; did not cover an area of 144 square inches or greater; and the evidence showed no other disabling effects.

CONCLUSIONS OF LAW

1. The criteria for entitlement to a separate 10 percent initial rating, but not higher, for left knee instability, as of December 3, 2019, but not earlier, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.2501, 4.1, 4.3, 4.6, 4.7, 4.14, 4.40, 4.45, 4.59, 4.71a, 20.300, Diagnostic Code 5257.

2. The criteria for a rating in excess of 10 percent for left knee patellofemoral pain syndrome have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.2501, 4.1, 4.3, 4.6, 4.7, 4.14, 4.40, 4.45, 4.71a, 20.300, Diagnostic Code 5260.

3. The criteria for a 10 percent initial rating, but not higher, for a single left knee scar, effective December 3, 2019, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.6, 4.7, 4118, Diagnostic Code 7804.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from February 1987 to March 1995 and from April 2005 to May 2006.

These matters come to the Board of Veterans' Appeals (Board) on appeal from a July 2020 Department of Veterans Affairs (VA) rating decision by the Department of Veterans Affairs (VA) Regional Office (RO), which is the Agency of Original Jurisdiction (AOJ). In September 2020, the Veteran filed VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) and elected the Hearing docket. Therefore, the Board may only consider the evidence of record at the time of the AOJ decision on appeal, and any evidence submitted at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302

At a July 2024 hearing, the Veteran testified before the undersigned Veterans law Judge. A hearing transcript is of record.

Any evidence added to the claims file after the rating decision on appeal, during a period of time when new evidence was not allowed for Board review under the Hearing docket option, is not reviewable by the Board. The Board cannot consider that evidence in this decision. However, the Veteran may file a Supplemental Claim and submit or identify that evidence. If the evidence is new and relevant, VA will issue another decision on the
J decision on appeal, and any evidence submitted at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302

At a July 2024 hearing, the Veteran testified before the undersigned Veterans law Judge. A hearing transcript is of record.

Any evidence added to the claims file after the rating decision on appeal, during a period of time when new evidence was not allowed for Board review under the Hearing docket option, is not reviewable by the Board. The Board cannot consider that evidence in this decision. However, the Veteran may file a Supplemental Claim and submit or identify that evidence. If the evidence is new and relevant, VA will issue another decision on the claim considering the new evidence, in addition to the evidence previously considered. 38 C.F.R. §§ 3.2501, 20.300.

Increased Ratings

Disability ratings are determined by the application of the VA Schedule for Rating Disabilities, which is based on average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3.

The Veteran's entire history is to be considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). A claimant may experience multiple distinct degrees of disability that may result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). The following analysis is undertaken with consideration of the possibility that different ratings may be warranted for different time periods.

While the Board must provide reasons and bases supporting a decision, there is no need to discuss, in detail, all the evidence submitted by or on behalf of the Veteran. Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000) (Board must review the entire record but does not have to discuss each piece of evidence). The analysis below focuses on the most salient and relevant evidence of record. The Veteran should not assume that the Board has overlooked pieces of evidence that are not explicitly discussed. Timberlake v. Gober, 14 Vet. App. 122 (2000).

The Board must assess the credibility and weight of all evidence, including the medical evidence, to determine its probative value, accounting for evidence that it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the Veteran. Equal weight is not given to each piece of evidence contained in the record. Every item of evidence does not have the same probative value. When the evidence is assembled, the Board is responsible for determining whether the evidence supports the claim or is in approximate balance, with the Veteran prevailing in either event, or whether the weight of the evidence is against a claim, in which case the claim is denied.

1. Entitlement to a separate 10 percent initial rating, but not higher, for left knee instability as of December 3, 2019, but not earlier

2. Entitlement to a rating in excess of 10 percent for left knee patellofemoral pain syndrome

As an initial matter, the period on appeal is from December 3, 2019, the date VA received the increased rating claim, to July 28, 2020, the notification date of the rating decision on appeal. The Board finds that the Veteran has continuously pursued the increased rating claim for a left knee disability since December 3, 2019.

On February 7, 2021, the VA Rating Schedule was amended with regard to rating musculoskeletal disabilities. 38 C.F.R. Part 4. However, the period under review is prior to the change in regulation, the Board will only consider the rating criteria in effect prior February 7, 2021. The Board notes that no changes were made to Diagnostic Codes 5260 and 5261 as part of the February 7, 2021, change in regulation. However, Diagnostic Codes 5003, 5010, 5257 and 5262 were amended, effective February 7, 2021. 85 Fed. Reg.
December 3, 2019.

Normal range of motion of the knee is to 0 degrees extension and to 140 degrees flexion. 38 C.F.R. § 4.71a, Plate II.

In considering range of motion ratings, it is important to consider whether a higher rating is warranted on the basis of functional loss due to pain or due to weakness, excess motion, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45. DeLuca v. Brown, 8 Vet. App. 202 (1995); Mitchell v. Shinseki, 25 Vet. App. 32 (2011). A minimum compensable rating for a joint disability is warranted for painful motion under 38 C.F.R. § 4.59.

Diagnostic Code 5003 provides that 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. 38 C.F.R. § 4.71a. When limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is generally for application. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. A rating for arthritis cannot be combined with a rating based on limitation of motion of the same joint. 38 C.F.R. § 4.71a, Diagnostic Code 5003.

Diagnostic Code 5257, used for rating knee instability, provides that a 10 percent rating is assigned for slight recurrent subluxation or lateral instability of a knee. A 20 percent rating is assigned for moderate recurrent subluxation or lateral instability. A 30 percent rating is assigned for severe knee impairment with recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, Diagnostic Code 5257. Subluxation of the patella is the incomplete or partial dislocation of the knee cap. Rykhus v. Brown, 6 Vet. App. 354 (1993).

Diagnostic Code 5260, used for rating limitation of flexion of the knee, provides 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 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260.

Diagnostic Code 5261, used for rating limitation of extension of the knee, provides that a 10 percent rating is assigned for extension limited to 10 degrees. A 20 percent rating is assigned for extension limited to 15 degrees. A 30 percent rating is assigned for extension limited to 20 degrees. A 40 percent rating is assigned for extension limited to 30 degrees. A 50 percent rating is assigned for extension limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261.

The words slight, moderate, and severe as used in the various Diagnostic Codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are equitable and just. 38 C.F.R. § 4.6.

In addition, separate ratings may be assigned for compensable limitation of both flexion and extension, or for limitation of motion and instability or subluxation of the knee, or meniscal pathology. However, a separate rating can only be assigned where additional compensable symptomatology is shown that is not duplicative of that used to assign another rating. 38 C.F.R. § 4.14; Lichtenfels v. Derwinski,
in the various Diagnostic Codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are equitable and just. 38 C.F.R. § 4.6.

The Veteran contends that the 10 percent initial rating assigned for left knee patellofemoral pain syndrome, based on painful motion, does not accurately compensate for the severity of the disability and asserts that a higher rating is warranted. Further, the Veteran contends that a separate rating is warranted for left knee instability due to frequent episodes of left knee locking that results in the Veteran falling.

During the period under review, the service-connected left knee patellofemoral pain syndrome, based on painful motion, is currently assigned a 10 percent rating, effective December 3, 2019, pursuant to Diagnostic Code 5260. The currently assigned rating contemplates pain on motion and would be consistent with limitation of flexion to 45 degrees. To warrant a higher rating, the limitation of flexion must approximate the functional equivalent of limitation of flexion to 30 degrees. 38 C.F.R. § 4.7.

The Board notes that as of April 24, 2022, the service-connected left knee disability included a total knee replacement and is currently rated 60 percent as of April 24, 2022; 30 percent as of May 1, 2023; 100 percent as of July 6, 2023; 100 percent as of September 1, 2023; and 30 percent as of January 1, 2024, pursuant to Diagnostic Code 5055 or pursuant to 38 C.F.R. 4.30 during a period of convalescence.

At a March 2020 VA knee examination, the examiner diagnosed left knee patellofemoral pain syndrome, status post removal of left proximal tibia ossicle. The Veteran reported pain with prolonged standing and walking. The left knee range of motion was at worst, to 0 degrees (normal) extension and at worst to 115 degrees (normal) flexion. The Veteran did not report, and the examination did not show, muscle atrophy, ankylosis, recurrent subluxation, lateral instability, dislocation, meniscal conditions, or tibial impairment or fibular impairment. The examiner reported a 1990 meniscus injury of the left knee with residual symptoms of limited range of motion and pain. The report indicated that the Veteran used a knee brace regularly as an assistive device to aid in locomotion. The examiner indicated that there was no functional impairment on the Veteran's ability to work.

The March 2020 VA knee examination is the only medical examination report of record during the period under review. The Board is not free to substitute its own judgment for a medical expert. Colvin v. Derwinski, 1 Vet. App. 171 (1991).

At a July 2024 hearing, the Veteran testified to symptoms related to the left knee disability that included symptoms of painful motion and instability, that included episodes of knee locking and falling. The Veteran testified that the disability required the use of a knee brace and cane or other assistive devices for ambulation, and prescription pain medication was used as needed.

The Board finds that the weight of the evidence supports the assignment of a separate 10 percent initial rating based on left knee instability, as of December 3, 2019, based on the rating criteria specified pursuant to Diagnostic Code 5257. While the March 2020 VA examination findings did not show objective evidence of instability, the examiner noted that the Veteran required the regular use of a knee brace for ambulation. Additionally, the Veteran's sworn hearing testimony included reports of instability that required the regular use of a knee brace and/or a cane. The Veteran is competent to describe symptoms of knee locking and the Board finds the Veteran's statements to be credible. For symptoms of instability, objective medical evidence is not categorically more probative than lay evidence. English v. Wilkie, 30 Vet. App. 347 (2018).

Additionally, the Board finds that the weight of the evidence is against the assignment of a rating in excess of 10 percent for
While the March 2020 VA examination findings did not show objective evidence of instability, the examiner noted that the Veteran required the regular use of a knee brace for ambulation. Additionally, the Veteran's sworn hearing testimony included reports of instability that required the regular use of a knee brace and/or a cane. The Veteran is competent to describe symptoms of knee locking and the Board finds the Veteran's statements to be credible. For symptoms of instability, objective medical evidence is not categorically more probative than lay evidence. English v. Wilkie, 30 Vet. App. 347 (2018).

Additionally, the Board finds that the weight of the evidence is against the assignment of a rating in excess of 10 percent for left knee patellofemoral pain syndrome, based on the rating criteria specified pursuant to Diagnostic Code 5260. The record shows the Veteran's consistent reports of pain in the left knee after prolonged standing and walking are precipitating factors for functional limitation related to the Veteran's inability to perform prolonged standing or walking due to painful motion. The March 2020 VA examination findings show normal left knee flexion and extension on active motion, during flare up, repetitive use, and on weight bearing. Although the Veteran had painful motion, that pain did not result in limitation of flexion or extension to the level that any separate or higher rating would be warranted. The Board has considered functional loss, as the medical evidence shows that the Veteran has complained of pain. However, the limitation of motion and functional loss documented in the medical records resulting from pain, including flare-ups, is contemplated in the disability rating that is currently assigned. The criteria have not been met to warrant a higher rating based on limitation of motion and the examination findings are consistent with the other evidence of record, to include treatment records. The Board finds that the weight of the evidence is against the assignment of a rating in excess of 10 percent for left knee patellofemoral pain syndrome based on the rating criteria specified pursuant to Diagnostic Code 5260. 38 C.F.R. §§ 4.59, 4.71a; 38 C.F.R. §§ 4.40, 4.45.

The Board has considered other diagnostic codes, and the Board finds that Diagnostic Codes 5003 (degenerative arthritis), 5256 (ankylosis of the knee), 5262 (nonunion or malunion of the tibia and fibula), and 5263 (genu recurvatum) are not applicable, as the competent medical evidence does not show that the Veteran had those left knee disabilities or symptomatology during the period under review.

The Board has considered Diagnostic Codes 5258 (dislocated semilunar cartilage), and 5259 (removal of semilunar cartilage). The March 2020 VA examination reported that the Veteran had a meniscectomy in approximately 1990 and experienced residual symptoms of limited range of motion and pain. However, the Veteran is already compensated for pain on motion that did not result in limitation of flexion or extension, pursuant to Diagnostic Code 5260. The Board finds that a separate rating for pain on motion as a residual of the 1990 meniscectomy is not warranted pursuant to Diagnostic Codes 5258 or 5259, which would constitute impermissible pyramiding. Esteban v. Brown, 6 Vet. App. 259 (1994).

The Board has considered the evidence of functionally limiting factors caused by limitation of motion due to painful motion, excess motion, weakened motion, fatigability, incoordination, and flare up. DeLuca v. Brown, 8 Vet. App. 202 (1995); Mitchell v. Shinseki, 25 Vet. App. 32 (2011).

The Veteran has not submitted, and the record does not show, competent medical evidence in support of any other higher ratings or separate ratings for a left knee disability. However, the Veteran may file a Supplemental Claim and submit or identify new and relevant evidence. If the evidence submitted is new and relevant, VA will issue another decision on the claim considering that evidence, in addition to the evidence previously considered. 38 C.F.R. §§ 3.2501, 20.300.

Accordingly, resolving reasonable doubt in favor of the Veteran, the Board finds the criteria for entitlement to a separate 10 percent initial rating, but not higher, effective December 3, 2019, for a left knee instability are met, and to that extent the appeal is granted. Further, the Board finds that the weight of the evidence is against the assignment of any higher rating or separate ratings for a left knee disability based on painful motion, or any other basis, there is no reasonable doubt to resolve in
submitted is new and relevant, VA will issue another decision on the claim considering that evidence, in addition to the evidence previously considered. 38 C.F.R. §§ 3.2501, 20.300.

Accordingly, resolving reasonable doubt in favor of the Veteran, the Board finds the criteria for entitlement to a separate 10 percent initial rating, but not higher, effective December 3, 2019, for a left knee instability are met, and to that extent the appeal is granted. Further, the Board finds that the weight of the evidence is against the assignment of any higher rating or separate ratings for a left knee disability based on painful motion, or any other basis, there is no reasonable doubt to resolve in favor of the Veteran, the claim for an increased initial rating in excess of 10 percent for left knee patellofemoral pain syndrome must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.59, 4.71a.

3. Entitlement to a 10 percent initial rating, but not higher, for a left knee scar as of December 3, 2019, but not earlier

As an initial matter, the period on appeal is from December 3, 2019, the date VA received the claim, to January 28, 2020, the notification date of the rating decision on appeal. The Board finds that the Veteran has continuously pursued the increased rating claim a left knee scar since December 3, 2019.

The Board notes that VA amended the rating criteria for rating skin disabilities, to include scars, effective August 13, 2018. However, Diagnostic Codes 7800, 7804, and 7805 remained unchanged. Effective August 13, 2018, the title to Diagnostic Code 7801 was amended to apply to burn scars or scars due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage and the title to Diagnostic Code 7802 was amended to burn scars or scars due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. However, the rating criteria remained unchanged. 83 Fed. Reg. 32593 (July 13, 2018); 38 C.F.R. § 4.118 (2019).

Under Diagnostic Code 7800, used for rating burn scars of the head, face, or neck; scars of the head, face, or neck due to other causes; or other disfigurement of the head, face, or neck, the criteria provide that a 10 percent rating is assigned if there is one characteristic of disfigurement. A 30 percent rating is assigned if there is 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, or lips), or if there are two or three characteristics of disfigurement. A 50 percent rating is assigned if there is visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, or lips), or if there are four or five characteristics of disfigurement. An 80 percent rating is assigned if there is visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, or lips), or there are six or more characteristics of disfigurement. 73 Fed. Reg. 54708 (Sept. 23, 2008); 38 C.F.R. § 4.118 (2009), Diagnostic Code 7800.

Diagnostic Code 7800 lists the eight characteristics of disfigurement, which are: (1) a scar five or more inches in length; (2) a scar at least one-quarter inch wide at widest part; (3) surface contour of scar elevated or depressed on palpation; (4) scar adherent to underlying tissue; (5) skin hypo- or hyper-pigmented in an area exceeding six square inches; (6) skin texture abnormal in an area exceeding six square inches; (7) underlying soft tissue missing in an area exceeding six square inches; and (8) skin indurated and inflexible in an area exceeding six square inches. 38 C.F.R. § 4.118, Diagnostic Code 7800, Note (
the eight characteristics of disfigurement, which are: (1) a scar five or more inches in length; (2) a scar at least one-quarter inch wide at widest part; (3) surface contour of scar elevated or depressed on palpation; (4) scar adherent to underlying tissue; (5) skin hypo- or hyper-pigmented in an area exceeding six square inches; (6) skin texture abnormal in an area exceeding six square inches; (7) underlying soft tissue missing in an area exceeding six square inches; and (8) skin indurated and inflexible in an area exceeding six square inches. 38 C.F.R. § 4.118, Diagnostic Code 7800, Note (1).

Under Diagnostic Code 7801, used for rating burn scars or scars due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage, the criteria provide that a 10 percent rating is assigned when the area of the scars 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 scars covers at least 12 square inches (77 square centimeters) but less than 72 square inches (456 square centimeters). A 30 percent rating is assigned when the area of the scars 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 scars covers at least 144 square inches (929 square centimeters) or greater. 38 C.F.R. § 4.118, Diagnostic Code 7801.

Under Diagnostic Code 7802, used for rating burn scars or scars due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage, the criteria provide that a 10 percent rating is assigned when the area or areas of the scar covers 144 square inches (929 square centimeters) or greater. 38 C.F.R. § 4.118, Diagnostic Code 7802.

Under Diagnostic Code 7804, a 10 percent rating is assigned for one or two scars that are unstable or painful. A 20 percent rating is assigned for three or four scars that are unstable or painful. A 30 percent rating is assigned for five or more scars that are unstable or painful. 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, an additional 10 percent should be added to the evaluation based on the total number of unstable or painful scars. 38 C.F.R. § 4.118, Notes 1-2.

Scars rated under Diagnostic Codes 7800, 7801, 7802, or 7805 may also receive a rating under Diagnostic Code 7804, when applicable. 38 C.F.R. § 4.118, Diagnostic Code 7804, Note 3.

Under Diagnostic Code 7805, ratings are provided for scars, other; and other effects of scars rated under Diagnostic Codes 7800, 7801, 7802, or 7804 for any disabling effects not considered in a rating provided under Diagnostic Codes 7800-7804 under an appropriate Diagnostic Code. 38 C.F.R. § 4.118, Diagnostic Code 7805.

The Veteran's left knee scar is currently assigned a 0 percent rating, for a single scar that is not painful or unstable, pursuant to Diagnostic Code 7802, effective December 3, 2019, and is assigned a 10 percent rating, for a single painful scar that is not unstable, pursuant to Diagnostic Code 7804, effective April 24, 2022.

At a July 2020 VA scars and disfigurement examination, the examiner indicated the Veteran's single left knee scar measured 7.0 centimeters in length and 0.75 centimeters in width, for a total of 5.25 square centimeters. The examiner indicated that the scar was not associated with underlying soft tissue damage and was not painful or unstable. The report noted that there was not a negative functional impact on the Veteran's ability to work.

At a July 2024 hearing, the Veteran testified that during the period under review, the service-connected single left knee scar did not have underlying soft tissue damage, and was painful, but not unstable.

The Board notes that the July 2020 VA examination is the only medical examination report of record
and disfigurement examination, the examiner indicated the Veteran's single left knee scar measured 7.0 centimeters in length and 0.75 centimeters in width, for a total of 5.25 square centimeters. The examiner indicated that the scar was not associated with underlying soft tissue damage and was not painful or unstable. The report noted that there was not a negative functional impact on the Veteran's ability to work.

The Board notes that the July 2020 VA examination is the only medical examination report of record during the period under review. The Board is not free to substitute its own judgment for a medical expert. Colvin v. Derwinski, 1 Vet. App. 171 (1991).

During the period under review, the Board finds that the evidence weighs in favor of the assignment of a 10 percent rating for a single left knee scar that was painful but not unstable, pursuant to Diagnostic Code 7804, based on the criteria for rating unstable or painful scars. The Board finds the Veteran's July 2024 hearing testimony to be credible regarding symptoms of pain experienced related to the single left knee scar. The evidence does not show, and the Veteran has not asserted that there are three or four unstable or painful scars. Therefore, the Board finds that the evidence demonstrates that single left knee painful scar more nearly approximates the criteria for a 10 percent rating, pursuant to Diagnostic Code 7804. 38 C.F.R. § 4.118.

The Board has considered the other Diagnostic Codes pertaining to scars. A rating under Diagnostic Code 7800 is not warranted, as the single left knee scar is not located on the head, face, or neck. A rating under Diagnostic Code 7801 is not warranted, as the single left knee scar is not associated with underlying soft tissue damage. A rating under Diagnostic Code 7802 is not warranted, as the single left knee scar does not cover an area or areas of 144 square inches or greater. Further, the evidence of record shows there are no other disabling effects not considered in a rating provided under Diagnostic Codes 7800 to 7804 as contemplated, pursuant to Diagnostic Code 7805.

Based on the credible and sworn testimony of the Veteran, the results from the VA examination, and treatment records, the Board finds that the criteria for a 10 percent initial rating, but not higher, for a single left knee scar that is painful, but not unstable, effective December 3, 2019, have been met. 38 C.F.R. § 4.118.

Accordingly, resolving reasonable doubt in favor of the Veteran, the Board finds the criteria for a 10 percent initial rating, but not higher, for a single left knee scar, as of December 3, 2019, but not earlier, pursuant to Diagnostic Code 7804 have been met. To that extent, the appeal is granted. With regard to any higher or separate rating for the scar, the Board finds that the evidence is not in approximate balance and there is no reasonable doubt to resolve in favor of the Veteran. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102.

Harvey P. Roberts

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Malec, Jennifer L., Associate Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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