OSTEOARTHRITIS

R. BISIGNANI · 2026 · Case ID: A26036700

MIXED

Summary

The Veteran, who served from April 1972 to March 1993, appeals the denial of a rating in excess of 10 percent for left knee degenerative joint disease and the denial of a compensable rating for bilateral hearing loss. The Board reviewed the evidence of record as of the December 2025 rating decision. For the left knee, the Veteran sought an increased rating for degenerative joint disease, limitation of extension, instability, and meniscal tear. The Board found that the current 10 percent rating for flexion limitation was adequate, but granted a separate 40 percent rating for left knee limitation of extension effective December 18, 2025, based on the December 2025 VA examination findings of limitation to 30 degrees during flare-ups, supported by lay evidence. A 20 percent rating was also granted for left knee instability with an incomplete/partial ligament tear requiring a brace and cane, and a separate 20 percent rating for meniscal tear with pain and effusion. For bilateral hearing loss, the Board reviewed three VA audiological examinations. All examinations indicated hearing thresholds that, when applied to the rating schedule, resulted in a zero percent, noncompensable disability rating under Diagnostic Code 6100. The Board found the evidence persuasively weighed against a compensable rating, and therefore denied entitlement to a compensable rating for bilateral hearing loss.

Rationale

Flexion never limited to 30 degrees or less; Current 10% rating for flexion limitation adequate

Special Benefit

NO SPECIAL BENEFIT

Docket No.

260219-632037

Full Decision Text

Citation Nr: A26036700
Decision Date: 04/21/26 Archive Date: 04/21/26

DOCKET NO. 260219-632037
DATE: April 21, 2026

ORDER

Entitlement to a rating in excess of 10 percent for left knee degenerative joint disease is denied.

Entitlement to a separate disability rating of 40 percent for left knee limitation of extension is granted, effective December 18, 2025.

Entitlement to a separate disability rating of 20 percent for left knee instability is granted, effective December 18, 2025.

Entitlement to a separate disability rating of 20 percent for left knee dislocation of semilunar cartilage is granted.

Entitlement to a compensable rating for bilateral hearing loss is denied.

FINDINGS OF FACT

1. Flexion of the Veteran's left knee is not limited to 30 degrees, even considering functional loss after repeated use over time.

2. Resolving any reasonable doubt in the Veteran's favor, the Veteran's left knee disability has been manifested by limitation of extension to 30 degrees during flare-ups since December 18, 2025.

3. Resolving any reasonable doubt in the Veteran's favor, the Veteran's left knee disability has been manifested by persistent instability, with an incomplete/partial ligament tear, that requires a prescription by a medical provider for a brace and a cane since December 18, 2025.

4. Resolving any reasonable doubt in the Veteran's favor, the Veteran's left knee disability has been manifested by dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint.

5. The Veteran's bilateral hearing loss has been manifested by hearing acuity of no worse than Level III in the right ear and no worse than Level III in the left ear.

CONCLUSIONS OF LAW

1. The criteria for a rating in excess of 10 percent for left knee degenerative joint disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes (DCs) 5260-5010.

2. The criteria for a separate disability rating of 40 percent for left knee limitation of extension have been met from December 18, 2025. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a DC 5261.

3. The criteria for a separate disability rating of 20 percent for left knee instability have been met from December 18, 2025. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5257.

4. The criteria for a separate disability rating of 20 percent for left knee dislocation of semilunar cartilage have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.10, 4.71a, DC 5258.

5. The criteria for a compensable rating for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.85, 4.86, DC 6100.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from April 1972 to March 1993.

This matter is before the Board of Veterans' Appeals (Board) on appeal from a December 2025 rating decision issued by a Regional Office (RO).

By way of history, in August 2025, the Veteran submitted a VA Form 20-0996 and requested review of a prior May 2025 rating decision with respect to the ratings assigned for the Veteran's left knee disability and bilateral hearing loss. By rating decision dated in November 2025, the agency of original jurisdiction (AOJ) found a difference of opinion had been asserted during the higher-level review for the claims on appeal; and the claims were returned due to the need to obtain additional evidence. In a December 2025 rating decision, the AOJ denied the claims on appeal.

In February 2026, the Veteran submitted a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), and elected the Direct Review docket.

The Board notes that the Veteran
20-0996 and requested review of a prior May 2025 rating decision with respect to the ratings assigned for the Veteran's left knee disability and bilateral hearing loss. By rating decision dated in November 2025, the agency of original jurisdiction (AOJ) found a difference of opinion had been asserted during the higher-level review for the claims on appeal; and the claims were returned due to the need to obtain additional evidence. In a December 2025 rating decision, the AOJ denied the claims on appeal.

In February 2026, the Veteran submitted a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), and elected the Direct Review docket.

The Board notes that the Veteran listed May 2025 and November 2025 rating decisions as the rating decisions on appeal. However, most recently, the December 2025 rating decision adjudicated the claims on appeal. Thus, the Board construes the most recent December 2025 rating decision as the rating decision on appeal to maximize the evidence available for the Board's review.

Therefore, the Board may only consider the evidence of record at the time of the December 2025 AOJ decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 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, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Increased Ratings

Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history, and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1.

If a reasonable doubt arises regarding the degree of disability after careful consideration of all procurable and assembled data, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. 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.

Importantly, the evaluation of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14. However, when it is not possible to separate the effects of the service-connected disability from a nonservice-connected condition, such signs and symptoms must be attributed to the service-connected disability. Mittleider v. West, 11 Vet. App. 181, 182 (1998); 38 C.F.R. § 3.102.

Entitlement to a rating in excess of 10 percent for left knee degenerative joint disease is denied.

Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. 38 C.F.R. § 4.40. Functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. 38 C.F.R. § 4.40; see 38 C.F.R. § 4.59 (discussing facial expressions such as wincing, muscle spasm, crepitation, etc.). Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. Excess fatigability and incoordination should be accounted for, in addition to more movement than normal, less movement than normal, and weakened movement. 38 C.F.R. § 4.45.

The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. 38 C.F.R. § 4.59. The schedule aims to recognize actually painful, unstable, or malaligned joints, due to healed injury
, muscle spasm, crepitation, etc.). Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. Excess fatigability and incoordination should be accounted for, in addition to more movement than normal, less movement than normal, and weakened movement. 38 C.F.R. § 4.45.

The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. 38 C.F.R. § 4.59. The schedule aims to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. Although the first sentence of 38 C.F.R. § 4.59 refers only to arthritis, the regulation applies to joint conditions other than arthritis, as well. Burton v. Shinseki, 25 Vet. App. 1, 3-5 (2011).

In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995).

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.").

Although pain may cause functional loss, pain itself does not constitute functional loss. Rather, pain must affect some aspect of "the normal working movements of the body," such as "excursion, strength, speed, coordination, and endurance," in order to constitute functional loss. Mitchell v. Shinseki, 25 Vet. App. 32, 38 43 (2011) (quoting 38 C.F.R. § 4.40).

The Veteran's left knee degenerative joint disease is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5260-5010, for limitation of flexion of the leg. Under Diagnostic Code 5010, traumatic arthritis is rated as limitation of motion, dislocation, or other specified instability under the affected joint. As the Veteran did not have compensable, limitation of motion, disability, or specified instability, the bilateral knee disability was rated 10 percent disabling under Diagnostic Code 5260-5010 for X-ray evidence of arthritis with noncompensable limitation of motion.

Under Diagnostic Code 5260, a noncompensable rating is warranted for flexion limited to 60 degrees. A 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260.

Under Diagnostic Code 5261, a noncompensable evaluation is assigned for extension limited to 5 degrees, and a 10 percent disability evaluation is contemplated for extension limited to 10 degrees. When there is limitation of extension to 15 degrees, a 20 percent evaluation is warranted. A 30 percent rating will be assigned for extension limited to 20 degrees, and a 40 percent rating is contemplated for limitation of extension to 30 degrees. A 50 percent disability evaluation is warranted for extension limited to 45 degrees. The regulations provide that a normal range of motion of the knee is 0 degrees on extension. 38 C.F.R. § 4.71, Plate II.

Turning to the evidence, a July 2024 VA examination, the Veteran reported that his knee swelled off and on, he could not play basketball anymore because if he played, his knee would give way. The Veteran treated his knee with pain medications, physical therapy in the past, and a brace. He reported moderate flare-ups a few times a week, for a few hours, characterized by swelling and more pain, precipitated by cold weather, and alleviated by rest. Functional impairment experienced during a flare-up was described as limited prolonged standing and walking, which caused pain in the left knee. The Veteran reported a history of instability or recurrent subluxation of the knee because his knee was giving way. He did not report or have a history of frequent effusion of the knee. Active range of motion testing for the Veteran's left knee showed flexion to 110 degrees and extension to 0 degrees, with pain on flexion and extension. Passive range of motion testing was the same as active, with pain on flexion and extension. The examiner indicated that the Veteran had pain on active motion and passive motion. Pain caused functional loss because it limited prolonged standing and walking caused knee pain. There was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The Veteran was able to perform repetitive-use testing with at least three repetitions. Procured evidence suggested pain and lack of endurance significantly limited functional ability with repeated use over time. The examiner estimated left knee flexion to 100 degrees and extension to 0 degrees. Procured evidence suggested pain significantly limited functional ability with flare ups. The examiner estimated left knee flexion to 100 degrees and extension to 0 degrees. There were no additional contributing factors of disability. The Veteran did not have muscle atrophy or ankylosis. He used a brace as an assistive device. The examiner noted there was no objective evidence of left knee instability.

At an April 2025 VA examination, the Veteran reported symptoms of swelling and aching. The Veteran treated his left knee with Ibuprofen, a heating pad, and "natural treatment." He reported daily, moderate flare-ups, for minutes to hours, characterized by swelling and aching, precipitated by prolonged standing or walking, and alleviated by rest. Functional impairment experienced during a flare-up was described as being unable to bend over to pick items off the floor. The Veteran did not report a history of instability or recurrent subluxation of the knee or a history of frequent effusion of the knee. Active range of motion testing for the Veteran's left knee showed flexion to 105 degrees and extension to 0 degrees, with pain on flexion and extension. Passive range of motion testing was the same as active, with pain on flexion and extension. The examiner indicated that the Veteran had pain on weight-bearing, active motion and passive motion, which did not result in or cause functional loss. He was unable to bend over to pick items off the floor. There was objective evidence of moderate localized pain on palpation of the left knee due to degenerative arthritis. The Veteran was able to perform repetitive-use testing with at least three repetitions. Procured evidence suggested pain and fatigability significantly limited functional ability with repeated use over time. The examiner estimated left knee flexion to 100 degrees and extension to 0 degrees. Procured evidence suggested pain, fatigability, weakness, and lack of endurance significantly limited functional ability with flare ups. The examiner estimated left knee flexion to 100 degrees and extension to 0 degrees. There were no additional contributing factors of disability. The Veteran did not have ankylosis. He used a brace as an assistive device. The examiner noted there was no objective evidence of left knee instability. The Veteran's left knee impacted his ability to work such that occupational tasks such as prolonged standing or walking should be avoided for greater than 15 minutes to prevent flare ups.

During a December 2025 VA examination, the Veteran reported symptoms of swelling, giving out, and pain. The Veteran treated his left knee with Lidocaine patches, Diclofenac cream, Tylenol, and at home exercises he was given during physical therapy a year prior. He reported daily, constant flare-ups, characterized by dull and achiness when sitting but sharp when moving, precipitated by overuse, and alleviated "a little" by medications. Functional impairment experienced during a flare-up was described as being unable to bend, walk long, stand. The Veteran stated that his knee gave way, swelled, and was "very painful." He reported a history of instability or recurrent subluxation of the knee and a history of frequent effusion of the knee. Active range of motion testing for the Veteran's left knee showed flexion to 115 degrees and extension to 15 degrees, with pain on flexion and extension. Passive range of motion testing was the same as active, with pain on flexion and extension. The examiner indicated that the Veteran had pain on weight-bearing, nonweight-bearing, active motion, passive motion, and on rest/non-movement, which caused functional loss. There was objective evidence of crepitus and moderate localized pain on palpation of the left knee due to degenerative arthritis. The Veteran was able to perform repetitive-use testing with at least three repetitions. Procured evidence suggested pain, fatigability, weakness, lack of endurance, and incoordination significantly limited functional ability. The examiner estimated left knee flexion to 110 degrees and extension to 20 degrees. The Veteran was not examined immediately after repeated use over time. Procured evidence suggested pain, fatigability, weakness, lack of endurance, and incoordination limited functional ability. The examiner estimated left knee flexion to 105 degrees and extension to 25 degrees. While the Veteran was not examined during a flare-up, procured evidence suggested pain, fatigability, weakness, lack of endurance, and incoordination limited functional ability with flare ups. The examiner estimated left knee flexion to 100 degrees and extension to 30 degrees. Additional contributing factors of disability were interference with standing, disturbance of locomotion, less movement than normal, interference with sitting, swelling, weakened movement, and instability of station. The Veteran did not have muscle atrophy or ankylosis. He had recurrent subluxation or persistent instability requiring a prescription for a cane and brace. The examiner found the Veteran had an incomplete/partial ligament tear. He also had recurrent patellar instability requiring a prescription for a cane and brace. The examiner indicated that the Veteran had meniscal tear, frequent episodes of joint pain, and frequent episodes of joint effusion. In this regard, the examiner stated there was evidence of complex medial and posterior meniscus tear and ACL Tear, presumably secondary to the degenerative process noted on MRI in 2004. The Veteran's left knee impacted his ability to work such that he was in pain and his decreased ROM had progressed. He stated that he decided to have a total knee replacement and was scheduled for surgery on January 22, 2026. The examiner additionally remarked that it was possible to evaluate the severity of the Veteran's left knee disability as if not taking medication.

Upon review, the Board finds that a higher rating under DC 5260 is not warranted for the Veteran's flexion of his left knee. The Veteran's flexion of his left knee was never limited to 30 degrees or less. In fact, all VA examinations during the appeal period reflect flexion greater than 60 degrees, even with consideration of pain and functional loss. Accordingly, the current 10 percent rating adequately compensates the Veteran for painful limited flexion in the left knee.

However, the Board finds that a separate 40 percent disability rating under DC 5261 for limitation of extension is warranted for the left knee, effective December 18, 2025. The December 2025 VA examiner estimated that during flare-ups, the left knee would be limited to 30 degrees. This estimate was supported by the Veteran's consistent reports of stiffness, swelling, giving out, difficulty standing, and functional limitations with routine daily activities. Pursuant to Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017), examiners are required to "elicit relevant information as to the veteran's flares or repeated use," and if not directly observed, must "estimate functional loss based on all the evidence of record, including the veteran's lay statements." The Board finds that the December 2025 VA examiner complied with Sharp and provided a reliable estimate of functional limitation. Resolving reasonable doubt in the Veteran's favor, the Board finds that extension limited to 30 degrees is shown for the left knee during flare-ups, warranting a separate 40 percent rating under DC 5261, effective December 18, 2025. A higher 50 percent rating under DC 5261 is not warranted, as extension limited to 45 degrees has not been shown or approximated at any point during the appeal period. Prior to December 18, 2025, there was no indication the Veteran's knee warranted a compensable rating for limitation of extension. Indeed, July 2024 and April 2025 VA examinations found the Veteran's extension was limited at most to 0 degrees.

The Board has also considered the other Diagnostic Codes pertaining to the knee and leg. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment).

The Veteran did not have left knee ankylosis at any time, so Diagnostic Code 5256 is not applicable. The Board has considered whether the Veteran's symptoms approximate ankylosis during these periods. See Chavis v. McDonough, 34 Vet. App. 1 (2021) (holding that the criteria for a rating based on ankylosis may be met by evidence demonstrating the functional equivalent of ankylosis). However, the evidence in this case does not show the functional equivalent of ankylosis, even when contemplating functional loss due to symptoms such as pain, fatigue, and lack of endurance; or due to repetitive use over time and/or flare-ups. None of the medical evidence suggests that the severity of the Veteran's service-connected left knee disability is the functional equivalent of ankylosis. Notably, the VA examinations and treatment records from the period on appeal demonstrate that the Veteran retained range of motion in his left knee. 38 C.F.R. § 38 C.F.R. §§ 4.40, 4.45, 4.59; See DeLuca v. Brown, 8 Vet. App. Hence, even with these considerations, the record presents no basis for the assignment of a rating higher than 10 percent based on functional loss.

VA examinations also found no evidence of impairment of the left tibia or fibula, or genu recurvatum, so Diagnostic Codes 5262 and 5263 are not applicable.

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

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
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 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).

The Board observes that in the July 2024 VA examination, the Veteran reported a history of instability and stated that his knee gave way; however, the examiner found no objective evidence of knee instability. At the April 2025 VA examination, he did not report a history of instability or recurrent subluxation. However, during the December 2025 VA examination, the examiner found the Veteran had recurrent subluxation or persistent instability, incomplete/partial ligament tear, requiring a prescription for a cane and brace.

The Board has carefully considered the Veteran's reports about instability, including his accounts of giving way and use of assistive devices. English, 30 Vet. App. 347, 352-53. Overall, the lay and medical evidence indicates that the Veteran's left knee disability has been manifested by recurrent subluxation or instability, with incomplete/partial ligament tear, and a medical provider has prescribed both an assistive device of a cane and a brace for ambulation. Therefore, the Board finds that the criteria for entitlement to a 20 percent rating under Diagnostic Code 5257 for left knee instability is granted, effective December 18, 2025.

A rating higher than 10 percent for patellar instability is not warranted because the Veteran has not had surgical repair.

Finally, the Board has considered the applicability of DCs 5258 and 5259, which pertain to the semilunar cartilage, or meniscus. The evidence of record, to include the December 2025 VA examination, notes that the Veteran had a left knee meniscal tear and experienced frequent episodes of joint pain and frequent episodes of joint effusion as a result of that tear. The examiner stated there was evidence of complex medial and posterior meniscus tear and ACL Tear, presumably secondary to the degenerative process noted on MRI in 2004.

Separate ratings under DCs 5258 and 5260 do not constitute "pyramiding" under 38 C.F.R. § 4.14. In the case of DC 5258, the schedular criteria include pain, locking, and effusion or swelling in the joint, while in the case of DCs 5260, limitation of motion is encompassed by the limitation of flexion or extension, including limitation of motion due to pain. While the DCs list criteria of symptoms of pain, the Board finds the "pain" associated with torn semilunar cartilage under DC 5258 is distinct from that associated with the arthritis and painful limitation of motion under DC 5260. Lyles v. Sh
under DCs 5258 and 5260 do not constitute "pyramiding" under 38 C.F.R. § 4.14. In the case of DC 5258, the schedular criteria include pain, locking, and effusion or swelling in the joint, while in the case of DCs 5260, limitation of motion is encompassed by the limitation of flexion or extension, including limitation of motion due to pain. While the DCs list criteria of symptoms of pain, the Board finds the "pain" associated with torn semilunar cartilage under DC 5258 is distinct from that associated with the arthritis and painful limitation of motion under DC 5260. Lyles v. Shulkin, 29 Vet. App. 107 (2017). Separate disability ratings under DC 5258 and 5260/5261 are therefore permissible in this instance and do not amount to impermissible pyramiding. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). Thus, resolving reasonable doubt in the Veteran's favor, a separate disability rating of 20 percent under 38 C.F.R. § 4.71a, DC 5258, for dislocated semilunar cartilage for the left knee is warranted. This is the maximum schedular rating for this disability.

In making the above findings, the Board is cognizant of the fact that the Veteran has used medication, including Ibuprofen, to treat his left knee 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." Ingram v. Collins, 38 Vet. App. 130 (2025).

The Board notes, however, that neither Jones nor Ingram address how the Board is to discount the beneficial effects of medication without resorting to speculation. Remanding this appeal to order an addendum medical opinion based on Jones and Ingram 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 service-connected condition. See, e.g., Hood v. Shinseki, 23 Vet. App. 295, 298-99 (2005) (medical opinions that are speculative have "little probative value"). 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 left knee 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 ascertain the severity of his left knee without the use of 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.

Entitlement to a compensable rating for bilateral hearing loss is denied.

The Veteran is seeking a compensable rating for his bilateral hearing loss. Evaluations of defective hearing range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of a controlled Maryland CNC speech discrimination test together with the average hearing threshold level measured by pure tone audiometry tests in the frequencies of 1000, 2000, 3000, and 4000 cycles per second (Hertz). 38 C.F.R. § 4.85, Diagnostic Code 6100.

To evaluate the degree of disability from bilateral service-connected hearing loss, the schedule establishes 11 auditory hearing acuity levels designated from Level I for essentially normal hearing acuity through Level XI for profound deafness. 38 C.F.R. § 4.85, Tables VI and VII.

An exceptional pattern of hearing impairment occurs when the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more. 38 C.F.R. § 4.86(a). In that situation, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. Further, when the average pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral, and that numeral will then be elevated to the next higher numeral. 38 C.F.R. § 4.86(b).

A March 2024 VA examination reveals that the Veteran reported it was hard to hear people at times, they did not sound clear, and he misunderstood them. 38 C.F.R. § 4.10; Martinak v. Nicholson, 21 Vet. App. 447 (2007). On the authorized audiological evaluation from this examination pure tone thresholds, in decibels, were as follows:

HERTZ

500 1000 2000 3000 4000

RIGHT 20 45 40 45 50

LEFT 25 45 40 45 45

Speech audiometry revealed speech recognition ability of 78 percent in the left ear and 80 percent in the right ear.

Applying the results to Table VI, the findings yield a numeric designation of Level III in the right ear and Level III in the left ear. Entering the resulting bilateral numeric designation of Level III for the right ear and Level III for the left ear to 38 C.F.R. § 4.85, Table VII, equates to a zero percent, noncompensable disability rating under Diagnostic Code 6100.

An exceptional pattern of hearing impairment under 38 C.F.R. § 4.86 is not shown in either ear.

An April 2025 VA examination reveals that the Veteran reported having hearing loss. 38 C.F.R. § 4.10; Martinak v. Nicholson, 21 Vet. App. 447 (2007). On the authorized audiological evaluation from this examination pure tone thresholds, in decibels, were as follows:

HERTZ

500 1000 2000 3000 4000

RIGHT 15 30 45 50 55

LEFT 15 30 40 45 55

Speech audiometry revealed speech recognition ability of 80 percent in the left ear and 80 percent in the right ear.

An exceptional pattern of hearing impairment under 38 C.F.R. § 4.86 is not shown in either ear.

A December 2025 VA examination reveals that the Veteran reported that people complained he could not hear them. 38 C.F.R. § 4.10; Martinak v. Nicholson, 21 Vet. App. 447 (2007). On the authorized audiological evaluation from this examination pure tone thresholds, in decibels, were as follows:

HERTZ

500 1000 2000 3000 4000

RIGHT 10 40 50 50 55

LEFT 10 30 40 40 50

Speech audiometry revealed speech recognition ability of 76 percent in the left ear and 76 percent in the right ear.

An exceptional pattern
1000 2000 3000 4000

RIGHT 10 40 50 50 55

LEFT 10 30 40 40 50

Speech audiometry revealed speech recognition ability of 76 percent in the left ear and 76 percent in the right ear.

An exceptional pattern of hearing impairment under 38 C.F.R. § 4.86 is not shown in either ear.

Based on the evidence above, a compensable rating for the Veteran's bilateral hearing loss is not warranted.

The Board expressly acknowledges its consideration of the lay evidence of record when adjudicating this claim, including the Veteran's reports of increased difficulty hearing conversations. The Veteran is competent to report difficulty hearing; however, disability ratings for hearing loss are derived from a mechanical application of the rating schedule to the numeric designations resulting from audiometric testing. See Lendenmann v. Principi, 3 Vet. App. 345 (1992).

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All the Veteran's hearing loss symptoms and described hearing impairments are contemplated by the schedular rating criteria. The rating criteria contemplate speech reception thresholds and ability to hear spoken words on Maryland CNC testing. The schedular rating criteria specifically provide for ratings based on all levels of hearing loss in various contexts, as measured by both audiometric testing and speech recognition testing. Doucette v. Shulkin, 28 Vet. App. 366 (2017). The Veteran's main complaint is reduced hearing acuity and clarity, which is what is contemplated in the rating assigned. See Rossy v. Shulkin, 29 Vet. App. 142, 145 (2017).

Accordingly, the most probative evidence of record persuasively weighs against the claim of entitlement to a compensable rating for bilateral hearing loss. As the most probative evidence of record persuasively weighs against a compensable 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 (Fed. Cir. 2021). The appeal is denied.

R. Bisignani

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Griffith, S.

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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