KNEE IMPAIRMENT OF

Summary

The veteran, who served in the United States Navy from March 1998 to January 2011, appeals for higher disability ratings for a left knee condition and a left knee scar. The primary issue concerned the left knee, which had undergone a total replacement in October 2024. The veteran sought an increased rating beyond the initial 30 percent awarded for residuals of the prosthesis, citing severe painful motion and weakness. A VA examination in January 2025 documented these chronic residuals, specifically noting pain on flexion and extension, and the examiner's findings emphasized the severity of the painful motion. The Board found these symptoms best approximated the criteria for a 60 percent rating under Diagnostic Code 5055, granting this increased rating effective February 28, 2025. The Board determined that a higher rating was not possible due to the maximum schedular rating and that rating by analogy would not provide a more beneficial outcome. For the left knee scar, the veteran contended it warranted a higher rating. However, the Board found the scar, a single linear residual from surgery, did not meet the criteria for a compensable rating under Diagnostic Codes 7801, 7802, 7804, or 7805, as it was not painful, unstable, or of significant area, and did not cause functional loss. The Board acknowledged the veteran's competency to describe symptoms but found the professional medical opinions more persuasive regarding the severity of the disability.

Rationale

VA examination documented chronic residuals of severe painful motion or weakness.; Symptoms approximated criteria for 60 percent rating under DC 5055.; Maximum schedular rating for this condition.

Full Decision Text

Citation Nr: A26039066
Decision Date: 04/27/26	Archive Date: 04/27/26

DOCKET NO. 250516-546869
DATE: April 27, 2026

ORDER

From February 28, 2025, a disability rating of 60 percent for left total knee replacement with left knee arthritis status post meniscal repair with painful motion and with reduced flexion, is granted.

A compensable disability rating for scar, status post left knee arthroscopy, is denied.

FINDINGS OF FACT

1. From February 28, 2025, the Veteran's left total knee replacement with left knee arthritis status post meniscal repair with painful motion and with reduced flexion resulted in chronic residuals consisting of severe painful motion or weakness.

2. The Veteran's scar, status post left knee arthroscopy, is not of a size to warrant a compensable rating and does not result in any disabling effects. 

CONCLUSIONS OF LAW

1. From February 28, 2025, the criteria for a 60 percent disability rating for left total knee replacement with left knee arthritis status post meniscal repair with painful motion and with reduced flexion, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.71a, Diagnostic Code 5055.

2. The criteria for a compensable rating for scar, status post left knee arthroscopy, have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.118, Diagnostic Code 7801. 

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Navy from March 1998 to January 2011.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in March 2025 by a Department of Veterans Affairs (VA) Regional Office.

In her May 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the rating decision on appeal. 38 C.F.R. § 20.301. If evidence was submitted during the period after the decision was issued, the Board did not consider it in its decision. 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, she 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 Disability Ratings

The Veteran seeks higher disability ratings. Disability ratings are determined by applying the rating criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule) and represent the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10.

In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA compensation as well as the whole recorded history of a veteran's disability. 38 C.F.R. §§ 4.1, 4.2; see generally Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria for that rating. 38 C.F.R. § 4.7. Otherwise, the lower rating is assigned. Id. Additionally, while it is not expected that all cases will show all the findings specified, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21.

Separate ratings can be assigned for separate periods based on the facts found, in a practice known as staged ratings. Hart v
, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria for that rating. 38 C.F.R. § 4.7. Otherwise, the lower rating is assigned. Id. Additionally, while it is not expected that all cases will show all the findings specified, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21.

Separate ratings can be assigned for separate periods based on the facts found, in a practice known as staged ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id.

The intent of the schedule is to recognize painful motion with joint or particular pathology as productive of disability. It is the intention 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. The provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to arthritis, and must be considered when raised by the Veteran or when reasonably raised by the record. Burton v. Shinseki, 25 Vet. App. 1 (2011).

When evaluating a disability based upon limitation of motion, the Board must also consider, in conjunction with the otherwise applicable diagnostic codes, any additional functional loss the veteran may have sustained by virtue of other factors as described in 38 C.F.R. §§ 4.40 and 4.45. DeLuca v. Brown, 8 Vet. App. 202, 204-7 (1995). Such factors include more or less movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, swelling, and deformity or atrophy from disuse. A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the veteran. 38 C.F.R. § 4.40; Johnston v. Brown, 10 Vet. App. 80, 85 (1997).

When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in the veteran's favor. 38 C.F.R. § 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Left knee  

The Veteran's left total knee replacement with left knee arthritis status post meniscal repair with painful motion and with reduced flexion (hereinafter, "left knee disability") is assigned a 30 percent disability rating under Diagnostic Code 5055 for prosthetic replacement of the knee joint, which contemplates pain, limited motion, and weakness. 38 C.F.R. § 4.71a. The Veteran asserts that a higher rating is warranted. 

Under Diagnostic Code 5055, a 100 percent rating is warranted for four months following implantation of the prosthesis. Thereafter, a 30 percent rating is assigned. A higher, 60 percent rating is warranted for chronic residuals consisting of severe painful motion or weakness in the affected extremity. Where there are intermediate degrees of residual weakness, pain, or limitation of motion, the disability should be rated by analogy to Diagnostic Codes 5256 (ankylosis), 5261 (limitation of extension), or 5262 (impairment of the tibula and fibula). The minimum rating following replacement of a knee joint is 30 percent. 38 C.F.R. § 4.71a, Diagnostic Code 5055.

The record shows that the Veteran underwent a left knee total replacement in October 2024. In January 2025, she was provided with a VA knee and lower leg examination. At that time, she reported symptoms such as sharp pain and left knee swelling, treated with prescription pain medication. During daily flare-ups, the result of walking, standing, or sitting, the Veteran's left knee disability manifested by pain resulting in functional loss. Range of motion testing documented range that was reduced by pain on flexion and extension, in active motion and passive motion. The examiner noted that the Veteran experienced chronic residuals consisting of severe painful motion or
 is 30 percent. 38 C.F.R. § 4.71a, Diagnostic Code 5055.

The record shows that the Veteran underwent a left knee total replacement in October 2024. In January 2025, she was provided with a VA knee and lower leg examination. At that time, she reported symptoms such as sharp pain and left knee swelling, treated with prescription pain medication. During daily flare-ups, the result of walking, standing, or sitting, the Veteran's left knee disability manifested by pain resulting in functional loss. Range of motion testing documented range that was reduced by pain on flexion and extension, in active motion and passive motion. The examiner noted that the Veteran experienced chronic residuals consisting of severe painful motion or weakness, with specific emphasis on pain. 

Based on this evidence, the Board finds that from February 28, 2025, the symptoms of the Veteran's left knee disability best approximated chronic residuals consisting of severe painful motion or weakness, entitling her to an increased 60 percent disability rating. It is specifically persuaded by the determination made by the January 2025 VA examiner who, upon assessment of the Veteran's symptoms, specifically found in her report that such were chronic and manifested by severe painful motion or weakness. Thus, the Board must find that a 60 percent rating under Diagnostic Code 5055 is warranted. 

A 60 percent rating under Diagnostic Code 5055 is the maximum schedular disability rating available under that code (excluding a 100 percent disability rating assigned for four months following implantation of prosthesis), thus a higher rating for the period on appeal is not possible. In addition, as the VA examination showed that the Veteran's left knee was not manifested at any time by ankylosis, or symptoms more nearly approximating functional ankylosis, extension limited to 30 degrees or less, or impairment of the tibia or fibula, rating her left knee disability by analogy does not provide the Veteran with a more beneficial outcome. The Board finds no other basis for the assignment of any higher rating based on consideration of functional loss for the periods on appeal. 38 C.F.R. §§ 4.40, 4.45, 4.59; Mitchell v. Shinseki, 25 Vet. App. 32, 38 (2011); Correia v. McDonald, 28 Vet. App. 158 (2016); Sharp v. Shulkin, 29 Vet. App. 26, 35-36 (2017); see also Deluca, supra. For the reasons set forth herein, and to the extent that the criteria for the highest possible disability rating have been met for the period beginning on February 28, 2025, the claim is granted. 

Left knee scar

The Veteran generally contends, without specificity, that her service-connected left knee arthroscopy scar warrants a higher, compensable disability rating. For the entire appeal period, the scar was rated as noncompensably disabling pursuant to Diagnostic Code 7805. 38 C.F.R. § 4.118.

In this regard, scars are rated under 38 C.F.R. § 4.118, Diagnostic Codes 7800 through 7805. In evaluating the Veteran's scar, the Board has considered each code. Diagnostic Code 7800 pertains to 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. However, as the scar at issue affects the Veteran's knee, Diagnostic Code 7800 is inapplicable. Diagnostic Code 7801 pertains to burn scars or scars due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage. Under this Diagnostic Code, a 10 percent rating is assigned when the scar(s) cover an area or areas of at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.). Higher ratings are available for greater areas affected.

Diagnostic Code 7802 pertains 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. Under this Diagnostic Code, a single 10 percent rating is assigned when the scar(s) cover an area or areas of 144 square inches (929 sq. cm) or greater.

Diagnostic Code 7804 provides that one or two scars that are unstable or painful warrant a 10 percent evaluation. Three or four scars that are unstable or painful warrant a 20 percent rating, while five or more scars that are unstable or painful warrant a 30 percent evaluation. Note (1) states that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar
ains 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. Under this Diagnostic Code, a single 10 percent rating is assigned when the scar(s) cover an area or areas of 144 square inches (929 sq. cm) or greater.

Diagnostic Code 7804 provides that one or two scars that are unstable or painful warrant a 10 percent evaluation. Three or four scars that are unstable or painful warrant a 20 percent rating, while five or more scars that are unstable or painful warrant a 30 percent evaluation. Note (1) states that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) states that if one or more scars are both unstable and painful, the rater is to add 10 percent to the evaluation that is based on the total number of unstable or painful scars. Scars evaluated under Diagnostic Codes 7800, 7801, 7802, or 7805 may also receive an evaluation under Diagnostic Code 7804, when applicable. Note (3).

Diagnostic Code 7805 provides that other scars (including linear scars) and other effects of scars evaluated under Diagnostic Codes 7800, 7801, 7802, and 7804 that require the evaluation of any disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-7804 should be rated under an appropriate Diagnostic Code.

In January 2025, the Veteran underwent a VA scars/disfigurement examination. At that time, it was noted that she had a single linear knee scar which was the residual of knee surgery in 2024. It was not painful, unstable, or due to a burn. The scar measured 19 centimeters by one centimeter, for an approximate total area of 19 square centimeters. The scar did not result in limitation of function, and there were no other pertinent physical findings, complications, conditions, signs and/or symptoms associated with the scar.

Based on this evidence, a compensable disability rating is not warranted. Specifically, as pertinent to Diagnostic Code 7801, the Board finds that the scar does not affect an area or areas of at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.). The Veteran's scar is 19 square centimeters in area. Thus, a higher or separate rating under such Diagnostic Code is not warranted.

In regard to Diagnostic Code 7802, the evidence does not show that the Veteran's scar is superficial, nonlinear, and not associated with underlying soft tissue damage, and does not affect an area or areas of 144 square inches (929 sq. cm) or greater. Thus, a higher rating under such Diagnostic Code is not warranted.

As pertinent to Diagnostic Code 7804, a higher rating is not warranted as the scar was not found to be painful. Moreover, at no point during the appeal period has the Veteran's scar been unstable. Thus, higher or separate ratings based on such symptomatology under Diagnostic Code 7804 is not warranted.

Finally, as relevant to Diagnostic Code 7805, the evidence does not show, nor does the Veteran contend, that her scar results in any disabling effects. Rather, the VA examination performed during the appeal period clearly reflects that the service-connected scar does not result in limitation of function. Consequently, a higher or separate disability rating is not warranted under Diagnostic Code 7805. 

The Board recognizes the Veteran's belief that her service-connected disabilities are more severe than reflected by the currently assigned ratings, and notes she is competent to describe her symptoms and their effects on her daily life. See Layno v. Brown, 6 Vet. App. 465 (1994); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006).

However, the Veteran is not competent to provide an opinion regarding the severity of her symptomatology in accordance with the rating criteria. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). The Board finds instead that the medical evidence in which professionals with medical expertise examined the Veteran, completed necessary testing, acknowledged her reported symptoms, and described the manifestations of her disabilities in light of the rating criteria is more persuasive than her own reports regarding their severity.

The Board has also considered whether staged ratings under Hart, supra, are appropriate for the Veteran's service-connected disabilities. However, the Board finds that her
 the rating criteria. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (although the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical questions). The Board finds instead that the medical evidence in which professionals with medical expertise examined the Veteran, completed necessary testing, acknowledged her reported symptoms, and described the manifestations of her disabilities in light of the rating criteria is more persuasive than her own reports regarding their severity.

The Board has also considered whether staged ratings under Hart, supra, are appropriate for the Veteran's service-connected disabilities. However, the Board finds that her symptomatology has been stable throughout the appeal period and assigning staged ratings is not warranted.

The Board has considered the doctrine of reasonable doubt, which has resulted in the grant of a higher disability rating for the Veteran's left knee disability; however, for the remaining claim, the evidence is persuasively against a higher rating and therefore, the doctrine is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert, supra; Lynch, supra. For the reasons set forth above, and other than to the extent granted therein, the claims are denied.

 

 

R. FEINBERG

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Jeremy J. Olsen, 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.