TINNITUS

L. B. CRYAN · 2026 · Case ID: A26039093

MIXED

Summary

The veteran, who served in the United States Army from August 1989 to March 2000, appeals the denial of service connection for tinnitus and seeks higher initial ratings for his service-connected left knee disability. The Board denied service connection for tinnitus, finding that while the veteran's MOS involved moderate noise exposure and he currently reports tinnitus, service treatment records showed no complaints or diagnosis of tinnitus, and his separation examination indicated normal hearing. The Board found the veteran's lay statements regarding tinnitus onset and continuity to be internally inconsistent and not credible, particularly given the long gap between service and the claim, and the denial of tinnitus during private treatment shortly before filing. The Board found the VA examiner's opinion, which concluded tinnitus was less likely than not related to service due to lack of in-service auditory injury, to be persuasive. For the left knee, the Board granted a separate 10 percent rating for persistent instability associated with recurrent subluxation, resolving doubt in the veteran's favor. This rating was based on the veteran's credible reports of his knee giving way and instability, corroborated by one VA examination finding objective instability, despite another examination finding none. The Board found this instability met the criteria for a 10 percent rating under Diagnostic Code 5257. However, the Board denied higher ratings for limitation of flexion (DC 5260) or extension (DC 5261), finding the veteran's range of motion limitations did not meet the criteria for higher percentages. The Board also denied any higher rating for the left knee under other diagnostic codes, finding no evidence of ankylosis or other specific impairments.

Rationale

No in-service complaints or diagnosis of tinnitus.; Separation examination showed normal hearing.; Veteran's lay statements regarding onset and continuity were internally inconsistent and not credible.; VA examiner found tinnitus less likely than not related to service due to lack of in-service auditory injury.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

260108-621846

Full Decision Text

Citation Nr: A26039093
Decision Date: 04/27/26 Archive Date: 04/27/26

DOCKET NO. 260108-621846
DATE: April 27, 2026

ORDER

Service connection for tinnitus is denied.

An initial rating in excess of 10 percent for service-connected left knee strain with limitation of flexion is denied.

An initial compensable rating for service-connected left knee strain with limitation of extension is denied.

A separate 10 percent rating for persistent instability associated with recurrent subluxation of the left knee is granted for the entire period on appeal.

FINDINGS OF FACT

1. Symptoms of tinnitus were not chronic in service, did not manifest to a compensable degree within one year of separation, and have not been continuous since service separation; the Veteran's tinnitus is not etiologically related to service.

2. The service-connected left knee disability is manifested by limitation of flexion, which has not been limited to 30 degrees or less; limitation of extension, which has not been limited to 15 degrees or less, even with consideration of pain, and other functional impairment; there is no evidence of semilunar cartilage impairment, recurrent subluxation, tibia or fibula impairment or ankylosis.

3. The probative and persuasive evidence is approximately balanced as to whether the Veteran's service-connected left knee disability has been productive of persistent instability associated with recurrent subluxation throughout the appeal period; it does not require a prescription from a medical provider for an assistive device or bracing for ambulation.

CONCLUSIONS OF LAW

1. The criteria for service connection for tinnitus are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309.

2. The criteria for a rating in excess of 10 percent for the service-connected left knee disability on the basis of limitation of flexion, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260.

3. The criteria for a compensable rating for the service-connected left knee disability on the basis of limitation of extension, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5261.

4. Resolving all reasonable doubt in the Veteran's favor, for the entire period on appeal, the criteria for a separate 10 percent rating for the service-connected left knee disability based on persistent instability associated with recurrent subluxation have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 4.7, 4.10, 4.21, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5257.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from August 1989 to March 2000.

This case comes before the Board of Veterans' Appeals (Board) on appeal from a November 2025 rating decision issued by a Department of Veterans Affairs (VA) Regional Office, which is an agency of original jurisdiction (AOJ). In that decision, in pertinent part, the AOJ granted service connection for a left knee disability and assigned an initial 10 percent rating for left knee limitation of flexion, and a noncompensable rating for left knee limitation of extension. The AOJ denied service connection for tinnitus.

In the July 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran selected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the November 2025 AOJ decision on appeal. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision on appeal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If
a noncompensable rating for left knee limitation of extension. The AOJ denied service connection for tinnitus.

In the July 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran selected the Direct Review docket.

If the Veteran would like VA to consider any evidence that was added to the claims file that the Board could not consider in this decision, he 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

In a January 2026 statement, the Veteran waived the right to select a different Board review option. See 38 C.F.R. § 20.202(c)(2); see also Williams v. McDonough, 37 Vet. App. 305 (2024).

Service Connection

Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty from active military, naval, air or service. 38 U.S.C. §§ 1110, 1131; 38?C.F.R. § 3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that which is pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. §?3.303(d).

To establish a right to compensation for a present disability, a veteran must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service' the so-called nexus' requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (citing Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).

Certain chronic diseases (those listed under 38 C.F.R. § 3.309(a)), including organic diseases of the nervous system, of which tinnitus is considered) will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1?Vet. App.?41?Vet. App.?49, 53 (1990); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Entitlement to service connection for tinnitus

The Veteran asserts that his currently diagnosed tinnitus is the result of in-service noise exposure, including radio frequency transmission, air conditioning units, and generators with intermittent hearing protection with a military occupational specialty (MOS) of satellite communication systems operator-maintainer, which the RO has conceded has a moderate probability of hazardous noise
38 U.S.C. § § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1?Vet. App.?41?Vet. App.?49, 53 (1990); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Entitlement to service connection for tinnitus

The Veteran asserts that his currently diagnosed tinnitus is the result of in-service noise exposure, including radio frequency transmission, air conditioning units, and generators with intermittent hearing protection with a military occupational specialty (MOS) of satellite communication systems operator-maintainer, which the RO has conceded has a moderate probability of hazardous noise exposure. He reports that tinnitus began between 1997 and 1999 and has been continuous and progressively worsening since that time. See July 2025 VA 21-526EZ, Fully Developed Claim and November 2025 VA Hearing Loss and Tinnitus Disability Benefits Questionnaire (DBQ).

In the November 2025 rating decision on appeal, the AOJ made the favorable finding that the Veteran is currently diagnosed with tinnitus. See November 2025 VA Hearing Loss and Tinnitus DBQ. The AOJ also found that a qualifying event, injury, or disease had its onset in service, as the Veteran's military occupational specialty (MOS) was satellite communication systems operator-maintainer, which has a moderate probability of hazardous noise exposure. As such, the first and second elements of the service connection claim are met.

Service treatment records contain no complaints or diagnosis of tinnitus. Reports of Medical History from June 1995 and December 1988 show that the Veteran specifically denied having ear trouble, and a Report of Medical Examination from January 2000 shows that the Veteran's ears and ear drums were evaluated as normal. Accordingly, chronic tinnitus was not shown in the service treatment records and was not noted during service or to a degree of at least 10 percent following service.

As such, the criteria for presumptive service connection on the basis of a chronic disease have not been satisfied. See 38 C.F.R. § 3.307(a)(3).

Additionally, the Veteran's reports of the onset of tinnitus prior to discharge and continuing and progressing since is not supported by the evidence, including the Veteran's own internally inconsistent statements. During private treatment in 2023 and 2024, the Veteran denied experiencing tinnitus. See private treatment records from Abrazo Medical Group. Approximately 25 years after discharge, the Veteran filed his initial claim for service connection, including tinnitus, in July 2025. The Board acknowledges that symptoms, not treatment, are the essence of evidence of continuity of symptomatology (Savage v. Gober, 10 Vet. App. 488, 496 (1997)); however, in this case, the Veteran did not report any tinnitus during service, at separation, or for more than twenty years afterward, only first asserting symptoms in 2025. Moreover, the specific denial of tinnitus during treatment in 2023 and 2024, just one to two years before filing his claim for service connection, underscores the absence of continuous symptomatology. This long lapse of time between service separation and treatment for tinnitus symptoms is one factor that weighs against a finding that the Veteran's tinnitus is related to service. See Maxson v. Gober, 230 F. 3d 1330, 1333 (Fed. Cir. 2000) (holding that it was proper to consider the veteran's entire medical history in determining if service-connection is warranted, including a lengthy period of absence of complaints).

As it pertains to a current tinnitus disability and a possible nexus to service, the Veteran was afforded a VA audiological examination in November 2025. He reported that his tinnitus began between 1997 and 1998 during his military service in the Army, where his MOS was Satellite Communication (SATCOM) Systems Operator/Maintainer, a role with a moderate probability of hazardous noise exposure, which exposed him to radio frequency transmissions, generators, and air conditioning units, with intermittent use of hearing protection. He described his tinnitus as bilateral, constant throughout the day, and fluctuating in pitch and intensity, and noted that it has worsened since service. See November 2025 VA Hearing Loss and Tinnitus DBQ.

The examiner reviewed the Veteran's claims file and opined that the Veteran's tinnitus was less likely than not related to military noise exposure. The examiner noted that, although the Veteran reported a history of hazardous noise exposure during service, there was no hearing loss documented on entrance or separation examinations, indicating no permanent auditory damage during active duty. Additionally, there were no
probability of hazardous noise exposure, which exposed him to radio frequency transmissions, generators, and air conditioning units, with intermittent use of hearing protection. He described his tinnitus as bilateral, constant throughout the day, and fluctuating in pitch and intensity, and noted that it has worsened since service. See November 2025 VA Hearing Loss and Tinnitus DBQ.

The examiner reviewed the Veteran's claims file and opined that the Veteran's tinnitus was less likely than not related to military noise exposure. The examiner noted that, although the Veteran reported a history of hazardous noise exposure during service, there was no hearing loss documented on entrance or separation examinations, indicating no permanent auditory damage during active duty. Additionally, there were no complaints of tinnitus in service treatment records or at separation. The examiner found that while the Veteran currently reports tinnitus, and excessive noise exposure during service is acknowledged, there is no evidence of auditory injury during active duty to establish a nexus. Based on this record, the examiner concluded that the Veteran's tinnitus is less likely than not caused by or the result of military noise exposure.

The Board affords the November 2025 VA examiner's opinion significant probative weight. The examiner conducted a thorough review of the Veteran's claims file, considered the Veteran's reported in-service and post-service noise exposure, and accurately accounted for the Veteran's medical history. The opinion is supported by a clear rationale, relying on contemporaneous service records, including entrance and separation audiometric testing, which showed no hearing loss, and the absence of any complaints of tinnitus in service treatment records or at separation. While the Veteran reports tinnitus currently, the examiner reasonably concluded that there is no evidence of auditory injury during service to establish a nexus. Accordingly, the examiner's conclusion is well-reasoned, consistent with the evidence of record, and more persuasive than the Veteran's internally inconsistent lay statements regarding the onset of tinnitus. Thus, although a lay person is competent to report the onset and continuation of recurrent tinnitus, in this case, the Veteran's statements made in conjunction with his claim not credible for the reasons set forth above, including the Veteran's inconsistent statements as to onset.

Based on the competent and probative medical evidence, the Veteran's current tinnitus began many years following service, and with respect to nexus, the Veteran is not competent to relate his current tinnitus to noise exposure in service because continuity of symptoms during, and since service is not shown. As a lay person, the Veteran does not have the requisite medical knowledge, training, or experience to be able to render a competent medical opinion regarding the cause of the tinnitus, where as here, the Veteran's statements of his observable symptoms of tinnitus during and since service are not found credible.

For these reasons, the Board finds that a preponderance of the evidence is against the claim for service connection for tinnitus, and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

Increased Ratings

Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. § Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1.

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule) to the symptoms that a veteran exhibits within the relevant period of review. Separate Diagnostic Codes identify the various disabilities within the Rating Schedule. 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular Diagnostic Code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. 38 U.S.C. § 5107; 38 C.F.R. § 4.3. Where there is an "approximate balance" of positive and negative evidence to support a claim, the veteran will receive the "benefit of the doubt". Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021).

For disabilities evaluated on the basis of limitation of motion, VA is required to apply the provisions of 38 C.F
higher rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

For disabilities evaluated on the basis of limitation of motion, VA is required to apply the provisions of 38 C.F.R. §§ 4.40, 4.45, pertaining to functional impairment. The Court has instructed that in applying these regulations VA should obtain examinations in which the examiner determined whether the disability was manifested by weakened movement, excess fatigability, incoordination, or pain. Such inquiry is not to be limited to muscles or nerves. These determinations should, if feasible, be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, flare-ups, or pain. DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Johnston v. Brown, 10 Vet. App. 80, 84-5 (1997); 38 C.F.R. § § 4.59.

Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011).

In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint."

In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination.

The evaluation of the same disability under various diagnoses is to be avoided. 38 C.F.R. § § 4.14. However, § 4.14 does not preclude the assignment of separate evaluations for separate and distinct symptomatology where none of the symptomatology justifying an evaluation under one diagnostic code is duplicative of or overlapping with the symptomatology justifying an evaluation under another diagnostic code. Esteban v. Brown, 6 Vet. App. 259, 262 (1994).

In both initial rating claims and normal increased rating claims, the Board must discuss whether any "staged ratings" are warranted, and if not, why not. Fenderson v. West, 12?Vet. App.?119 (1999); Hart v. Mansfield, 21?Vet. App.?505 (2007).

The Veteran's service-connected left knee disability is rated under 38 C.F.R. § 4.71a, Diagnostic Codes 5260, for limitation of flexion of the leg and Diagnostic Code 5261, for limitation of extension of the leg. 38 C.F.R. § 4.71a, Diagnostic Code 5260.

As pertinent herein, disabilities of the knee are rated under 38 C.F.R. § 4.71a, Diagnostic Codes 5256 through 5263.

For VA compensation purposes, normal flexion and extension of the knee is from 0 degrees of extension to 140 degrees of flexion. 38 C.F.R. § 4.71, Plate II.

Limitation of flexion of a leg warrants a noncompensable evaluation if flexion is limited to 60 degrees, a 10 percent evaluation if flexion is limited to 45 degrees, a 20 percent evaluation if flexion is limited to 30 degrees, or a maximum 30 percent evaluation if flexion is limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260.

Limitation of extension of a leg warrants a noncompensable evaluation if extension is limited to 5 degrees, a 10 percent evaluation if extension
0 degrees of extension to 140 degrees of flexion. 38 C.F.R. § 4.71, Plate II.

Limitation of extension of a leg warrants a noncompensable evaluation if extension is limited to 5 degrees, a 10 percent evaluation if extension is limited to 10 degrees, a 20 percent evaluation if extension is limited to 15 degrees, a 30 percent evaluation if extension is limited to 20 degrees, a 40 percent evaluation if extension is limited to 30 degrees, or a maximum 50 percent evaluation if extension is limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261.

Ankylosis of a knee warrants a 30 percent evaluation if it is at a favorable angle in full extension, or in slight flexion between 0 and 10 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5256.

The VA General Counsel has held that a claimant who has arthritis and instability of a knee may be rated separately under Diagnostic Codes 5003 and 5257, while cautioning that any such separate rating must be based on additional disabling symptomatology. VAOPGCPREC 23-97, 62 Fed. Reg. 63, 604 (July 1, 1997); VAOPGCPREC 9-98, 63 Fed. Reg. 56,704 (Aug. 14, 1998).

The VA General Counsel also held that separate ratings under 38 C.F.R. § 4.71a, Diagnostic Code 5260 (limitation of flexion of the leg) and Diagnostic Code 5261 (limitation of extension of the leg), may be assigned for disability of the same joint. VAOGCPREC 9-2004 (Sept. 17, 2004).

1. Entitlement to an initial rating in excess of 10 percent for service-connected left knee strain with limitation of flexion

2. Entitlement to an initial compensable rating for service-connected left knee strain with limitation of extension

The Veteran seeks higher initial ratings for his service-connected left knee disability based on limitation of flexion and limitation of extension. However, he has not provided any specific argument or explanation as to why higher ratings are warranted.

In July 2025, the Veteran filed his initial claim for service connection for a bilateral knee disability. In a November 2025 rating decision, the RO granted service connection for a left knee strain. A 10 percent rating was assigned for limitation of flexion and a 0 percent (noncompensable) rating was assigned for limitation of extension, both effective from July 8, 2025. The Veteran has appealed the initial ratings for his service-connected left knee strain. See January 2026 VA Form 10182, NOD.

The Board finds that a rating in excess of 10 percent for left knee flexion, or a compensable rating for left knee extension, is not warranted at any time during the period on appeal.

As noted, the Veteran's left knee strain is rated based on limitation of flexion under 38 C.F.R. § 4.71a, Diagnostic Code 5260. In order to get the next higher rating of 20 percent under Diagnostic Code 5260, the evidence must show flexion limited to 30 degrees. The evidence does not show left knee flexion limited to 30 degrees to warrant the next higher rating of 20 percent.

The Board further finds that a compensable rating for the left knee disability with limitation of extension is not warranted under the rating criteria for 38 C.F.R. § 4.71a at any time during the period on appeal.

As noted, the Veteran's left knee strain is rated based on limitation of extension under 38 C.F.R. § 4.71a, Diagnostic Code 5261. In order to get a compensable rating of 10 percent under Diagnostic Code 5261, the evidence must show extension limited to 10 degrees. The evidence does not show left knee extension limited to 10 degrees to warrant the next higher rating of 10 percent for the left knee.

On VA Knee and Lower Leg Conditions examination on October 20, 2025, the Veteran reported left knee pain and limited range of motion
under the rating criteria for 38 C.F.R. § 4.71a at any time during the period on appeal.

On VA Knee and Lower Leg Conditions examination on October 20, 2025, the Veteran reported left knee pain and limited range of motion, managed with over-the-counter medication (OTC), rest, and elevation. He denied experiencing flare-ups. On physical examination, range of motion testing revealed flexion to 100 degrees and extension to 5 degrees, with pain noted on both active and passive motion. The examiner indicated that the pain did not result in functional loss, and there was no additional limitation of motion following repetitive-use testing. Crepitus was observed, but there was no objective evidence of localized tenderness or pain on palpation of the joint or surrounding soft tissue. The examiner further determined that the evidence, including the Veteran's own statements, did not suggest that pain, fatigability, weakness, lack of endurance, or incoordination significantly limited functional ability with repeated use over time or during flare-ups. The Veteran reported functional impairments described as increased discomfort with prolonged standing, walking, kneeling, and climbing stairs, as well as reduced endurance due to weakened movement and fatigue. He also reported a sense of the knee "giving way" and instability of station, resulting in occasional imbalance when weight-bearing on the affected knee. These symptoms contributed to disturbance of locomotion and interference with standing, particularly during extended periods of activity. Objective testing, however, revealed no recurrent subluxation, persistent instability, or patellar instability, and the Veteran did not require the use of assistive devices. There was no muscle atrophy or ankylosis. See October 20, 2025 VA Knee and Lower Leg Conditions Disability Benefits Questionnaire (DBQ).

By contrast, VA Knee and Lower Leg Conditions examination on October 29 2025, showed left knee recurrent subluxation or persistent instability, but no ligament tear. Physical examination revealed full range of motion in both flexion and extension in the left knee (0-140 degrees). The remainder of the examination findings were very similar to the findings from the October 20, 2025 examination. See October 29, 2025 VA Knee and Lower Leg Conditions Disability Benefits Questionnaire (DBQ).

The October 2025 Knee and Lower Leg Conditions examinations are adequate for evaluation purposes. They are probative and persuasive as they conformed with the requirements set forth in Correia, as the examiners discussed pain in the left knee, and noted that there was pain with active and passive motion, weight-bearing, and non-weight-bearing. The record does not otherwise indicate that a rating in excess of 10 percent for limitation of flexion or a compensable rating for limitation of extension would be warranted for the left knee under the principles of Correia. The reports also complied with the requirements set forth in Sharp because the examiners asked the Veteran about flare-ups and recorded his responses. The examiners also opined that pain would not significantly limit functional ability in the left knee with repeated use over a period of time or during a flare-up. The examiners also noted the Veteran's reported functional impairment, in accordance with DeLuca, as discussed further below. DeLuca v. Brown, 8 Vet. App. at 202; Sharp v. Shulkin, 29 Vet. App. at 32; Correia v. McDonald, 28 Vet. App. at 158.

With regard to private treatment records, the Veteran submitted a December 2024 primary care report showing that he presented with a chief complaint of shoulder pain. That record includes a problem list noting genital herpes simplex, hypogonadism, hyperlipidemia, obesity, chronic rhinitis, left shoulder pain onset in June 2017; and, left shoulder impingement syndrome with onset in March 2024. Knee pain is not mentioned or listed as a problem on the report. There are no additional private treatment records regarding the left knee received during the evidentiary window in this case.

In summary, the totality of the probative evidence, which includes VA examination findings and consideration of the Veteran's lay statements persuasively weighs against the assignment of a rating in excess of 10 percent for the left knee limitation of flex
a chief complaint of shoulder pain. That record includes a problem list noting genital herpes simplex, hypogonadism, hyperlipidemia, obesity, chronic rhinitis, left shoulder pain onset in June 2017; and, left shoulder impingement syndrome with onset in March 2024. Knee pain is not mentioned or listed as a problem on the report. There are no additional private treatment records regarding the left knee received during the evidentiary window in this case.

In summary, the totality of the probative evidence, which includes VA examination findings and consideration of the Veteran's lay statements persuasively weighs against the assignment of a rating in excess of 10 percent for the left knee limitation of flexion or a compensable rating for the left knee limitation of extension. The Veteran has consistently reported experiencing chronic left knee pain, and examination during the period on appeal reflects painful motion. However, objective testing has shown no worse than 100 degrees of flexion and no worse than 5 degrees of extension, even after repetitive-use testing and with repeated use over time.

Thus, a review of the record shows no evidence of limitation of left knee motion that would meet the criteria for a rating in excess of 10 percent under Diagnostic Code 5260 or a compensable rating under Diagnostic Code 5261. Therefore, these Diagnostic Codes do not provide a basis for a rating in excess of 10 percent or a compensable rating for the service-connected left knee disability.

In short, the Veteran's limitation of motion due to pain and functional impairment does not rise to the level necessary to warrant a rating in excess of 10 percent under Diagnostic Code 5260 or a compensable rating under Diagnostic Code 5261.

In reaching this determination, the Board also acknowledges that VA is required "to discount beneficial medication effects when relevant rating criteria do not specifically contemplate medication use," Ingram v. Collins, 38 Vet. App. 130, 131 (2025). Here, the Veteran reported on his initial examination in October 2025 that he treated his left knee with OTC medication. There is no indication in the records as to whether this OTC medication provided any relief for the Veteran. Notably, however, the Veteran did not report using medication to treat his left knee disability during his most recent October 29, 2025 VA examination. For the reasons set forth, there are no ameliorative effects of medication to consider. Accordingly, the examination reports are adequate to base a decision.

With respect to whether a higher or separate rating is warranted under alternative diagnostic codes for the service-connected left knee disability based on limitation of motion, the Board finds that it is not. In this regard, the evidence does not demonstrate ankylosis (Diagnostic Code 5256), dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion (Diagnostic Code 5258), or symptomatic removal of semilunar cartilage (Diagnostic Code 5259). Additionally, there is no evidence of impairment of the tibia and fibula, medial tibial stress syndrome, or shin splints (Diagnostic Code 5262). Accordingly, a higher or separate rating under these diagnostic codes is not warranted.

As noted above, ankylosis is defined as immobility and consolidation of a joint due to disease, injury, or surgical procedure. See Lewis v. Derwinski, 3 Vet. App. 259 (1992). The clinical findings, while reflecting pain and functional impairment, do not show any evidence of ankylosis, or the functional equivalent of ankylosis. In Chavis v. McDonough, 34 Vet. App. 1 (2021), the Court of Appeals for Veterans Claims (CAVC or Court) held that in the absence of a medical diagnosis of ankylosis, a claimant may still receive a rating under ankylosis based on the functional equivalent of ankylosis (i.e., the claimant's symptoms sufficiently resemble ankylosis despite the absence of a formal diagnosis). In short, if a claimant's functional loss "is the functional equivalent of ankylosis," a higher rating may be warranted on that basis. Id. at 11. Although the Veteran has reported pain the knee and limitation of motion is shown in at least one of the VA examination reports, the medical findings do not indicate, and the Veteran does not assert that his left knee is stuck in a fixed position or that he is prevented from flexing and/or extending his left knee at all. .

In making this determination, the Board has considered whether there is any additional functional loss not contemplated by the rating assigned. See 38 C.F.R. §§ 4.40, 4.45, 4
In short, if a claimant's functional loss "is the functional equivalent of ankylosis," a higher rating may be warranted on that basis. Id. at 11. Although the Veteran has reported pain the knee and limitation of motion is shown in at least one of the VA examination reports, the medical findings do not indicate, and the Veteran does not assert that his left knee is stuck in a fixed position or that he is prevented from flexing and/or extending his left knee at all. .

In making this determination, the Board has considered whether there is any additional functional loss not contemplated by the rating assigned. See 38 C.F.R. §§ 4.40, 4.45, 4.59; see also Deluca, 8 Vet. App. at 206; Mitchell v. Shinseki, 25 Vet. App. 32, 33 (2011). Although the Veteran has reported chronic knee pain and functional difficulties with climbing stairs, kneeling, squatting, and prolonged standing and walking, objective testing shows that left knee flexion has been limited to no worse than 100 degrees and extension to no worse than 5 degrees, even after repetitive-use testing. Moreover, on both examinations in October 2025, the Veteran denied flare-ups of left knee pain, and on his most recent examination in October 2025, range of motion was normal on active and passive motion, and not further reduced after repetitive-use testing.

In conjunction with the Veteran's NOD, the Veteran's representative specifically asserted that the Veteran is entitled to a separate 10 percent rating for his recurrent subluxation or persistent instability, referring to the findings from the October 29, 2025 VA examination.

The Board has considered the statements of the Veteran as to the extent of his left knee symptoms. He is certainly competent to report that his symptoms are worse. Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, in evaluating a claim for an increased schedular rating, VA must weigh his statements against the factors as enumerated in the rating criteria discussed above, which in part, involves the examination of clinical data gathered by competent medical professionals.

In conclusion, the evidence of record persuasively weighs against the Veteran's claim for an increased rating for the service-connected left knee disability limitation of motion. As the evidence of record persuasively weighs against a rating in excess of 10 percent based on limitation of flexion or a compensable rating based on limitation of extension, 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, 781-82 (Fed. Cir. 2021).

Effective February 7, 2021, Diagnostic Code 5257, which pertains to recurrent subluxation and/or instability of the knee, was revised. Under the current criteria, ratings are assigned for either recurrent subluxation or instability; or for patellar instability.

With respect to recurrent subluxation or instability, a 10 percent rating is assigned where there is a 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, crutches, walker) or bracing for ambulation. A 20 percent rating is assigned where there is a sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device or bracing for ambulation. A maximum 30 percent rating is assigned where there is an unrepaired or failed repair of a complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device and bracing for ambulation. 38 C.F.R. § 4.71a, Diagnostic Code 5257.

With respect to patellar instability, a 10 percent rating is assigned for a diagnosed condition involving the patellofemoral complex with recurrent instability that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent rating is assigned for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription for a brace, cane, or walker. A maximum 30 percent rating is assigned for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription for both a brace and either a cane or walker. 38 C.F.R. § 4.71a, Diagnostic Code 5257.

Note
With respect to patellar instability, a 10 percent rating is assigned for a diagnosed condition involving the patellofemoral complex with recurrent instability that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent rating is assigned for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription for a brace, cane, or walker. A maximum 30 percent rating is assigned for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription for both a brace and either a cane or walker. 38 C.F.R. § 4.71a, Diagnostic Code 5257.

Note (1): For purposes of this diagnostic code, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon.

Note (2): A surgical procedure that does not involve repair of one or more of these structures does not qualify as surgical repair for patellar instability.

Turning to the evidence, the Veteran has competently and consistently reported symptoms of left knee instability throughout the appeal period. At the October 2025 VA examinations, he reported a sense of the knee "giving way," instability of station, and intermittent buckling, resulting in occasional imbalance when weight-bearing. He also described functional limitations with standing, walking, climbing stairs, kneeling, and squatting, as well as reduced endurance due to weakened movement and fatigue.

Although the October 20, 2025 VA examination did not reveal objective evidence of instability, the subsequent October 29, 2025 VA examination documented recurrent subluxation and persistent instability of the left knee. This objective finding, when considered together with the Veteran's credible and consistent lay reports, supports the presence of instability sufficient to warrant a compensable rating. The Board notes that objective medical evidence is not necessarily required to show knee instability under Diagnostic Code 5257 [at the 10 percent level], so objective medical evidence cannot be categorically found more probative than lay evidence with respect to this Diagnostic Code. See English v. Wilkie, 30 Vet. App. 347, 352-53 (2018). objective medical evidence is not required to establish instability under Diagnostic Code 5257, and lay evidence may be sufficient. See English v. Wilkie, 30 Vet. App. 347, 352-53 (2018).

Here, the competent and probative medical evidence of record is approximately balanced as to whether the Veteran's left knee is unstable. Additionally, there is no reason to question the Veteran's credibility with regard to his reports of his left knee buckling and giving way. As such, the extent that it is considered severe enough to meet the threshold for a 10 percent rating under Diagnostic Code 5257. The Veteran is competent to report symptoms that he can personally observe and feel, such as buckling and a feeling of give way weakness. See Layno v. Brown, 6 Vat. App. 465 (1994). The left knee instability described by the Veteran is consistent with a 10 percent rating under Diagnostic Code 5257 for the left knee for the entire appeal. In this regard, the Veteran has reported the same symptoms related to his left knee disability, including instability, since he filed his claim in July 2025. Moreover, given that objective evidence of instability was documented on October 29, 2025, just days after the October 20, 2025 examination, and within a short period following the July 2025 claim, the Board finds it reasonable to conclude that such symptoms were present throughout the appeal period.

Therefore, with all reasonable doubt resolved in favor of the Veteran, the Board concludes that the Veteran's left knee disability is manifested by a sprain with persistent instability, consistent with the criteria for a 10 percent rating under Diagnostic Code 5257 for the entire period on appeal. 38 C.F.R. §§ 4.3, 4.7; see also English v. Wilkie, 30?Vet. App. 347, 352 (2018).

A rating in excess of 10 percent is not warranted, as the evidence does not show a sprain, incomplete ligament tear, or repaired complete ligament tear resulting in persistent instability with a prescription from a medical provider for a brace or assistive device for ambulation, as required for a higher, 20 percent rating under Diagnostic Code 5257. The record likewise does not demonstrate an unrepaired or failed repair of a complete ligament tear with both prescribed bracing and an assistive device, as required for a 30 percent rating. Additionally, the medical evidence does not reflect a diagnosed condition involving the patellofemoral complex with recurrent instability
30?Vet. App. 347, 352 (2018).

Accordingly, the Board finds that a separate 10 percent rating, but no higher, for left knee instability is warranted under Diagnostic Code 5257. The Board finds that the evidence persuasively weighs against the assignment of any higher rating. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

As the Veteran has remained gainfully employed during the period covered by this appeal, a total disability rating based on individual unemployability (TDIU) due to service-connected disability is not raised by the record in conjunction with this appeal. Rice v. Shinseki, 22 Vet. App. 447 (2009). His occupational impairment, described above as a limited ability to stand, walk, climb stairs and squat for prolonged periods, resulting in the loss of 0 to 1 week of work time during the preceding 12 months, is adequately contemplated by the current ratings assigned, as these ratings are meant to compensation for the average impairment of earning capacity. 38 C.F.R. § 4.1, and they are consistent with the level of severity in terms of the rating schedule, as explained above.

L. B. CRYAN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board F. Yankey, 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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