KNEE IMPAIRMENT OF

S. CHARLES NEILL · 2026 · Case ID: A26039492

DENIED

Summary

The veteran, who served with multiple periods of service between October 2010 and July 2023, appeals the denial of increased disability ratings for his left knee condition. The claims involve limitations in flexion, extension, and instability, rated under Diagnostic Codes 5260, 5261, and 5257 respectively. The case has a complex procedural history involving multiple appeals, remands, and decisions from the Board of Veterans' Appeals and the Court of Appeals for Veterans Claims. The Board reviewed VA examinations from June 2022, September 2023, and December 2023. The June 2022 examination noted pain on weight-bearing and active motion, with flexion to 105 degrees and extension to 5 degrees, but found no instability. The September 2023 examination showed flexion to 90 degrees and extension to 0 degrees, with pain and crepitus, but no instability or ligament tear. The December 2023 examination found flexion to 100 degrees and extension to 20 degrees, with pain on active motion but no localized tenderness, and slight lateral instability but no ligament tear or patellar instability. The Board found that the evidence did not support ratings higher than the current 10 percent for flexion and instability, nor did it support the claimed increased ratings for extension. The Board noted that the veteran's flexion was never limited to the 30 degrees required for a 20 percent rating, and extension limitations did not meet the criteria for higher ratings. Instability findings also did not meet the criteria for increased ratings. The Board concluded that the evidence persuasively favored against the veteran's claims, and the benefit of the doubt doctrine was inapplicable. All claims for increased ratings were denied.

Rationale

Evidence did not support flexion limitation to 30 degrees or worse.; Current rating of 10 percent is maximum warranted based on evidence.

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

5260

Docket No.

240119-409258

Full Decision Text

Citation Nr: A26039492
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 240119-409258
DATE: April 28, 2026

ORDER

1. Entitlement to rating in excess of 10 percent for left knee patellofemoral pain syndrome and degenerative arthritis limitation of flexion (a left knee disability) is denied.

2. Entitlement to a rating in excess of 10 percent for left knee limitation of extension prior to December 2023, and in excess of 30 percent thereafter, is denied.

3. Entitlement to a rating in excess of 10 percent for left knee instability is denied.

FINDINGS OF FACT

1. The evidence of record shows that, during the period on appeal, the Veteran's most limiting flexion was 60 degrees during flare-ups.

2. The evidence of record shows that, prior to December 2023, the Veteran's left knee extension was, at worst, limited to 10 degrees during flare-ups. From December 2023, extension was, at worst, limited to 25 degrees during flare-ups.

3. Throughout the period on appeal, the Veteran did not have patellar instability and while slight knee instability was noted, there was no evidence that it was due to a ligament tear or sprain.

CONCLUSIONS OF LAW

1. The criteria for entitlement to a rating in excess of 10 percent for left knee limitation of flexion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.1, 4.3, 4.7, 4.40, 4.45, 4.49, 4.71a; Diagnostic Code (DC) 5260.

2. The criteria for entitlement to a rating in excess of 30 percent, from October 21, 2023, for left knee limitation of extension, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.1, 4.3, 4.7, 4.40, 4.45, 4.49, 4.71a; DC 5261.

3. The criteria for a compensable rating for left knee instability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.1, 4.3, 4.7, 4.40, 4.45, 4.49, 4.71a; DC 5257.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from October 4, 2010, to March 12, 2011, from April 18, 2011, to February 18, 2012, and from February 19, 2012, to July 5, 2012.

The case comes before the Board of Veterans' Appeals (Board) on appeal from a December 2023 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO).

In January 2024, the Veteran submitted a VA Form 10182 Decision Review Request: Board Appeal (Notice of Disagreement), requesting Direct Review of the evidence considered by the agency of original jurisdiction (AOJ). Under this appeal lane, the Board may only consider evidence of record at the time of the issuance of the rating 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.

In July 2024, the Board issued a decision regarding these issues. The Veteran appealed this decision to the United States Court of Appeals for Veterans Claims (the Court).

In September 2025, the parties agreed a Joint Motion for Partial Remand (JMPR). These issues have now been returned to the Board.

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 evaluations are determined by the application of a schedule of ratings
, the parties agreed a Joint Motion for Partial Remand (JMPR). These issues have now been returned to the Board.

Increased Ratings

Disability evaluations are determined by the application of a schedule of ratings that is based on the average impairment of earning capacity. In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Separate diagnostic codes (DCs) identify the various disabilities. 38 U.S.C. § 1155. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned.

VA is responsible for determining whether the evidence persuasively favors one side or another. 38 C.F.R. § 4.3. When there is an approximate or nearly equal balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the Veteran and the claim will be granted on the merits. 38 U.S.C. § 5107(b). When the evidence persuasively favors against the claim of the Veteran, the benefit of the doubt doctrine is inapplicable, and the claim will be denied on its merits. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021) (en banc).

The Veteran's left knee condition is rated under DC 5260 for limitation of flexion, DC 5261 for limitation of extension, and DC 5257 for instability. The Board notes that, as separate ratings, DCs 5260 and 5261 may be (as in the present case) assigned for disabilities of the same knee joint. See VAOPGCPREC 9-2004.

Under DC 5260, a 10 percent rating is warranted where flexion is limited to 45 degrees. A rating of 20 percent is warranted where flexion is limited to 30 degrees, and a rating of 30 percent is warranted where flexion is limited to 15 degrees. 38 C.F.R. § 4.71a. The maximum assignable rating for limitation of knee flexion under DC 5260 is 30 percent.

The Board notes that, under DC 5261, a 10 percent rating is warranted where extension is limited to 10 degrees and a 20 percent rating where extension is limited to 15 degrees. A rating of 30 percent is warranted where extension is limited to 20 degrees, while a 40 percent rating is warranted where extension is limited to 30 degrees. A 50 percent is warranted where extension is limited to 45 degrees.

Effective February 7, 2021, the criteria for knee instability were amended. See 82 Fed. Reg. 76453 (Nov. 30, 2020, as corrected); 38 C.F.R. § 4.71a; DC 5257.

Under the new criteria of DC 5257, a 10 percent rating is assigned 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, crutch, walker) or bracing for ambulation. A 20 percent rating is assigned for sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace or assistive device (e.g., cane, crutch, walker) for ambulation, or unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane, crutch, walker) or bracing for ambulation. A 30 percent rating is assigned for unrepaired or failed repair of complete ligament tears causing persistent instability, and a medical provider prescribes both an assistive device (e.g
., cane, crutch, walker) or bracing for ambulation. A 20 percent rating is assigned for sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace or assistive device (e.g., cane, crutch, walker) for ambulation, or unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane, crutch, walker) or bracing for ambulation. A 30 percent rating is assigned for unrepaired or failed repair of complete ligament tears causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane, crutch, walker) and bracing for ambulation.

Furthermore, under the new criteria, separate ratings may also be assigned for patellar instability. For patellar instability, a 10 percent rating is assigned 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 assigned 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; and a 30 percent rating is assigned 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 following the criteria provides that, for patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. Note 2 following the criteria 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 surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration).

Under DC 5258, a maximum 20 percent rating is warranted for semilunar cartilage, dislocated, with frequent episodes of "locking," pain, and effusion into the joint. Under DC 5259, a maximum 10 percent rating is warranted for removal of semilunar cartilage that is symptomatic.

DCs 5256, 5258, 5259, 5262 and 5263 pertain to additional knee and leg disorders. However, the applicability of these DCs is not reasonably raised by the evidence of record as discussed below, and they will not be considered further. 38 C.F.R. § 4.71a, DCs 5256, 5258, 5259, 5262 and 5263; see Robinson v. Shinseki, 557 F.3d 1355, 1361 (Fed. Cir. 2009) ("Where a fully developed record is presented to the Board with no evidentiary support for a particular theory of recovery, there is no reason for the Board to address or consider such a theory").

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).

1. Entitlement to an increased rating for left knee limitation of flexion.

2. Entitlement to an increased rating for left knee limitation of extension.

3. Entitlement to an increased rating for left knee instability.

Pursuant to the July 2025 JMPR, the Court vacated the portion of the July 2024 Board decision "that denied entitlement to (1) an evaluation in excess of 20% for left knee patellofemoral pain syndrome and degenerative arthritis limitation of flexion (a left knee disability), (2) an evaluation in excess of 30% from October 21, 2023, for left knee limitation of extension and (3) a compensable evaluation for left knee instability." See September 2025 CAVC Decision at 37. The Board notes that, throughout the period on appeal, including at the time of this decision, the Veteran has been in receipt of a 10 percent rating for left knee limitation of flexion, and a 10 percent rating for left knee instability. See November 2025 Rating Decision - Codesheet.

The JMPR was
excess of 20% for left knee patellofemoral pain syndrome and degenerative arthritis limitation of flexion (a left knee disability), (2) an evaluation in excess of 30% from October 21, 2023, for left knee limitation of extension and (3) a compensable evaluation for left knee instability." See September 2025 CAVC Decision at 37. The Board notes that, throughout the period on appeal, including at the time of this decision, the Veteran has been in receipt of a 10 percent rating for left knee limitation of flexion, and a 10 percent rating for left knee instability. See November 2025 Rating Decision - Codesheet.

The JMPR was narrow in scope, as the parties only found error with the Board's failure "to provide adequate reasons or bases for determining the period on appeal for Appellant's left knee claims, both for when the appeal period began and when it ended." See July 2025 CAVC Decision at 39. The Board must follow the terms of the JMPR. See Forcier v. Nicholson, 19 Vet. App. 414, 426 (2006). Specifically, when a case is remanded pursuant to the JMPR, the Board must address the identified deficiencies. See Carter v. Shinseki, 26 Vet. App. 534, 543 (2014).

The Board thus turns to the complex procedural history for the Veteran's left knee claims, which involves several appeal streams. Initially, the Board acknowledges that the Veteran contends that the genesis of the claims currently on appeal began in July 2019. See July 2025 CAVC Decision.

In July 2019, the Veteran submitted a claim, which was denied by the AOJ in October 2019. The Veteran submitted a VA Form 10182 in December 2019, and again in March 2020. A docketing letter was provided in May 2020, confirming that the Veteran had elected the Direct Review lane. In October 2020, the Board issued a decision, dismissing the Veteran's claim, due to entitlement to service connection having been granted in July 2020. This decision was not appealed, and as such it is final.

A second appeal stream stems from the July 2020 rating decision which granted entitlement to service connection for the Veteran's left knee condition, effective July 2019. A higher-level review (HLR) request was submitted in March 2021. A rating decision concerning service connection was provided in June 2021, and a second rating decision concerning an earlier effective date and an increased rating claim was provided in August 2021. As the Veteran did not submit a supplemental claim, or a VA Form 10182 within one year, the decision became final.

A third appeal stream stems from an October 2020 claim for an increased rating of his left knee conditions. A deferred decision was made in November 2021, and a rating decision was provided in December 2021. As the Veteran did not submit a HLR request, a supplemental claim, or VA Form 10182 within one year, the decision became final.

A fourth appeal stream stems from a December 2021 claim for an increased rating. A rating decision was provided later in the same month. The Veteran submitted an HLR request in January 2022, and an HLR rating decision was made later in the same month. The Veteran submitted a VA Form 10182 in April 2022, in which he cited the December 2021 rating decision. A docket letter was provided in April 2022. The Board initially made a decision in December 2023, which the Veteran appealed to the Court. The parties agreed to a JMPR. A second decision was provided in April 2025, in which entitlement to a rating in excess of 10 percent for limitation of flexion was denied, and both a separate noncompensable rating for left knee limitation of extension, and a separate 10 percent rating for left knee instability, was granted. As this decision was not appealed to the Court, it became final.

A fifth appeal stream stems from a June 2022 supplemental claim filed by the Veteran. The AOJ provided a rating decision in September 2022, and the Veteran appealed by submitting a VA Form 10182 in October 2022. A docket letter was provided later in the same month. The Board issued a remand order in April 2024. The AOJ granted an increased rating for left knee patellofemoral pain syndrome and degenerative arthritis, limitation of extension, in February 2025. The Veteran did not appeal this decision within one year
and a separate 10 percent rating for left knee instability, was granted. As this decision was not appealed to the Court, it became final.

A fifth appeal stream stems from a June 2022 supplemental claim filed by the Veteran. The AOJ provided a rating decision in September 2022, and the Veteran appealed by submitting a VA Form 10182 in October 2022. A docket letter was provided later in the same month. The Board issued a remand order in April 2024. The AOJ granted an increased rating for left knee patellofemoral pain syndrome and degenerative arthritis, limitation of extension, in February 2025. The Veteran did not appeal this decision within one year, and as such it became final. Because this appeal stream begins with a supplemental claim, it could be argued that it encompasses continuously pursued claims prior to that filing. However, the April 2024 Board decision and the subsequent AOJ decision were not appealed. Therefore, the Board lacks jurisdiction relating to this decision and any claims continuously pursued therein.

Rather, the Board finds that the current claims stem from a sixth, and final appeal stream. This began on July 27, 2023, when the Veteran submitted a claim for increased ratings for his left knee conditions. In October 2023, a rating decision was provided. The Veteran proceeded to submit three supplemental claims, each citing the October 2023 rating decision. In December 2023, a rating decision was provided.

In January 2024, the Veteran submitted a VA Form 10182, and a docket letter was provided later in the same month. The Board issued a decision in July 2024 that led to the JMPR outlined above.

This claim stands alone, independent from prior claims, as a claim for service connection and a subsequent claim for an increased rating are not the same case. See Jackson v. McDonough, 37 Vet. App. 277 (2024).

The Board thus finds that the evidentiary window began with the July 2023 claim for increased ratings. Furthermore, increased compensation claims allow for a one-year look back via 38 U.S.C. § 5110(b)(3), which has been applied in the present case. The Federal Circuit has held that the Board must review the entire record but does not have to discuss each piece of evidence. Gonzales v. West, 218 F.3d 1378 (Fed. Cir. 2000). Therefore, the Board will discuss the evidence pertinent to the claims at issue.

As an initial matter, the JMPR instructed the Board to determine both when the appeal period began and ended. In this regard, the Veteran's January 2024 VA Form 10182 elected the Direct Review lane. The evidentiary window closes on the date of the decision being appealed. The parties stated that the Board "impermissibly limited the end date for an increased evaluation to the day before the RO's initial decision." See September 2025 CAVC Decision at 41. However, at the time of this decision, the Veteran's 30 percent rating for limitation of extension has not been limited to the day prior to the RO's initial decision. See November 2025 Rating Decision - Codesheet. The Board does not define the appeal period in a manner that limits the Board's authority to assign ratings only during this period, and the evidence of record does not reflect that the Veteran's end date for an increased evaluation been limited in such a way. Accordingly, the Board finds no remaining legal or factual controversy with respect to this issue.

The Board thus turns to the question of reconsideration of the claims within this corrected period. Previously, the Board considered evidence from October 21, 2023; however, in light of the JMPR, the Board must now reconsider, pursuant to 38 U.S.C. § 5110(b)(3), whether it is factually ascertainable that an increase in disability occurred within the one-year prior to the July 27, 2023, claim for increased ratings. Accordingly, the Board has reviewed the June 2022 VA examination, which falls within the statutory lookback window, as well as the September 2023 VA examination, which was conducted within the evidentiary period.

The Board notes that a VA examination was provided in June 2022. It is noted that the Board, in developing a separate appeal stream, had previously determined that this examination was inadequate, as the examiner did not consider the Veteran's lay statements. While a remand was ordered so that a new examination could be provided, the Board has considered the evidence that is relevant and favorable to the Veteran. See April 2024 BVA Decision.

27, 2023, claim for increased ratings. Accordingly, the Board has reviewed the June 2022 VA examination, which falls within the statutory lookback window, as well as the September 2023 VA examination, which was conducted within the evidentiary period.

At the examination, the Veteran reported having a "very sharp pain under [his] knee cap," along with soreness and painful motion. Flare-ups were reported to occur daily and were described as severe. These symptoms were alleviated by stretching the leg out. He further reported that his left knee would "give away" and he would have to catch himself as it felt like he would fall. While the examiner stated that the Veteran had a history of instability or recurrent subluxation of the knee, no instability was found on examination. See June 2022 C&P Exam at 3, 7. The examination also disclosed no evidence of a ligament tear or sprain, nor did the Veteran have patellar instability. Id. at 8.

Upon examination, range of motion testing showed flexion to 105 degrees and extension to 5 degrees. Evidence of pain was found on weight-bearing, active motion, and passive motion. Id. at 5. No changes were found on observed repetitive use testing, repeated use over time, or flare-ups. Id. at 6, 7. No ankylosis was found. Id. at 8. The examiner opined that due to the Veteran's knee condition, it was painful to kneel and when walking for long periods of time. Difficulty with balance to the knee going out was noted, as well as the Veteran being demoted at work due to knee pain. Id. at 11.

A second VA examination was provided in September 2023. There, the Veteran reported current symptoms of sharp and aching pain, popping of the knees, loss of balance, and wobbling of the patella. See September 2023 C&P Exam at 4. Daily flare-ups were reported, occurring at least once a month and lasting one to four days. These flare-ups were precipitated by over-exertion, and were alleviated by rest, elevation, and injections. The examiner found that the Veteran did not have a history of instability or recurrent subluxation of the knee or a history of frequent effusion of the knee. Id. The examiner did not find that, at the examination, the Veteran had slight lateral instability of the left knee. The examination also disclosed no evidence of a ligament tear or sprain, and the Veteran did not have patellar instability. Id. at 9.

Upon examination, range of motion testing showed flexion to 90 degrees and extension to 0 degrees. Id. at 6. Evidence of pain was found on active motion, along with crepitus that caused localized tenderness or pain on palpation. Id. at 7. No changes were found on observed repetitive use testing; however, repeated use over time showed flexion to 80 degrees. Id. The examiner opined that flare-ups caused flexion to 60 degrees and extension to 10 degrees. Id. at 8. No ankylosis was found. Id. at 9. The examiner opined that due to the Veteran's knee condition, he could not tolerate periods of prolonged knee flexion, including sitting, driving, standing or ambulation. His condition stopped him from being able to run, jump, lunge, kneel, crawl, climb, squat, or crouch. He was found to have difficulty using stairs. Id. at 12.

Also of record is a VA examination, dated December 2023. This examination was previously considered, and no deficiencies were noted by the parties in the JMPR. For the purpose of providing a complete analysis, the Board has included its prior analysis herein.

At the examination, the Veteran reported current symptoms of left knee pain, which was worsening over time. See December 2023 C&P Exam at 3. Daily flareups were reported, caused by "any type of physical activities." Id. at 4. The examiner found that the Veteran did not have a history of instability or recurrent subluxation of the knee or a history of frequent effusion of the knee. Id. at 5. The examiner did find that, at the examination, the Veteran had slight lateral instability of the left knee. The examination also disclosed no evidence of a ligament tear or sprain, nor did the Veteran have patellar instability. Id. at 15, 22. Upon examination, range of motion testing showed flexion to 100 degrees and extension to 20 degrees. Id. at 7.

Evidence of pain was found on active motion, along with crepitus that did not cause localized tenderness or pain on palpation. Id. at 8. No changes were found on observed repetitive use testing; however, repeated use over time showed flexion to 90 degrees and extension to 25 degrees and the examiner opined that flareups shared the range of motion as repeated use over time testing. Id. at 9, 10. No ankylosis was found. Id. at 14. The examiner opined that the Veteran's left knee condition caused zero to one week of work time lost in a year, and that the left knee condition caused pain when standing and walking. Id. at 21.

A review of the medical record does not show any evidence that contradicts the findings of the VA examiner at any point in the period on appeal.

The Board begins with the Veteran's left knee flexion. In this, the Veteran is rated at 10 percent disabling from July 2012. See November 2025 Rating Decision - Codesheet. The Veteran's most limiting flexion was 60 degrees during flare-ups, as documented in the September 2023 examination. However, at no time during the period on appeal was the Veteran's left knee flexion limited to 30 degrees, which would warrant a 20 percent rating. Therefore, an increased rating based on limitation of flexion is not warranted for the period on appeal. 38 C.F.R. § 4.71a; DC 5260.

The Board moves to the issue of the Veteran's left knee extension. In this, the Veteran is rated as being noncompensable (0 percent) from May 2021 to October 2023, 10 percent disabling from October 2023 to December 2023, and 30 percent thereafter. See November 2025 Rating Decision - Codesheet.

The probative evidence of record shows that, prior to December 2023, extension was, at worst, limited to 10 degrees during flare-ups, as documented in the September 2023 VA examination. From December 2023, extension was, at worst, limited to 25 degrees during flare-ups, as documented in the December 2023 VA examination. A review of the record does not show any medical or lay evidence that shows his condition had worsened beyond what was documented at the time of the December 2023 examination.

Previously, the Board had found that based upon the Veteran's lay statements about worsening symptoms, reasonable doubt must be resolved in the Veteran's favor. This necessitated the grant of a 30 percent rating. The Board had also previously found that the evidence of record did not show left knee extension limited to 30 degrees or worse, and therefore a rating in excess of 30 percent could not be granted. 38 C.F.R. § 4.71a; DC 5261. A careful review of the entirety of the evidence of record does not show any evidence that alters this analysis.

The Board has also considered the Veteran's left knee instability. This condition is rated at 10 percent disabling from July 2019. See November 2025 Rating Decision - Codesheet. The evidence of record does not show that the Veteran had a left knee sprain, incomplete ligament tear, or repaired complete ligament tear, that caused persistent instability necessitating a medical provider prescribing a brace or assistive device. Likewise, the record does not show an unrepaired or failed repair
30 percent could not be granted. 38 C.F.R. § 4.71a; DC 5261. A careful review of the entirety of the evidence of record does not show any evidence that alters this analysis.

The Board has also considered the Veteran's left knee instability. This condition is rated at 10 percent disabling from July 2019. See November 2025 Rating Decision - Codesheet. The evidence of record does not show that the Veteran had a left knee sprain, incomplete ligament tear, or repaired complete ligament tear, that caused persistent instability necessitating a medical provider prescribing a brace or assistive device. Likewise, the record does not show an unrepaired or failed repair of a complete ligament tear, causing persistent instability with a medical provider prescribing an assistive device for ambulation. Therefore, a rating in excess of 10 percent is not warranted. 38 C.F.R. § 4.71a, DC 5257.

The Board has further considered other potentially applicable diagnostic codes of the knee that could warrant an increased and/or separate rating. However, the current evidence of record does not reveal or otherwise suggest that the Veteran's left knee disability has related ankylosis, tibia or fibula impairment, genu recurvatum, or a meniscus condition, as to warrant consideration of ratings under DCs 5256, 5258, 5262, and 5263.

In reaching the above conclusions, it is noted that 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); Ingram v. Collins, 38 Vet. App. 130 (2025). The Court also held that, with respect to DCs that do not reference medication, "the Board must discount beneficial medication effects when assigning an evaluation." Id. Here, Diagnostic Codes referenced do not consider the ameliorative effects of medication. The Board notes, however, that the record contains no indication (and the Veteran has not contended) that medication was prescribed or that over the counter medication resulted in ameliorative effects during the review period. Thus, the Board's application of the relevant DCs in this case does not consider any ameliorative effects of medication in assessing the level of impairment caused by the Veteran's conditions, as the record does not show that it does.

[The Board has also considered whether entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is raised by the record in the context of the instant claims for increase. The Board finds it is not. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Notably, the record does not show (and the Veteran has not alleged) that he is unemployable due to his left knee conditions.]

For the reasons set forth above, the Board concludes that the evidence persuasively favors against assigning ratings higher than those currently assigned or additional separate ratings for the left knee beyond that assigned herein; the benefit of the doubt rule does not apply. See Lynch, 21 F.4th at 781. The claims must be denied.

S. CHARLES NEILL

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board P. Abels, Attorney Advisor

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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