OSTEOARTHRITIS

Summary

The Veteran, an Army Veteran who served from May 2005 to August 2006 and October 2010 to December 2011, appeals the denial of increased disability ratings for his right ankle and right knee conditions. The Veteran sought ratings in excess of 10 percent for both conditions, citing degenerative arthritis and bone spurs. The Board reviewed the March 2025 VA examination, which indicated normal range of motion for the right ankle with pain, but no functional loss or instability. The Veteran's own reports of pain and limitation were found to be outweighed by the objective medical findings. For the right knee, the Veteran claimed entitlement to a higher rating for limitation of flexion and a separate rating for limitation of extension. The VA examination found flexion limited to 130 degrees during flare-ups, which did not meet the criteria for a higher rating under Diagnostic Code 5260. However, the examination did note extension limited to 10 degrees during flare-ups, which met the criteria for a 10 percent rating under Diagnostic Code 5261. The Board found the evidence persuasively weighed against higher ratings for the right ankle and right knee flexion, denying those claims. Service connection for the right knee limitation of extension was granted at 10 percent.

Rationale

Weight of evidence persuasively against assignment of rating in excess of 10 percent.; Objective medical evidence showed normal range of motion with pain but no functional loss.; Veteran's subjective complaints outweighed by objective findings.

Full Decision Text

Citation Nr: A26039964
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 250404-535305
DATE: April 29, 2026

ORDER

Entitlement to a rating in excess of 10 percent for right ankle, bone spur with degenerative arthritis is denied.

Entitlement to a rating in excess of 10 percent for right knee, bone spur with degenerative arthritis, limitation of flexion, is denied.

Entitlement to a separate 10 percent rating for right knee, limitation of extension, is granted. 

FINDINGS OF FACT

1. The Veteran's right ankle disability did not manifest as marked limitation of motion of the ankle defined as less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion.

2. The Veteran's right knee flexion is not limited to 30 degrees or less, to include during flareups and after repeated use over a period of time.? 

3. The Veteran's right knee disability resulted in, at worst, limitation of extension to 10 degrees.

CONCLUSIONS OF LAW

1. The criteria for entitlement to an evaluation in excess of 10 percent for a right ankle disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5271.

2. The criteria for entitlement to an evaluation in excess of 10 percent for a right knee disorder are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5260.? 

3. The criteria for entitlement to a separate 10 percent disability rating for limitation of extension of the right knee, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.1, 4.7, 4.40, 4.45, 4.71a, Diagnostic Code 5261.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from May 2005 to August 2006 and from October 2010 to December 2011. 

He filed a supplemental claim in February 2025. In a March 2025 rating decision, the Agency of Original Jurisdiction (AOJ) continued the 10 percent ratings for the Veteran's right ankle and right knee disorders. 

In the April 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 March 2025 AOJ decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the 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. 

Increased Ratings

Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38?U.S.C. § 1155; 38 C.F.R. Part 4. The percentage ratings in VA's Schedule for Rating Disabilities (Rating Schedule) represent as far as can practicably be determined the average impairment in earning capacity resulting from such disabilities and their residual conditions in civil occupations. 38 C.F.R. § 4.1.

Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38?C.F.R. §?4.7. When there is an approximate 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
 C.F.R. Part 4. The percentage ratings in VA's Schedule for Rating Disabilities (Rating Schedule) represent as far as can practicably be determined the average impairment in earning capacity resulting from such disabilities and their residual conditions in civil occupations. 38 C.F.R. § 4.1.

Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38?C.F.R. §?4.7. When there is an approximate 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 claimant. 38 U.S.C. § 5107(b); 38?C.F.R. §§?3.102, 4.3. 

Where entitlement to compensation has already been established and increase in disability is at issue, the present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994). However, "staged" ratings are appropriate where the factual findings show distinct time periods when the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); see also Fenderson v. West, 12 Vet. App. 119 (1999). 

Additionally, disabilities, including those arising from a single disease entity, are generally rated separately before ratings are then combined in accordance with 38 C.F.R. § 4.25. However, VA is prohibited from pyramiding (rating the same disability, or the same manifestation of a disability, under different diagnostic codes). 38 C.F.R. §?4.14. When disabilities have duplicative or overlapping symptoms, the rule against pyramiding prohibits VA from compensating the Veteran more than once for the same symptom or impairment. Esteban v. Brown, 6?Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107 (2017). 

When evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). The Court has clarified that although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011); cf. Powell v. West, 13 Vet. App. 31, 34 (1999); Hicks v. Brown, 8 Vet. App. 417, 421 (1995); Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991). 

Instead, the Court in Mitchell explained that pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance, as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing. See 38 C.F.R. §§ 4.40, 4.45. Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. In evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors.

The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize 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 final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of ROM testing "for pain on both active (AROM) and passive motion (PROM) [and] in weight-bearing and non-weight-bearing and, if possible, with ROM measurements of the opposite undamaged joint." Correia v. McDonald, 28 Vet. App
.

The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize 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 final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of ROM testing "for pain on both active (AROM) and passive motion (PROM) [and] in weight-bearing and non-weight-bearing and, if possible, with ROM measurements of the opposite undamaged joint." Correia v. McDonald, 28 Vet. App. 158 (2016). The spine has no opposite joint. 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. Sharp v. Shulkin, 29 Vet. App. 26 (2017).

When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use. Further, 38 C.F.R. § 4.45 requires consideration be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8?Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). That said, while the background factors listed in §§?4.40 and 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38?C.F.R. §?4.71a; a separate or higher rating under §?4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of §?4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the §?4.71a criteria."). 

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

The Veteran is entitled to a staged rating for any part of the rating period on appeal where his disability manifested with greater severity. See Fenderson v. West, 12 Vet. App. 119 (1999). 

1. Entitlement to a rating in excess of 10 percent for the Veteran's right ankle disability 

The Veteran's right ankle disability has been evaluated under Diagnostic Code 5271. 38?C.F.R. §?4.71a. 

Diagnostic Code 5271 provides that moderate limitation of motion of the ankle (defined as less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion) warrants a 10 percent rating, and marked limitation of motion (defined as less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion) is assigned a 20 percent rating. The normal range of motion of the ankle is 0 to 20 degrees of dorsiflexion and 0 to 45 degrees of plantar flexion. 38?C.F.R. §?4.71, Plate II. 

Turning to the evidence, the Veteran was afforded a VA examination for ankle conditions in March 2025. The examiner indicated diagnoses of degenerative arthritis and plantar spur, right ankle. The Veteran reported a worsening of pain and with flare ups a few times per month. Regarding functional impairment, during a flare up, it is difficult for the Veteran to walk. The Veteran denied instability. Active and passive range of motion testing of the right ankle was normal, with pain but no functional loss. There was objective evidence of tenderness to palpation. The Veteran was able to perform repetitive use testing with at least three repetitions with plantar flexion limited to 40 degrees and dorsiflexion to 15 degrees for the right ankle. The examiner stated that the examination was conducted after repeated use over time and during a flare up, and plantar flexion was limited to 40 degrees and dorsiflexion was limited to 15
 The Veteran reported a worsening of pain and with flare ups a few times per month. Regarding functional impairment, during a flare up, it is difficult for the Veteran to walk. The Veteran denied instability. Active and passive range of motion testing of the right ankle was normal, with pain but no functional loss. There was objective evidence of tenderness to palpation. The Veteran was able to perform repetitive use testing with at least three repetitions with plantar flexion limited to 40 degrees and dorsiflexion to 15 degrees for the right ankle. The examiner stated that the examination was conducted after repeated use over time and during a flare up, and plantar flexion was limited to 40 degrees and dorsiflexion was limited to 15 degrees for the right ankle. The examiner noted no muscle atrophy or ankylosis. Regarding stability, anterior drawer test was negative. Regarding occupational impairment, the Veteran reported that he is a police officer and has lost less than one week of work time over the prior 12 months. 

The Board finds that the March 2025 VA examination is in compliance with Sharp and Correia. Sharp, 29 Vet. App.at 26; Correia, 28 Vet. App. at 158.

No other range of motion findings are of record that demonstrate limitation of right ankle motion that was more than of average or medium quantity, quality, or extent, to include with repeated use over time and/or during flare-ups. There is certainly no evidence that shows dorsiflexion to have been 5 degrees or less, or plantar flexion to have been 10 degrees or less even with repeated use over time and during flare-ups. 

The Veteran has not identified any evidence which demonstrates more than moderate limitation of right ankle motion during this period. Moreover, he has not alleged, nor is there any evidence to show, that he would have had markedly limited motion of the right ankle but for the ameliorative effects of medication. See, e.g., Ingram v. Collins, 38?Vet. App.?130, 135 (2025); Jones (David J.) v. Shinseki, 26 Vet. App. 56 (2012). 

The?Board has carefully considered?the?Veteran's assertions regarding the severity of his right?ankle disorder. He is competent to state how he experiences symptoms, such as pain and limitation of motion that?require?only personal knowledge as it comes to him through his senses. See Washington v. Nicholson,?19?Vet. App.?362, 368?(2005). However, he is?not?competent to identify the?specific level?of?disability according to?the?relevant diagnostic codes. See Jandreau v. Nicholson,?492 F.3d 1372?(Fed. Cir. 2007). His opinions are outweighed by the medical evidence of record, which shows?that?he is?not?entitled to an evaluation in excess?of?the one presently assigned.? 

In light of the foregoing, the Board finds that the weight of the evidence is persuasively against the assignment of a rating in excess of 10 percent for the Veteran's service-connected right ankle and left ankle disabilities during the entirety of the period on appeal. As the evidence weighs persuasively against the Veteran's claim, the benefit-of-the-doubt doctrine is not for application. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. 

2. Entitlement to a rating in excess of 10 percent for right knee, bone spur with degenerative arthritis, limitation of flexion

3. Entitlement to a separate 10 percent rating for right knee, limitation of extension

The Veteran contends that his service-connected right knee disability is worse than that which is contemplated by his 10 percent rating under 38 C.F.R. § 4.71a, Diagnostic Code 5260.

Under Diagnostic Code 5260, a noncompensable disability evaluation is assigned when flexion limited to 60 degrees, a 10 percent disability evaluation is assigned when flexion is limited to 45 degrees, and a 20 percent disability evaluation is warranted when flexion is limited to 30 degrees. A 30 percent disability evaluation is assigned when flexion is limited to 15 degrees, which is the maximum evaluation available under Diagnostic Code 5260.

Under Diagnostic Code 5261, a noncompensable disability evaluation is assigned when extension is limited to 5 degrees, a 10 percent rating for extension limited to 10 degrees, a 20 percent rating for extension limited to 15 degrees, a 30 percent rating for extension limited to 20 degrees, and 40 percent rating for extension limited to 30 degrees, and a maximum 50
 a 10 percent disability evaluation is assigned when flexion is limited to 45 degrees, and a 20 percent disability evaluation is warranted when flexion is limited to 30 degrees. A 30 percent disability evaluation is assigned when flexion is limited to 15 degrees, which is the maximum evaluation available under Diagnostic Code 5260.

Under Diagnostic Code 5261, a noncompensable disability evaluation is assigned when extension is limited to 5 degrees, a 10 percent rating for extension limited to 10 degrees, a 20 percent rating for extension limited to 15 degrees, a 30 percent rating for extension limited to 20 degrees, and 40 percent rating for extension limited to 30 degrees, and a maximum 50 percent rating for extension limited to 45 degrees or more.

For rating purposes, normal range of motion in a knee joint is from 0 to 140 degrees. 38 C.F.R. § 4.71, Plate II. An evaluation of a knee disability under Diagnostic Codes 5257, 5260, or 5261 does not, as a matter of law, preclude separate evaluation of a meniscal disability of the same knee under Diagnostic Code 5258 or 5259, and vice versa. Lyles v. Shulkin, 29 Vet. App. 107 (2017). Rather, a separate evaluation in a given case depends on whether manifestations for which a separate evaluation is being sought have already been compensated by an assigned evaluation under a different Diagnostic Code; and that, in evaluations of musculoskeletal disabilities based on limitation of motion, a manifestation has not been compensated, for separate evaluation and pyramiding purposes, if that manifestation did not result in an elevation of the evaluation under 38 C.F.R. §§ 4.40 and 4.45, pursuant to principles set forth in DeLuca. Lyles, 29 Vet. App. at 118-19.

The Board has carefully reviewed the evidence of record and finds the evidence persuasively weighs against the award of a rating more than 10 percent for right knee disability.

The Veteran was afforded a VA examination in March 2025. The examiner noted a diagnosis of degenerative arthritis and enthesophyte. Regarding symptoms, the Veteran reported tightness and decreased flexibility. The Veteran reported flare ups occurring a coupon of days per month, lasting a couple days. He denied functional impairment, frequent effusion, and instability, but reported wearing a knee brace at the gym. Active and passive range of motion testing was normal, with pain on active flexion and extension that did not result in functional loss. There was objective evidence of crepitus, but no localized tenderness or pain on palpation. The Veteran was able to perform repetitive use testing with no additional loss in range of motion. With flare ups, the examiner estimated a loss of 10 degrees of flexion and extension due to pain, fatiguability, and weakness. There was no atrophy or ankylosis. Regarding joint stability, the examiner noted no recurrent subluxation, patellar instability, persistent instability, and no ligament tear. Regarding occupational impairment, the Veteran reported that he is a police officer and has lost less than one week of work time over the prior 12 months. 

The Board finds that the March 2025 VA examination is in compliance with Sharp and Correia. Sharp, 29 Vet. App.at 26; Correia, 28 Vet. App. at 158.

Upon review of the record, the Board finds that a rating in excess of 10 percent for a right knee disorder, limitation of flexion, is not warranted. At no point during the period on appeal does the record show that the Veteran's flexion was limited to 30 degrees or less to warrant a higher 20 percent rating. The VA examiner estimated limitation of flexion to 130 degrees, at worst, during a flare up and with consideration of repeated use over time. Therefore, entitlement to an increased rating for limitation of flexion is not warranted. 

Looking to other diagnostic codes addressing limitation of motion, the Board finds that a separate 10 percent rating under Diagnostic Code 5261 for limitation of extension is warranted. At the March 2025 VA examination, the examiner noted that the Veteran's right knee extension was limited to 10 degrees during flare ups. Accordingly, a separate 10 percent rating for limitation of extension is granted. As extension is not limited beyond 10 degrees, a higher rating is not warranted. 

Regarding other relevant Diagnostic Codes of the knee, the record shows no ankylosis, no meniscal conditions, and no tibial or fibular disorders for ratings under Diagnostic Codes 5256, 5258, 5259, or 5262. 

Regarding instability, although the Veteran reported the use of a brace during exercise, he denied instability
 percent rating under Diagnostic Code 5261 for limitation of extension is warranted. At the March 2025 VA examination, the examiner noted that the Veteran's right knee extension was limited to 10 degrees during flare ups. Accordingly, a separate 10 percent rating for limitation of extension is granted. As extension is not limited beyond 10 degrees, a higher rating is not warranted. 

Regarding other relevant Diagnostic Codes of the knee, the record shows no ankylosis, no meniscal conditions, and no tibial or fibular disorders for ratings under Diagnostic Codes 5256, 5258, 5259, or 5262. 

Regarding instability, although the Veteran reported the use of a brace during exercise, he denied instability and no subluxation or instability was found upon examination. To the extent he alleges instability, the Board finds a conflict of evidence in the record. The examination report is assigned more weight. See English v. Wilkie, 30 Vet. App. 347, 352-3. Therefore, a separate rating under Diagnostic Code 5257 is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.45, 4.59, 4.71a, Diagnostic Code 5257.?

The Veteran has not alleged, nor is there any evidence to show, that he would have had additional limited motion of the right knee but for the ameliorative effects of medication. See, e.g., Ingram, 38?Vet. App.?at 135; Jones, 26 Vet. App. at 56. 

The?Board has carefully considered?the?Veteran's assertions regarding the severity of his right?knee?disability. He is competent to state how he experiences symptoms, such as pain, limitation of motion, and instability, that?require?only personal knowledge as it comes to him through his senses. See Washington,?19?Vet. App.?at 368. However, he is?not?competent to identify the?specific level?of?disability according to?the?relevant diagnostic codes, and the Board takes into account the ranges of motion measurements that are not contradicted by the record. See Jandreau,?492 F.3d at 1372. His opinions are outweighed by?the?medical?evidence and ranges of motion?of?record, which shows?that?he is?not?entitled to an evaluation in excess?of?that presently assigned.? 

In conclusion,?the?evidence?of?record persuasively weighs against?the?Veteran's claim?for ratings?in excess?of?10 percent?for?limitation of flexion and extension of the right knee. As the evidence of record persuasively weighs against the Veteran's claims, the benefit-of-the-doubt rule does not apply. 38?U.S.C. §?5107 (b); 38 C.F.R. §§?4.3, 4.7;?Lynch,?21 F.4th at 776. 

 

 

Emily Tamlyn

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Shana Z. Siesser, 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.