KNEE IMPAIRMENT OF

L.M. YASUI · 2026 · Case ID: A26040133

DENIED

Summary

The veteran, who served from November 1976 to March 1977 and August 1978 to April 1980, appeals the denial of an increased rating for his service-connected left knee strain. The veteran contended that his left knee strain, with limitation of extension, should be rated higher than the current 10 percent, and that his left knee strain, with limitation of flexion, should receive a compensable rating. The Board reviewed the evidence of record, including VA treatment records and a July 2019 VA examination. The examination noted normal range of motion for the right knee and flexion to 90 degrees and extension to 0 degrees for the left knee. While pain on extension caused functional loss, the examiner estimated the range of motion after repeated use as flexion to 70 degrees and extension to 0 degrees, with normal muscle strength. The Board found that the evidence persuasively weighed against a rating higher than 10 percent for the extension limitation, as the Veteran's lay reports of moderate flare-ups did not demonstrate a limitation of motion approximating 15 degrees or more. For the flexion limitation, the Board found the evidence persuasively weighed against a compensable rating, as the Veteran's lay reports and the objective medical evidence did not demonstrate a limitation of motion to 45 degrees or less. The Board denied both claims for an increased rating.

Rationale

Evidence persuasively weighs against rating in excess of 10 percent; Lay reports of moderate flare-ups did not demonstrate sufficient limitation of motion; VA examination found normal range of motion after repeated use, with pain causing functional loss

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

5261

Docket No.

200511-86694

Full Decision Text

Citation Nr: A26040133
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 200511-86694
DATE: April 29, 2026

ORDER

Entitlement to an initial evaluation in excess of 10 percent for left knee strain, limitation of extension, is denied.

Entitlement to an initial compensable evaluation for left knee strain, limitation of flexion is denied.

FINDINGS OF FACT

1. At no point during the appeal period did the Veteran's service-connected left knee strain, limitation of extension, manifest as extension limited to 15 degrees or more.

2. At no point during the appeal period did the Veteran's service-connected right knee strain, limitation of flexion, manifest as pain with flexion or flexion limited to 45 degrees or less.

CONCLUSIONS OF LAW

1. The criteria for an initial evaluation in excess of 10 percent for left knee strain, limitation of extension, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.7, 4.71a, Diagnostic Code 5261.

2. The criteria for an initial compensable rating for left knee strain, limitation of flexion, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.7, 4.71a, Diagnostic Code 5260.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served active duty from November 1976 to March 1977 and August 1978 to April 1980.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2019 rating decision (RD) issued by the Department of Veterans Affairs (VA) Regional Office (RO).

In the May 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on July 25, 2024, and a transcript associated with the claims file.

Therefore, the Board may only consider the evidence of record at the time of the August 2019 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 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.

The Board thoroughly reviewed all evidence in the Veteran's file. In every decision, the Board must provide a statement of the reasons and bases for its determination, adequate to enable an appellant to understand the precise basis for the Board's decision, as well as to facilitate review by the Court. 38?U.S.C. §?7104(d)(1). Although the entire record must be reviewed by the Board, the Court has repeatedly found that the Board is not required to discuss, in detail, every piece of evidence. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000); Dela Cruz v. Principi, 15?Vet. App.?143, 149 (2001) (rejecting the notion that the Veterans Claims Act mandates the Board discuss all evidence). Rather, the law requires only that the Board address its reasons for rejecting evidence favorable to the appellant. See Timberlake v. Gober, 14?Vet. App.?122 (2000). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim. The appellant must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake, supra.

Increased Ratings

VA has adopted a Schedule for Rating Disabilities (Schedule) to evaluate service-connected disabilities. See 38 U.S.C
et. App.?143, 149 (2001) (rejecting the notion that the Veterans Claims Act mandates the Board discuss all evidence). Rather, the law requires only that the Board address its reasons for rejecting evidence favorable to the appellant. See Timberlake v. Gober, 14?Vet. App.?122 (2000). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim. The appellant must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake, supra.

Increased Ratings

VA has adopted a Schedule for Rating Disabilities (Schedule) to evaluate service-connected disabilities. See 38 U.S.C. § 1155; 38 C.F.R., Part IV. Disability evaluations assess the ability of the body as a whole, the psyche, or a body system or organ to function under the ordinary conditions of daily life, to include employment. 38 C.F.R. § 4.10. The percentage ratings in the Schedule represent the average impairment in earning capacity resulting from service-connected diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The percentage ratings are generally adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the disability. Id.

In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991).

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 and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also to 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). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria.").

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).

A veteran may receive a compensable disability rating based on pain, pursuant to 38 C.F.R. § 4.59, which relates to painful motion. This regulation notes: "The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or maligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint." 38 C.F.R. § 4.59. The United States Court of Appeals for Veterans Claims (Court) has explained that 38 C.F.R. § 4.59 applies when evaluating joint pain, even if such pain is not arthritis related. Burton v. Shinseki, 25 Vet. App. 1, 4 (2011).

The Secretary shall consider all information, lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When all the evidence is assembled, the Board is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the evidence is persu
for the joint." 38 C.F.R. § 4.59. The United States Court of Appeals for Veterans Claims (Court) has explained that 38 C.F.R. § 4.59 applies when evaluating joint pain, even if such pain is not arthritis related. Burton v. Shinseki, 25 Vet. App. 1, 4 (2011).

The Secretary shall consider all information, lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When all the evidence is assembled, the Board is then responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the evidence is persuasively against the claim, in which case the claim is denied. When there is an approximate balance of positive and negative evidence regarding an issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3.

Generally, a Veteran is assumed to be seeking the highest rating possible in appeal, See AB v. Brown, 6 Vet. App. 35 (1993) (unless a veteran expresses a desire for a specific rating for a service-connected disability, he/she is presumed to be seeking the maximum benefit permitted under the regulations).

1. Entitlement to an initial evaluation in excess of 10 percent for left knee strain, limitation of extension

The Veteran contends the initial evaluation of left knee strain, limitation of extension should be greater than 10 percent. See May 2020 Notice of Disagreement.

The Veteran's left knee strain, limitation of extension is rated 10 percent from June 26, 2019, under 38 C.F.R. § 4.71a, Diagnostic Code 5261, limitation of extension of the knee. Under Diagnostic Code 5261, a noncompensable rating is warranted for extension limited to 5 degrees. A 10 percent rating is warranted for extension limited to 10 degrees. A 20 percent rating is warranted for extension limited to 15 degrees. A 30 percent rating is warranted for extension limited to 20 degrees. A 40 percent rating is warranted for extension limited to 30 degrees. A 50 percent rating is warranted for extension limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261.

The Board notes VA amended the rating criteria for disabilities of the knee and leg effective February 7, 2021; however, DC 5261 was unchanged.

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 and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also 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). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria.").

Here, the AOJ rated the Veteran's left knee strain, limitation of extension, 10 percent as minimum compensation based on painful motion upon extension of the knee. See August 2019 Rating decision.

The Board finds that the evidence of record persuasively weighs against a rating in excess of 10 percent for left knee strain, limitation of extension. The Board acknowledges the Veteran's lay reports of symptoms and that
, the AOJ rated the Veteran's left knee strain, limitation of extension, 10 percent as minimum compensation based on painful motion upon extension of the knee. See August 2019 Rating decision.

The Board finds that the evidence of record persuasively weighs against a rating in excess of 10 percent for left knee strain, limitation of extension. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to repetitive use, pain during flare-ups, and pain during repetitive use over time. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements that moderate flare-ups once or twice a week lasting a couple of days would not result in limitation of motion more nearly approximating extension limited to 15 degrees or more.

VA treatment records during the period on appeal show that left knee pain continued as an active problem with no evidence that the Veteran sought care for left knee issues. See VBMS entry document type "CAPRI," receipt date 01/16/2020, pgs. 94, 156, 243; VBMS entry document type "CAPRI," receipt date 07/11/2019, pgs. 9, 45, 85; VBMS entry document type "CAPRI," receipt date 07/02/2024, pg. 416.

The Veteran attended a VA examination regarding knee disability in July 2019. He reported a history of left leg pain following an in-service back injury. Current symptoms are numbness, pain, and tingling with moderate flare-ups of left knee pain occurring once or twice a week, lasting a couple of days. Flare-ups are triggered by sitting or standing for long periods of time and are alleviated by rest. The Veteran reported functional impairment comprised of difficulty sitting or standing for too long. Both knees were examined with weight-bearing and non-weight-bearing. Range of motion for the right knee was normal. Initial range of motion of the left knee was flexion to 90 degrees and extension to 0 degrees out of the normal 0 to 140-degree range of motion for the knee. The abnormal range of motion itself did not contribute to a functional loss of use. However, pain with extension caused functional loss. The examiner estimated the Veteran's range of motion of the left knee after repeated use over to time as flexion to 70 degrees and extension to 0 degrees with additional loss of function due to pain and lack of endurance described as range of motion 0 degrees to 60 degrees. Muscle strength was normal bilaterally in both flexion and extension. The examiner noted no muscle atrophy, ankylosis, recurrent subluxation or instability, meniscus condition, patellar dislocation, shin splints, chronic exertional compartment syndrome, or other tibial or fibular impairment on either side.

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

As discussed above, there is no evidence of ankylosis, recurrent subluxation or instability, meniscus condition, patellar dislocation, shin splints, chronic exertional compartment syndrome, or other tibial or fibular impairment of the left knee. Further, the Board considered the Veteran's lay contention of knee instability, particularly during the July 2024 Board hearing. However, the Veteran did not report instability or any symptoms related to instability of the left knee during the appeal period. See English v. Wilkie, 30 Vet. App. 347, 352 (2018) (holding that when addressing knee instability under DC 5257 for the rating criteria prior to February 7, 2021, objective medical evidence is not required or is to be favored over lay evidence). Stated another way, in English v. Wilkie, the Court held that, unless explicitly contemplated, objective evidence of a symptom is not categorically more probative than lay evidence in determining whether to assign an increased rating. To be clear, the Board finds the objective medical evidence more prob
2024 Board hearing. However, the Veteran did not report instability or any symptoms related to instability of the left knee during the appeal period. See English v. Wilkie, 30 Vet. App. 347, 352 (2018) (holding that when addressing knee instability under DC 5257 for the rating criteria prior to February 7, 2021, objective medical evidence is not required or is to be favored over lay evidence). Stated another way, in English v. Wilkie, the Court held that, unless explicitly contemplated, objective evidence of a symptom is not categorically more probative than lay evidence in determining whether to assign an increased rating. To be clear, the Board finds the objective medical evidence more probative than the Veteran's report of perceived left knee instability. In reaching this finding, the Board notes that a medical professional physically examined the Veteran's knees and found there was no instability. Indeed, in the July 2019 VA examination report, the examiner documented that the examiner performed four tests to assess whether the knees had instability. Here, the examiner found no instability. Specifically, the examiner tested for anterior instability, posterior instability, medial instability, and lateral instability (four tests) and found all four tests were normal. The four tests, which did not reveal instability, support the conclusion that the Veteran's perceived knee instability is not due to anterior, posterior, medial, or lateral knee joint laxity. Thus, changing the diagnostic code or assignment of a separate rating is not warranted. 38 C.F.R. § 4.71a, Diagnostic Code 5256, 5257, 5258, 5259, 5262, 5263.

In conclusion, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for a rating in excess of 10 percent for left knee strain, limitation of extension, disability. As the evidence of record persuasively weighs against a rating in excess of 10 percent, 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 (2021).

2. Entitlement to an initial compensable evaluation for left knee strain, limitation of flexion

The Veteran contends the initial evaluation of left knee strain, limitation of flexion should be greater than 0 percent. See May 2020 Notice of Disagreement.

The Veteran's left knee strain, limitation of flexion is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5260, for limitation of flexion of the leg. Under Diagnostic Code 5260, a noncompensable rating is warranted for flexion limited to 60 degrees. A 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260.

The Board notes VA amended the rating criteria for disabilities of the knee and leg effective February 7, 2021; however, DC 5260 was unchanged.

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 and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also 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). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria.").

Under 38 C.F.R. § 4.59, painful motion
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.").

The Board finds that the evidence of record persuasively weighs against a compensable rating for left knee strain, limitation of flexion. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to repetitive use, pain during flare-ups, and pain during repetitive use over time. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements that moderate flare-ups once or twice a week lasting a couple of days would not result in limitation of motion would not result in limitation of motion more nearly approximating flexion limited to 45 degrees or less.

The discussion above of VA treatment records and the July 2019 VA examination during the period on appeal and the Board's consideration of other Diagnostic Codes pertaining to the knee and leg are incorporated herein. The evidence did not show pain on flexion or limitation of motion to 45 degrees or less of the left knee at any time during the period on appeal.

In conclusion, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for a compensable rating for left knee strain, limitation of flexion. As the evidence of record persuasively weighs against a compensable rating, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (2021).

L.M. YASUI

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Spears, J.E.

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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