KNEE IMPAIRMENT OF

RAY BARTO SLABBEKORN, JR. · 2026 · Case ID: A26040961

GRANTED

Summary

The veteran, who served in the United States Marine Corps from December 2009 to October 2017, appeals the denial of increased ratings for bilateral knee strain and the grant of a noncompensable rating for shin splints. The veteran also sought entitlement to special monthly compensation (SMC) at the housebound rate and a total disability rating based on individual unemployability (TDIU). The Board granted an increased rating of 20 percent for both the right and left knee strain, effective October 25, 2017, based on painful motion and functional loss equivalent to flexion limited to 30 degrees, applying the benefit of the doubt. The Board also granted a separate noncompensable rating for shin splints, acknowledging the M21-1 guidance for compensating shin splints without pyramiding, but found the evidence did not support a higher rating or a compensable rating under current or prior criteria. The Board granted SMC at the housebound rate from October 25, 2017, to March 11, 2024, due to the veteran having a 100 percent rating for an acquired psychiatric disorder and additional service-connected disabilities independently rated at 60 percent. The TDIU claim was dismissed as moot due to the combined effect of the 100 percent psychiatric disorder rating and the SMC housebound grant, which effectively established a 100 percent schedular rating.

Rationale

Painful motion and functional loss due to flexion limited to 30 degrees; Discounted ameliorative effects of medication; Applied benefit of the doubt

Service Branch

MARINE CORPS

Special Benefit

SMC - HOUSEBOUND; TDIU

Docket No.

210908-183686

Full Decision Text

Citation Nr: A26040961
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 210908-183686
DATE: April 30, 2026

ORDER

From October 25, 2017, entitlement to an increased 20 percent rating, but no higher, for right knee strain is granted.

From October 25, 2017, entitlement to an increased 20 percent rating, but no higher, for left knee strain is granted.

From October 25, 2017, entitlement to a separate initial noncompensable rating for shin splints is granted.

From October 25, 2017 to March 11, 2024, entitlement to special monthly compensation at the housebound rate is granted.

Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities is dismissed.

FINDINGS OF FACT

1. From October 25, 2017, the Veteran's right knee strain was manifested by functional impairment equivalent to flexion limited to 30 degrees during repeated use over time and flareups.

2. From October 25, 2017, the Veteran's left knee strain was manifested by functional impairment equivalent to flexion limited to 30 degrees during repeated use over time and flareups.

3. The Veteran's shin splints were non symptomatic and did not affect the range of motion of the knee or ankle; pain during flareups were attributed to his knee disabilities.

4. Throughout the appeal period, the Veteran has additional service-connected disabilities apart from his acquired psychiatric disorder independently ratable at 60 percent or more disabling.

5. The award of an earlier effective date for the 100 percent rating for acquired psychiatric disorder in a separate Board decision along with the grant of special monthly compensation at the housebound rate in this decision renders moot the issue of entitlement to a total disability rating based on individual unemployability.

CONCLUSIONS OF LAW

1. From October 25, 2017, the criteria for a rating of 20 percent, but no higher, for right knee strain have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.3, 4.71a, Diagnostic Code 5260.

2. From October 25, 2017, the criteria for a rating of 20 percent, but no higher, for left knee strain have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.3, 4.71a, Diagnostic Code 5260.

3. From October 25, 2017, the criteria are met for a separate initial noncompensable rating for shin splints. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.7, 4.71a, Diagnostic Code 5262.

4. From October 25, 2017 to March 11, 2024, the criteria for special monthly compensation at the housebound rate are met. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350.

5. The appeal regarding entitlement to a total disability rating based on individual unemployability is dismissed as moot. 38 U.S.C. § 7105(d)(5); 38 C.F.R. § 4.16.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Marine Corps from December 2009 to October 2017.

In September 2017, the Veteran submitted a predischarge claim for bilateral knee disabilities. A Department of Veterans Affairs (VA) Regional Office (RO) originally granted the Veteran's claims in a December 2017 rating decision. The RO granted service connection for right knee strain, rated 10 percent due to painful motion, effective October 25, 2017 (date after release from active duty). The RO also granted service connection for left knee strain, rated 10 percent due to painful motion, effective October 25, 2017 (date after release from active duty). In December 2018, the Veteran submitted a Notice of Disagreement. In a February 2020 Statement of the Case, the RO denied the Veteran's increased rating appeals. The RO concluded that the evidence only supported the minimum compensable evaluation for painful motion. In April 2020, the Veteran opted into the modernized appeals system (AMA). He elected Higher-Level review of his knee ratings. In a September 2020 Rating
motion, effective October 25, 2017 (date after release from active duty). The RO also granted service connection for left knee strain, rated 10 percent due to painful motion, effective October 25, 2017 (date after release from active duty). In December 2018, the Veteran submitted a Notice of Disagreement. In a February 2020 Statement of the Case, the RO denied the Veteran's increased rating appeals. The RO concluded that the evidence only supported the minimum compensable evaluation for painful motion. In April 2020, the Veteran opted into the modernized appeals system (AMA). He elected Higher-Level review of his knee ratings. In a September 2020 Rating Decision, the RO denied increased rating based on the evidence supporting a minimum compensable evaluation for painful motion.

In the September 2021 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Hearing docket. Based on this request, the Board scheduled a hearing for the Veteran and notified the Veteran and the Veteran's attorney more than two months before the scheduled hearing date. The Veteran's attorney submitted a withdrawal of the Veteran's hearing request three days before the hearing was scheduled to take place. As an appeal in which the appellant withdrew his hearing request, the Board's decision is based on a review of the evidence of record at the time of the decision on the issues on appeal, as well as evidence submitted by the appellant or his Attorney within 90 days following the hearing withdrawal.

The Veteran's attorney is reminded that the Standards of Conduct for persons providing representation before the VA include the expectation that an attorney providing representation "shall not delay, without good cause, the processing of a claim at any stage of the administrative process." 38 C.F.R. § 14.632(c)(7). Failing to submit a timely request to withdraw a hearing request wastes a hearing docket appointment that could otherwise be used for another Veteran. These are finite resources and each Veteran awaiting a hearing would no doubt prefer to use that docket slot instead of wasting it. Moreover, the wait for a decision when a hearing request is pending is currently much longer than the wait for a decision when a hearing is not required, and, so, any unnecessary delay works to the detriment of the Veteran. Counsel is encouraged to determine, as early as possible following the submission of a hearing request, whether their client wishes to withdraw that request, and to notify the Board as early as possible when they wish to withdraw it. Doing so will assist the Board in maximizing the use of its hearing docket appointments. Failing to do so could, if habitual, be interpreted as a failure to abide by the Standards of Conduct listed above. Of course, the Board imputes no prejudice to this Veteran in the course of issuing this reminder to the Veteran's Counsel.

The Veteran requested a change in representation in January 2025 by submitting a new VA Form 21-22a. The request was untimely and did not expressly offer good cause for the untimely request. An appellant and his representative, if any, are granted a period of 90 days following receipt of a Notice of Disagreement (NOD), or up to and including the date the appellate decision is promulgated by the Board, whichever comes first, during which they may submit a request for a change in representation. 38 C.F.R. § 20.1304(a). The Board informed the Veteran of this timeframe in the September 13, 2021 docketing letter sent to him. The time to change representatives expired prior t January 2025. Therefore, pursuant to 38 C.F.R. § 20.1304(b), following the expiration of the period described in paragraph (a), the Board does not accept a request for a change in representation except when the appellant demonstrates on motion that there was good cause for the delay, and the motion must be in writing and must comply with the criteria set forth in 38 C.F.R. § 20.1304(b). Good cause has not been received to explain the delay in requesting a change in representation. The Board refers the request for a change in representation to the Regional Office for association with the appellant's file for any pending or subsequently received claims upon completion of the Board's action on the pending appeal without action by the Board concerning the request. 38 C.F.R. § 20.1304(b)(1).

There is evidence in the Veteran's claims file that arrived there after the decision on appeal, which means the Board may not, and did not, consider it in deciding this appeal. If the Veteran would like VA to consider any evidence that was added to the claims file that the Board could not consider, the Veteran may file
(b). Good cause has not been received to explain the delay in requesting a change in representation. The Board refers the request for a change in representation to the Regional Office for association with the appellant's file for any pending or subsequently received claims upon completion of the Board's action on the pending appeal without action by the Board concerning the request. 38 C.F.R. § 20.1304(b)(1).

There is evidence in the Veteran's claims file that arrived there after the decision on appeal, which means the Board may not, and did not, consider it in deciding this appeal. If the Veteran would like VA to consider any evidence that was added to the claims file 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.

A total disability rating based on individual unemployability (TDIU) has been expressly raised by the Veteran. See VA Form 10182, January 2026. Although the TDIU is raised in a different appeal stream and would normally be outside the reviewable evidence submission window, the Board interprets the assertion of TDIU as an argument regarding the appropriate knee ratings and has thus added it to this appeal stream as well. See Rice v. Shinseki, 22 Vet. App. 447 (2009) (holding that a request for TDIU is not a separate claim for benefits, but rather involves an attempt to obtain an appropriate rating for a disability or disabilities, either as part of the initial adjudication of a claim or, if a disability upon which entitlement to TDIU is based has already been found to be service connected, as part of a claim for increased compensation); Roberson v. Principi, 251 F.3d 1378 (Fed. Cir. 2001) (TDIU can be reasonably raised by the record when it is "part and parcel" of an increased rating claim; put another way, if a claimant files a claim for the highest possible rating and also submits evidence of unemployability, TDIU must be addressed.).

Factual history

In October 2017, the RO afforded the Veteran a Knee and Lower Leg Conditions Compensation and Pension (C&P) exam. An October 2017 examiner diagnosed the Veteran with bilateral knee strain. The October 2017 examiner also noted that the Veteran had bilateral resolved shin splints that did not affect the range of motion of the knee or ankle. The Veteran stated he began to notice a constant aching and soreness in both knees around 2013. He reported he used to carry heavy equipment and noticed pain to the knees after his deployment had completed. No treatment was reported. The Veteran had full flexion and extension of the right knee, but the Veteran exhibited pain on flexion of the right knee. The Veteran's flexion of the left knee was limited to 125 degrees and extension of the left knee was not limited. The Veteran exhibited pain on flexion and extension of the left knee. Functional loss was loss of range of motion. There was objective evidence of localized tenderness or pain on palpation of the right knee joint or associated soft tissue, described by the October 2017 examiner as direct achy pain and shooting pain to lateral aspect of patella and directly above patella. There was objective evidence of localized tenderness or pain on palpation of the left knee joint or associated soft tissue, described by the October 2017 examiner as direct sharp shooting, achy pain on palpation to medial and above patella. The October 2017 examiner stated that the pain on both knees did not result in or cause functional loss. No flareups were noted in either knee. There was objective evidence of crepitus of the knees. The October 2017 examiner did not provide range of motion estimates for repeated use over time. The October 2017 examiner explained that he was unable to provide such estimates without mere speculation. No instability was noted. The impact on the Veteran's ability to perform any type of occupational task was impact during prolonged standing and prolonged walking. The October 2017 examiner noted that the Veteran was unemployed.

December 2018 VA treatment records indicated that the Veteran had chronic bilateral knee pain in the anterior knee and below the patella and which was worse when coming down the stairs. It was treated with over-the-counter neoprene sleeve and 3g Tylenol a day. The Veteran was prescribed
the knees. The October 2017 examiner did not provide range of motion estimates for repeated use over time. The October 2017 examiner explained that he was unable to provide such estimates without mere speculation. No instability was noted. The impact on the Veteran's ability to perform any type of occupational task was impact during prolonged standing and prolonged walking. The October 2017 examiner noted that the Veteran was unemployed.

In a statement, received May 2025, the Veteran stated that he had experienced severe flare ups of his bilateral knee condition and had been experiencing these flare ups continuously since service. These flare ups occurred approximately once or twice a week and lasted for at least a full day, according to the Veteran. He stated he noticed that these flare ups occurred more often with increased activity where he was walking more as well as when there were changes in the weather if it was cold or if there were storms with quick changes in temperature. During these flare ups, he stated he suffered from increased pain, stiffness, and limited range of motion. He stated he had been experiencing these symptoms and flare ups continuously since service.

In a statement, received May 2025, the Veteran stated that he experienced severe flare ups of his bilateral shin splints and had been experiencing these flare ups continuously since service. These flare ups occurred approximately once or twice a week and lasted for at least a full day, according to the Veteran. He noticed that these flare ups occurred more often with increased activity when he was walking more as well as when he was carrying any additional weight. He noticed flare ups of the shin splints from activities as simple as carrying his daughter in the grocery store. He stated this pain that he experienced was not the same pain that he experienced in his knee. He stated this pain was located in the lower portion of his leg below the knees and extended down to his ankles. He stated he could only describe this pain as sharp stabbing pain in his shins that made it extremely painful to walk or run. He stated he had been experiencing these symptoms and flare ups continuously since service.

Increased ratings

The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. Thus, with or without degenerative arthritis, 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; see Burton v. Shinseki, 25 Vet. App. 1, 5 (2011) (holding that the provisions of 38 C.F.R. § 4.59 are not limited to disabilities involving arthritis).

Moreover, when evaluating musculoskeletal disabilities, VA may, in addition to applying the schedular criteria, assign a higher disability rating when the evidence demonstrates functional loss due to limited or excessive movement, pain, weakness, excessive fatigability, or incoordination, to include during flare-ups and with repeated use, if those factors are not considered in the rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; see also DeLuca v. Brown, 8 Vet. App. 202 (1995); Burton, 25 Vet. App. at 5.

Nonetheless, a disability rating higher than the minimum compensable rating is not assignable under any diagnostic code relating to range of motion where pain does not cause a compensable functional loss. Rather, the "pain must affect some aspect of 'the normal working movements of the body' such as 'excursion, strength, speed, coordination, and endurance," as defined in 38 C.F.R. § 4.40, before a higher rating may be assigned. See Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011).

As the ratings criteria for evaluating musculoskeletal disabilities do not explicitly contemplate medication use, the beneficial effects of the medication taken for a musculoskeletal disability must be discounted and the symptoms of the musculoskeletal disability must be evaluated at their baseline without the beneficial effects of the use of medication. Ingram v. Collins, 38 Vet. App. 130, 137 (2025).

In Correia v. McDonald, 28 Vet. App. 158, 169-70 (2016), the United States Court of Appeals for Veterans Claims (Court) clarified the additional requirements that VA examiners should address when assessing musculoskeletal disabilities, holding specifically, that the joints involved should be tested for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with the range of the opposite undamaged joint.

In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must provide opinions regarding flare-ups based upon estimates derived from information procured from relevant sources, including lay statements, when a flare-up is not observable at the time of examination.

"When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant." 38 U.S.C. § 5107(b). "Evidence is not in 'approximate balance' or 'nearly equal,' and therefore the benefit-of-the-doubt rule does not apply, when the evidence persuasively favors one side or the other." Lynch v. McDonough, 21 F. 4th 776 (Fed. Cir. 2021); see also Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001).

Knees

Effective February 7, 2021, VA revised the criteria for evaluating musculoskeletal disorders. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76464 (Nov. 30, 2020); Correction, 86 Fed. Reg. 8142, 8143 (Feb. 4, 2021).

VA's General Counsel has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board first determines whether the revised version is more favorable to the Veteran. In so doing, it is sometimes necessary for the Board to apply both the old and new versions of the regulation. When the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C.A. § 5110(g) is no earlier than the effective date of that change. The Board generally applies both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change.

VA thus considers the claim for a higher rating pursuant to the former and revised regulations during the latter part of this appeal. See VAOPGCPREC 3 2000, 65 Fed. Reg. 33,422 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997). Therefore, the Board considers the Veteran's claim under the old criteria prior to February 7, 2021, and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran is applied.

The amendments to the schedule of ratings for musculoskeletal disabilities made no changes to the ratings criteria for Diagnostic Codes 5256, 5260, and 5261. 38 C.F.R. § 4.71a.

Under Diagnostic Code 5256, ankylosis of the knee in a favorable angle in full extension, or in slight flexion between 0 and 10 degrees warrants a 30 percent rating; ankylosis of the knee in flexion between 10 and 20 degrees warrants a 40 percent rating; ankylosis of the knee in flexion between 20 and 45 degrees warrants a 50 percent rating; and extremely unfavorable ankylosis of the knee, in flexion at an angle of 45 degrees or more warrants a maximum rating of 60 percent. Id.

Under Diagnostic Code 5260, a 10 percent rating is warranted for limitation of flexion to 45 degrees; a 20 percent rating is warranted for limitation of flexion to 30 degrees, and a maximum rating of 30 percent is warranted for limitation of flexion to 15
degrees warrants a 30 percent rating; ankylosis of the knee in flexion between 10 and 20 degrees warrants a 40 percent rating; ankylosis of the knee in flexion between 20 and 45 degrees warrants a 50 percent rating; and extremely unfavorable ankylosis of the knee, in flexion at an angle of 45 degrees or more warrants a maximum rating of 60 percent. Id.

Under Diagnostic Code 5261, a 10 percent rating is warranted for limitation of extension to 10 degrees, a 20 percent rating is warranted for limitation of extension to 15 degrees, a 30 percent rating is warranted for extension limited to 20 degrees, a 40 percent rating is warranted for limitation of extension to 30 degrees, and a maximum rating of 50 percent is warranted for limitation of extension to 50 degrees. Id.

For comparison, normal range of motion of the knee is from 0 degrees of extension to 140 degrees of flexion. 38 C.F.R. § 4.71, Plate II.

Separate ratings may be assigned under Diagnostic Codes 5260 and 5261 for limitation of flexion and limitation of extension of the same joint. VAOPGCPREC 9-2004 (Sept. 17, 2004).

Pursuant to the old criteria for Code 5262, the Veteran's shin splints are rated by analogy. Under the prior version of Diagnostic Code 5262, which provides ratings for impairment of the tibia and fibula, a 10 percent rating was warranted for impairment of the tibia and fibula with slight knee or ankle disability, a 20 percent rating was warranted for impairment of the tibia and fibula with moderate knee or ankle disability, a 30 percent rating was warranted when there was malunion of the tibia and fibula with marked knee or ankle disability, and a maximum rating of 40 percent was warranted when there is nonunion of the tibia and fibula with loose motion requiring a brace. 38 C.F.R. § 4.71a.

When rating a disability by analogy, there is no requirement for the unlisted condition to identically match the criteria of the listed condition. Webb v. McDonough, 71 F.4th 1377, 1380-81 (Fed. Cir. 2023).

Under the current version of Diagnostic Code 5262, a noncompensable rating is warranted for medial tibial stress syndrome (MTSS) or shin splints of one or both lower extremities requiring less than 12 consecutive months of treatment. A 10 percent rating is warranted for MTSS or shin splints of one or both lower extremities requiring treatment for no less than 12 consecutive months and unresponsive to either shoe orthotics or other conservative treatment. A 20 percent rating is warranted for MTSS or shin splints of one lower extremity requiring treatment for no less than 12 consecutive months and unresponsive to surgery and either shoe orthotics or other conservative treatment. A 30 percent rating is warranted for MTSS or shin splints of both lower extremities requiring treatment for no less than 12 consecutive months and unresponsive to surgery and either shoe orthotics or other conservative treatment. A 40 percent rating is warranted for nonunion of the tibia and fibula with loose motion and requiring brace. Malunion of the tibia and fibula is to be evaluated under Diagnostic Codes 5256, 5257, 5260, or 5261 for the knee, or 5270 or 5271 for the ankle, whichever results in the highest evaluation.

Malunion is "union of the fragments of a fractured bone in a faulty position." Dorland's Illustrated Medical Dictionary 1115 (31st ed. 2007). Nonunion is the "failure of the ends of a fractured bone to unite." Id. at 1309. Disability from malunion of the tibia shaft is produced mainly by rotational deformity, lateral and posterior bowing, and usually some degree of shortening. See Canale & Beaty, Campbell's Operative Orthopaedics 2931 (12th ed. 2012).

Under Diagnostic Code 5257, prior to February 7, 2021, recurrent subluxation and lateral instability of the knee warranted a 10 percent rating if slight, a 20 percent rating if moderate, and a maximum rating of 30 percent if severe
1115 (31st ed. 2007). Nonunion is the "failure of the ends of a fractured bone to unite." Id. at 1309. Disability from malunion of the tibia shaft is produced mainly by rotational deformity, lateral and posterior bowing, and usually some degree of shortening. See Canale & Beaty, Campbell's Operative Orthopaedics 2931 (12th ed. 2012).

The terms "slight," "moderate," and "severe" were not defined. In the absence of guidance, the following dictionary definitions for these subjective adjectives has been considered in the application of the ratings criteria for Diagnostic Codes 5257 and 5262. Merriam-Webster dictionary defines "slight" as small of its kind or in amount; "moderate" as tending toward the mean or average amount or dimension; and "severe" is "of a great degree." See https://www.merriam-webster.com/dictionary/slight; https://www.merriam-webster.com/dictionary/moderate; and https://www.merriam-webster.com/dictionary/severe. (last visited April 2026).

Under the amended criteria for Diagnostic Code 5257, a 10 percent rating is warranted where a sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causes persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. Alternatively, a 10 percent rating is warranted 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. 38 C.F.R. § 4.71a.

A 20 percent rating is warranted for (a) a sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device for ambulation; or (b) an unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device or bracing for ambulation. Alternatively, a 20 percent rating is warranted 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, cane, or walker. Id.

A maximum rating of 30 percent is warranted for an unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device and bracing for ambulation. Alternatively, a maximum rating of 30 percent is warranted 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. Id.

Patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. Id. at Note (1). 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). Id. at Note (2).

Diagnostic Codes 5258 and 5259, which provide ratings for semilunar cartilage conditions, remained the same under the revised criteria. When the knee disability affects the meniscus, a maximum rating of 20 percent is warranted when there is dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint. 38 C.F.R. § 4.71a, Diagnostic Code 5258. A maximum rating of 10 percent is warranted when there has been removal of semilunar cartilage (e.g., meniscectomy) and current residual symptoms. 38 C.F.R. § 4.71a, Diagnostic Code 5259.

As the Veteran has not had resurfacing or replacement of the knee, the changes to DC 5055 are not relevant here.

Special monthly compensation

Under 38 U.S.C. § 1114(s), special monthly compensation (SMC
there is dislocated semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint. 38 C.F.R. § 4.71a, Diagnostic Code 5258. A maximum rating of 10 percent is warranted when there has been removal of semilunar cartilage (e.g., meniscectomy) and current residual symptoms. 38 C.F.R. § 4.71a, Diagnostic Code 5259.

As the Veteran has not had resurfacing or replacement of the knee, the changes to DC 5055 are not relevant here.

Special monthly compensation

Under 38 U.S.C. § 1114(s), special monthly compensation (SMC) is payable where the Veteran has a single service-connected disability rated as 100 percent and (1) has additional disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems, or (2) is permanently housebound by reason of service-connected disability or disabilities. The requirement for a single disability rated as total may be satisfied by a TDIU premised on a single disability. See Bradley v. Peake, 22 Vet. App. 280 (2008). This requirement cannot be satisfied by a TDIU premised on multiple disabilities, including multiple disabilities that may be considered as a single disability for TDIU purposes as set forth at 38 C.F.R. § 4.16(a)(2) and (3). MacKey v. Collins, No. 2024-1854, 2026 LX 192784 (Fed. Cir. Mar. 30, 2026).

1. Entitlement to a rating in excess of 10 percent for right knee strain

The Veteran seeks a higher rating for his right knee strain. See Notice of Disagreement. The period on appeal is from October 25, 2017 (day after release from active duty). The Board finds that after discounting the ameliorative effects of medication and affording the Veteran the benefit of the doubt, during repeated use over time and flareups the Veteran's right knee strain was manifested by functional loss equivalent to flexion limited to 30 degrees. As such, from October 25, 2017, the criteria for a rating of 20 percent, but no higher, for right knee strain have been met.

First, the October 2017 examiner stated that the functional impact of the Veteran's right knee disability was loss of range of motion and impact on standing and walking. Yet the October 2017 examiner did not provide how much loss of range of motion could be estimated during repeated use over time. The October 2017 examiner noted that the Veteran had pain during flexion. Limitations in standing and walking cannot reasonably suggest full flexion.

Second, December 2018 VA treatment records indicated that the Veteran continued to have knee problems to the point that he had problems going down steps and needed daily Tylenol, as well as knee straps. In providing range of motion estimates, the October 2017 examiner did not discount the ameliorative effects of medication as the Veteran denied treatment at that time.

Third, Veteran stated that he had experienced severe flare ups of his bilateral knee condition and had been experiencing these flare ups continuously since service. These flare ups occurred approximately once or twice a week and lasted for at least a full day, according to the Veteran. He stated he noticed that these flare ups occurred more often with increased activity where he was walking more as well as when there were changes in the weather if it was cold or if there were storms with quick changes in temperature. During these flare ups, he stated he suffered from increased pain, stiffness, and limited range of motion. He stated he had been experiencing these symptoms and flare ups continuously since service. These flareups were not accounted for in the October 2017 VA examination.

As such, affording the Veteran the benefit of the doubt and discounting the ameliorative effects of medication, the Board finds that the Veteran's right knee strain has been manifested by range of flexion limited to 30 degrees. Lynch v. McDonough, 21 F. 4th 776 (Fed. Cir. 2021); Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001); Jones v. Shinseki, 26 Vet. App. 56, 63 (2012); Ingram v. Collins, 38 Vet. App. 130 (2025). Accordingly, the criteria for a rating of 20 percent under DC 5260 based on limitation of flexion of the right knee have been met for the entire appeal period
of medication, the Board finds that the Veteran's right knee strain has been manifested by range of flexion limited to 30 degrees. Lynch v. McDonough, 21 F. 4th 776 (Fed. Cir. 2021); Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001); Jones v. Shinseki, 26 Vet. App. 56, 63 (2012); Ingram v. Collins, 38 Vet. App. 130 (2025). Accordingly, the criteria for a rating of 20 percent under DC 5260 based on limitation of flexion of the right knee have been met for the entire appeal period from October 25, 2017.

The Board has also considered the other Diagnostic Codes 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). A separate rating under DC 5261 is not supported by the evidence of record as the Veteran had full extension during the October 2017 VA examination. Even if the October 2017 VA examiner did not provide range of motion estimates during repeated use over time and flareups, the evidence does not support limitations in extension of the right knee. DC 5256 for knee ankylosis is not for application as the Veteran retained movement. DC 5257 is not supported by the evidence of record as the most probative evidence did not show instability. DC 5258/5259 is not for application as the evidence does not suggest removed semilunar cartilage. DC 5262 is addressed further below for the Veteran shin splints. DC 5263 is not for application as the evidence does not suggest genu recurvatum.

The Board finds that the evidence of record persuasively weighs against a rating in excess of 20 percent for right knee strain. Even considering the Veteran's noted functional loss and limitations in standing, walking, pain, stiffness, and limited range of motion, the degree of additional limitation reflected by the Veteran's statements would not result in limitation of motion more nearly approximating flexion limited to 15 degrees.

In reaching these conclusions, the Board has considered and applied the benefit-of-the-doubt rule. "When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant." 38 U.S.C. § 5107(b). "Evidence is not in 'approximate balance' or 'nearly equal,' and therefore the benefit-of-the-doubt rule does not apply, when the evidence persuasively favors one side or the other." Lynch v. McDonough, 21 F. 4th 776 (Fed. Cir. 2021); see also Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). In this case, the evidence persuasively favors a finding that from October 25, 2017, the Veteran's right knee strain was manifested by functional loss equivalent to flexion limited to 30 degrees during repeated use over time and flare-ups. Thus, the benefit-of-the-doubt rule does not change the outcome on this issue.

2. Entitlement to a rating in excess of 10 percent for left knee strain

The Veteran seeks a higher rating for his left knee strain. See Notice of Disagreement. The period on appeal is from October 25, 2017 (day after release from active duty). The Board finds that after discounting the ameliorative effects of medication and affording the Veteran the benefit of the doubt, that during repeated use over time the Veteran's left knee strain was manifested by functional loss equivalent to flexion limited to 30 degrees. As such, from October 25, 2017, the criteria for a rating of 20 percent, but no higher, for left knee strain have been met.

First, the October 2017 examiner stated that the functional impact of the Veteran's left knee disability was loss of range of motion and impact on standing and walking. Yet the October 2017 examiner did not provide estimates of range of motion during repeated use over time or flareups. The October 2017 examiner noted the Veteran had pain during flexion and extension. Limitations in standing
Veteran the benefit of the doubt, that during repeated use over time the Veteran's left knee strain was manifested by functional loss equivalent to flexion limited to 30 degrees. As such, from October 25, 2017, the criteria for a rating of 20 percent, but no higher, for left knee strain have been met.

Second, December 2018 VA treatment records indicated that the Veteran continued to have knee problems to the point that he had problems going down steps and needed daily Tylenol, as well as knee straps. The ameliorative effects of medication were not accounted for in the October 2017 VA examination.

Third, in May 2025 the Veteran stated that he had experienced severe flare ups of his bilateral knee condition and had been experiencing these flare ups continuously since service. These flare ups occurred approximately once or twice a week and lasted for at least a full day, according to the Veteran. He stated he noticed that these flare ups occurred more often with increased activity where he was walking more as well as when there were changes in the weather if it was cold or if there were storms with quick changes in temperature. During these flare ups, he stated he suffered from increased pain, stiffness, and limited range of motion. He stated he had been experiencing these symptoms and flare ups continuously since service. The Veteran's flareups were not accounted for in the October 2017 VA examination.

As such, affording the Veteran the benefit of the doubt and discounting the ameliorative effects of medication, the Board finds that the Veteran's left knee strain has been manifested by functional loss equivalent to range of flexion limited to 30 degrees. Lynch v. McDonough, 21 F. 4th 776 (Fed. Cir. 2021); Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001); Jones v. Shinseki, 26 Vet. App. 56, 63 (2012); Ingram v. Collins, 38 Vet. App. 130 (2025). Accordingly, the criteria for a rating of 20 percent under DC 5260 based on limitation of flexion of the left knee have been met for the entire appeal period from October 25, 2017.

The Board has also considered the other Diagnostic Codes 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). Though the Veteran had painful extension, DC 5261 for limitation of extension is not for application as the Veteran had full extension. Even if the VA examiner did not provide repeated use over time estimates for extension, the evidence does not otherwise support limitations in extension of the left knee. DC 5256 for knee ankylosis is not for application as the October 2017 examiner noted no ankylosis and the Veteran retained movement, which indicates that the Veteran did not have the functional equivalent of ankylosis. DC 5257 is not supported by the evidence of record as the most probative evidence did not show instability. DC 5258/5259 is not for application as the evidence does not suggest removed semilunar cartilage. DC 5262 is addressed further below for the Veteran shin splints. DC 5263 is not for application as the evidence does not suggest genu recurvatum.

The Board finds that the evidence of record persuasively weighs against a rating in excess of 20 percent for left knee strain. Even considering the Veteran's noted functional loss and limitations in standing, walking, pain, stiffness, and limited range of motion, the degree of additional limitation reflected by the Veteran's statements would not result in limitation of motion more nearly approximating flexion limited to 15 degrees.

In reaching these conclusions, the Board has considered and applied the benefit-of-the-doubt rule. "When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter,
Veteran shin splints. DC 5263 is not for application as the evidence does not suggest genu recurvatum.

In reaching these conclusions, the Board has considered and applied the benefit-of-the-doubt rule. "When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant." 38 U.S.C. § 5107(b). "Evidence is not in 'approximate balance' or 'nearly equal,' and therefore the benefit-of-the-doubt rule does not apply, when the evidence persuasively favors one side or the other." Lynch v. McDonough, 21 F. 4th 776 (Fed. Cir. 2021); see also Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). In this case, the evidence persuasively favors a finding that from October 25, 2017, after discounting the ameliorative effects of medication, the Veteran's left knee strain was manifested by functional loss equivalent to flexion limited to 30 degrees during repeated use over time and flareups. Thus, the benefit-of-the-doubt rule does not change the outcome on this issue.

3. Entitlement to a separate noncompensable rating for shin splints is granted

Based on the evidence as outlined above, the evidence is at least evenly balanced, if not higher, that throughout the period on appeal from October 25, 2017, the Veteran's shin splints warrant a separate non compensable rating, but no higher, under the prior version of Diagnostic Code 5262.

The Veterans Benefits Administration (VBA) Procedures Manual (M21-1) provides guidance for "Evaluating Pain Associated with Shin Splints" in M21-1, Part V, Subpart iii, Chapter 1, Section B - Musculoskeletal Disabilities of the Extremities and Spine (hereinafter "V.iii.1.B"). See https://vaww.vrm.km.va.gov/system/templates/selfservice/va_kanew/help/agent/locale/en-US/portal/554400000001034/content/554400000014410/M21-1-Part-V-Subpart-iii-Chapter-1-Section-B-Musculoskeletal-Disabilities-of-the-Extremities-and-Spine?query=shin%20splints. V.iii.1.B contains favorable guidance for the Veteran that if the shin splints are associated with painful motion of the shin and the same joint (here, knee) is not already compensably evaluated, then a compensable evaluation is assigned under DC 5262, but if the shin splints are associated with painful motion of the knee and the joint is already compensably evaluated, a noncompensable evaluation is assigned for shim splints under DC 5262. A single evaluation is assigned under DC 5262 whether the shin splints affects one or both legs. The Board is required to discuss any relevant provisions contained in the M21-1 as part of its duty to provide adequate reasons and bases. See Overton v. Wilkie, 30 Vet. App. 257 (2018); see also Nat'l Org. of Veterans' Advocates, Inc. v. Sec'y of Veterans Affairs, 981 F.3d 1360 (Fed. Cir. 2020). The Board finds that V.iii.1.B provides guidance for compensating shin splints without violating the pyramiding rules in 38 C.F.R. § 4.14. As such, the Board adopts V.iii.1.B.

Finally, the evidence is not evenly balanced, nor approximately so that the symptoms of the Veteran's shin splints warrant compensable ratings under either the current or prior ratings criteria for Diagnostic Code 5262, at any point during the period on appeal. The evidence of record (October 2017 VA exam) indicates that the symptoms of the Veteran's residuals of shin splints did not affect range of motion of the knee or ankle. The October 2017 examiner indicated that the Veteran's shin splints had resolved, which indicated that they were non-symptomatic. The VA treatment records do not otherwise support symptomatic shin splints.

The Board acknowledges
As such, the Board adopts V.iii.1.B.

The Board acknowledges the Veteran's May 2025 statement that he experienced severe flare ups of his bilateral shin splints and had been experiencing these flare ups continuously since service. These flare ups occurred approximately once or twice a week and lasted for at least a full day, according to the Veteran. He noticed that these flare ups occurred more often with increased activity when he was walking more as well as when he was carrying any additional weight. He noticed flare ups of the shin splints from activities as simple as carrying his daughter in the grocery store. He stated that this pain that he experienced was not the same pain that he experienced in his knee. He stated this pain was located in the lower portion of his leg below the knees and extended down to his ankles. He stated he could only describe this pain as sharp stabbing pain in his shins that made it extremely painful to walk or run. He stated he had been experiencing these symptoms and flare ups continuously since service.

The Board assigns more probative weight to the VA treatment records and October 2017 VA examination. In addition, assigning compensable ratings for residuals of shin splints under the prior ratings criteria for Diagnostic Code 5262 for tibia and fibula impairment with slight knee disabilities, would constitute pyramiding, contrary to the provisions of 38 C.F.R. § 4.14. Limitation of motion and functional impairment or functional loss due to the symptoms of the Veteran's knee disabilities have already been considered in the Veteran's 20 percent ratings under Diagnostic Code 5260 for painful limitation of flexion of his knees. In effect, the Veteran is not entitled to separate and additional ratings for knee disabilities under Diagnostic Code 5262, as manifestations of a disability under multiple diagnoses (i.e., pyramiding) is to be avoided under 38 C.F.R. § 4.14. In this regard, as shin pain on use (by way of leg motion) and functional loss are manifestations of both Diagnostic Codes 5260 and 5262, the Veteran is already compensated by his ratings under Diagnostic Code 5260. Separate compensable ratings cannot be established for overlapping symptomatology. In addition, higher ratings are not warranted under the current ratings for criteria of Diagnostic Code 5262, as the evidence does not support a finding that the Veteran's shin splints have required treatment for at least 12 consecutive months and were unresponsive to either shoe orthotics or other conservative treatment.

In reaching these conclusions, the Board has considered and applied the benefit-of-the-doubt rule. "When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant." 38 U.S.C. § 5107(b). "Evidence is not in 'approximate balance' or 'nearly equal,' and therefore the benefit-of-the-doubt rule does not apply, when the evidence persuasively favors one side or the other." Lynch v. McDonough, 21 F. 4th 776 (Fed. Cir. 2021); see also Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). In this case, the evidence persuasively favors a finding that the Veteran's shin splints were non symptomatic and did not affect the range of motion of the knee or ankle. Thus, the benefit-of-the-doubt rule does not change the outcome on this issue.

4. From October 25, 2017 to March 11, 2024, special monthly compensation at the housebound rate is granted.

The issue of entitlement to statutory housebound prior to March 11, 2024 is raised by the record. VA has a "well-established" duty to maximize a claimant's benefits. See Buie v. Shinseki, 24 Vet. App. 242 (2011); AB v. Brown, 6 Vet. App. 35, 38 (1993). This duty to maximize benefits requires VA to assess all of a claimant
the knee or ankle. Thus, the benefit-of-the-doubt rule does not change the outcome on this issue.

4. From October 25, 2017 to March 11, 2024, special monthly compensation at the housebound rate is granted.

The issue of entitlement to statutory housebound prior to March 11, 2024 is raised by the record. VA has a "well-established" duty to maximize a claimant's benefits. See Buie v. Shinseki, 24 Vet. App. 242 (2011); AB v. Brown, 6 Vet. App. 35, 38 (1993). This duty to maximize benefits requires VA to assess all of a claimant's disabilities to determine whether any combination of disabilities establishes entitlement to special monthly compensation (SMC) under 38 U.S.C. § 1114. See Bradley v. Peake, 22 Vet. App. 280, 294 (2008).

The Veteran had been assigned statutory housebound from March 11, 2024. See September 2024 Rating Decision. In a separate Board decision, an earlier effective date of October 25, 2017 has been granted for the Veteran's 100 percent disabling acquired psychiatric disorder. See Board decision in re Docket No. D260109-622328.

Here, because the Veteran now has a single service-connected disability rated as total (acquired psychiatric disorder) from October 25, 2017, and additional service-connected disabilities independently rated at 60 percent (knees, right shoulder strain, left hand disability, and tinnitus), the criteria for SMC under 38 U.S.C. § 1114(s)(1) are met from October 25, 2017.

5. Entitlement to a total disability rating based on individual unemployability is dismissed as moot.

A TDIU is considered a lesser benefit than the 100 percent rating, and the award of a 100 percent rating generally renders moot the issue of entitlement to a TDIU for the period when the 100 percent rating is in effect. An exception to this is a separate award at the housebound rate or a TDIU predicated on a single disability (perhaps not ratable at the schedular 100-percent level) when considered together with another disability separately rated at 60 percent or greater may warrant payment of SMC under 38 U.S.C. § 1114(s). Bradley v. Peake, 22 Vet. App. 280 (2008).

In this case, pursuant to the earlier effective date of the 100 percent acquired psychiatric disorder rating, in combination with the above SMC housebound grant from October 25, 2017, the Veteran has established a 100 percent schedular rating, along with SMC at the housebound rate for the entire period on appeal. Hence the grant of the 100 percent rating renders the claim for TDIU moot. The appeal as to the TDIU issue is therefore dismissed. 38 U.S.C. § 7105(d)(5); 38 C.F.R. § 4.16.

RAY BARTO SLABBEKORN, JR.

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Koottappillil, Arun X.

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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