A 20 percent initial disability rating for right knee limitation of flexion under Diagnostic Code 5260 is granted effective February 8, 2011 (replacing the rating under Diagnostic Code 5010 for arthritis of the right…

Citation Nr: 26001372 Decision Date: 01/30/26 Archive Date: 01/30/26 DOCKET NO. 14-15 910 DATE: January 30, 2026 ORDER A 20 percent initial disability rating for right knee limitation of flexion under Diagnostic Code 5260 is granted effective February 8, 2011 (replacing the rating under Diagnostic Code 5010 for arthritis of the right knee); subject to the laws and regulations governing the payment of monetary benefits. A 20 percent initial disability rating for right knee limitation of extension under Diagnostic Code 5261 is granted effective February 8, 2011; subject to the laws and regulations governing the payment of monetary benefits. A 10 percent initial disability rating for left knee limitation of flexion under Diagnostic Code 5260 is granted effective February 8, 2011; subject to the laws and regulations governing the payment of monetary benefits. A 20 percent initial rating for left knee limitation of extension under Diagnostic Code 5261 is granted effective February 8, 2011; subject to the laws and regulations governing the payment of monetary benefits. FINDINGS OF FACT 1. The evidence is at least in approximate balance that, from February 8, 2011, the Veteran's right knee disability more nearly approximated flexion limited to 30 degrees. 2. The evidence is at least in approximate balance that, from February 8, 2011, the Veteran's right knee disability more nearly approximated extension limited to 15 degrees. 3. The evidence is at least in approximate balance that, from February 8, 2011, the Veteran's left knee disability more nearly approximated flexion limited to 45 degrees. 4. The evidence is at least in approximate balance that, from February 8, 2011, the Veteran's left knee disability more nearly approximated extension limited to 15 degrees. CONCLUSIONS OF LAW 1. The criteria for a 20 percent initial disability rating for right knee limitation of flexion from February 8, 2011 are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.71a, Diagnostic Code 5260. 2. The criteria for a 20 percent initial disability rating for right knee limitation of extension from February 8, 2011 are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.71a, Diagnostic Code 5261. 3. The criteria for a 10 percent initial disability rating for left knee limitation of flexion from February 8, 2011 are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.71a, Diagnostic Code 5260. 4. The criteria for a 20 percent initial disability rating for left knee limitation of extension from February 8, 2011 are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 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 April 1979 to September 1996. These matters come before the Board of Veterans' Appeals (Board) on appeal from an August 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) and were previously remanded by the Board in December 2015. The May 2025 rating decision also granted separate evaluations for right knee limitation of extension and left knee limitation of flexion. A 10 percent rating was assigned for right knee limitation of extension under Diagnostic Code 5261 effective February 28, 2025 and a noncompensable (0 percent) rating was assigned under Diagnostic Code 5260 for left knee limitation of flexion effective February 28, 2205. Accordingly, as the right knee extension and left knee flexion ratings are part and parcel of adjudication of entitlement to higher initial ratings for the Veteran's service-connected right and left knee disabilities, the Board will adjudicate the ratings assigned for these issues. The Board's December 2015 remand directed the RO to schedule the Veteran for a new VA examination to determine the current severity of his service-connected bilateral knee disabilities. The Board finds that there has been substantial compliance with its December 2015 remand directives, and it will proceed with adjudication of the issues on appeal. Stegall v. West, 11?Vet. App.?268 (1998). Increased Ratings Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity caused by a given disability. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 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 picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. However, if different disability ratings are warranted for different periods of time over the life of a claim, "staged" ratings may be assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). 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 is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. Significantly, while this appeal was pending, the United States Court of Appeals for Veterans Claims (Court) held that the Board is required "to discount beneficial medication effects when relevant rating criteria do not specifically contemplate medication use." Ingram v. Collins, 38 Vet. App. 130, 131 (2025). 1. Entitlement to an initial disability rating higher than 10 percent for right knee arthritis 2. Entitlement to an initial disability rating higher than 10 percent for chondromalacia of the left knee The Veteran seeks higher initial ratings for his service-connected right and left knee disabilities. As an initial matter, the Board notes that the August 2011 rating decision classified the Veteran's left knee disability as chondromalacia of the left knee, rating it as 10 percent disabling under Diagnostic Code 5010, and the Veteran's right knee disability as right knee arthritis, rating it as 10 percent disabling under Diagnostic Code 5010. 38 C.F.R. § 4.71, Schedule of ratings - musculoskeletal system. In a May 2025 rating decision, the RO changed the Diagnostic Code for rating the Veteran's chondromalacia of the left knee to Diagnostic Code 5261 based on limitation of extension, keeping the effective date of February 8, 2011. For reasons discussed below, the Board finds that it is more advantageous to the Veteran to also rate his right knee arthritis (previously rated under Diagnostic Code 5010 from February 8, 2011) under Diagnostic Code 5261 based on limitation of extension, in line with the left knee limitation of extension rating, both dating back to February 8, 2011. Turning to the evidence of record, during the June 2011 VA examination, the Veteran reported bilateral knee pain that limits prolonged walking and standing. He noted experiencing constant pain at a 10 out of 10 level of severity. He indicated that he medicates his knee pain with over-the-counter ibuprofen. The examiner noted symptoms of bilateral knee pain, weakness, and inflammation. Pain with active motion was found, but the examiner did not note which degrees in flexion or extension that pain began, only that right knee flexion was to 110 degrees and left knee flexion was to 120 degrees, with normal bilateral knee extension. Pursuant to the Board's December 2015 remand, the Veteran was afforded another VA examination in February 2025 to assess the current severity of his bilateral knee disabilities. The Veteran reported that he cannot stand for more than 4 minutes at a time and that he continues to treat his bilateral knee pain with over-the-counter medication. He reported flare-ups every month lasting for one week at a time with pain severity at a level 7 out of 10. Initial range of motion was noted as 35 degrees flexion and 10 degrees extension in the right knee and 55 degrees flexion and 10 degrees extension in the left knee. The Veteran was unable to perform repetitive use testing on his knees. The examiner found that pain, fatigability, and weakness caused functional loss in the Veteran's knees, but that there was no change in range of motion as to reported flare-ups. No ankylosis was found. The examiner found no evidence of instability or subluxation, and the Veteran did not indicate that he uses an assisted device, such as a knee brace or cane, to ambulate. Post-service VA treatment records throughout the period on appeal note reported bilateral knee pain. While portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021, during the pendency of this appeal, Diagnostic Codes 5260 and 5261 were not changed. Under Diagnostic Code 5260, a noncompensable (0 percent) rating is assigned for evidence of knee flexion limited to 60 degrees; a 10 percent rating is assigned for flexion limited to 45 degrees; a 20 percent rating is assigned for flexion limited to 30 degrees; and a maximum 30 percent rating is assigned for flexion limited to 15 degrees. 38 C.F.R. § 4.71a. Under Diagnostic Code 5261, a noncompensable (0 percent) rating is assigned for evidence of knee extension limited to 5 degrees; a 10 percent rating is assigned for extension limited to 10 degrees; a 20 percent rating is assigned for extension limited to 15 degrees; a 30 percent rating is assigned for extension limited to 20 degrees; a 40 percent rating is assigned for extension limited to 30 degrees; and a maximum rating of 50 percent is assigned for extension limited to 45 degrees. 38 C.F.R. § 4.71a. Normal range of motion of the knee is to 0 degrees extension and to 140 degrees flexion. 38 C.F.R. § 4.71a, Plate II. Separate ratings may be assigned for compensable limitation of both flexion (Diagnostic Code 5260) and extension (Diagnostic Code 5261), or for limitation of motion and instability or subluxation of the knee (Diagnostic Code 5257), or meniscal pathology. However, a separate rating can only be assigned where additional compensable symptomatology is shown that is not duplicative of that used to assign another rating. 38 C.F.R. § 4.14; Lichtenfels v. Derwinski, 1 Vet. App. 484 (1991). Upon review of the relevant evidence, the Board determines that a 20 percent initial rating for right knee limitation of flexion under Diagnostic Code 5620 is warranted from February 8, 2011; a 20 percent initial rating for right knee limitation of extension under Diagnostic Code 5261 is warranted from February 8, 2011; a 10 percent initial rating for left knee limitation of flexion under Diagnostic Code 52601 is warranted from February 8, 2011; and a 20 percent initial rating for left knee limitation of extension is warranted from February 8, 2011. As discussed above, the RO changed the Diagnostic Code from 5010 to 5261 as to the Veteran's 10 percent left knee rating effective February 8, 2011. The 2011 VA examination reflects normal, but painful extension in both the right and left knees. The Board finds that Diagnostic Code 5261 is more beneficial to the Veteran's initial right knee disability rating from February 8, 2011, as he experienced the same painful extension symptoms in his right knee as he did in his left knee. Additionally, the 2025 VA examination reflects right knee flexion to 35 degrees and left knee flexion to 55 degrees, which corresponds to a 10 percent evaluation for right knee limitation of flexion under Diagnostic Code 5260 and a 0 percent evaluation for left knee limitation of flexion under Diagnostic Code 5260. The Veteran's right and left knee extensions were also limited to 10 degrees, corresponding to 10 percent evaluations for right ad left knee limitation of extension under Diagnostic Code 5261. The Board acknowledges that, following its 2015 remand decision, the Veteran was not scheduled for his VA examination until nearly 10 years later. The 2011 VA examination was not compliant with Sharp in that the VA examiner did not provide an estimation of further limitation of range of motion when the Veteran was experiencing reported flare-ups. Despite the VA examiner noting that the Veteran did not experience any knee flare-ups during the examination, the Veteran reported symptoms in line with flare-ups (pain with movement, inability to stand long or walk far, swelling). As such, the Board affords greater probative weight to the most recent 2025 VA examination. The 2025 VA examination showed that, when considering the Veteran's limitations when experiencing bilateral knee flare-ups, he would be limited to 35 degrees flexion and 10 degrees extension in the right knee and 55 degrees flexion and 10 degrees extension in the left knee. These findings equate to a 10 percent rating under Diagnostic Code 5260 for right knee limitation of flexion, a 0 percent rating under Diagnostic Code 5260 for left knee limitation of flexion, a 10 percent rating under Diagnostic Code 5261 for right knee limitation of extension, and a 10 percent rating under Diagnostic Code 5261 for left knee limitation of extension. 38 C.F.R. § 4.71a. The Board acknowledges that VA is required "to discount beneficial medication effects when relevant rating criteria do not specifically contemplate medication use." Ingram v. Collins, 38 Vet. App. 130 (2025). Here, since the beginning of the Veteran's claim, the evidence reflects that he consistently treated his bilateral knee disabilities with over-the-counter ibuprofen. The beneficial effects of medication on the Veteran's knees are not known. Therefore, the Board has considered it in the adjudication of this matter, resolving all reasonable doubt in the Veteran's favor. Here, the Board finds that the Veteran's right knee limitation of flexion has manifested in symptoms that more closely approximates the severity contemplated by a 20 percent rating; his left knee limitation of flexion has manifested in symptoms that more closely approximates the severity contemplated by a 10 percent rating; his right knee limitation of extension has manifested in symptoms that more closely approximates a 20 percent rating; and his left knee limitation of extension has manifested in symptoms that more closely approximate a 20 percent rating. In light of the foregoing, the Board finds that a 20 percent initial rating under Diagnostic Code 5260 for right knee limitation of flexion should extend back to February 8, 2011, the beginning of the appeal period; a 10 percent initial rating under Diagnostic Code 5260 for left knee for left knee limitation of flexion should extend back to February 8, 2011; a 20 percent initial rating under Diagnostic Code 5261 for right knee limitation of extension should extend back to February 8, 2011; and a 20 percent initial rating under Diagnostic Code 5261 for left knee limitation of extension should extend back to February 8, 2011. The Board notes that the Veteran's 20 percent initial rating for right knee limitation of flexion under Diagnostic Code 5260 now replaces the prior 10 percent right knee arthritis rating under Diagnostic Code 5010. The Board has also considered whether ratings under Diagnostic Codes 5256, 5257, 5262, and 5263 for ankylosis, recurrent subluxation or instability, impairment of tibia and fibula, and genu recurvatum are warranted, respectively. However, as the medical evidence shows that such impairments are absent, and the Veteran does not contend otherwise, higher ratings are not available under those Diagnostic Codes. (Continued on the next page) In conclusion, a 20 percent initial disability rating under Diagnostic Code 5260 for right knee limitation of flexion is granted effective February 8, 2011 (replacing Diagnostic Code 5010 for arthritis of the right knee); a 10 percent initial disability rating under Diagnostic Code 5260 for left knee limitation of flexion is granted effective February 8, 2011; a 20 percent initial disability rating under Diagnostic Code 5261 for right knee limitation of extension is granted effective February 8, 2011; and a 20 percent initial disability rating under Diagnostic Code 5261 for left knee limitation of extension is granted effective February 8, 2011. Thomas L. English Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Houle, Denise 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.