Citation Nr: 0003451 Decision Date: 02/10/00 Archive Date: 02/15/00 DOCKET NO. 97-27 503 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Newark, New Jersey THE ISSUE Entitlement to a higher rating for a left knee disorder, currently rated 10 percent disabling. REPRESENTATION Appellant represented by: New Jersey Department of Military and Veterans' Affairs ATTORNEY FOR THE BOARD Kimberly E. Harrison Osborne, Counsel INTRODUCTION The veteran served in the Army National Guard and Army Reserve, including a period of active service from July 1988 to October 1988 (active duty for training, during which she incurred a service-connected left knee disability). This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 1997 rating decision by the RO which granted service connection and a 10 percent rating for a left knee disorder; the veteran appeals for a higher rating. FINDINGS OF FACT The veteran's left knee disability, including patellofemoral syndrome and arthritis, is manifested by complaints of pain, but there is nearly full range of motion (there is full extension of 0 degrees, and minimal limitation of flexion to 120 degrees), and the joint is stable. CONCLUSION OF LAW The criteria for a rating in excess of 10 percent for a left knee disorder have not been met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. § 4.71a, Codes 5003, 5010, 5257, 5260, 5261 (1999). REASONS AND BASES FOR FINDING AND CONCLUSION I. Factual Background The veteran had active duty for training from July 1988 to October 1988. Her service medical records show that in September 1988, she injured her left knee (contusion and sprain) during a fall. In August 1996, she filed a claim of service connection for a left knee disorder. In support of her claim, she submitted medical records from the early 1990s showing treatment for her left knee, and diagnoses included tendinitis and chondromalacia patella. In October 1996, the veteran underwent a VA orthopedic examination of her left knee. Physical examination revealed no effusion. There was no ligamentous instability of the knee. Range of motion of the left knee was 0 degrees to 125 degrees of flexion without crepitus. There was a negative McMurray's sign. She had no joint line tenderness. She had discomfort on subluxating the patella medial and palpating the under surface. She also had some discomfort on compression of the patella against the femoral condyle. She complained of anterior sub-patellar discomfort when she did a squat. The diagnosis was mild patellofemoral syndrome. In April 1997, the RO granted service connection for patellofemoral syndrome of the left knee and assigned a 10 percent rating. In a June 1997 notice of disagreement and August 1997 substantive appeal, the veteran claimed her left knee disability was more disabling than reflected in the 10 percent rating assigned. She stated she was in constant pain daily. She reported her knee constantly would grind when she walked and went up and down stairs. She claimed her left knee was tender to touch. VA examination of the left knee in August 1997 revealed no swelling. There was no atrophy of the quadriceps, ligamentous instability, or joint line tenderness. She was positive for pain on compression of the patellar against the femoral condyle. McMurray's sign was negative. Range of motion of the left knee joint was extension to 0 degrees and flexion to 125 degrees. X-rays showed mild degenerative changes of the left knee joint, and this was also the clinical diagnosis. During an April 1999 VA examination, the veteran stated her left knee bothered her on a daily basis. She stated the knee swelled. She reported having grinding of the knee with negotiating stairs. She related she wore an elastic support when walking long distances. She stated she could walk 5 to 6 blocks but had pain. She stated she took Ibuprofen. She reported that she needed to change her employment due to her knee problems. She claimed her condition had worsened since 1992. Physical examination revealed the veteran's gait was grossly normal. Her motor strength was 5/5. She had 0 to 120 degrees of flexion. There was no instability or drawer sign appreciated. There was mild diffuse swelling. There was medial joint line tenderness and patellofemoral pain and 2+ crepitation. X-ray studies of the left knee revealed mild degenerative changes. The diagnosis were status post left knee injury and degenerative changes of the left knee with some progression from prior examination. In a September 1999 letter, the RO asked the veteran to provide information on any treatment for her left knee problems during the last year; she did not respond. II. Analysis The veteran's claim for a rating higher than 10 percent for her service-connected left knee disorder (which includes patellofemoral syndrome and arthritis) is well grounded, meaning plausible. The file shows that the RO has properly developed the evidence, and there is no further VA duty to assist the veteran with her claim. 38 U.S.C.A. § 5107(a). In every instance where the schedule does not provide a 0 percent evaluation for a diagnostic code, a 0 percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. The RO has assigned a 10 percent rating for the veteran's left knee disorder under 38 C.F.R. § 4.71a, Code 5257. This code provides a 10 percent rating for slight recurrent subluxation or lateral instability of the knee, and a 20 percent is assigned when it is moderate. VA examinations in 1996, 1997, and 1999 all reveal the veteran had no instability of the left knee. As the veteran is not shown to have even a slight degree of recurrent subluxation or lateral instability of the knee, a compensable rating is not warranted under Code 5257. 38 C.F.R. § 4.31. Mild degenerative arthritis of the left knee was noted by X- rays at the VA examinations. Traumatic arthritis is rated as degenerative arthritis. 38 C.F.R. § 4.71a, Code 5010. Degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate limitation-of-motion diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a, Code 5003. Standard motion of a knee is from 0 degrees extension to 140 degrees flexion. 38 C.F.R. § 4.71, Plate II. A 0 percent rating is warranted for limitation of leg flexion when it is limited to 60 degrees, a 10 percent rating is warranted when it is limited to 45 degrees, and a 20 percent rating is warranted when it is limited to 30 degrees. 38 C.F.R. § 4.71a, Code 5260. A 0 percent rating is warranted when leg extension is limited to 5 degrees, a 10 percent rating is warranted when it is limited to 10 degrees, and a 20 percent rating is warranted when it is limited to 15 degrees. 38 C.F.R. § 4.71a, Code 5261. VA examinations from 1996, 1997, and 1999 show the veteran had 0 degrees of extension, which is full, and she had minimal limitation of flexion which was no worse than 120 degrees. If the veteran's left knee disorder was strictly rated under either Code 5260 or 5261, she would be assigned a noncompensable rating. However, the presence of left knee arthritis with at least some limitation of motion supports a 10 percent rating under Codes 5003 and 5010. There is no objective evidence of additional limitation of motion of the knee due to pain on use, and certainly not additional limitation to the extent necessary for a higher rating under the limitation of motion codes. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). VA General Counsel's opinions hold that under certain circumstances, arthritis and instability of a knee may be rated separately under Codes 5003 and 5257. The opinions are inapplicable in the present case because a compensable rating under Code 5257, based on knee instability, is not warranted. VAOPGCPREC 9-98; VAOPGCPREC 23-97. In light of the foregoing, the Board finds that the preponderance of the evidence is against the veteran's claim for a rating in excess of 10 percent for a left knee disorder. Thus, the benefit-of-the-doubt rule is inapplicable, and the claim must be denied. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER A rating in excess of 10 percent for a left knee disorder is denied. L. W. TOBIIN Member, Board of Veterans' Appeals