Citation Nr: 0006667 Decision Date: 03/13/00 Archive Date: 03/17/00 DOCKET NO. 97-340 22 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Newark, New Jersey THE ISSUE Entitlement to an increased rating for a left knee disorder, post operative status, currently evaluated as 20 percent disabling. WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD J. Horrigan, Counsel INTRODUCTION The veteran had active service from July 1972 to July 1975. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 1997 rating decision by the RO which granted service connection and a 20 percent rating for the postoperative residuals of a medial meniscectomy with degenerative joint disease of the left knee. In November 1999 the veteran appeared and gave testimony at a hearing before the undersigned Board member at the RO. A transcript of this hearing is of record. FINDING OF FACT The veteran's service connected left knee disorder, post operative status, results in severe left knee disability. CONCLUSION OF LAW The criteria for a 30 percent rating for a left knee disorder, post operative status, have been met. 38 U.S.C.A. §§ 1155, 5107(a) (West 1991 & Supp. 1999); 38 C.F.R. § 4.71(a), Diagnostic Code 5257 (1999) REASONS AND BASES FOR FINDING AND CONCLUSION Initially, the Board notes that it finds the veteran's claim for an increased rating for a left knee disorder to be "well grounded" within the meaning of 38 U.S.C.A. § 5107(a), in that the claim is plausible. The Board also finds that all relevant facts pertinent to the claim have been developed to the extent possible, and no further assistance to the veteran is required in order to satisfy the VA's duty to assist him in the development of this claim as mandated by 38 U.S.C.A. § 5107(a). Of record is a May 1997 statement from M. K. Levitsky, M.D., who reported evaluating the veteran in April 1997, after he injured his left knee in a fall. Evaluation revealed no joint effusion. There was a healed incision over the medial aspect of the left knee. There was significant medial laxity with valgus stressing with no lateral instability present. Tenderness was noted medially over the medial collateral ligament. Lachman's and Drewar's tests were very positive. X-rays showed severe medial compartment degenerative arthritis and a fairly normal appearing patellofemoral joint space. The diagnoses included left knee sprain; medial compartment degenerative arthritis of the left knee; old tear of the anterior cruciate ligament; and sprain of the medial collateral ligament. Dr. Levitsky noted that the left knee was very unstable and he believed that the veteran would require a total left knee replacement in the future. On a July 1997 VA orthopedic examination, the veteran complained of episodes of left knee pain that occur a few times a week. There had been no swelling or locking, but buckling did occur. The veteran also said that he had had fallen when his knee gave out, with the most recent fall occurring in March 1997. He said that his symptoms were increased with weather changes but did not indicate that climbing one or two flights of steps increased his knee symptoms. Examination revealed that the veteran did not limp on ambulation. Heel and toe walking was accomplished well. Left knee motion was from 0 to 135 degrees with patellofemoral crepitation. There was a bony prominence medially but there was no effusion. There was 1+ laxity of the patella, 1+ anterior laxity, and 1+ medial laxity There was tenderness about the patella and medial joint fissure. A scar was noted on the medial aspect of the knee which was 6 inches long with numbness laterally. There was moderate atrophy of the vastus medialis of the left thigh. The diagnoses were status post reconstruction, lateral ligaments left knee, with residual instability; degenerative joint disease, post traumatic, left knee with atrophy of the vastus medialis; and symptomatic arthrofibrosis of the left knee. The examiner also commented that there would be a functional problem with the left knee resulting in lack of strength, lack of endurance, increased fatigability, and flare-ups which will cause loss of motion. It was said that this was supported by instability, atrophy of the left thigh, and bony productivity clinically evident on the medial aspect of the left knee. During a November 1999 hearing before the undersigned Board member, the veteran said that he had undergone knee surgery in 1974, while in the service. The veteran said that his left knee would totally pop out of its socket on occasion. He further said his knee had gotten worse since his July 1997 examination. Disability evaluations are determined by application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155; 38 C.F.R. § Part 4. Separate diagnostic codes identify the various disabilities. The veteran's service connected left knee disability has been assigned a 20 percent evaluation under the provisions of 38 C.F.R. § 4.71(a), Diagnostic Code 5257 on the basis of impairment of the knee. Under the provisions of this diagnostic code, a 20 percent evaluation is assigned for impairment of the knee with recurrent subluxation or lateral instability, resulting in moderate disability. A 30 percent rating is assignable under Diagnostic Code 5257 if there is recurrent subluxation or lateral instability of the knee resulting in severe disability. The record contains a statement from the veteran's private physician who indicated that the veteran has instability of his left knee and the physician also opined that the veteran would eventually require a total left knee replacement. On a recent VA orthopedic examination essentially full range of motion in the left knee was reported, but the veteran was noted to have patella laxity, medial laxity, and anterior laxity in the left knee. Moderate atrophy of the vastus medialis of the left knee was also reported. The examiner also commented that there was lack of strength, lack of endurance, and increased fatigability in the left knee. Given the degree of left knee instability, the weakness in the left knee, and the muscle atrophy, and given the holding of the United States Court of Appeals for Veterans Claims in DeLuca v. Brown, 8 Vet. App. 202 (1995), the Board is of the opinion that the veteran currently experiences severe left knee disability. Since that is the case, a 30 percent evaluation under the provisions of Diagnostic Code 5257 is warranted for the veteran's service connected left knee disorder. Ratings in excess of 30 percent for a left knee disorder may be assigned when extension of the knee is limited to 30 degrees or when the knee is ankylosed in flexion between 10 degrees and 20 degrees. In each of these cases a 40 percent rating may be assigned. See Diagnostic Codes 5256 and 5261. However, no such pathology is present here. The veteran does not have ankylosis of the knee at any angle, and he has a full range of extension of the knee to a zero degree position. As such, a rating in excess of 30 percent is not warranted here. ORDER An increased rating for a left knee disorder is granted to the extent indicated, subject to the law and regulations governing payment of monetary benefits BRUCE E. HYMAN Member, Board of Veterans' Appeals