BVA9508435 DOCKET NO. 93-12 143 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Chicago, Illinois THE ISSUE Entitlement to an increased rating for residuals of a right knee injury, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD James A. Pritchett, Associate Counsel INTRODUCTION The veteran served on active duty from June 1976 to November 1977. This appeal arises from a November 1991 decision by the Chicago, Illinois, Department of Veterans Affairs (VA) Regional Office (RO) that denied an increased evaluation for residuals of a right knee injury. The veteran is service-connected for Schwannoma of the left mandible, currently evaluated as 10 percent disabling. The RO should clarify whether the veteran desires to pursue a claim for an increased evaluation for this disability. Also, in a September 1993 presentation, the veteran's representative raised the issue of service connection for a neurological deficit as the result of trauma sustained by the veteran in basic training. This issue also is referred to the RO for appropriate consideration. CONTENTIONS OF APPELLANT ON APPEAL It is contended that the veteran's right knee disability is more disabling than currently evaluated. He avers that he has locking, swelling, and giving way which affect his ability to carry heavy objects at work. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that a preponderance of the evidence is against an increased rating for residuals of a right knee disability. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. The service-connected right knee disability is manifested by mild degenerative changes, tenderness and slight limitation of motion. CONCLUSION OF LAW An evaluation greater than 10 percent for a right knee disability is not warranted. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.7, 4.40, 4.71a, Code 5257-5003 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran's claim is "well grounded" within the meaning of 38 U.S.C.A. § 5107. That is, he has presented a claim which is plausible, and all relevant facts have been properly developed. No further assistance to the veteran is required to comply with the duty to assist the veteran mandated by 38 U.S.C.A. § 5107. The veteran's service medical records include the report of the examination for entrance, dated in September 1975, which is negative for complaints or findings of a knee disability. The service medical records do not contain treatment notes regarding the veteran's right knee. However, in October 1977, a Physical Evaluation Board (PEB) found that he had moderately severe chondromalacia of the right knee and that his right patella was hypermobile. The PEB evaluated his right knee disability as 10 percent disabling and recommended that he be discharged with severance pay. He was separated from active service for medical disability in November 1977. The report of a VA examination dated in August 1978 contains complaints of pain in the right knee during hot and cold weather and upon walking too much. The report states that the veteran had lost no time from his job as a messenger because of his knee. On examination, full range of motion of the right knee with pain only on squatting was reported. He had a normal gait and was able to hop without symptoms. Both knees extended fully without hyperextension. He complained of some discomfort on the anterolateral aspect of his right knee on extreme flexion. No instability was observed. The cruciate and collateral ligaments were intact bilaterally. There was no capsular thickening nor evidence of synovitis reported. No quadriceps atrophy or weakness was observed. There was no joint swelling, crepitus, erythema, deformity or evidence of inflammation. Both lower extremities were equally strong against resistance, although the veteran stated that the right knee tired more readily than the left. X-rays were negative for both knees. The diagnosis was history of contusion, right knee, with symptomatic residuals, physical findings negative. By rating decision in August 1978, service connection was established for history of traumatic chondromalacia of the right knee and a noncompensable evaluation was assigned. A VA orthopedic examination was conducted in September 1991. Range of motion of the right knee was from 0 to 120 degrees. Clinical examination was otherwise unremarkable. At his personal hearing in May 1992, the veteran testified that he was a folder at a printing plant until he was laid off because business was poor. He stated that contrary to normal practice he was allowed to use a chair to ease the pain from prolonged standing on the job. He testified that he and several others were laid off but that the others had been rehired while he had not. He stated that he felt that his knee condition was the only reason he was not rehired. He testified that he had been denied one job because the physical examination required squatting, which he could not do. He stated that he did occasional jobs like painting apartments, but had not found full time employment. He testified that regular Tylenol was the only medication that he was taking, but that it did not seem to help anymore. He stated that during cold weather it felt like the bones in his knee rubbed together. He described the pain as like a cramp mainly underneath the kneecap. He testified that sometimes his knee had locked when he was going down stairs and that he sometimes lost his footing as a result. He stated that he could not run because he could not trust his knee. He stated that the only time it did not hurt was when he was in a jacuzzi or a whirlpool. He testified that there was a lot of swelling at times and that at times the knee would lock for a minute or two. Massaging the knee would allow movement but that it would feel like the bones were rubbing once he started moving again. He stated that his knee would make a popping sound if he were going down stairs. He testified that he had moved from a third floor apartment to a first floor apartment to avoid climbing stairs. He stated that a brace had been recommended by a VA physician but that he had had to buy it himself. He testified that it helped at work, but that he quit wearing it because his knee looked bad when he took the brace off. The report of a VA special orthopedic examination dated in September 1992 contains complaints of increasing knee pain that was aggravated by activity. The report states that there was no rest pain. The veteran also complained that the right knee gave way, locked and swelled. On examination, no swelling was observed in the right knee. There was anterolateral and medial joint line tenderness in the right knee. No ligamentous instability was observed. Flexion was to 130 degrees and extension was 0 degrees. The X-ray report notes relative narrowing at the medial joint space with minimal genu varum deformity which could support local clinical degenerative joint disease (DJD) and meniscus pathology, possibly related to previous injury. The examiner's diagnosis was very mild DJD and possible torn meniscus. In a decision dated in November 1992, the hearing officer granted a 10 percent evaluation for the service-connected right knee disability based on X-ray evidence of degenerative arthritis and painful motion. On the most recent VA examination in September 1992, there was only anterolateral and medial joint line tenderness, but no swelling of the right knee. Range of motion was only slightly limited and no subluxation or lateral instability was observed. In reaching its decision, the Board has carefully considered the testimony provided by the veteran regarding the problems caused by the service-connected right knee disability. Nevertheless, given the degree of functional impairment currently shown, the Board finds that the current 10 percent evaluation, based on evidence of degenerative changes and pain on motion, is appropriate. The evidence does not raise doubt as to any material issue. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. § 4.71a, Codes 5010-5003, 5257, 5260, 5261. The Board also has considered the complete history of the disability in question as well as the current clinical manifestations and the effect the disability may have on the earning capacity of the veteran. 38 C.F.R. 4.1, 4.2, 4.16 (1994). The nature of the original injury has been reviewed and the functional impairment which can be attributed to pain or weakness has been taken into account. 38 C.F.R. 4.40. Further, the Board finds that in this case the disability picture is not so exceptional or unusual so as to warrant an evaluation on an extraschedular basis. It has not been shown that the service- connected right knee disability has caused marked interference with employment or necessitated frequent periods of hospitalization. 38 C.F.R. 3.321(b)(1)(1994). The criteria for an evaluation greater than 10 percent have not been met or approximated. 38 C.F.R. § 4.7. ORDER Entitlement to an increased rating for residuals of a right knee injury is denied. WAYNE M. BRAEUER Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals.