BVA9501585 DOCKET NO. 93-10 621 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Detroit, Michigan THE ISSUES 1. Entitlement to an increased (compensable) rating for right knee tendonitis. 2. Entitlement to an increased (compensable) rating for the residuals of a left femur fracture. 3. Entitlement to an increased rating for left knee tendonitis, currently rated as 10 percent disabling. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States ATTORNEY FOR THE BOARD Robert B. Swanson, Associate Counsel INTRODUCTION The veteran had active service from April 1991 to February 1992. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 1992 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Detroit, Michigan. The RO granted service connection for left knee patellar tendonitis (rated 10 percent), right knee patellar tendonitis (rated zero percent), and residuals of a left femur fracture (rated zero percent). The veteran appeals for increased ratings. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that increased ratings for tendonitis of his left and right knees and residuals of a left femur fracture are warranted based upon his symptomatology. He states that his knees are equally bad, and he has pain on movement and on prolonged standing required by his job. He asserts the VA compensation examination was inadequate. 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 the evidence supports granting a 10 percent rating for right knee tendonitis, and that the preponderance of the evidence is against increased ratings for left femur fracture residuals and left knee tendonitis. FINDINGS OF FACT 1. Right knee patellar tendonitis produces slight functional impairment of the knee. 2. Left knee patellar tendonitis produces slight functional impairment of the knee. 3. Residuals of a left femur fracture are asymptomatic and cause no functional impairment. CONCLUSIONS OF LAW 1. The criteria for a 10 percent rating for right knee tendonitis have been meet. 38 U.S.C.A. §§ 1155, 5107(b) (West 1991); 38 C.F.R. §§ 4.40, 4.71a, Diagnostic Code 5257 (1993). 2. The criteria for a rating in excess of 10 percent for left knee tendonitis have not been meet. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.71a, Diagnostic Code 5257. 3. The criteria for a compensable rating for left femur fracture residuals have not been meet. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.31, 4.71a, Diagnostic Code 5255. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Duty to Assist The veteran is seeking increased ratings for patellar tendonitis of his left and right knees and residuals of a left femur fracture. He has presented well-grounded claims, which are claims that are plausible, as required by 38 U.S.C.A. § 5107(a). In the judgment of the Board, the VA has satisfactorily assisted the veteran in fully developing the facts relevant to his claims as required by 38 U.S.C.A. § 5107(a). Although the veteran asserts that the June 1992 VA compensation examination was inadequate, and the VA general medical examiner recommended further evaluation by an orthopedic surgeon, the Board finds that the examination is fully adequate for rating purposes. 38 C.F.R. § 4.2. The examination contains all necessary findings for evaluating the disabilities, particularly when those findings are viewed against the historical service records. Hence, further examination in connection with the present claims is not warranted. II. Factual Background According to the veteran's service medical records, he received periodic outpatient treatment at service medical facilities for bilateral knee pain, mostly the left one, beginning in June 1991. This was primarily diagnosed as patellar tendonitis. In August 1991, it was noted there was evidence of a stress fracture of the left femur, which had been revealed by a bone scan. In September 1991, a Medical Board examination was conducted. The findings included bilateral knee pain with patellofemoral compression and other tests. The left thigh was normal. X-rays revealed no abnormalities. A bone scan revealed an increased uptake in the left posteromedial aspect of the femur consistent with a stress reaction of the femur. The diagnoses were bilateral patellofemoral stress syndrome, and left femur stress reaction. The Medical Board found that the veteran was unable to perform full duty. He was referred to a Physical Evaluation Board which, in November 1991, found him unfit for duty on account of bilateral patellofemoral stress syndrome (considered 10 percent disabling) and a stress reaction of the left femur (considered zero percent disabling). Due to these conditions, the veteran was discharged from service, with severance pay, in February 1992. In June 1992, a general VA medical examination was conducted. The veteran reported recently becoming employed as a bouncer and assistant. The examiner reviewed the disability history. The veteran complained of pain under his left knee cap, which made it difficult to extend the knee, and he also said he had slight pain under the right knee cap. The clinical findings with respect to the knees included a normal appearance, equal size, no deformities, no effusion, stable joints, no drawer sign, no valgus or varus motion, and range of motion of both knees of zero degrees to 130 degrees, which the examiner said was full. The doctor also noted tenderness, with marked sensitivity to touch or percussion of the patella tendons, left knee greater than right. The hips had normal motion. Neurological findings included normal motor, sensory, and coordination, bilaterally, and deep tendon reflexes of 2+ at the knees, which were again noted to be tender. X-rays of the knees revealed no abnormalities. The diagnoses were chronic bilateral patellar tendonitis, left greater than right, and history of a left femur stress fracture. III. Analysis A. Increased Rating for Right Knee Tendonitis The veteran claims an increase in the noncompensable rating assigned for right knee patellar tendonitis. Disability evaluations are determined by the 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. If the right knee condition were rated under codes pertaining to limitation of motion, a zero percent rating would be proper, in light of the full, or virtually full, range of motion (zero degrees-130 degrees) shown at the 1992 VA examination. 38 C.F.R. § 4.71a, Codes 5260, 5261. In the judgment of the Board, the disability is most appropriately rated under Code 5257, which provides for a 10 percent rating for a knee impairment, with recurrent subluxation or lateral instability, which is slight in degree, and a 20 percent rating when the impairment is moderate in degree. The last VA examination did not show any instability or other right knee abnormalities, except for objective signs of tenderness and subjective complaints of pain. Being mindful that pain can be productive of functional impairment, 38 C.F.R. § 4.40, and giving the veteran the benefit of the doubt, 38 U.S.C.A. § 5107(b), the Board finds that the effects of pain from right knee patellar tendonitis produce slight functional impairment, justifying an increased rating, to 10 percent, for this disability. B. Increased Rating for Left Knee Tendonitis The veteran claims an increase in the current 10 percent rating assigned for left knee patellar tendonitis. Range of motion of this knee is zero degrees-130 degrees, according to the latest VA examination, which would not support even a compens-able rating under codes pertaining to range of motion (Codes 5250, 5261). As with the other knee, the VA examination showed no instability or other abnormalities, other than objective signs of tenderness and subjective complaints of pain. With reference to Code 5257, the evidence shows no more than a slight left knee impairment from patellar tendonitis, even when the effect of pain on functional impairment is considered. A moderate left knee impairment, as required for a rating in excess of 10 percent under Code 5257, is not shown. The left knee condition does not involve an exceptional or unusual disability picture, with such factors as frequent periods of hospitalization or marked interference with employment, as would render impractical the application of the usual schedular rating standards. Thus, an increased rating on an extraschedular basis is not warranted. 38 C.F.R. § 3.321(b). The preponderance of the evidence is against the claim for an increase in the current 10 percent rating for left knee tendonitis; therefore, the benefit-of-the-doubt doctrine does not apply, and the claim must be denied. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet.App. 49 (1990). C. Increased Rating for Left Femur Fracture Residuals The veteran's left femur fracture residuals are currently rated as noncompensable. A 10 percent rating for impairment of the femur is assigned when there is malunion of the femur, with slight knee or hip disability. 38 C.F.R. § 4.71a, Code 5255. When these requirements are not shown, a zero percent rating will be assigned. 38 C.F.R. § 4.31. The service records show no major fracture of the left femur, but only a stress fracture or stress "reaction" of the bone. At the 1992 VA examination, there were no clinical findings of abnormalities of the left femur, nor did the veteran actually complain about this particular disability. The stress fracture was noted by history only, and no functional impairment was attributed to the condition. Even assuming that there are some residuals from the old stress fracture of the left femur, the examination shows they do not affect the left hip, which functioned normally. Moreover, if any femur fracture residuals affected the left knee, it would violate the rule against pyramiding disability ratings, 38 C.F.R. § 4.14, to assign a compensable rating for left femur fracture residuals, when a left knee disability is separately rated and assigned a compensable rating. The evidence establishes that residuals of a left femur fracture are asymptomatic and cause no functional impairment. A zero percent rating is proper. 38 C.F.R. § 4.31. This condition does not represent an exceptional or unusual disability picture which would justify an increased rating on an extraschedular basis. 38 C.F.R. § 3.321(b). As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine is inapplicable, and an increased (compensable) rating for residuals of a left femur fracture must be denied. 38 U.S.C.A. § 5107(b); Gilbert, supra. ORDER An increased rating, to 10 percent, for right knee tendonitis is granted. An increased (compensable) rating for left femur fracture residuals is denied. An increased rating for left knee tendonitis is denied. L. W. TOBIN 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.