Citation Nr: 0000148 Decision Date: 01/05/00 Archive Date: 12/28/01 DOCKET NO. 96-48 519 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Buffalo, New York THE ISSUES 1. Entitlement to service connection for a back disorder. 2. Entitlement to service connection for an acquired psychiatric disorder including posttraumatic stress disorder (PTSD). 3. Entitlement to an increased evaluation for residuals of a right medial meniscectomy, currently rated 10 percent disabling. 4. Entitlement to an increased evaluation for residuals of a left medial meniscectomy, currently rated 10 percent disabling. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD C. S. Freret, Counsel INTRODUCTION The appellant had active military service from September 1968 to July 1971. This appeal initially came before the Board of Veterans' Appeals (Board) from an April 1996 rating decision by the Department of Veterans Affairs (VA) Buffalo, New York, Regional Office (RO), and it was remanded in September 1997 for the purpose of scheduling the appellant for a Travel Board hearing. The record reflects that he failed to report for a May 1999 Travel Board hearing. In a July 1999 statement, the appellant's representative raised the issue of entitlement to service connection for a sleep disorder. This claim is not inextricably intertwined with the current claim and has not been developed for appellate consideration by the RO. Therefore, this matter is referred to the RO for appropriate action. FINDINGS OF FACT 1. There is no competent evidence of PTSD. 2. There is no competent evidence of an acquired psychiatric disorder in service, or of a nexus between the appellant's current dysthymia and inservice disease or injury. 3. There is no competent evidence of a back disorder. 4. The appellant's residuals of a right medial meniscectomy include slight instability, degenerative joint disease, and painful motion. 5. The appellant's residuals of a left medial meniscectomy include slight instability, degenerative joint disease, and painful motion. CONCLUSIONS OF LAW 1. The appellant has not submitted a well-grounded claim for service connection for an acquired psychiatric disorder including PTSD. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. §§ 3.303(d), 3.304(f) (1999). 2. The appellant has not submitted a well-grounded claim for service connection for a back disorder. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. §§ 3.303(d) (1999). 3. The schedular criteria for an evaluation in excess of 10 percent for postoperative residuals of a right medical meniscectomy, based on instability or limitation of motion, are not met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. Part 4, Diagnostic Codes 5257, 5260, 5261 (1999). 4. The criteria for a 10 percent evaluation for right knee disability due to arthritis and painful motion are met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. Part 4, Diagnostic Codes 5003, 5010 (1999); Lichtenfels v. Derwinski, 1 Vet. App. 484 (1991), Hicks v. Brown, 8 Vet. App. 417 (1995); VA O.G.C. Prec. Op. No. 23-97 (July 1, 1997), VA O.G.C. Prec. Op. No. 9-98 (August 14, 1998). 5. The schedular criteria for an evaluation in excess of 10 percent for postoperative residuals of a left medical meniscectomy, based on instability or limitation of motion, are not met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. Part 4, Diagnostic Codes 5257, 5259, 5260, 5261 (1999). 6. The criteria for a 10 percent evaluation for left knee disability due to arthritis and painful motion are met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. Part 4, Diagnostic Codes 5003, 5010 (1999); Lichtenfels v. Derwinski, 1 Vet. App. 484 (1991), Hicks v. Brown, 8 Vet. App. 417 (1995); VA O.G.C. Prec. Op. No. 23-97 (July 1, 1997), VA O.G.C. Prec. Op. No. 9-98 (August 14, 1998). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by wartime military service. 38 U.S.C.A. § 1110. Regulations also provide that service connection may be established where all the evidence of record, including that pertinent to service, demonstrates that the veteran's current disability was incurred in service. 38 C.F.R. § 3.303(d). Service connection for posttraumatic stress disorder requires medical evidence establishing a clear diagnosis of the condition, credible supporting evidence that the claimed inservice stressor actually occurred, and a link, established by medical evidence, between current symptomatology and the claimed inservice stressor. If the claimed stressor is related to combat, service department evidence that the veteran engaged in combat or that the veteran was awarded the Purple Heart Medal, Combat Infantryman Badge, or similar combat citation will be accepted, in the absence of evidence to the contrary, as conclusive evidence of the claimed inservice stressor. Additionally, if the claimed stressor is related to the claimant having been a prisoner of war, prisoner-of-war experience that satisfies the requirements of 38 C.F.R. § 3.1(y) (1999) will be accepted, in the absence of evidence to the contrary, as conclusive evidence of the claimed inservice stressor. 38 U.S.C.A. § 1154(b); 38 C.F.R. § 3.304(f). Disability evaluations are based upon the average impairment of earning capacity as determined by a schedule for rating disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. Separate rating codes identify the various disabilities. In determining the current level of impairment, the disability must be considered in the context of the whole-recorded history. 38 C.F.R. § 4.2. An evaluation of the level of disability present also includes consideration of the functional impairment of the appellant's ability to engage in ordinary activities, including employment. 38 C.F.R. § 4.10. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. A claimant filing for VA benefits has the duty to submit evidence that must "justify a belief by a fair and impartial individual" that the claim is plausible, and, therefore, well grounded. 38 U.S.C.A. § 5107(a). A claim is not well grounded if the claimant fails to present such evidence. Tirpak v. Derwinski, 2 Vet. App. 609 (1992). Evidentiary assertions by the claimant must be accepted as true for the purpose of determining if a claim is well grounded, except where such assertions are inherently incredible or beyond the competence of the person making the assertion. King v. Brown, 5 Vet. App. 19 (1993). Generally, claims for increased evaluations are considered to be well grounded. A claim that a condition has become more severe is well grounded where the condition was previously service connected and rated, and the claimant subsequently asserts that a higher rating is justified due to an increase in severity since the original rating. Proscelle v. Derwinski, 2 Vet. App. 629, 632 (1992). The Board is satisfied that all relevant facts pertaining to the appellant's claims of entitlement to increased evaluations for his residuals of a right medial meniscectomy and residuals of a left medial meniscectomy have been properly developed. There is no indication of any additional pertinent records that have not been obtained. No further assistance to the appellant is required to comply with the duty to assist mandated by 38 U.S.C.A. § 5107. I. An Acquired Psychiatric Disorder Including PTSD, and a Back Disorder The appellant contends that he has PTSD that is related to traumatic events to which he was exposed during combat in Vietnam. He argues that he was awarded the Purple Heart Medal, the Bronze Star Medal, and the Army Commendation Medal, which prove that his claimed stressful experiences in Vietnam led to the development of PTSD. He also claims that he has a back disability that has developed as a result of his service-connected right and left leg disabilities. For a claim of service connection to be well grounded, there must be competent evidence of current disability, of the incurrence or aggravation of a disease or injury during service, and of a nexus between the inservice injury or disease and the current disability. That is, an injury during service may be verified by competent medical or lay witness statements; however, the presence of a current disability requires a medical diagnosis. Where an opinion is used to link the current disorder to a cause or symptoms during service, a competent opinion of a medical professional is required. Caluza v. Brown, 7 Vet. App. 498 (1995). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet. App 439 (1995), reconciling, Leopoldo v. Brown, 4 Vet. App. 216 (1993), and Tobin v. Derwinski, 2 Vet. App. 34 (1991). Moreover, to establish a well-grounded claim for service connection for a disorder on a secondary basis, the veteran must present medical evidence to render plausible a connection or relationship between the service-connected disorder and the new disorder. See Jones v. Brown, 7 Vet. App. 134, 137 (1994). The Board has carefully reviewed the evidence of record to determine if there are well-grounded claims for service connection for an acquired psychiatric disorder including PTSD and for a back disorder. With regard to the claim for service connection for a back disorder, the first element required to show a well-grounded claim is not met because the medical evidence of record fails to show the presence of a back disorder. At a December 1995 VA orthopedic examination, the appellant was able to come within two inches of the floor on forward bending. The Board also notes that the second element under Caluza is also not satisfied because the service medical records do not show the presence of a back disability. With regard to the claim for service connection for an acquired psychiatric disorder including PTSD, the Board notes that there is no competent evidence of record that establishes that the appellant has PTSD. A private psychologist, A.W. Frenz, indicated in a December 1995 medical statement that he had treated the appellant between December 1992 and June 1993 and had diagnosed dysthymia, which was the same diagnosis reported on a subsequent VA psychiatric examination performed in February 1996. The second element of Caluza is not met because the service medical records do not show treatment for an acquired psychiatric disorder. The third element of Caluza is also not met because the appellant fails to show the required nexus between his currently dysthymia and any injury or disease in service. There is no medical evidence establishing a link of the dysthymia to the appellant's active military service. See Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992); Franko v. Brown, 4 Vet. App. 502, 505 (1993). Medical diagnoses involve questions that are beyond the range of common knowledge and experience. Rather, they require the special knowledge and experience of a trained medical professional. Although the appellant has presented statements regarding his psychiatric disorder and claimed back disorder, the record does not show that he is a medical professional, with the training and expertise to provide clinical findings regarding any etiological relationship between his dysthymia and service, or regarding diagnoses of PTSD or a back disorder. Consequently, his lay statements, while credible with regard to his subjective complaints and history, are not competent evidence for the purpose of showing a nexus between current complaints and service or the presence of a back disorder. See Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1992); Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). Based upon the foregoing, the Board concludes that the appellant has failed to meet his initial burden of presenting evidence that his claims for service connection for an acquired psychiatric disorder including PTSD, and a back disorder, are plausible or otherwise well grounded. Therefore, they must be denied. Where the veteran has not met his initial burden, VA has no duty to assist him in developing facts pertinent to his claim, including no duty to provide him with a medical examination. 38 U.S.C.A. § 5107(a); Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992) (where the claim was not well grounded, VA was under no duty to provide the veteran with an examination). However, in the limited circumstances where a claim for benefits is incomplete, and references other known and existing evidence, VA is obliged under 38 U.S.C.A. § 5103(a) to advise the claimant of the evidence needed to complete his application, and this duty must be based on the facts of each case. See Robinette v. Brown, 8 Vet. App. 69, 80 (1995). In this case, the RO substantially complied with this obligation in the statement of the case issued in July 1996. Unlike the situation in Robinette, he has not put VA on notice of the existence of any specific evidence that, if submitted, could make these claims well grounded. II. Residuals of a Right Medical Meniscectomy The appellant claims that his service-connected right knee disability has worsened, thereby entitling him to a higher evaluation for the disorder. Service medical records show that the appellant underwent a right medial meniscectomy in November 1970, after giving a history of a right knee injury in Vietnam. Medical records dated since service show that he has continued to experience problems with his right knee, with a lateral meniscectomy performed in February 1980. A September 1988 VA orthopedic examination revealed a 10 degree loss of extension and full flexion in the right knee, with pain on full extension; the diagnosis was postoperative and postsurgical changes of the right knee with stress symptoms and posttraumatic degenerative arthritis. A December 1995 VA orthopedic examination revealed slight instability in the lateral aspect of the right knee and full range of motion for extension and flexion of the knee, with pain in the knee on full extension. The appellant walked with a normal gait and was able to perform a deep knee bend, albeit with pain. An X-ray of the right knee in December 1995 showed moderate degenerative changes. Service connection was granted for residuals of a right medial meniscectomy by a December 1971 rating decision, and a 10 percent evaluation was assigned under Diagnostic Code 5259, from July 15, 1971. A March 1981 rating decision granted a 20 percent evaluation under Diagnostic Code 5257 for the appellant's right knee disability, effective May 1, 1980. A January 1985 rating decision reduced the right knee disability evaluation to 10 percent, effective December 12, 1984. For knee impairment involving recurrent subluxation or lateral instability, a 30 percent evaluation is assigned when the condition is severe, a 20 percent evaluation is assigned if the condition is moderate, and a 10 percent evaluation is assigned when the condition is slight. 38 C.F.R. § 4.71a, Diagnostic Code 5257. As the appellant's right knee was described with slight instability at the most recent VA examination, the evidence does not indicate that he experiences symptomatology demonstrating moderate instability or subluxation in the knee. Therefore, the Board is unable to identify a basis to grant an evaluation greater than 10 percent his right knee disability based on instability. The Board has considered whether the appellant's right knee disability can be assigned an evaluation greater than 10 percent based on limitation of motion. Under Diagnostic Code 5260, limitation of knee flexion is assigned a 30 percent evaluation when the limitation is to 15 degrees, a 20 percent evaluation when the limitation is to 30 degrees, and a 10 percent evaluation when the limitation is to 45 degrees. Under Diagnostic Code 5261, limitation of knee extension is assigned a 50 percent evaluation when the limitation is to 45 degrees, a 40 percent evaluation when the limitation is to 30 degrees, a 30 percent evaluation when the limitation is to 20 degrees, a 20 percent evaluation when the limitation is to 15 degrees, and a 10 percent when the limitation is to 10 degrees. 38 C.F.R. § 4.71a. Because the most recent range of motion testing for extension and flexion in the appellant's right knee, at the December 1995 VA examination, revealed that extension and flexion were each full, the Board finds that an evaluation greater than 10 percent is not warranted for his right knee disability based on limitation of motion. Consideration has also been given to the provisions of 38 C.F.R. §§ 4.40 and 4.45, See DeLuca v. Brown, 8 Vet. App. 202, 206 (1995), as well as to 38 C.F.R. § 4.59. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage, and the functional loss, with respect to all these elements. The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. A little used part of the musculoskeletal system may be expected to show evidence of disuse, either through atrophy, the condition of the skin, absence of normal callosity or the like. 38 C.F.R. § 4.40. As regards the joints, the factors of disability reside in reductions of their normal excursion of movements in different planes. Inquiry will be directed to these considerations: (a) Less movement than normal (due to ankylosis, limitation or blocking, adhesions, tendon-tie-up, contracted scars, etc.); (b) More movement than normal (from flail joint, resections, nonunion of fracture, relaxation of ligaments, etc.); (c) Weakened movement (due to muscle injury, disease or injury of peripheral nerves, divided or lengthened tendons, etc.); (d) Excess fatigability; (e) Incoordination, impaired ability to execute skilled movements smoothly; (f) Pain on movement, swelling, deformity or atrophy of disuse. Instability of station, disturbance of locomotion, and interference with sitting, standing, and weight-bearing are related considerations. 38 C.F.R. § 4.45. With any form of arthritis, painful motion is an important factor of disability; the facial expression, wincing, etc., on pressure or manipulation should be carefully noted and definitely related to affected joints. Muscle spasm will greatly assist the identification. Sciatic neuritis is not uncommonly caused by arthritis of the spine. The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. Crepitation either in the soft tissues such as the tendons or ligaments, or crepitation within the joint structures should be noted carefully as points of contact which are diseased. Flexion elicits such manifestations. The joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint. 38 C.F.R. § 4.59. While the appellant complains of pain in his right knee, the Board does not find that such pain has resulted in functional disability in excess of that contemplated in the 10 percent evaluation already assigned. He walks with a normal gait, is able to perform a deep knee bend, albeit with pain, and has normal extension and flexion in the knee. Because the currently assigned 10 percent evaluation is based on slight instability that involves functional impairment, a higher disability evaluation is not warranted for the right knee disability on the basis of functional disability. The Board must consider whether a separate evaluation may be assigned for disability in the appellant's right knee under VA O.G.C. Prec. Op. No. 23-97 or VA O.G.C. Prec. Op. No. 9-98 and the Court's decisions in Lichtenfels and Hicks. Under the provision of VA O.G.C. Prec. Op. No. 23-97 (July 1, 1997), when a veteran with knee disability rated for instability also has arthritis and limitation of motion in the knee to at least the noncompensable degree, then a separate rating could be assigned for the arthritis and limitation of motion under Diagnostic Codes 5003, 5260, and 5261. A subsequent VA General Counsel opinion, VA O.G.C. Prec. Op. No. 9-98 (August 14, 1998), indicated in a footnote that "[a] separate rating for arthritis could also be based on X-ray findings and painful motion under 38 C.F.R. § 4.59..." under the holding in Lichtenfels v. Derwinski, 1 Vet. App. 484 (1991). In Lichtenfels, the Court held that "[r]ead together, Diagnostic Code 5003 and 38 C.F.R. § 4.59 thus state that painful motion of a major joint or groups of joints caused by degenerative arthritis, where the arthritis is established by X-ray, is deemed to be limited motion and entitled to a minimum 10 percent rating, per joint, combined under Diagnostic Code 5003, even though there is no actual limitation of motion." Id. at 488; see also Hicks v. Brown, 8 Vet. App. 417, 420-21 (1995). In this instance, flexion in the appellant's right knee does not meet the noncompensable level of flexion limitation (60 degrees) under Diagnostic Code 5260, nor is the noncompensable level of extension limitation (5 degrees) shown in the right knee, because extension is shown to be full. Under VA O.G.C. Prec. Op. No. 23-97, if the veteran does not at least meet the criteria for a zero percent rating under either Diagnostic Code 5260 or Diagnostic Code 5261, there is no additional disability for which a rating may be assigned. Cf. Degmetich v. Brown, 104 F. 3d 1328, 1331 (Fed. Cir. 1997). Because the appellant does not have limitation of motion in the right knee that meets the noncompensable level under Diagnostic Code 5260 or Diagnostic Code 5261, a separate disability evaluation is not warranted for the arthritis and limitation of motion in the appellant's right knee under VA O.G.C. Prec. Op. No. 23-97. However, as there is X-ray evidence of arthritis in the appellant's right knee, and he experiences painful motion, the Board finds that he is entitled to a separate evaluation based on arthritis and limitation of motion in the right knee under VA O.G.C. Prec. Op. No. 9-98 and Lichtenfels and Hicks. Because the arthritis in the right knee is described as moderate, and the pain is elicited on full extension, the Board finds that the evidence demonstrates that the highest rating warranted for the arthritis and painful motion in the appellant's right knee is 10 percent. II. Residuals of a Left Medical Meniscectomy The appellant claims that his service-connected left knee disability has worsened, thereby entitling him to a higher evaluation for the disorder. Medical records show that the appellant underwent a medial meniscectomy on the left knee in January 1981. The September 1988 VA orthopedic examination revealed a 10 degree loss of extension and full flexion in the left knee, with stability, no tenderness, and pain on full extension. The diagnosis was residuals of injury and repeated meniscectomies of the left knee with posttraumatic degenerative arthritis and loss of 10 degrees of extension. A November 1990 VA orthopedic examination revealed that the left knee was stable with no ligamentous laxity, and an X-ray of the left knee showed degenerative arthritis that was persistently symptomatic. The December 1995 VA orthopedic examination revealed slight instability in the lateral aspect of the left knee, full range of motion for extension and flexion of the knee, and pain in the knee on full extension. The appellant walked with a normal gait and was able to perform a deep knee bend, albeit with pain. An X-ray of the left knee in December 1995 showed moderate degenerative changes. Service connection was granted for residuals of a left medial meniscectomy, secondary to the appellant's right knee disability, by an August 1981 rating decision, with a 10 percent evaluation assigned under Diagnostic Code 5259, from November 21, 1980, and a noncompensable evaluation assigned from March 1, 1981. The January 1985 rating decision granted a 10 percent evaluation for the appellant's left knee disability, effective December 12, 1984. When a knee is symptomatic following removal of the semilunar cartilage, a 10 percent evaluation is assigned. 38 C.F.R. § 4.71a, Diagnostic Code 5259. Because the appellant is already assigned a 10 percent evaluation for his left knee disability, a higher schedular evaluation is not assignable under Diagnostic Code 5259. As slight instability was noted in the appellant's left knee at the most recent VA examination, the evidence does not indicate that he experiences symptomatology demonstrating moderate instability or subluxation in the knee. Therefore, the Board is unable to identify a basis to grant an evaluation greater than 10 percent his left knee disability based on instability. The Board has considered whether the appellant's left knee disability can be assigned an evaluation greater than 10 percent based on limitation of motion. Because the most recent range of motion testing for extension and flexion in the appellant's left knee, at the December 1995 VA examination, revealed that extension and flexion were each full, the Board finds that an evaluation greater than 10 percent is not warranted for his left knee disability based on limitation of motion. Consideration has also been given to the provisions of 38 C.F.R. §§ 4.40 and 4.45, See DeLuca, supra, as well as to 38 C.F.R. § 4.59. While the appellant complains of pain in his left knee, the Board does not find that such pain has resulted in functional disability in excess of that contemplated in the 10 percent evaluation already assigned. He walks with a normal gait, is able to perform a deep knee bend, albeit with pain, and has normal extension and flexion in the knee. Because the currently assigned 10 percent evaluation is based on findings that the left knee is symptomatic with slight instability, which involve functional impairment, a higher disability evaluation is not warranted for the left knee disability on the basis of functional disability. The Board must consider whether a separate evaluation may be assigned for disability in the appellant's left knee under VA O.G.C. Prec. Op. No. 23-97 or VA O.G.C. Prec. Op. No. 9-98 and the Court's decisions in Lichtenfels and Hicks. In this instance, flexion in the appellant's left knee does not meet the noncompensable level of flexion limitation (60 degrees) under Diagnostic Code 5260, nor is the noncompensable level of extension limitation (5 degrees) shown in the left knee, because extension is shown to be full. Under VA O.G.C. Prec. Op. No. 23-97, if the veteran does not at least meet the criteria for a zero percent rating under either Diagnostic Code 5260 or Diagnostic Code 5261, there is no additional disability for which a rating may be assigned. Cf. Degmetich, supra. Because the appellant does not have limitation of motion in the left knee that meets the noncompensable level under Diagnostic Code 5260 or Diagnostic Code 5261, a separate disability evaluation is not warranted for the arthritis and limitation of motion in the appellant's left knee under VA O.G.C. Prec. Op. No. 23-97. However, as there is X-ray evidence of arthritis in the appellant's left knee, and he experiences painful motion, the Board finds that he is entitled to a separate evaluation based on arthritis and limitation of motion in the left knee under VA O.G.C. Prec. Op. No. 9-98 and Lichtenfels and Hicks. Because the arthritis in the left knee is described as moderate, and the pain is elicited on full extension, the Board finds that the evidence demonstrates that the highest rating warranted for the arthritis and painful motion in the appellant's left knee is 10 percent. ORDER The claims for service connection for an acquired psychiatric disorder including PTSD, and for a back disorder, are denied. Increased evaluations are denied for residuals of a right medial meniscectomy and residuals of a left medial meniscectomy, based on instability or limitation of motion. A separate 10 percent evaluation is granted for arthritis and painful motion in the right knee, subject to the laws and regulations governing the award of monetary benefits. A separate 10 percent evaluation is granted for arthritis and painful motion in the left knee, subject to the laws and regulations governing the award of monetary benefits. M. S. SIEGEL Acting Member, Board of Veterans' Appeals