BVA9503978 
DOCKET NO.  93-03 585     )       DATE
          )
          )

On appeal from the decision of the
Department of Veterans Affairs Regional Office in Montgomery,
Alabama

THE ISSUE

Entitlement to an increased rating for left knee disability,
currently evaluated as 10 percent disabling.

REPRESENTATION

Appellant represented by: Disabled American Veterans

WITNESS AT HEARING ON APPEAL

Appellant

ATTORNEY FOR THE BOARD

P. J. McCarty,  Associate Counsel
INTRODUCTION

The veteran had active service from August 1988 to December 1989.

This appeal arises from a February 1991 decision of the
Department of Veterans Affairs (VA) Regional Office (RO) in
Montgomery, Alabama, which denied a rating in excess of 10
percent for left knee disability.  The Board also notes that the
veteran was denied secondary service connection for right knee
disability in a rating decision of November 1992.  On VA
examination in June 1993, he was found to have right knee
arthralgia secondary to his service-connected left knee
disability.  The RO has not rendered a determination as to
whether the secondary service connection claim should be reopened
based upon the June 1993 examination report.  The matter is
referred to the RO for appropriate action.

CONTENTIONS OF APPELLANT ON APPEAL

The veteran contends that he experiences considerable disability
as a result of his left knee patellofemoral chondrosis, and that
a rating in excess of 10 percent is warranted.  Specifically, he
maintains that the manifestations of the disability include pain,
stiffness, atrophy of the left thigh, and limitation of motion,
and that the disability causes him to walk with a limp and
necessitates the use of a cane.

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 preponderance of the evidence supports a 20
percent disability evaluation for left knee disability.

FINDINGS OF FACT

1.  All relevant evidence necessary for an equitable disposition
of the appeal has been obtained.

2.  The veteran's left knee disability is productive of moderate
impairment.

3.  No unusual or exceptional disability factors have been
presented.

CONCLUSION OF LAW

The criteria for a 20 percent evaluation for the veteran's left
knee disability have been met.  38 U.S.C.A. §§ 1155, 5107 (West
1991); 38 C.F.R. § 3.321(b)(1), and Part 4, including § 4.71a,
Code 5257 (1993).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Board has found the veteran's claim to be well-grounded
within the meaning of 38 U.S.C.A. § 5107(a).  The Board is
satisfied that all relevant facts have been properly developed,
and that no further assistance is required to comply with the
duty to assist the veteran mandated by 38 U.S.C.A. § 5107(a).

In accordance with 38 C.F.R. §§ 4.1, 4.2 (1993) and Schafrath v.
Derwinski, 1 Vet.App. 589 (1991), the Board has reviewed the
service medical records and all other evidence of record
pertaining to the history of the veteran's service-connected left
knee disability.  The Board has found nothing in the historical
record that would lead to a conclusion that the current evidence
of record is not adequate for rating purposes.  Moreover, the
Board is of the opinion that this case presents no evidentiary
considerations that would warrant an exposition of the remote
clinical histories and findings pertaining to the disability at
issue.

Disability evaluations are determined by application of VA's
Schedule for Rating Disabilities (Rating Schedule), found in 38
C.F.R. Part 4.  The percentage ratings contained in the Rating
Schedule represent, as far as can be practically determined, the
average impairment in earning capacity resulting from diseases or
injuries incurred in or aggravated during military service and
their residual conditions in civil occupations.  38 U.S.C.A.
§ 1155; 38 C.F.R. Part 4.

In January 1990, the RO granted service connection for left
patellofemoral chondrosis and assigned a 10 percent evaluation,
effective from December 1989.  A Medical Evaluation Board
determined in October 1989 that the veteran had tenderness on the
medial and lateral facets of the left patella, and full range of
motion of the left knee with minimal crepitance.  X-rays of the
left knee were normal.

A February 1991 VA examination report shows that the veteran
complained of pain in his left knee after long periods of
standing or walking, and with weather changes.  He also reported
walking "awkwardly" to take the pressure off of his left knee,
and taking Motrin to relieve his pain.  He denied experiencing
swelling of the knee.  On physical examination he was found to
have parapatellar tenderness.  Patellar compression produced
pain.  He had full range of motion.  The pertinent diagnoses were
status post injury of the left knee with surgery and
chondromalacia of the left patella.

A June 1992 VA examination report reveals that the veteran
complained of pain and swelling of the left knee, difficulty
standing and an inability to walk for prolonged periods.
Examination showed that he had tenderness in the infrapatellar
region, 1+ effusion, and a large scar.  He was able to flex the
knee 30 degrees, and extend it 45 degrees.  He was diagnosed as
having traumatic osteoarthritis.  A July 1992 MRI of the left
knee revealed evidence of a partial tear or hypertrophic synovium
of the anterior cruciate ligament tendons.

An October 1992 VA examination report shows that the veteran
complained of pain in his left knee after walking or standing for
long periods of time.  His knee felt weak and he reported that he
walked with a limp.  Examination of the left knee revealed no
swelling or effusion.  There was slight tenderness over the
superior inferior aspect and the superior medical aspect of the
patella.  Slight tenderness was also noted on patellar
compression.  Flexion was performed to 90 degrees, and extension
to 0 degrees.  Questionable mild crepitus was noted.  The veteran
was unable to perform deep knee bends normally with his left
knee, and he could not walk on his heel or toe.  He was noted to
ambulate with a limp favoring the left knee.  X-rays of the knee
were normal.  He was diagnosed as having residuals of a severe
soft tissue injury to the left knee with marked scarring and
limited range of motion as described.

A June 1993 VA examination report reveals that the veteran
complained of having left knee pain almost all of the time,
experiencing occasional numbness, and having tenderness over the
left knee.  He described having sharp pains through the knee and
experiencing stiffness.  He also reported that he was unable to
squat or kneel because of knee pain.

Physical examination revealed that the left thigh appeared
smaller than the right indicating some atrophy of the quadriceps
muscles on the left side.  No swelling was noted.  He had
tenderness around the left patella in almost every direction.
Examination of the ligaments of the left knee revealed no
evidence of subluxation or laxity.  Extension of the left knee
was to 0 degrees and flexion of the left knee was to 110 degrees.
The veteran requested that knee jerk testing not be performed on
his left knee due to pain.  He had a negative Lachman's test,
though the maneuver was somewhat uncomfortable.  The McMurray's
sign on the left was very painful, but there was no locking or
evidence of meniscal tear.  The Apley grind test was very painful
on the left.  The Apley's stretch test was moderately painful on
the left.  He had a slight limp and placed most of his weight on
his right foot.  He was diagnosed as having chondrosis or
synovitis of the left knee with some atrophy of the left thigh
muscles, gait disturbance, and chronic pain which the examiner
found to be genuine.

Here, the veteran's left knee disability has been rated under
Diagnostic Code (DC) 5257 of the VA Schedule for Rating
Disabilities, 38 C.F.R. Part 4.  This code provides a 10 percent
rating for slight impairment of the knee, a 20 percent rating for
moderate impairment, and a 30 percent rating for severe
impairment of the knee.

Other pertinent sections of the Schedule for Rating Disabilities
include 5260 and 5261.  Under DC 5260, flexion limited to 60
degrees warrants a 0 percent rating; flexion limited to 45
degrees warrants a 10 percent rating; a 20 percent rating is
provided for flexion limited to 30 degrees; and a 30 percent
rating is provided for flexion limited to 15 degrees.  Under DC
5261, a 10 percent rating is warranted for extension limited to
10 degrees; a 20 percent rating is assigned for extension limited
to 15 degrees; and a 30 percent rating is provided for extension
limited to 20 degrees.

Although the evidence does not show that the veteran has
sufficient limitation of motion to warrant a higher evaluation
under DC 5260 or DC 5261, it does show that he also has
significant pain, and that the knee disability has resulted in an
altered gait and thigh atrophy.  Overall, the Board is satisfied
that the left knee impairment is moderate, as required for an
evaluation of 20 percent.  However, in view of the remaining
range of left knee motion and the absence of objective evidence
of significant instability of the left knee or frequent locking
of the left knee, the Board is unable to conclude that the
disability is productive of more than the moderate knee
impairment contemplated by a 20 percent evaluation.  Finally, the
Board notes that no unusual or exceptional disability factors
warranting extraschedular consideration have been presented.  38
C.F.R. § 3.321(b)(1).

ORDER

A 20 percent evaluation for left knee disability is granted,
subject to the criteria applicable to the payment of monetary
benefits.

          SHANE A. DURKIN
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.