Source: https://va-claim.com/2018/12/09/psychiatric-disorder-to-include-ptsd-and-anxiety-granted-right-knee-disability-right-knee-injury-status-post-right-anterior-cruciate-ligament-and-medial-meniscus-repair-granted-citation-nr/
Timestamp: 2019-04-18 22:47:47
Document Index: 581526679

Matched Legal Cases: ['§ 7105', '§ 3', '§ 5108', '§ 3', '§ 1110', '§ 3', '§ 1155', '§ 3', '§ 1110', '§ 3', '§ 3', '§ 3', '§ 4', '§ 3', '§ 3', '§ 5107', '§ 5107', '§ 1155', '§ 4', '§ 4', '§ 4', '§ 4', '§ 4', '§ 4', '§4', '§ 4', '§4', '§4', '§ 4', '§ 4', '§ 4', '§ 4', '§ 4', '§ 4', '§ 4', '§ 4', '§ 5107', '§ 3']

Psychiatric disorder, to include (PTSD) and anxiety [GRANTED]; right knee disability, right knee injury, status post right anterior cruciate ligament and medial meniscus repair [GRANTED] Citation Nr: 18124081 – VAClaims.org ~ A Non-Profit Non Governmental Agency
Citation Nr: 18124081
DOCKET NO. 15-28 750
As new and material evidence sufficient to reopen the previously denied claim for service connection for a psychiatric disorder has been received, the application to reopen is granted.
Entitlement to service connection for a psychiatric disorder, to include posttraumatic stress disorder (PTSD) and anxiety, is granted.
Entitlement to an initial disability rating of 20 percent for a right knee disability, right knee injury, status post right anterior cruciate ligament and medial meniscus repair, is granted.
1. In a rating decision dated in June 2006, the RO denied a claim for service connection for PTSD because the Veteran’s in-service stressor events could not be verified; the Veteran submitted a notice of disagreement in June 2007.
2. Following a May 2008 statement of the case, the Veteran did not submit a formal appeal to the Board within 60 days, and the June 2006 rating decision became final.
3. Evidence submitted subsequently bears directly and substantially upon the specific matter under consideration, is not cumulative or redundant, and in connection with evidence previously assembled raises a reasonable possibility of substantiating the claim of entitlement to service connection for a psychiatric disorder.
4. The Veteran’s currently diagnosed anxiety disorder is likely the result of his active service.
5. Throughout the appellate period, the Veteran’s right knee disability has been manifested by limitation of flexion to 95 degrees, episodes of locking pain with effusion into the joint, mild instability, reduced strength, requiring an assistive device, and pain on active motion, passive motion, and at rest.
1. The June 2006 rating decision denying the claim for service connection for a psychiatric disorder, claimed as PTSD, is final.  38 U.S.C. § 7105 (2012); 38 C.F.R. §§ 3.104(a), 20.1103 (2017).
2. New and material evidence sufficient to reopen the Veteran’s claim of entitlement to service connection for a psychiatric disorder has been submitted.  38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156(a) (2017).
3. The criteria for service connection are met for an acquired psychiatric disorder.  38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303(a), 3.304(f) (2017).
4. The criteria for a disability rating of 20 percent for residuals of a right knee disability manifested in frequent episodes of locking, pain, and effusion have been met.  38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.159, 4.59, 4.71a, Diagnostic Code 5258 (2017).
The Veteran served in the Army Reserve from February 2000 to July 2006, with active duty from March 2000 to June 2000 and February 2003 to May 2004.
These matters come before the Board of Veterans’ Appeals (Board) on appeal from an October 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Montgomery, Alabama.
The Veteran originally filed a claim of entitlement to service connection for PTSD and his right knee disability in November 2004.  Service connection for PTSD and a right knee disability were denied in a June 2006 rating decision.  In February 2012, he again claimed service connection for a psychiatric disorder, claimed as PTSD, as well as his right knee disability.
Although not expressly claimed by the Veteran, the Board has broadened the PTSD claim to include all acquired psychiatric disorders.  See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (a claimant without medical expertise cannot be expected to precisely delineate the diagnosis of his mental illness; he filed a claim for the affliction his mental condition, whatever it is, causes him.).  The issue has been recharacterized above.
In the October 2013 rating decision, the RO denied service connection for PTSD and granted service connection for his right knee, assigning an effective date as the date of his February 2012 claim to reopen.  In February 2015, the RO granted a separate earlier effective date claim, and reassigned the effective date of award for the Veteran’s right knee disability as May 21, 2004.
1. New and material evidence to reopen the claim for a psychiatric disorder
Since the June 2006 final decision, the Board finds new and material evidence has since been associated with the Veteran’s claims file regarding a psychiatric disorder.  Specifically, since the last prior final denial, VA has been in receipt of the Veteran’s military personnel records, a March 2004 post-deployment assessment, an August 2013 VA examination report, VA post-service treatment records, and a March 2017 stressor statement setting forth new information regarding experiences in service.
As this new evidence tends to show in-service onset, the Board will reopen the claim.  Shade v. Shinseki, 24 Vet. App. 110, 118 (2010); see also Hodge v. West, 155 F.3d 1356, 1363 (Fed. Cir. 1998) (noting that new evidence could be sufficient to reopen a claim if it could contribute to a more complete picture of the circumstances surrounding the origin of a claimant’s injury or disability, even where it would not be enough to convince the Board to grant the claim).
Reopening the issue of service connection for a psychiatric disorder is therefore warranted.
2. Service connection for a psychiatric disorder
As the Veteran’s psychiatric claim is granted herein, any error related to the duties to notify and assist is moot.  See Mayfield v. Nicholson, 19 Vet. App. 103 (2005), rev’d on other grounds, Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006).
The Veteran asserted that his acquired psychiatric disorder is the result of his participation in Operation Iraqi Freedom while in service, including witnessing explosions and violence.
Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).  Establishing service connection generally requires competent evidence of three things: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and, (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability.  Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a).
There are particular requirements for establishing entitlement to service connection for PTSD in 38 C.F.R. § 3.304(f) that are separate from those for establishing service connection generally.  Arzio v. Shinseki, 602 F.3d 1343, 1347 (Fed. Cir. 2010).  Those requirements are: (1) a diagnosis of PTSD in accordance with 38 C.F.R. § 4.125; (2) credible supporting evidence that the claimed in-service stressor actually occurred; and, (3) medical evidence of a causal nexus between current symptomatology and the specific claimed in-service stressor.  38 C.F.R. § 3.304(f).
If the evidence establishes a diagnosis of PTSD during service and the claimed stressor is related to that service, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the veteran’s service, the veteran’s lay testimony alone may establish the occurrence of the claimed in-service stressor.  38 C.F.R. § 3.304(f)(1).
The claimant bears the burden of presenting and supporting his/her claim for benefits.  38 U.S.C. § 5107(a).  See Fagan v. Shinseki, 573 F.3d 1282 (Fed. Cir. 2009).  In its evaluation, the Board shall consider all information and lay and medical evidence of record.  38 U.S.C. § 5107(b).  When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board shall give the benefit of the doubt to the claimant.  Id.
Personnel records indicate that the Veteran was ordered to active duty in support of operation enduring freedom under Title 10 of the U.S. Code and served in imminent danger areas.  He was awarded the Global War on Terrorism Expeditionary Medal and the National Defense Service Medal among others.
The Veteran’s service treatment records are unavailable for review.  See September 2013 Memorandum (formal finding on the unavailability of records).  There is a March 2004 post-deployment assessment in the record showing the Veteran did not ever feel like he was in great danger of being killed, did not experience feeling down, depressed, or lack of interest in the previous two weeks, and no experiences within the previous two months to cause nightmares, feeling numb, or being easily startled.  He responded that he was not interested in help for stress and he was not referred for mental health treatment.
In August 2005, the Veteran submitted a typed statement of an experience in service when he and others were just starting a mission, heading down route outside Tikrit, an Iraqi Guard checkpoint had been attacked and he witnessed a man walking around holding his face together who had been shot.  In a handwritten August 2005 statement, the Veteran described his symptoms of often feeling nervous, especially around people he does not know or when he is in big crowds.  Additionally, if he is around a lot of traffic his stomach feels as though it is turning and he experiences gastrointestinal upset.  He struggles to focus if people walk by as well, and sometimes he will jerk awake suddenly from sleep if he has nightmares.
While still in the Reserves, on VA examination in September 2005, the Veteran had described experiencing nightmares two times per month, having no flashbacks, and recalling feeling helpless due to the fear of being killed at anytime in Iraq due to bombs.  Symptoms included being startled with loud noises, difficulty trusting others, difficulty related to others, being moody and irritable, rare anger outbursts, feeling down for a couple days at a time, and getting nervous easily.  The Veteran expressed that talking about his time in Iraq bothered him.  The examiner provided an assessment of PTSD.
In September 2005, there were no emotional or psychological factors of concern, and in November 2005, depression and anxiety were not identified.  In May 2007, again emotional and psychological factors were not indicated.
In April 2013, the Veteran wrote to let VA know he received medications for anxiety and for sleeping trouble.
At his August 2013 VA examination, the Veteran was diagnosed with anxiety disorder, not otherwise specified (NOS).  The examiner reviewed the file, interviewed the Veteran, and described his military stressors.  However, he did not meet the diagnostic criteria for PTSD under the DSM-IV.  Regarding his anxiety disorder, the examiner noted the Veteran had some mild arousal and avoidance behavior, sleep disruptions, and relationship strain that were most likely caused by or related to his fear of hostile military or terrorist activity stemming from active duty service.  Though he endorsed sleep disturbances, nightmares were denied as the Veteran said he could not remember his dreams.
Stressors relayed included experiences of when someone in front of the Veteran was hit by a sniper and everyone went under their vehicles for cover which caused him fear, two times when in a convoy and IEDs exploded which caused fear, an occasion at a police checkpoint that had been attacked and the Veteran saw an injured man holding his own jaw together, and attempting to plan where to situate himself in convoys to avoid injury.
In his August 2015 formal appeal to the Board, the Veteran indicated that he does not tend to open up to medical professionals and that is why he believed he was denied service connection.  He also wrote being on medication helps him.
In March 2017, the Veteran submitted a statement in support of claim for service connection for PTSD that while at Camp Spichard in Iraq, the convoy was struck with an improvised explosive device (IED) and his sergeant’s truck was hit.  He recalled thinking how he could have been hit if he had chosen another spot in the convoy.  Weeks later another sergeant’s truck was hit with an IED.  He also experienced small arms fire and rocket-propelled grenades (RPGs) in Fallujah, small arms fire on the Tampa route, and the bombing of the “chow hall” in Camp Diamond, Mosul.
An August 2017 screen for depression was negative.
In this case, with regard to a current condition, the record reflects post-active-service psychiatric assessments of PTSD and diagnosis of anxiety disorder.  The Board notes that there is conflicting evidence as to whether the Veteran meets the criteria for diagnosis of PTSD.  While the August 2013 VA examiner determined that the Veteran’s symptoms and stressors were not sufficient to meet the diagnosis, while still in the Reserves, the September 2005 examiner provided an assessment of PTSD.  The Board finds that the evidence is at least in equipoise as to whether the Veteran has a current condition of PTSD, and the evidence supports a finding of anxiety disorder.  As such, the Board finds that the Veteran’s PTSD and anxiety disorder are sufficient to satisfy the first element of service connection for an acquired psychiatric disability and for PTSD.
With regard to an in-service incurrence, service treatment records are missing.  However, shortly after his active service, while still serving in the Reserves, the Veteran reported stressors related to his fear of hostile military activity, and the Veteran has consistently reported psychological stressors related to his deployment in Iraq.  In 2005, he also identified psychological symptoms. Given the proximity of these records to active service, and given that service treatment records are unavailable, the Board finds that the Veteran has suffered in-service stressors for PTSD, and also suffered psychological symptoms in service.  Thus, the second element of service connection for an anxiety disorder and for PTSD has been met.
With regard to nexus, after affording the Veteran the benefit of the doubt, the Board finds this element is satisfied as well.  The September 2005 examination appeared to relate the Veteran’s PTSD diagnosis to the Veteran’s in-service stressors.  The August 2013 examination related anxiety disorder to service.  In light of these favorable opinions, and especially in light of sufficient probative evidence in opposition, affording the Veteran the benefit of the doubt, the Board finds that the final element of service connection for an anxiety disorder and PTSD has been met.  For the foregoing reasons, service connection is warranted.
3. A rating in excess of 10 percent for a right knee disability, right knee injury, status post right anterior cruciate ligament and medial meniscus repair
Neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist.  See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board…to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument).
The Board reviewed all evidence in the record.  Although the Board has an obligation to provide adequate reasons or bases supporting its decision, there is no requirement that each item of evidence submitted by the Veteran or obtained on his behalf be discussed in detail.  Rather, the Board will summarize the evidence as deemed appropriate, and the analysis below will focus specifically on what the evidence shows, or fails to show, with respect to the claims.  See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000).
Disability ratings are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities.  See 38 U.S.C. § 1155; 38 C.F.R. § 4.1.  If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned.  See 38 C.F.R. § 4.7.  Consideration must be given to increased evaluations under other potentially applicable diagnostic codes.  Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991).
The Veteran’s entire history is reviewed when assigning disability ratings.  See generally 38 C.F.R. § 4.1.  In general, when an increase in the disability rating is at issue, it is the present level of disability that is of primary concern.  See Francisco v. Brown, 7 Vet. App. 55, 58 (1994).  For initial rating claims, the most relevant evidence is “the evidence of record from the time of the veteran’s application” for service connection.  Fenderson v. West, 12 Vet. App. 119, 127 (1999).  In this case, the Veteran’s effective date has been assigned from May 21, 2004, the date of his discharge due to his prior November 2004 claim for service connection for the right knee being within one year of separation.  Therefore, the initial evaluation appeal period is from May 21, 2004.
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.  38 C.F.R. § 4.40 (2017).  Functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion.  Id.; see also 38 C.F.R. § 4.59 (2017).  Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled.  Id.  Excess fatigability and incoordination should be taken into account in addition to more movement than normal, less movement than normal, and weakened movement.  38 C.F.R. § 4.45 (2017).
In this case, the Veteran is in receipt of a 10 percent evaluation due to pain causing functional loss under 38 C.F.R. §4.59 for right knee injury, status post right anterior cruciate ligament and medial meniscus repair, pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5260.  See 38 C.F.R. §§4.40, 4.45 (concerning functional loss due to pain, fatigue, weakness, or lack of endurance, incoordination, and flare-ups, applicable under 38 C.F.R. §4.59); see also DeLuca v. Brown, 8 Vet. App. 202 (1995).  The Veteran’s right knee diagnostic imaging results also document arthritis.  See July 2016 VA examination for knees.
Under Diagnostic Code 5010, arthritis due to trauma and substantiated by x-ray findings is rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved.  When, however, the limitation of motion of the specific joint or joints involved in noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added.  Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, a 10 percent evaluation is assigned with x-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups.  A 20 percent is assigned with x-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups and occasional incapacitating exacerbations.  38 C.F.R. § 4.71a, Diagnostic Code 5010.
Diagnostic Codes 5260 and 5261 provide the criteria for rating limitation of motion of the knee and leg.  Normal range of motion for the knee is from 0 degrees of extension to 140 degrees of flexion.  38 C.F.R. § 4.71, Plate II.
Under Diagnostic Code 5260, a noncompensable rating is assigned for flexion of the leg limited to 60 degrees.  A 10 percent rating is assigned for flexion of the leg limited to 45 degrees.  A 20 percent rating is assigned for flexion of the leg limited to 30 degrees. A 30 percent rating is assigned for flexion of the leg limited to 15 degrees.  38 C.F.R. § 4.71a, Diagnostic Code 5260.
Under Diagnostic Code 5261, a noncompensable rating is assigned for extension of the leg limited to 5 degrees.  A 10 percent rating is assigned for extension of the leg limited to 10 degrees.  A 20 percent rating is assigned for extension of the leg limited to 15 degrees.  A 30 percent rating is assigned for extension of the leg limited to 20 degrees.  A 40 percent rating is assigned for extension of the leg limited to 30 degrees.  A 50 percent rating is assigned for extension of the leg limited to 45 degrees.
Separate ratings under Diagnostic Code 5260 and Diagnostic Code 5261 may be assigned for disability of the same joint, if none of the symptomatology on which each rating is based is duplicative or overlapping.  See VAOPGCPREC 9-04; 69 Fed. Reg. 59990 (2004); 38 C.F.R. § 4.14.
Consideration of a higher evaluation for functional loss, to include during flare-ups, due to these factors accordingly is warranted for diagnostic codes predicated on the veteran’s limitation of motion.  38 C.F.R. §§ 4.40, 4.45, 4.59 (2017); DeLuca v. Brown, 8 Vet. App. 202 (1995).  Pain itself does not constitute functional loss, and painful motion does not constitute limited motion for the purposes of rating under diagnostic codes pertaining to limitation of motion.  Mitchell v. Shinseki, 25 Vet. App. 32 (2011).  Pain indeed must affect the ability to perform normal working movements with normal excursion, strength, speed, coordination, or endurance in order to constitute functional loss.  Id.
Diagnostic Code 5257 provides ratings of 10, 20, and 30 percent for recurrent subluxation or lateral instability of the knee, which is slight, moderate, or severe, respectively.  38 C.F.R. § 4.71a, Diagnostic Code 5257.
Diagnostic Code 5258 provides a 20 percent rating may be assigned for dislocated semilunar cartilage with frequent episodes of “locking,” pain, and effusion into the joint.  38 C.F.R. § 4.71a, Diagnostic Code 5258.
Diagnostic Code 5259 provides for a 10 percent rating for symptomatic removal of the semilunar cartilage.
VA treatment records show evaluation of the Veteran’s right knee disability for limited mobility in September 2004, pain and reduced strength from October 2004, instability from December 2004, significant crepitus on passive range of motion in November 2005, and “catching” in the knee with effusions from January 2006.
The Veteran has been afforded three VA examinations for his right knee.
The August 2013 VA examiner provided diagnoses of an anterior cruciate ligament (ACL) and meniscal tear of the right knee.  He recorded the Veteran’s reports of daily pain, worse with prolonged walking, lying in certain positions, and using stairs, though no flare-ups were reported.  There was also tenderness or pain to palpation.  Functional loss included having less movement than normal, weakened movement, excess fatigability, and pain on movement.  The functional impact was that it impacted the Veteran’s ability to work as he is assigned different duties when his knee worsens.
At the time of the August 2013 examination, the Veteran’s range of motion on flexion was to 95 degrees; however, pain began from 0 degrees.  It was also noted that the Veteran underwent a meniscectomy in 2006, and since has frequent episodes of joint locking, pain, and effusion.
The July 2016 VA examiner provided diagnoses of the Veteran’s 2006 right knee meniscal tear, and the 2004 ACL tear.  He recorded no flare ups but noted pain on weight bearing, tenderness or pain on palpation, and evidence of crepitus.  Though additional factors included less movement than normal due to ankylosis, adhesions, disturbance of locomotion, and interference with standing, the examiner answered that there was no ankylosis on the right side.  There was no recurrent subluxation, no history of lateral instability, no history of recurrent effusion, and no joint stability found.  The Veteran wore a brace regularly, and arthritis was documented from imaging studies.
At the time of the July 2016 examination, the Veteran’s range of motion on flexion was to 115 degrees, and during testing the Veteran exhibited pain.  It was also noted that the Veteran had a meniscal tear, ACL repair in 2004, medial meniscectomy in 2006, and frequent episodes of joint pain.
The April 2017 VA examiner provided diagnoses of a 2004 meniscal tear, 2004 ACL tear, and arthritic conditions from 2015.  He recorded the Veteran’s reports of constant pain, sometimes worse at nighttime, treated with ice, topical antiinflammatory cream, and by wrapping.  Flare-ups were reported as occurring about two times per week at which point the knee swells and pain increases for about a day at a time, generally after more use than usual.  Functional loss was that the Veteran was unable to stand or walk for long periods, was unable to squat, avoid stairs, and does not participate in sports.  The functional impact was that the Veteran cannot perform physically demanding work or that which requires extensive walking or standing.  There was medial and patellar tenderness to palpation and muscle atrophy.
At the time of the April 2017 examination, the Veteran’s range of motion on flexion was to 95 degrees, with pain on both flexion and extension.  The examiner also included that the right knee pain occurs at rest and on passive and active motion.  It was also noted that the right knee had no recurrent subluxation and no lateral instability but does have a history of recurrent effusion.
Upon review of all the evidence of record, lay and medical, the Board finds that under the diagnostic codes pertaining to limitation of motion, the Veteran’s right knee disability does not warrant more than a 10 percent disability rating.  There is no evidence of flexion limited to 30 degrees or extension limited to 15 degrees to warrant an increased or separate rating based on limitation of motion.  The Veteran’s limitation of motion has been noncompensable throughout the appeals period.  Despite this, he has been assigned a 10 percent evaluation for his reports of painful motion.  See Mitchell, supra.
However, although a rating in excess of 10 percent cannot be granted for arthritis or limitation of motion of the right knee, a higher rating is warranted under Diagnostic Code 5258, which contemplates dislocation of the semilunar cartilage, with frequent episodes of locking, pain, and effusion into the joint.  The Veteran has undergone meniscal surgery and his right knee has remained symptomatic since.  He has consistently complained of pain and instances of “catching” or locking and a effusions in the joint have been documented.  The Board finds that the Veteran is competent to report these symptoms, as these are observable symptoms and there is no evidence indicating the statements are not credible.  Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).
For these reasons a 20 percent rating for the right knee is warranted under Diagnostic Code 5258.  Twenty percent is the maximum evaluation available under Diagnostic Code 5258.
There is no indication that the Veteran’s right knee disability warrants an increased rating under any other diagnostic code relating to the knees.  The claims folder contains no medical evidence indicating that it is manifested by ankylosis; recurrent subluxation or moderate or severe lateral instability; impairment of the tibia and fibula; genu recurvatum; or symptoms other than those discussed above.  As such, an increased rating cannot be assigned under Diagnostic Codes 5256, 5257, 5262, and 5263.  See 38 C.F.R. § 4.71a.
Further, the Board notes that there is no indication in the medical evidence of record that the Veteran’s right knee symptomatology warranted other evaluations than the currently assigned disability ratings throughout the appeal period. The assignment of staged ratings is not warranted.  See Fenderson, supra.
For all of the foregoing reasons, the Board finds that the above ratings are appropriate for the right knee throughout the appeals period.  In reaching the above-stated conclusions, the Board has considered the applicability of the benefit-of-the-doubt doctrine.  However, as the preponderance of the evidence is against the Veteran’s claims of entitlement to an increased rating, in excess of the rating granted herein, that doctrine is not applicable.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Ortiz v. Principi, 274 F.3d 1361, 1365 (Fed. Cir. 2001).
ATTORNEY FOR THE BOARD	B. Kuczynski
Posted in Board of Veterans Appeals (BVA), Initial Appeal GrantedTagged anxiety, Compensation and Pension, medial meniscus repair, Posttraumatic stress disorder (PTSD), right knee disability, right knee injury, status post right anterior cruciate ligament, VA, VA Appeal, VA Appeal Process, VA Appeals Claims Compensation, VA Benefits, va claims, VA Compensation, VA Disabilities, VA Disabilities Compensation, va disability, VA Disability Benefits, VA Pension Quick Start, VBA, Veterans, Veterans Administration, Veterans Benefits, Veterans Compensation, Veterans Disability Compensation
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