Citation Nr: 1003377 Decision Date: 01/22/10 Archive Date: 02/01/10 DOCKET NO. 03-29 449 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Waco, Texas THE ISSUES 1. Entitlement to service connection for a heart disorder. 2. Entitlement to service connection for Crohn's disease. 3. Entitlement to service connection for peripheral neuropathy of the hands and feet, claimed as tingling and numbness of the hands and feet. 4. Entitlement to an initial compensable rating for residuals of a right hip fracture. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD D. Johnson, Associate Counsel INTRODUCTION The Veteran has verified active military service from October 1967 to August 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2003 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas, which denied service connection for a heart disorder, Crohn's disease, and tingling and numbness of the hands and feet. The RO also declined to reopen a previously denied claim of service connection for hemorrhoids and post- traumatic stress disorder (PTSD). In a January 2004 rating decision, the RO granted service connection for residuals of a left hip fracture (citing to an August 1983 National Guard service treatment record showing a "nondisplaced fracture of the right ischium"). A noncompensable disability rating was assigned pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5252, effective from July 25, 2003. The Veteran disagreed with the evaluation assigned. In August 2005, the RO issued a rating decision to "correct the anatomical area of disability" (citing the August 1983 right ischium injury) and recharacterized the issue as residuals of a right hip fracture. The Veteran testified before the undersigned in May 2006. A transcript of the hearing is of record. In a June 2007 decision, the Board reopened and remanded the issue of service connection for PTSD. The remaining issues were also remanded. A portion of the remand was based on the need to determine the correct anatomical area of the hip disability to be evaluated. The Board noted that it was nearly impossible to determine which hip should actually have been rated, based upon the limited evidence in the claims file. The remand gave instructions to locate the August 1983 National Guard record in question, but attempts to locate this document have proven unsuccessful. Accordingly, the issue has been phrased as shown on the title page. The remand also set forth detailed instructions with regards to additional development to locate all outstanding service records and records of post-service VA treatment. This portion of the development has been completed to the extent possible. In April 2008, while the case was still pending at the Appeals Management Center following the Board's remand, the Veteran submitted a statement in which he withdrew his appeal as to the issue of whether new and material evidence had been submitted to reopen the claim for service connection for hemorrhoids. Accordingly, that issue does not remain pending. See 38 C.F.R. § 20.204 (2009). In a March 2009 rating decision, service connection for PTSD was granted. Therefore, this issue is no longer before the Board. On October 13, 2009, in accordance with authority provided in 38 U.S.C. § 1116, the Secretary of Veterans Affairs announced his decision to establish presumptions of service connection, based upon exposure to herbicides within the Republic of Vietnam during the Vietnam era, for three new conditions: ischemic heart disease, Parkinson's disease, and B cell leukemias. As required by 38 U.S.C. 1116, the Department of Veterans Affairs (VA) will issue regulations through notice and comment rule-making procedures to establish the new presumptions of service connection for those diseases. Those regulations will take effect on that date that a final rule is published in the Federal Register. Until that time, VA does not have authority to establish service connection and award benefits based upon the planned new presumptions. On November 20, 2009, the Secretary of Veterans Affairs directed the Board to stay action on all claims for service connection that cannot be granted under current law but that potentially may be granted based on the planned new presumptions of service connection for ischemic heart disease, Parkinson's disease, and B cell leukemias based upon exposure to herbicides used in the Republic of Vietnam during the Vietnam era. As this appeal contains at least one claim that may be affected by these new presumptions, the Board must stay action on that matter in accordance with the Secretary's stay. Once the planned final regulations are published, the adjudication of any case or claim that has been stayed will be resumed. Finally, it is noted that the Veteran has submitted additional medical evidence, without a waiver of initial RO review and consideration. Upon review of the additional evidence, the Board finds that it is not material to the issues on appeal. Therefore, remand is not necessary. See 38 C.F.R. § 20.1304 (2009). FINDINGS OF FACT 1. The Veteran's service treatment records from his period of active service are unavailable; all efforts to locate them have been unsuccessful. 2. The Veteran served in Vietnam and is presumed to have been exposed to Agent Orange during service. 3. There is no competent medical evidence showing a diagnosis of Crohn's disease, or peripheral neuropathy of the hands and feet until many years after active service. 4. There is no competent medical evidence linking current Crohn's disease, or peripheral neuropathy of the hands and feet to any aspect of active military service. 5. Throughout the course of this appeal, a right hip disability manifested with noncompensable limitation of motion and only occasional complaints of mild pain. CONCLUSIONS OF LAW 1. Crohn's disease was not incurred in, or aggravated by active military service, and may not be presumed to have been incurred as a result of exposure to Agent Orange during service. 38 U.S.C.A. §§ 1110, 1131 (West 2002); 38 C.F.R. § 3.303, 3.307(a)(6), 3.309(e) (2009). 2. Peripheral neuropathy of the hands and feet was not incurred in, or aggravated by active military service, and may not be presumed to have been incurred as a result of exposure to Agent Orange during service. 38 U.S.C.A. §§ 1110, 1112, 1131 (West 2002); 38 C.F.R. § 3.30, 3.307(a)(6), 3.309(e) (2009). 3. The criteria for a compensable rating for a hip disability have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002 and Supp. 2009); 38 C.F.R. §§ 4.1, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5252 (2009). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS VCAA The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations impose obligations on VA to provide claimants with notice and assistance. 38 U.S.C.A. §§ 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2009); 38 C.F.R §§ 3.102, 3.156(a), 3.159, 3.326(a) (2009). Under 38 U.S.C.A. § 5103, VA must notify the claimant of any information or evidence not of record that is necessary to substantiate the claim, as well as what parts of that information or evidence VA will seek to provide, and what parts VA expects the claimant to provide. 38 C.F.R. § 3.159(b) (2009). VA must provide such notice to a claimant prior to an initial unfavorable decision on a claim for VA benefits by the agency of original jurisdiction (AOJ). See Pelegrini v. Principi, 18 Vet. App. 112, 119-120 (2004). For claims pending before VA on or after May 30, 2008, 38 C.F.R. 3.159 was amended to eliminate the requirement that VA request that a claimant submit any evidence in his or her possession that might substantiate the claim. 73 Fed. Reg. 23,353 (Apr. 30, 2008). The Court of Appeals for Veterans Claims (Court) has also held that that the VCAA notice requirements of 38 U.S.C.A. § 5103(a) and 38 C.F.R. § 3.159(b) apply to all five elements of a service connection claim. Those five elements include: (1) veteran status; (2) existence of a disability; (3) a connection between the veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. Dingess/Hartman v. Nicholson, 19 Vet App 473 (2006). As it relates to the claim for service connection, VA provided VCAA-required notice, in correspondence sent to the Veteran in July 2001, February 2003, November 2003, and August 2007. These letters notified the Veteran of VA's responsibilities in obtaining information to assist him in completing his service connection claims, and identified his duties in obtaining information and evidence to substantiate his claims. The August 2007 letter provided notice of the type of evidence necessary to establish a disability rating or effective date for the claimed disabilities under consideration, pursuant to the recent holding in the Dingess decision. To the extent that several of the letters were issued after the rating decision, the Board notes that the claims were thereafter readjudicated by way of supplemental statements of the case, to include the most recent one, which was dated in April 2009. As it relates to the right hip disability, the appeal arises from the Veteran's disagreement with the initial evaluation assigned with the grant of service connection. Court's have held that were the underlying claim for service connection has been granted and there is disagreement as to downstream questions, the claim has been substantiated and there is no need to provide additional VCAA notice or prejudice from absent VCAA notice. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App. 112 (2007). In consideration of Hartman and Dunlap, further VCAA notice is not required. Duties to Assist VA has also made reasonable efforts to assist the Veteran in obtaining evidence necessary to substantiate his service connection and increased rating claims. 38 U.S.C.A. § 5103A (West 2002). The information and evidence associated with the claims file consist of the Veteran's National Guard records, VA and private medical treatment records, and records from the Social Security Administration (SSA). The Veteran was also afforded VA examinations in connection with his claims. The Veteran's service treatment records are missing. Records which have been obtained confirm that the Veteran was a member of the Army Reserve from October 1969 to April 1973 and a member of the Arkansas National Guard from April 1973 to an unverified end date. There are some National Guard medical records dated in 1973 and 1977 in the claims file. A copy of his DD 214 is of record as well. Where service medical records are missing, VA also has a duty to search alternate sources of service records. Washington v. Nicholson, 19 Vet. App. 362 (2005). Requests for service records were made to the National Personnel Records Center (NPRC) in 1994. The NPRC requested additional information and noted that if the Veteran had received inpatient treatment in service, the hospital's name and other information should be provided for a clinical records search to be done. The RO contacted the Veteran in August 1994 and asked him to provide this information. He did not respond. Another request for records was made to the NPRC in August 2000. The NPRC responded that they were unable to identify a record based on the information furnished, and requested that the RO obtain a completed NA Form 13075 from the Veteran. This form was sent to the Veteran in July 2001; it was not returned. Pursuant to the Board's June 2007 remand instructions, the Appeals Management Center (AMC) made additional attempts to locate the Veteran's service records, with requests to the Office of the Chief for the Army Reserves, the WACO VA RO, the Arkansas National Guard (AK ARNG) and the Veteran in January 2008. The AMC also sent requests to the Army Reserve Personnel Center (ARPC) and NPRC in March 2008. Negative responses were received from the WACO VA RO, the ARPC, and the AK ARNG; however, the AK ARNG did send additional copes of the National Guard records. The Veteran did not respond to the letter sent to him. NPRC was unable to conduct their search due to the Veteran's failure to provide the requested information. Based on the foregoing, the Board finds that VA has satisfied its duty to assist the Veteran in obtaining service treatment records and search alternate sources and further efforts to obtain the missing service records would likely be futile. 38 U.S.C.A. § 5103A. The Veteran has been advised that his assistance is required for the development of his claims, but he has failed to respond to repeated requests for such assistance. The Court has stated that VA's duty to assist "is not always a one-way street. If a veteran wishes help, he cannot passively wait for it." See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). All of VA's requests for service records and responses received have been documented in the record. For the reasons set forth above, the Board finds that VA has complied with the VCAA's notification and assistance requirements. The appeal is thus ready to be considered on the merits. Service Connection Service connection will be granted if it is shown that the veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303. Disorders diagnosed after discharge will be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Chronic diseases, such as organic diseases of the nervous system, manifested to a degree of 10 percent or more within one year from the date of separation from service are considered to have been incurred in or aggravated by service, even if there is no evidence of the disease occurring during service. 38 U.S.C.A. § 1112; 38 C.F.R. §§ 3.307, 3.309(a). The governing law provides that a "veteran who, during active military, naval, or air service, served in the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, 1975 shall be presumed to have been exposed during such service to an herbicide agent . . . unless there is affirmative evidence to establish that the veteran was not exposed to any such agent during that service." 38 U.S.C.A. § 1116(f) (West 2002). VA regulations provide that, if a veteran was exposed to an herbicide agent during active service, presumptive service connection is warranted for the following disorders: chloracne or other acneform disease consistent with chloracne; type 2 diabetes; Hodgkin's disease; Chronic lymphocytic leukemia (CLL); multiple myeloma; Non-Hodgkin's lymphoma; acute and subacute peripheral neuropathy; porphyria cutanea tarda; prostate cancer; respiratory cancers (cancer of the lung, bronchus, larynx, or trachea); and, soft-tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi's sarcoma, or mesothelioma). Presumptive service connection for these disorders as a result of Agent Orange exposure is warranted if the requirements of Sec. 3.307(a)(6) are met. 38 C.F.R. § 3.309(e) (2009)(emphasis added). Note 2 provides that the terms "acute and subacute peripheral neuropathy" means transient peripheral neuropathy that appears within weeks or months of exposure and to an herbicide agent and resolved within two years of date of onset. Id. Note 2. Notwithstanding the foregoing, the United States Court of Appeals for the Federal Circuit has determined that the Veterans' Dioxin and Radiation Exposure Compensation Standards (Radiation Compensation) Act, Pub. L. No. 98-542, § 5, 98 Stat. 2724, 2727- 29 (1984), does not preclude a veteran from establishing service connection with proof of actual direct causation. Combee v. Brown, 34 F.3d 1039 (Fed.Cir. 1994). The Court of Appeals for Veterans Claims has specifically held that the provisions of Combee are applicable in cases involving Agent Orange exposure. McCartt v. West, 12 Vet. App. 164, 167 (1999). Service connection is also warranted on a presumptive basis with exposure to specified vesicant agents during active military service under specified circumstances together with the subsequent development of any of the indicated conditions is sufficient to establish service connection for that condition: (1) full-body exposure to nitrogen or sulfur mustard during active military service together with the subsequent development of chronic conjunctivitis, keratitis, corneal opacities, scar formation, or the following cancers: nasopharyngeal; laryngeal; lung (except mesothelioma); or squamous cell carcinoma of the skin; (2) full-body exposure to nitrogen or sulfur mustard or Lewisite during active military service together with the subsequent development of a chronic form of laryngitis, bronchitis, emphysema, asthma or chronic obstructive pulmonary disease; and (3) full-body exposure to nitrogen mustard during active military service together with the subsequent development of acute nonlymphocytic leukemia. 38 C.F.R. § 3.316(a). Service connection will not be established if the claimed condition is due to the veteran's own willful misconduct or there is affirmative evidence that establishes a non-service- related supervening condition or event as the cause of the claimed condition. 38 C.F.R. § 3.316(b). Where the determinative issue involves medical causation or a medical diagnosis, competent medical evidence is required. Grottveit v. Brown, 5 Vet. App. 91 (1993); see also Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Background National Guard medical records show that in March 1977 there was a complaint of stomach pain, diarrhea and vomiting, with a history of surgical removal of a small intestinal tumor in March 1976. Private medical records dated between August 1975 and September 1981 reflect treatment for gastrointestinal complaints, with clinical diagnoses of peptic ulcer disease and gastritis. The Veteran was diagnosed with Crohn's disease by colon biopsy in January 1988. The Veteran underwent a VA examination in October 2001, where a VA examiner noted in the narrative history that the benign tumor, resected from the Veteran's bowel in March 1976, was unrelated to the currently diagnosed Crohn's disease. During an RO hearing held in August 2003, the Veteran denied having gastrointestinal problems, other than diarrhea in Vietnam while taking malaria pills. At a hearing before the undersigned held in May 2006, the Veteran denied treatment in service for Crohn's disease, symptoms of tingling and numbness in hands and feet. He stated that his current gastrointestinal problems began 2 years after service. He noticed the tingling in hands and feet around the same time as the heart problems, which was five or six years after service. Records associated with the Veteran's SSA file show that he was awarded disability benefits in September 2002 for a primary diagnosis of hypertrophic cardiomyopathy, with a disability onset date in January 2002; and a secondary diagnosis of Crohn's disease. The medical records associated with the SSA file show treatment of heart complications and Crohn's disease, but do not reflect any complaint of tingling or numbness symptoms in the Veteran's hands and feet. The Veteran was given a VA examination in December 2008 for his claim of tingling and numbness in his hands and feet. He reported that over the past year he had developed a persistent numbness in his fingers, hands, and feet; and had begun to drop things, and feel coldness in his hands. The examiner indicated that he had reviewed the Veteran's claim file, and noted diagnoses of colon cancer and Crohn's disease. Based on the review of the claims file and physical examination, the examiner provided diagnoses of sensory peripheral neuropathy involving all four extremities; and carcinoma of the colon, metastatic to local lymph nodes. The examiner opined that the current peripheral neuropathy was more likely than not related to the Veteran's cancer and/or chemotherapy for the same. He explained that it is commonly accepted that cancers can cause peripheral neuropathy even before they are diagnosed and some chemotherapy agents do produce peripheral neuropathy. Analysis The Veteran claims entitlement to service connection for Crohn's disease and peripheral neuropathy of the hands and feet, claimed as tingling in the hands and feet. Although he served during a time of war, he does not allege that any of his conditions began in combat and; therefore, 38 U.S.C.A. § 1154(b), pertaining to proof of service incurrence or aggravation of a disease or injury in the case of a veteran who engaged in combat with the enemy, is not for application. On his initial claim for Crohn's disease, the Veteran indicated that he had been exposed to herbicides and mustard gas in service. (See VA Form 21-526, Application for Compensation and/or Pension, received in July 2000). He did not describe his personal exposure to mustard gas and he has not since specifically contended that any of his claimed disabilities are secondary to the alleged mustard gas exposure. There is no competent, credible evidence that supports or suggests any exposure to mustard gas in service nor does any competent evidence indicate that the claimed disabilities are related to claimed mustard gas exposure. At any rate, the Board notes that Crohn's disease, and peripheral neuropathy are not among the conditions associated with full body exposure to sulfur mustard (mustard gas). Therefore, they may not be service-connected on a presumptive basis for any alleged exposure to mustard gas in service. See 38 C.F.R. § 3.316(a)(2). With regards to his contention that his current disorders are due to Agent Orange exposure, his DD 214 confirms service in the Republic of Vietnam during the requisite period of time for presumed exposure to Agent Orange. However, Crohn's disease is not a disability that warrants presumptive service connection on the basis of Agent Orange exposure, and thus, may not be service-connected on a presumptive basis. See 38 C.F.R. § 3.309(e). Although acute and sub-acute peripheral neuropathy are listed in 38 C.F.R. § 3.309(e), there is no indication that the Veteran's current peripheral neuropathy is of the 'acute or sub-acute' type. According to the definition of acute and sub-acute peripheral neuropathy, those types of peripheral neuropathy manifest within two years of exposure to herbicides. The Veteran's peripheral neuropathy of the hands and feet is not shown to have manifested until several decades after active service and was not diagnosed as acute or sub-acute. Hence, the current peripheral neuropathy of the hands and feet is not presumed to have been incurred as a result of exposure to herbicides in service. See Id. As indicated, failure to establish service connection on a presumptive basis does not preclude the Veteran from establishing service connection with proof of actual direct causation. Combee v. Brown, 34 F.3d 1039 (Fed.Cir. 1994). Service treatment records for his period of active duty from October 1967 to August 1969 are unavailable and all efforts to locate them have proven unsuccessful. Hence, there is no evidence showing Crohn's disease or peripheral neuropathy of the hands and feet during active service. By the Veteran's own accounts, however, these disorders did not manifest during service. (See Hearing Transcripts dated in August 2003 and May 2006.) The Veteran separated from active service in August 1969. While the record reflects that the Veteran had gastrointestinal complaints in the mid to late 1970's, he was not diagnosed with Crohn's disease until 1988; which is almost two decades after he separated from active service. Finally, the medical records are completely negative for any complaints or objective findings related to neurological disturbances in the Veteran's hands and feet, to include peripheral neuropathy, until the December 2008 VA examination. The first manifestations of these disorders are shown to have been decades after service, and thus, are too remote in time from service, to be related to service absent competent (medical) evidence to the contrary. See Maxson v. West, 12 Vet. App. 453 (1999), aff'd, 230 F.3d 1330 (Fed. Cir. 2000) (incurrence of a disorder or disease during service may be rebutted by absence of medical treatment for, or related complaints about, the claimed condition for a prolonged period after service). In this case, there is no competent, credible medical evidence of record linking current Crohn's disease or peripheral neuropathy to service, to include any presumed exposure to Agent Orange, and alleged exposure to mustard gas therein. The October 2001 VA examiner opined that the current Crohn's disease was not related to the resected tumor during National Guard service. Moreover, it is noted that the evidence does not show that the Veteran is disabled as a result of a disease or injury incurred or aggravated during a period of active duty for training (ACDUTRA) or from an injury incurred or aggravated during a period of inactive duty for training (INACDUTRA) in the line of duty or from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident which occurred during such training. See 38 C.F.R. § 3.6(a). Instead, the December 2008 VA examiner opined that the current peripheral neuropathy of the hands and feet is more likely than not related to the Veteran's cancer and/or chemotherapy for cancer treatment. The examiner rationalized that it is commonly accepted that cancers can cause peripheral neuropathy even before they are diagnosed. Thus, the only evidence of a nexus between the claimed disorders and service is by the Veteran's contention and the Veteran is not competent to provide opinions as to the etiology of Crohn's disease and a purported relationship to service. The Board has considered whether additional VA examinations are warranted for medical opinions as to whether the claimed conditions are related to service. However, the Board finds that the VA examination report pertaining to the Veteran's claim for service connection for peripheral neuropathy was adequate as the examiner reviewed the claims folder, completed an examination of the Veteran, and provided a diagnosis as well as an opinion regarding etiology with a supporting rationale. With respect to Crohn's disease, as there is no competent evidence showing that Crohn's disease may be linked to active service, no examination is necessary. See McLendon v. Nicholson, 20 Vet. App. 79 (2006) (discussing circumstances when a VA examination is required). As there is no evidence of the claimed disorders in service, or for years thereafter, and no evidence of a nexus between the claimed disorders and active service, the preponderance of the evidence is against the claims. Thus, the "benefit of the doubt" rule is not for application. See 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Service connection for Crohn's disease and peripheral neuropathy of the hands and feet is denied. Increased Ratings In a January 2004 rating decision, the RO granted service connection for residuals of a left hip fracture (citing to an August 1983 National Guard service treatment record showing a "nondisplaced fracture of the right ischium"). A noncompensable disability rating was assigned pursuant to 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5252, effective from July 25, 2003. The Veteran disagreed with the evaluation assigned. In August 2005, the RO issued a rating decision to "correct the anatomical area of disability" (again citing the August 1983 right ischium injury) and recharacterized the issue as residuals of a right hip fracture. Pursuant to the Board's June 2007 remand decision, the AMC attempted to locate the cited National Guard record to determine which hip had actually sustained a fracture in service, and should therefore be rated on appeal. Unfortunately, the document in question was not found. For lack of further clarifying evidence, the issue remains as last characterized by the RO- entitlement to an initial compensable rating for residuals of a right hip fracture. Disability evaluations are determined by the application of a schedule of ratings, which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R., Part 4. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. The veteran's entire history is reviewed when making disability evaluations. See generally 38 C.F.R. 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3. Where, as here, the question for consideration is the propriety of the initial evaluation assigned, evaluation of the medical evidence since the grant of service connection and consideration of the appropriateness of "staged rating" is required. Fenderson v. West 12 Vet. App. 119, 126 (1999). The veteran is presumed to be seeking the maximum benefit allowed by law and regulation. AB v. Brown, 6 Vet. App. 35, (1993). Diagnostic Code 5251 assigns a 10 percent evaluation for limitation of extension of the thigh to five degrees. 38 C.F.R. § 4.71a, DC 5251 (2009). Diagnostic Code 5252 provides for a 10 percent evaluation for limitation of flexion of the thigh if flexion is limited to 45 degrees. A 20 percent is warranted for flexion of the thigh limited to 30 degrees. A 30 percent evaluation is allowed for flexion of the thigh limited to 20 degrees. A 40 percent evaluation, the highest schedular evaluation available under this code provision, is assigned for flexion of the thigh limited to 10 degrees. 38 C.F.R. § 4.71a, DC 5252 (2009). Diagnostic Code 5253 applies where there is limitation of abduction of the thigh. A 10 percent rating is assigned for limitation of abduction of the thigh, cannot cross legs; or limitation of rotation, cannot toe out more than 15 degrees of the affected leg. A 20 percent evaluation, the highest schedular evaluation available under this code, is assigned for limitation of abduction of the thigh with motion lost beyond 10 degrees. 38 C.F.R. § 4.71a, DC 5253 (2009). Normal range of motion for the hip on flexion is to 125 degrees, while normal range of motion for the hip on abduction is to 45 degrees. See 38 C.F.R. § 4.71a, Plate II (2009). In determining the degree of limitation of motion, consideration is given to each of the following: the provisions of 38 C.F.R. § 4.40 concerning lack of normal endurance, functional loss due to pain, and pain on use and during flare-ups; the provisions of 38 C.F.R. § 4.45 concerning weakened movement, excess fatigability, and incoordination; and the provisions of 38 C.F.R. § 4.10 concerning the effects of the disability on the veteran's ordinary activity. See DeLuca v. Brown, 8 Vet. App. 202 (1995). As noted, the Veteran's service treatment records are unavailable. Available National Guard records show no evidence of complaint or treatment for any hip injury. Post- service VA and private treatment records are also negative for complaints, treatment, or findings related to hip pain. The Veteran was afforded a VA examination in December 2003, where he reported to the examiner that he had not sustained a fracture of the left hip, but rather had suffered a fracture of his left ankle. His hip was not examined. Private records include a February 2004 CT scan of the left hip with no evidence of synovial osteochondromatosis; an ossification of the left superolateral acetabulum characteristic of remote injury or accessory ossification center; and no evidence of acute fracture. The Veteran underwent VA examinations in September 2004 and October 2005, where he was evaluated by a physician assistant (PA-C). In reporting the Veteran's history at the September 2004 examination, the PA-C stated that the Veteran sustained a left ischium fracture when he fell during National Guard duty. This healed without sequela. Current complaints of pain involved the left lower back, buttocks and grain, with radiation down the left leg. On physical examination, the hip joints were normal. There was some tenderness of the groin, but none in the ileum or ischial areas. Range of motion of the LEFT hip joint included: flexion to 95 degrees; abduction and adduction to 25 degrees; external rotation to 45 degrees; internal rotation to 15 degrees; and extension to 0 degrees. The Veteran had a normal gait and used no ambulatory aids. Following the examination, the examiner stated that he found no indication that the nondisplaced healed ilium fracture was the cause of his present problems. Rather, the Veteran had classic lumbar nerve root entrapment pain and probably herniated disc with spinal stenosis that was unrelated to his prior ischium fracture. During the October 2005 examination, the PA-C again referred to a National Guard record of emergency treatment for a nondisplaced fracture-although at this time he noted that it was a fracture of the right iliac wing, superior anterior lateral margin of the right acetabulum. On physical examination, there was no limp or use of ambulatory aids. Palpation of the right ileum produced some tenderness all the way to the posterior lumbar spine. Active and passive range of motion of the right hip included: flexion to 90 degrees; abduction to 40 degrees; adduction to 20 degrees; external rotation to 30 degrees; internal rotation to 20 degrees; and extension to 0 degrees. Repetitive motion of the hip caused increased low back pain, but there was no hip pain, loss of motion, weakness, fatigability, or incoordination. The diagnosis was healed nondisplaced fracture of the iliac wing and the lateral margin of the acetabulum, which was currently asymptomatic. The current pain syndrome was related to the degenerative changes of the lumbar spine and spinal stenosis and not to the asymptomatic service-connected condition. Private records include the report of a July 2007 CT scan which showed minimal degenerative changes in both hips. Given the evidence of record, the Board finds that the Veteran's service-connected right hip disability does not warrant a compensable rating for any period of time that is covered by this appeal. The October 2005 VA examination showed that the Veteran's right hip flexion was possible to 90 degrees. Repetitive motion of the hip did not result in any increased hip pain, loss of motion, weakness, fatigability, or incoordination. Therefore, even with consideration of the DeLuca factors, a compensable rating is not warranted under 38 C.F.R. § 4.71a, DC 5252. See DeLuca, supra. A compensable evaluation is not warranted under DC 5251 as the evidence does not reflect limitation of extension of the thigh to five degrees. The Veteran has been assessed as having extension to 0 degrees. Similarly, the Veteran is not entitled to a compensable evaluation under DC 5253 for limitation of abduction and adduction of the thigh. The October 2005 examination report shows the Veteran was able to abduct to 40 degrees and adduct to 20 degrees. The Board has also considered evaluating the Veteran's right hip disability under other pertinent diagnostic codes, but they are not applicable in the Veteran's case. For instance, there is no objective evidence of ankylosis, flail joint, or any impairment of the femur. See 38 C.F.R. § 4.71a, Diagnostic Codes 5250, 5254, 5255 (2009). In sum, the initial noncompensable rating assigned for residuals of a right hip fracture was proper. The Board further finds that there is no evidence that the manifestations of the Veteran's service-connected residuals of a right hip disability are unusual or exceptional to demonstrate that the rating schedule is inadequate for determining the proper level of disability. Given the relatively nonexistent subjective complaints and clinical evidence of residuals, as discussed above, his disability is reasonably described by the rating schedule. Therefore, the Board finds that the criteria for submission for an extraschedular rating pursuant to 38 C.F.R. § 3.321(b)(1) are not met. See Thun v. Peake, 22 Vet. App 111, 115-16 (2008); see also Bagwell v. Brown, 9 Vet. App. 237 (1996). ORDER Service connection for Crohn's disease is denied. Service connection for peripheral neuropathy of the hands and feet, claimed as tingling and numbness of the hands and feet, is denied. An initial compensable rating for residuals of a right hip fracture is denied. ____________________________________________ S. S. Toth Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs