Citation Nr: 1318909 Decision Date: 06/11/13 Archive Date: 06/21/13 DOCKET NO. 09-44 716 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in San Diego, California THE ISSUES 1. Entitlement to a compensable rating prior to January 21, 2010, and a rating in excess of 10 percent from January 21, 2010, for right wrist strain. 2. Entitlement to a compensable rating prior to January 21, 2010, and a rating in excess of 10 percent from January 21, 2010, for left wrist strain. 3. Entitlement to a compensable rating prior to January 21, 2010, and a rating in excess of 10 percent from January 21, 2010, for right hip strain. 4. Entitlement to a compensable rating prior to January 21, 2010, and a rating in excess of 10 percent from January 21, 2010, for left hip strain. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD D. M. Casula, Counsel INTRODUCTION The Veteran had active service from June 2004 to February 2009, and subsequent service in the Army National Guard. This matter comes before the Board of Veterans' Appeals (Board) from a March 2009 rating decision of the above Regional Office (RO) of the Department of Veterans Affairs (VA) which granted service connection for, and assigned 0 percent disability ratings, for bilateral wrist strain and bilateral hip strain, effective February 25, 2009. A January 2010 rating decision granted 10 percent ratings for all four disabilities, effective January 21, 2010. However, as those increases do not represent a total grant of benefits sought on appeal, the claims for increase remains before the Board. AB v. Brown, 6 Vet. App. 35 (1993). FINDINGS OF FACT 1. Prior to January 21, 2010, the Veteran's right (major) wrist strain was manifested by complaints of dull pain and stiffness. However, there no showing of limitation of wrist motion, pain on motion, or ankylosis. 2. Prior to January 21, 2010, the Veteran's left (minor) wrist strain was manifested by complaints of dull pain and stiffness. However, there was no more than slight limitation of wrist motion, and no showing of pain on motion or ankylosis. 3. As of January 21, 2010, the Veteran's right wrist strain has been manifested by pain, stiffness, tenderness, flare-ups, pain at end ranges of motion, and pain after repetitive use. However, there has been no objective evidence showing limitation of wrist motion or ankylosis and the Veteran has been in receipt of the maximum rating allowed for limitation of motion of a major wrist. 4. As of January 21, 2010, the Veteran's left wrist strain has been manifested by pain, tenderness, stiffness, flare-ups, pain at end ranges of motion, and pain after repetitive use. However, there has been no objective evidence showing limitation of wrist motion or ankylosis and the Veteran has been in receipt of the maximum rating allowed for limitation of motion of a minor wrist. 5. Prior to January 21, 2010, the Veteran's right and left hip strain have each been manifested by pain, and complaints of stiffness, giving way, and fatiguing easily. However, neither hip was shown to be productive of limitation of extension to 5 degrees, limitation of flexion of the thigh to 45 degrees, limitation of adduction with an inability to cross the legs, or limitation of rotation with an inability to toe-out more than 15 degrees with the affected leg. 6. Effective from January 21, 2010, the Veteran's right and left hip strain have each been manifested by pain, stiffness, lack of endurance, tenderness, and flare-ups. However, they were not productive of limitation of flexion of the thigh to 30 degrees or limitation of abduction of the thigh with motion lost beyond 10 degrees. CONCLUSIONS OF LAW 1. The criteria for an initial compensable rating for right wrist strain, prior to January 21, 2010, have not been met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 4.7, 4.71a, Diagnostic Codes 5214, 5215 (2012). 2. The criteria for a rating in excess of 10 percent for right wrist strain, effective January 21, 2010, have not been met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 4.7, 4.71a, Diagnostic Codes 5214, 5215 (2012). 3. The criteria for an initial compensable rating for left wrist strain, prior to January 21, 2010, have not been met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 4.7, 4.71a, Diagnostic Codes 5214, 5215 (2012). 4. The criteria for a rating in excess of 10 percent for left wrist strain, effective January 21, 2010, have not been met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 4.7, 4.71a, Diagnostic Codes 5214, 5215 (2012). 5. The criteria for an initial compensable rating for right hip strain, prior to January 21, 2010, have not been met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 4.7, 4.71a, Diagnostic Codes 5251-5253 (2012). 6. The criteria for a rating in excess of 10 percent for right hip strain, effective January 21, 2010, have not been met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 4.7, 4.71a, Diagnostic Codes 5251-5253 (2012). 7. The criteria for an initial compensable percent rating for left hip strain, prior to January 21, 2010, have not been met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 4.7, 4.71a, Diagnostic Codes 5251-5253 (2012). 8. The criteria for a rating in excess of 10 percent for left hip strain, effective January 21, 2010, have not been met. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. §§ 4.7, 4.71a, Diagnostic Codes 5251-5253 (2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Duty to Notify and Assist VA has a duty to notify and assist claimants in substantiating claims for VA benefits. 38 U.S.C.A. §§ 5103, 5103A, 5107, 5126 (West 2002); 38 C.F.R. §§ 3.102, 3.159, 3.326(a) (2012). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his representative of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a) (West 2002); 38 C.F.R. § 3.159(b) (2012); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Proper notice from VA must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. 38 C.F.R. § 3.159(b)(1) (2012). The notice must be provided prior to an initial decision on a claim by the RO. Mayfield v. Nicholson, 444 F.3d 1328 (Fed. Cir. 2006); Pelegrini v. Principi, 18 Vet. App. 112 (2004). The notice requirements apply to all five elements of a service connection claim: (1) veteran status; (2) existence of disability; (3) connection between service and the disability; (4) degree of disability; and (5) effective date of benefits where a claim is granted. Dingess v. Nicholson, 19 Vet. App. 473 (2006). If complete notice is not provided until after the initial adjudication, that timing error can be cured by subsequent legally adequate notice, followed by readjudication of the claim, such as in a statement of the case or supplemental statement of the case. Moreover, where there is an uncured timing defect in the notice, subsequent action by the RO which provides the claimant a meaningful opportunity to participate in the processing of the claim can prevent any defect from being prejudicial. Mayfield v. Nicholson, 499 F.3d 1317 (Fed. Cir. 2007); Prickett v. Nicholson, 20 Vet. App. 370 (2006). The burden of proving harmful error due to defective notice rests with the party attacking the agency decision. Shinseki v. Sanders, 129 S. Ct. 1696 (2009). The notice requirement for increased rating claims is for generic notice of the type of evidence needed to substantiate the claim, namely, evidence demonstrating a worsening or increase in severity of the disability and the effect that worsening has on employment, and general notice regarding how disability ratings and effective dates are assigned. Vazquez-Flores v. Shinseki, 580 F.3d 1270 (Fed.Cir. 2009). In this case, the duty to notify was satisfied by a letter sent to the Veteran in May 2009 that fully addressed the notice elements and was sent after the initial RO decision in this matter. Although the appellate issues in this case are downstream issues from that of service connection, the May 2009 notice letter advised the Veteran of what was necessary with respect to claims for higher ratings. That letter informed the Veteran of what evidence was required to substantiate the claims and of his and VA's respective duties for obtaining evidence. The May 2009 letter also advised the Veteran how disability ratings and effective dates are assigned. See Dingess v. Nicholson, 19 Vet. App. 473 (2006). Moreover, he has not demonstrated any error in notice. Shinseki v. Sanders, 129 S. Ct. 1696 (2009). Thus, the Board concludes that all required notice has been given to the Veteran. The Board also finds VA has satisfied the duty to assist the Veteran in the development of the claims. The RO obtained all identified and available service treatment records for the Veteran, and the Veteran has indicated he has had no post-service treatment for either his wrists or his hips. Further, the record shows that the Veteran underwent VA examinations in February 2009 and January 2010. In the January 2010 VA examination report, the Veteran is referred to as "female" and "she." That appears to have been a typographical error, as a review of the VA examination report, in conjunction with the rest of the record, including statements by the Veteran and his representative, shows that the findings made on the VA examination in 2010 pertain to the Veteran. Thus, notwithstanding the references to the Veteran as a female, the Board will consider the 2010 VA examination report. In reviewing the VA examination reports from 2009 and 2010, it appears that each examination included a review of the record and a history obtained from the Veteran, and examination findings were reported, along with diagnoses/opinions, which were supported in the record; thus, the examination reports are adequate for rating purposes. Barr v. Nicholson, 21 Vet. App. 303 (2007). It appears that all obtainable evidence identified by the Veteran relative to his claims has been obtained and associated with the claims folder, and that neither he nor his representative has identified any other pertinent evidence, not already of record, which would need to be obtained for a fair disposition of this appeal. The Board concludes that no further notice or assistance to the Veteran is required to fulfill VA's duty to assist him in the development of the claims. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001). The Board concludes that VA has satisfied the duty to assist the Veteran in apprising him as to the evidence needed, and in obtaining evidence pertinent to his claims. No useful purpose would be served in remanding this matter for more development. Such a remand would result in unnecessarily imposing additional burdens on VA, with no additional benefit flowing to the Veteran. Sabonis v. Brown, 6 Vet. App. 426, 430 (1994). Factual Background On VA examination in February 2009, the Veteran reported discomfort in the hips, greater on the right than the left, and reported the pain was at level 5 in both hips. The hips were not weak, but felt somewhat stiff and did not swell, get hot, or lock. The hips gave way slightly and fatigued easily, and he noted popping in his hips. He reported no history of flare ups of pain. It was noted that his hips limited his ability to do his work and recreational activities, but not his usual daily activities. He reported that his wrists had been popping and causing dull pain since 2007. He reported pain at a level of 2 to 3 in both wrists, and that his wrists were not weak, but were slightly stiff, gave way, and tired easily. He did not have flare-ups, but it was noted that his wrists decreased his ability to do his work, but not his recreational activities or his usual daily activities. On physical examination of the hips there was no objective evidence of painful motion, edema, effusion, instability, weakness, tenderness, redness, heat, or abnormal movement. Range of motion testing of both hips revealed that flexion was to 130 degrees, abduction to 40 degrees, adduction to 25 degrees, external rotation to 25 degrees, internal rotation to 30 degrees to the right and to 25 degrees on the left, and extension was to 10 degrees. Repetitive activity in both wrists produced no pain, crepitation, or change in the range of motion due to pain, fatigue, weakness, lack of endurance, or incoordination. On physical examination, the right and left wrists revealed no objective evidence of painful motion, edema, effusion, instability, weakness, tenderness, redness, heat, or abnormal movements. Range of motion testing of the right wrist revealed that dorsiflexion was to 70 degrees, palmar flexion was to 80 degrees; ulnar deviation was to 45 degrees, and radial deviation was to 15 degrees. Range of motion testing of the left wrist revealed that dorsiflexion was to 65 degrees, palmar flexion was to 70 degrees; ulnar deviation was to 45 degrees, and radial deviation was to 10 degrees. Repetitive activity of the right and left wrists produced no pain, 2+ crepitation, and no change in range of motion due to pain, fatigue, weakness, lack of endurance, or incoordination. X-rays of the wrists and hips revealed normal findings. The diagnoses included mild bilateral wrist strain, with no apparent functional impairment, and mild bilateral hip strain, with no apparent functional impairment. VA treatment records showed that in July 2009, the Veteran was seen to establish a new primary care physician (PCP) for health issues, and he reported a history of bilateral hip pain related to a service-connected injury, and that the pain worsened when walking. He also complained of bilateral wrist pain for three years, that was related to service. On examination his hips had normal range of motion and were nontender, and his wrists were nontender and had negative Phalen's and Tinel's signs. An x-ray report dated in July 2009 revealed normal right and left wrists. An x-ray report dated in August 2009, provided an impression of bilateral hip series fails to demonstrate fracture, compromise, or joint space compromise. An MRI of the hips, conducted in September 2009, was negative. Received from the Veteran in October 2009 was a substantive appeal in which he reported that his wrists and hips were in pain every day, and that the pain increased with use. On VA examination in January 2010, the Veteran reported having bilateral wrist pain and stiffness, but denied experiencing other symptoms. He reported flare ups, as often as 5 times per week, lasting for a half hour, with a severity level of 7. With regard to his hips, he reported having stiffness, lack of endurance and pain, but denied other symptoms. He reported flare ups as often as three times per week, lasting one hour, with a severity level of 5. He reported that flare-ups of his wrists and hips were precipitated by physical activity, and alleviated by rest. Also, during flare-ups he had no functional impairment or limitation of joint motion. Objective examination of the right and left wrists, and the right and left hips, revealed tenderness, but no signs of edema, instability, abnormal movement, effusion, weakness, redness, heat, deformity, guarding of movement, malalignment, drainage, subluxation, or ankylosis. Range of motion testing of the wrist joints and the hip joints showed full range of motion, with pain at the end ranges of motion, but repetitive motion caused no additional degree of limitation. The examiner indicated that for the right and left wrists and the right and left hips, the joint function was additionally limited by pain, after repetitive use, and that pain caused the major functional impact for both wrists and hips. X-ray findings of the right and left wrists were within normal limits. X-rays of the right and left hips showed acetabular dysplasia and osteoarthritis. The diagnoses included right and left wrist strain, and right and left hip acetabular dysplasia and osteoarthritis. The examiner opined that the Veteran's wrists and hip conditions had no affect on his usual occupation or his daily activities. Analysis Disability rating are determined by comparing a Veteran's present symptomatology with criteria set forth in VA's Schedule for Rating Disabilities. The percentage ratings represent, as far as can practicably be determined, the average impairment in earning capacity resulting from such diseases and injuries and their residual conditions in civil occupations. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C.A. § 1155 (West 2002); 38 C.F.R. § 4.1, Part 4 (2012). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2012). Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3 (2012). In general, when an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). Staged ratings are appropriate in any increased rating claim in which distinct time periods with different ratable symptoms can be identified. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). In rating disabilities of the musculoskeletal system, it is necessary to consider functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). Functional loss may be due to due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. 38 C.F.R. § 4.40 (2012). Pain on movement, swelling, deformity, or atrophy of disuse are relevant factors in regard to joint disability. 38 C.F.R. § 4.45 (2012). Painful, unstable, or malaligned joints, due to a healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59 (2012). Right Wrist Strain and Left Wrist Strain The Veteran contends he should be entitled to higher initial ratings for his service-connected right and left wrist disabilities; to include compensable ratings prior to January 21, 2010, and ratings in excess of 10 percent from January 21, 2010. A March 2009 rating decision granted service connection for bilateral wrist strain and assigned an initial 0 percent rating, effective February 25, 2009, pursuant to Diagnostic Code 5215. 38 C.F.R. § 4.71a (2012). Thereafter, a January 2010 decision granted separate 10 percent ratings for right wrist strain and for left wrist strain, with both ratings effective January 21, 2010. The Veteran's service-connected right wrist disability involves his right major upper extremity as he is right-handed. 38 C.F.R. § 4.69 (2012). The disability encompasses orthopedic impairment only and has been rated pursuant to Diagnostic Code 5215. 38 C.F.R. § 4.71a (2012). A maximum 10 percent rating is warranted for limitation of motion of the wrist (major or minor), when dorsiflexion is less than 15 degrees or palmar flexion is limited in line with the forearm. 38 C.F.R. § 4.71a, Diagnostic Code 5215 (2012). A 30 percent rating is assigned for a major (dominant) wrist and a 20 percent rating is assigned for a minor (nondominant) wrist if there is favorable ankylosis of the wrist, in 20 degrees to 30 degrees dorsiflexion. 38 C.F.R. § 4.71a, Diagnostic Code 5214 (2012). Normal range of palmar flexion for the wrist is 80 degrees, and normal range of dorsiflexion is 70 degrees. Palmar flexion in line with the forearm equates to 0 degrees of palmar flexion or dorsiflexion. 38 C.F.R. § 4.71a, Plate I (2012). The Veteran contends he should be entitled to initial compensable ratings for service-connected right and left wrist strains, prior to January 21, 2010, and ratings in excess of 10 percent, from January 21, 2010. He contends that he has daily pain in his wrists that increases with use. Additionally, in May 2013, the representative indicated that pain was a major part of the Veteran's bilateral wrist disabilities, and indicated that pain must be considered to determine functional loss. Prior to January 21, 2010, the Veteran's service-connected right and left wrist disabilities were primarily manifested by complaints of dull pain and stiffness. However, there was only slight limitation of motion shown on left wrist dorsiflexion and palmar flexion and no limitation of right wrist motion, and ankylosis of the wrists was neither shown nor alleged during that period. In order for a compensable rating to be assigned for the right and left wrist disabilities, the competent evidence would need to show dorsiflexion less than 15 percent or palmar flexion limited in line with the forearm, or comparable functional impairment. The competent evidence of record, prior to January 21, 2010, does not show that either the Veteran's right wrist or left wrist disorder caused a level of functional loss that would contemplate the assignment of a compensable rating. Although the Veteran reported having dull pain and stiffness, the competent evidence did not show limitation of motion or pain on motion, such that the extent to which the range of motion might be additionally limited would not merit greater than a 0 percent rating under the appropriate Diagnostic Codes. DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. §§§ 4.40, 4.45, 4.71a, Diagnostic Codes 5214, 5215 (2012). The Veteran's report of wrist pain has been considered, but the competent evidence does not show functional loss that caused a limitation of function such that a compensable rating would be warranted. 38 C.F.R. §§ 4.40, 4.45 (2012). Therefore, the Board finds that compensable ratings prior to January 21, 2010, for the service-connected wrist disabilities are not warranted. The Board will next consider entitlement to ratings in excess of 10 percent, effective January 21, 2010, for the right and left wrist disabilities. On the VA examination in 2010, the Veteran complained of wrist pain and flare ups, and examination showed tenderness in the wrists. Although there was no limitation of wrist motion shown, the examiner indicated that the wrist joint function was additionally limited by pain, after repetitive use, and that pain caused the major functional impact for the wrists. The record shows that the RO assigned 10 percent ratings for each wrist, essentially based on that finding. Because the maximum rating for limitation of motion of the wrist has been granted, effective January 21, 2010, for each wrist, in order to warrant the assignment of a higher rating for either right or left wrist strain, the competent evidence would need to show favorable ankylosis of the wrist, in 20 degrees to 30 degrees dorsiflexion, or comparable impairment. 38 C.F.R. § 4.71a, Diagnostic Code 5214 (2012). While the Veteran's reports of pain and flare ups are acknowledged, the Board finds that the effects of pain reasonably shown to be due to the service-connected right and left wrist disabilities are already contemplated by the 10 percent rating. the medical evidence indicates that although there was pain at end ranges of wrist motion and pain with repetitive movements, the pain did not in limit motion to such a degree that it was analogous to ankylosis. In addition, there is no indication in the record that the Veteran's pain due to his service-connected right and left wrist disabilities caused functional loss greater than that contemplated by the 10 percent ratings already assigned. 38 C.F.R. §§ 4.40, 4.45 (2012); DeLuca v. Brown, 8 Vet. App. 202 (1995). The Board also notes that in the assignment of the current 10 percent ratings that additional function loss has been considered, as without taking into consideration the Veteran's wrist complaints of additional functional loss, the 10 percent ratings might not be justified. Thus, the overall objective evidence fails to show that the Veteran's pain resulted in additional functional limitation such as to enable a finding that his wrist disability picture more nearly approximated a rating in excess of 10 percent under Diagnostic Code 5214 for either wrist. 38 C.F.R. §§ 4.40, 4.45, 4.71a (2012). The Board also finds that higher ratings are also not warranted under Diagnostic Code 5213, as there was no evidence that the Veteran's right or left wrist strain resulted in limitation of pronation with motion lost beyond the last quarter of arc, or evidence of bone fusion of the forearm. In sum, the preponderance of the evidence of record is against assigning compensable ratings prior to January 21, 2010, and against assigning 10 percent ratings from January 21, 2010, for service-connected right and left wrist disabilities. As the preponderance of the evidence is against the claims for higher ratings for the service-connected right and left wrist disabilities, the claims must be denied. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Right Hip Strain and Left Hip Strain The Veteran contends he should be entitled to higher initial ratings for his service-connected right and left hip disabilities; to include compensable ratings prior to January 21, 2010, and ratings in excess of 10 percent from January 21, 2010. A March 2009 rating decision granted service connection for bilateral hip strain and assigned a 0 percent rating, effective February 25, 2009, pursuant to Diagnostic Code 5251. 38 C.F.R. § 4.71a (2012). Thereafter, a January 2010 decision granted, separate 10 percent ratings for right hip strain and for left hip strain, with both ratings effective January 21, 2010. The Veteran's right and left hip disabilities may be rated under Diagnostic Codes 5251, 5252, or 5253, for limitation of motion of the thigh. Diagnostic Code 5251 provides for a maximum 10 percent rating for limitation of extension of the thigh to 5 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5251 (2012). Diagnostic Code 5252 provides for a 10 percent rating for limitation of flexion to 45 degrees. A 20 percent rating is warranted for limitation of flexion to 30 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5252 (2012). Diagnostic Code 5253 provides for a 10 percent rating for impairment of the thigh manifested by limitation of adduction and inability to cross the legs, or by limitation of rotation and inability to toe-out more than 15 degrees of the affected leg. A 20 percent rating is warranted for impairment of the thigh, manifested by limitation of abduction, where motion is lost beyond 10 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5253 (2012). In considering the Veteran's claims for compensable ratings, prior to January 21, 2010, for right and left hip strain, the evidence of record for that period essentially consists of the Veteran's statements and the VA examination report dated in 2009. The Veteran reported hip pain at level 5, but that the discomfort in the right hip was greater than the left. He reported his hips felt stiff, gave way slightly, and fatigued easily. However, physical examination of the hips showed no painful motion, instability, weakness, or tenderness, and range of motion testing of both hips found that flexion was full and abduction was only slightly limited. The diagnosis was mild bilateral hip strain, with no apparent functional impairment. The Board finds that the evidence of record prior to January 21, 2010, does not show that the Veteran experiences or even approximates limitation of extension of the thigh to 5 degrees, or limitation of flexion of the thigh to 45 degrees or less, or limitation of adduction of the thigh with an inability to cross the legs, or limitation of rotation of the thigh with an inability to toe-out more than 15 degrees on the affected leg. Thus, the Board finds that neither the Veteran's right hip strain nor his left hip strain approximated the criteria for a compensable rating at any point prior to January 21, 2010. 38 C.F.R. § 4.7 (2012). In concluding the Veteran is not entitled to compensable ratings prior to January 21, 2010, the Board has considered whether he had additional functional loss beyond that objectively shown due to pain, weakness, excess fatigability, incoordination, or other factors. DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. §§ 4.40, 4.45 (2012). However, there is no indication in the record that the Veteran's functional ability is decreased beyond the very slight limitation of motion shown on examination. As a result, the Board concludes that the current 0 percent ratings assigned prior to January 21, 2010, are appropriate considering the Veteran's extent of pain, including the resulting effect on range of motion and function. With regard to the Veteran's claims for ratings in excess of 10 percent, for the right and left hip strain, effective January 21, 2010, the evidence of record for that period essentially consists of the VA examination report dated in 2010. Therein, he reported having hip pain, stiffness, lack of endurance, and flare ups of pain, with no functional impairment or limitation of motion, and examination revealed tenderness and full range of motion with pain at the end ranges of motion. The diagnoses included right and left hip acetabular dysplasia and osteoarthritis. Considering the applicable rating criteria as set forth above, the Board finds that the evidence of record effective from January 21, 2010, does not show that the Veteran experiences or approximates limitation of flexion of the thigh to 30 degrees or less, or limitation of abduction of the thigh with motion lost beyond 10 degrees. Thus, the Board finds that neither the Veteran's right hip strain nor left hip strain approximates the criteria for a 10 percent rating at after January 21, 2010. 38 C.F.R. § 4.7 (2012). In concluding the Veteran is not entitled to ratings in excess of 10 percent, effective from January 21, 2010, the Board has considered whether he has additional functional loss beyond that objectively shown due to his pain, or because of weakness, excess fatigability, incoordination, or other factors. DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. §§ 4.40, 4.45 (2012). However, there is no indication in the record that the Veteran's functional ability is decreased such that there is any additional limitation of motion. As a result, the Board concludes that the current 10 percent ratings assigned, effective from January 21, 2010, are appropriate considering the Veteran's extent of pain and flare ups, including the resulting effect on his range of motion and functioning. The Board notes that in adjudicating a claim the Board must assess the competence and credibility of the Veteran. Buchanan v. Nicholson, 451 F.3d 1331(Fed. Cir. 2006); Washington v. Nicholson, 19 Vet. App. 362 (2005). The Board acknowledges that the Veteran is competent to report about what he observes or experiences, such as pain and limited mobility. Layno v. Brown, 6 Vet. App. 465 (1994). While the Veteran is competent to report the symptoms he experiences, and the Board finds him credible in this regard in that report, a review of the record shows that the objective clinical findings considered with the Veteran's reported symptoms are consistent with the assigned schedular ratings. The Board concludes that at no time period prior to January 21, 2010, was the Veteran's service-connected right or left hip strain more disabling than the 0 percent ratings currently assigned, and at no time since January 21, 2010 have his service-connected right or left hip strain been more than 10 percent disabling. The Board finds the preponderance of the evidence is against the assignment of compensable ratings prior to January 21, 2010, or higher than 10 percent ratings as of January 21, 2010, for right hip strain and left hip strain. Therefore, the claims must be denied. 38 U.S.C.A. § 5107(b) (West 2002); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Extraschedular Ratings The rating schedule represents as far as practicable, the average impairment of earning capacity. Ratings will generally be based on average impairment. 38 C.F.R. § 3.321(a),(b) (2012). To afford justice in exceptional situations, an extraschedular rating can be assigned. First, the RO or the Board must determine whether the evidence presents such an exceptional disability picture that the available schedular ratings for that disability are inadequate. Second, if the schedular rating does not contemplate the Veteran's level of disability and symptomatology and is found inadequate, the RO or Board must determine whether the claimant's exceptional disability picture exhibits other related factors such as those provided by the regulation as governing norms. Third, if the rating schedule is inadequate to rate a Veteran's disability picture and that picture has attendant thereto related factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether the Veteran's disability picture requires the assignment of an extraschedular rating. 38 C.F.R. § 3.321(b) (2012); Thun v. Peake, 22 Vet. App. 111 (2008). The Veteran's symptoms associated with his service-connected right and left wrist disabilities, and his right and left hip disabilities, included various complaints and findings, including pain, stiffness, tenderness, and slight limitation of motion. Moreover, those disabilities impact his ability to do certain activities. However, the impairment due to the disabilities is contemplated and adequately compensated by the applicable rating criteria. The rating criteria regarding limitation of motion of the wrists and the hips reasonably describe the Veteran's disabilities and provide for higher ratings for more severe impairment, which is not shown. In addition, the Veteran has not alleged marked interference with employment due to his service-connected disabilities, nor has he been frequently hospitalized for any of the disabilities. Therefore, the Board finds that referral for consideration of an extraschedular rating is not warranted. 38 C.F.R. § 3.321(b) (2012). ORDER An initial compensable rating, effective prior to January 21, 2010, for right wrist strain, is denied. An initial compensable rating, effective prior to January 21, 2010, for left wrist strain, is denied. A rating in excess of 10 percent, effective from January 21, 2010, for right wrist strain, is denied. A rating in excess of 10 percent, effective from January 21, 2010, for left wrist strain, is denied. An initial compensable rating, effective prior to January 21, 2010, for right hip strain, is denied. An initial compensable rating, effective prior to January 21, 2010, for left hip strain, is denied. A rating in excess of 10 percent, effective from January 21, 2010, for right hip strain, is denied. A rating in excess of 10 percent, effective from January 21, 2010, for left hip strain, is denied. ____________________________________________ HARVEY P. ROBERTS Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs