Citation Nr: 18143528 Decision Date: 10/19/18 Archive Date: 10/19/18 DOCKET NO. 18-35 890 DATE: October 19, 2018 ORDER Entitlement to an increased rating above 10 percent for left knee arthritis is denied. Entitlement to an increased rating above 10 percent for right knee arthritis is denied. Entitlement to an increased rating above 10 percent for left knee instability is denied. Entitlement to an increased rating above 10 percent for right knee instability is denied. Entitlement to an increased rating above 10 percent for arthritis of the right hip, resulting in limitation of extension, is denied. Entitlement to a compensable rating for arthritis of the right hip, resulting in limitation of flexion, is denied. Entitlement to a compensable rating for arthritis of the right hip, resulting in limitation of adduction, is denied. REMANDED Entitlement to an increased rating above 10 percent for left hip arthritis is remanded. FINDINGS OF FACT 1. The Veteran’s bilateral knee arthritis manifests with flare-ups, pain, weakness, fatigability, incoordination, and pain on movement with range of flexion not less than 95 degrees on the left and 100 degrees on the right; there is no muscle atrophy, ankylosis, recurrent patellar dislocation, or impairment of the tibia or fibula. 2. The Veteran’s bilateral knee instability is slight. 3. The Veteran’s right hip extension is limited to 5 degrees; limitations of motion in other directions are not worse than 90 degrees flexion, 30 degrees abduction, 10 degrees adduction, 30 degrees external rotation, and 20 degrees internal rotation; the Veteran was not unable to cross his legs or toe-out more than 15 degrees; there is no evidence of ankylosis, malunion or nonunion of the femur, or a flail hip joint. CONCLUSIONS OF LAW 1. The criteria for an increased rating above 10 percent for left knee arthritis have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5010-5260 (2017). 2. The criteria for an increased rating above 10 percent for right knee arthritis have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5010-5260 (2017). 3. The criteria for an increased rating above 10 percent for left knee instability have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5257 (2017). 4. The criteria for an increased rating above 10 percent for right knee instability have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5257 (2017). 5. The criteria for an increased rating above 10 percent for right hip arthritis, resulting in limitation of extension, have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5010-5251 (2017). 6. The criteria for a compensable rating for right hip arthritis, resulting in limitation of flexion, have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5010-5252 (2017). 7. The criteria for a compensable rating for right hip arthritis, resulting in limitation in adduction, have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5010-5253 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1951 to November 1953 in the United States Army. This appeal comes to the Board of Veterans’ Appeals (Board) from rating decisions on August 23, 2016 for the right hip arthritis, and August 30, 2017 for the knees and left hip; both rating decisions come from the Department of Veterans Affairs (VA) Regional Office (RO) in Des Moines, Iowa. Prior to filing his fully developed claim on July 31, 2017, the Veteran had a pending appeal for his right hip degenerative joint disease (DJD). He received a statement of the case (SOC) on December 16, 2016. From that date he needed to file his substantive appeal “within 60 days from the date that the agency of original jurisdiction mails the Statement of the Case to the appellant, or within the remainder of the 1-year period from the date of mailing of the notification of the determination being appealed, whichever period ends later.” 38 C.F.R. § 20.302(b)(1). The RO ultimately treated the July 2017 fully developed claim as a substantive appeal for the right hip, and provided a supplemental statement of the case (SSOC) for the right hip on July 12, 2018 indicating to the Veteran and his representative that the appeal for an increased rating for the right hip disability remained pending. This appeal for increased ratings for the bilateral knees and left hip began on July 31, 2017 when the Veteran filed a fully developed claim asking VA to reevaluate his bilateral knee arthritis and instability, and his bilateral hip disabilities- which include separate ratings for limitation of flexion, extension, abduction, and adduction. An August 30, 2017 rating decision adjudicated only his bilateral knee arthritis, instability, and his left knee flexion and extension. The June 21, 2018 notice of disagreement (NOD) addressed only the bilateral knee claims, and so the July 12, 2018 statement of the case (SOC) adjudicated only the bilateral knee arthritis and instability. A substantive appeal was filed on July 23, 2018 that appealed his bilateral knee and bilateral hip disabilities. Also on July 23, 2018, a statement expressing disagreement with not receiving a higher rating for his bilateral hip disability was filed. That statement will be treated as a NOD for the left hip, and it therefore requires an SOC in response which will be addressed in the remand section. Duty to Notify and Assist Neither the Veteran nor his representative identified any shortcomings in fulfilling VA’s duty to notify and assist. Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015). The Board thus finds that further action is unnecessary under 38 U.S.C. § 5103A and 38 C.F.R. § 3.159. The Veteran will not be prejudiced because of the Board’s adjudication of the claims below. Increased Rating Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole recorded history is necessary so that a rating may accurately reflect the elements of any disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran’s medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999). Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information, lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). To deny a claim on its merits, the weight of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portray the anatomical damage and the functional loss with respect to all of these elements. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, 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 absence of part, or all, of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective enervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.10, 4.40, 4.45. Bilateral Knee Arthritis If entitlement to an increase arises within a year of the claim for an increase being filed then the effective date of the increase will be on the date that an increase was “factually ascertainable.” 38 C.F.R. § 3.400(o)(2); Harper v. Brown, 10 Vet. App. 125 (1997); VAOPGCPREC 12-98 (Sept. 23, 1998). Within a year of filing his claim the Veteran received an examination on August 16, 2016. If this examination demonstrates a factually ascertainable increase then it is the earliest date upon which an increase may be effective. During the August 16, 2016 exam the Veteran reported he could not bend his knees and he was in more pain than before, and that pain was in the joints. He reported a “fairly constant dull pain” that got worse at times. He did not have swelling, catching, or locking; his left knee was worse than his right. Limitations on activities included climbing stairs, kneeling, standing up, and getting on his tractor. He reported flare-ups, and his range of motion (ROM) was limited to 100 degrees in his right knee and 95 degrees in his left knee, with full extension in both. Both knees exhibited pain in flexion and extension, pain with weight bearing, localized tenderness or pain on palpation, and crepitus. Repetitive use testing did not show worsening ROM. However, the examiner was not able to say, without speculation, whether repetitive use caused pain, weakness, fatigability, or incoordination over time. During the exam the Veteran reported having “a little bit” of a flare-up in his left knee. Strength reduction was noted in flexion and extension in the right knee, but the examiner said the reduction was not entirely due to the claimed disability. There was no ankylosis, subluxation, or effusion. Anterior, posterior, medial, and lateral instability was found in both knees from 0-5mm. The Veteran did report that he used a walker on occasion. The examiners findings and impressions were: Bilateral severe medial compartment narrowing. Bilateral marginal osteophytosis. Dense femoral artery calcifications. Mild bilateral patellofemoral narrowing. No acute fracture or dislocation. Bilateral severe medial compartment narrowing appears progressed in both knees compared to prior exam. There is no acute fracture. On July 27, 2017 the Veteran submitted a statement that noted that he has trouble standing up without support from a sturdy object, struggled to do chores around the house, and reported his knees are giving out more causing several falls. A compensation and pension (C&P) examination took place on August 23, 2017. The Veteran reported that his left knee was worse, and that he stopped wearing his knee brace because it was cutting off circulation. He told the examiner his “knees are cracking more and feels his knees are about to give out.” He described intermittent pain, and some sharp pain that would last for some time. Flare-ups were reported, as was functional loss. His range of motion (ROM) in both knees was limited to 120 degrees for his flexion, but he had full extension; this abnormal ROM did not contribute to functional loss, but his flexion did exhibit pain on movement. Symptoms included pain on weight bearing, localized tenderness or pain on palpation, and crepitus. Repetitive use and repeated use testing revealed flexion in both knees was limited to 110 degrees with full extension. The examination was conducted during a flare-up. Pain, weakness, fatigability or incoordination did significantly limit the functional ability of the knees during the flare-up. Muscle strength was reduced to 4/5 in the right knee on flexion and extension; the strength reduction was entirely due to the arthritis of the right knee. There was no ankylosis, subluxation, or effusion in either knee. However, both knees had anterior and medial instability of 0-5mm. Neither knee had meniscal abnormalities, and there were no other pertinent physical findings. The examiners impression was, Three views of both knees demonstrate bilateral severe medial compartment osteoarthritis changes, similar to the prior May 20, 2016. Subtle compartment are preserved with small osteophyte formation compatible with mild degenerative changes. Both patellofemoral joints demonstrate mild degenerative osteophyte changes. Both knees demonstrate spurring at the insertion of the tibial tuberosity. Functional loss included trouble walking long distances, standing for long periods of time, and bending at the knees. On September 1, 2017 an addendum opinion was supplied for the August 23, 2017 examination. It requested that the examiner opine on the level of the Veteran’s instability. The examiner responded that the “instability level is mild/slight.” The Veteran’s notice of disagreement (NOD) from June 19, 2018 said he was still in great pain, and that his primary care physician told him that his knees are “bone on bone.” He said his left knee feels like giving out, and that he takes caution when walking. At that time, he was using a cane to support his left knee. After reviewing all of the evidence the Board does not find that a rating higher than 10 percent for bilateral knee arthritis is warranted. 38 C.F.R. §§ 4.59, 4.71a, Diagnostic Code 5010-5003. A compensable rating for limitation of motion alone is not available here as the Veteran’s flexion has not been limited to 60 degrees at any point, and extension has not been limited to 10 degrees at any point during this appeal. 38 C.F.R. § 4.71a, Diagnostic Code 5260 and 5261. This also means that a rating above 10 percent based on limitation of motion is not applicable. To receive a 30 percent rating for limited flexion the knee must be limited to 20 degrees of flexion; a 30 percent rating requires limitation be at 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Higher ratings for extension are warranted when extension is limited to 15 degrees (20 percent evaluation), 20 degrees (30 percent), 30 degrees (40 percent), or 45 degrees (50 percent). 38 C.F.R. § 4.71a, Diagnostic Code 5261. Despite examinations finding that flare-ups caused additional loss of motion due to pain, weakness, fatigability, and incoordination the motion is still not limited to a compensable level. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995) (although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded). Under Diagnostic Code 5003, the Veteran’s arthritic symptoms would need to cause “occasional incapacitating episodes” to warrant a 20 percent rating. 38 C.F.R. § 4.71a. The Veteran has endorsed issues with walking, standing, sitting, getting up, kneeling, and overall pain; he has not however explained incapacitating episodes, and no examiner has noted these as an issue. Functional loss would include incapacitating episodes, but even on flare-ups the Veteran displays a non-compensable range of motion that has not resulted in incapacitation. In June 2018 the Veteran did state that his knees feel like giving out and he has been told that his knees are “bone on bone.” In cases where an examination is too old to adequately evaluate the current state of the condition, and evidence shows a worsening of the condition, a new examination shall be provided. Olson v. Principi, 3 Vet. App. 480, 482 (1992). The Board notes that an examination does not become outdated after any arbitrary amount of time. The duty to get a new examination is triggered only when the available evidence indicates that the previous examination no longer reflects the current state of the Veteran’s disability. The duty to assist does not require that a claim be remanded solely because of the passage of time since an otherwise adequate VA examination was conducted. See Palczewski v. Nicholson, 21 Vet. App. 174, 181-83 (2007); VAOPGCPREC 11-95 (1995). A remand for a new examination should be based upon a finding that there is an indication in the record that condition has changed. Conversely, if there is no affirmative indication that the condition has changed, then the case should be decided based upon the available evidence and a finding that there is no indication that the condition has changed since the last examination. In this case, the most recent examination was provided just 14 months ago. Since that date the Veteran has self-reported a deteriorating condition and he has not provided VA with the medical evidence to substantiate the statement that his knees are now “bone on bone” or that his condition is worsening. Although VA has a duty to assist, the duty to assist is not a one-way street; a claimant cannot stand idle when the duty to assist is invoked by failing to provide important information or otherwise failing to cooperate. Woods v. Gober, 14 Vet. App. 214, 224 (2000); Hurd v. West, 13 Vet. App. 449, 452 (2000) (noting that a veteran cannot passively wait for help from VA). The Veteran has had an opportunity provide the Board with this evidence of his knees being “bone on bone” and thus far has not done so. His most recent examination noted issues with stability, pain, weakness, fatigue, incoordination, weight bearing, walking, sitting, and climbing. Since that examination, there is not enough objective medical evidence to warrant a new examination. The Board has also considered whether a higher disability rating or separate disability is warranted under other diagnostic codes. 38 C.F.R. § 4.71a, Diagnostic Codes 5256, 5258, and 5262. However, for the appeal period, treatments records and examination reports do not demonstrate knee ankylosis, dislocated semilunar, cartilage with frequent episodes of “locking,” pain, and effusion into the joint, or malunion of the tibia and fibula with moderate knee or ankle disability. As such, no higher disability rating is warranted under Diagnostic Codes 5256, 5258, and 5262 or any others. Throughout this appeal the Veteran has experienced limitation of motion, but it has not reached a compensable degree. He has not had incapacitating episodes. He continues to have pain on movement and that pain is the result of flare-ups that cause incoordination, weakness, and fatigue but do not create any additional functional loss not already contemplated in the rating schedule. Although he has limited walking and standing endurance, he is able to ambulate with the use of support devices to prevent falls. Therefore, a 10 percent evaluation for bilateral knee arthritis based on painful motion under 38 C.F.R. § 4.59 is appropriate, and a higher rating than 10 percent is denied. Bilateral Knee Instability Instability was first found in both knees during the August 16, 2016 VA examination. Joint stability testing revealed that both knees where demonstrating anterior, posterior, medial, and lateral instability between 0 and 5mm. Based on the August 2016 examination the Veteran received a 10 percent rating for slight instability in the September 29, 2016 rating decision. 38 C.F.R. § 4.71a, Diagnostic Code 5257. On July 27, 2017 the Veteran provided a statement saying that “lately my knees have been giving out more, it used to be a problem on uneven surfaces or going up and down stairs, but now even on flat surfaces, my knees cannot support me and I have fallen numerous times.” An examination on August 23, 2017 found similar results, but there was no lateral or posterior instability. The medial and anterior instability in both knees was still between 0 and 5mm. An addendum opinion on instability was requested, and on September 1, 2017 Dr. M. responded. The addendum opinion stated, The RO would like clarification on [the Veteran’s] physical exam of his knee that was performed on 8/23/2017, and would like to know the level of instability. Reviewed [the Veteran’s] physical exam of his knee, bilaterally and the instability level is mild/slight. In a June 19, 2018 statement the Veteran said that “[m]y left knee feels like it wants to give out and I have to be careful when I walk due to this issue. I am currently using a cane to help support my left knee issue.” Slight instability of the knees is rated at 10 percent, moderate instability is rated at 20 percent, and severe instability is rated at 30 percent. 38 C.F.R. § 4.71a, Diagnostic Code 5257. The terms mild (or slight), “moderate” and “severe” are not defined in VA regulations, and the Board must arrive at an equitable and just decision after having evaluated the evidence. 38 C.F.R. § 4.6. The Veteran has testified that his knees feel like giving out and he has recently fallen more often. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits). Recent examinations have shown only a slight instability and the examination in August 2017 even showed an improvement in overall stability as there was no lateral or posterior instability upon testing. While the Board has considered the lay testimony, it finds that the contemporaneous medical evidence based on testing the knee stability is more probative in this matter. Both the August 2016 and August 2017 examinations found slight instability with some improvement during that period, and the September 2017 addendum opinion clarified that the Veteran’s instability is “mild/slight.” With these findings the Board does not find that a rating above 10 percent is warranted for bilateral knee instability. Right Hip Degenerative Joint Disease From the time the Veteran applied for an increased rating for his bilateral hip DJD on June 15, 2016 the RO has given him the impression that his appeal for an increased rating for his right hip has remained open. Because of this, the Board will be assessing the time period from one year prior to the claim for an increased rating for the right hip, up to the present day. 38 C.F.R. § 3.400(o)(2); Harper v. Brown, 10 Vet. App. 125 (1997); VAOPGCPREC 12-98 (Sept. 23, 1998) (if the increase occurred within one year prior to the claim, the increase is effective as of the date the increase was “factually ascertainable”). A note from July 28, 2015 found the Veteran had tenderness over the right greater trochanteric region of his hip; this pain was noted as mild. There was also tenderness with a slight leg raise. He did not have pain with internal or external rotation. By August 11, 2015 the pain in the right trochanter was gone, but pain did go down the leg and into the foot; the examiner believed the Veteran had stenosis and would need an epidural. During the September 14, 2015 C&P exam the Veteran said he had received at least 5 cortisone injections for pain in his hips, and had trouble sitting or walking for long periods of time. Flare-ups were denied. The overall ROM was abnormal, with flexion being only 90 degrees, extension only 10 degrees, abduction only 30 degrees, and adduction limited to 10 degrees. Internal and external rotation were both 40 degrees. Pain on motion caused functional loss, there was pain with weight bearing, and localized tenderness. The left hip experienced slightly better results with 90 degrees of flexion, 10 degrees of extension, full abduction, 15 degrees of adduction, full external and internal rotation. Pain on motion of the left hip caused functional loss, and there was pain with weight bearing. Repetitive use testing revealed the same results in both hips. Neither hip experienced pain, weakness, fatigability, or incoordination that limited functionality with repeated use over time. Muscle strength was slightly reduced on flexion in the right hip. Neither hip had muscle atrophy or ankylosis. At that time the Veteran regularly used a walker. At the August 16, 2016 examination the examiner said changes since the last review were, The pt reports that the right hip seems more painful. Pain laterally and anterolaterally, does not catch or lock, “just pain.” The pain is mostly sharp and pretty constant, worse when sleeping on it. No recent injuries. Left hip- “nothing like the right one,” same kind of pain but less frequent and less severe. Flare-ups were reported this time; the Veteran says they happened when the weather gets worse. Right hip ROM was 110 for flexion, full extension, 35 for abduction, and 20 for adduction. His external and internal rotation was 30 and 20 degrees respectively, and he could cross his legs. Pain did create functional loss, there was pain with weight bearing, and localized tenderness. Left hip ROM was 100 degrees for flexion, 10 for extension, 40 for abduction and 15 for adduction. External and internal rotation was 50 and 35 degrees respectively. Pain was noted on motion, but there was no pain with weight bearing, no localized tenderness, and no crepitus. Repetitive use testing did not change the ROM. The examiner was unable to say whether pain, weakness, fatigability, or incoordination significantly limited functional ability with repeated use over time; and the same went for flare-ups. Muscle strength in the right hip was slightly less with flexion, and reduction of muscle strength was also found in the left hip. The reduction in muscle strength was connected to the aging process rather than the hip condition. There was no atrophy or ankylosis, and there was no malunion or nonunion of the femur, no flail hip joint or leg length discrepancy. He told the examiner he now used the walker on occasion. Findings and impressions were, Mild superior acetabular joint degenerative change bilaterally, slightly greater on the left side. No acute fracture or dislocation. No focal bone destruction. Joint spaces are preserved bilaterally. Bilateral femoral artery calcifications. Mild degenerative changes of hips. No acute interval change. The functional impact of his DJD was difficulty climbing, lifting, and bending and the knees, hips, or lumbar spine. On September 15, 2016 the Veteran submitted a statement about his right hip. He said, I had pain and discomfort in my [right] hip for over 10 years. I have limited motion and mobility concerning this hip and being seen by a local physician and receive cortisone shots in this area, I even go to a local chiropractor and receive treatment, because it is very painful some days to walk and the pain causes me to sit down for long period of times. The Veteran was seen for hip pain on September 30, 2016. This visit revealed that the Veteran’s bursa was injected a year prior due to inflammation. His hip did not experience pain with internal or external rotation. The examiner believed that the Veteran had trochanteric bursitis in the right hip, and an injection was recommended. He was injected again on January 31, 2017 due to his bursitis. On May 23, 2017 he was still tender over the right trochanter, and there was no pain on internal or external rotation. He was going to receive another injection due to success from the previous injections. A July 27, 2017 statement noted that he has difficulty bending at his hips and trouble getting out of bed, and that he has been to the pain clinic for his hip problems. He most recently had a right hip examination on August 23, 2017. He told the examiner he has constant pain in his right hip. It is a dull ache with 4-5 flare-ups per day that last 5 to 10 minutes. Sitting, standing, walking, and certain positions aggravate his pain. Functional loss due to flare-ups was reported. His bilateral flexion, abduction, and adduction were all normal; as was his internal and external rotation in both hips. His extension was limited bilaterally to 5 degrees. Painful motion was noted in both hips, with pain on weight bearing. Additional functional loss was found after repetitive use. The examination was conducted during a flare-up and there was objective evidence of pain, weakness, fatigability or incoordination that led to functional loss. He had muscle strength reduction of his right hip with flexion, extension, and abduction, but this was attributed mostly to his lumbar spine stenosis. There was no atrophy or ankylosis, and no malunion or nonunion of the femur, flail hip joint or leg length discrepancy. He was not using an assistive device. The functional loss included inability to sit or stand for long periods of time. Currently, the Veteran is rated at 10 percent for limitation of extension, and 0 percent for limitation of flexion and adduction. Based on the evidence the Board does not find that a higher rating is warranted for limitation of extension, flexion, abduction, or adduction of the right hip. Extension The Veteran is currently rated at the highest schedular rating for limitation of extension as his extension is just 5 degrees. He first received a 10 percent evaluation in the August 2016 rating decision for pain on motion in his right hip. 38 C.F.R. § 4.59. That rating was based on the August 2016 examination. His extension is now limited to 5 degrees, which allows for a compensable rating under 38 C.F.R. § 4.71a, Diagnostic Code 5251. Therefore, the Board finds that a 10 percent rating for his limited extension, effective August 16, 2016, is adequate because there is no evidence that his DJD manifested to a compensable degree before that date. Flexion, Abduction, and Adduction Throughout the entire appeal process for the right hip the Veteran has received a non-compensable rating for his limited flexion of the right hip. Diagnostic Code 5252 assigns a 10 percent rating for thigh (hip) flexion limited to 45 degrees; a 20 percent rating for thigh (hip) flexion limited to 30 degrees; a 30 percent rating for flexion limited to 20 degrees; and a 40 percent rating for flexion limited to 10 degrees. 38 C.F.R. § 4.71a; see also 38 C.F.R. § 4.71, Plate II. Diagnostic code 5253 grants a 10 percent rating for limitation of adduction (inability to cross legs), and a 20 percent rating for limitation of abduction for lost motion beyond 10 degrees. 38 C.F.R. § 4.71a. The Board finds that the evidence does not show that the Veteran’s flexion, adduction, or abduction of the right hip warrant higher ratings. Specifically, he is rated at 10 percent for limitation of extension, which is the maximum schedular rating under Diagnostic Code 5251. Additionally, the VA examinations show that, at worst, he had right hip flexion to 90 degrees, abduction to 30 degrees, adduction to 10 degrees, external rotation to 30 degrees, and internal rotation to 20 degrees. The evidence does not show that the Veteran was unable to cross his legs or toe-out more than 15 degrees, had flexion limited to 45 degrees, ankylosis, malunion or nonunion of the femur, or a flail hip joint. Accordingly, the Veteran is not entitled to a higher rating pursuant to the schedular rating criteria. The Board also considered whether the Veteran is entitled to a higher rating due to functional impairment under the provisions of 38 C.F.R. §§ 4.40 and 4.45. DeLuca v. Brown, 8 Vet. App. 202, 206-7 (1995). The Board based the Veteran’s ratings on his maximum range of motion prior to objective evidence of pain. Importantly, it would be inappropriate to assign a compensable rating under Diagnostic Code 5252 based on painful motion as the Veteran’s 10 percent rating for extension already contemplates arthritis and painful motion, pursuant to 38 C.F.R. § 4.59. Indeed, a single 10 percent rating for arthritis is appropriate to rate a major joint unless the limitation of motion shown is separately compensable under the appropriate diagnostic codes. In light of the Veteran’s reported symptoms and the medical evidence, the Board finds that the Veteran is not entitled to higher ratings for his limited flexion, abduction, and adduction in his right hip. Because the Veteran’s DJD has not caused a compensable limitation of motion in the flexion, abduction, and adduction of the right hip a compensable rating is not granted for those diagnostic codes. Pyramiding While the Veteran experienced painful motion for his extension and flexion in September 2015, a compensable rating for those diagnostic codes is prohibited based on painful motion alone since adduction was already compensated under the provisions of 38 C.F.R. § 4.59. The Board cannot grant the minimum compensable rating under Diagnostic Codes 5251 or 5252 based on painful motion because painful motion of the hips was considered in the grant of the minimum compensable rating under Diagnostic Code 5253. See 38 C.F.R. § 4.14 (evaluation of the “same disability” or, more appropriately in this case, the “same manifestation” under various diagnoses is to be avoided). Accordingly, a compensable rating is not warranted under Diagnostic Codes 5251 and 5252 for limitation of extension and flexion of the right hip. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND Left Hip Degenerative Joint Disease The June 19, 2018 NOD only appealed the bilateral knee issues. On July 12, 2018, the RO properly drafted a statement of the case (SOC) that only addressed the bilateral knee arthritis. However, the Veteran filed another NOD on July 23, 2018 expressing disagreement with the decision rendered for his bilateral hip disability. No SOC has addressed the July 23, 2018 NOD for the left hip, and therefore a remand is necessary to provide the Veteran with an SOC. Manlincon v. West, 12, Vet. App. 238, 240-41 (1999). The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records (the most recent records are from May 18, 2018). Request that the Veteran identify any other relevant treatment that he has received or is receiving, and request that he forward any additional records to VA to associate with the claims file or provide VA with authorization to obtain such records. 2. Review all medical records for the left hip for up to one year before the fully developed claim was filed on July 31, 2017. Most important to this claim are the examinations provided on August 16, 2016, and the examinations from August 23, 2017. 3. Supply the Veteran with a SOC for the left hip disability and include in that SOC a discussion of all the residuals of his left hip arthritis (extension, flexion, adduction, abduction). J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Harner, Associate Counsel