Citation Nr: 21004131 Decision Date: 01/26/21 Archive Date: 01/26/21 DOCKET NO. 18-14 911 DATE: January 26, 2021 ORDER Entitlement to service connection for urinary incontinence secondary to total hysterectomy is granted. Entitlement to a rating in excess of 10 percent for chondrocalcinosis of the right knee is denied. Entitlement to a rating in excess of 10 percent for limited flexion associated with degenerative joint disease of the left hip is denied. Entitlement to a compensable rating for limitation of extension of the left hip prior to March 26, 2019, and in excess of 10 percent thereafter is denied. Entitlement to a rating in excess of 10 percent for degenerative joint disease of the left hip manifested by limited abduction, adduction, external rotation, or internal rotation is denied. Entitlement to a compensable rating for limited flexion of the right hip is denied. Entitlement to a compensable rating for limited extension of the right hip prior to March 26, 2019, and in excess of 10 percent thereafter is denied. Entitlement to a rating in excess of 10 percent for degenerative joint disease of the right hip manifested by limited abduction, adduction, external rotation, or internal rotation is denied. Entitlement to a compensable rating for headaches is denied. FINDINGS OF FACT 1. The Veteran’s service-connected hysterectomy proximately caused her urinary incontinence. 2. The Veteran’s right knee disability does not cause flexion limited to 30 degrees or extension limited to 15 degrees. 3. The Veteran’s left hip disability does not cause flexion limited to 30 degrees. 4. Prior to March 26, 2019, the Veteran’s left hip disability does not cause extension limited to 5 degrees. 5. From March 26, 2019, the Veteran’s left hip disability resulted in extension limited to 5 degrees. 6. The Veteran’s left hip does not cause limitation of abduction with motion lost beyond 10 degrees. 7. The Veteran’s right hip disability does not cause flexion limited to 30 degrees. 8. Prior to March 26, 2019, the Veteran’s right hip disability does not cause extension limited to 5 degrees. 9. From March 26, 2019, the Veteran’s right hip disability resulted in extension limited to 5 degrees. 10. The Veteran’s right hip does not cause limitation of abduction with motion lost beyond 10 degrees. 11. For the entire rating period, the Veteran’s headaches did not manifest in characteristic prostrating attacks averaging one in 2 months over the last several months. CONCLUSIONS OF LAW 1. The criteria for service connection for urinary incontinence secondary to total hysterectomy have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.306, 3.307, 3.309, 3.310. 2. The criteria for a rating in excess of 10 percent for limited extension or flexion of the right knee have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DC) 5261, 5262. 3. The criteria for to a rating in excess of 10 percent for limited flexion associated with degenerative joint disease of the left hip have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5252. 4. The criteria for a compensable rating for limitation of extension of the left hip prior to March 26, 2019, and in excess of 10 percent thereafter have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5251. 5. The criteria for a rating in excess of 10 percent for limited adduction of the left hip have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5253. 6. The criteria for to a rating in excess of 10 percent for limited flexion associated with degenerative joint disease of the right hip have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5252. 7. The criteria for a compensable rating for limitation of extension of the right hip prior to March 26, 2019, and in excess of 10 percent thereafter have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5251. 8. The criteria for a rating in excess of 10 percent for limited adduction of the right hip have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5253. 9. The criteria for a compensable rating for headaches have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.321, 4.1-4.10, 4.124, DC 8100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from December 1980 to December 2004. This matter comes to the Board of Veterans’ Appeals (Board) from rating decisions dated in July 2017 of a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). The Board remanded these specific issues to the AOJ for additional development most recently in November 2018. The Board finds that the AOJ substantially complied with remand directives, and the issues are ready for adjudication. Stegall v. West, 11 Vet. App. (1998). 1. Entitlement to service connection for urinary incontinence secondary to total hysterectomy Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110. Service connection can be established by evidence that shows “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service-the so-called “nexus” requirement.” Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may alternatively be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310 (a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists; and (2) that the current disability was either: (a) proximately caused by; or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). In order to prevail under a theory of secondary service connection, there must be: (1) evidence of a current disorder; (2) evidence of a service-connected disability; and, (3) a medical nexus between the service-connected disability and the current disorder. See Wallin v. West, 11 Vet. App. 509, 512 (1998). In adjudicating a claim, the Board is charged with the duty to assess the credibility and weight given to evidence. See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997). Competency of evidence differs from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). To deny a claim on its merits, the preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. The Veteran has contended that her urinary incontinence is secondary to her service-connected hysterectomy, or that it is secondary to her service-connected membranous glomerulonephritis with hypertension. As explained below, the Board finds that service connection is warranted based on the first theory, and will not address the second theory advanced in detail. The Board notes that the first two prongs of Wallin are satisfied. The Veteran has a diagnosis of urinary incontinence, as confirmed by outpatient records and VA examinations. A code sheet also shows that the Veteran has been service-connected for status post hysterectomy since January 2005, and is in receipt of a disability rating for uterus removal (but not for a voiding dysfunction). Therefore, the Veteran’s claim for secondary service connection hinges on the third prong, nexus. The Veteran’s service treatment records show that she had a myectomy in 1993 and a total hysterectomy in 1997. A May 2017 outpatient record indicates that the Veteran was diagnosed with incontinence after the myomectomy. A July 2017 VA examination indicates that the Veteran was diagnosed with urinary incontinence around 1993. She reported that incontinence began after fibroids were removed, and has worsened over time. The examiner indicated that the etiology is “possibly due to post-surgical changes.” The Veteran was afforded another VA examination in July 2020. The examiner indicated that it is at least as likely as not that the Veteran’s condition is proximately due to or the result of the service-connected hysterectomy. The rationale included that urinary incontinence is a complication of the surgery, and the examiner cited two studies indicating that urinary tract dysfunction is a common finding and there is significant relation to hysterectomy. Based on the competent evidence of record, the Board finds that service connection for urinary incontinence is warranted. The July 2020 VA examiner provided a positive nexus opinion with rationale. Therefore, the claim shall be granted. Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of, or incident to, military service. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability ratings is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, and the entire history of the Veteran’s disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The evaluation of the same disability under various diagnoses, and the evaluation of the same manifestation under different diagnoses, is to be avoided. 38 C.F.R. § 4.14. The critical element is that none of the symptomatology for any of the conditions is duplicative of or overlapping with symptomatology of the other conditions. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259 (1995). Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). Thus, staged ratings are appropriate for an increase rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart, 21 Vet. App. 505. Where there is a question as to which of two evaluations shall be applied, the higher evaluation 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. After consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. 2. Entitlement to a compensable rating for limited extension of the right knee The Veteran contends that she should be rated higher than 10 percent for her right knee because of pain and an inability to stand and walk for prolonged periods. Pertinent to this case, in rating 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). The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated innervation, or other 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. § 4.40. Pain on movement, swelling, deformity, or atrophy of disuse as well as instability of station, disturbance of locomotion, interference with sitting, standing, and weight bearing are relevant considerations for determination of joint disabilities. 38 C.F.R. § 4.45. Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that 38 C.F.R. § 4.59 applies to disabilities other than arthritis). Although pain may cause functional loss, pain, itself, does not constitute functional loss and is just one factor to be considered when evaluating functional impairment. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). 38 C.F.R. § 4.40 does not require a separate rating for pain but rather provides guidance for determining ratings under other diagnostic codes assessing musculoskeletal function. See Spurgeon v. Brown, 10 Vet. App. 194 (1997); see also Correia v. McDonald, 28 Vet. App. 158 (2016); Sharp v. Shulkin, 29 Vet. App. 26 (2017). The Board finds that the July 2020 VA examination is adequate for rating. In this case, the examiner documented active ranges of motion for both knees, and noted pain with weight-bearing. The Veteran reported functional limitations caused by the right knee. In addition, the examiner reported passive ranges of motion for both knees. Further, at the July 2020 VA examination, the Veteran reported flare-ups, and the examiner estimated loss of range of motion during flares. During the appeal period, the Veteran’s right knee disability is assigned a 10 percent rating under DC 5003-5260. When a disease, injury, or residual condition requires rating by analogy, the DC number will be hyphenated. The additional code used to identify the specific basis for the evaluation is shown after a hyphen. 38 C.F.R. § 4.27. DC 5003 applies to arthritis, and provides that arthritis shall be rated on the basis of limitation of motion under the appropriate diagnostic code for the specific joint involved. DC 5260 applies to limited flexion of the knee. The normal range of motion of the knee is to 0 degrees (full extension) to 140 degrees (full flexion). 38 C.F.R. § 4.71a, Plate II. When flexion of the knee is limited to 45 degrees, a 10 percent rating may be assigned. When flexion is limited to 30 degrees, a 20 percent evaluation may be assigned. A 30 percent rating may be assigned when flexion of the leg is limited to 15 degrees. 38 C.F.R. § 4.71a, DC 5260. When extension of the knee is limited to 10 degrees, a 10 percent evaluation may be assigned. When extension is limited to 15 degrees, a 20 percent evaluation may be assigned. When limited to 20 degrees, a 30 percent rating may be assigned. When extension is limited to 30 degrees, a 40 percent evaluation is assignable. A 50 percent evaluation may be assigned when extension of the leg is limited to 45 degrees. 38 C.F.R. § 4.71a, DC 5261. However, if there is painful motion of the knee with or without arthritis, and a compensable rating is not warranted based on limitation of motion, a 10 percent evaluation shall be assigned. See DC 5003, 5260-1; VAOPGCPREC 9-98; Mitchell, Burton, supra; 38 C.F.R. § 4.59. Having reviewed the applicable diagnostic codes for limited movement, the questions before the Board are: 1) whether the Veteran’s knee disability warrants a rating in excess of 10 percent for limitation of motion, which would require flexion limited to 30 degrees or extension limited to 15 degrees; and 2) whether the Veteran’s right knee disability warrants a rating in excess of 10 percent under a different diagnostic code. The Board finds that at no point during the appellate period does the Veteran’s right knee have limitation of motion sufficient to warrant a higher rating, and no other diagnostic code is applicable, meaning a higher rating is not available under another DC. The Veteran was afforded a VA examination of her knees in July 2017. The Veteran reported continued problems with the knees, especially with climbing stairs. She described the problems as crunchy, achy pain, with flare-ups involving episodes of more intense, crampy pain. Functional limitations included poor tolerance for walking and inability to squat. Active range of motion of the right knee was flexion to 95 degrees and extension to 5 degrees. The Veteran was able to perform repetitive-use testing with three repetitions, but there was no additional limitation in range of motion after repetitive use. The examiner indicated that the examination was medically consistent with the Veteran’s description of functional loss during a flare-up, but did not estimate additional loss of range of motion during a flare. Muscle strength was decreased. The Veteran did not show evidence of knee instability on joint stability testing. The Veteran did not have a tibia or fibula impairment or a meniscal condition. The examiner concluded that the Veteran’s right knee disability impacted her ability to work because she had interference with extended walking and standing. The Veteran submitted a written statement in September 2017. She argued that a higher rating was warranted because her gait changed, she could not sit or stand from sitting without support, and could not sit or walk for long periods of time. The Veteran submitted another statement in April 2020. She explained that she continued to have flare-ups of the right knee, during which she experienced swelling and pain and was unable to completely straighten the knee or bend it. The Veteran also described the knee giving out. The Veteran underwent a VA examination of her knees in July 2020. The Veteran’s symptoms included dull pain over the right knee with popping and swelling. She reported flare-ups with worse pain with movement and exertion. Functional limitations included difficulty with prolonged walking due to pain. Active range of motion of the right knee was flexion to 90 degrees and extension to 0 degrees. The Veteran was able to perform repetitive-use testing with three repetitions, but there was no additional limitation in range of motion after repetitive use. The examiner estimated that after repetitive-use over time and during a flare-up, the Veteran would have right knee flexion to 60 degrees and extension to 0 degrees. Muscle strength was normal. The Veteran did not show evidence of knee instability on joint stability testing. The Veteran did not have a tibia or fibula impairment or a meniscal condition. The examiner concluded that the Veteran’s right knee disability impacted her ability to work because she had difficulty walking for long due to pain. Based on a review of the evidence outlined above, the Board finds that with respect to a rating in excess of 10 percent for limited range of motion of the right knee, given that the VA examinations do not reflect limited range of motion sufficient for a 20 percent rating of the knee, there is no evidence to support a finding of additional functional loss for a higher rating. As mentioned above, under DC 5260, flexion of the knee must be limited to 30 degrees for a 20 percent rating. Considering functional loss from pain and during a flare-up, the VA examinations reflected flexion of the right knee greater than 30 degrees. Under DC 5261, extension of the knee must be limited to 15 degrees to warrant a 20 percent rating. The VA examinations of record reflected extension of both knees greater than 15 degrees, even considering additional functional loss caused by pain, during a flare-up, or after repetitive-use. Thus, the Veteran is not entitled to a rating in excess of 10 percent for limited range of motion of the right knee. The Board notes that the Veteran submitted private records, but finds that they do not warrant a higher rating based on limited motion. The records do not comply with Correia and Sharp, as described above, and do not indicate that the Veteran’s right knee more nearly approximates limitation of flexion to 30 degrees or extension to 15 degrees. Thus, the Board finds that the functional limitations reported and documented do not more nearly approximate limited range of motion in either flexion or extension that would warrant a 20 percent rating. The Board acknowledges the Veteran’s report of symptoms such as pain, popping, and swelling, but notes that these symptoms do not warrant a higher rating under the applicable criteria, as they do not cause limitation of motion approximating flexion of 30 degrees or extension of 15 degrees. Moreover, the reported symptoms themselves do not warrant a higher or separate rating, and are factors to be considered, which the Board has done. See Mitchell v. Shinseki, 25 Vet. App. at 43. Finally, the Board concludes that a higher rating is not warranted under any other diagnostic code, as no other diagnostic codes are applicable to the knee. There is no evidence of meniscal removal or dislocation during the appellate period such that a separate rating would be in order under either the provisions of DCs 5258 or 5259. Likewise, an evaluation for symptomatic removal of the semilunar cartilage of the knee is contemplated by DC 5259. 38 C.F.R. § 4.71a. However, in this case, as the Veteran does not have service-connected removal of the semilunar cartilage of the knee, this DC is not for application. While the Veteran argues that her knee “gives way,” the Board notes that instability testing was performed, and was normal. While the objective evidence as to this symptomatology is not necessarily dispositive on this point, the Board finds that the objective findings in this case should be given greater probative weight when the evidence overall with the absence of notations of instability is considered. See English v. Wilkie, 30 Vet. App. 347 (2018). Therefore, a separate rating for instability is also not warranted based on the competent evidence of record. In conclusion, the Veteran’s claim for a rating in excess of 10 percent for limitation of movement associated with her right knee disability is denied. The Board finds that the preponderance of the evidence is against the claim, and the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102; 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 3. Entitlement to a rating in excess of 10 percent for limited flexion associated with degenerative joint disease of the left hip 4. Entitlement to a compensable rating for limitation of extension of the left hip prior to March 26, 2019, and in excess of 10 percent thereafter 5. Entitlement to a rating in excess of 10 percent for degenerative joint disease of the left hip manifested by limited abduction, adduction, external rotation, or internal rotation 6. Entitlement to a compensable rating for limited flexion of the right hip 7. Entitlement to a compensable rating for limited extension of the right hip prior to March 26, 2019, and in excess of 10 percent thereafter 8. Entitlement to a rating in excess of 10 percent for degenerative joint disease of the right hip manifested by limited abduction, adduction, external rotation, or internal rotation Limitation of motion of the hip or thigh is rated under Diagnostic Codes 5251, 5252, and 5253. For the left hip, the Veteran is in receipt of a 10 percent rating for limitation of adduction or abduction of the hip under DC 5253 for the entire appeal period; prior to March 26, 2019, she is assigned a noncompensable (0 percent) evaluation for limited extension pursuant to DC 5251, and from March 26, 2019, the rating was increased to 10 percent; and for the entire appellate period, under DC 5252, the Veteran is assigned a noncompensable rating for limited flexion. Regarding the right hip, the Veteran is in receipt of a 10 percent evaluation under DC 5253 for limited adduction or abduction for the entire appeal period; prior to March 26, 2019, the right hip is noncompensable under DC 5251 for limited extension, and the rating was increased to 10 percent effective March 26, 2019; and the Veteran is in receipt of a noncompensable evaluation for limited flexion of the right hip under DC 5252 for the entire appeal period. Under Diagnostic Code 5251, a maximum 10 percent disability evaluation is warranted where there is limitation of extension of the thigh to 5 degrees. A 10 percent evaluation is the maximum statutorily allowable for limitation of extension. 38 C.F.R. § 4.71a, DC 5251. Under Diagnostic Code 5252, a 10 percent disability evaluation is assigned for flexion of the thigh limited to 45 degrees. For the next higher evaluation, a 20 percent rating, there must be limitation of flexion to 30 degrees. Limitation of thigh flexion to 20 degrees warrants a 30 percent rating, and limitation of flexion to 10 degrees warrants a 40 percent rating. 38 C.F.R. § 4.71a, DC 5252. Under Diagnostic Code 5253, a 10 percent disability evaluation is assigned for limitation of thigh rotation, with an inability to toe-out (external rotation) in excess of 15 degrees, or where there is limitation of adduction such that one cannot cross legs. A 20 percent disability evaluation is warranted for limitation of thigh abduction, where motion is lost beyond 10 degrees. A 20 percent evaluation is the maximum under this Diagnostic Code for limited rotation. 38 C.F.R. § 4.71a, DC 5253. Normal ranges of motion of the hip include hip flexion from 0 degrees to 125 degrees, and hip abduction from 0 degrees to 45 degrees. 38 C.F.R. § 4.7, Plate II Additionally, under DC 5250, a 60 percent rating is available for favorable ankylosis of the hip joint. Under DC 5254, an 80 percent rating is applicable for flail hip joint. However, the Board finds that these Diagnostic Codes are not applicable, and therefore a higher rating under these codes is not warranted, as the Veteran does not have ankylosis of the right hip or right flail hip joint. The requirements for an adequate VA examination of the musculoskeletal system are outlined above. The Board finds that the July 2020 VA examination of the hips and thighs is adequate for rating. In this case, the examiner documented active ranges of motion for both hips, and noted there was evidence of pain with weight-bearing. The Veteran reported functional limitations caused by the right hip. The Board notes that passive ranges of motion were documented as being the same as active ranges. Further, at the July 2020 VA examination, the Veteran reported flare-ups, and the examiner estimated loss of range of motion during flares. As explained in detail below, the Board finds that a higher rating based on DC 5251 for either hip is not warranted; a higher rating based on DC 5252 is also not warranted for either hip; and, a rating in excess of 10 percent under DC 5353 is similarly not warranted for the left or right hip. Turning to the evidence, the Veteran underwent a VA examination in July 2017. She reported the right hip was worse than the left, with intense pain that was worse at night, and especially bad with abduction or external rotation. Flare-ups involved episodes of more intense crampy, and sometimes grinding pain. Functional loss included difficulty sitting and standing for a long time. Active range of motion testing was performed, and the Veteran had right hip flexion to 80 degrees and extension to 20 degrees. Abduction was to 15 degrees, external rotation was to 20 degrees, and adduction was limited such that the Veteran could not cross her legs. For the left hip, the Veteran had flexion to 90 degrees, extension to 20 degrees, abduction to 15 degrees, adduction to 25 degrees, and external rotation to 15 degrees. Adduction of the left hip was not so limited that the Veteran could not cross her legs. The Veteran was able to perform repetitive-use testing with three repetitions, but there was no additional loss of range of motion of either hip. The examiner opined that the Veteran’s hip disability impacted her ability to work because of poor tolerance for extended walking, standing, stair climbing, or squatting. The Veteran submitted a VA Form 9 in March 2018. She explained that had difficulty swinging her leg outward, stiffness, and pain with prolonged walking, standing, and sitting. A private record dated in October 2018 indicates that the Veteran had bilateral hip arthritis, with the left hip worse than the right. Ranges of motion were reported. In March 2019, the Veteran submitted a Disability Benefits Questionnaire (DBQ) for the hips and thighs. No medical history was provided, no flare-ups were reported, and no functional loss was documented. Ranges of motion were reported, but there is no physician’s certification, signature, printed name, address, or date provided. The Veteran was afforded another VA examination in March 2019. Flare-ups involved pain, stiffness, and tightness. Functional loss included difficulty bending, standing, and walking long distances. Active range of motion testing was performed, and the most limiting ranges reported were estimated during a flare-up of both hips. The examiner reported that, at worst, the Veteran had right hip flexion to 60 degrees, extension to 5 degrees, abduction to 25 degrees, and external rotation to 35 degrees. For the left hip, at worst, the examiner reported that the Veteran had flexion to 50 degrees, extension to 5 degrees, abduction to 20 degrees, adduction to 25 degrees, and external rotation to 30 degrees. The examiner opined that the Veteran’s hip disability impacted her ability to work because sitting or standing up to an hour caused increase in pain with stiffness, difficulty using stairs, and difficulty with forward flexion and bending. In April 2020, the Veteran submitted a statement in support of her claim. She reported that when she woke up in the mornings, she used a stationary bike at a slow pace to help with stiffness. The Veteran reported walking with a limp and an inability to cross her legs. She was limited in the amount of time she could sit or lie down. The Veteran had a VA examination of her hips in July 2020. She reported flare-ups as being “worse with movement and exertion.” Functional loss included difficulty walking for long due to pain. Active range of motion testing was performed, and the most limiting ranges reported were estimated during a flare-up of both hips. The examiner reported that, at worst, the Veteran had right hip flexion to 85 degrees, extension to 15 degrees, abduction to 15 degrees, and external rotation to 10 degrees. For the left hip, at worst, the examiner reported that the Veteran had flexion to 85 degrees, extension to 15 degrees, abduction to 15 degrees, and external rotation to 10 degrees. The examiner opined that the Veteran’s hip disability impacted her ability to work because of difficulty walking for long. After a de novo review of the record, the Board concludes, first, that a compensable rating for limited extension of the right hip and left hip prior to March 26, 2019 is not warranted, and in excess of 10 percent thereafter is also not warranted. As explained above, under DC 5251, extension limited to 5 degrees warrants a 10 percent evaluation. The March 2019 VA examination was the earliest date where the Veteran demonstrated extension limited to 5 degrees; the July 2017 VA examination documented bilateral hip extension to 20 degrees. Therefore, prior to March 26, 2019, a compensable rating for extension of either hip is not warranted. From March 26, 2019, the Veteran is in receipt of the highest schedular rating for limitation of extension of both hips. Therefore, the claims for higher ratings based on extension must be denied. Second, the Board concludes that a compensable rating for limitation of right hip flexion is not warranted, a compensable rating for limitation of left hip flexion is also not warranted. As explained above, flexion limited to 45 degrees warrants a 10 percent rating under DC 5252. There is no competent evidence showing that the flexion of either hip is limited to 45 degrees, even during a flare-up or with repetitive use. At worst, the March 2019 VA examiner estimated that the Veteran’s left hip flexion was limited to 50 degrees during a flare, and the right hip flexion was limited to 60 degrees. Therefore, the limited flexion of the left and right hip do not meet the criteria for a 10 percent rating. Third, the Board concludes that a rating in excess of 10 percent for limited abduction, adduction, or external rotation, is not warranted for either hip. As noted above, a 20 percent rating shall be assigned for limitation of abduction with motion lost beyond 10 degrees. At worst, the July 2017 and July 2020 VA examinations showed that the Veteran had abduction of each hip to 15 degrees. As the competent evidence does not show motion lost beyond 10 degrees abduction, the claim for a higher rating under DC 5253 must be denied. The Board acknowledges that the Veteran submitted private records and a DBQ. However, the Board affords them little weight in its analysis because they are not adequate for rating purposes since they do not comply with Sharp and Correia. Moreover, the DBQ submitted in March 2019 did not include the physician’s information, and had incomplete sections of the form. In conclusion, the Board finds that the Veteran’s claim for a higher rating must be denied. The Board has considered the Veteran’s documented subjective reports of symptoms and limitations in walking and sitting, and finds that the limitations do not more nearly approximate hip flexion limited to 30 degrees or abduction lost beyond 10 degrees. To the extent that the Board has denied the claim, it finds that the preponderance of the evidence is against the claim, and the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102; 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 3. Entitlement to a compensable rating for headaches The Veteran has been assigned a noncompensable rating for headaches during the appeal period. She contends that a higher rating is warranted because of a benign tumor. Unfortunately, for the reasons explained below, the claim must be denied. The Veteran’s headaches are rated under Diagnostic Code 8100, which applies to migraines. A 10 percent rating is assigned for migraine headaches when a veteran has characteristic prostrating attacks averaging once in two months over the last several months. A 0 percent (noncompensable) rating is provided for migraines with less frequent attacks. 38 C.F.R. § 4.124a. The phrase “characteristic prostrating attacks” is used in the criteria corresponding to 10 percent and 30 percent ratings under DC 8100 to describe the nature and severity of migraines, but it is not defined in the regulation. Pursuant to Dorland’s Illustrated Medical Dictionary 1531 (32d ed. 2012), prostration is defined as “extreme exhaustion or powerlessness.” Thus, the phrase “characteristic prostrating attacks” is understood to describe migraine attacks that typically produce extreme exhaustion or powerlessness, or a lack of vitality. Johnson v. Wilkie, No. 16-3808, 2018 U.S. App. Vet. Claims Lexis 1253 (Sept. 19, 2018). In other words, the term “prostrating” takes on its plain meaning of “lacking in vitality or will; powerless to rise; laid low.” Id. The Veteran underwent VA examinations in July 2017 and March 2018. The Veteran reported headaches three or four times per week, lasting one to four hours. She had a funny feeling in her face, non-pulsatile, with occasional nausea, but no vomiting or other symptoms. The VA examinations indicated that the Veteran suffered from headaches, but that she did not have any characteristic prostrating attacks. After review of all the lay and medical evidence of record, the Board finds that the weight of the evidence is against finding that the disability picture for headaches more closely approximates the criteria for a compensable rating under DC 8100 for any period. Throughout this period, headaches were manifested by headache pain lasting less than one day with no prostrating attacks of headache pain. A compensable rating under DC 8100 is not warranted unless there are migraines with characteristic prostrating attacks averaging one in 2 months over the last several months. The VA examinations did not show any prostrating attacks, and there are no complaints of prostrating attacks in the VA treatment records. In consideration thereof, the Board finds that the disability picture is consistent with a 0 percent schedular rating under DC 8100, so a higher (compensable) rating under DC 8100 is not warranted for any period. As the preponderance of the evidence is against a compensable rating, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. The Board acknowledges the Veteran’s argument that a compensable rating is warranted for headaches under DC 8003 for a benign tumor. However, the Board notes that the Veteran is already in receipt of compensable disability ratings for residuals of a benign tumor, including under DC 8207 (cranial nerve paralysis), DC 7804 (surgical scar), and DC 8003-6516 (larynx). The Board does not have jurisdiction to review the ratings assigned under these diagnostic codes. Nevertheless, the Board has reviewed the March 2018 VA examination of the Veteran’s central nervous system, which documented headaches before and after neurosurgery, no residuals other than those above, and no characteristic prostrating attacks of migraine. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Smith, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.