Citation Nr: 21061785 Decision Date: 10/05/21 Archive Date: 10/05/21 DOCKET NO. 17-38 219 DATE: October 5, 2021 ORDER An initial disability rating higher than 10 percent for a left knee disability based on limitation of flexion is denied. Effective June 8, 2021, a separate disability rating of 10 percent for a left knee disability based on limitation of extension is granted. Prior to June 8, 2021, a rating higher than 10 percent for left knee instability/subluxation is denied. Effective June 8, 2021, a rating of 20 percent, but no higher, for left knee instability/subluxation, is granted. A rating higher than 10 percent for a right hip disability based on limitation of extension is denied. A rating higher than 10 percent for a right hip disability based on limitation of abduction is denied. A compensable disability rating for a right hip disability based on limitation of flexion of the right hip is denied. FINDINGS OF FACT 1. The Veteran's left knee disability is manifested by complaints of pain, with flexion limited to no less than 125 degrees. 2. Prior to June 8, 2021, left knee extension was to 0 degrees, with slight recurrent subluxation/instability; from June 8, 2021, left knee extension was to 10 degrees, with moderate recurrent subluxation/instability. 3. The Veteran's right hip disability is manifested by complaints of pain, with flexion limited to no less than 60 degrees and extension to no less than 15 degrees. 4. The Veteran's right hip disability exhibits impairment of the right thigh manifested by limitation of abduction of the thigh with an inability to cross the legs; limitation of abduction with motion lost beyond 10 degrees is not shown. CONCLUSIONS OF LAW 1. The criteria for a rating higher than 10 percent for a left knee disability, based on limitation of flexion, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5260. 2. From June 8, 2021, the criteria for a 10 percent disability rating, but no higher, for a left knee disability, based on limitation of extension, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5261. 3. Prior to June 8, 2021, the criteria for a rating higher than 10 percent for left knee recurrent subluxation/instability have been not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5257. 4. From June 8, 2021, the criteria for a 20 percent disability rating, but no higher, for left knee recurrent subluxation/instability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5257. 5. The criteria for a rating higher than 0 percent for a right hip disability based on limitation of flexion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5252. 6. The criteria for a rating higher than 10 percent for a right hip disability based on limitation of abduction have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5253. 7. The criteria for a rating higher than 10 percent based on limitation of extension of the right hip have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5251. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from December 1971 to July 1977. This matter comes before the Board of Veterans' Appeals (Board) on appeal from August 2013, May 2014, and May 2017 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded this matter in May 2019 and June 2020 for additional development. During the pendency of the appeal, a June 2021 rating decision, granted a noncompensable disability rating for limitation of flexion of the right hip, effective February 25, 2021. Although the Veteran has not filed a notice of disagreement with respect to the assigned rating, the Board considers the separate rating to be part of the Veteran's increased rating claim for his right hip disability. Increased Rating Ratings for service-connected disabilities are determined by comparing the Veteran's symptoms with criteria listed in VA's Schedule for Rating Disabilities, which is based, as far as practically can be determined, on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 C.F.R. Part 4. When rating a service-connected disability, the entire history must be borne in mind. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). 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 required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2009). The assignment of a particular diagnostic code to evaluate a disability is "completely dependent on the facts of a particular case." See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, the diagnosis, and demonstrated symptomatology. Traumatic arthritis shown by x-ray studies is rated based on limitation of motion of the affected joint. When limitation of motion would be noncompensable under a limitation-of-motion code, but there is at least some limitation of motion, a 10 percent disability rating may be assigned for each major joint so affected. 38 C.F.R. § 4.71a, Diagnostic Codes 5003 (degenerative arthritis) and 5010 (traumatic arthritis). Diagnostic Code 5003 states that degenerative arthritis established by x-ray findings will be rated on the basis of limitation of motion under the appropriate Diagnostic Codes for the specific joint or joints involved. 38 C.F.R. § 4.71a, Diagnostic Code 5003. When, however, the limitation of motion is noncompensable under the appropriate Diagnostic Codes, a rating of 10 percent may be applied to each such major joint or group of minor joints affected by limitation of motion. The limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a, Diagnostic Code 5003. In the absence of limitation of motion, x-ray evidence of arthritis involving two or more major joints or two or more minor joint groups, will warrant a rating of 10 percent; in the absence of limitation of motion, x-ray evidence of arthritis involving two or more major joint groups with occasional incapacitating exacerbations will warrant a 20 percent rating. The above ratings are to be combined, not added under Diagnostic Code 5003. 38 C.F.R. § 4.71a, Diagnostic Code 5003, Note 1. The intent of the rating schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. Thus, with or without degenerative arthritis, it is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. §§ 4.59; see Burton v. Shinseki, 25 Vet. App. 1, 5 (2011) (holding that the provisions of 38 C.F.R. § 4.59 are not limited to disabilities involving arthritis). Moreover, when evaluating musculoskeletal disabilities, VA may, in addition to applying the schedular criteria, assign a higher disability rating when the evidence demonstrates functional loss due to limited or excessive movement, pain, weakness, excessive fatigability, or incoordination, to include during flare-ups and with repeated use, if those factors are not considered in the rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; see also DeLuca v. Brown, 8 Vet. App. 202 (1995); Burton, 25 Vet. App. at 5. The Court also held in Correia v. McDonald, 28 Vet. App. 158 (2016) that the final sentence of 38 C.F.R. §§ 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. Nonetheless, a disability rating higher than the minimum compensable rating is not assignable under any diagnostic code relating to range of motion where pain does not cause a compensable functional loss. Rather, the "pain must affect some aspect of 'the normal working movements of the body' such as 'excursion, strength, speed, coordination, and endurance," as defined in 38 C.F.R. §§ 4.40, before a higher rating may be assigned. See Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011) (noting that while "pain may cause a functional loss, pain itself does not constitute a functional loss," and, is therefore, not grounds for entitlement to a higher disability rating). During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021 and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied. 1. Entitlement to higher disability ratings for the left knee disability The Veteran's service-connected left knee disability has been assigned a 10 percent disability rating for limitation of flexion under Diagnostic Codes 5003-5260, and a 10 percent rating for instability/subluxation under Diagnostic Codes 5003-5257. 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5260, 5257. Flexion of the leg limited to 60 degrees warrants a 0 percent rating, flexion limited to 45 degrees warrants a 10 percent rating, flexion limited to 30 degrees warrants a 20 percent rating, and flexion limited to 15 degrees warrants a 30 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Extension limited to 5 degrees warrants a 0 percent rating, extension limited to 10 degrees warrants a 10 percent rating, extension limited to 15 degrees warrants a 20 percent rating, extension limited to 20 degrees warrants a 30 percent rating, extension limited to 30 degrees warrants a 40 percent rating, and extension limited to 45 degrees warrants a 50 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5261. Flexion of the knee to 140 degrees is considered full and extension to 0 degrees is considered full. See 38 C.F.R. § 4.71, Plate II. VA's General Counsel has held that separate ratings may be assigned for disability of the same joint under Diagnostic Codes 5260 (for limitation of flexion) and 5261 (for limitation of extension). VAOGCPREC 9-2004 (September 2004). In contrast, an evaluation under Code 5003 may not be combined with one under Code 5260 or Code 5261; Code 5003 does not specify the plane of limited motion considered, and so evaluation under either of the other limitation of motion Codes forecloses the possibility of multiple evaluations. See generally VAOPGCPREC 23-97 and VAOPGCREC 9-98; 38 C.F.R. § 4.14. Prior to the regulatory change, the rating schedule provided for a 10 percent rating for slight recurrent subluxation or lateral instability, a 20 percent rating for moderate recurrent subluxation or lateral instability, and a 30 percent rating for severe recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, Diagnostic Code 5257. As of February 7, 2021, under the amended criteria for recurrent subluxation or lateral instability, a 10 percent rating is warranted for sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 20 percent rating is warranted for (a) sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation, or (b) unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 30 percent rating is warranted for unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation. 38 C.F.R. § 4.71a, Diagnostic Code 5257. As of February 7, 2021, under the amended criteria for recurrent patellar instability, a 10 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: A brace, cane, or walker. A 30 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. 38 C.F.R. § 4.71a, Diagnostic Code 5257. For patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. 38 C.F.R. § 4.71a, Diagnostic Code 5257, Note (1). A surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration). 38 C.F.R. § 4.71a, Diagnostic Code 5257, Note (2). Dislocated semilunar cartilage, with frequent episodes of "locking," pain, and effusion into the joint will be rated a maximum 20 percent disabling. 38 C.F.R. § 4.71a , Diagnostic Code 5258. Removal of the semilunar cartilage, if symptomatic, will be rated a maximum 10 percent disabling. 38 C.F.R. § 4.71a, Diagnostic Code 5259. The Board has also considered whether separate or increased evaluations are warranted under any other Diagnostic Codes pertaining to knee disabilities that would afford the Veteran higher ratings. Here, there is no evidence of ankylosis of the knee to warrant a rating under Diagnostic Code 5256; there is no evidence of dislocated semilunar cartilage, or removal of the semilunar cartilage under Diagnostic Codes 5258, 5259; no evidence of malunion or nonunion of the tibia and fibula to warrant a rating under Diagnostic Code 5262 for impairment of the tibia, and; no evidence of genu recurvatum to warrant a rating under Diagnostic Code 5263. Hence, the Board will not discuss these Diagnostic Codes any further. The Veteran seeks higher disability ratings than those currently assigned for his left knee disability. On VA examination in March 2014, the Veteran reported intermittent knee pain, stiffness, giving way, buckling, locking and swelling. He denied a history of hospitalizations or surgery. The Veteran also denied flare-ups. Flexion of the left knee was to 100 degrees and extension was to 0 degrees. There was no additional loss of motion or function with repetitive movement. Strength was 5/5. Joint stability testing revealed no abnormalities. There was no weakness, incoordination or fatigability noted on examination. There was no evidence or history of recurrent patellar subluxation/dislocation. He did not require assistive devices for ambulation. Imaging studies in October 2008 revealed moderate left knee osteoarthritis in the medial tibiofemoral compartment. The examiner opined that the knee condition did not impact the Veteran's ability to work. On VA examination in June 2021, the examiner noted that the left knee disability was manifested by knee osteoarthritis, recurrent subluxation and knee instability. The Veteran reported left knee pain and swelling with occasional popping. He took over the counter medication for his symptoms, as needed. The Veteran endorsed moderate flare-ups of symptoms twice a month, lasting two to four days. The knee flare-ups were precipitated by prolonged walking or standing, and were alleviated by rest and elevation of the lower extremity. He described intolerance to prolonged walking and occasional popping during flare-ups. Flexion of the left knee was to 130 degrees and extension was to 10 degrees. There was no additional loss of motion or function with repetitive movement. During flare-ups flexion was reduced to 125 degrees and extension was to 8 degrees. There was pain on weight-bearing, active and passive range of motion. There was moderate recurrent subluxation. The Veteran did not require a prescribed assistive device for ambulation. There was no patellar instability. The left knee anterior instability, posterior instability and medial instability test results were normal. The left knee lateral instability test result was 1+(0-5mm). There were no findings of chronic exertional compartment syndrome of the left lower extremity. The knee condition affected the Veteran's tolerance for prolonged walking and standing. Although his gait was antalgic and he ambulated using a cane, it was attributed to a recent stroke, as opposed to the knee disability. The Board notes that Diagnostic Code 5003 cannot serve as the basis for a higher rating for the left knee disability, inasmuch as the knee is a single joint. A maximum rating of 10 percent would be assigned for the knee under Diagnostic Code 5003, therefore a higher rating is not warranted. 38 C.F.R. § 4.71a. Diagnostic Code 5003. Pertaining to limitation of motion, the Board finds that the record is adequate to address the concerns raised by the Court holdings in Sharp and Correia. Specifically, the Board finds that the post-Remand VA examination dated in June 2021 provided VA with medical opinions evidence adequate to rate the Veteran's left knee when considering his complaints of pain with and without weight bearing and resistance in passive and active range of motion as well as during flare-ups because the examiner specifically addressed each of these concerns. Here, the range of motion findings detailed above, throughout the appeal, do not show limitation so severe as to meet the criteria for the next higher rating under Diagnostic Codes 5260. In this regard, during the course of the claim the Veteran's left knee flexion has been shown to be limited to, at worst, 125 degrees. As such, the evidence does not reflect limitation of motion to a compensable level for the left knee under Diagnostic Code 5260, as his range of motion was beyond required flexion limited to 45 degrees, even when considering Deluca factors. 38 C.F.R. §§ 4.40 and 4.45. See DeLuca, 8 Vet. App. at 207; see also Mitchell, 25 Vet. App. at 32; Correia, 28 Vet. App. at 158; Sharp v. Shulkin, 29 Vet. App, 26 (2017). Concerning left knee extension, the March 2014 VA examination recorded 0 degrees of left knee extension. Thus, the evidence does not reflect limitation of motion to a compensable level for the left knee under Diagnostic Code 5261, as his range of motion was beyond required extension limited to 10 degrees, even when considering Deluca factors. However, on VA examination in June 2021, extension of the left knee was to 10 degrees, thus warranting a separate 10 percent disability rating based on limitation of left knee extension. His range of motion was beyond required extension to 15 degrees for the next higher rating of 20 percent. 38 C.F.R. §§ 4.40 and 4.45. See DeLuca, 8 Vet. App. at 207; see also Mitchell, 25 Vet. App. at 32; Correia, 28 Vet. App. at 158; Sharp v. Shulkin, 29 Vet. App, 26 (2017). Therefore, effective June 8, 2021, a separate 10 percent disability rating, but no higher, for left knee extension is granted. Although the Veteran has reported pain associated with his range of motion, the Court has held that "pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system." See Mitchell, 25 Vet. App. 32. Indeed, the Court found that nothing in its case law supports an appellant's contentions that he should be given the maximum disability ratings under Diagnostic Codes 5260 and 5261 simply because he experienced pain throughout the range of motion of the knee. Id. Prior to June 2021, the weight of the evidence is against a finding of moderate subluxation/instability in the left knee. While the Veteran complained of knee popping and giving way, the VA examination report in March 2014 revealed no instability, and instability testing was within normal limits. Accordingly, a rating higher than 10 percent for left knee subluxation/instability prior to June 8, 2021, is not warranted. 38 C.F.R. § 4.71a, Diagnostic Code 5257. The VA examiner in June 2021, noted moderate recurrent left knee subluxation and the lateral instability test result was 1+(0-5mm) for the left knee. Accordingly, the Board finds that effective June 8, 2021, a 20 percent disability rating for moderate left knee recurrent subluxation under the rating criteria in effect prior to February 7, 2021, is warranted. There is no indication that any instability found to have been present was severe in severity. Specifically, other than lateral instability, stability testing consistently revealed no abnormalities and there was no muscle atrophy. Additionally, there is no evidence that the Veteran was prescribed an assistive device for ambulation, to include a brace, cane, crutch or a walker, due to the left knee disability. Therefore, a rating of 20 percent, but no higher, for recurrent subluxation and lateral instability of the knee is warranted from June 8, 2021. 38 C.F.R. § 4.71a Diagnostic Code 5257. While the Veteran clearly has problems with his left knee (if he did not, there would be no basis for the current compensation level) the Board finds the medical evidence of record to be highly probative as to the current nature, extent, and severity of the Veteran's left knee disorder. The medical reports were based on physical examinations and provided sufficient information to allow the Board to apply the schedular criteria. Thus, although the Veteran's competent and credible reports of symptoms have been considered and are probative, the Board attaches greater probative weight to the clinical findings of skilled, unbiased professionals. See Cartleft v. Derwinski, 2 Vet. App. 24, 25 (1991). As such, the objective medical findings and opinions provided by the VA examiners have been accorded greater probative weight and outweigh the Veteran's contentions. For all the foregoing reasons, the Board finds resolving all reasonable doubt in the Veteran's favor, a separate disability rating of 10 percent for limitation of extension of the left knee and a disability rating higher than 20 percent for moderate recurrent subluxation are warranted. The preponderance of the evidence is against assignment of any higher and/or separate ratings for the left knee disability. See 38 U.S.C. § 5107 (b); Gilbert, supra. 2. Entitlement to higher disability ratings for the right hip disability The Veteran seeks higher disability ratings than those currently assigned for his right hip disability. The Veteran's service-connected right hip disability has been assigned a noncompensable disability rating for limitation of flexion under Diagnostic Code 5252, a 10 percent disability rating for limited extension of the right hip under Diagnostic Code 5251, and a 10 percent disability rating for impairment of the right thigh with limitation of abduction/adduction under Diagnostic Code 5253. 38 C.F.R. § 4.71a, Diagnostic Codes 5251, 5252, 5253. The criteria applicable to musculoskeletal hip disorders (Diagnostic Codes 5251, 5252, 5253) were unchanged by the revised regulations effective February 7, 2021. Diagnostic Code 5251 affords a single 10 percent disability based on limitation of extension of the thigh when extension is limited to 5 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5251. Diagnostic Code 5252 compensates based on limitation of flexion of the thigh. Under the applicable rating criteria, a 10 percent rating is assigned for flexion limited to 45 degrees. Flexion limited to 30 degrees is afforded a 20 percent rating. Flexion limited to 20 degrees is afforded a 30 percent rating. Finally, a 40 percent rating is assigned for flexion of the thigh limited to 10 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5252. Hip flexion is measured from 0 degrees to 125 degrees; abduction is measured from 0 degrees to 45 degrees. 38 C.F.R. § 4.71a, Plate II. Impairment of the thigh, implying limitation of abduction, adduction or rotation, is compensated under Diagnostic Code 5253. Under the applicable rating criteria, limitation of abduction of the thigh, with motion lost beyond 10 percent, is afforded a 20 percent rating. Limitation of adduction of the thigh, implying an inability to cross the legs, is afforded a 10 percent rating. Limitation of rotation, described as an inability to toe-out more than 15 degrees in the affected leg, is afforded a 10 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5253. To the extent that the Veteran has been assigned multiple ratings for his right hip disability at various times throughout the appeal period, the Board is cognizant that the assignment of multiple ratings based on the same symptoms or manifestations constitutes prohibited pyramiding. 38 C.F.R. § 4.14. However, here, the Board finds that the assignment of separate ratings based on limitation of extension, flexion, and abduction of the right hip under Diagnostic Codes 5251, 5252, and 5253 would not amount to pyramiding under 38 C.F.R. § 4.14. In this regard, separate ratings under different diagnostic codes may be assigned where "none of the symptomatology for any of [the] conditions is duplicative of or overlapping with the symptomatology of the other... conditions." Esteban v. Brown, 6 Vet. App. 259, 262 (1994). Here this key consideration has been met, in that limitation of extension, flexion, and abduction/adduction concern excursions of movements in different planes, and these limitations therefore constitute different bases for rating the hip. 38 C.F.R. § 4.45. If these limitations are demonstrated, they must be rated separately to adequately compensate for functional loss associated with the service-connected right hip disability. Cf. VAOPGCPREC 9-2004 (providing that separate ratings may be assigned for disability of the same joint where the Veteran has both limitation of flexion and limitation of extension of same leg); see also Yonek v. Shinseki, 722 F.3d 1355 (2013) (finding separate ratings are not warranted for limitation of motion in different planes of the shoulder because they are not warranted under the applicable diagnostic codes, but that diagnostic codes addressing joints other than the shoulder assign different codes to limitation of motion in different planes, or to limitation of motion in different directions within a single plane, for example, Diagnostic Codes 5252 and 5253 with regard to the thigh). Also applicable to the hip and thigh are Diagnostic Codes addressing ankylosis, flail joint, and impairment of the femur (nonunion, false joint, or malunion). 38 C.F.R. § 4.71a , Diagnostic Codes 5250, 5254, 5255. As is noted below, the Veteran does not show such pathology, and therefore, these Diagnostic Codes to not apply in this matter. On VA examination in June 2013, the examiner noted a diagnosis of right hip strain. The Veteran described hip pain with walking restricted to approximately one mile. He denied any flare-ups. Flexion was to 110 degrees and extension was to 0 degrees. Adduction was limited to where the Veteran was not able to cross his legs. Rotation was not limited such that the Veteran could not toe-out more than 15 degrees. There was pain on movement and tenderness to palpation. There was no additional loss of motion with repetitive use testing. The examiner noted disturbance of locomotion and interference with sitting, standing and or weight-bearing. Muscle strength was normal with no atrophy. There was no ankylosis, malunion or nonunion of femur, flail hip joint or leg length discrepancy. The Veteran did not require assistive devices for ambulation. The hip disability impacted all physical employment but not sedentary employment. On VA examination in June 2021, the examiner noted a diagnosis of right hip tendinitis. The Veteran described hip pain with walking and inability to tolerate prolonged walking and standing. He did not take any medications for his symptoms. The Veteran denied any flare-ups. Active and passive range of motion showed flexion was to 60 degrees, extension was to 15 degrees, abduction was to 35 degrees, adduction was to 20 degrees, external rotation was to 45 degrees and internal rotation was to 30 degrees. There was no additional limitation of motion with repetitive movement or with repeated use over time. Limitation in adduction prevented the Veteran from crossing his leg. The examiner noted pain on weight-bearing, active and passive range of motion. There was no crepitus or muscle atrophy. There was no ankylosis, malunion or nonunion of femur, flail hip joint or leg length discrepancy. He used a cane to assist with ambulation. The examiner opined that the right hip disability did not impact the Veteran's ability to work. This evidence shows painful flexion with a noncompensable limitation of motion. He is separately assigned 10 percent rating for limitation of motion of this joint. Without a compensable loss of flexion, a separate 10 percent rating is not assignable based on painful flexion as only a single 10 percent rating is assignable on that basis. See, e.g., Mitchell, 25 Vet. App. at 36. The Veteran is further seeking an increased rating for impairment of the right thigh. The 10 percent rating currently assigned contemplates limitation of adduction such that the Veteran cannot cross his legs. The maximum 20 percent rating under Diagnostic Code 5253 requires limitation of abduction with motion lost beyond 10 degrees. On examination in June 2013 and June 2021, the examiner noted adduction limited to where the Veteran was not able to cross his legs. However, the examiner in 2013 reported that abduction was not lost beyond 10 degrees. Similarly, the examiner in June 2021 noted abduction to 35 degrees. As such, the evidence of record does not show that the Veteran's right hip disability resulted in limitation of abduction of the thigh, with motion lost beyond 10 percent, even in contemplation of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45. See DeLuca, 8 Vet. App. at 207; see also Mitchell, 25 Vet. App. at 32; Correia, 28 Vet. App. at 158; Sharp, 29 Vet. App. at 26. Additionally, limitation of adduction of the thigh, implying an inability to cross the legs, or limitation of rotation, described as an inability to toe-out more than 15 degrees, was not shown. Therefore, the Veteran did not meet the criteria for a rating higher than 10 percent under Diagnostic Code 5253. Finally, the Veteran has been assigned a 10 percent rating based on limitation of extension of the right hip, throughout the appeal. A higher rating under Diagnostic Code 5251 is not warranted because the 10 percent rating assigned for limitation of extension under Diagnostic Code 5251 is the maximum schedular rating available based on limitation of extension. 38 C.F.R. § 4.71a. The Board has carefully reviewed the other available evidence of record, to include the available medical treatment records, but finds nothing further which it could use to apply the statutory rating criteria or other pertinent caselaw. In sum, the Board finds that the Veteran's right hip disability, which is presently rated as 10 percent disabling based on limitation of extension; 0 percent disabling based on limitation of flexion; and as 10 percent disabling based on limitation of abduction, should not be granted increased ratings for any period on appeal. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine; however, because the preponderance of the evidence is against the claim, that doctrine does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. As a final matter, the Veteran has not specifically claimed entitlement to a total disability due to individual unemployability (TDIU) as a result of his service-connected left knee and right hip disorders. In the event that a claim of a TDIU was implicitly raised (see Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009)), review of the medical evidence does not reflect that the Veteran meets the required percentage criteria. Nor does the record suggest that the Veteran's service-connected connected left knee and right hip disabilities alone preclude employment so as to warrant a referral for extraschedular consideration. John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Azizi, T. 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.