Citation Nr: 21069170 Decision Date: 11/17/21 Archive Date: 11/17/21 DOCKET NO. 16-15 109A DATE: November 17, 2021 ORDER Entitlement to service connection for an eye disorder is granted. Entitlement to a compensable rating prior to August 26, 2019 for right hip arthralgia sacroiliitis with trochanteric pain syndrome (limitation of extension) is denied. Entitlement to a rating in excess of 10 percent from August 26, 2019 to the present for right hip arthralgia sacroiliitis with trochanteric pain syndrome (limitation of extension) is denied. Entitlement to a compensable rating prior to August 26, 2019 for left hip arthralgia sacroiliitis with trochanteric pain syndrome (limitation of extension) is denied Entitlement to a rating in excess of 10 percent from August 26, 2019 to the present for left hip arthralgia sacroiliitis with trochanteric pain syndrome (limitation of extension) is denied. Entitlement to a rating in excess of 10 percent prior to August 26, 2019 for right hip limitation of flexion is denied Entitlement to a compensable rating from August 26, 2019 to the present for right hip limitation of flexion is denied. Entitlement to a rating in excess of 10 percent prior to August 26, 2019 for left hip limitation of flexion is denied. Entitlement to a compensable rating from August 26, 2019 to the present for left hip limitation of flexion is denied. Entitlement to a compensable rating for right hip thigh impairment is denied. Entitlement to a compensable rating for left hip thigh impairment is denied. FINDINGS OF FACT 1. The evidence is at the very least in equipoise as to whether her eye disorders had onset during active service. 2. Prior to August 26, 2019, the evidence of record fails to demonstrate that the Veteran's right hip arthralgia sacroiliitis with trochanteric pain syndrome (limitation of extension) was manifested by extension limited to 5 degrees. 3. Since August 26, 2019, the Veteran's right hip arthralgia sacroiliitis with trochanteric pain syndrome (limitation of extension) is rated as 10 percent disabling, which is the maximum schedular rating permitted for limitation of extension of the thigh. 4. Prior to August 26, 2019, the evidence of record fails to demonstrate that the Veteran's left hip arthralgia sacroiliitis with trochanteric pain syndrome (limitation of extension) was manifested by extension limited to 5 degrees. 5. Since August 26, 2019, the Veteran's left hip arthralgia sacroiliitis with trochanteric pain syndrome (limitation of extension) is rated as 10 percent disabling, which is the maximum schedular rating permitted for limitation of extension of the thigh. 6. Prior to August 26, 2019, the Veteran's right hip limitation of flexion was manifested by painful motion, but not by flexion limited to 45 degrees. 7. Since August 26, 2019, the Veteran's right hip limitation of flexion manifested in flexion limited to, at worst, 110 degrees during a flare-up or after repetitive use. 8. Prior to August 26, 2019, the Veteran's left hip limitation of flexion was manifested by painful motion, but not by flexion limited to 45 degrees. 9. Since August 26, 2019, the Veteran's left hip limitation of flexion manifested in flexion limited to, at worst, 110 degrees during a flare-up or after repetitive use. 10. The Veteran's right hip thigh impairment does not result in an inability to toe-out more than 15 degrees, an inability to cross legs, or motion lost beyond 10 degrees on abduction. 11. The Veteran's left hip thigh impairment does not result in an inability to toe-out more than 15 degrees, an inability to cross legs, or motion lost beyond 10 degrees on abduction. CONCLUSIONS OF LAW 1. The criteria for service connection for an eye disorder are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. Prior to August 26, 2019, the criteria for a compensable rating for right hip arthralgia sacroiliitis with trochanteric pain syndrome (limitation of extension) are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5251. 3. Since August 26, 2019, the criteria for a rating in excess of 10 percent for right hip arthralgia sacroiliitis with trochanteric pain syndrome (limitation of extension) are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5251. 4. Prior to August 26, 2019, the criteria for a compensable rating for left hip arthralgia sacroiliitis with trochanteric pain syndrome (limitation of extension) are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5251. 5. Since August 26, 2019, the criteria for a rating in excess of 10 percent for left hip arthralgia sacroiliitis with trochanteric pain syndrome (limitation of extension) are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5251. 6. Prior to August 26, 2019, the criteria for a rating in excess of 10 percent for right hip limitation of flexion are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5252. 7. Since August 26, 2019, the criteria for a compensable rating for right hip limitation of flexion are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5252. 8. Prior to August 26, 2019, the criteria for a rating in excess of 10 percent for left hip limitation of flexion are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5252. 9. Since August 26, 2019, the criteria for a compensable rating for left hip limitation of flexion are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5252. 10. The criteria for a compensable rating for right hip, thigh impairment, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5253. 11. The criteria for a compensable rating for left hip, thigh impairment, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5253. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from September 2009 to March 2010, March 2012 to February 2013, and from April 2021 to May 2021. The matters were previously before the Board in October 2018 and again in December 2020. In the December 2020 decision, the Board granted entitlement to service connection for a right-hand condition; accordingly, that issue is no longer before the Board. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The Veteran contends that her current eye disorders are related to service, specifically to a chemical burn sustained while service in the line of duty in April 2012. Initially, the Veteran has been diagnosed with blepharitis and associated dry eye, as well as pterygium in both eyes and pinguecula. Service treatment records show that upon enlistment into the National Guard in November 2008, her eyes were evaluated as clinically normal. She sought treatment in April 2012 after she was sprayed in the eyes with pepper spray. She complained of blurry vision and dry eye and was diagnosed with chemical conjunctivitis. A week after the incident, she was evaluated and had no eye symptoms or irritation. However, in January 2013, during a period of active duty, she sought treatment for eye pain and dry eye syndrome, which at the time were noted as chronic conditions. Post-service medical evidence shows that in July 2013, the Veteran told a provider that she had a history of chemical conjunctivitis and that her eyes had been blurry and dry since the incident in service. At a September 2013 VA eye consultation, the Veteran told the provider that she had been exposed to pepper spray a year earlier and since then had experienced blurred vision. At an April 2014 VA examination, the Veteran told the examiner that after being struck with pepper spray, she developed eyelid swelling, foreign body sensation, redness, and light sensitivity, and that she currently experienced burning, redness, and a "sandy" sensation in the eyes. At a December 2015 VA eye consultation, the Veteran was noted to have dry eyes and pinguecula. In her April 2016 substantive appeal, the Veteran stated that her eye condition manifested while on active duty and had not improved. Multiple VA opinions addressing the etiology of the Veteran's eye disabilities have been obtained. An October 2018 Board decision found that April 2014 and January 2017 VA opinions were inadequate to decide the claim based on the fact that neither considered the aforementioned in-service January 2013 treatment record indicating that the Veteran suffered from eye pain and dry eye syndrome almost 10 months after the pepper spray incident. Similarly, a November 2019 VA examiner also failed to address the January 2013 treatment for dry eye, which the Board noted in December 2020 was potentially favorable evidence. Thus, the Board requested that VA obtain another opinion, which was received in June 2021. The Veteran told the June 2021 VA examiner that she had experienced dry eyes and sensitivity to light ever since the pepper spray exposure in service in April 2012. In an opinion, the examiner opined that the Veteran's eye disorders were less likely than not related to the pepper spray exposure in service. By way of rationale, the examiner noted that chemical burns could cause dry eyes at the moment of exposure or for a few days after the exposure but eventually resolved with rest and artificial tears. Thus, the examiner stated that it was unlikely or not probable that the Veteran's dry eye syndrome was due to the pepper spray exposure event in service. The examiner further noted that blepharitis, which the examiner specifically noted was diagnosed in 2014, was due to inflammation of the lacrimal glands on the lid margin leading to mild infection with symptoms of itching and burning of the lids, and that pterygium and pinguecula were due to excessive sunlight exposure leading to degeneration of the conjunctival tissue. Thus, the examiner reasoned that none of the conditions were due to pepper spray chemical burns. Pepper spray typically affected the cornea, lids, and conjunctiva and resolved with eye flushing, without major consequences. Regarding the January 2013 treatment note for dry eyes, the examiner reiterated that the dry eye was due to blepharitis, and that the Veteran was "most likely" having symptoms of dry eye in January 2013 related to bilateral blepharitis. While the June 2021 examiner concluded that chemical burns could cause eye issues such as dry eye at the moment of exposure or for a few days after, suggesting that the conditions were unrelated to the incident in service, the examiner also appeared to ascribe the Veteran's current eye conditions to those that were noted in January 2013 during a period of active service. Taken together with the Veteran's statements to multiple VA providers that she had experienced specific eye symptoms ever since service, including in 2013 and 2015, and her service entrance examination which reflects a normal clinical evaluation of the eyes, the Board finds that it is at the very least in equipoise that her current eye conditions onset during service, either at the time of her pepper spray exposure, or in January 2013, on which date chronic dry eye syndrome and eye pain were noted in the service records. Accordingly, the Board will resolve all doubt in her favor and find that service connection for her eye disorders, to include dry eye syndrome, pterygium, and pinguecula, is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 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. 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. 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. A veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where the appeal arises from the original assignment of a disability evaluation following an award of service connection, the severity of the disability at issue is to be considered during the entire period from the initial assignment of the disability rating to the present time. See Fenderson v. West, 12 Vet. App. 119 (1999). As in the instant case, separate ratings can be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. Id. at 126. The Veteran seeks higher ratings for her service-connected hip conditions. The December 2020 Board decision summarized the procedural history of the claims in detail. Pertinently, the January 2013 rating decision granted service connection for the Veteran's hip disabilities and assigned ratings. The June 2014 rating decision on appeal denied higher ratings. Following the first Board Remand and subsequent examination, a July 2020 rating decision increased the ratings for the Veteran's service-connected left and right hip arthralgia sacroiliitis with trochanteric pain syndrome (limitation of extension); reduced the ratings for right and left hip limitation of flexion; and granted service connection for right and left hip limitation of thigh. As noted in the December 2020 Board decision, the Agency of Original Jurisdiction (AOJ) was not required to provide extra notification of the rating reductions because the reductions did not decrease the Veteran's overall combined evaluation. See July 2020 Codesheet. The Veteran's hip disabilities are rated pursuant to Diagnostic Codes 5251, 5252, and 5253. Diagnostic Code 5251 provides for a maximum 10 percent rating for hip extension limited to 5 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5251. Diagnostic Code 5252 provides for a 10 percent rating for hip flexion limited to 45 degrees; a 20 percent rating for hip flexion limited to 30 degrees; a 30 percent rating for hip flexion limited to 20 degrees; and a maximum 40 percent rating for hip flexion limited to 10 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5252. Diagnostic Code 5253 provides for a 10 percent rating for limitation of motion (cannot toe-out more than 15 degrees for the affected leg) or for limitation of adduction (cannot cross legs); and a 20 percent rating for limitation of abduction when motion is lost beyond 10 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5253. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). To the extent that the evidence does not show evidence of ankylosis, flail joint issues, or impairment of the femur, the Board will not further consider the applicability of Diagnostic Codes 5250, 5254 and 5255. In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. Pertinent evidence of record includes the Veteran's lay statements, VA treatment records, and February 2012, June 2014, January 2017, August 2019, and June 2021 VA examination reports. At her February 2012 examination, the Veteran reported flare-ups of her hips that manifested in pain with prolonged standing as well as ambulation. Initial range of motion testing showed right and left hip flexion both to 125 degrees, with pain beginning at 10 degrees (right hip) and 5 degrees (left hip). Extension was greater than 5 degrees on both hips. Abduction was not lost beyond 10 degrees on either hip. Adduction was not so limited that the Veteran could not cross her legs. Rotation was not so limited that the Veteran could not toe-out more than 15 degrees. She was able to perform repetitive-use testing with three repetitions without additional loss of range of motion following repetitive-use testing. There was no functional loss and/or functional impairment noted of the hip or thigh. Full muscle strength in both hips was shown. At her June 2014 VA examination, the Veteran demonstrated full flexion in both hips, with pain beginning at 110 degrees (right hip) and 100 degrees (left hip). She demonstrated extension on both hips greater than 5 degrees. Abduction was not lost beyond 10 degrees in either hip. Adduction was not limited such that the Veteran could not cross her legs. Rotation was not limited such that the Veteran could not toe-out more than 15 degrees. She was able to perform repetitive-use testing without additional loss of range of motion. The examiner was unable to estimate additional loss of range of motion after repetitive use or during a flare-up without resorting to speculation. There was no change in abduction, adduction, or rotation after repetitive-use testing. Contributing factors of disability including pain on movement and interference with sitting, standing, and weight-bearing. There was localized tenderness or pain to palpation in both hips. At a January 2017 VA examination, the Veteran stated that she experienced flare-ups that manifested in severe pain in both sacroiliac areas, such that she struggled with prolonged sitting and standing. Initial range of motion testing showed full flexion in both hips with pain that did not result in any functional loss. There was full extension of both hips. The Veteran was able to perform repetitive use testing with at least three repetitions without additional loss of function or range of motion after three repetitions. The Veteran was not being examined immediately after repetitive use over time, but the examiner noted that the examination was medically consistent with the Veteran's statements describing functional loss with repetitive use over time. The examiner stated that pain in the hip joints could significantly limit functional ability during a flare-up or when the joint was used over a period of time, however, the examiner stated that there was no evidence of weakness and there was no evidence of fatigability or incoordination at the moment of the examination. To express additional limitation due to pain in terms of degrees of additional range of motion, the examiner stated, was not possible because any estimate would be speculative. Full muscle strength was indicated. The Veteran underwent a VA hip examination in August 2019. She endorsed flare-ups that limited any activities requiring ambulation. Initial range of motion testing showed right and left hip flexion each to 120 degrees with full extension; abduction to 40 degrees, adduction to 20 degrees, and external and internal rotation each to 30 degrees; and left hip flex. Pain was noted on examination but did not result in any functional loss. The Veteran was able to perform repetitive-use testing with at least three repetitions without additional loss of function or range of motion after three repetitions. The Veteran was not being examined immediately after repetitive use over time or during a flare-up, but the examiner noted that pain, weakness, fatigability, or incoordination would limit functional ability with repeated use over a period of time or during a flare-up. In both scenarios, the examiner opined that the Veteran would have right and left hip flexion to 120 degrees; right and left hip extension to 30 degrees; right and left hip abduction to 40 degrees; right and left hip adduction to 20 degrees; and right and left external and internal rotation each to 30 degrees. Post-test adduction would not limit the Veteran's ability to cross her legs. No additional contributing factors of disability were noted. Full muscle strength was shown. The Board noted in its December 2020 decision that the findings from the August 2019 VA examination appeared contradictory insofar as the examiner stated that pain limited functional ability during flare-ups and after repetitive use but then estimated the same range of motion during repetitive use or a flare-up as a period of non-flare-up/repetitive use. Accordingly, the Veteran underwent another VA examination in June 2021. At the June 2021 examination, the Veteran reported flare-ups of the hips that occurred two to three times per month and were manifested by moderate pain at the hips. The Veteran stated that during a flare-up, she had to lie down to achieve improvement. Initial range of motion testing showed right and left hip flexion each to 125 degrees; right and left extension each to 30 degrees; right and left abduction each to 45 degrees; right and left adduction each to 25 degrees; right external rotation to 50 degrees; left external rotation to 55 degrees; right internal rotation to 30 degrees; and left internal rotation to 35 degrees. The Veteran was not being examined immediately after repetitive use over time or during a flare-up. However, the examiner was able to estimate range of motion measurements in such scenarios. Specifically, the examiner estimated that after repetitive use, the Veteran would have 110 degrees of flexion in both hips; 20 degrees of extension in both hips; 35 degrees of abduction in both hips; 10 degrees of adduction (right hip); 20 degrees of adduction (left hip); 50 degrees of external rotation (right hip); 40 degrees of external rotation (left hip); 30 degrees of internal rotation (right hip); and 20 degrees of internal rotation (left hip). During a flare-up, the examiner estimated right left hip flexion to 110 degrees; right and left hip extension to 20 degrees; right and left hip abduction to 30 degrees; right and left hip adduction to 15 degrees; external rotation to 30 degrees (right hip) and 40 degrees (left hip); and internal rotation to 20 degrees (right hip) and 30 degrees (left hip). There was no evidence that limitation in adduction after repetitive use or during a flare-up would prevent the Veteran from crossing her legs. No additional contributing factors of disability were noted. Ratings under Diagnostic Code 5251 Turning first to the Veteran's ratings for right and left hip arthralgia sacroiliitis with trochanteric pain syndromelimitation of extensionboth hips are rated as noncompensable from September 12, 2011 and as 10 percent disabling from August 26, 2019, pursuant to Diagnostic Code 5251. As the Veteran is in receipt of the highest schedular rating for limitation of extension for both hips from August 26, 2019, there is no basis to award higher ratings for the right or left hip arthralgia sacroiliitis with trochanteric pain syndrome under Diagnostic Code 5251 from that date. Prior to August 26, 2019, the Board has considered whether compensable ratings are warranted. After a review of the foregoing, the Board concludes that the preponderance of the evidence is against concluding that the Veteran's right or left arthralgia sacroiliitis with trochanteric pain syndromelimitation of extensionwarrant 10 percent ratings at any point prior to August 26, 2019. The Veteran demonstrated full hip extension in both hips at her February 2012, June 2014, and January 2017 VA examinations. Full extension is 30 degrees of extension, which is six times greater than that required for a compensable rating. The Board notes that at the January 2017 VA examination, the Veteran was not examined after repetitive use or during a flare-up, but the examiner stated that pain could significantly limit functional ability during a flare-up or when the joint was used over a period of time. That stated, no report suggests that the specific findings on examination, in terms of range of motion, would change to the degree required for a higher rating during a flare-up, after repetitive use, due to pain, nor does any other evidence of record to include the Veteran's lay statements. In this regard, during the January 2017 examination the Veteran reported flare-ups but stated that flare-ups manifested in severe pain, but not in reduced range of motion. Also, the Board has looked to range of motion measurements from later in the appeal period, which show that even during a flare-up or after repetitive use, extension has been, at its worst, limited to 20 degrees (in June 2021). Treatment records do not show greater limitation of motion than the examination findings. Absent indication by the Veteran or other evidence suggesting additional limitation of motion in the hips during a flare-up or after repetitive use over time, there is no reason to suspect range of motion would be more limited than as estimated by the examiner. Thus, compensable ratings pursuant to Diagnostic Code 5251 are not warranted for right or left limitation of hip extension prior to August 26, 2019. Ratings under Diagnostic Code 5252 As noted above, the Veteran is in receipt of 10 percent ratings for her right and left hip limitation of flexion prior to August 26, 2019, and noncompensable ratings from August 26, 2019. As noted above, Diagnostic Code 5252 provides for a 10 percent rating for hip flexion limited to 45 degrees; a 20 percent rating for hip flexion limited to 30 degrees; a 30 percent rating for hip flexion limited to 20 degrees; and a maximum 40 percent rating for hip flexion limited to 10 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5252. For the period prior to August 26, 2019, the Board concludes that ratings in excess of 10 percent are not warranted. Here, the 10 percent ratings were assigned based on the presence of painful motion under Diagnostic Code 5252 for limitation of flexion. The examination reports of record show the presence of a noncompensable level of hip limitation of flexion. While the Board acknowledges the Veteran's reports that she experiences severe pain during a flare-up that affects prolonged sitting or standing, the Veteran's currently assigned 10 percent ratings account for the presence of pain. See 38 C.F.R. §§ 4.40, 4.45, 4.59, 4.71a, DeLuca, 8 Vet. App. at 202. There is no evidence that either hip has shown flexion limited to 30 degrees, as would be required for a higher rating. Indeed, prior to August 26, 2019, the Veteran demonstrated full flexion in both hips at three separate VA examinations. Thus, at all times prior to August 26, 2019, there is no basis to assign ratings in excess of the currently assigned 10 percent. The Board notes that the AOJ reduced the Veteran's ratings for her right and left hip limitation of flexion by way of a July 2020 rating decision. The Board notes that the August 2019 VA examination continued to reflect the Veteran's reports of pain in her hips; that stated, the AOJ, also in the July 2020 rating decision, increased the Veteran's ratings for her right and left hip limitation of extension, to 10 percent each, based on pain. Assigning compensable ratings based on painful motion pursuant to both Diagnostic Codes 5251 and 5252 would amount to pyramiding, insofar as the 10 percent ratings in effect as of August 26, 2019 under Diagnostic Code 5251 are based on a finding of painful motion. 38 C.F.R. § 4.59. Thus, compensable ratings pursuant to Diagnostic Code 5252, since August 26, 2019, are not warranted. The Board adds that since that date, the Veteran's right and left hip flexion has been limited to, at worst, 110 degrees during a flare-up or after repetitive use. Thus, even in consideration of DeLuca, there is no basis to assign a higher rating. Ratings under Diagnostic Code 5253 Lastly, the Veteran is in receipt of noncompensable ratings for both her right and left hips under Diagnostic Code 5253, for thigh impairment. Diagnostic Code 5253 provides for a 10 percent rating for limitation of motion (cannot toe-out more than 15 degrees for the affected leg) or for limitation of adduction (cannot cross legs); and a 20 percent rating for limitation of abduction when motion is lost beyond 10 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5253. All the VA examiners have indicated that adduction was not so limited such that the Veteran could not cross her legs. The Veteran has never asserted that her hip disabilities manifested in an inability to cross her legs at any time during the appeal period. Furthermore, the evidence, as laid out above, similarly does not show that the Veteran experiences limitation of rotation, such that she could not toe-out more than 15 degrees or limitation of abduction beyond ten degrees, so as to warrant a 10 or a 20 percent rating under Diagnostic Code 5253. All range of motion tests have shown limitations that were less severe. Finally, as noted above, the evidence does not show that the Veteran has hip ankylosis, hip flail joint, or any other femur impairment; accordingly, separate or higher ratings are not warranted under Diagnostic Codes 5250, 5254, or 5255. In denying all ratings, the Board notes that, as demonstrated above, separate ratings may be assigned for functional disability in differing planes of movement, as they measure different impairments. However, multiple ratings for a single joint under 38 C.F.R. § 4.59 for generalized painful motion is not permitted. Such is applied regardless of plane of motion, and so assigning more than a single 10 percent under that regulation, or in addition to a compensable rating for a joint-specific Code, would be duplicative and constitute prohibited pyramiding. 38 C.F.R. § 4.14. The Board finds that the Veteran's currently assigned ratings are appropriate. The evidence does not support an award of separate or higher ratings under any of the available hip and thigh Diagnostic Codes. Accordingly, her claim for increased ratings at any point during the appeal period must be denied. V. Chiappetta Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Polly Johnson, 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.