Citation Nr: 21006034 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 16-15 641 DATE: February 3, 2021 ORDER From March 26, 2014 to December 21, 2018, entitlement to a rating in excess of 10 percent for the service-connected right hip disability is DENIED. Between September 1, 2014 and December 23, 2019, entitlement to a 60 percent rating, but not greater, for the service-connected left total knee arthroplasty is GRANTED. Between September 1, 2014 and December 20, 2018, entitlement to a total disability rating based on individual unemployability (TDIU) is GRANTED. REMANDED On and after March 1, 2020, entitlement to a rating in excess of 70 percent for the service-connected right total hip arthroplasty is REMANDED. On and after December 24, 2019, entitlement to a rating in excess of 60 percent for the service-connected left total knee arthroplasty is REMANDED. FINDINGS OF FACT 1. From March 26, 2014 to December 21, 2018, at worst, the Veteran demonstrated 90 degrees of right hip flexion and 15 degrees of abduction. The Veteran did not demonstrate right hip ankylosis, flexion limited to 30 degrees, abduction of the thigh lost beyond 10 degrees, hip flail joint, or malunion of the femur. 2. Between September 1, 2014 and December 23, 2019, the Veteran demonstrated chronic residuals of the left knee arthroplasty, to include painful motion and instability. 3. Between September 1, 2014 and December 20, 2018, the Veteran’s service-connected disabilities preclude him from securing or following a substantially gainful occupation. CONCLUSIONS OF LAW 1. From March 26, 2014 to December 21, 2018, the criteria for entitlement to a rating in excess of 10 percent for the service-connected right hip disability have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1-4.14, 4.25, 4.27, 4.40, 4.45, 4.59, 4.71a, DCs 5250 thru 5255 (2020). 2. Between September 1, 2014 and December 23, 2019, the criteria for entitlement to a 60 percent rating, but not greater, for the service-connected left knee total arthroplasty have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 4.1-4.14, 4.25, 4.27, 4.40, 4.45, 4.59, 4.71a, DC 5055 (2020). 3. Between September 1, 2014 and December 20, 2018, the criteria are met for entitlement to a TDIU rating. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.102, 3.159, 3.340, 3.341, 4.1, 4.3, 4.16(a), 4.19, 4.25 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably in the United States Navy from May 1977 to October 1979. Increased Ratings, Generally Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities (Rating Schedule), which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2017). The basis of disability evaluations 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. If there is a question as to which evaluation to apply to the Veteran’s disability, 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. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of any disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the veteran’s medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31, 34 (1999). The Board must also assess the competence and credibility of lay statements and testimony. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). In increased rating claims, a Veteran’s lay statements alone, absent a negative credibility determination, may constitute competent evidence of worsening, at least with respect to observable symptoms. See Vazquez-Flores v. Shinseki, 24 Vet. App. 94, 102 (2010), rev’d on other grounds by Vazquez-Flores v. Shinseki, 580 F.3d 1270, 1277 (Fed. Cir. 2009). The Veteran is uniquely suited to describe the severity, frequency, and the duration of the symptoms that accompany his service-connected right hip and left knee disabilities. See Falzone v. Brown, 8 Vet. App. 398 (1995); Heuer v. Brown, 7 Vet. App. 379 (1995). As noted above, the Veteran’s entire history is reviewed when assigning a disability evaluation. 38 C.F.R. § 4.1. However, where service connection has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). In determining the present level of a disability for any increased evaluation claim, the Board must consider the application of staged ratings. See Hart v. Mansfield, 21 Vet. App. 505, 509-510 (2007); Fenderson v. West, 12 Vet. App. 119, 126 (1999). The Board must consider whether there have been times when his disabilities on appeal have been more severe than at others, and rate them accordingly. “The relevant temporal focus for adjudicating an increased-rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim.” Hart, 21 Vet. App. at 509. 1. From March 26, 2014 to December 21, 2018, entitlement to a rating in excess of 10 percent for the service-connected right hip disability is denied. On March 26, 2014, correspondence from the Veteran’s medical provider was associated with the claims file. After review of imaging results, the provider relayed an assessment for moderate right hip arthritis. The provider noted that the Veteran’s right hip had a slight loss of internal rotation, but normal abduction and flexion were demonstrated. The Veteran complained of pain at the limits of motion. During the claim period, the Veteran’s service-connected right hip disability was rated under 38 C.F.R. § 4.71A, Diagnostic Codes (DCs) 5010-5253 and 5010-5252. The Veteran was rated as 10 percent disabled under DC 5253 and non-compensable under DC 5252. Under DC 5250, a rating of 60 percent is assigned for ankyloses of the hip where it is favorable in flexion at an angle between 20 degrees and 40 degrees, and slight adduction or abduction. A rating of 70 percent is assigned upon intermediate ankyloses and a rating of 90 percent is awarded upon unfavorable ankylosis, extremely unfavorable ankylosis with the foot not reaching ground, crutches necessitated. Id. Under DC 5251 (limitation of extension of the thigh), a rating of 10 percent is assigned when extension is limited to 5 degrees. Id. Under DC 5252, ratings for limitation of flexion of the thigh are assigned as follows: flexion limited to 45 degrees is 10 percent; flexion limited to 30 degrees is 20 percent; flexion limited to 20 degrees is 30 percent rating; and flexion is limited to 10 degrees is 40 percent. Id. Under DC 5253, where there is limitation of rotation of the thigh to the point that the claimant cannot toe-out more than 15 degrees, a 10 percent evaluation is assigned. A 10 percent rating is also assigned where there is limitation of abduction to the point at which the claimant cannot cross his or her legs. A 20 percent rating is assigned where there is limitation of abduction of the thigh beyond 10 degrees. Id. Diagnostic Code 5254 provides an 80 percent rating will be assigned for hip flail joint. Id. Diagnostic Code 5255 provides an 80 percent rating will be assigned for impairment of femur, fracture shaft or anatomical neck, with nonunion, with loose motion (spiral or oblique fracture); a 60 percent rating will be assigned for impairment of femur with nonunion, without loose motion, weight bearing preserved with aid of brace, or for fracture of surgical neck of the femur with false joint; a 30 percent rating will be assigned for malunion of the femur with marked knee or hip disability; a 20 percent rating will be assigned for malunion of the femur with moderate knee or hip disability; and a 10 percent rating will be assigned for malunion of the femur with slight knee or hip disability. The Board notes that normal hip motion is defined as flexion from zero to 125 degrees and abduction from zero to 45 degrees. See 38 C.F.R. § 4.71, Plate II. The Board finds DCs 5252 and 5253 most appropriately addresses the Veteran’s service-connected right hip disability. See Butts v. Brown, 5 Vet. App. 532, 538 (1993) (choice of diagnostic code should be upheld if supported by explanation and evidence). In April 2015, the Veteran underwent a VA examination that considered the severity of the service-connected right hip disability. The VA examiner noted a diagnosis for right hip osteoarthritis. The Veteran did not report flare-ups of the right hip disability. The Veteran reported that his ability to walk was limited to about 50 yards. The VA examiner reported the following abnormal initial range of motion (ROM) in degrees: 105 flexion, 10 extension, 15 abduction, 20 adduction, 40 external rotation, and 30 internal rotation. On palpation, the VA examiner noted tenderness laterally, anteriorly. The Veteran was able to perform right hip repetitive testing without additional loss of ROM. The VA examiner noted that pain significantly limited functional ability with repeated use over time. The VA examiner relayed that, “the Veteran would have additional limitation during joint flare-ups, or when the joint is used repeatedly over a period of time, manifested primarily by pain and difficulty continuing joint movement.” The Veteran did not demonstrate right hip ankylosis or loss in muscle strength. The Veteran reported constant cane use and the need to utilize a walker occasionally. For functional impact, the VA examiner noted limitations in prolonged standing and walking, difficulty climbing, and difficulty with uneven terrain. In July 2015, the Director of Compensation Service addressed the Veteran’s claims file (for a claim for TDIU). The Director relayed that, “(e)ntitlement to an extra-schedular evaluation under § 3.321 (b) (1) is warranted. An additional 10% evaluation is to be awarded under diagnostic code 5253 (emphasis in original).” In December 2018, an Orthopedic Surgery Note was generated at the Lexington VA Medical Clinic (VAMC). The note was generated the same day as, and prior to, the Veteran’s right hip arthoplasty. At that time, the Veteran demonstrated pain with ROM of the right hip. The Veteran demonstrated 90 degrees of flexion. The Veteran demonstrated 15 degrees of external rotation. During the claim period, the Veteran’s government and private medical treatment records were associated with the claims file on multiple occasions. After deliberate review of the treatment records, the Board notes that the Veteran did not demonstrate right hip ankylosis, flexion limited to 30 degrees, abduction of the thigh lost beyond 10 degrees, hip flail joint, or malunion of the femur. Ultimately, the Board finds that the preponderance of the evidence stands counter to the Veteran’s claim for a rating in excess of 10 percent for the service-connected right hip disability between March 26, 2014 to December 21, 2018. Since the preponderance of the evidence is against this increased rating claim, the provisions of 38 U.S.C. § 5107(b), regarding reasonable doubt, are not applicable. The Veteran’s claim for a rating in excess of 10 percent for the service-connected right hip disability between March 26, 2014 to December 21, 2018 must be denied, because the preponderance of the evidence weighs against his claim. The Board notes that the Veteran and his representative have not raised any other issues, nor have any other issues been reasonably raised by the record for this claim period. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). 2. Between September 1, 2014 and December 23, 2019, entitlement to a 60 percent rating, but not greater, for the service-connected left knee total arthroplasty is granted. In October 2013, the AOJ issued a rating decision. Therein, the AOJ assigned a 100 percent disability rating that was effective the day of the Veteran’s left knee arthroplasty, July 17, 2013. The AOJ assigned a 30 percent rating, effective September 1, 2014, which is first day of the month after the required post-surgical convalescence period. Under 38 C.F.R. § 4.71A, DC 5055, a temporary 100 percent disability evaluation is awarded for one year following the implantation of a knee prosthesis. Thereafter, a 30 percent rating is warranted as a minimum rating post-knee replacement. A 60 percent disability rating is assigned for chronic residuals consisting of severe painful motion or weakness in the affected extremity. With intermediate degrees of residual weakness, pain or limitation of motion, adjudicators are instructed to rate by analogy to DCs 5256 (knee ankylosis), 5261 (limitation of leg extension), or 5262 (impairment of the tibia and fibula). In the Veteran’s case, the medical and lay evidence of record do not support a finding of ankylosis or evidence of non-union of the tibia and fibula to warrant a disability rating in excess of 30 percent under Diagnostic Codes 5256 or 5262. Therefore, each of those Diagnostic Codes is inapplicable to the Veteran’s appeal. Also, application of Diagnostic Code 5261 would not result in a higher disability evaluation than 60 percent and, therefore, is not applicable to the Veteran’s claim. On March 26, 2014, correspondence from the Veteran’s medical provider was associated with the claims file. The provider reported that the Veteran walked slowly with a slight limp. The provider noted that the Veteran lacked 8 degrees of left knee extension, and he could flex the left knee to 85 degrees. In March 2015, the Veteran underwent a VA examination that addressed the severity of the service-connected left knee disability. The VA examiner noted a diagnosis for left knee degenerative arthritis. The VA examiner noted that the Veteran underwent total left knee replacement on July 13, 2013. At that time, the Veteran denied left knee flare-ups due to inactivity. The Veteran reported an inability to walk, run, climb, or squat due to pain and limited left knee ROM. The VA examiner noted the following abnormal initial ROM (in degrees): 90 flexion and 10 extension. For functional loss, the VA examiner noted an inability to squat or bend at the knee due to pain and limited movement. The VA examiner noted left knee pain with palpation and during weight bearing. The VA examiner noted that there was no left knee ROM decrease after repetitive testing. The VA examiner noted that the Veteran’s left knee resulted in swelling, instability in station, disturbance of locomotion, and interference with sitting and standing. The Veteran demonstrated 5/5 left knee muscle strength and no atrophy. The Veteran did not demonstrate left knee ankylosis, recurrent subluxation, lateral instability, or joint effusion. The VA examiner reported that the Veteran had never demonstrated recurrent patellar dislocation, “shin splints”, stress fractures, chronic exertional compartment syndrome or any other tibial and/or fibular impairment. The Veteran reported that, after the left knee replacement in 2013, he endured constant pain and limited movement. The Veteran demonstrated an antalgic gait. In February 2019, the Veteran supplied sworn testimony to the undersigned Veterans’ Law Judge (VLJ). The Veteran testified that he endures chronic 4/10 left knee pain after the arthroplasty. The Veteran testified that he had fallen three times after the left knee arthroplasty; consequently, he uses a knee brace and cane for stabilization. The Veteran testified that the left knee was still unstable after the arthroplasty; consequently, he used a brace for stability. The Veteran relayed that knee pain caused him to wake up in the middle of the night. The Board notes that, between September 1, 2014 and December 23, 2019, the Veteran demonstrated chronic residuals of the left knee arthroplasty, to include painful motion and instability. Consequently, the Board concludes that a 60 percent rating is warranted under DC 5055 during the claim period. 38 C.F.R. § 4.71A. Ultimately, the Board finds that the preponderance of the evidence favors the Veteran’s claim for a 60 percent rating for the service-connected left knee total arthroplasty between September 1, 2014 and December 23, 2019. Consequently, this increased rating claim must be granted. The Board notes that the Veteran and his representative have not raised any other issues, nor have any other issues been reasonably raised by the record for this claim period. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). 3. Between September 1, 2014 and December 20, 2018, entitlement to a total disability rating based on individual unemployability (TDIU) is granted. On March 29, 2013, the Veteran submitted a VA Form 21-4138. Therein, the Veteran requested an increased rating for the service-connected left knee disability. The Veteran relayed that, “I am in constant severe pain and this is affecting my work.” The Board notes that, when the issue of TDIU is raised by the record during the appeal of a claim for an increased rating, the issue of TDIU is considered part of the pending claim for an increased rating. Rice v. Shinseki, 22 Vet. App. 447, 454 (2009). Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities (Rating Schedule), which is based on the average impairment of earning capacity. 38 U.S.C. § 1155 (West 2014). Total disability is considered to exist when there is any impairment which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340 (a) (1). Total disability may or may not be permanent. Id. Total ratings are authorized for any disability or combination of disabilities for which the Rating Schedule prescribes a 100 percent evaluation. 38 C.F.R. § 3.340 (a) (2). A TDIU may be assigned when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. 38 C.F.R. § 4.16 (a). If there is only one such disability, it must be rated at 60 percent or more; if there are two or more disabilities, at least one disability must be rated at 40 percent or more, with sufficient additional disability to bring the combined rating to 70 percent or more. Id. For the above purpose of one 60 percent disability, or one 40 percent disability in combination, the following will be considered as one disability: (1) disabilities of one or both upper extremities, or of one or both lower extremities, including the bilateral factor, if applicable, (2) disabilities resulting from common etiology or a single accident, (3) disabilities affecting a single body system, e.g. orthopedic, digestive, respiratory, cardiovascular-renal, neuropsychiatric, (4) multiple injuries incurred in action, or (5) multiple disabilities incurred as a prisoner of war. Id. Entitlement to a total rating must be based solely on the impact of the Veteran’s service-connected disabilities on his ability to keep and maintain substantially gainful employment. See 38 C.F.R. §§ 3.340, 3.341, 4.16. In reaching such a determination, the central inquiry is “whether the Veteran’s service connected disabilities alone are of sufficient severity to produce unemployability.” Hatlestad v. Brown, 5 Vet. App. 524, 529 (1993). For VA purposes, the term “unemployability” is synonymous with an inability to secure and follow a substantially gainful occupation. VAOPGPREC 75-91; 57 Fed. Reg. 2317 (1992). Consideration may be given to the Veteran’s level of education, special training, and previous work experience in arriving at a conclusion. However, individual unemployability must be determined without regard to any nonservice-connected disabilities or the Veteran’s advancing age. 38 C.F.R. §§ 3.341 (a), 4.16, 4.19; Van Hoose v. Brown, 4 Vet. App. 361 (1993). A high rating in itself is recognition that the impairment makes it difficult to obtain or keep employment, but the ultimate question is whether the Veteran is capable of performing the physical and mental acts required by employment, not whether he can find employment. Van Hoose, 4 Vet. App. at 363. If a Veteran fails to meet the threshold minimum percentage standards enunciated in 38 C.F.R. § 4.16 (a), rating boards should refer to the Director of Compensation and Pension Service for extraschedular consideration all cases where the Veteran is unable to secure or follow a substantially gainful occupation by reason of service-connected disability. 38 C.F.R. § 4.16 (b). See also Fanning v. Brown, 4 Vet. App. 225 (1993). Thus, the Board must evaluate whether there are circumstances in the Veteran’s case, apart from any non-service-connected conditions and advancing age, which would justify a TDIU rating. 38 C.F.R. §§ 3.341 (a), 4.16(a), 4.19. See Van Hoose v. Brown, 4 Vet. App. 361 (1993); see also Hodges v. Brown, 5 Vet. App. 375 (1993); Blackburn v. Brown, 4 Vet. App. 395 (1993). The Veteran’s service-connected disabilities, employment history, educational and vocational attainment, and all other factors having a bearing on the issue must be addressed. 38 C.F.R. § 4.16 (b). The ability to work sporadically or obtain marginal employment is not substantially gainful employment. 38 C.F.R. § 4.16 (a); Moore v. Derwinski, 1 Vet. App. 356, 358 (1991). Marginal employment, i.e., earned annual income that does not exceed the poverty threshold for one person, is not considered substantially gainful employment. 38 C.F.R. § 4.16 (a). When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. In May 2013, the Veteran submitted a VA Form 21-4138. Thereby, the Veteran renewed a claim for a TDIU. The Veteran relayed that, “on 4/19/2013 I was dismissed from my job because my employer said ‘we can’t continue to carry you.’ I have worked for this company for over 25 years and risen to the position of supervisor. The company said that due to my service connected disabilities I could no longer work there. I am no longer able work due to my service connected disabilities.” In May 2013, the Veteran submitted a VA 21-8940. Therein, the Veteran relayed that his service connected disabilities resulted in employment termination on April 19, 2013. In March 2014, a Contact Brief was associated with the claims file. Therein, the Veteran relayed that his doctor advised that he was no longer able to work due to his service-connected disabilities. In March 2014, correspondence from the Veteran’s medical provider was associated with the claims file. The provider relayed that, “he’s done heavy lifting at his job as a supervisor in railroad car repair work and got to the point where he could no longer do the job because of physical limitations and he was terminated in April 2013.” The provider opined that, “he should consider applying for disability as he should not be climbing and he should not be crawling and he would only qualify, in my opinion, for sedentary work.” In January 2015, the Veteran submitted a VA 21-8940. Therein, the Veteran relayed that his service connected left knee and right hip resulted in an inability to maintain employment in April 2013. In March 2015, the Veteran underwent a VA examination that addressed the severity of the service-connected left knee disability. At that time, the Veteran reported that, after 25-years of employment with the same company, “he was ‘let go’ for ‘not being able to perform my job.’” The VA examiner opined that, “(t)here would be a mild impact on sedentary employment related to veterans bilateral knee condition due to pain. There would be a moderate to severe impact on physical employment related to veteran’s bilateral knee condition due to pain and limited movement of the knees.” In July 2015, a C&P Examination Note was associated with the claims file. Therein, the VA examiner determined that the Veteran’s service connected right hip condition would have a severe impact to physical employment and a mild impact to sedentary employment due to pain limitations moving on uneven terrain, and limitations in prolonged standing, walking and climbing associated with the condition. In July 2015, the Director of Compensation Service addressed the Veteran’s TDIU claim on an extraschedular basis. The Director relayed that, “review of the evidence in its entirety revealed that the service-connected disabilities have a severe effect on the Veteran’s ability to perform physical work and a mild effect on the ability to perform sedentary work. Therefore, the evidence does not show that the Veteran is unable to secure and follow a substantially gainful occupation. However, the Veteran’s last full-time employment, as a railroad car repairer, ended due to his inability to perform his occupational duties, in part, due to the service-connected disabilities. Therefore, the record presents evidence of marked interference with employment, which render application of the current rating schedular criteria inadequate.” In February 2019, the Veteran supplied sworn testimony to the undersigned Veterans’ Law Judge (VLJ). The Veteran testified that he attempted to work prior to the left knee replacement. The Veteran testified that he was unable to work after the left knee replacement. The Veteran testified that the combination of his leg and hip conditions caused him problems with being able to maintain gainful employment. Prior to his knee and hip replacements, the Veteran reported that he worked in construction, train car repair, or always something that required a lot of strength and durability. The Veteran testified that those types of jobs were no longer feasible, because of the state of his left knee and right hip. The Veteran was granted Social Security disability for these conditions in 2014. Due to the pain from his right hip and left knee, the Veteran did not believe that he could sit for an eight-hour day and function in a job that required him not to move around. When questioned by his representative, the Veteran confirmed that a prolonged sedentary position exacerbated his hip and knee pain. In June 2019, the Board addressed the Veteran’s claim for a TDIU. The Board determined that the claim was inextricably intertwined with the remanded right hip and left knee increased rating claims. Consequently, the Board remanded the TDIU claim to the AOJ. In January 2020, a VA-generated Individual Unemployability Statement was associated with the claims file. Therein, the VA examiner relayed that, “the Veteran would not be able to perform sedentary work due to his service connected condition of left knee total arthroplasty. He is unable to bend, stoop, extend his left knee. He can stand with assistive device but not for prolonged periods of time.” The United States Court of Appeals for Veterans’ Claims (Court) has recognized that a 100 percent rating under the Schedule for Rating Disabilities means that a Veteran is totally disabled. Holland v. Brown, 6 Vet. App. 443, 446 (1994), citing Swan v. Derwinski, 1 Vet. App. 20, 22 (1990). Thus, if VA has found a veteran to be totally disabled as a result of a particular service-connected disability or combination of disabilities pursuant to the rating schedule, there is no need, and no authority, to otherwise rate that Veteran totally disabled on any other basis. See Herlehy v. Principi, 15 Vet. App. 33, 35 (2001) (finding a request for TDIU moot where 100 percent schedular rating was awarded for the same period). The Board notes that the Veteran maintained a 100 percent disability rating during most of the claim period, March 29, 2013 to present. The overall 100 percent ratings were primarily based on the convalescence leave periods following the left knee and right hip total arthroplasty surgeries. However, between September 1, 2014 and December 20, 2018, the Veteran’s disability ratings totaled 50 percent; consequently, he did not satisfy the criteria for a schedular TDIU. As noted above, the Director of Compensation Service considered an extraschedular TDIU in July 2015. The Director denied the Veteran’s claim because the evidence at that time did not show that the Veteran was unable to secure and follow a substantially gainful occupation. The Board notes that the VA examination reports prior to the Director’s decision revealed that the left knee and right hip disabilities severely impacted the Veteran’s ability to follow physical employment. After the Director’s decision, additional evidence has been associated with the claims file. First, in the January 2016 VA Form 9, the Veteran relayed that, “I can’t sit for a very long period of time because of the pain in my right hip....” During the Board hearing, the Veteran competently and credibly relayed that a prolonged sedentary position exacerbated his hip and knee pain. Importantly, the January 2020 VA examiner opined that the Veteran was unable to perform sedentary work due to his service-connected left knee total arthroplasty. Consequently, the Board concludes that a TDIU is warranted by the evidence for the claim period between September 1, 2014 and December 20, 2018. The Board notes that the TDIU claim period began on March 29, 2013; at that time, the Veteran filed a claim for an increased rating for the service-connected left knee disability. The Board also notes that the Veteran has reported that his employment ended in April 2013 because his service-connected right hip and left knee prevented satisfaction of the job requirements of a railcar supervisor. However, the Veteran testified that he became unable to follow substantially gainful employment after the left knee arthroplasty, which occurred on July 17, 2013. Moreover, the January 2020 VA examiner opined that the Veteran was unable to perform sedentary work due to his service-connected left knee total arthroplasty. Consequently, the Board finds that a TDIU is not warranted for the 4- month portion of the claim period prior to the Veteran’s left knee arthroplasty. Ultimately, the preponderance of the evidence favors the Veteran’s claim for a TDIU between September 1, 2014 and December 20, 2018. Accordingly, this claim must be granted. The Board notes that the Veteran and his representative have not raised any other issues, nor have any other issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND Upon review of the record, the Board concludes that further procedural development is necessary. Although the Board sincerely regrets this delay and is appreciative of the Veteran’s service to his country, a remand is necessary to ensure VA provides the Veteran with appropriate assistance in developing his claims prior to final adjudication. 4. On and after March 1, 2020, entitlement to a rating in excess of 70 percent for the service-connected right total hip arthroplasty is remanded. The Veteran’s claim was before the Board in June 2019; at that time, the Board remanded the claim for an additional VA examination report. Upon return to the Board, the Veteran’s representative submitted a brief requesting extraschedular consideration of the Veteran’s right hip disability as the symptoms were exceptional and unusual. Under the provisions of 38 C.F.R. § 3.321 (b) (1), the Under Secretary for Benefits or the Director, Compensation and Pension Service, is authorized to approve an extraschedular evaluation if the case “presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards.” Id. As the Board itself cannot assign an extraschedular rating in the first instance pursuant to 38 C.F.R. § 3.321 (b), it must specifically adjudicate whether to refer a case to the Director of C&P Service for an extra-schedular evaluation when the issue is either raised by the claimant or is reasonably raised by the evidence of record. Thun v. Peake, 22 Vet. App. 111, 115 (2008); Barringer v. Peake, 22 Vet. App. 242 (2008). In December 2019, the Veteran underwent a VA examination that addressed the severity of the service-connected right total hip arthroplasty disability. The VA examiner noted diagnoses for right hip degenerative arthritis and total arthroplasty. The Veteran relayed that he is constant pain, to include laying in bed, sitting, or standing for prolonged periods. The Veteran also relayed that right hip pain kept him awake at night. The Veteran relayed 8-9 pain during a flare-up, and he was unable to walk or stand for prolonged periods. The Veteran demonstrated the following ROM (in degrees): 80 flexion, 5 extension, 15 abduction, 5 adduction, and 5 external and internal rotation. The Veteran exhibited pain through all ROM planes. The Veteran demonstrate objective pain with palpation and weight bearing. The Veteran was unable to perform repetitive ROM due fear of pain. The VA examiner relayed that pain, fatigue, weakness, lack of endurance, and incoordination significantly limit functional ability with repeated use of time. The VA examiner relayed that, “he is very limited in movement of the right hip and had to carry his right leg too.” The VA examiner relayed that pain, fatigue, weakness, lack of endurance, and incoordination significantly limit functional ability during a flare up. The Veteran did not exhibit right hip ankylosis, but he did demonstrate 3/5 strength in flexion, extension, and abduction. The VA examiner noted markedly severe residual weakness, pain or limitation of motion following the December 23, 2018 implantation of prosthesis. The VA examiner noted that the Veteran constantly employed a cane, and regularly utilized a walker, for locomotion. The Veteran did not utilize crutches for mobilization. The VA examiner noted that there was objective evidence of pain with passive ROM and in non-weight bearing. Importantly, the VA examiner noted that the Veteran’s right total hip arthroplasty impacted his ability to perform occupational tasks. The Veteran reported that he lost his job because of an inability to perform his duties. In July 2020, the AOJ issued a statement of the case (SOC). Therein, the AOJ increased the Veteran’s rating for the service-connected right total hip arthroplasty disability from 30 to 70 percent. The AOJ assigned a March 1, 2020 effective date, which is first day of the month after the required convalescence period. Under Diagnostic Code 5054, a total disability rating is assigned from the date of the implantation of the prosthesis and one year following implantation. A disability rating of 70 percent is assigned for markedly severe residual weakness, pain, or limitation of motion. A disability rating of 90 percent is assigned for painful motion or weakness such as to require crutches. 38 C.F.R. § 4.71A, Diagnostic Code 5054. The Board observes that the Veteran’s right hip disability does not require the use of crutches. However, the Veteran utilizes a cane or walker for mobilization. Moreover, the December 2019 VA examiner noted that the Veteran’s right total hip arthroplasty impacted his ability to perform occupational tasks. Consequently, the Board concludes that the Veteran’s service-connected right hip disability must be referred to the Director of Compensation and Pension to determine if an extraschedular rating is warranted on and after March 1, 2020. 5. On and after December 24, 2019, entitlement to a rating in excess of 60 percent for the service-connected left total knee arthroplasty is remanded. In June 2019, the Board addressed the Veteran’s claim for a rating excess of 30 percent for the service-connected left total knee arthroplasty. At that time, the Board remanded the claim to the AOJ in order to obtain a VA examination report that addressed the severity of the Veteran’s left knee disability following surgery. Upon return to the Board, the Veteran’s representative submitted a brief requesting extraschedular consideration of the Veteran’s left knee disability as the symptoms were exceptional and unusual. Again, under the provisions of 38 C.F.R. § 3.321 (b) (1), the Under Secretary for Benefits or the Director, Compensation and Pension Service, is authorized to approve an extraschedular evaluation if the case “presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards.” Id. As the Board itself cannot assign an extraschedular rating in the first instance pursuant to 38 C.F.R. § 3.321 (b), it must specifically adjudicate whether to refer a case to the Director of C&P Service for an extra-schedular evaluation when the issue is either raised by the claimant or is reasonably raised by the evidence of record. Thun, 22 Vet. App. at 115; Barringer, 22 Vet. App. 242. In December 2019, the Veteran underwent a VA examination that addressed the severity of the service-connected left total knee arthroplasty. The VA examiner noted diagnoses for left knee degenerative arthritis and total arthroplasty. The Veteran relayed that, “he is still in pain and keeps a brace on to keep his balance stable. The pain also radiates laterally to his left lower leg on movement. He is unable to bend the knee full or extend fully, hence difficulty in getting in and out of vehicles or prolong sitting & standing cause pain.” For flare-ups, the Veteran relayed that he wakes in the middle of the night with pain, and he is unable to get back to sleep. The Veteran relayed that an unsteady gait and the inability to stand without the assistance of a cane or walker. The VA examiner recorded the following abnormal initial ROM (in degrees): 90 flexion and 40 extension. The Veteran demonstrated 5-7 pain with flexion. The Veteran reported a burning sensation during palpation of the left knee, but there was no objective pain with weight bearing. The Veteran was unable to perform repetitive testing of the left knee due to fear of pain. The VA examiner relayed that, “he is unable to fully extend flexion of the left knee. He was wincing and in pain during the exam. If we initiate an exam for repeated use, he will not be able to perform them and the ROM would be 0 for both extension and flexion.” The Veteran did not demonstrate left knee ankylosis, but he did demonstrate 2/5 strength in flexion and 3/5 strength during extension. The VA examiner did not note a history of left knee subluxation or lateral instability. The VA examiner was unable to test left knee stability because, “the Veteran could not withstand the pain elicited when I tried to perform the tests. The joint was stiff and non-pliable to movement.” The VA examiner noted that the Veteran constantly utilized a cane for locomotion, and regularly used a walker. For functional impact, the VA examiner relayed that, “he lost his job because he was unable to sit or stand for prolong periods of time and had had to be able to ambulate well to perform his duties. He became unstable in stance and falling.” The VA examiner noted objective evidence of pain with passive ROM and non-weight bearing. In July 2020, the AOJ issued a (SOC). Therein, the AOJ increased the Veteran’s rating for the service-connected left total knee arthroplasty from 30 to 60 percent. The AOJ assigned a December 24, 2019 effective date, which was based on the evidence presented during the VA examination. Under Diagnostic Code 5055, following the 100 percent rating for one year, a 60 percent rating is warranted if there are chronic residuals consisting of severe painful motion or weakness in the affected extremity. 38 C.F.R. § 4.71a, DC 5055. The Board observes that 60 percent is the highest schedular rating for the Veteran’s left knee disability after arthroplastic surgery. However, the December 2019 VA examiner noted that the Veteran’s left knee arthroplasty impacted his ability to perform occupational tasks. Moreover, the VA examiner reported severe symptoms that accompanied the Veteran’s left knee disability. Consequently, the Board concludes that the Veteran’s service-connected left knee disability must be referred to the Director of Compensation and Pension to determine if an extraschedular rating is warranted on and after December 24, 2019. Consequently, the matters are REMANDED to the AOJ for the following action: 1. Refer the Veteran’s claims for increased ratings for the right hip and left knee to the Director of the Compensation Service for extraschedular consideration. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board RLBJ, 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.