Citation Nr: 21008064 Decision Date: 02/11/21 Archive Date: 02/11/21 DOCKET NO. 14-16 575 DATE: February 11, 2021 ORDER New and material evidence has not been submitted to reopen a previously denied claim of entitlement to service connection for a right shoulder disability, and the claim remains denied. New and material evidence has not been submitted to reopen a previously denied claim of entitlement to service connection for a left knee disability, and the claim remains denied. An initial rating in excess of 10 percent for left shoulder acromioclavicular separation residuals is denied. An initial rating in excess of 10 percent for right knee degenerative arthritis is denied. An initial rating in excess of 10 percent for right femur fracture residuals is denied. An initial rating in excess of 10 percent for limitation of right thigh flexion is denied. An initial compensable rating for limitation of right thigh extension is denied. An initial compensable rating for limitation of right thigh adduction, abduction, and rotation is denied. FINDINGS OF FACT 1. Claims for service connection for right shoulder and left knee disabilities were previously denied in a December 2003 rating decision, the Veteran did not appeal the decision, and no new evidence pertinent to the claims was received within one year from the date the Veteran was mailed notice of the decision. 2. No additional evidence received since the final December 2003 decision raises a reasonable possibility of substantiating either claim. 3. The Veteran’s left shoulder acromioclavicular separation residuals approximate pain and limitation of motion with some weakness and functional impairment in reaching, lifting, and other normal uses of the shoulder, but not limitation to shoulder level or less. 4. The Veteran’s right knee degenerative arthritis does not approximate disability to the level of flexion limited to 30 degrees or greater. 5. The Veteran’s right femur fracture residuals and associated right hip disability approximates, at most, thigh flexion limited to 45 degrees and slight hip disability. CONCLUSIONS OF LAW 1. The additional evidence presented since the December 2003 rating decision is not new and material, and the claim for service connection for a right shoulder disability is not reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 2. The additional evidence presented since the December 2003 rating decision is not new and material, and the claim for service connection for a left knee disability is not reopened. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). 3. The criteria for an initial rating in excess of 10 percent for left shoulder acromioclavicular separation residuals are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5019, 5201. 4. The criteria for an initial rating in excess of 10 percent for right knee degenerative arthritis are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5003, 5260. 5. The criteria for an initial rating in excess of 10 percent for right femur fracture residuals are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5255. 6. The criteria for an initial rating in excess of 10 percent for limitation of right thigh flexion are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5252. 7. The criteria for an initial compensable rating for limitation of right thigh extension are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5251. 8. The criteria for an initial compensable rating for limitation of right thigh adduction, abduction, and rotation are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5253. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1973 to July 1977. This appeal is before the Board of Veterans’ Appeals (Board) from an April 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office. New and Material Evidence Pertinent procedural regulations provide that "[n]othing in [38 U.S.C. § 5103A] shall be construed to require [VA] to reopen a claim that has been disallowed except when new and material evidence is presented or secured, as described in [38 U.S.C. § 5108]." 38 U.S.C. § 5103A(f). Reopening a claim for service connection which has been previously and finally disallowed requires that new and material evidence be presented or secured since the last final disallowance of the claim. 38 U.S.C. § 5108; Evans v. Brown, 9 Vet. App. 273, 285 (1996); see also Graves v. Brown, 8 Vet. App. 522, 524 (1996). New evidence means existing evidence not previously submitted to VA. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). It is the Board’s jurisdictional responsibility to consider whether it is proper for a claim to be reopened. Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001). The agency of original jurisdiction (AOJ) denied service connection for right shoulder and left knee disabilities in a December 2003 rating decision. This decision was not appealed, and no new evidence pertinent to the claim was received by VA within one year from the date that the AOJ mailed notice of the decision to the Veteran. Furthermore, VA has not received or associated with the claims file any relevant official service department records that existed and had not been associated with the claims file at the time of that decision. Therefore, that decision is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 19.20, 19.52, 20.1103; see also 38 C.F.R. § 3.156(b), (c). The bases of the December 2003 denials were that there was no in-service injury or condition to which a current right shoulder or left knee disability could be linked. The AOJ, in that decision, also noted that there was no clinical evidence documenting a current disease or dysfunction of the right shoulder or left knee. At the time of that decision, the evidence of record included the Veteran’s November 2002 claim, in which he asserted that his knee and shoulder were “in very bad condition” and caused him “a lot of pain,” and that he had taken pain medication for years for his conditions and was unable to work, in part, due to those conditions. In that claim, he asserted that his current shoulder and knee condition were related to his strenuous duties on a boat in service. Evidence obtained since the December 2003 rating decision includes VA and private treatment records, including those dated in October 2010, March 2011, and May 2013, as well as an October 2010 VA examination report. However, the Board finds this evidence not material, as it essentially reiterates the right shoulder and left knee pain and dysfunction reported of at the time of the Veteran’s November 2002 claim. The fact that such problems were documented in medical records does not raise any reasonable possibility of substantiating either of the Veteran’s service connection claims at issue. There is no new evidence of any in-service injury or event to which a current right shoulder or left knee problem can be linked, or any new evidence indicating a nexus between a current disability and service, which might raise a reasonable possibility of substantiating the Veteran’s service connection claims, and would warrant further development of the one or both claims. On the contrary, an October 2010 private treatment record documenting the Veteran’s complaints of right shoulder pain notes an “onset [of symptoms] 2 years ago.” The Board notes Shade v. Shinseki, 24 Vet. App. 110 (2010), in which the Court found that the Board had misapplied 38 C.F.R. § 3.156(a) by determining that that because the evidence submitted did not relate to the missing nexus element of a previously denied claim, it did not raise a reasonable possibility of substantiating the claim where it related to another unestablished element of current disability. In doing so, the Court noted that “[w]hen making a determination whether the submitted evidence meets the definition of new and material evidence, the Board should take cognizance of whether that evidence could, if the claim were reopened, reasonably result in substantiation of the claim, applying concepts derived from the VCAA.” Shade, 24 Vet. App. at 118. The Court specifically pointed to the provisions of 38 C.F.R. § 3.159(c)(4)(iii), which restrict the requirement of providing a VA medical examination as part of the duty to assist to situations where claims have been reopened, if previously denied. See id. at 120. As suggested in Shade, the Board has considered “whether that evidence could, if the claim were reopened, reasonably result in substantiation of the claim, applying concepts derived from the VCAA,” specifically with respect to whether, considering such additional evidence, any further development including obtaining a VA examination or opinion would be warranted. However, as there is still no competent evidence indicating that any right shoulder or left knee disability may be associated with service, obtaining any such VA examination or opinion, or any further development generally, would not be warranted. See 38 C.F.R. § 3.159(c)(4), McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Thus, the additional evidence pertaining to the Veteran’s current right shoulder and left knee pain and dysfunction in this case cannot be said to raise a reasonable possibility of substantiating either previously denied service connection claim. See Shade, 24 Vet. App. at 124 (Lance, J., concurring) (noting that, in claims to reopen, where new evidence would “not be sufficient to at least trigger further assistance” by VA, “reopening the claim would be a Pyrrhic victory and any error in failing to reopen the claim would be necessarily harmless”). Under these circumstances, the Board finds that new and material evidence has not been submitted to reopen the Veteran’s claims of service connection for right shoulder and left knee disabilities. Accordingly, the claims are not reopened, and remain denied. Increased Rating Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran. See 38 C.F.R. § 4.3. Staged ratings are appropriate when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007); Fenderson v. West, 12 Vet. App. 119 (1999). Disability of the musculoskeletal system is primarily the inability, due to damage or infection of parts of the musculoskeletal system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. The functional loss may be due to absence of part, or all, of the necessary bones, joints, and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995). Reasonable doubt regarding any point is resolved in favor of the claimant. 38 U.S.C. § 5107. 1. An initial rating in excess of 10 percent for left shoulder acromioclavicular separation residuals is denied. The Veteran’s left shoulder acromioclavicular separation residuals are rated under 38 C.F.R. § 4.71, Diagnostic Code (DC) 5201-5019, and are therefore rated under the provisions of DC 5003. See 38 C.F.R. §§ 4.20, 4.27, 4.71a, DC 5019. His left shoulder is his nondominant (minor) shoulder. DC 5003 provides that degenerative arthritis that is 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. When there is some limitation of motion of the specific joint or joints involved that is noncompensable (0 percent) under the appropriate diagnostic codes, DC 5003 provides a rating of 10 percent for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under DC 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. When there is limitation of motion of the specific joint or joints that is compensable (10 percent or higher) under the appropriate diagnostic codes, the compensable limitation of motion should be rated under the appropriate diagnostic codes for the specific joint or joints involved. 38 C.F.R. § 4.71a. Under DC 5201, for a minor (non-dominant) shoulder joint, motion limited to 25 degrees from the side warrants a maximum 30 percent rating, while motion limited to midway between side and shoulder level, and motion limited to shoulder level, both warrant a 20 percent rating. 38 C.F.R. § 4.71a, DC 5201. On October 2010 VA examination of the left shoulder, the Veteran reported stiffness, giving way, lack of endurance, fatigability, tenderness, pain and snapping, but not weakness, swelling, heat, redness, locking, deformity, drainage, effusion, subluxation or dislocation. He reported flare-ups as often as 10 times per day, precipitated by physical activity, during which he experienced additional limitation of joint motion of not being able to raise his hand over his head, and his arm hurting when writing, and overall functional impairment of pain and weakness. The Veteran was noted to be right-hand dominant. Examination of the left shoulder revealed weakness, tenderness and guarding of movement, with no signs of edema, instability, abnormal movement, effusion, redness, heat, deformity, malalignment drainage, subluxation or ankylosis. Range of motion of the shoulder joint revealed flexion and abduction of 100 degrees out of a normal 180 degrees with pain at that point, and external and internal rotation of 65 degrees out of a normal 90 degrees, with pain at that point; motion was the same with repetition. Joint function was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use. It was noted that functional impairment would include pain with heavy lifting. VA treatment records reflect a similar level of shoulder disability as on October 2010 VA examination. In February 2011, the Veteran complained of pain in his left shoulder, and stated that he could not really elevate the arm above shoulder level and felt “grainy” in the shoulder when he moved it. In March 2011, he reported that that the left shoulder clicked and popped and had a locking sensation in the fully abducted position. The left shoulder pain was described as constant, but worse with overhead activity such as reaching, with no numbness or tingling in the left upper extremity. Examination of the left shoulder revealed him full abduction and full forward flexion, but some restricted external rotation in the 0 abducted position, and some impingement in the left shoulder with internal rotation in the abducted forward flexed position. He also had some mild discomfort in the left shoulder with cross-arm adduction. Strength to resisted abduction and external rotation was 5/5, as was resisted adduction and internal rotation. Grip, wrist extension, biceps, and triceps strength were normal bilaterally, and sense was normal in both hands. Based on the evidence of record, the Veteran’s left shoulder disability most closely approximates the criteria a for a 10 percent rating: it approximates pain and limitation of motion with some weakness and functional impairment in reaching, lifting, and other normal uses of the shoulder, but does not approximate limitation of motion to shoulder level or less. While the Veteran reported on VA examination that, during flare-ups, he might experience additional limitation of motion of the joint of not being able to raise his hand over his head, and in February 2011 reported not really being able to elevate the arm above shoulder level, the evidence as whole has not shown disability approximating the limitation of the arm motion to shoulder level or less. Again, the Veteran’s range of motion on VA examination was greater than shoulder level, to 100 degrees with pain at that point; on evaluation during treatment in March 2011 it was even greater, with full abduction and full forward flexion, and only some restricted external rotation in the 0 abducted position, some impingement in the left shoulder with internal rotation in the abducted forward flexed position, and some mild discomfort in the left shoulder with cross-arm adduction. Even considering such factors as pain and some weakness of the shoulder, and the Veteran’s reported flare-ups, the evidence as a whole shows disability approximating limitation of arm motion less than that of only to shoulder level. In this regard, again, on March 2011 evaluation during treatment, strength to resisted abduction and external rotation was full 5/5, as was resisted adduction and internal rotation; grip, wrist extension, biceps, and triceps strength were also normal. Accordingly, an initial rating greater than 10 percent for left shoulder acromioclavicular separation residuals is denied. 2. An initial rating in excess of 10 percent for right knee degenerative arthritis is denied. The Veteran’s right knee degenerative arthritis is rated under 38 C.F.R. § 4.71a, DC 5003-5260, and is therefore rated under DC 5260 for limitation of flexion of the leg. See 38 C.F.R. §§ 4.20, 4.27. Under DC 5260, flexion of the leg limited to 60 degrees is rated noncompensable (0 percent); flexion of the leg limited to 45 degrees is rated 10 percent; flexion of the leg limited to 30 degrees is rated 20 percent; and flexion of the leg limited to 15 degrees is rated 30 percent. 38 C.F.R. § 4.71a. See VAOPGCPREC 09-04 (separate ratings may be granted based on limitation of flexion (Diagnostic Code 5260) and limitation of extension (Diagnostic Code 5261) of the same knee joint). DC 5261 provides ratings based on limitation of extension of the leg. Extension of the leg limited to 5 degrees is rated noncompensable (0 percent); extension of the leg limited to 10 degrees is rated 10 percent; extension of the leg limited to 15 degrees is rated 20 percent; extension of the leg limited to 20 degrees is rated 30 percent; extension of the leg limited to 30 degrees is rated 40 percent; and extension of the leg limited to 45 degrees is rated 50 percent. 38 C.F.R. § 4.71a. See VAOPGCPREC 09-04 (separate ratings may be granted based on limitation of flexion (Diagnostic Code 5260) and limitation of extension (Diagnostic Code 5261) of the same knee joint). Normal ranges of motion of the knee are to 0 degrees in extension, and to 140 degrees in flexion. 38 C.F.R. § 4.71, Plate II. DC 5257 provides ratings for other impairment of the knee that includes recurrent subluxation or lateral instability. Slight recurrent subluxation or lateral instability of the knee is rated 10 percent; moderate recurrent subluxation or lateral instability of the knee is rated 20 percent; and severe recurrent subluxation or lateral instability of the knee is rated 30 percent. 38 C.F.R. § 4.71a. Separate disability ratings are possible for limitation of motion and instability of a knee under DC 5257. See VAOPGCPREC 23-97. On October 2010 VA examination, the Veteran reported symptoms of weakness, stiffness, redness, giving way, lack of endurance, fatigability, tenderness and pain, but no swelling, heat, locking, deformity, drainage, effusion, subluxation or dislocation. He also reported flare-ups as often as 2 times per day, precipitated by physical activity, during which he could put weight on his knees and or straighten his legs. He reported difficulty with standing/walking, in that he could walk more than half a block without feeling pain, sitting for a long period of time will also cause pain. He reported 2 incapacitating episodes in the previous 12 months requiring bed rest prescribed by a physician, and difficulty using steps. On examination of the right knee there was weakness, tenderness and guarding of movement, but no no signs of edema, instability, abnormal movement, effusion, redness, heat, deformity, malalignment and drainage, and no subluxation. There was also no locking pain, genu recurvatum, crepitus or ankylosis. Range of motion of the right knee revealed 90 degrees of flexion with 0 degrees extension, with pain at endpoints, and no additional range of motion loss with repetition. The joint function was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use. The medial/lateral collateral ligaments stability test, the anterior/posterior cruciate ligaments stability test and the medial/lateral meniscus stability test were all within normal limits for the right knee. It was noted that the effect of the Veteran’s knee condition on his occupation and daily activities would be pain with heavy lifting and difficulty with prolong standing, walking and climbing stairs. VA treatment records reflect that in March 2011, active range of motion of the right knee was measured to be 10 to 115 degrees without right knee joint effusion, no tenderness about the knee, no increased pain with varus or valgus stress, and minimal laxity of the medial cruciate ligament (MCL). No Lachman was appreciated. There was no lower extremity swelling, and circulation, motor and sensory function were intact. In April 2012, the Veteran reported that he had mostly anterior right knee pain, did knee exercises, and used a knee brace periodically. He reported having had no swelling, no click, pop, or giving away. On examination, active range of motion of the right knee was 104 degrees, with some medial and lateral midline tenderness but no increased pain with varus or valgus stress or laxity of the MCL or lateral cruciate ligament. The evidence, as discussed above, reflects right knee disability approximating the criteria for a 10 percent rating, but no greater. Right knee flexion, on VA examination and on treatment, has been shown to be limited, but, at most to 90 degrees, or twice as much flexion as contemplated in a 10 percent rating under DC 5260. Even considering any pain, weakness, or other such factors, the Veteran’s reported flare-ups, and his functional impairment including difficulty with standing, walking and stairs, such disability does not approximate limitation of motion to 30 degrees, the criteria for a 20 percent rating under DC 5260. While extension was generally noted to be full, to 0 degrees, in March 2011 active range of motion of the right knee was measured to be 10 to 115 degrees. While the findings at this time indicate extension to only 10 degrees—the criteria for a 10 percent rating under DC 5261—even if the Board were to determine that the Veteran’s knee extension approximated limitation of extension to 10 percent, based on this evidence, separate ratings under DCs 5260 and 5261 would not be warranted, as the Veteran’s flexion, while limited due to his disability, was not limited to the compensable level under DC 5260; at the time of the March 2011 treatment, flexion was to 115 degrees. See VAOPGCPREC 09-04 (explaining that “if the veteran’s range of motion in a knee is from 30 degrees to 90 degrees, then the veteran would be awarded a 40-percent rating for limitation of extension to 30 degrees under DC 5261,” but “[a] rating under DC 5260 would not be in order because the leg can flex beyond an angle of 60 degrees”). Also, while the Veteran reported no giving way of his knee on April 2012 treatment, he reported giving way on October 2010 VA examination. However, despite this general, and mixed, subjective report, the weight of the evidence as a whole does not reflect what would be considered even “mild” lateral instability. On October 2010 VA examination, there were noted to be no signs of instability or subluxation, and stability test were all within normal limits for the right knee, including medial/lateral collateral ligaments, the anterior/posterior cruciate ligaments and the medial/lateral meniscus. While there was noted to be minimal laxity of the MCL on March 2011 treatment, there was noted to be no MCL laxity on April 2012 treatment or on October 2010 VA examination. Such evidence, considered as a whole with the rest of the evidence of record, does not reflect lateral instability of the right knee. Accordingly, an initial rating in excess of 10 percent for right knee degenerative arthritis is denied. 3. An initial rating in excess of 10 percent for right femur fracture residuals is denied. 4. An initial rating in excess of 10 percent for limitation of right thigh flexion is denied. 5. An initial compensable rating for limitation of right thigh extension is denied. 6. An initial compensable rating for limitation for right thigh adduction, abduction, and rotation is denied. Disability of the hip and thigh are rated under 38 C.F.R. § 4.71a, DCs 5250 to 5255. Under DC 5250 ankylosis of the hip, unfavorable, extremely unfavorable ankylosis, the foot not reaching ground, crutches necessitated warrants a 90 percent rating; intermediate ankylosis warrants a 70 percent rating; and favorable ankylosis, in flexion at an angle between 20 degrees and 40 degrees, and slight adduction or abduction, warrants a 60 percent rating. Under DC 5251 for limitation of extension of the thigh, extension limited to 5 degrees warrants a maximum 10 percent rating. Under DC 5252 for limitation of flexion of the thigh, flexion limited to 10 degrees warrants a 40 percent rating; flexion limited to 20 degrees warrants 30 percent; flexion limited to 30 degrees warrants 20 percent; flexion limited to 45 degrees warrants 10 percent. Under DC 5253 for impairment of the thigh, limitation of abduction with motion lost beyond 10 degrees warrants a 20 percent rating; limitation of adduction where one cannot cross legs warrants 10 percent; and limitation of rotation where one cannot toe-out more than 15 degrees of the affected leg also warrants 10 percent. Under DC 5254 flail hip joint warrants an 80 percent rating. Under DC 5255 for impairment of the femur, fracture of the shaft or anatomical neck: with nonunion, with loose motion (spiral or oblique fracture), warrants an 80 percent rating; with nonunion, without loose motion, weightbearing preserved with aid of brace, warrants 60 percent; and fracture of surgical neck of, with false joint, warrants 60 percent. Malunion of the femur: with marked knee or hip disability warrants a 30 percent rating; with moderate knee or hip disability warrants 20 percent; and with slight knee or hip disability warrants 10 percent. On October 2010 VA examination of the Veteran’s right femur fracture residuals, the Veteran reported pain in the femur and muscles around femur, which occurred constantly and traveled to the hip, described is crushing, aching and cramping, exacerbated by physical activity. He reported stiffness and swelling, but no weakness, redness, fever, giving way, debility, locking, abnormal motion, heat or drainage. He reported limitations on his ability to stand and walk because of his bone condition, and that on average he could stand for 30 minutes and walk about 50 yards. On examination, his posture was normal and he walked with a normal gait. Examination of the feet did not reveal any signs of abnormal weight bearing or breakdown, callosities, or any unusual shoe wear pattern, but for ambulation he required a cane. Examination of the right femur was within normal limits. Hip examination revealed weakness, tenderness and guarding of movement, but no signs of edema, instability, abnormal movement, effusion, redness, heat, deformity, malalignment, drainage, subluxation, or ankylosis. Range of motion testing of the hip revealed flexion of the hip to 90 degrees (out of 125), extension to 25 degrees (out of 30), adduction to 20 degrees (out of 25), abduction to 40 degrees (out of 40), external rotation to 55 degrees (out of 60), and internal rotation to 35 degrees (out of 40), with pain at each endpoint and no additional limitation on repetition. Joint function was not additionally limited by pain, fatigue, weakness, lack of endurance, or incoordination after repetitive use. VA treatment records reflect that, in March 2011, on examination of the right lower extremity, the Veteran had “good range of motion of the right hip.” On evaluation in April 2012, he was noted to have had “satisfactory range of motion of the right hip.” Given this evidence, initial compensable ratings for right thigh extension or right thigh adduction, abduction, and rotation, are not warranted. The Veteran’s motion in such movements was only slightly limited, and nowhere near the limitation requirements for a compensable rating under either DC 5251 or DC 5253. Furthermore, a rating greater than 10 percent for either right femur fracture residuals or limitation of right thigh flexion is also not warranted. Flexion of the hip was to 90 degrees—twice the motion contemplated in a 10 percent rating under DC 5252 and three times the motion contemplated for the higher, 20 percent rating. Also, particularly considering his separate rating for range of hip motion, the Veteran’s hip disability—including any additional pain, stiffness, and resulting functional impairment of the hip, not contemplated in that 10 percent rating for limitation of hip motion—are adequately contemplated in the 10 percent rating for slight residual hip disability due to fracture of the femur, under DC 5255. Again, in addition to the findings on October 2010 VA examination, the Veteran was found to have had “good” and “satisfactory” motion of the right hip in March 2011 and April 2012. There is no further evidence of record indicating worse hip disability, or any other worse residual disability of the Veteran’s femur fracture, than that contained in the evidence above. Accordingly, the Veteran’s increased initial rating claims for right femur fracture residuals and various limitations of thigh motion are denied. JONATHAN B. KRAMER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Andrew Mack, 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.