Citation Nr: 21008169 Decision Date: 02/11/21 Archive Date: 02/11/21 DOCKET NO. 16-32 363 DATE: February 11, 2021 ORDER Entitlement to an initial rating in excess of 10 percent for limited motion associated with right knee iliotibial band syndrome with patellofemoral syndrome is denied. Entitlement to a separate 10 percent rating, but no higher, for lateral instability of the right knee is granted from January 5, 2018, subject to the laws and regulations governing the payment of monetary benefits. Entitlement to a rating in excess of 10 percent for limited extension associated with right hip strain is denied. Entitlement to an initial compensable rating for limitation of flexion associated with right hip strain prior to July 7, 2016 is denied. Entitlement to a rating in excess of 10 percent from July 7, 2016 for limitation of flexion associated with right hip strain is denied. Entitlement to an initial compensable rating for right hip limitation of abduction, adduction, internal rotation, and external rotation prior to January 7, 2019 is denied. Entitlement to a 10 percent rating, but no higher, for limited hip adduction from January 7, 2019 is granted, subject to the laws and regulations governing the payment of monetary benefits. FINDINGS OF FACT 1. The Veteran’s right knee disability does not cause flexion limited to 30 degrees or extension limited to 15 degrees. 2. From January 5, 2018, the Veteran’s right knee manifested slight lateral instability. 3. For the appeal period, the Veteran’s right hip strain resulted in extension limited to 5 degrees. 4. Prior to July 7, 2016, the Veteran’s right hip strain did not result in flexion limited to 45 degrees. 5. From July 7, 2016, the Veteran’s right hip strain did not result in flexion limited to 30 degrees. 6. Prior to January 7, 2019, the Veteran’s right hip strain did not result in inability to toe-out more than 15 degrees or inability to cross legs. 7. From January 7, 2019, the Veteran’s right hip strain did not result in limitation of abduction with motion lost beyond 10 degrees. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 10 percent for limited motion associated with right knee iliotibial band syndrome with patellofemoral syndrome are not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DC) 5261, 5262. 2. The criteria for a separate 10 percent rating for right knee instability from January 5, 2018 are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.40, 4.45, 4.59, 4.71a, DC 5257. 3. The criteria for a rating in excess of 10 percent for limited extension associated with right hip strain are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5251. 4. The criteria for an initial compensable rating for limitation of flexion associated with right hip strain are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5252. 5. The criteria for a rating in excess of 10 percent from July 7, 2016 for limitation of flexion associated with right hip strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5252. 6. Prior to January 7, 2019, the criteria for an initial compensable rating for right hip limitation of abduction, adduction, internal rotation, or external rotation are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5253. 7. The criteria for a rating in excess of 10 percent from January 7, 2019 for right hip limitation of abduction, adduction, internal rotation, or external rotation have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5253. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty service from August 1992 to June 1993. This matter comes to the Board of Veterans’ Appeals (Board) from rating decisions dated in July 2014 and November 2014 of a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). The Veteran testified at a Board hearing in January 2019, and a copy of the transcript has been associated with the record. The Board remanded these specific issues to the AOJ for additional development most recently in September 2019. The Board finds that the AOJ substantially complied with remand directives, and the issues are ready for adjudication. Stegall v. West, 11 Vet. App. (1998). Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of, or incident to, military service. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability ratings is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, and the entire history of the Veteran’s disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The evaluation of the same disability under various diagnoses, and the evaluation of the same manifestation under different diagnoses, is to be avoided. 38 C.F.R. § 4.14. The critical element is that none of the symptomatology for any of the conditions is duplicative of or overlapping with symptomatology of the other conditions. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259 (1995). Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). Thus, staged ratings are appropriate for an increase rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart, 21 Vet. App. 505. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise the lower rating will be assigned. 38 C.F.R. § 4.7. After consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. 1. Entitlement to an initial rating in excess of 10 percent for right knee iliotibial band syndrome with patellofemoral syndrome The Veteran contends that he should be rated higher than 10 percent for his right knee because of pain and an inability to stand and walk for prolonged periods. Pertinent to this case, in rating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated innervation, or other pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. Pain on movement, swelling, deformity, or atrophy of disuse as well as instability of station, disturbance of locomotion, interference with sitting, standing, and weight bearing are relevant considerations for determination of joint disabilities. 38 C.F.R. § 4.45. Painful, unstable, or malaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011) (holding that 38 C.F.R. § 4.59 applies to disabilities other than arthritis). Although pain may cause functional loss, pain, itself, does not constitute functional loss and is just one factor to be considered when evaluating functional impairment. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). 38 C.F.R. § 4.40 does not require a separate rating for pain but rather provides guidance for determining ratings under other diagnostic codes assessing musculoskeletal function. See Spurgeon v. Brown, 10 Vet. App. 194 (1997); see also Correia v. McDonald, 28 Vet. App. 158 (2016); Sharp v. Shulkin, 29 Vet. App. 26 (2017). The Board finds that the February 2020 VA examination is adequate for rating. In this case, the examiner in February 2020 documented active ranges of motion for both knees, and noted there was no evidence of pain with weight-bearing. The Veteran reported functional limitations caused by the right knee. In addition, the examiner documented that passive ranges of motion were the same as active ranges of motion. Although passive ranges of motion were not specifically documented in degrees, it is reasonable to assume that assisted motion would be less limiting than active motion, and therefore, the failure to report passive motion is harmless error. Further, at the February 2020 VA examination, the Veteran reported no flare-ups, so the examiner was not expected to estimate loss of range of motion during flares. During the appeal period, the Veteran’s right knee disability is assigned a 10 percent rating under DC 5260, which applies to limited flexion. However, if there is painful motion of the knee with or without arthritis, and a compensable rating is not warranted based on limitation of motion, a 10 percent evaluation shall be assigned. See DC 5003, 5010; VAOPGCPREC 9-98; Mitchell, Burton, supra; 38 C.F.R. § 4.59. The normal range of motion of the knee is to 0 degrees (full extension) to 140 degrees (full flexion). 38 C.F.R. § 4.71a, Plate II. When flexion of the knee is limited to 45 degrees, a 10 percent rating may be assigned. When flexion is limited to 30 degrees, a 20 percent evaluation may be assigned. A 30 percent rating may be assigned when flexion of the leg is limited to 15 degrees. 38 C.F.R. § 4.71a, DC 5260. When extension of the knee is limited to 10 degrees, a 10 percent evaluation may be assigned. When extension is limited to 15 degrees, a 20 percent evaluation may be assigned. When limited to 20 degrees, a 30 percent rating may be assigned. When extension is limited to 30 degrees, a 40 percent evaluation is assignable. A 50 percent evaluation may be assigned when extension of the leg is limited to 45 degrees. 38 C.F.R. § 4.71a, DC 5261. DC 5257 applies to lateral instability or recurrent subluxation of the knee. A 10 percent rating is warranted for “slight” instability; a 20 percent rating shall be assigned for “moderate” instability; and a 30 percent rating is warranted for “severe” instability. Having reviewed the applicable diagnostic codes for limited movement, the questions before the Board are: 1) whether the Veteran’s knee disability warrants a rating in excess of 10 percent for limitation of motion, which would require flexion limited to 30 degrees or extension limited to 15 degrees; and 2) whether the Veteran’s right knee disability warrants a separate rating or a rating in excess of 10 percent under a different diagnostic code. The Board finds that at no point during the appellate period does the Veteran’s right knee have limitation of motion to a degree that would warrant a higher rating, and from January 5, 2018, a separate 10 percent rating is warranted for slight instability. The Veteran was afforded a VA examination of his knees in October 2014. The Veteran reported intermittent pain at least every other day, and a cracking sensation with bending. He reported flare-ups with prolonged walking, and that he needed to stop and rest periodically when walking long distances. Active range of motion of the right knee was flexion to 140 degrees or greater and extension to 0 degrees. There was no evidence of painful motion with movement on examination. The Veteran was able to perform repetitive-use testing with three repetitions, but there was no additional limitation in range of motion after repetitive use. The examiner indicated that pain and disturbance of locomotion contributed to disability with repeated use over time. There were no additional factors contributing to knee disability. Muscle strength testing was normal, and the Veteran did not show evidence of knee instability on joint stability testing. The Veteran did not have a meniscus condition. The Veteran did not have a tibia or fibula impairment or a meniscal condition. Imaging studies were completed, and no arthritis or patellar subluxation was documented. The examiner concluded that the Veteran’s right knee disability impacted his ability to work because he had to stop and rest sometimes and left work early once because of knee pain. The Veteran underwent another VA examination of his knees in March 2016. The Veteran reported that he seemed to have more pain over the previous few months, and was most prominent with prolonged ambulation. There was no associated weakness or numbness. The Veteran did not report flare-ups of the knee, and the examiner noted that the Veteran was familiar with exacerbators and avoided anything that would cause a flare. Active range of motion of the right knee was flexion to 140 degrees and extension to 0 degrees. There was no pain noted with movement on examination, but the Veteran had tenderness on palpation. The Veteran was able to perform repetitive-use testing with three repetitions, but there was no additional limitation in range of motion after repetitive use. Muscle strength testing was normal, and the Veteran did not show evidence of knee instability on joint stability testing. There was no history of recurrent effusion. The Veteran did not have a meniscus condition. The Veteran did not have a tibia or fibula impairment or a meniscal condition. The examiner concluded that the Veteran’s right knee disability impacted his ability to work because of pain with prolonged ambulation. The Veteran’s private outpatient records show that he was seen in January 2018 for orthopedic complaints. Regarding the right knee, the Veteran reported having tried braces with no relief. The Veteran had right knee pain on palpation and range of motion to 125 degrees. Anterior drawer test and varus valgus stress were “1+.” Muscle strength was normal. The Veteran was diagnosed with knee instability and subjective sense of giving way. The Veteran testified at a Board hearing in January 2019. He reported knee pain daily and taking pain medication. The Veteran also testified that he had instability, and his knee had given out, causing him to fall. The Veteran’s right knee disability limited his ability to climb stair and get in and out of vehicles. He testified that his knee flared up every other week for a day or two, and during that time the pain was worse, it felt swollen or tight, and was difficult to bend. The Veteran had a VA examination of his knees in February 2020. The Veteran reported that he experienced pain, popping, and difficulty with walking, squatting, and climbing. The Veteran did not report flare-ups of the knee. Active range of motion of the right knee was flexion to 110 degrees and extension to 0 degrees. Pain was noted on flexion, and caused functional loss. The Veteran was able to perform repetitive-use testing with three repetitions, but there was no additional limitation in range of motion after repetitive use. Muscle strength testing was decreased, but there was no atrophy. The Veteran did not show evidence of knee instability on joint stability testing. Specifically, anterior instability, posterior instability, medial instability (valgus pressure), and lateral instability (varus pressure) were all “normal,” and not “1+,” “2+,” or “3+.” There was no history of recurrent effusion. The examiner concluded that the Veteran’s right knee disability impacted his ability to work because of interference with walking and squatting. Based on a review of the evidence outlined above, the Board finds that with respect to a rating in excess of 10 percent for limited range of motion of the right knee, given that the VA examinations do not reflect limited range of motion sufficient for a 20 percent rating of the knee, there is no evidence to support a finding of additional functional loss for a higher rating. As mentioned above, under DC 5260, flexion of the knee must be limited to 30 degrees for a 20 percent rating. Considering functional loss from pain, the VA examinations reflected flexion of both knees greater than 30 degrees. Under DC 5261, extension of the knee must be limited to 15 degrees to warrant a 20 percent rating. The VA examinations of record reflected extension of both knees greater than 15 degrees, even considering additional functional loss caused by pain. Thus, the Veteran is not entitled to a rating in excess of 10 percent for limited range of motion of the right knee. However, the Board finds that a 10 percent rating is warranted for slight instability under DC 5257 from January 5, 2018. On January 5, 2018, the Veteran was shown in an outpatient record to have “1+” instability of the right knee. There is no objective or competent evidence prior to this date showing instability. Moreover, the Veteran testified to a subjective feeling of instability in January 2019. Although from the date of the February 2020 VA examination, no objective right knee instability is shown, the United States Court of Appeals for Veterans Claims has held that DC 5257 does not require objective evidence of instability. English v. Wilkie, 30 Vet. App. 347 (2018). Therefore, as the Veteran's report of his right knee giving out at the January 2019 Board hearing is consistent with the January 2018 private report documenting knee instability, in giving the Veteran the benefit of the doubt, the Board finds the evidence most nearly approximates a 10 percent, but no higher, rating for recurrent lateral instability of the right knee from the date of the private report, January 5, 2018. 38 C.F.R. § 4.71a, DC 5257. A higher rating is not warranted, as subsequent clinical testing did not reveal any instability. See February 2020 VA examination report. The Board acknowledges the Veteran’s June 2014 argument that the VA examinations did not include MRIs. However, the Board notes that the criteria do not require MRIs to be performed, and that the ratings under DCs 5260 and 5261 are based on objective measurements of ranges of motion in degrees using a goniometer. While the Board is denying a rating in excess of 10 percent based on limited motion, the Board also nevertheless acknowledges the Veteran’s reports that his knee is painful and has gotten worse since onset. However, the criteria for a higher rating have not been met. While the October 2014 and March 2016 VA examinations do not document left knee ranges of motion, the right knee ranges of motion that are documented are still relevant. In this particular case, the examinations of record provide sufficient details and symptoms to allow a conclusion to be reached regarding the appropriate diagnostic code and the average limitation of range of motion or which rating criteria the Veteran’s disability most closely approximates. See 38 C.F.R. § 4.1 (ratings are based on the average impairment of earning capacity) (emphasis added); and 38 C.F.R. § 4.3, 4.7 (an evaluation is assigned if the disability more closely approximates the criteria required for that rating). Specifically, the Veteran’s documented subjective reports of symptoms and limitations in walking, along with his testimony, have been considered and can be interpreted such that the limitations do not more nearly approximate flexion limited to 30 degrees or extension limited to 15 degrees in either knee. Moreover, the Veteran has never reported that there was any circumstance or condition that would limit his range of motion beyond what was documented. Overall, there is no evidence in the record or indication by the Veteran that any repeated use or pain limits the range of motion of the Veteran’s knees such that the right knee would only flex to 30 degrees or extend to 15 degrees. Indeed, no VA examination documented any limitation in extension, even with pain, and the Veteran has not reported an inability to straighten his knees. Similarly, no VA examination documented any limitation in flexion warranting even a compensable evaluation, and the Veteran has not reported any limitation in flexion under any circumstances beyond what was documented in the VA examinations. The Veteran’s complaints of pain, popping, and giving way, and limitations in walking and standing have been taken into consideration, but there is no evidence that his service-connected knee disability results in significant or additional functional loss beyond that contemplated by the assigned 10 percent evaluation for loss of motion. See 38 C.F.R. § 4.71, DCs 5260-5261; 38 C.F.R. §§ 4.40, 4.45, 4.59. The Board also finds that the private records submitted do not warrant a higher rating based on limited motion. The records do not comply with Correia and Sharp, as described above, and do not indicate that the Veteran’s right knee more nearly approximates limitation of flexion to 30 degrees or extension to 15 degrees. Thus, the Board finds that the functional limitations reported and documented do not more nearly approximate limited range of motion in either flexion or extension that would warrant a 20 percent rating. The Veteran’s representative has argued that higher ratings are warranted based on the Veteran’s pain and the painful movement of the knee. However, the Board further notes that the rating criteria are not based on severity of pain but rather the functional impairment due to that pain. Moreover, the reported symptoms themselves do not warrant a higher or separate rating, and are factors to be considered, which the Board has done. See Mitchell v. Shinseki, 25 Vet. App. at 43. Finally, the Board concludes that a higher rating is not warranted under any other diagnostic code, as no other diagnostic codes are applicable to the knee. There is no evidence of meniscal removal or dislocation during the appellate period such that a separate rating would be in order under either the provisions of DCs 5258 or 5259. Likewise, an evaluation for symptomatic removal of the semilunar cartilage of the knee is contemplated by DC 5259. 38 C.F.R. § 4.71a. However, in this case, as the Veteran does not have service-connected removal of the semilunar cartilage of the knee, this DC is not for application. In conclusion, the Veteran’s claim for a rating in excess of 10 percent for limitation of movement associated with his right knee disability is denied. However, from January 5, 2018, the Board finds that a separate 10 percent rating, but no higher, for right knee instability is warranted. A separate rating before that timeframe is denied. To the extent that the Board has denied the claim, it finds that the preponderance of the evidence is against the claim, and the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102; 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). 2. Entitlement to a rating in excess of 10 percent for limited extension associated with right hip strain 3. Entitlement to an initial compensable rating for limitation of flexion associated with right hip strain, and a rating in excess of 10 percent from July 7, 2016 4. Entitlement to an initial compensable rating for right hip limitation of abduction, adduction, internal rotation, and external rotation, and in excess of 10 percent from February 6, 2020 Limitation of motion of the hip or thigh is rated under Diagnostic Codes 5251, 5252, and 5253. For the entire appeal period, the Veteran is in receipt of a 10 percent rating for limitation of extension of the right hip under DC 5251; from October 2013 to July 6, 2016, he is assigned a noncompensable (0 percent) evaluation for limited flexion pursuant to DC 5252, and from July 7, 2016, the rating was increased to 10 percent; and from July 7, 2016 to February 6, 2020, under DC 5253, the Veteran is assigned a noncompensable rating for limited abduction, adduction, and internal and external rotation, which was increased to 10 percent effective February 6, 2020. Under Diagnostic Code 5251, a maximum 10 percent disability evaluation is warranted where there is limitation of extension of the thigh to 5 degrees. A 10 percent evaluation is the maximum statutorily allowable for limitation of extension. 38 C.F.R. § 4.71a, DC 5251. Under Diagnostic Code 5252, a 10 percent disability evaluation is assigned for flexion of the thigh limited to 45 degrees. For the next higher evaluation, a 20 percent rating, there must be limitation of flexion to 30 degrees. Limitation of thigh flexion to 20 degrees warrants a 30 percent rating, and limitation of flexion to 10 degrees warrants a 40 percent rating. 38 C.F.R. § 4.71a, DC 5252. Under Diagnostic Code 5253, a 10 percent disability evaluation is assigned for limitation of thigh rotation, with an inability to toe-out (external rotation) in excess of 15 degrees, or where there is limitation of adduction such that one cannot cross legs. A 20 percent disability evaluation is warranted for limitation of thigh abduction, where motion is lost beyond 10 degrees. A 20 percent evaluation is the maximum under this Diagnostic Code for limited rotation. 38 C.F.R. § 4.71a, DC 5253. Normal ranges of motion of the hip include hip flexion from 0 degrees to 125 degrees, and hip abduction from 0 degrees to 45 degrees. 38 C.F.R. § 4.7, Plate II Additionally, under DC 5250, a 60 percent rating is available for favorable ankylosis of the hip joint. Under DC 5254, an 80 percent rating is applicable for flail hip joint. However, the Board finds that these Diagnostic Codes are not applicable, and therefore a higher rating under these codes is not warranted, as the Veteran does not have ankylosis of the right hip or right flail hip joint. The requirements for an adequate VA examination of the musculoskeletal system are outlined above. The Board finds that the July 2016 VA examination of the hips and thighs is adequate for rating. In this case, the examiner in July 2016 documented active ranges of motion for both hips, and noted there was no evidence of pain with weight-bearing. The Veteran reported functional limitations caused by the right hip. The Board notes that passive ranges of motion were not specifically documented in degrees, but it is reasonable to assume that assisted motion would be less limiting than active motion, and therefore, the failure to report passive motion is harmless error. Further, at the July 2016 VA examination, the Veteran reported flare-ups, and the examiner estimated loss of range of motion during flares. As explained in detail below, the Board finds that a higher rating based on DC 5251 is not warranted; a higher rating based on DC 5252 is also not warranted; and, from January 7, 2019, the date of the Veteran’s testimony, a 10 percent rating, but no higher, under DC 5353 shall be assigned. Turning to the evidence, the Board notes that the Veteran has submitted private outpatient records in support of his claim for an increased rating, including orthopedic records, physical therapy records, and emergency room documents. However, the Board finds that the private records are not adequate for rating purposes because they do not comply with Sharp and Correia. The Veteran underwent a VA examination in May 2014. He reported pain with prolonged sitting and standing, and that his hip pain was significant by the end of his 12-hour shifts. The Veteran reported that flare-ups of the right hip occurred several times monthly in the form of increased pain. Active range of motion testing was performed, and the Veteran had right hip flexion to 90 degrees and extension greater than 5 degrees. Abduction was not lost beyond 10 degrees, rotation was not so limited that he could not toe-out more than 15 degrees, and adduction was not so limited that the Veteran could not cross his legs. The Veteran was able to perform repetitive-use testing with three repetitions, but there was no additional loss of range of motion. Pain caused functional loss. The examiner opined that the Veteran’s hip disability impacted his ability to work because of increased absenteeism. The Veteran had a VA examination of his hips in July 2016. He reported that flare-ups of the right hip occurred and his hip hurt to the point of having to hold it while walking. The Veteran described functional limitations, including difficulty climbing stairs and walking. Active range of motion testing was performed, and, at worst, the Veteran had right hip flexion to 40 degrees, extension to 20 degrees, abduction to 15 degrees, and external rotation to 20 degrees. At no point was adduction so limited that the Veteran could not cross his legs. Pain and weakness caused functional loss. Disturbance of locomotion and interference with sitting were additional factors contributing to disability. The examiner opined that the Veteran’s hip disability impacted his ability to work because he had difficulty with sitting and walking long distances. The Veteran testified at a Board hearing in January 2019. He reported that he had flare-ups of the hip if he stood or sat for too long in one position, which made it difficult to drive long distances. The Veteran also testified that his hip impacted his abilities to get in and out of vehicles and climb stairs. During the hearing, the Veteran attempted to cross his right leg over his left, and could not. The Veteran was afforded a VA examination in February 2020. He reported that he had flare-ups of the right hip, resulting in more severe pain and stiffness than usual. The Veteran described functional limitations, including difficulty walking, squatting, and changing positions. Active range of motion testing was performed, and the Veteran had right hip flexion to 45 degrees, extension to 10 degrees, abduction to 15 degrees, and external rotation to 10 degrees. The Veteran’s adduction so limited that he could not cross his legs. The examiner indicated that it was not possible to estimate the Veteran’s loss of range of motion during a flare-up because there were gross inconsistencies noted between range of motion testing on the focused physical examination versus observed movements in transitions, indicating probable intentional manipulation of examination results. After a de novo review of the record, the Board concludes, first, that a rating in excess of 10 percent based on limited extension of the right hip is not warranted. The Veteran is in receipt of the highest schedular rating for limitation of extension of the hip. Therefore, the claim for a higher rating must be denied. Second, the Board concludes that an initial compensable rating for limitation of right hip flexion prior to July 7, 2016 is not warranted; and a rating in excess of 10 percent from July 7, 2016 is also not warranted. As explained above, flexion limited to 45 degrees warrants a 10 percent rating under DC 5252, and flexion limited to 30 degrees warrants a 20 percent rating. The first competent evidence showing right hip flexion limited to 45 degrees was the adequate July 2016 VA examination. Therefore, prior to the date of this VA examination, the claim for an initial compensable rating is denied. From July 7, 2016, the claim for a rating in excess of 10 percent must also be denied because the evidence does not show flexion limited to 30 degrees. The July 2016 VA examination showed flexion to 40 degrees and the February 2020 VA examination showed flexion to 45 degrees. Third, the Board concludes that a 10 percent rating for limited adduction is warranted from January 7, 2019, the date of the Veteran’s Board testimony. On that date, the Veteran demonstrated an inability to cross his legs. At the February 2020 VA examination, the Veteran continued to show an inability to cross his legs. However, a rating in excess of 10 percent for limited abduction, external rotation, or adduction is not warranted, as the competent evidence does not show motion lost beyond 10 degrees abduction. At worst, the competent and adequate VA examination showed abduction to 15 degrees. In conclusion, the Board finds that the Veteran’s claim for a higher rating must be denied, except that a 10 percent rating for limited adduction is warranted from an earlier date. The Board has considered the Veteran’s documented subjective reports of symptoms and limitations in walking, and driving long distances, along with his testimony, and finds that the limitations do not more nearly approximate hip flexion limited to 30 degrees or abduction lost beyond 10 degrees. Moreover, the Veteran has never reported that there was any circumstance or condition that would limit his range of motion beyond what was documented. To the extent that the Board has denied the claim, it finds that the preponderance of the evidence is against the claim, and the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102; 4.3; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Smith, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.