Citation Nr: 21009979 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 10-16 237 DATE: February 23, 2021 REMANDED Entitlement to a rating in excess of 10 percent for right hip trochanteric bursitis under Diagnostic Code 5255 is remanded. Entitlement to a compensable rating for right hip trochanteric bursitis under Diagnostic Code 5251 is remanded. Entitlement to a compensable rating for right hip trochanteric bursitis under Diagnostic Code 5252 is remanded. Entitlement to a rating in excess of 10 percent for right knee patellofemoral arthritis is remanded. Entitlement to a total rating for compensation purposes based on individual unemployability due to service connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran had active service from July 1968 to August 1969. The Veteran appeared at an October 2014 videoconference hearing before the undersigned Veterans Law Judge. The hearing transcript is of record. 1. Entitlement to increased ratings for a right hip disability is remanded. The report of a February 2020 hip examination conducted for the Department of Veterans Affairs (VA) states that the Veteran indicated that “any movement in right hip is painful.” On examination of the right hip, the Veteran exhibited a range of motion of flexion to 90 degrees, extension to 20 degrees, abduction to 40 degrees, adduction to 20 degrees, external rotation to 20 degrees, and internal rotation to 20 degrees; pain with all ranges of motion; adduction limited such that the Veteran could not cross his legs; and no right femoral abnormalities. The examiner commented that, “due to trochanter bursitis, Veteran is unable to do any bending or squatting due to severe sharp pain” and “job requires tight spaces and prolonged standing and walking making the pain increased.” The nurse practitioner did not indicate the degree at which the Veteran experienced pain on motion of the right hip. Because of that deficiency, the Board finds that the functional loss associated with the service-connected right hip disability is unclear and the examination report is of limited probative value. The Board observes that the Secretary of VA has recently amended that portion of 38 C.F.R. Part 4 which pertain to musculoskeletal disabilities. On February 7, 2021, the provisions of 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5019, and 5255 addressing bursitis and impairment of the femur were amended. Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5019, 5255). VA’s duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121 (1991). When VA obtains an evaluation, the evaluation must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Because of the cited deficiencies in the February 2020 VA hip examination and the recent amendment of the relevant diagnostic codes, the Board finds that further VA hip evaluation is needed. Clinical documentation dated after February 2020 is not of record. VA should obtain all relevant VA and private treatment records which could potentially be helpful in resolving the Veteran’s claims. Murphy v. Derwinski, 1 Vet. App. 78 (1990); Bell v. Derwinski, 2 Vet. App. 611 (1992). 2. Entitlement to a rating in excess of 10 percent for right knee patellofemoral arthritis is remanded. The report of a February 2020 knee examination conducted for VA states that the Veteran indicated that he experienced recurrent “very sharp right knee pain daily;” knee tightness with limited mobility; and “right knee locks up.” On examination of the right knee, the Veteran exhibited a range of motion of 5 to 100 degrees with pain; pain with weight bearing; and no joint instability. The examiner commented that, “due to right knee patellofemoral arthritis, Veteran is unable to stand for prolong periods of time, walk or bend with pain and weakness to right knee.” The nurse practitioner did not indicate the degree at which the Veteran experienced pain on motion of the right knee. Because of that deficiency, the Board finds that the functional loss associated with the service connected right knee disability is unclear and the examination report is of limited probative value. VA has recently amended that portion of 38 C.F.R. Part 4 which pertain to musculoskeletal disabilities. On February 7, 2021, the provisions of 38 C.F.R. § 4.71a, Diagnostic Codes 5010 and 5257 addressing post traumatic arthritis and impairment of the knee were amended. Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Codes 5010, 5257). Because of the cited deficiencies in the February 2020 VA knee examination and the recent amendment of the relevant diagnostic codes, the Board finds that further VA knee evaluation is needed. 3. Entitlement to TDIU is remanded. Entitlement to TDIU requires an accurate assessment of the impairment associated with all of the service connected disabilities. Because the claim for TDIU is inextricably intertwined with other claims being remanded, the issue of entitlement to TDIU must also be remanded. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for each private healthcare provider who treated him for the service connected right hip and right knee disabilities. Make two requests for the authorized records from all identified healthcare providers unless it is clear after the first request that a second request would be futile. 2. Obtain the Veteran’s VA clinical documentation not already of record, including treatment records dated after February 2020. 3. Schedule the Veteran for a VA examination conducted by a medical doctor to assist in determining the current nature and severity of right hip trochanteric bursitis and right knee patellofemoral arthritis. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Identify any right femoral disability associated with the right tronchanteric bursitis. If no right femoral disability is found, the examiner should specifically state that fact. (b) Provide ranges of motion for weight-bearing and nonweight-bearing and passive and active motion of both lower extremities including the hips and the knees. The examiner should specifically indicate the degree at which the Veteran experiences pain on motion of the right hip and the right knee. (c) State whether there is any additional loss of function of the right lower extremity, including the right hip and the right knee, due to painful motion, weakened motion, excess motion, fatigability, incoordination, or on flare up. (d) State whether there is any recurrent lateral instability or subluxation of the right knee and, if so, the severity of any instability or subluxation. (e) Opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran is unable to secure or follow a substantially gainful occupation due to the service-connected disabilities. If the Veteran is felt capable of work despite the service connected disabilities, the examiner should describe what type of work and what accommodations would be necessary due to the service connected disabilities. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. T. Hutcheson, 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.