Citation Nr: 21012148 Decision Date: 03/03/21 Archive Date: 03/03/21 DOCKET NO. 16-54 021 DATE: March 3, 2021 ORDER A disability rating of 90 percent, but not higher, for the initial rating period from November 17, 2009 for right hip avascular necrosis with osteoarthritis status-post implantation of prosthetic hip replacement is granted. An initial disability rating in excess of 10 percent for the period prior to June 9, 2014 for left hip avascular necrosis with osteoarthritis is denied. A disability rating of 90 percent, but not higher, for the initial rating period from August 1, 2015 for left hip avascular necrosis with osteoarthritis status-post implantation of prosthetic hip replacement is granted. FINDINGS OF FACT 1. Resolving any doubt in the Veteran’s favor, the Veteran’s right hip avascular necrosis with osteoarthritis status-post implantation of prosthetic hip replacement was productive of painful motion and weakness status post-surgical implantation of replacement right hip such as to require the use of a wheelchair, walker, rollator, cane, and electric scooter for the entire initial rating period. 2. Resolving any doubt in the Veteran’s favor, the Veteran’s left hip avascular necrosis with osteoarthritis was productive of reduced range of motion of the left thigh, painful motion, weakness, and falls for the period prior to June 9, 2014. 3. On June 9, 2014, the Veteran underwent surgical implantation of a replacement left hip. 4. Resolving any doubt in the Veteran’s favor, the Veteran’s left hip avascular necrosis with osteoarthritis status post implantation of prosthetic hip replacement was productive of painful motion and weakness status post-surgical implantation of replacement left hip such as to require the use of wheelchair, walker, rollator, cane, and electric scooter for the initial rating period from June 9, 2014 excluding the period of a temporary total rating. CONCLUSIONS OF LAW 1. Resolving any reasonable doubt in the Veteran’s favor, for the entire initial rating period, commencing November 17, 2009, the criteria for a 90 percent rating for right hip avascular necrosis with osteoarthritis status post implantation of prosthetic hip replacement were met. 38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. §§ 4.3, 4.7, 4.71a, Diagnostic Code 5054 (2020). 2. For the initial rating period from November 17, 2009 to June 8, 2014, the criteria for a rating in excess of 10 percent for left hip avascular necrosis with osteoarthritis were not met. 38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. §§ 4.3, 4.7, 4.71a, Diagnostic Code 5252 (20209). 3. For the initial rating period from June 9, 2014 through July 30, 2015, the criteria for a temporary total rating and an initial 100 percent rating for left hip avascular necrosis with osteoarthritis status post implantation of prosthetic hip replacement were met. 38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. §§ 4.30, 4.71a, Diagnostic Code 5054 (2020). 4. Resolving any reasonable doubt in the Veteran’s favor, for the initial rating period from August 1, 2015, the criteria for a 90 percent rating for left hip avascular necrosis with osteoarthritis status post implantation of prosthetic hip replacement were met. 38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. §§ 4.3, 4.7, 4.71a, Diagnostic Code 5054 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from August 1944 to July 1946, and active duty for training (ACDUTRA) from March 7 to March 21, 1951; from June 1, 1952 to June 15, 1952; and from July 25, 1954 to August 8, 1954. He participated in combat during World War II and received the Combat Infantryman Badge. Unfortunately, the Veteran died in December 2017. The Board greatly appreciates the Veteran’s honorable service. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. Procedural History In January 2016, the Board remanded both hip claims for issuance of a Statement of the Case. In May 2017, the Board again remanded both issues for further evidentiary development. Both issues were again remanded by the Board in December 2017 to ensure compliance with its prior remand orders. Stegall v. West, 11 Vet. App. 268, 271 (1998). Thus, the Veteran’s appeal was pending at the time of his death in December 2017. In January 2018, the Appellant, the Veteran’s surviving spouse, submitted an Application for Dependency and Indemnity Compensation or Death Pension (VA Form 21-534). Under 38 C.F.R. § 3.1010(c)(2), in lieu of a specific request for substitution as the claimant in this appeal, a claim for accrued benefits, survivors pension, or dependency and indemnity compensation by an eligible person listed in §3.1000(a)(1) through (5), which includes a veteran’s spouse, is deemed to include a request for substitution if, as here, a claim or appeal is pending when the claimant died. Thus, the Appellant’s January 2018 application was deemed a request for substitution. In May 2018, VA notified the Appellant that she met the basic eligibility requirements for substitution for this appeal. See 38 C.F.R. § 3.1010(a). In October 2020, the Board remanded the claims to allow the RO to consider additional relevant evidence, including VA treatment records, for which a waiver was not provided by the appellant. On remand, the RO obtained VA medical opinions regarding the severity of the Veteran’s right and left hip disabilities and those opinions have been associated with the claims file. The claim now returns to the Board for further appellate review. Preliminary Matters As phrased on the title page of this decision, the Board recharacterized the issues involving left hip avascular necrosis with osteoarthritis to reflect the evaluation of the disability as status-post implantation of prosthetic hip replacement from the date of the Veteran’s left hip replacement surgery in June 2014. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). In the analysis below, the Board reviews the Veteran’s left hip avascular necrosis with osteoarthritis prior to the June 2014 surgery in the context of rating criteria for limited motion under 38 C.F.R. § 4.71a, DC 5252, as VA did initially. See Rating Decision dated July 10, 2015 at pgs. 2-3. VA’s subsequent assignment of the rating for this period under DC 5054, rather than DC 5252, appears to have been in error. See Rating Code Sheet dated July 10, 2015, et seq. The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Veteran and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016). Increased Ratings Applicable Laws and Regulations Disability evaluations are determined by comparing a veteran’s present symptoms with the criteria set forth in the VA Schedule for Rating Disabilities, which is based upon average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code (DC), the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt is resolved in favor of the Veteran. 38 C.F.R. § 4.3. A disability rating may require re-evaluation in accordance with changes in a veteran’s condition. Thus, it is essential that the disability be considered in the context of the entire recorded history when determining the level of current impairment. See 38 C.F.R. § 4.1. When a claimant is awarded service connection and assigned an initial disability rating, separate disability ratings may be assigned for separate periods of time in accordance with the facts found. Where the veteran is appealing the rating for an already established service-connected condition, his or her present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Staged ratings are appropriate for an increased rating claim 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). Disorders of the hips are rated under DC 5250 through DC 5255 of 38 C.F.R. § 4.71a. Hip flexion is measured from 0 degrees to 125 degrees; abduction is measured from 0 degrees to 45 degrees. 38 C.F.R. § 4.71a, Plate II. Under DC 5251 (limitation of extension of the thigh), a 10 percent rating is assigned with extension limited to 5 degrees. Under DC 5252 (limitation of flexion of the thigh), a 10 percent rating is assigned with flexion limited to 45 degrees; a 20 percent rating is assigned with flexion limited to 30 degrees; a 30 percent rating is assigned with flexion limited to 20 degrees; and a 40 percent rating is assigned with flexion limited to 10 degrees. Under DC 5253, pertaining to impairment of the thigh, a 10 percent rating is warranted for limitation of adduction of the thigh such that the legs cannot be crossed or there is limitation of rotation such that it is not possible to toe out more than 15 degrees; a 20 percent rating requires limitation of abduction with motion lost beyond 10 degrees. DC 5255 contemplates impairment of the femur. Malunion of the femur warrants a 10 percent rating with slight knee or hip disability, a 20 percent rating with moderate knee or hip disability, and 30 percent rating with marked knee or hip disability. 38 C.F.R. § 4.71a. DC 5054 lists the diagnostic criteria specifically applicable to hip replacement (prosthesis). This DC applies where a Veteran, as here, has undergone prothetic replacement of the head of the femur or of the acetabulum. A 30 percent evaluation is the minimum rating to be assigned following implantation of the hip joint prosthesis. A 50 percent evaluation is warranted for moderately severe residuals of weakness, pain or limitation of motion following implantation of the hip joint prosthesis. A 70 percent evaluation is warranted for markedly severe residual weakness, pain or limitation of motion following implantation of the hip joint prosthesis. A 90 percent evaluation is warranted where painful motion or weakness such as to require the use of crutches follows implantation of the hip joint prosthesis. A 100 percent evaluation is afforded for one year following implantation of the prosthesis. 38 C.F.R. § 4.71a, DC 5054 (2019). Note (1) following the DCs for prothetic implants states that the 100 percent rating for one year following the implantation of prosthesis will commence after initial grant of the one-month total rating assigned under 38 C.F.R. § 4.30 following hospital discharge. Note (2) following the DCs for prosthetic implants states that special monthly compensation (SMC) is assignable during the 100 percent rating period the earliest date permanent use of crutches is established. The Board notes that the Veteran was in receipt of SMC from December 2009. On February 7, 2021, amendments to the schedule for rating disabilities of the musculoskeletal system, including DCs 5054 and DC 5255 for hip disabilities, went into effect. See 85 Fed. Reg. 76460 (November 30, 2020). However, as the amendment of DC 5054 applies only to hip “resurfacing,” and the amendment of DC 5255 pertains to malunion of the femur, which is not shown on this record, the amendments are not relevant to the instant appeal. The Board notes however that DCs 5251-5253 were not amended. Neither the Rating Schedule nor the regulations provide definitions for descriptive words such as “mild,” “moderate,” “moderately severe,” and “severe.” Rather than applying a mechanical formula, VA must evaluate all evidence, to the end that decisions will be equitable and just.  38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for an increased rating. 38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6; Spellers v. Wilkie, 30 Vet. App. 211, 219-20 (2018). When evaluating disabilities of the musculoskeletal system, 38 C.F.R. § 4.40 allows for consideration of functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements. See DeLuca v. Brown, 8 Vet. App. 202 (1995). Further, 38 C.F.R. § 4.45 provides that consideration also be given to weakened movement, excess fatigability and incoordination. Where arthritis results in painful motion of the joint, the rating criteria allow for at least the minimum compensable evaluation for the joint.  38 C.F.R. § 4.59. The intent of the rating schedule is to recognize painful motion with joint or particular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or misaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint.  Id.  The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided.  38 C.F.R. § 4.14. The critical element in permitting the assignment of several ratings under various DCs is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the claims file. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). A veteran is competent to report symptoms because this requires only personal knowledge, not medical expertise, as it comes to him or her through their senses. See Layno v. Brown, 6 Vet. App. 465 (1994). Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr, 21 Vet. App. 303. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. Analysis The RO assigned an initial 30 percent disability rating for the Veteran’s right hip avascular necrosis with osteoarthritis (right hip disability), effective November 17, 2009. See Rating Decision dated July 10, 2015. The RO assigned a 10 percent initial rating for the Veteran’s left hip avascular necrosis with osteoarthritis (left hip disability) on the basis of painful motion under 38 C.F.R. § 4.59, see DeLuca, supra, effective November 17, 2009, a 100 percent rating from June 9, 2014, and a 70 percent rating effective August 1, 2015. See Rating Decision dated July 10, 2015; Statement of the Case dated August 24, 2016; Rating Decision dated December 7, 2020; Supplemental Statement of the Case dated December 7, 2020. The Veteran, and now the appellant, assert that the severity of the Veteran’s right and left hip disabilities warranted higher than the assigned ratings. The Board addresses the increased rating claims together as they stem from the same facts and law. Turning to the evidence, VA outpatient notes dated September 2009 reflect that the Veteran’s lower extremity muscle strength was normal, bilaterally. Reflex testing indicated deficiencies, and it was noted that the Veteran’s range of motion (ROM) was reduced, although no ROM measurements were recorded. The Veteran was negative for crepitus. VA treatment records dated August 2010 reflect that the Veteran was experiencing uncontrolled bilateral hip pain. It was noted that he had a balance problem and was using an electric wheelchair at home, and a walker outside the home. Notably, because of mobility problems involving both hips, he needed help getting in and out of the shower, with toileting, and with grooming. The Veteran underwent a VA examination in October 2010, during which the examiner conducted a motor examination, noting that the Veteran had active hip movement against some resistance, bilaterally. The examiner also noted that the Veteran’s gait was abnormal, that he used a wheelchair at home, an electric scooter outside the home, as well as a cane for ambulation. See VA examination report dated October 21, 2010. During a February 2011 VA outpatient appointment, the Veteran described sharp hip pain, bilaterally. He continued to experience balance problems, necessitating use of a wheelchair at home and a walker outside the home. He continued to need help getting in and out of the shower, with toileting, and with grooming. VA outpatient notes dated June and September 2012 reflect that the Veteran’s lower extremity muscle strength was normal, bilaterally. However, reflex testing indicated deficiencies, and it was noted that the Veteran’s ROM was reduced, although to what degree was not noted. The Veteran was negative for crepitus. VA outpatient records dated December 2013 reflect that the Veteran had fallen in November 2013. In December 2013, the Veteran was fitted for a new wheelchair to be provided by VA, and it was recommended that VA issue the Veteran an electric scooter. VA outpatient treatment notes dated January 2014 reflect that the Veteran experience bilateral hip pain when walking. On June 9, 2014, the Veteran underwent left hip replacement surgery. See Private hospital operative report dated June 9, 2014. As indicated above, the Veteran’s left hip disability was assigned a 100 percent rating for surgical convalescence effective the date of the surgery through August 1, 2015. VA outpatient notes dated January 2015 reflect that the Veteran described leg weakness when walking and he had recurrent falls. It was observed that the Veteran’s gait and balance were stable when he used a walker. The Veteran was afforded a VA examination in April 2015. The diagnosis was avascular necrosis of the bilateral hips. The examiner noted that the Veteran had undergone a total right hip replacement in 2004 and a total left hip replacement in 2014. An MRI indicated bilateral aseptic necrosis on the right more than the left. Initial ROM testing revealed right hip flexion to 100 degrees and extension to 5 degrees; left hip flexion was to 90 degrees and extension was to 5 degrees. Abduction was to 45 degrees, bilaterally; adduction was to 25 degrees, bilaterally. There was no limitation of adduction bilaterally that prevented the Veteran from crossing his legs. External rotation was to 60 degrees and internal rotation was to 40 degrees, bilaterally. The Veteran denied flare-ups and it appears there was no additional reduction in motion, bilaterally, after repeated use over time. The Veteran denied flare-ups and there was no reduction in functionality after repeated use testing. Muscle strength testing indicated reduced strength during flexion and extension; however, the examiner attributed the loss of strength to generalized muscle weakness not solely caused by the Veteran’s service-connected hip disabilities. The Veteran was negative for ankylosis of the hips as well as malunion or nonunion of the femur, flail hip, and leg length discrepancy, bilaterally. The examiner observed surgical scars on both hips, but noted that neither scar was painful or unstable, or covered an area greater than 39 square cm (6 square inches). Notably, the examiner recorded that the Veteran required constant use of a walker for ambulation due, in part, to instability associated with his bilateral hip replacements. The examiner concluded that the Veteran’s bilateral hip disabilities, in part, impacted the Veteran’s ability to work in that it was more difficult for the Veteran to bend over or fully flex his hips. See VA hip and thigh examination report dated April 13, 2015. During a May 2015 VA outpatient appointment, the Veteran reported continuing bilateral hip pain and weakness when walking. He continued to need help getting in and out of the shower, with toileting, and with grooming, and he was using a wheelchair at home and a walker outside his home. The Veteran was unsteady when walking and standing. September 2015 VA outpatient progress notes reflect that the Veteran had poor balance, necessitating use of a walker. The Veteran was using a wheelchair to move about at home. To leave his home, the Veteran used a walker to reach his scooter in the garage and then drove the scooter to and from the neighborhood swimming pool. Notably, the Veteran’s wife reported that he continued to have ongoing falls at home. The Veteran’s remarks submitted with his October 2015 Notice of Disagreement reflect that he experienced hip pain on weight-bearing, that he had endured years of chronic pain and lack of mobility due to his bilateral hip disabilities, that the June 2014 left hip joint replacement did nothing to reduce his left hip pain, and that he needed a wheelchair for mobility due to his bilateral hip symptoms. The Veteran noted that he routinely fell because of severe hip weakness and pain, and that he avoided walking because of his fear of falling. See Correspondence from Veteran received October 15, 2015. The Board finds the Veteran’s description of his symptoms credible as they were observable and/or came to him through his senses. See Layno, supra. VA outpatient treatment notes dated June 2016 reflect that the Veteran continued to experience severe hip pain while walking. His gait and balance were poor. He used a walker and a wheelchair to move about inside his home, and he used an electric scooter to travel to and from the neighborhood pool. Nevertheless, he needed help getting in and out of the shower, with toileting, and with grooming. In correspondence received from the Veteran in October 2016, he emphasized that his pain and lack of mobility caused by both hips “exited before and after they were replaced,” and “I still live with it every day!!” See Correspondence from Veteran received October 24, 2016. During a March 2017 VA appointment, the Veteran said he had “near” falls daily, and he was falling once a week. At home, he needed help getting in and out of the shower, with toileting, and with grooming. Notably, the Veteran was falling weekly. He was using a powered wheelchair and rollator to move about at home. To leave home to visit the neighborhood swimming pool, he used a walker to reach his electric scooter in the garage. The VA clinician noted that the Veteran presented as a fall risk. April 2017 VA outpatient notes reflect that the Veteran continued to use a wheelchair and three-wheeled walker at home. The Veteran was afforded a VA examination in July 2017. The diagnosis was avascular necrosis of the bilateral hips, status post bilateral hip replacement with residual scarring of both hips, bilateral hip strain, osteoarthritis of the left hip. Initial range of motion (ROM) testing revealed right hip flexion to 70 degrees, extension to 20 degrees, abduction to 20 degrees, adduction to 15 degrees, external rotation to 30 degrees, and internal rotation to 20 degrees. Left hip flexion was to 80 degrees, extension was to 12 degrees, abduction was to 15 degrees, adduction was to 10 degrees, external rotation was to 30 degrees, and internal rotation was to 20 degrees. Pain was evidence in all planes of motion, bilaterally. Adduction was limited, bilaterally, such that the Veteran was unable to cross his legs. There was evidence of pain on weight-bearing, bilaterally. The examiner noted mild lateral hip tenderness to palpation, bilaterally. The Veteran denied flare-ups and there was no reduction in functionality after repeated use testing. Muscle strength testing indicated no reduction in strength. The Veteran was negative for ankylosis of the hips as well as malunion or nonunion of the femur, flail hip, and leg length discrepancy, bilaterally. The examiner observed surgical scars on both hips, i.e., a 10.0 cm x 1.0 cm scar at the right posterolateral hip, and a 7.0 cm x 1.0 cm scar at the left posterolateral hip, noting that neither scar was painful or unstable, or covered an area greater than 39 square cm (6 square inches). The examiner recorded that the Veteran required regular use of a wheelchair and walker, and constant use of an electric scooter for ambulation. The examiner concluded that the Veteran’s bilateral hip disabilities impacted the Veteran’s ability to work in that he experienced difficulty standing and walking. See VA hip and thigh examination report dated July 13, 2017. During a VA outpatient appointment in September 2017, the Veteran requested to be supplied with14 tubes per month of lidocaine cream for hip pain, an increase over the 12 tubes/month he had been using. In December 2020, a VA examiner opined “based on records,” the Veteran’s bilateral hip disabilities more nearly approximate “markedly severe residuals of weakness, pain or limitation of motion following implantation of prosthesis.” See VA medical opinions dated December 3, 2020. Although the VA examiner indicated that he reviewed the Veteran’s treatment records and surgical notes, other than his statement that his opinions are “based on records,” there is no supporting rationale for either opinion. See Nieves-Rodriguez, 22 Vet. App. At 304 (the probative value of a medical opinion comes from its being factually accurate, fully articulated, and having a sound reasoning for the conclusion). Moreover, the examiner failed to consider the Veteran’s lay statements describing pain on weight-bearing that required the use of a walker, cane, and scooter for ambulation and to avoid falls, which is suggestive that the examiner’s review of the claims file was cursory at best. Id. Accordingly, the Board assigns the December 2020 VA opinions low to no probative value. Upon review of all the evidence, lay and medical, and resolving reasonable doubt in the appellant’s favor, the Board finds that the Veteran’s service-connected right hip disability more nearly approximated the criteria for a 90 percent rating for the entire initial rating period. The Veteran’s right hip prosthesis was implanted several years prior to the commencement of the initial rating period considered here. Therefore, from the commencement of the rating period, the Veteran’s right hip prosthesis was in place, and he experienced painful motion and weakness in his right hip, which went unrelieved until his death. Notably, the Veteran emphasized in correspondence received in October 2016, that pain and lack of mobility caused by both hips “existed before and after they were replaced,” and “I still live with it every day!!” See Correspondence from Veteran received October 24, 2016. Although the record does not reflect that the Veteran used “crutches,” which is specifically noted in the criteria for a 90 percent rating, throughout the rating period, the Veteran’s weakness associated with his right hip disability necessitated use of a wheelchair, walker, rollator, cane, and electric scooter for physical support and ambulation. Indeed, the competent lay and medical evidence reveals that without these ambulation aids, the Veteran would routinely experience near falls and actual falls. See, e.g., VA primary care note dated January 30, 2015; VA hip and thigh examination report dated April 13, 2015. As the Veteran’s use of a wheelchair, walker, rollator, cane, and electric scooter were a natural consequence of the musculoskeletal symptoms he reported, the Board finds, in this instance, that their use is contemplated by the rating schedule set forth under DC 5054. Accordingly, resolving any reasonable doubt in the Veteran’s favor, a 90 percent rating is warranted under DC 5054 for the Veteran’s right hip disability for the entirety of the initial rating period from November 17, 2009. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. Regarding the Veteran’s service-connected left hip disability, the Board finds that for the period prior to June 9, 2014, the date of the Veteran’s left hip replacement surgery, a rating greater than 10 percent based on limitation of motion is not warranted as the record does not reflect flexion limited to 30 degrees or less, or loss of abduction at 10 degrees during this period. See 38 C.F.R. § 4.71a, DCs 5252-5253. The Board has considered whether a higher rating was warranted during this period under any other DC applicable to hip conditions and symptoms. However, the medical evidence does not show ankylosis, flail joint, or femur impairment of the left hip prior to June 9, 2014. Therefore, application of 38 C.F.R. § 4.71a, DCs 5250, 5254, or 5255 would not have benefited the Veteran during this period. In sum, the Board finds a rating in excess of 10 percent for the Veteran’s left hip disability prior to June 9, 2014 is not warranted. For the initial rating period from August 1, 2015, the Board finds that the Veteran’s service-connected left hip disability, status-post left hip replacement, more nearly approximated the criteria for a 90 percent rating. The record reflects that from June 2014, with the left hip prosthesis in place, the Veteran experienced painful motion, weakness, and falls due to his left hip disability until his death. Although the record does not reflect that the Veteran used “crutches,” which is specifically noted in the criteria for a 90 percent rating, from June 9, 2014, the Veteran’s weakness associated with his left hip disability necessitated use of a wheelchair, walker, rollator, cane, and electric scooter for physical support and ambulation. Indeed, the competent lay and medical evidence reveals that without these ambulation aids, the Veteran would routinely experience near falls and actual falls as noted above. See, e.g., VA primary care note dated January 30, 2015; VA hip and thigh examination report dated April 13, 2015. As the Veteran’s use of a wheelchair, walker, rollator, cane, and electric scooter were a natural consequence of the musculoskeletal symptoms he reported, the Board finds, in this instance, that their use is contemplated by the rating schedule set forth under DC 5054. Accordingly, resolving any reasonable doubt in the Veteran’s favor, a 90 percent rating is warranted under DC 5054 for the Veteran’s left hip disability from August 1, 2015. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. The Board also finds that VA appropriately assigned a temporary total rating commencing June 9, 2014 pursuant to 38 C.F.R. § 4.30, and a 100 percent rating assigned under DC 5054 for the period ending July 30, 2015. However, a 100 percent rating is not warranted at any other time during the pendency of the appeal for either hip. As discussed above, a 100 percent schedular rating is specifically provided only for one year following implantation of hip prosthesis and ceases at the end of that year by the terms of DC 5054. See Rossiello v. Principi, 3 Vet. App. 430, 433 (1992) (Court found that 100 percent rating ceased to exist by operation of the diagnostic code). In this case, approximately five years had elapsed from the date of surgical implantation of the right hip prosthesis prior to the Veteran’s claim for service connection. Regarding the Veteran’s left hip replacement surgery on June 9, 2014, the 100 percent rating was in effect until August 1, 2015, which included the post-surgery temporary total rating provided for under 38 C.F.R. § 4.30 and a 100 percent rating provided for under 38 C.F.R. § 4.71a, DC 5054. There is no evidence of a subsequent implantation or revision of either hip prosthesis during the initial rating period. For these reasons, the Board must find that, with the exception of the 100 percent ratings for the Veteran’s left hip replacement for the period from June 9, 2014 through July 30, 2015, a rating in excess of 90 percent for either hip disability is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, DC 5054. The Board recognizes that the Veteran was also service-connected for residual scars related to his service-connected hip disabilities; however as the record reflects that these scars were well-healed, not painful or unstable, and that neither scar limited function at any time during the rating period, separate compensable ratings for the hip scars are not warranted. 38 C.F.R. § 4.118, DC 7805. Finally, neither the appellant nor her representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 69-70 (2017). S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Farrell, Bradley 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.