Citation Nr: 21013991 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 15-04 184A DATE: March 11, 2021 ORDER Entitlement to a disability rating in excess of 30 percent for status post fracture, right ankle with internal fixation of the medial malleolus with diffuse swelling, pain, and limitation of motion, is denied. A disability rating of 10 percent, but no higher, for status post fracture right pelvis with right hip pain prior to July 24, 2018, is granted. Entitlement to a disability rating in excess of 50 percent for total right hip replacement from September 1, 2019, is denied. REMANDED Entitlement to service connection for right leg tingling is remanded. FINDINGS OF FACT 1. At no point during the appeal period has the Veteran’s right ankle disability manifested by ankylosis or nonunion of the tibia and fibula. 2. Prior to July 24, 2018, the Veteran’s right hip disability manifested by painful, but noncompensable, limitation of motion. 3. From September 1, 2019, the Veteran’s right hip replacement manifested by moderately severe residuals of pain and limitation of motion. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 30 percent for a left ankle disability have not been met. 38 U.S.C. §§ 1155, 5103, 5013A, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.71a, Diagnostic Code 5262 (2019). 2. Prior to July 24, 2018, the criteria for a rating of 10 percent, but no higher, for a right hip disability have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.20, 4.27, 4.40, 4.71a, Diagnostic Code 5299-5255 (2019). 3. From September 1, 2019, the criteria for a rating in excess of 50 percent for right hip replacement have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.20, 4.27, 4.40, 4.71a, Diagnostic Code 5054 (2019). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1974 to July 1977. These matters come to the Board of Veterans’ Appeals (Board) from an August 2010 rating decision which, in pertinent part, continued a 30 percent rating for a right ankle disability, continued a noncompensable rating for a right hip disability, and denied service connection for right leg tingling. In a November 2018 rating decision, the RO, in pertinent part, granted a temporary total evaluation effective July 24, 2018, for the Veteran’s right hip replacement, and continued a 30 percent rating from September 1, 2019. In a June 2020 rating decision, the RO, in pertinent part, increased the Veteran’s right hip replacement rating to 50 percent, effective September 1, 2019. While the grant of a temporary total rating from July 24, 2018 to September 1, 2019 represents a maximum award of benefits, the remaining grant of a 50 percent rating from September 1, 2019 does not; therefore, the increased rating claim remains pending before the Board. In January 2020, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a Board videoconference hearing. A copy of the transcript is of record. In February 2020 and July 2020, the Board remanded the matters for further development, to include obtaining outstanding VA and private treatment records and VA examinations. Increased Ratings Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities. The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3. Where entitlement to compensation has already been established and an increase in disability rating is at issue, the present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Within that context, VA must assess the level of disability from the date of initial application and determine whether the level of disability warrants the assignment of different disability ratings at different times over the life of the claim, a practice known as a “staged rating.” See Fenderson v. West, 12 Vet. App. 119 (1999). The relevant temporal focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. As such, the Board has considered the Veteran’s claims from June 2008 to the present. Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Generally, the Board has been directed to consider only those factors contained wholly in the rating criteria. See Massey v. Brown, 7 Vet. App. 204, 208 (1994); but see Mauerhan v. Principi, 16 Vet. App. 436 (2002) (finding it appropriate to consider factors outside the specific rating criteria in determining level of occupational and social impairment). When evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, fatigue, weakness, or lack of endurance, incoordination, or flare-ups is demonstrated, and those factors are not contemplated in the relevant rating criteria. See DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1995); see also 38 C.F.R. §§ 4.40, 4.45, 4.59. Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors such as decreased or abnormal excursion, strength, speed, coordination, or endurance, as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement. Mitchell v. Shinseki, 25 Vet. App. 32, 42-43 (2011). Therefore, in evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors. The standard of proof to be applied in decisions on claims for veteran’s benefits is set forth in 38 U.S.C. § 5107. A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 C.F.R. § 3.102. When a claimant seeks benefits and the evidence is in relative equipoise, the claimant prevails. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet. App. 518 (1996). 1. Entitlement to a disability rating in excess of 30 percent for status post fracture, right ankle with internal fixation of the medial malleolus with diffuse swelling, pain, and limitation of motion. The Veteran contends that an increased rating is warranted for his right ankle disability. The Veteran’s right ankle disability is currently evaluated at 30 percent pursuant to 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5262. DC 5262 pertains to impairment of the tibia and fibula. Malunion of the tibia and fibula with marked knee or ankle disability warrants a 30 percent evaluation. Nonunion of the tibia and fibula, with loose motion requiring a brace, warrants a 40 percent evaluation. DC 5270 pertains to ankylosis of the ankle. Under this diagnostic code, a 30 percent evaluation is warranted for ankylosis in plantar flexion between 30 degrees and 40 degrees, or in dorsiflexion between 0 degrees and 10 degrees. A 40 percent evaluation is warranted for ankylosis in plantar flexion at more than 40 degrees, or in dorsiflexion at more than 10 degrees, or with abduction, adduction, inversion or eversion deformity. Turning to the evidence of record, a November 2008 VA treatment record reflects the Veteran complained of right ankle pain for which he had been receiving corticosteroid injections twice a year. In a July 2009 buddy statement, the Veteran’s spouse stated that the Veteran underwent injections for his right ankle twice a year, but that they often wore off long before it was time for a new injection. She reported that the Veteran ambulated slowly and had to give himself extra time in the mornings to get ready for work. In a July 2009 statement, the Veteran reported increased pain and stiffness in his ankle and that he sometimes had difficulty operating a vehicle due to his ankle. A September 2009 VA examination report reflects the Veteran reported discomfort in his right ankle with prolonged standing and walking. The examiner noted that while the Veteran was carrying a cane, it was not prescribed, and he walked briskly into the examining room without his cane. Upon examination, plantar flexion was to 20 degrees and dorsiflexion was to 10 degrees. There was no pain in range of motion, no loss of motion on repeated used, and no evidence of additional loss of range of motion after repetitive use due to pain, weakness, fatigue, lack of endurance, or incoordination. While there was localized swelling around the ankle, there was no evidence of uneven weightbearing or ankylosis, genu curvatus, malunion, or os calcis, and no episodes of locking, giving way, or subluxation. Imaging studies revealed posttraumatic deformity of the distal tibia with tibiotalar remodeling, irregularity of the tibial plafond, and joint space narrowing. The examiner provided a diagnosis of posttraumatic degenerative joint disease of the right ankle. VA treatment records dated in October 2009 reflect plantar flexion to 15 degrees and dorsiflexion, eversion and inversion to 5 degrees each, with moderate discomfort in active range of motion and increased discomfort in passive range of motion. In December 2009, plantar flexion decreased to 10 degrees while dorsiflexion increased to 10 degrees, with pain noted in the extremes. Private treatment records show the Veteran continued to complain of chronic right ankle pain and to receive injections to his right ankle. Private treatment records dated in July 2013 reflect the Veteran complained of chronic pain in his right ankle with difficulty ambulating. He was noted to be exercising and was physically active but that his ankle had recently limited his exercise tolerance. March 2014 VA treatment records reflect significant tissue swelling and discomfort in the Veteran’s right ankle with plantar flexion to 10 degrees and dorsiflexion to 5 degrees. In July 2014, the Veteran decided to undergo ankle replacement but this was postponed pending a cardiac workup. During the January 2020 Board hearing, the Veteran stated he had not yet been cleared by his cardiologist for ankle replacement, but that his ankle continued to swell and cause him to limp. A March 2020 VA examination report reflects the Veteran reported stiffness in his ankle in the mornings and pain when stepping down. He denied flare-ups. Upon examination, plantar flexion was to 35 degrees and dorsiflexion was to 5 degrees, with pain in all planes and loss of range of motion causing difficulty with prolonged walking and an inability to run. Pain and lack of endurance further limited functional ability after repeated use over time, with plantar flexion further limited to 30 degrees. There was pain with weight-bearing, but no evidence of tenderness to palpation, crepitus, reduction in muscle strength, ankylosis, or joint instability. The examiner noted regular cane use due to right hip, knee, and ankle disabilities. Based on the foregoing, the Board finds that a rating in excess of 30 percent is not warranted for the Veteran’s right ankle disability. The Veteran is currently in receipt of the highest rating available without evidence of nonunion of the tibia and fibula, ankylosis, or ankle replacement. The evidence of record does not show symptomatology more closely approximated by a 40 percent rating, including nonunion of the tibia and fibula with loose motion and requiring a brace or ankylosis of the right ankle. The evidence of record does not show ankylosis of the subastragalar or tarsal joint, malunion of the os calcis or astragalus, or astragalectomy. Accordingly, analysis under DCs 5272, 5273, or 5274 is not warranted. Furthermore, the evidence of record does not reflect that the Veteran has undergone right ankle replacement. Thus, a separate or higher rating in excess of 30 percent for the Veteran’s right ankle disability is not warranted. The Board acknowledges there may be outstanding treatment records pertinent to the Veteran’s ankle disability that could be favorable to his claim. In July 2020 and August 2020 letters, VA requested the Veteran complete VA Form 21-4142 (Authorization to Disclose) for any recent non-VA treatment related to his right ankle. To date, there has been no response. Therefore, the Board has considered the Veteran’s claim based on the evidence of record. The Board notes that during the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes “to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities.” Id. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. Therefore, the Board has considered whether the new rating criteria is more favorable to the Veteran from February 7, 2021. As is pertinent to this claim, effective February 7, 2021, DC 5262 provides a 40 percent evaluation for nonunion of the tibia and fibula with loose motion requiring a brace. Malunion is rated under DCs 5256, 5257, 5260, or 5261 for the knee, or medial tibial stress syndrome (MTSS) or shin splints. The maximum rating available for MTSS is 30 percent for MTSS requiring treatment for no less than 12 consecutive months and unresponsive to surgery and either shoe orthotics or other conservative treatment, both lower extremities. The Board notes that the Veteran is separately service-connected for his right knee disability and the evidence does not show, nor does the Veteran claim, that his right ankle disability is manifested by ankylosis or instability, or that it affects the range of motion of his knee. Thus, a separate or higher rating is not warranted under the new regulations. In sum, the Board finds that the preponderance of the evidence is against a rating in excess of 30 percent for the Veteran’s right ankle disability. As the preponderance of the evidence is against the claim, the benefit-of-the-doubt doctrine does not apply, and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 2. Entitlement to a compensable disability rating for status post fracture right pelvis with right hip pain prior to July 24, 2018, and in excess of 50 percent for total right hip replacement from September 1, 2019. The Veteran contends that an increased rating is warranted for his right hip disability. Prior to July 24, 2018, the Veteran’s right hip disability is rated as noncompensable under DC 5299-5255. From September 1, 2019, the Veteran’s right hip replacement is rated under DC 5054. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires the use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. Here, the use of DC 5299-5255 reflects that there is no diagnostic code specifically applicable to the Veteran’s service-connected right hip disability, and that this disability has been rated by analogy to impairment of the femur under DC 5255. See 38 C.F.R. § 4.20 (allowing for rating of unlisted condition by analogy to closely related disease or injury). Impairment of the femur is evaluated under DC 5255. Impairment of the femur with fracture of the shaft or anatomical neck warrants an 80 percent rating with nonunion with loose motion, or 60 percent with nonunion without loose motion. A 60 percent rating is warranted with fracture of the surgical neck with false joint. A 30 percent rating is warranted for malunion with marked knee or hip disability, 20 percent for malunion with moderate knee or hip disability, and 10 percent for malunion with mild knee or hip disability. Limitation of motion of the thigh is evaluated under DCs 5251, 5252, and 5253. Limitation of extension of the thigh to 5 degrees warrants a rating of 10 percent under DC 5251. There is no higher rating available under that code. Under DC 5252, limitation of flexion of the thigh to 45 degrees warrants a rating of 10 percent, a 20 percent rating is warranted where limitation is limited to 30 degrees, a 30 percent rating is warranted where flexion is limited to 20 degrees, and a 40 percent rating is warranted where flexion is limited to 10 degrees. Under DC 5253, where there is limitation of abduction to the point at which the claimant cannot cross his or her legs, a 10 percent rating is warranted. A 10 percent rating is also warranted where there is limitation of rotation where one cannot toe out more than 15 degrees. A 20 percent rating, the highest available rating under DC 5253, is warranted where there is limitation of abduction of the thigh, or motion lost beyond 10 degrees. Flail joint of the hip warrants an 80 percent disability rating under DC 5254. Ankylosis of the hip is evaluated under DC 5250. Favorable ankylosis in flexion at an angle between 20 and 40 degrees with slight adduction or abduction warrants a rating of 60 percent. Intermediate unfavorable ankylosis warrants a rating of 70 percent. Assignment of a 90 percent evaluation, the highest rating for unfavorable ankylosis of the hip, is contemplated for extremely unfavorable ankylosis, in which the foot does not reach the ground, and crutches are necessary. In addition, a note to DC 5250 indicates that where the 90 percent evaluation is assigned, entitlement to a special monthly compensation is warranted. Id. Under DC 5054 for hip replacement, a 100 percent rating is assigned for one year following implantation of a prosthesis. Thereafter, a 90 percent rating is assigned for implantation of prosthesis with painful motion or weakness such as to require the use of crutches; a 70 percent rating is assigned for markedly severe residual weakness, pain or limitation of motion following implantation of prosthesis; a 50 percent rating is assigned for moderately severe residuals of weakness, pain or limitation of motion; and a 30 percent rating is the minimum rating following implantation of prosthesis. Turning to the evidence of record, in a July 2009 statement, the Veteran reported he had tremendous pain in his hip. In a July 2009 buddy statement, the Veteran’s spouse reported that the Veteran ambulated slowly and had to give himself extra time in the mornings to get ready for work. A September 2009 VA examination report reflects the Veteran reported discomfort in his right hip aggravated by prolonged standing and walking, but that he had not sought treatment for his right hip since service. The examiner noted that while the Veteran was carrying a cane, it was not prescribed, and he walked briskly into the examining room without his cane. Upon examination, forward flexion was to 125 degrees, abduction was to 45 degrees, external rotation was to 55 degrees, and internal rotation was to 25 degrees. There was no pain in range of motion or loss of motion after repetitive use. There was no evidence of localized tenderness, swelling, deformity, instability, stiffness, weakness, uneven weight-bearing, leg length discrepancy, or ankylosis and no episodes of locking, giving way, or subluxation. Imaging studies revealed minimal hip joint space narrowing with a right pubis deformity compatible with old fracture. The examiner provided a diagnosis of degenerative joint disease and healed pelvic fracture with no residuals. Private treatment records dated in October 2014 document mild degenerative changes in the Veteran’s hips bilaterally. In October 2016, the Veteran was noted to have degenerative changes in his hips, right more so than left. VA treatment records dated in June 2016 reflect the Veteran reported right anterior hip pain ongoing for months, with discomfort after extended periods of walking. There was no radiation of pain, but there was pain on external rotation. A November 2017 imaging study revealed severe degenerative findings of osteoarthritis in the Veteran’s right hip. In May 2018, the Veteran reported that his right hip started bothering him after he stepped off of a curb and that he initially thought he had pulled a muscle; however, imaging studies revealed severe joint disease and hip replacement was recommended. Private treatment records reflect that in July 2018, the Veteran underwent a right hip replacement after conservative measures for right hip pain failed. The Veteran was noted to have had pain, limited range of motion, and antalgic-style gait due to his hip. In a June 2019 letter, the Veteran’s private treating clinician, Dr. G.W., reported the Veteran was being treated for severe hip pain at Johns Hopkins. The Veteran was noted to be post total hip replacement, resulting in reduction of pain. However, pain was noted to prevent the Veteran’s activities of daily living and his coaching of baseball. No further description of the Veteran’s hip disability or additional information was provided. A July 2019 letter from J.L., a nurse practitioner, reflects the Veteran had sought treatment from a spine specialist for muscular pain and radiculopathy. A March 2020 VA examination report reflects the Veteran reported difficulty with standing from a seated position, walking long distances, and an inability to run. The Veteran denied flare-ups. Upon examination, flexion was to 110 degrees, extension was to 30 degrees, abduction was to 45 degrees, adduction was to 25 degrees, external rotation was to 40 degrees, and internal rotation was to 35 degrees, with pain in flexion, external rotation, and internal rotation and causing functional loss. The Veteran was able to cross his legs. Pain and lack of endurance limited functional ability after repeated use, with flexion further limited to 100 degrees, extension to 30 degrees, abduction to 45 degrees, adduction to 25 degrees, external rotation to 35 degrees, and internal rotation to 30 degrees. While there was evidence of pain with weight-bearing, there was no evidence of crepitus, reduced muscle strength, or ankylosis. The examiner noted the Veteran regularly used a cane for his right hip, knee, and ankle disability. Based on the foregoing, the Board finds that prior to July 24, 2018, a 10 percent rating, but no higher, is warranted for the Veteran’s right hip disability. While the evidence of record does not show malunion of the femur or limitation of range of motion that would result in a compensable rating, the Veteran has consistently reported painful motion of his right hip. In cases where a Veteran has pain upon motion, a compensable rating under 38 C.F.R. § 4.59 is for consideration when there is evidence of painful motion even without actual limitation of motion or loss of motion that is noncompensable. See Burton v. Shinseki, 25 Vet. App. 1 (2011). Thus, resolving reasonable doubt in the Veteran’s favor, the Board finds that the criteria for a 10 percent rating, but no higher, was approximated prior to July 24, 2018. However, at no time does the evidence of record show symptomatology more nearly approximated by a 20 percent evaluation or higher, including malunion of the femur with moderate hip disability or nonunion of the femur, false or flail joint, limitation of abduction beyond 10 degrees, limitation of flexion to 20 degrees, limitation of extension to 5 degrees, or ankylosis of the hip. From September 1, 2019, the Board finds that a disability rating in excess of 50 percent is not warranted. The evidence of record does not show symptomatology more closely approximated by a 60 percent rating or higher, including nonunion of the of the femur, false or flail joint, ankylosis, or post-replacement residuals such as markedly severe residual weakness, pain, or limitation of motion following implantation of the prosthesis or painful motion or weakness such as to require the use of crutches. Thus, a separate or higher rating in excess of 50 percent for the Veteran’s right hip replacement is not warranted. The Board acknowledges that there may be outstanding private treatment records related to the Veteran’s hip disability that could be favorable to his claim. In July 2020 and August 2020 letters, VA requested the Veteran complete VA Form 21-4142 (Authorization to Disclose) for any recent non-VA treatment related to his right hip. However, to date, there has been no response. Therefore, the Board has considered the Veteran’s claim based on the evidence of record. As discussed above, during the pendency of this appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). Therefore, the Board has considered whether the new rating criteria is more favorable to the Veteran from February 7, 2021. As is pertinent to this claim, DC 5054 assigns a 100 percent rating for four months following implantation of a prosthesis. Thereafter, a 90 percent rating is assigned for implantation of prosthesis with painful motion or weakness such as to require the use of crutches; a 70 percent rating is assigned for markedly severe residual weakness, pain or limitation of motion following implantation of prosthesis. DC 5255 assigns an 80 percent evaluation for impairment of the femur with fracture of the shaft or anatomical neck and nonunion with loose motion (spiral or oblique fracture), a 60 percent evaluation for impairment of the femur with fracture of the shaft or anatomical neck and nonunion without loose motion and with weightbearing preserved with aid of brace, and a 60 percent evaluation for fracture of the surgical neck with false joint. Malunion of the femur is evaluated under DCs 5256, 5257, 5260, or 5261 for the knee, or 5250 through 5254 for the hip. DCs 5250 through 5254 and 5256, 5257, 5260, and 5261 did not change. The Board notes that the Veteran is separately service-connected for his right knee disability and the evidence does not show, nor does the Veteran claim, that his right hip disability is manifested by ankylosis or instability, or that it affects the range of motion of his knee. Additionally, the evidence does not show compensable limitation of motion prior to July 24, 2018, or markedly severe residual weakness, pain, or limitation of motion following implantation of the prosthesis or painful motion or weakness such as to require the use of crutches from September 1, 2019. Thus, a separate or higher rating is not warranted under the new regulations. In sum, the Board finds that affording the Veteran the benefit of the doubt, prior to July 24, 2018, a 10 percent rating, but no higher, is warranted for the Veteran’s right hip disability. However, the preponderance of the evidence is against a rating in excess of 10 percent prior to July 24, 2018 and in excess of 50 percent from September 1, 2019 for the Veteran’s right hip disability. As the preponderance of the evidence is against the claim for a rating in excess of 10 percent prior to July 24, 2018, and in excess of 50 percent from September 1, 2019, the benefit-of-the-doubt doctrine does not apply, and the claim must be denied. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).   REASONS FOR REMAND 1. Entitlement to service connection for right leg tingling is remanded. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for right leg tingling at this time. While a September 2020 VA examiner opined that the Veteran’s right leg tingling was due to a nonservice-connected lumbar spine disability, and not caused or aggravated by a service-connected hip or ankle disability, the examiner’s rationale was that there was insufficient evidence to support that the Veteran’s altered gait caused his right knee disability and that he was already service-connected for his right hip. The Board finds the opinion inadequate, as the rationale provided is not responsive to the question as to whether the Veteran’s right leg tingling is aggravated by his service-connected right hip, right knee, and/or right ankle disability. Therefore, a remand is warranted for an addendum opinion as to the nature and etiology of the Veteran’s right leg tingling. The matter is REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s right leg tingling, diagnosed as right lower extremity radiculopathy due to a nonservice-connected lumbar spine disability, is at least as likely as not aggravated beyond its natural progression by service-connected disability, including an altered gait from the Veteran’s service-connected right hip, right knee, and/or right ankle disabilities. 2. After completing the above, and any other development as may be indicated, the Veteran’s claim should be readjudicated based on the entirety of the evidence. If the claim remains denied, the Veteran and his representative should be issued a supplemental statement of the case (SSOC). An appropriate period of time should be allowed for response. Thereafter, the case should be returned to the Board for further appellate consideration, if otherwise in order. K. Parakkal Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Owen, 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.