Citation Nr: 21015297 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 10-15 375 DATE: March 17, 2021 ORDER 1. Entitlement to service connection for a psychiatric disability is dismissed. 2. Entitlement to increases in the (10 percent prior to March 8, 2011, 30 percent from that date to March 1, 2014, and 20 percent from that date) staged ratings assigned for lumbar strain with sacroiliitis, to include the propriety of a reduction of the rating for such disability from 30 percent to 20 percent, is denied. 3. Entitlement to staged (20 percent prior to August 29, 2013 and 30 percent from August 29, 2013) combined increased ratings for a right knee disability is granted; entitlement to further increases in the staged ratings is denied. 4. Entitlement to staged (20 percent prior to August 29, 2013, and 30 percent from August 29, 2013) combined increased ratings for a left knee disability is granted; entitlement to further increases in the staged ratings is denied. 5. Entitlement to a rating in excess of 10 percent for right hip strain is denied. 6. Entitlement to a rating in excess of 10 percent for left hip strain is denied. FINDINGS OF FACT 1. In January 2018 correspondence, prior to the promulgation of a decision in the matter, the Veteran withdrew in writing her appeal seeking service connection for a psychiatric disability; there is no question of fact or law in the matter remaining for the Board to consider. 2. The coding of the Veteran’s low back disability as 30 percent disabling was a clear and unmistakable administrative error that required correction . 3. Prior to March 8, 2011, the Veteran’s low back disability was manifested by forward flexion greater than 60 degrees, and combined range of motion greater than 120 degrees, and there was no ankylosis or muscle spasm or guarding resulting in an abnormal gait; from March 8, 2011 to March 1, 2014 the low back disability was manifested by forward flexion greater than 60 degrees, and there was no evidence of ankylosis or muscle spasm or guarding resulting in abnormal gait; from March 1, 2014 the low back disability is not shown to have been manifested by forward flexion of the thoracolumbar spine limited to 30 degrees or less or by favorable ankylosis of the entire thoracolumbar spine; incapacitating episodes of intervertebral disc syndrome (IVDS) are not shown. 4. Prior to August 29, 2013, the Veteran’s right and left knee disabilities are shown to have been manifested by subjective reports of slight instability, and painful motion not limited to a compensable degree of flexion or extension limitation; from August 29, 2013, the right and left knee disabilities are shown to have been manifested by subjective reports of slight instability, and extension limited at 15 degrees. 5. The Veteran’s right and left hip disabilities have been manifested by painful motion, but not flexion limited to 45 degrees or less; extension limited to 5 degrees or less; abduction lost beyond 10 degrees; adduction limited to cannot cross legs; or rotation limited to cannot toe-out more than 15 degrees. CONCLUSIONS OF LAW 1. The criteria for withdrawal of a substantive appeal are met with respect to the claim of service connection a psychiatric disability; the Board has no further jurisdiction to consider an appeal in the matter. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 2. The reduction of the rating for the Veteran’s low back disability from 30 to 20 percent was done to correct an administrative error, and did not involve a due process violation; it was in accordance with governing law, and was proper. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.105 (e), 4.71a, Diagnostic Code (Code) 5237. 3. Prior to March 8, 2011 a rating in excess of 10 percent was not warranted for the Veteran’s low back disability; from that date to March 1, 2014 a rating in excess of 30 percent was not warranted; from March 1, 2014 a rating in excess of 20 percent is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § § 3.321, 4.1, 4.3, 4.7, 4.40, 4.71a, Codes 5003, 5235-5243. 4. The Veteran’s right and left knee disabilities, each, warrant staged combined ratings of 20 percent (but no higher) prior to August 29, 2013, and 30 percent (but no higher) from August 29, 2013. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.21, 4.40, 4.59, 4.71a, Codes 5003, 5256-5263. 5. Ratings in excess of 10 percent for right and left hip disabilities are not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.20, 4.59, 4.71a, Codes 5251, 5252, 5253. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant is a Veteran who served in the Army National Guard, and had active duty for training from June 2006 to March 2007. These matters are before the Board of Veterans’ Appeals (Board) on appeal from September 2009 and September 2012 rating decisions. In August 2016 the Board remanded these matters for additional development. In October 2016, a Travel Board hearing was held before the undersigned; a transcript is in the record. In August 2017, these matters were remanded for additional development. The August 2017 remand incorrectly indicated there were two staged ratings assigned to the back disability. The characterization of the issues has been amended to (more accurately) reflect that there were three stages in the ratings assigned for the back disability. In February 2018 correspondence, the Veteran withdrew her claim seeking unemployability (a TDIU rating). [The August 2016 Board decision denied an effective date prior to October 20, 2009 for the award of service connection for lumbar strain, resolving that matter. That decision also remanded (for development and issuance of a statement of the case (SOC) claims of service connection for peripheral neuropathy of each foot and seeking increased ratings for sciatica of each lower extremity (which were not addressed were not addressed at the October 2016 hearing). A review of the record did not find that an SOC addressing these matters has been issued. As the development sought in those matters remains pending, they are not currently before the Board. The Veteran also has pending claims of service connection for right hand, right wrist, and eft shoulder disabilities. In his July 2019 substantive appeal, she requested a videoconference hearing on these claims (which has not yet been held). Accordingly, they are not before the Board at this time, and will be decided after the videoconference hearing is held (by the VLJ who conducts the hearing. 1. Entitlement to service connection for a psychiatric disability is dismissed. The Board has jurisdiction where there is a question of law or fact on appeal to the Secretary. 38 U.S.C. § 7104; 38 C.F.R. § 20.101. The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination on the matter on appeal. 38 U.S.C. § 7105. An appeal may be withdrawn at any time before the Board promulgates a decision. Withdrawal may be made by the appellant, and must be in writing or on the record at a hearing. 38 C.F.R. § 20.204. In January 2018 correspondence, the Veteran withdrew in writing her appeal seeking service connection for a psychiatric disability. Accordingly, there is no allegation of error of fact or law in this matter for the Board to consider, and the Board no longer has jurisdiction to consider an appeal in the matter. The Veteran later filed a claim to reopen her claim of service connection for a psychiatric disability. That claim is not yet before the Board. Increased Rating Revisions were made to certain regulations governing ratings for musculoskeletal disabilities, effective February 7, 2021. As the Veteran’s appeal was pending at the time of this revision, from that date, she is entitled to a rating under the old or the new criteria, whichever are more favorable. Disability ratings are determined by applying the criteria set forth in VA’s Schedule for Rating Disabilities (Rating Schedule). 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. Under 38 C.F.R. § 4.45, consideration must be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. Instability of station, disturbance of locomotion, interference with sitting, standing and weight bearing are related considerations. Painful, unstable, or misaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59. Although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Osteoarthritis established by X-ray findings is rated based on limitation of motion under the appropriate diagnosis codes for the specific joint involved. When, the limitation of motion of a specific joint with arthritis is noncompensable under the appropriate diagnostic code(s), a maximum rating of 10 percent may be assigned for painful motion. Full range of knee motion is from 0 degrees extension to 140 degrees flexion. 38 C.F.R. § 4.71a, Code 5003 and Plate II. When the appeal is from the initial rating assigned with an award of service connection, the entire period from the grant of service connection to the present is to be considered, and varying “staged” ratings may be assigned for separate distinct periods based on facts (regarding degree of severity during the periods) found. See Fenderson v. West, 12 Vet. App. at 125-26 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Reasonable doubt regarding the degree of disability should be resolved in favor of the claimant. 38 C.F.R. § 4.3. A claim will be denied only if the preponderance of the evidence is against the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 56 (1990). 1. Entitlement to increases in the (10 percent prior to March 8, 2011, 30 percent from that date to March 1, 2014, and 20 percent from March 1, 2014) staged ratings assigned for lumbar strain with sacroiliitis, to include the propriety of the reduction of the rating from 30 percent to 20 percent is denied. Initially it is noted that the Veteran has been found to have neurological manifestations of the low back disability for which service connection has been established, for which separate compensable ratings are assigned (bilateral lower extremity sciatica). Those ratings are not at issue in this appeal, and will not be discussed further. As noted below, bowel and bladder disturbances are not shown. Accordingly, consideration of separate ratings for such disabilities is not necessary. As noted above, some revisions to musculoskeletal Codes have been made effective February 7, 2021. The Veteran’s low back disability is rated under Code 5237 (which was not modified by the revisions). If there is IVDS, it may alternatively be rated under the Formula for Rating IVDS based on incapacitating episodes (Code 5243). This Code was revised on February 7, 2021. However, the record does not reflect that alternative rating based on IVDS is warranted under either the old or new version of Code 5243. Under Code 5237 and the General Rating Formula for Diseases and Injuries of the Spine (General Formula), a 20 percent rating is warranted when forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or there is muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted when forward flexion of the thoracolumbar spine is limited to 30 degrees or less; or with favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. Note (1) to the General Formula specifies that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be separately evaluated under an appropriate diagnostic code. 38 C.F.R. § 4.71a. An August 2009 X-Ray showed mild scoliosis. On February 2010 examination, it was noted that the Veteran had no orthopedic back complaints or impairment and that she refused a back examination for scoliosis. February 2011 correspondence notes the Veteran was seen with sharp pain in the low back. A March 2011 lumbar spine MRI showed normal vertebral bodies, no disc herniation, and no nerve root impingement. On May 2011 Back Conditions examination, the diagnosis was lumbosacral strain with bilateral sacroiliitis. The Veteran reported her low back disability had worsened since onset in 2008. She reported use of a cane and back brace, but did not bring she devices to the examination. Range of motion was abnormal with flexion limited to 60 degrees, and extension to 0 degrees. On August 2012 Back Conditions DBQ, the Veteran’s complaint of chronic intermittent low back pain was noted. She reported that she was unable to run due to back flare-ups. On physical examination there was no tenderness on palpation. Range of motion was abnormal with flexion to 70 degrees, extension limited at 15 degrees, right lateral rotation to 20 degrees, and left lateral rotation not examined due to pain. After repeated attempts, flexion is reduced to 40 degrees, extension was limited at 20 degrees, right lateral rotation is 30 degrees. The Veteran reported occasional use of a back brace. A May 2013 orthopedic record notes the Veteran was seen with low back pain (persistent for four weeks). A June 2013 MRI of the lumbar spine showed normal intervertebral disc height without significant disc bulge/protrusion. The impression was no abnormality identified to account for the patient’s symptoms. On August 2013 Back Conditions DBQ the diagnosis was lumbar strain. The Veteran reported flare-ups of increased pain. Range of motion was abnormal with flexion to 70 degrees, and extension, right lateral flexion, left lateral flexion, right lateral rotation, and left lateral rotation each to 15 degrees (with objective evidence of painful motion shown with each). Localized tenderness, pain on palpation, guarding and/or muscle spasm were not shown. There was no muscle atrophy, and no IVDS. The veteran did not use assistive devices. There were no bowel and bladder problems associated with the low back disability. On December 2015 Back Conditions DBQ, lumbosacral strain was diagnosed. The examiner noted the Veteran occasionally wore a brace for back pain. Range of motion testing was normal. There was no objective evidence of localized tenderness or pain with weight bearing , and no guarding or muscle spasm. There was no ankylosis, and there were no bowel or bladder problems associated with the low back disability. At the October 2016 Travel Board hearing the Veteran testified that she had a problem with one of her discs. On December 2016 Back Conditions DBQ the diagnoses were lumbosacral strain, lumbar strain with spondylosis, sacroiliitis, and sciatica. Flare-ups were not reported. The Veteran reported inability to lift heavy objects, or to run. Range of motion was abnormal, with flexion to 70 degrees, extension and right lateral rotation each to 15 degrees, right lateral flexion to 10 degrees, and left lateral flexion and left lateral rotation each to 30 degrees. There was no objective evidence of localized tenderness or pain on palpation, and no guarding or muscle spasm. There was no muscle atrophy or ankylosis, and no IVDS. The disability had not required bed rest prescribed by a physician in the past twelve months. It was noted that the Veteran occasionally used a can and back brace. Bowel and bladder problems were not shown. Propriety of the reduction from 30 percent to 20 percent effective March 1, 2014 A September 2012 rating decision assigned a 20 percent rating for the Veteran’s low back disability effective March 8, 2011. A September 2012 rating decision Codesheet (incorrectly) shows that the rating for the Veteran’s low back disability was increased to 30 percent effective March 8, 2011. A November 2012 notification letter informed the Veteran that her low back disability was increased to 20 percent effective March 8, 2011. An April 2013 rating decision noted the coding error associated with the September 2012 rating decision, and proposed to reduce the rating of the low back to 20 percent no earlier than September 1, 2013. A November 2013 rating decision reduced the rating of the low back from 30 percent to 20 percent effective March 1, 2014. The rating reduction did not involve a due process violation. See 38 C.F.R. § 3.105 (e). A February 2014 letter notified the Veteran of the proposal to reduce the rating for her low back disability. The Board finds that the RO complied with the due process requirements in 38 C.F.R. § 3.105 (e) governing rating reductions; the Veteran was not denied due process. The analysis turns to whether the reduction in the rating was factually warranted. As noted above, the September 2012 correctly assigned a 20 percent rating for the Veteran’s low back disability effective March 8, 2011 and the Veteran was notified of such rating in November 2012. However, on the rating Codesheet. the low back disability was incorrectly coded as rated 30 percent instead of the actual 20 percent. The 30 percent rating entered on the codesheet was a coding error. The General Rating formula under which the disability is rated does not provide for a 30 percent rating for the low back, and the entry of such on the rating codesheet was unauthorized by law and a clear and unmistakable (sole administrative) error that required correction by reduction. Considering the foregoing, the Board finds that reduction in the rating for the Veteran’s low back disability from 30 to 20 was proper. Prior to March 8, 2011 At the outset, the Board notes that no examination report or treatment record reflects (and she has not alleged) that the Veteran had incapacitating episodes of IVDS at any time under consideration. Consequently, the criteria for rating low back disability based on incapacitating episodes of IVDS are not for consideration. The reports of the VA examinations, treatment records, and the Veteran’s own lay statements do not show that symptoms of her low back disability at any time prior to March 8, 2011 included flexion of the thoracolumbar spine limited to 60 degrees or less; or, that combined range of motion of the thoracolumbar spine was limited to 120 degrees or less; or that there was muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis (the criteria which would warrant the next higher, 20 percent, rating). Consequently, a rating in excess of 10 percent was not warranted under the General Formula prior to March 8, 2011. From March 8, 2011 to March 1, 2014 The reports of the VA examinations, treatment records, and the Veteran’s own lay statements do not show that symptoms of the Veteran’s low back disability at any time included forward flexion of the thoracolumbar spine limited to 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine (the criteria which would warrant the next higher, 40 percent, rating). Consequently, a rating in excess of 30 percent under the General Formula was not warranted prior to March 1, 2014. From March 1, 2014 The reports of the VA examinations, treatment records, and the Veteran’s own lay statements (including in hearing testimony) do not show that symptoms of the Veteran’s low back disability at any time included forward flexion of the thoracolumbar spine limited to 30 degrees or less, or ankylosis of the entire thoracolumbar spine (the criteria which would warrant the next higher, 40 percent, rating). Consequently, a rating in excess of 20 percent is not warranted under the General Formula criteria. 2. 4. Entitlement to combined 20 percent ratings, each, prior to August 29, 2013, and to combined 30 percent ratings, each, from that date is granted for the Veteran’s right and left knee disabilities. As noted above, revisions were made to regulations governing ratings for musculoskeletal disabilities effective February 7, 2021. With respect to ratings for knee disabilities, a pertinent here revision was made to Code 5257 (for rating recurrent subluxation or instability). As the instant claim was pending at the time of this revision, the revised criteria must be considered from their effective date. Ankylosis of a knee is rated under Code 5256. Recurrent subluxation or lateral instability of a knee is rated 10, 20 or 30 percent based on whether such impairment is slight, moderate, or severe, respectively. Code 5257. Knee disability may also be rated under Code 5258 (20 percent for dislocated semilunar cartilage), or Code 5259 (10 percent for symptomatic removal of semilunar cartilage). 38 C.F.R. § 4.71a. Under Code 5260, limitation of knee flexion is rated 0 percent when to 60 degrees; 10 percent when to 45 degrees; 20 percent when to 30 degrees; and 30 percent when to 15 degrees. Under Code 5261, knee extension limitation at 5 degrees is rated 0 percent; when at 10 degrees, 10 percent; when at 15 degrees, 20 percent; when at 20 degrees 30 percent; when at 30 degrees, 40 percent; and when at 45 degrees, 50 percent. 38 C.F.R. § 4.71a. Separate ratings may be assigned for arthritis of a knee with compensable limitations of flexion and extension (or with painful, but less than compensable limited motion), recurrent subluxation or lateral instability, and dislocated or postoperative symptomatic semilunar cartilage. See VAOPGCPREC 23-97 and VAOPGCREC 9-98. A February 2009 treatment record notes the Veteran was seen with complaints of bilateral knee pain. On physical examination, each knee had full range of motion, no effusion, no tenderness on palpation, and normal joint stability testing. In March 2009 the Veteran was seen for pain in both knees. The right knee was swollen; physical therapy to strengthen the knee was recommended. On August 2009 knee examination, chronic bilateral knee strain was diagnosed. The Veteran reported constant and dull knee pain at rest. She reported that her right knee would give out once a week, and her left knee would give out once a month. She reported occasional use of an elastic support device on for each knee (more frequently right than on the left). Range of motion studies of the right knee showed flexion to 130 degrees, extension to 0 degrees. Studies of the left knee showed flexion to 140 degrees, and extension to 0 degrees. There was pain on motion in both knees. The examiner noted that both knees were clinically stable on examination. A September 2009 VA treatment record notes the Veteran was seen for chronic hip and knee pain, and requested knee braces. The impression was bilateral chondromalacia patella; she was referred to physical therapy for bilateral hinged knee braces for medio-lateral support. December 2009 correspondence notes that the Veteran was receiving physical therapy for chondromalacia patellae of each knee, and had knee braces prescribed for both knees. A December 2009 treatment record notes the Veteran was seen following two episodes of her knees buckling. On February 2010 examination, range of motion testing found flexion-extension of each knee to be from 120 to 0 degrees. There was evidence of some pain on motion. The examiner noted that an August 2009 X-Ray found no obvious arthritis of either knee. In May 2013 correspondence, the Veteran indicated that she was seen in May 2013 for cortisone shots to both knees; she reported that she continued to have pain and instability in each knee. On August 29, 2013 knee and lower leg conditions DBQ, range of motion of each knee was abnormal, with flexion of each limited to 110 degrees and extension at 15 degrees. There was no evidence of recurrent patellar subluxation/dislocation, and no meniscal condition. It was noted that the Veteran regularly used a brace, and that there was degenerative arthritis of each knee. On December 2015 knee and lower leg conditions DBQ, the diagnoses were bilateral knee strain, and right knee patellofemoral pain syndrome. Range of motion of both knees was normal. Pain on movement was noted, but did not contribute to functional loss. There was no muscle atrophy, and joint stability tests were normal. There was no history or presence of a meniscal condition. It was noted that the Veteran occasionally used a brace and cane. At the October 2016 Travel Board hearing, the Veteran testified that her knees gave way in 2009 (resulting in hip injuries). On December 2016 knee and lower leg conditions DBQ, the diagnoses were bilateral knee strain and bilateral knee joint osteoarthritis. There was no report of flare-ups. Right knee range of motion was abnormal with flexion limited to 80 degrees, and extension to 0 degrees; there was pain on motion. Left knee range of motion was normal. There was no muscle atrophy or ankylosis. Joint stability tests were normal, and there was no meniscal condition. It was noted that the Veteran occasionally used a cane. On March 2018 knee and lower leg conditions DBQ, the diagnoses were bilateral knee degenerative arthritis, and bilateral limitation of extension. Range of motion was abnormal with right and left knee flexion to 90 degrees and extension to 5 degrees. Pain on motion (not contributing to functional loss) was noted. Muscle atrophy was not shown. Ankylosis was not shown. No history of recurrent subluxation, lateral instability, or recurrent effusion was shown. No meniscus condition was shown. It was noted that the Veteran constantly used braces and a cane for stability when walking. The Veteran’s right and left knee disabilities have been assigned a 10 percent rating based on painful motion prior to August 29, 2013, and 20 percent for limitation of extension from August 29, 2013. Consequently, the questions before the Board are whether the right and left knees warrant a higher than 10 percent rating prior to August 29, 2013, and whether they warrant higher than 20 percent ratings from that date. Prior to August 29, 2013 Prior to August 29, 2013, the Veteran’s right and left knees were not shown to be ankylosed, there was no meniscus condition, and there was no associated tibia or fibular impairment, or genu recurvatum. Accordingly, Codes 5256, 5258, 5259, 5262, and 5263 do not apply. A 10 percent rating has been assigned for painful motion without a compensable degree of impairment. Compensable limitations of flexion or extension were not shown. Therefore, separate ratings under Code 5260 and/or Code 5261 were not warranted. However, the Veteran was consistent in her subjective reports of instability (and has consistently used bilateral knee braces). Considering the reasoning by the U.S. Court of Appeals for Veterans Claims (CAVC) in English v. Wilkie, 30 Vet. App. 347, 353 (2018), the Board finds that slight instability is reasonably show, and that a separate 10-percent rating under Code 5257 is warranted. Accordingly, a 20 percent combined (10 percent under Code 5257, and 10 percent under 38 C.F.R. § 4.59) rating is warranted for the right and left knee disabilities, each, prior to August 29, 2013. From August 29, 2013 The Veteran’s right and left knees remain not ankylosed, without a meniscus condition, and was not manifested by impairment of tibia or fibula, or genu recurvatum. Accordingly, Codes 5256, 5258, 5259, 5262, and 5263 do not apply. A 20 percent rating has been assigned for extension limited at 15 degrees on the August 29, 2013 VA examination. Compensable limitation of flexion was not noted. Therefore, separate ratings under Code 5260 were not warranted. The Veteran remained consistent in her subjective reports of instability (and has continued to wear knee braces on both knees). The Board finds that slight instability is reasonably shown from August 29, 2013, and that a separate 10-percent rating under Code 5257 is warranted. Accordingly, a 30 percent combined (10 percent under Code 5257, and 20 percent under Code 5261) rating is warranted for the right and left knee disabilities from August 29, 2013. 5. 6. Entitlement to a rating in excess of 10 percent for a right hip strain and entitlement to a rating in excess of 10 percent for a left hip strain is denied. The Veteran’s hip disabilities are rated under Code 5252 (which has not been modified by the February 2021 effective revisions to 38 C.F.R. § 4.71a). Under Code 5251 for limitation of extension of the thigh, a 10 percent rating is warranted for extension limited to 5 degrees. Under Code 5252 for limitation of flexion of the thigh, the minimum 10 percent rating is warranted for flexion limited to 45 degrees. A 20 percent rating is warranted for flexion limited to 30 degrees. A 30 percent rating is warranted for flexion limited to 20 degrees. The maximum 40 percent rating is warranted for flexion limited to 10 degrees. Under Code 5253 for impairment of the thigh, the minimum 10 percent rating is warranted for limitation of rotation of, cannot toe-out more than 15 percent, affected leg. A 10 percent rating is warranted for limitation of adduction of, cannot cross legs. The maximum 20 percent rating is warranted for limitation of abduction of motion lost beyond 10 percent. 38 C.F.R. § 4.71a. On August 2009 hip conditions examination, range of motion of each hip was flexion to 120 degrees, extension to 30 degrees, abduction to 45 degrees, adduction to 25 degrees, internal rotation to 40 degrees, external rotation to 60 degrees. There was pain on motion in each hip. The Veteran reported flare-ups, including of pain, in both hips. The examiner noted an additional 60 percent limitation of function of her daily activities during flare-ups of the right hip and an additional 80 percent limitation of function of daily activities during a left hip flare-up. X-rays of both hips showed a normal right hip and DJD in the left hip. In December 2009 correspondence, the Veteran’s private physician noted she Veteran was receiving physical for therapy bilateral hip disability, bilateral knee disability, and left ankle pain. The Veteran was advised to continue physical therapy for four weeks. On February 2010 hip conditions examination, the diagnoses were bilateral hip strain and arthritis of the left hip. Examination found flexion to 120 degrees, interior rotation to 40 degrees, exterior rotation to 60 degrees, backward extension to 30 degrees, abduction to 40 degrees, and adduction to 25 degrees. There was evidence of mild or minimal pain of both hips. On January 2013 hip examination, range of motion studies were abnormal, with flexion of each hip to 105 degrees, right hip extension greater than 5 degrees, left hip extension ending at 120 degrees without pain. The Veteran did not have abduction lost beyond 10 degrees in either leg. Adduction was not limited such that she could not cross her leg on the left, but she did experience some difficulty with adduction on the right. There was no ankylosis. On December 2015 hip and thigh conditions DBQ, trochanteric pain syndrome (including trochanteric bursitis) was diagnosed. Range of motion was normal. There was no muscle atrophy or ankylosis. Malunion or nonunion of femur, flail hip joint or leg length discrepancy was not shown. It was noted that the Veteran occasionally used a cane. At the October 2016 Travel Board hearing, the Veteran testified that she receives treatment for her hip disabilities. On December 2016 hip and thigh conditions DBQ, right hip range of motion testing was abnormal, with flexion to 110 degrees, extension to 10 degrees, abduction to 30 degrees, adduction to 25 degrees. Adduction was not limited such that the Veteran could not cross her right leg. External rotation was to 40 degrees, and internal rotation was to 30 degrees. Left hip range of motion testing was normal. She did not report flare-ups. There was no muscle atrophy or ankylosis. Malunion or nonunion of femur, flail hip joint and leg length discrepancy were not shown. It was noted that the Veteran occasionally used a cane. The Veteran’s right and left hip disabilities are rated 10 percent each based on painful motion of the hip under 38 C.F.R. § 4.59. Under Code 5251, the only rating provided (10 percent) is warranted when extension is limited to 5 degrees. Extension has not been shown to be limited to 5 degrees. Accordingly, even a 10 percent under Code 5251 is not warranted. Under Code 5252, a 10 percent rating requires limitation of flexion to 45 degrees. Flexion has not been shown to be limited to 45 degrees. Accordingly, even a 10 percent rating under Code 5252 is not warranted. Under Code 5253 a 10 percent rating is warranted when limitation of rotation is limited to cannot toe-out more than 15 degrees of the affected leg, or with limitation of adduction of, cannot cross legs. Rotation has not been shown to be limited to 15 degrees, and adduction has not been shown to be limited such that the Veteran cannot cross legs. Accordingly, compensable ratings under Code 5253 are also not warranted. Considering the foregoing, the Board finds that the degrees of impairment due to these disabilities are adequately reflected by the 10 percent ratings, each, that are currently assigned under the provisions in 38 C.F.R. § 4.59, and that the evidence does not support an increase in the ratings. The preponderance of the evidence is against these claims and there is no doubt to be resolved. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1991). GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Staskowski, 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.