Citation Nr: 21027812 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 15-12 084 DATE: May 6, 2021 ORDER Prior to April 8, 2019, a rating higher than 10 percent for right hip strain, limitation of extension, is denied. Prior to September 14, 2017, a rating higher than 10 percent for left hip strain, limitation of extension, is denied. From September 14, 2017 to April 8, 2019, a higher rating for left hip strain, impairment of thigh, is denied. As of April 8, 2019, a higher rating for right hip strain, currently rated 10 percent for limitation of extension and 20 percent for impairment of the thigh, is denied. As of April 8, 2019, a higher rating for left hip strain, currently rated 10 percent for limitation of extension and 20 percent for impairment of the thigh, is denied. FINDINGS OF FACT 1. Prior to April 8, 2019, the Veteran's right hip strain manifested as pain and a noncompensable degree of limitation of motion. 2. Prior to April 8, 2019, the Veteran's left hip strain manifested as pain, tenderness, stiffness, and a noncompensable degree of limitation of motion. 3. As of April 8, 2019, the Veteran's right and left hip strains are rated as 10 percent disabling for limitation of extension of the thigh and 20 percent disabling for impairment of the thigh, both of which are the maximum schedular rating permitted under their respective diagnostic codes. He does not have a compensable degree of limitation of flexion, ankylosis, flail joint, or femur impairment of either hip. CONCLUSIONS OF LAW 1. Prior to April 8, 2019, the criteria for a rating higher than 10 percent for right hip strain were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code (DC) 5251. 2. Prior to April 8, 2019, the criteria for a rating higher than 10 percent for left hip strain were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5251. 3. From September 14, 2017 to April 8, 2019, the criteria for a rating higher than 10 percent for left hip strain, impairment of thigh, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5253. 4. As of April 8, 2019, the criteria for a rating higher than 10 percent for right hip strain based on limitation of extension and/or higher than 20 percent based on impairment of the thigh have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes (DCs) 5251, 5252, 5253. 5. As of April 8, 2019, the criteria for a rating higher than 20 percent for left hip strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes (DCs) 5251, 5252, 5253. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 2010 to November 2013. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a January 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO), which granted service connection for right hip strain residual functional pain, left hip strain residual functional pain, lumbar strain, left knee residual chondromalacia pain, and right shoulder strain. In a December 2014 notice of disagreement, the Veteran appealed the initial ratings assigned for his back and bilateral hips. The RO issued a statement of the case in March 2015 and the Veteran perfected his appeal with a VA Form 9 later that month. In a January 2018 rating decision, the RO continued the 10 percent rating for right hip strain; granted a separate 10 percent rating for left hip strain residual functional pain and a noncompensable (0 percent) rating for left hip strain residual functional pain, limitation of flexion of thigh; and decreased his rating for left hip strain residual functional pain, limitation of extension of thigh, from 10 percent to 0 percent all effective September 14, 2017. In June 2018, the Board remanded these issues for further development. In an April 2019 rating decision, the RO granted a separate 20 percent rating for right hip strain residual functional pain and increased the Veteran's rating to left hip strain residual functional pain to 20 percent both effective April 8, 2019. This rating decision also restored the previous 10 percent rating under DC 5251 for left hip strain based on limitation of extension. Higher ratings are available for bilateral hip disabilities and this award does not encompass the entire appeals period. As the Veteran is presumed to be seeking the maximum available benefit, the claim remains on appeal. See AB v. Brown, 6 Vet. App. 35, 39 (1993). In October 2020, the Board granted an increased rating for lumbar strain and remanded the bilateral hip issues for further development. Increased Rating 1. Increased rating for right hip strain 2. Increased rating for left hip strain As noted above, the Veteran was initially granted service connection for right and left hip strain in the January 2014 rating decision on appeal. At that time, the Veteran's right hip strain residual functional pain was rated 10 percent under Diagnostic Code (DC) 5252 and his left hip strain residual functional pain was rated 10 percent under DC 5251 both effective November 13, 2013. While different diagnostic codes were initially assigned, the rationale for both was painful motion of the hip without a compensable degree of limitation of motion under any of the relevant diagnostic code. Below, the Board describes this as warranting a compensable rating under DC 5003, which is more accurate but does not result in a change in the ratings assigned or any other substantive change. After the Veteran perfected his appeal to the Board, but before it had been adjudicated, he filed an increased rating claim for these disabilities that was received September 14, 2017. His appeal of the initial rating assigned was still pending and so this claim is subsumed into the current appeal. The record also reflects a 10 percent rating for left hip strain, impairment of thigh, effective September 14, 2017. The January 2018 rating decision originally granted a 10 percent rating for left hip strain, impairment of thigh, under hyphenated diagnostic code 5003-5253 and reduced the Veteran's rating for left hip strain, limitation of extension of thigh, under DC 5251 from 10 percent to 0 percent, both effective September 14, 2017. This rating decision also awarded a separate noncompensable rating for left hip strain, limitation of flexion of thigh, under hyphenated diagnostic code 5003-5252 effective September 14, 2017. This effective date of September 14, 2017 appears to be the result of some confusion related to the status of his initial rating appeal. In the accompanying narrative, the RO explained that the new 10 percent rating was for painful motion without a compensable limitation of motion and the reduction was because a compensable degree of limitation of motion was not shown. Thus, this rating decision in essence changed which diagnostic code was assigned the 10 percent rating for painful motion with a noncompensable degree of limited motion. In an April 2019 rating decision, as explained in the accompanying statement of the case, the RO granted a separate 20 percent rating for right hip strain residual functional pain under DC 5253 and increased the Veteran's rating to left hip strain residual functional pain to 20 percent under DC 5003-5253 both effective April 8, 2019. This rating decision also restored the previous 10 percent rating under DC 5251 for left hip strain based on limitation of extension for failure to show sustained improvement. In doing so, it created a period from September 14, 2017, to April 8, 2019, during which the Veteran had separate compensable ratings under both DC 5003-5253 and DC 5251. The accompanying codesheet also reassigned the Veteran's rating for his right hip strain to DC 5251. Hyphenated diagnostic codes are used when a rating under one DC requires use of an additional DC to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. The Veteran's bilateral hip strain is rated under 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5251, 5252, and 5253. During the pendency of the claim, VA issued a final rule revising the portion of the VA Schedule for Rating Disabilities that addresses the musculoskeletal system and schedule of ratings- musculoskeletal system. 85 Fed. Reg. 76453 (Nov. 30, 2020), as corrected at 85 Fed. Reg. 85523 (Dec. 29, 2020), as corrected at 86 Fed. Reg. 8142 (Feb. 4, 2021). The final rule went into effect February 7, 2021. Where there is a change in the rating criteria during the appeal period, the Board will consider the claim in light of both the former and revised schedular rating criteria, although an increased evaluation based on the revised criteria cannot predate the effective date of the amendments. The former version of Diagnostic Code (DC) 5003 provided rating criteria for degenerative arthritis substantiated by x-ray findings, rated either on limitation of motion of the affected joint under the appropriate diagnostic code or, if only a noncompensable limitation of motion is found, a 10 percent rating will be assigned for each affected major joint or group of minor joints. 38 C.F.R. § 4.71a. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Id. In the absence of limitation of motion, a 10 percent rating is warranted if there is x-ray evidence of involvement of two or more major joints or two or more minor joint groups and a 20 percent rating is warranted if there is x-ray evidence of involvement of two or more major joints or two or more minor joint groups and there are occasional incapacitating exacerbations. Id. Under both versions of DC 5251 for limitation of extension of the thigh, a maximum 10 percent rating is warranted for extension of the thigh limited to 5 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5251. Under both versions of Diagnostic Code 5252 for limitation of flexion of the thigh, a 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. A maximum 40 percent rating is warranted for flexion limited to 10 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5252. Under both versions of Diagnostic Code 5253 for impairment of the thigh, a maximum 20 percent rating is warranted for limitation of abduction, motion lost beyond 10 degrees. A 10 percent rating is warranted for either limitation for adduction, cannot cross legs, or limitation of rotation, affected leg cannot toe-out more than 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5253. Under the revised DC 5003, degenerative arthritis, other than post-traumatic, established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbations, a 20 percent disability rating is warranted. With X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, a 10 percent disability rating is warranted. Note (1): The 20 percent and 10 percent ratings based on X-ray findings, above, will not be combined with ratings based on limitation of motion. Note (2): The 20 percent and 10 percent ratings based on X-ray findings, above, will not be utilized in rating conditions listed under Diagnostic Codes 5013 to 5024, inclusive. 38 CFR Part 4, Schedule for Rating Disability: Musculoskeletal System and Muscle Injuries; Correction, 85 Fed. Reg. 249, 85523 (December 29, 2020). When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria."). Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. Prior to April 8, 2019 The February 2013 VA examination noted complaints of intermittent bilateral hip pain, tenderness, and left hip stiffness. There was no deformity; giving way; instability; weakness; incoordination; decreased speed of joint motion; episodes of dislocation, subluxation, or locking; effusions, or other symptoms. These conditions did not affect the motion of either hip joint. He had no flare-ups of joint disease. He did not have any constitutional symptoms of arthritis or any incapacitating episodes of arthritis. His range of motion of the bilateral hips was flexion to 125 degrees, extension to 30 degrees, and abduction to 45 degrees with objective evidence of pain with active motion on both sides. He was able to cross his right leg over his left and his left leg over his right. He could toe out to more than 15 degrees on both sides. There was objective evidence of pain following repetitive motion, but no additional limitations of range of motion. He had full muscle strength for hip flexion and extension bilaterally. These disabilities did not impact his ability to work or perform usual daily activities. A November 2013 VA treatment record noted bilateral hip pain. No abnormalities or tenderness to palpation of the hips was found on examination. Muscle tone was normal and no atrophy was noted. He had full range of hip flexion and extension and full muscle strength. A December 2013 VA treatment record shows decreased range of motion with internal and external rotation of the left knee and hip, and pain with this motion. The left hip had pain with palpation and joint manipulation. Straight leg testing was negative. He had tight hamstrings. His left leg had decreased strength on extension of left leg (3/5) and flexion (4/5). Both were normal (5/5) in the right leg. A February 2014 VA treatment record notes left hip pain and stiffness. There was no tenderness with palpation over the greater trochanteric bursa. His left hip was fully neurovascularly intact. His skin was intact. He had no flexion contracture and no buttocks pain. He had full muscular strength. The January 2015 hip and thigh disability benefits questionnaire (DBQ) noted the Veteran's reports of bilateral hip pain, left worse than right. He described this hip pain as predominantly in the left hip, usually on the superior lateral hip, but on the day of this exam it was more anterior hip flexor region. This pain was grinding with occasional popping. It was worse with sitting and better with standing. His range of motion of the right hip was flexion to 112 degrees, extension to 30 degrees, abduction to 45 degrees, adduction to 25 degrees, external rotation to 48 degrees, and internal rotation to 40 degrees with no pain noted on examination. There was no objective evidence of tenderness or pain to palpation of the right hip. His range of motion of the left hip was flexion to 100 degrees, extension to 30 degrees, abduction to 45 degrees, adduction to 25 degrees, external rotation to 48 degrees, and internal rotation to 40 degrees with pain in flexion, external rotation, and internal rotation that caused functional loss. He had tenderness to palpation of the anterior and lateral left hip, flexor tendons, and greater trochanter. There was no evidence of pain with weight bearing for either hip. He was able to perform repetitive use testing without additional loss of function or range of motion in either hip. The Veteran was examined immediately after repetitive use over time, but the examiner was unable to say without resorting to speculation whether pain, weakness, fatigability or incoordination significantly limited functional ability of either hip with repeated use over time. The rationale was that there was insufficient evidence or objective exam findings that would provide a reliable prediction of decreased functional ability during flare-ups or when either hip was used repeatedly for a period of time. Based on the available evidence and exam findings, it was not possible, without resorting to speculation, to predict within a reasonable degree of medical certainty, a potential loss of range of motion manifested as a consequence of a flare or exacerbation outside the clinical setting. He was not examined during a flare-up of either hip. However, he did not report flare ups. Thus, pain, weakness, fatigability or incoordination did not significantly limit functional ability of either hip with flare-ups. He reported left hip pain with prolonged sitting, but no additional contributing factors of disability in the right hip. He had full muscle strength in flexion, extension, and abduction in both hips and no muscle atrophy. No ankylosis was shown in either hip. The Veteran did not have malunion or nonunion of femur, flail hip joint, or leg length discrepancy. The Veteran have any associated scars or other pertinent physical findings, complications, conditions, signs, or symptoms related to either disability. He occasionally used a cane for his left knee condition. His hip disabilities do not result in functional impairment of an extremity such that no effective functions remain other than that which would be equally well served by an amputation with prosthesis. Imaging studies did not show arthritis. There was no objective evidence of crepitus. These disabilities impacted his ability to work in that he had difficulty sitting for long periods of time causing stiffness and pain in left hip. Tenderness to palpation was noted to left anterior hip and greater trochanter region. An October 2015 to July 2017 VA treatment records note pain over the lateral aspect of the left hip, hip flexion to 110 degrees, and internal rotation to 10 degrees without hip pain. The January 2018 hip and thigh disability benefits questionnaire (DBQ) notes diagnoses of bilateral hip arthritis in 2016. The Veteran reported aching hips all the time, especially the left, which was worse and made it hard to stand or walk. He had trouble with riding in the car and had to get out to rest and stretch every twenty minutes. His range of motion of the right hip was flexion to 110 degrees, extension to 30 degrees, abduction to 45 degrees, adduction to 25 degrees, external rotation to 60 degrees, and internal rotation to 40 degrees with no pain noted on examination. There was tenderness to palpation of the lateral iliac region, but no evidence or pain with weight bearing. His range of motion of the left hip was flexion to 85 degrees, extension to 20 degrees, abduction to 45 degrees, adduction to 25 degrees, external rotation to 60 degrees, and internal rotation to 30 degrees with pain in flexion, adduction, and internal rotation that caused functional loss. In the left hip, there was evidence of pain with weight bearing and tenderness to palpation of the anterior femur. His adduction was not limited such that he could not cross his legs. There was no objective evidence of crepitus in either hip. He was able to perform repetitive use testing without additional loss of function or range of motion in either hip. The Veteran was not examined immediately after repetitive use over time and the examination was neither medically consistent nor inconsistent with the Veteran's statements describing functional loss with repetitive use over time. The examiner was unable to say without resorting to speculation whether pain, weakness, fatigability, or incoordination significantly limited functional ability of either hip with repetitive use over time. The rationale was that there was insufficient evidence demonstrating functional loss due to pain, weakness, fatigability, or incoordination with repetitive use over time. He did not report flare ups. He reported left hip pain that impaired function, including less movement that normal due to ankylosis, adhesions, etc.; disturbance of locomotion, interference with sitting, and interference with standing. He reported no additional contributing factors of disability in the right hip. He had full muscle strength in flexion, extension, and abduction in both hips. He had muscle atrophy in the left quadricep when compared to the right. No ankylosis was shown in either hip. The Veteran did not have malunion or nonunion of femur, flail hip joint, or leg length discrepancy. The Veteran have any associated scars or other pertinent physical findings, complications, conditions, signs, or symptoms related to either disability. He did not use an assistive device. His hip disabilities do not result in functional impairment of an extremity such that no effective functions remain other than that which would be equally well served by an amputation with prosthesis. Imaging studies documented arthritis of the bilateral hips. These disabilities impacted his ability to work in that he had impaired range of motion with pain that affected his ability to perform prolonged or strenuous weight bearing and load bearing physical activity. There was no evidence of pain on passive range of motion testing. There was no evidence of pain when either him was used in non-weight bearing. Based on the above, prior to April 8, 2019, the Veteran's bilateral hip strains manifested as pain and limitation of motion with additional left hip symptoms of tenderness and stiffness. There was conflicting evidence regarding left hip muscle strength and left quadricep atrophy, but he consistently had full muscle strength in flexion, extension, and abduction in the right hip. His range of motion of the right hip was flexion to no less than 110 degrees, extension to no less than 30, abduction to no less than 45 degrees, adduction to no less than 25 degrees, external rotation to no less than 45 degrees, and internal rotation to no less than 40 degrees. His left hip range of motion was flexion to no less than 85 degrees, extension to no less than 20 degrees, abduction to no less than 45, adduction to no less than 25 degrees, external rotation to no less than 48 degrees, and internal rotation to no less than 10 degrees. At no point did the Veteran's limitation of adduction of either hip prevent him from being able to cross his legs. At no point did the Veteran's limitation of adduction of either hip prevent him from being able to cross his legs. These range of motion measurements are insufficient to warranted a compensable rating for limitation of flexion, extension, abduction, adduction, or rotation of either hip as a compensable rating based on limitation of extension requires limitation to 5 degrees, a compensable rating based on limitation of flexion requires limitation to 45 degrees, a compensable rating based on limitation of rotation requires an inability to toe-out more than 15 degrees, a compensable rating based on limitation of adduction requires an inability to cross legs, and compensable rating based on limitation of abduction requires motion lost beyond 10 degrees. All of these represent significantly more severe limitation of motion than reflected here for either hip. Nevertheless, as painful motion is shown, 10 percent ratings under DC 5251 are warranted for this period prior to April 8, 2019. The Board has also considered the other Diagnostic Codes pertaining to the hip and thigh. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); see also Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). As explained above, the current 10 percent rating reflects painful limitation of motion that falls short of the delineated compensable limitations of motion listed in DC 5251, DC 5252, and DC 5253. See 38 C.F.R. § 4.71a. Therefore, separate ratings under these diagnostic codes are not warranted for either hip during this period. Furthermore, the evidence of record does not show ankylosis, flail joint, or femur impairment of either hip so a rating under DC 5250, DC 5254, or DC 5255 is not warranted. See id. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's appeal for ratings higher than 10 percent for right hip strain and/or left hip strain prior to April 8, 2019. In denying such ratings, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. From September 14, 2017 to April 8, 2019 As explained above, the Veteran is currently rated 10 percent under DC 5003-5253 from September 14, 2017, to April 8, 2019. Again, the record does not show limitation for adduction, cannot cross legs, or limitation of rotation, affected leg cannot toe-out more than 15 degrees as required for a 10 percent rating under that diagnostic code. See 38 C.F.R. § 4.71a. There is evidence of painful motion, but as that serves as the basis for the restored 10 percent rating under DC 5251, a compensable rating based on that would be impermissible pyramiding. See 38 C.F.R. § 4.14. Nevertheless, the Board will not disturb this rating. A higher rating of 20 percent is not warranted for left hip strain, impairment of thigh, unless the record shows limitation of abduction, motion lost beyond 10 degrees. 38 C.F.R. § 4.71a, DC 5253. Neither this, nor symptoms of similar severity are shown during this period. Therefore, a rating higher than 10 percent for left hip strain, impairment of thigh, from September 14, 2017, to April 8, 2019, is not warranted. In denying such a rating, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. As of April 8, 2019 The April 8, 2019, hip and thigh disability benefits questionnaire (DBQ) noted the Veteran's reports of flare-ups of the bilateral hips that were activity driven. For example, too much bending or walking downstairs would result in increased pain with walking or sitting for a day. This occurred once a week. His range of motion of the right hip was flexion to 100 degrees, extension to 15 degrees, abduction to 40 degrees, adduction to 25 degrees, external rotation to 40 degrees, and internal rotation to 20 degrees with pain in all planes. He was very tender over the right posterior lateral hip due to hip degenerative joint disease. His range of motion of the left hip was flexion to 100 degrees, extension to 10 degrees, abduction to 15 degrees, adduction to 20 degrees, external rotation to 30 degrees, and internal rotation to 20 degrees with pain in all planes. The Veteran was very tender over the left lateral trochanter and in the left groin due to hip degenerative joint disease. Limitation of motion itself did not contribute to a functional loss. Pain did not result in or cause functional loss. There was evidence of pain with weight bearing. His adduction was not limited such that he could not cross his legs. There was objective evidence of crepitus. He was able to perform repetitive use testing without additional loss of function or range of motion in either hip. The Veteran was not examined immediately after repetitive use over time and the examination was medically consistent with the Veteran's statements describing functional loss with repetitive use over time. The examiner estimated that pain, fatigue, and lack of endurance with repeated use over time limited the functional ability of his hips equal to right hip flexion to 50 degrees, extension to 5 degrees, abduction to 10 degrees, adduction to 12 degrees, external rotation to 10 degrees, and internal rotation to 10 degrees and left hip flexion to 50 degrees, extension to 0 degrees, abduction to 5 degrees, adduction to 10 degrees, external rotation to 10 degrees, and internal rotation to 10 degrees. This additional limitation did not include limitation of adduction such that the Veteran could not cross his legs. Similarly, this examination was not conducted during a flare-up time and was medically consistent with the Veteran's statements describing functional loss during a flare-up. The examiner estimated that pain, fatigue, weakness, and lack of endurance limited the functional ability of his hips during a flare-up equal to right hip flexion to 50 degrees, extension to 5 degrees, abduction to 10 degrees, adduction to 12 degrees, external rotation to 10 degrees, and internal rotation to 10 degrees and left hip flexion to 50 degrees, extension to 0 degrees, abduction to 5 degrees, adduction to 10 degrees, external rotation to 10 degrees, and internal rotation to 10 degrees. This additional limitation did not include limitation of adduction such that the Veteran could not cross his legs. He reported no additional contributing factors of disability in either hip. He had full muscle strength in flexion, extension, and abduction in both hips. He had no muscle atrophy or ankylosis in either hip. The Veteran did not have malunion or nonunion of femur, flail hip joint, or leg length discrepancy. The Veteran have any associated scars or other pertinent physical findings, complications, conditions, signs, or symptoms related to either disability. He did not use an assistive device. His hip disabilities do not result in functional impairment of an extremity such that no effective functions remain other than that which would be equally well served by an amputation with prosthesis. Imaging studies documented arthritis of the bilateral hips. These disabilities impacted his ability to work in that they raised a safety concern for manual labor as any heavy lifting, repetitive lifting, or prolonged bending was prohibited. Sedentary labor, such as student, secretary, or desk clerk, was possible. There was evidence of pain on passive range of motion testing and in non-weight bearing. The January 2021 hip and thigh disability benefits questionnaire (DBQ) noted the Veteran's complaints of progressive daily bilateral hip pain (left worse than right) exacerbated by prolonged standing/sitting for more than half an hour or bending at the waist. The Veteran no longer enjoyed hiking, skiing, baseball, soccer, hockey, or football because of bilateral hip pain. He treated this with ibuprofen as needed. He did not report flare-ups of hip symptoms. His range of motion of the right hip was flexion to 100 degrees, extension to 30 degrees, abduction to 45 degrees, adduction to 25 degrees, external rotation to 50 degrees, and internal rotation to 40 degrees with pain in flexion, adduction, and internal rotation with no pain noted on examination. His range of motion of the left hip was flexion to 90 degrees, extension to 30 degrees, abduction to 45 degrees, adduction to 25 degrees, external rotation to 50 degrees, and internal rotation to 40 degrees with pain in all planes, but this did not result in or cause functional loss. His adduction was not limited such that he could not cross his legs. This limitation of motion resulted in difficulty squatting to retrieve items from the floor. There was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. There was evidence of pain with weight bearing. There was no objective evidence of crepitus. He was able to perform repetitive use testing without additional loss of function or range of motion in either hip. The Veteran was not examined immediately after repetitive use over time and the examination was neither medically consistent nor inconsistent with the Veteran's statements describing functional loss with repetitive use over time. This examiner found that pain, weakness, fatigability, and/or incoordination did not significantly limit functional ability with repeated use over a period of time. He expressed this in terms of the ranges of motion listed above. Likewise, this examination was not conducted during a flare-up and the examiner found that this the examination was neither medically consistent nor inconsistent with the Veteran's statements describing functional loss during flare-ups. This examiner found that pain, weakness, fatigability, and/or incoordination did not significantly limit functional ability during flare-ups. The examiner could not express this in terms of the range of motion. The Veteran reported no additional contributing factors of disability in either hip. He had full muscle strength in flexion, extension, and abduction in both hips. He had no muscle atrophy or ankylosis in either hip. The Veteran did not have malunion or nonunion of femur, flail hip joint, or leg length discrepancy. The Veteran have any associated scars or other pertinent physical findings, complications, conditions, signs, or symptoms related to either disability. He did not use an assistive device. His hip disabilities do not result in functional impairment of an extremity such that no effective functions remain other than that which would be equally well served by an amputation with prosthesis. These disabilities limited the Veteran's capacity for occupations that required strenuous activities such as heavy lifting, running, kneeling, or squatting. His capacity for sedentary activities is not limited by his bilateral hip disabilities. There was objective evidence of pain when either hip was used in non-weight bearing. His passive ranges of motion were the same as the active ranges of motion listed above. In a February 2021 addendum, the January 2021 examiner clarified that the Veteran was able to toe out to more than 15 degrees on both sides. Pain was noted on examination of the right hip and caused functional loss. Based on the above, as of April 8, 2019, the Veteran's bilateral hip strains resulted in additional limitation of motion and activity-driven flare-ups. During this period, the Veteran's range of motion of the right hip was flexion to no less than 100 degrees, extension to no less than 15, abduction to no less than 40 degrees, adduction to no less than 25 degrees, external rotation to no less than 40 degrees, and internal rotation to no less than 20 degrees. His left hip range of motion was flexion to no less than 90 degrees, extension to no less than 10 degrees, abduction to no less than 15, adduction to no less than 20 degrees, external rotation to no less than 30 degrees, and internal rotation to no less than 20 degrees. The April 2019 DBQ examiner acknowledged the Veteran's reports of additional limitations during flare-ups and estimated that pain, fatigue, weakness, and lack of endurance limited the functional ability of the Veteran's hips during a flare-up equal to right hip flexion to 50 degrees, extension to 5 degrees, abduction to 10 degrees, adduction to 12 degrees, external rotation to 10 degrees, and internal rotation to 10 degrees and left hip flexion to 50 degrees, extension to 0 degrees, abduction to 5 degrees, adduction to 10 degrees, external rotation to 10 degrees, and internal rotation to 10 degrees. Thus, even considering the Veteran's lay reports of additional symptoms and limitations during a flare-up, there is no evidence to suggest symptoms more nearly approximating flexion limited to 45 degrees in either hip. This is insufficient to warrant a compensable rating under DC 5252 for limitation of flexion of either hip. The Veteran is already in receipt of the highest schedular ratings for limitation of extension of the bilateral thighs and impairment of the bilateral thighs throughout this period. Thus, there is no basis to award a higher rating for either hip under DC 5251 and/or 5253. 38 C.F.R. § 4.71a. Again, the Board has also considered the other Diagnostic Codes pertaining to the hip and thigh. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); see also Lyles v. Shulkin, 29 Vet. App. 107 (2017) (holding that 38 C.F.R. § 4.14 prohibits paying compensation twice for the same symptoms or functional impairment). The evidence of record does not show ankylosis, flail joint, or femur impairment of either hip so a rating under DC 5250, DC 5254, or DC 5255 is not warranted. See id. In conclusion, the Board finds that the preponderance of the evidence is against the Veteran's appeal for ratings higher than 10 percent for right hip strain and/or left hip strain under DC 5251 and against ratings higher than 20 percent for right and/or left hip strain under DC 5253. In denying such ratings, the Board finds the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. Joshua Castillo Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Houbeck 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.