Citation Nr: 21040504 Decision Date: 07/05/21 Archive Date: 07/05/21 DOCKET NO. 13-24 063 DATE: July 5, 2021 REMANDED Entitlement to an initial rating in excess of 10 percent for chronic left hip strain with limitation of flexion of the thigh prior to October 5, 2017 and 20 percent thereafter is remanded. Entitlement to an initial compensable rating for left hip strain with limitation of the thigh is remanded. Entitlement to an initial compensable rating for left hip strain with limitation of extension of the thigh is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1991 to June 1991. This appeal comes before the Bord of Veterans' Appeals (Board) from December 2011 and January 2018 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board regrets a further remand of this appeal but finds that remand is warranted because there was not substantial compliance with the earlier remand. See Stegall v. West, 11 Vet. App. 268 (1998). The August 2019 Board remand directed the RO to afford the Veteran an examination to determine the current nature and severity of his service-connected left hip disability. The examiner was requested to discuss whether the Veteran's bowing deformity of the left hip, as well as the left leg length discrepancy, results from non-union or malunion of the service-connected transverse stress fracture in the left femoral neck and/or is otherwise causally related to the mechanism of injury in service. If the bowing deformity of the left hip was attributable to service-connected origin, the examiner was to conduct an examination to determine the nature and severity of the left knee. The April 2021 VA examiner indicated the Veteran had left hip femoral neck stress fracture with chronic left hip strain resulting in bowing deformity. There was a 10-degree difference between the left hip and right in length which appears to be due to the pain in the left hip as the Veteran tries to compensate when walking or standing. The examiner indicated the left hip pain is worsening over time due to progression. The Veteran's bowing deformity appears to be due to malunion which can result in shortening of the bone caused by improper alignment of the bone during healing. Degenerative arthritis appears to be a progression of this. The examiner found the Veteran had malunion of the femur with slight hip disability. While the April 2021 VA examiner indicated the Veteran's bowing deformity appeared to be due to malunion, she did not address whether it was malunion of the service-connected transverse stress fracture in the left femoral neck. Nor did she address whether the malunion is otherwise causally related to the mechanism of injury in service. If the malunion is related to service, the prior remand required that a knee examination be conducted. Remand is warranted to clarify whether the Veteran's malunion is related to his service. If so, a knee examination should be conducted. Additionally, 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). Diagnostic Code 5255 now provides that malunion of the femur be evaluated under diagnostic codes 5256, 5257, 5260, or 5261 for the knee, or 5250-5254 for the hip, whichever results in the highest evaluation. A knee evaluation is also needed to ensure the record contains sufficient evidence to rate the Veteran's disability under the new rating criteria. The matters are REMANDED for the following actions: Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's malunion of the femur is at least as likely as not (50 percent probability or greater) (a) related to his left hip injury while in service that resulted in a left femoral neck stress fracture, (b) proximately due to service-connected disability, including left hip strain, and/or (c) aggravated by service-connected disability, including left hip strain. (Continued on the next page) If so, schedule the Veteran for an examination by an appropriate clinician, to determine the nature and severity of any left knee disability related to the Veteran's bowing deformity. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Vemulapalli, 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.