Citation Nr: 22018063 Decision Date: 03/28/22 Archive Date: 03/28/22 DOCKET NO. 18-38 016 DATE: March 28, 2022 ORDER A rating higher than 20 percent for a lumbar spine disability is denied. A separate rating higher than 10 percent for right sciatic radiculopathy is denied. A rating higher than 10 percent for a left knee disability is denied. Restoration of the prior 10 percent rating for limitation of flexion of the left thigh is granted. A rating higher than 10 percent for limitation of flexion of the left thigh is denied. A compensable rating for limitation of extension of the left thigh is denied. A separate rating higher than 10 percent for impairment of the left thigh (limitation of adduction) is denied. Restoration of the prior 10 percent rating for limitation of flexion of the right thigh is granted. A rating higher than 10 percent for limitation of flexion of the right thigh is denied. A compensable rating for limitation of extension of the right thigh is denied. A separate rating higher than 10 percent for impairment of the right thigh (limitation of adduction) is denied. FINDINGS OF FACT 1. The Veteran's lumbar spine disability does not limit forward flexion to 30 degrees or less; he does not have ankylosis of the spine; and he did not have incapacitating episodes of intervertebral disc syndrome (IVDS) totaling at least 4 weeks over a 12-month period. 2. The Veteran has no more than mild incomplete paralysis of the sciatic nerve in the right lower extremity. 3. The Veteran's left knee disability causes painful motion, but it does not limit flexion to 30 degrees or limit extension to 15 degrees. 4. The Veteran continues to have painful motion of the left thigh on flexion. 5. The Veteran's left hip disability does not limit flexion of the thigh to 30 degrees or less. 6. The Veteran's left hip disability does not limit extension of the thigh to 5 degrees. 7. The Veteran's left hip disability prevents him from crossing legs, but it does not cause a loss of abduction beyond 10 degrees. 8. The Veteran continues to have painful motion of the right thigh on flexion. 9. The Veteran's right hip disability does not limit flexion of the thigh to 30 degrees or less. 10. The Veteran's right hip disability does not limit extension of the thigh to 5 degrees. 11. The Veteran's right hip disability prevents him from crossing legs, but it does not cause a loss of abduction beyond 10 degrees. CONCLUSIONS OF LAW 1. The criteria for a rating higher than 20 percent for a lumbar spine disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5242. 2. The criteria for a separate rating higher than 10 percent for right sciatic radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.71a, 4.120, 4.123, 4.124, 4.124a, Diagnostic Code 8520. 3. The criteria for a rating higher than 10 percent for a left knee disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5260-5621. 4. The rating reduction from 10 percent to noncompensable for limitation of flexion of the left thigh, effective November 8, 2021, was improper. 38 U.S.C. §§ 1155, 5112; 38 C.F.R. §§ 3.105, 3.344. 5. The criteria for a rating higher than 10 percent for limitation of flexion of the left thigh have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5252. 6. The criteria for a compensable rating for limitation of extension of the left thigh have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5251. 7. The criteria for a separate rating higher than 10 percent for impairment of the left thigh (limitation of adduction) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5253. 8. The rating reduction from 10 percent to noncompensable for limitation of flexion of the right thigh, effective November 8, 2021, was improper. 38 U.S.C. §§ 1155, 5112; 38 C.F.R. §§ 3.105, 3.344. 9. The criteria for a rating higher than 10 percent for limitation of flexion of the right thigh have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5252. 10. The criteria for a compensable rating for limitation of extension of the right thigh have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5251. 11. The criteria for a separate rating higher than 10 percent for impairment of the right thigh (limitation of adduction) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5253. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 2011 to May 2015. In October 2021, the Board of Veterans' Appeals (Board) remanded his increased rating claims to the agency of original jurisdiction (AOJ) for additional development. The AOJ substantially complied with the Board's remand instructions, and the claims are ready for further review. Stegall v. West, 11 Vet. App. 268, 271 (1998). Increased Ratings & Restoration of Prior Ratings Disability ratings are determined by the application of VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. VA must evaluate all of the evidence so that its decisions are equitable and just. 38 C.F.R. § 4.6. Where there is a question as to which of two evaluations shall be applied, a higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. During the course of this appeal, VA amended portions of the rating schedule for musculoskeletal disabilities. However, these amendments did not affect the applicable diagnostic codes in this case. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453 (Nov. 30, 2020) (codified at 38 C.F.R. § 4.71a). When evaluating musculoskeletal disabilities based on limitation of motion, VA must consider functional loss caused by pain or other factors that could occur during flare-ups or after repeated use which may not be reflected on range-of-motion testing. 38 C.F.R. § 4.40. Under 38 C.F.R. § 4.45, VA must also consider 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). Under 38 C.F.R. § 4.59, painful motion associated with joint or periarticular pathology typically warrants at least the minimum compensable rating for the affected joint. Id. at 36; see also Burton v. Shinseki, 25 Vet. App. 1 (2011). VA must observe certain regulatory requirements before reducing disability ratings. The notice provisions of 38 C.F.R. § 3.105 apply only where a rating reduction decreases the Veteran's total compensation amount for service-connected disabilities. O'Connell v. Nicholson, 21 Vet. App. 89, 92 n.3 (2007). In such cases, VA must first prepare a proposed rating setting forth material facts and reasons for the reduction, notify the beneficiary and allow them 60 days to submit additional evidence, and inform the beneficiary of their right to request a predetermination hearing. 38 C.F.R. § 3.105(e), (i). In any rating-reduction case, VA must determine: (1) whether the evidence reflects an actual change in the disability based upon review of the entire recorded history of the condition; (2) whether the examination reports reflecting such change are based upon thorough and adequate examinations; and (3) whether any improvement actually reflects an improvement in the claimant's ability to function under the ordinary conditions of life and work. Murphy v. Shinseki, 26 Vet. App. 510, 516-17 (2014); see also Brown v. Brown, 5 Vet. App. 413, 421 (1993). These substantive requirements apply whether or not there is a reduction in the overall compensation amount. See 38 C.F.R. §§ 3.344, 4.1, 4.2, 4.10, 4.13. If VA fails to comply with any of the applicable requirements, the rating reduction will be considered "void ab initio" (void from the beginning) and the prior rating will be restored. Greyzck v. West, 12 Vet. App. 288, 292 (1999). 1. Lumbar Spine Disability The Veteran seeks a rating higher than 20 percent rating for a service-connected lumbar spine disability. After careful review, the Board finds that an increased rating is not warranted. Back disabilities are rated under either the General Rating Formula for Diseases and Injuries of the Spine (General Formula) or the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Formula), whichever method results in a higher evaluation. See 38 C.F.R. § 4.71a. Under the General Formula, a 20 percent rating is warranted where forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees; where the combined range of motion of the thoracolumbar spine is not greater than 120 degrees; or where 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. 38 C.F.R. § 4.71a. A 40 percent rating is warranted where forward flexion of the thoracolumbar spine is limited to 30 degrees or less; or for favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. Id. Any associated objective neurologic abnormalities, including but not limited to bowel or bladder impairment, are rated separately under an appropriate diagnostic code. Id., General Formula at Note 1. Ankylosis is generally defined as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." Dorland's Illustrated Medical Dictionary, 94 (32nd ed. 2012). For VA purposes, "unfavorable ankylosis" means that the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurological symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id., General Formula at Note 5. The IVDS Formula provides that a 20 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A maximum 60 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a. An "incapacitating episode" is defined as a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. Id., IVDS Formula at Note 1. The most probative evidence of record demonstrates that the Veteran is not entitled to a rating higher than 20 percent. In October 2021, the Board remanded for a new VA examination because the prior examinations were inadequate to decide the claim. The Board explained that the September 2015 examiner did not properly address range-of-motion loss with repeated use over time, as required by Sharp v. Shulkin, 29 Vet. App. 26 (2017), and that the October 2019 examiner did not specify the degree at which pain began, as required by DeLuca, 8 Vet. App. 202, and Mitchell, 25 Vet. App. at 38. A VA contractor provided a new examination in November 2021, as instructed. The November 2021 examiner reviewed the electronic claims file, performed all required testing, and reported all signs and symptoms necessary for evaluating the Veteran's back disability under the rating criteria. Thus, the Board finds that this examination provides the most probative evidence of record regarding the severity of the disability. The Veteran told the November 2021 examiner that his back disability had stayed the same since its onset in 2011. He reported lower back pain, which radiates down both legs. He described "moderate" flare-ups of lower back pain that occur once or twice a week and last several hours. He stated that these flare-ups happen after working a full shift or two shifts back to back as a police officer; they are precipitated by weight-bearing and active movement, and are alleviated by rest and pain medication. He reported no specific functional loss or functional impairment of his back, including with repeated use over time. He did not use any assistive devices. The Veteran's range of motion was 80 degrees on forward flexion and 25 degrees on extension, right lateral flexion, left lateral flexion, right lateral rotation, and left lateral rotation. He exhibited pain in every direction, starting at 15 degrees on forward flexion, 5 degrees on extension, and 10 degrees on right lateral flexion, left lateral flexion, right lateral rotation, and left lateral rotation. There was no additional loss of function or range of motion after three repetitions. The examiner indicated that pain did not result in or cause functional loss. The examiner also determined, based on the Veteran's statements, that pain, fatigability, weakness, lack of endurance, and incoordination would not significantly limit functional ability with repeated use over time or flare-ups. Similarly, the examiner determined that the disability did not impact the Veteran's ability to perform any type of occupational task. The examination revealed no evidence of ankylosis of the spine and no incapacitating episodes of IVDS over the past 12 months. The examiner noted that the Veteran has bilateral lower extremity radiculopathy. However, there were no other associated neurologic abnormalities. The Veteran does not contend that the November 2021 examination was inadequate or that the examiner's findings were inaccurate. He does not point to any other evidence that would support a rating higher than 20 percent under either the General Formula or the IVDS Formula. The Board finds no such evidence in the record. In sum, the evidence is persuasively against finding that the Veteran's disability limits forward flexion to 30 degrees or less, or that it causes ankylosis of the spine. This is the case even when considering his lay statements regarding repeated use over a period of time and flare-ups. Likewise, the evidence is persuasively against finding that he had incapacitating episodes of IVDS totaling at least 4 weeks over a 12-month period. There is no reasonable doubt to resolve in his favor in this instance. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. A rating higher than 20 percent is denied. 2. Right Sciatic Radiculopathy On remand, the AOJ granted a separate 10 percent rating for right sciatic radiculopathy as secondary to the Veteran's lumbar spine disability. See November 2021 Rating Decision. The Board finds that entitlement to an increased rating for this associated objective neurologic abnormality is within the scope of the appeal. Chavis v. McDonough, 34 Vet. App. 1 (2021) (citing 38 C.F.R. § 4.71a, General Formula at Note 1). A rating higher than 10 percent is not warranted. The Board notes that it previously addressed the evaluation of the Veteran's left lower extremity radiculopathy in its October 2021 decision. There is no basis for the Board to revisit that decision here. Under Diagnostic Code 8520, a 10 percent rating is warranted for mild incomplete paralysis of the sciatic nerve. A 20 percent rating is warranted for moderate incomplete paralysis of the sciatic nerve. A 40 percent rating is warranted for moderately severe incomplete paralysis of the sciatic nerve. A 60 percent rating is warranted for severe incomplete paralysis of the sciatic nerve, with marked muscular atrophy. A maximum 80 percent rating is warranted for complete paralysis of the sciatic nerve, where the foot dangles and drops, there is no active movement possible for muscles below the knee, and flexion of the knee is weakened or lost. 38 C.F.R. § 4.124a. The terms "mild," "moderate," and "severe" are not defined in the rating schedule for diseases of the peripheral nerves. VA regulations provide that ratings for peripheral neurological disorders are assigned based on the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. VA must also consider loss of reflexes, pain, and muscle atrophy. 38 C.F.R. §§ 4.123, 4.124. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis of the nerve. When incomplete paralysis is wholly sensory, the rating should be for the mild, or at most, moderate degree. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376, 380 (2017) (non-sensory manifestations are not necessarily rated at a higher level). The most probative evidence of record regarding the severity of the Veteran's right lower extremity radiculopathy comes from the November 2021 examination. This examination reflects that the disability is wholly sensory and, at most, mild. At the examination, the Veteran reported mild intermittent pain and mild numbness, but no other signs or symptoms of radiculopathy. Sensory testing revealed decreased sensation at the right thigh/knee, lower leg/ankle, and foot/toes. He had normal muscle strength (5/5) on hip flexion, knee extension, ankle plantar flexion, ankle dorsiflexion, and great toe extension. Deep tendon reflexes at the knee and ankle were likewise normal (2+). The Board finds no evidence of non-sensory manifestations of right sciatic radiculopathy in the record. The Veteran does not argue otherwise. The evidence is persuasively against finding that the Veteran has more than mild incomplete paralysis of the sciatic nerve in the right lower extremity. As such, there is no reasonable doubt to resolve in his favor. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. A rating higher than 10 percent is denied. 3. Left Knee Disability The Veteran seeks a rating higher than 10 percent for a service-connected left knee disability. After careful review, the Board finds that an increased rating is not warranted. In general, knee disabilities are rated based on limitation of flexion or extension of the leg. Normal range of motion of the leg is from 140 degrees on flexion to 0 degrees on extension. 38 C.F.R. § 4.71a, Plate II. Under Diagnostic Code 5260, a 10 percent rating is assigned where flexion is limited to 45 degrees, a 20 percent rating is assigned where flexion is limited to 30 degrees, and a maximum 30 percent rating is assigned where flexion is limited to 15 degrees. 38 C.F.R. § 4.71a. Under Diagnostic Code 5261, a 10 percent rating is assigned where extension is limited to 10 degrees, a 20 percent rating is assigned where extension is limited to 15 degrees, a 30 percent rating is assigned where extension is limited to 20 degrees, a 40 percent rating is assigned where extension is limited to 30 degrees, and a maximum 50 percent rating is assigned where extension is limited to 45 degrees. Id. VA can assign separate ratings for limitation of extension and flexion without violating the rule against "pyramiding." This rule prohibits VA from paying compensation twice (or more) for the same symptoms or functional impairment. 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); Lyles v. Shulkin, 29 Vet. App. 107, 113 (2017). However, only one compensable rating can be assigned where there is painful but otherwise noncompensable limitation of movement. 38 C.F.R. § 4.59 does not permit separate compensable ratings for each joint movement that results in painful motion. Rather, it provides that painful motion warrants at least the minimum compensable evaluation for the joint. See Mitchell, 25 Vet. App. at 39. In other words, the rule against pyramiding prohibits separate compensable ratings based solely on painful motion. The most probative evidence of record demonstrates that the Veteran is not entitled to a rating higher than 10 percent. In October 2021, the Board remanded for a new VA examination of the Veteran's knee. The Board explained that the September 2015 knee examination, like the back examination, did not comply with the requirements of Sharp, 29 Vet. App. 26. Similarly, the October 2019 knee examination, like the back examination, did not comply with the requirements of DeLuca, 8 Vet. App. 202, and Mitchell, 25 Vet. App. at 38. A VA contractor examined the Veteran's knee in November 2021. The November 2021 examiner reviewed the electronic claims file, performed all required testing, and reported all signs and symptoms necessary for evaluating the Veteran's knee disability under the rating criteria. The Board finds that this examination provides the most probative evidence of record regarding the severity of the disability. The Veteran told the November 2021 examiner that his knee disability had stayed the same since its onset in 2011. He reported left knee pain, with "moderate" flare-ups of sharp pain that occur once or twice a week and last for a few hours. He stated that the flare-ups are precipitated by weight bearing and walking or standing for long periods, and alleviated with rest and pain medication. He noted that knee pain "makes it difficult to carry out his work." However, he did not report any specific functional loss or functional impairment of the knee, including with repeated use over time. He did not report a history of instability, recurrent subluxation, or frequent effusion of the knee. He did not use any assistive devices. The Veteran's range of motion was 120 degrees on forward flexion and 0 degrees on extension. He exhibited pain in both directions, starting at the same endpoints. There was no additional loss of function or range of motion after three repetitions. The examiner indicated that pain did not result in or cause functional loss. The examiner also determined, based on the Veteran's statements, that pain, fatigability, weakness, lack of endurance, and incoordination would not significantly limit functional ability with repeated use over time or flare-ups. The examiner found that the disability did not impact the Veteran's ability to perform any type of occupational task. Additionally, the examination revealed no evidence of ankylosis, joint instability, tibial or fibular impairment, or meniscal conditions that could support a rating under another diagnostic code for the knee. The Veteran does not contend that the November 2021 examination was inadequate or that the examiner's findings were inaccurate. He has not identified any evidence that would support a rating higher than 10 percent under any applicable diagnostic code. The Board finds no such evidence in the record. In sum, the evidence is persuasively against finding that the Veteran's knee disability limits flexion to 30 degrees or extension to 15 degrees. This is the case even when considering his lay statements regarding repeated use over a period of time and flare-ups. There is no reasonable doubt to resolve in his favor. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. A rating higher than 10 percent is denied. 4. Left & Right Hip Disabilities The Veteran also seeks increased ratings for left and right hip disabilities. He is service-connected for (1) limitation of flexion of each thigh (Diagnostic Code 5252); (2) limitation of extension of each thigh (Diagnostic Code 5251); and (3) limitation of adduction of each thigh such that he cannot cross legs (Diagnostic Code 5253). On remand, the AOJ reduced the ratings for limitation of flexion from 10 percent to noncompensable, effective November 8, 2021, and assigned the separate 10 percent ratings for limitation of adduction, effective from the same date. See November 2021 Rating Decision. Meanwhile, the limitation of extension on each side is rated as noncompensable for the entire period on appeal. After careful review, the Board finds that the prior 10 percent ratings for limitation of flexion must be restored. However, ratings higher than 10 percent for limitation of flexion are not warranted. Similarly, compensable ratings for limitation of extension, and ratings higher than 10 percent for limitation of adduction (or other impairments of the thighs) are not warranted. In general, hip disabilities are rated based on limitation of motion of the thigh. Under Diagnostic Code 5251, a maximum 10 percent rating is warranted for extension of the thigh limited to 5 degrees. 38 C.F.R. § 4.71a. Under Diagnostic Code 5252, a 10 percent rating is warranted where flexion of the thigh is limited to 45 degrees. A 20 percent rating is warranted where flexion is limited to 30 degrees. A 30 percent rating is warranted where flexion is limited to 20 degrees. A maximum 40 percent rating is warranted for flexion limited to 10 degrees. Id. Under Diagnostic Code 5253, a 10 percent rating is warranted for limitation of rotation such that a veteran cannot toe-out more than 15 degrees, or for limitation of adduction such that a veteran cannot cross legs. A maximum 20 percent rating is warranted for limitation of abduction where motion is lost beyond 10 degrees. Id. Like knee disabilities, VA can assign separate ratings under the hip diagnostic codes for limitation of extension, flexion, and abduction, adduction or rotation. However, separate compensable ratings based solely on painful motion are precluded by the rule against pyramiding. Mitchell, 25 Vet. App. at 39. First, the Board finds that the rating reduction for limitation of flexion, from 10 percent to noncompensable, was improper. It must be set aside. Greyzck, 12 Vet. App. at 292. The rating reduction did not affect the Veteran's total compensation amount for service-connected disabilities. His combined disability rating remained at 80 percent before and after November 8, 2021. Therefore, the AOJ was not required to observe the notice requirements of 38 C.F.R. § 3.105 prior to issuing the rating reduction. O'Connell, 21 Vet. App. at 92. However, the substantive requirements for rating reductions apply whether or not there is a reduction in the overall compensation amount. The evidence must show not only that an improvement in the disability has actually occurred, but also that the improvement actually reflects an improvement in the Veteran's ability to function under the ordinary conditions of life and work. Murphy, 26 Vet. App. at 516-17; Brown, 5 Vet. App. at 421. That is not the case here. A May 2015 rating decision granted service connection for limitation of flexion of the thigh, residual of left hip bursitis and iliotibial band syndrome, and for limitation of flexion of the thigh, residual of right hamstring strain. The AOJ assigned initial 10 percent ratings based on painful motion of the hip. This is the minimum compensable rating for the hip provided by 38 C.F.R. § 4.59. See Petitti v. McDonald, 27 Vet. App. 415, 425 (2015) (the trigger for a minimum disability rating is "painful motion" of joints or "actually painful" joints). The AOJ reduced these ratings based on the November 2021 examination. However, this examination does not support a reduction. The Veteran told the 2021 examiner that his hip disability had progressed or worsened since onset. He complained of pain in both hips with prolonged standing and walking. On range of motion testing, he exhibited pain with flexion on both sides. The November 2021 examination demonstrates that the Veteran continues to have painful motion on flexion, which warrants at least the minimum compensable (10 percent) rating for each hip under 38 C.F.R. § 4.59. In other words, there was no actual improvement in the disability. The Board finds that restoration here does not violate the rule against pyramiding because the Veteran is not separately compensated for painful motion under any other hip diagnostic code. Rather, the separate 10 percent ratings under Diagnostic Code 5253 are based on a specific, additional impairment: inability to cross legs. In sum, the rating reduction was improper. Restoration of the prior 10 percent ratings, effective November 8, 2021, is granted. Next, the Board finds that ratings higher than 10 percent for limitation of flexion, compensable ratings for limitation of extension, and ratings higher than 10 percent for limitation of adduction (or other impairments of the thighs) are not warranted. In October 2021, the Board remanded for a new hip examination for the same reasons noted above. Like the back and knee examinations, the Board found that the September 2015 hip examination was inadequate under Sharp, 29 Vet. App. 26, and that the October 2019 hip examination was inadequate under DeLuca, 8 Vet. App. 202, and Mitchell, 25 Vet. App. at 38. A VA contractor examined the Veteran's hips in November 2021. The November 2021 examiner reviewed the electronic claims file, performed all required testing, and reported all signs and symptoms necessary for evaluating the Veteran's bilateral hip disability under the rating criteria. The most probative evidence of record comes from this examination. As noted above, the Veteran reported worsening hip pain, including pain in both hips with prolonged standing and walking. He described "moderate" flare-ups of sharp pain in both hips occurring once or twice a week and lasting for a few hours at a time. He stated that the flare-ups are precipitated by walking or standing for long periods, and alleviated with rest and pain medication. He reported no specific functional loss or functional impairment of the hips, including with repeated use over time. He did not use any assistive devices. Range of motion of the left hip was 90 degrees on flexion, 25 degrees on extension, 30 degrees on abduction, 20 degrees on adduction, 40 degrees on external rotation, and 30 degrees on internal rotation. The Veteran exhibited pain in all directions at the same endpoints. The examiner indicated that limitation of adduction of the left thigh prevented him from crossing legs. There was no additional loss of function or range of motion after three repetitions. Range of motion of the right hip was 90 degrees on flexion, 20 degrees on extension, 30 degrees on abduction, 20 degrees on adduction, 40 degrees on external rotation, and 30 degrees on internal rotation. The Veteran exhibited pain in all directions at the same endpoints. Limitation of adduction of the right thigh prevented him from crossing legs. There was no additional loss of function or range of motion after three repetitions. The examiner indicated that pain did not result in or cause functional loss for either hip. The examiner also determined, based on the Veteran's statements, that pain, fatigability, weakness, lack of endurance, and incoordination would not significantly limit functional ability with repeated use over time or flare-ups of either hip. The examiner found that the bilateral hip disability did not impact the Veteran's ability to perform any type of occupational task. Additionally, the examination revealed no evidence of ankylosis, and no evidence of femur or flail hip joint impairment that could support a rating under another diagnostic code for the hip. The Veteran does not contend that the November 2021 examination was inadequate or that the examiner's findings were inaccurate. He has not identified any evidence that would support an increased rating under any applicable diagnostic code. The Board finds no such evidence in the record. The evidence is persuasively against finding that the Veteran's disability limits flexion to 30 degrees or less, that it limits extension to 5 degrees, or that it causes a loss of abduction beyond 10 degrees. This is the case even when considering his lay statements regarding repeated use over a period of time and flare-ups. There is no reasonable doubt to resolve in his favor. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. Accordingly, a rating higher than 10 percent for limitation of flexion of either thigh is denied. A compensable rating for limitation of extension of either thigh is denied. A rating higher than 10 percent for any other impairment of either thigh, to include limitation of adduction, is also denied. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D.Z. Wall, 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.