Citation Nr: A25035451 Decision Date: 04/17/25 Archive Date: 04/17/25 DOCKET NO. 240111-408192 DATE: April 17, 2025 ORDER Entitlement to a rating in excess of 20 percent for a low back disability is denied. Entitlement to a rating in excess of 10 percent for right hip limitation of flexion, as of June 17, 2023, is denied. Entitlement to a rating in excess of 0 percent for right hip limitation of flexion, prior to June 17, 2023, is denied. Entitlement to a rating in excess of 10 percent for left hip limitation of flexion, as of June 17, 2023, is denied. Entitlement to a rating in excess of 0 percent for left hip limitation of flexion, prior to June 17, 2023, is denied. Entitlement to a rating in excess of 0 percent for impairment of the right thigh, as of June 17, 2023, is denied. Entitlement to a rating in excess of 10 percent for impairment of the right thigh, prior to June 17, 2023, is denied. Entitlement to a rating in excess of 0 percent for impairment of the left thigh, as of June 17, 2023, is denied. Entitlement to a rating in excess of 10 percent for impairment of the left thigh, prior to June 17, 2023, is denied. REMANDED Entitlement to total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. During the entire evidentiary period, the Veteran's low back disability was manifested by symptomatology more nearly approximating a limitation of forward flexion of the thoracolumbar spine to, at worst, 55 degrees; during the same period, the Veteran's low back disability was not manifested by symptomatology more nearly approximating a limitation of forward flexion of the thoracolumbar spine to 30 degrees or less or favorable ankylosis of the entire thoracolumbar spine. 2. During the evidentiary period as of June 17, 2023, the Veteran's right hip disability was manifested by symptomatology more nearly approximating otherwise noncompensable limitation of flexion of the right hip; during that same period, the Veteran's right hip disability was not manifested by symptomatology more nearly approximating flexion of the thigh limited to 30 degrees. 3. During the evidentiary period prior to June 17, 2023, the Veteran's right hip disability was manifested by symptomatology more nearly approximating flexion of the right hip limited to, at worst, 110 degrees; during that same period, the Veteran's right hip disability was not manifested by symptomatology more nearly approximating flexion of the thigh limited to 45 degrees. 4. During the evidentiary period as of June 17, 2023, the Veteran's left hip disability was manifested by symptomatology more nearly approximating otherwise noncompensable limitation of flexion of the left hip; during that same period, the Veteran's left hip disability was not manifested by symptomatology more nearly approximating flexion of the hip limited to 30 degrees. 5. During the evidentiary period prior to June 17, 2023, the Veteran's left hip disability was manifested by symptomatology more nearly approximating flexion of the left hip limited to, at worst, 110 degrees; during that same period, the Veteran's left hip disability was not manifested by symptomatology more nearly approximating flexion of the hip limited to 45 degrees. 6. During the evidentiary period as of June 17, 2023, the Veteran's right hip disability was not manifested by impairment of the thigh symptomatology more nearly approximating limitation of rotation of the right thigh so that the Veteran could not toe-out more than 15 degrees; or limitation of adduction of the right thigh so that the Veteran could not cross the legs. 7. During the evidentiary period prior to June 17, 2023, the Veteran's right hip disability was manifested by impairment of the thigh symptomatology more nearly approximating otherwise noncompensable limitation of motion of the right hip; during that same period, the Veteran's right hip disability was not manifested by symptomatology more nearly approximating limitation of abduction the right thigh so that motion was lost beyond 10 degrees. 8. During the evidentiary period as of June 17, 2023, the Veteran's left hip disability was not manifested by symptomatology more nearly approximating limitation of rotation of the left thigh so that the Veteran could not toe-out more than 15 degrees; or limitation of adduction of the left thigh so that the Veteran could not cross the legs. 9. During the evidentiary period as of June 17, 2023, the Veteran's left hip disability was manifested by symptomatology more nearly approximating otherwise noncompensable limitation of motion of the left hip; during that same period, the Veteran's left hip disability was not manifested by symptomatology more nearly approximating limitation of abduction the left thigh so that motion was lost beyond 10 degrees. CONCLUSIONS OF LAW 1. For the entire evidentiary period, the criteria for a rating in excess of 20 percent for a low back disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5237. 2. For the evidentiary period as of June 17, 2023, the criteria for a rating in excess of 10 percent for right hip limitation of flexion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5003-5252. 3. For the evidentiary period prior to June 17, 2023, the criteria for a rating in excess of 0 percent for right hip limitation of flexion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5252. 4. For the evidentiary period as of June 17, 2023, the criteria for a rating in excess of 10 percent for left hip limitation of flexion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5003-5252. 5. For the evidentiary period prior to June 17, 2023, the criteria for a rating in excess of 0 percent for left hip limitation of flexion have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5252. 6. For the evidentiary period as of June 17, 2023, the criteria for rating in excess of 0 percent for impairment of the right thigh, as of June 17, 2023, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5253. 7. For the evidentiary period prior to June 17, 2023, the criteria for rating in excess of 10 percent for impairment of the right thigh, as of June 17, 2023, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5003-5253. 8. For the evidentiary period as of June 17, 2023, the criteria for rating in excess of 0 percent for impairment of the left thigh, as of June 17, 2023, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5253. 9. For the evidentiary period prior to June 17, 2023, the criteria for rating in excess of 10 percent for impairment of the left thigh, as of June 17, 2023, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5003-5253. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 2012 to November 2015. This appeal comes before the Board from a July 2023 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) which is the Agency of Original Jurisdiction (AOJ). In a January 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. After the issuance of the July 2023 rating decision, the Veteran filed a July 2023 VA Form 20-0996, Request for Higher-Level Review. In November 2023, the AOJ issued a higher-level review rating decision, again denying the claims on appeal. Therefore, the Board may only consider the evidence of record at the time of the July 2023 AOJ decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence relevant to those issues was submitted during the period after the AOJ issued the July 2023 AOJ decision, which was subsequently subject to higher-level review the Board would not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801. Regarding all of the claims being decided, if the Veteran wants VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim, VA Form 20-0995, and submit or identify that evidence. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. 38 C.F.R. § 3.2501. Specific instructions for filing a Supplemental Claim are included with this decision. Because the Board is remanding the claim of entitlement to TDIU, any evidence the Board could not consider will be considered by the AOJ in the adjudication of that claim. 38 C.F.R. § 3.103(c)(2)(ii). Increased Ratings Disability ratings are determined by the application of VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C. §1155; 38 C.F.R. Part 4. Where there is a question as to which of two ratings shall be applied, the 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. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. VA regulations allow Veterans to have separate ratings under different Diagnostic Codes for the same injury or disability. However, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. Esteban v. Brown, 6 Vet. App. 259 (1994); 38 C.F.R. § 4.14. When rating musculoskeletal disabilities based on limitation of motion, the rater must consider any functional loss caused by pain or other factors that could occur during flare-ups or after repeated use and, therefore, not be indicated on range of motion testing. The rater must also consider whether there is less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, fatigability, and pain on movement. 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995); Mitchell v. Shinseki, 25 Vet. App. 32 (2011). Nonetheless, even when the other functionally limited factors are relevant when rating 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 38 C.F.R. § 4.40 or 38 C.F.R. § 4.45 itself is not appropriate. Thompson v. McDonald, 815 F.3d 781 (Fed. Cir. 2016). Painful motion is a factor to be considered with any form of arthritis and is not limited to disabilities involving arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1 (2011). An examiner must 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. The Board notes that the spine has no opposite joint. 38 C.F.R. § 4.59; Correia v. McDonald, 28 Vet. App. 158 (2016), VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flare-ups from veterans when a flare-up is not observable at the time of examination. Sharp v. Shulkin, 29 Vet. App. 26 (2017). The Board finds that neither the Veteran nor the Veteran's representative has raised any other issues, nor have any other issues been reasonably raised by the record. Doucette v. Shulkin, 28 Vet. App. 366 (2017). The Veteran's entire history is to be considered when assigning disability ratings. 38 C.F.R. §4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). A Veteran may experience multiple distinct degrees of disability that may result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). The analysis of the claims for higher ratings is undertaken with consideration of the possibility that different ratings may be warranted for different time periods. 1. Entitlement to a rating in excess of 20 percent for a low back disability The Veteran is seeking a higher rating for a low back disability, because the Veteran contends that low back symptomatology was more severe than contemplated by the 20 percent rating assigned under Diagnostic Code 5237 during the entire evidentiary period. 38 C.F.R. § 4.71a, Diagnostic Code 5237. The Veteran initially established service connection for a low back disability prior to February 7, 2021. Effective February 7, 2021, the VA Rating Schedule was amended with regard to rating musculoskeletal disabilities. 38 C.F.R. Part 4. However, the changes that were made, effective February 7, 2021, under 38 C.F.R. § 4.71a, were not alterations to the rating schedule itself, but rather the addition of instructions used in classifying disabilities associated with intervertebral disc syndrome (IVDS) under Diagnostic Code 5243 and all other IVDS disabilities under Diagnostic Code 5242. Therefore, the changes did not impact the General Rating Formula for Diseases and Injuries of the Spine used in rating the Veteran's low back disability. Therefore, because the applicable regulations did not change after February 7, 2021, the Board need not further evaluate the Veteran's disability under the pre- and post-February 7, 2021, regulations. Diagnostic Code 5237, the criteria for rating lumbosacral or cervical strains, utilizes the General Rating Formula for Diseases and Injuries of the Spine. Under the General Rating Formula, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees, but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or 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 for forward flexion of the thoracolumbar spine to 30 degrees or less; or 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. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine. Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be rated separately under an appropriate diagnostic code. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note 1. Ankylosis is defined as immobility and consolidation of a joint due to disease, injury, or surgical procedure. DORLAND'S ILLUSTRATED MEDICAL DICTIONARY, 94 (32nd ed. 2012). Fixation of a spinal segment in neutral position of 0 degrees always represents favorable ankylosis. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note 5. The Board has reviewed the evidence for the evidentiary period, from the filing of the claim on April 6, 2023, with acknowledgement of the possibility that a factually ascertainable increase in disability during the year prior to the filing of the claim must also be considered, through the issuance of the July 17, 2023, rating decision. At a June 2023 VA back examination, the Veteran reported experiencing constant back pain and stiffness, resulting in difficulty with daily activities, such as bending, lifting, sitting for prolonged periods, standing, walking, and climbing. The Veteran denied experiencing any flare-ups of low back disability symptomatology. On examination, the examiner indicated that, on active motion, lumbar flexion was possible to 60 degrees; extension to 25 degrees; right lateral flexion to 30 degrees; left lateral flexion to 30 degrees; right lateral rotation to 30 degrees; and left lateral rotation to 30 degrees. The examiner indicated that the Veteran experienced pain throughout motion, but found that the pain did not further limit the range of motion of the lumbosacral spine. The examiner stated that passive motion testing was not performed due to medical concerns that the test would risk damage to the spine. The examiner indicated that the Veteran felt pain on active motion, but not on weight-bearing and nonweight-bearing testing. The examiner indicated that there was no additional loss of function or range of motion after three repetitions. Although the Veteran was not examined after repeated use over time, the examiner stated that after repeated use over time, based on all evidence, lumbar flexion would be possible to 55 degrees; extension to 20 degrees; right lateral flexion to 30 degrees; left lateral flexion to 30 degrees; right lateral rotation to 30 degrees; and left lateral rotation to 30 degrees. Based on the Veteran's statements indicating the lack of any flare-up episodes, the examiner indicated that the Veteran would not experience any additional loss of function upon flare-ups. The examiner indicated that there was no evidence of crepitus. The examiner noted objective evidence of mild pain on palpation at the paralumbar L1-S1 directly related to the low back disability. The examiner stated that the Veteran did not have any guarding or muscle spasm of the thoracolumbar spine. The examiner indicated that the Veteran had localized tenderness, described as paralumbar tenderness, but indicated that it would not result in an abnormal gait or abnormal spinal contour. The examiner found that the Veteran did not have any neurological symptoms involving the lower extremities, to include radiculopathy related to the low back disability. The examiner stated that the Veteran did not have IVDS of the thoracolumbar spine. The examiner stated that functioning of the spine was not so diminished that amputation with prosthesis would equally serve the Veteran. When asked to note any functional impact the disability would have upon the Veteran's performance of occupational tasks, the examiner stated that the Veteran could not lift, bend, sit for prolonged periods, or stand for prolonged periods. Based on the above, for the entire evidentiary period, the Board finds that the evidence of record persuasively weighs against a rating in excess of 20 percent for the Veteran's low back disability. In the June 2023 VA back examination report, the examiner noted that the flexion of the thoracolumbar spine was limited to, at worst, 55 degrees. The Board finds that limitation of flexion more nearly approximated the limitation of forward flexion of the thoracolumbar spine to greater than 30 degrees, but not greater than 60 degrees; contemplated by the currently assigned 20 percent rating under Diagnostic Code 5237. 38 C.F.R. § 4.71a. The Board also finds that, during the evidentiary period, the Veteran's low back disability did not more nearly approximate the limitation of forward flexion of the thoracolumbar spine to 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine contemplated by the next higher 40 percent rating under Diagnostic Code 5237. 38 C.F.R. § 4.71a. The record for the evidentiary period did not contain any notation suggesting limitation of forward flexion to any point less than the 55 degrees noted in the July 2023 VA back examination report. Moreover, the record of evidence did not contain any notation indicating the existence of ankylosis of the thoracolumbar spine. In the June 2023 VA medical examination report, the VA examiner found that there was no evidence of ankylosis. Therefore, the record for the entire evidentiary period did not contain sufficient evidence indicating that the Veteran's low back symptomatology more nearly approximated that required for the next higher 40 percent rating under Diagnostic Code 5237. 38 C.F.R. § 4.71a. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to the Veteran's low back disability during the evidentiary period. The Board notes the Veteran's reports of difficulty with bending, lifting, sitting for prolonged periods, standing, walking, and climbing due to the low back disability. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the Veteran's statements did not result in symptomatology more nearly approximating a limitation of forward flexion of the thoracolumbar spine to 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine as required for a next higher 40 percent rating under Diagnostic Code 5237. 38 C.F.R. § 4.71a. Consideration has also been given to assigning a rating under the Formula for IVDS Based on Incapacitating Episodes, found at Diagnostic Code 5243. However, the evidence for the evidentiary period contained no indication that the Veteran ever experienced IVDS symptomatology or that the Veteran was prescribed bed rest by a physician for any duration as is required for a rating under Diagnostic Code 5243. 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. Therefore, a rating under Diagnostic Code 5243 would not be appropriate. Regarding neurological impairment, the lay and medical evidence of record for the evidentiary period weighed against a finding that the Veteran had any other neurological abnormality associated with the low back disability. Therefore, the evidence weighs against the assignment of any separate rating for a neurological disability related to the low back disability. The Board finds that the evidence of record for the entire evidentiary period persuasively weighed against the Veteran's claim for a rating in excess of 20 percent for a low back disability. The Board finds that the evidence of record persuasively weighs against the assignment of a rating in excess of 20 percent, that the evidence is not in approximate balance, and that there is no reasonable doubt to resolve in favor of the Veteran. Therefore, the claim for an increased rating is denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (2021). 2. Entitlement to a rating in excess of 10 percent for right hip limitation of flexion, as of June 17, 2023, 3. Entitlement to a rating in excess of 0 percent for right hip limitation of flexion, prior to June 17, 2023, 4. Entitlement to a rating in excess of 10 percent for left hip limitation of flexion, as of June 17, 2023, 5. Entitlement to a rating in excess of 0 percent for left hip limitation of flexion, prior to June 17, 2023, 6. Entitlement to a rating in excess of 0 percent for impairment of the right thigh, as of June 17, 2023, 7. Entitlement to a rating in excess of 10 percent for impairment of the right thigh, prior to June 17, 2023, 8. Entitlement to a rating in excess of 0 percent for impairment of the left thigh, as of June 17, 2023, 9. Entitlement to a rating in excess of 10 percent for impairment of the left thigh, prior to June 17, 2023 The Veteran is seeking higher ratings for bilateral limitation of hip flexion and impairment of the thighs experienced during the entire evidentiary period. Prior to June 17, 2023, the Veteran was assigned separate 10 percent ratings under Diagnostic Code 5003-5253 for otherwise noncompensable limitation of motion of the right and left hip due to impairment of the thigh, and separate 0 percent ratings for limitation of flexion of the right and left hips under Diagnostic Code 5252. As of June 17, 2023, the Veteran has been assigned separate 10 percent ratings under Diagnostic Code 5003-5252 for otherwise noncompensable limitation of flexion of the right and left hip, and separate 0 percent ratings for limitation of motion of the right and left hip due to impairments of the thighs under Diagnostic Code 5253. 38 C.F.R. § 4.71a. Under Diagnostic Code 5003, degenerative arthritis is rated based on limitation of motion under the applicable Diagnostic Codes for each specific joint. When limitation of motion of the joint is noncompensable under the applicable Diagnostic Code, a rating of 10 percent for each major joint affected by limitation of motion, is combined, not added, under Diagnostic Code 5003. Limitation of motion must be objectively confirmed, including by satisfactory evidence of painful motion. In the absence of limitation of motion, a 10 percent rating is warranted with X-ray evidence of involvement of two or more major joints, or two or more minor joint groups. A 20 percent rating is warranted with X-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations. 38 C.F.R. § 4.71a. The hip is a major joint. 38 C.F.R. § 4.45. Diagnostic Code 5252 lists the criteria for rating limitation of flexion of the thighs. Under Diagnostic Code 5252, 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. Diagnostic Code 5253 lists the criteria for rating impairments of the thigh. Under Diagnostic Code 5253, a 10 percent rating is warranted for a limitation of rotation of the affected leg so that a Veteran cannot toe out more than 15 degrees. A 10 percent rating is also warranted for limitation of adduction so that a Veteran cannot cross the legs. A maximum 20 percent rating is warranted for limitation of abduction with motion lost beyond 10 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5253. The Board notes that the Veteran filed the claims for higher ratings for the right and left hips on April 6, 2023. The Veteran subsequently did not submit any lay statements regarding the hip disability symptoms during the evidentiary period. Moreover, the record does not contain any VA or private treatment records denoting diagnosis or treatment for the hips during the evidentiary period or within one year prior to the filing of the claim for increase. Therefore, the only probative evidence of record for the entire evidentiary period, lasting from the filing of the claim on April 6, 2023, through the issuance of the July 17, 2023, rating decision, consists of a June 17, 2023, VA hip examination report. At the June 17, 2023, VA hip examination, during an interview with the VA examiner, the Veteran reported that the right and left hip disabilities limited the Veteran's ability to run or climb. The Veteran denied experiencing any flare-ups of hip disability symptomatology in either hip. The examiner noted that the Veteran had limitation of ranges of active and passive motion of the right hip and thigh with flexion limited to 110 degrees, extension to 30 degrees, abduction to 35 degrees, adduction to 25 degrees, external rotation to 60 degrees, and internal rotation to 40 degrees. The examiner noted that the Veteran could cross the legs. The examiner reported that the Veteran experienced pain while performing flexion and abduction of the right hip, including during active and passive motion, but indicated that the pain did not result in functional loss throughout the measured activities. The examiner indicated that the Veteran did not feel pain during weight-bearing and nonweight-bearing testing. The examiner noted that the Veteran was able to perform repetitive use testing with at least three repetitions and did not experience additional loss of function of the right hip after those repetitions. Although the Veteran was not examined after repeated use over time, the examiner stated that after repeated use over time, based on all evidence, the Veteran would experience limitation of motion of the right hip and thigh due to pain and lack of endurance, resulting in flexion limited to 110 degrees, extension to 30 degrees, abduction to 30 degrees, adduction to 25 degrees, external rotation to 60 degrees, and internal rotation to 40 degrees. The examiner indicated that the Veteran would not experience any additional loss of function of the right hip during a flare-up. The examiner found no additional factors resulting in loss of motion of the right hip, no loss of muscle strength, and no evidence of muscle atrophy or ankylosis. The examiner stated that the Veteran would not experience any interference with sitting or standing, swelling, disturbance of locomotion, deformity, less movement than normal, more movement than normal, weakened movement, atrophy of disuse, or instability of station related to the right hip disability. The examiner found that the Veteran did not have any femur or flail hip joint impairment due to the right hip disability. The examiner indicated that the Veteran did use any assistive devices due to the right hip disability. The examiner further found that the Veteran did not experience functional impairment of the right hip such that no effective functions of the joint remained other than that which would be equally well served by an amputation with prosthesis. Regarding the left hip and thigh, the June 2023 VA examiner noted that the Veteran had limitation of ranges of active and passive motion of the left hip and thigh with flexion limited to 115 degrees, extension to 30 degrees, abduction to 35 degrees, adduction to 25 degrees, external rotation to 60 degrees, and internal rotation to 40 degrees. The examiner noted that the Veteran could cross the legs. The examiner reported that the Veteran experienced pain while performing active flexion, and passive flexion and abduction of the left hip, but indicated that the pain did not result in functional loss throughout the measured activities. The examiner indicated that the Veteran did not feel pain during weight-bearing and nonweight-bearing testing. The examiner noted that the Veteran was able to perform repetitive use testing with at least three repetitions and did not experience additional loss of function of the left hip after those repetitions. Although the Veteran was not examined after repeated use over time, the examiner stated that after repeated use over time, based on all evidence, the Veteran would experience limitation of motion of the left hip and thigh due to pain and lack of endurance, resulting in flexion limited to 110 degrees, extension to 30 degrees, abduction to 35 degrees, adduction to 25 degrees, external rotation to 60 degrees, and internal rotation to 40 degrees. The examiner indicated that the Veteran would not experience any additional loss of function of the left hip during a flare-up. The examiner found no additional factors resulting in loss of motion of the left hip, no loss of muscle strength, and no evidence of muscle atrophy or ankylosis. The examiner stated that the Veteran would not experience any interference with sitting or standing, swelling, disturbance of locomotion, deformity, less movement than normal, more movement than normal, weakened movement, atrophy of disuse, or instability of station related to the left hip disability. The examiner found that the Veteran did not have any femur or flail hip joint impairment due to the left hip disability. The examiner indicated that the Veteran did use any assistive devices due to the left hip disability. The examiner further found that the Veteran did not experience functional impairment of the left hip such that no effective functions of the joint remained other than that which would be equally well served by an amputation with prosthesis. Regarding both hip disabilities, the examiner stated that the Veteran's hip disabilities would require the Veteran to work in a position that would not involve prolonged sitting, standing, or climbing for greater than an hour at a time. Having reviewed the record, the Board finds that, during the evidentiary period as of June 17, 2023, the date of the examination, the Veteran's right and left hip limitation of flexion symptomatology more nearly approximated that required for the currently assigned 10 percent ratings granted for otherwise noncompensable limitation of flexion under Diagnostic Code 5003-5252. 38 C.F.R. § 4.71a. Specifically, during that period, the Veteran's right and left hip disabilities caused limitation of flexion to, at worst 110 degrees bilaterally. The Board notes that, to qualify for a minimum 10 percent rating under Diagnostic Code 5252, a hip disability must be manifested by limitation of flexion of the hip limited to, at least, 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5252. Therefore, the Veteran's limitation of flexion of the hips more nearly approximated the otherwise noncompensable limitations of flexion contemplated by the currently assigned 10 percent ratings under Diagnostic Code 5003-5252. 38 C.F.R. § 4.71a. The Board also finds that, during the same period, the Veteran's right and left limitations of flexion of the hips did not more nearly approximate the symptomatology required for a next higher rating 20 percent rating for either leg under either Diagnostic Code 5252 or Diagnostic Code 5003. During that period, the Veteran's right and left hip disabilities caused limitation of flexion to, at worst 110 degrees bilaterally, far in excess of the limitation of flexion to 30 degrees required for a next higher 20 percent rating under Diagnostic Code 5252. Additionally, because the hip is considered a single major joint under Diagnostic Code 5003, a 20 percent rating cannot be assigned under Diagnostic Code 5003, because any limitation of flexion of the hip would not involve two or more major or minor joints, as required for a 20 percent rating under the criteria for Diagnostic Code 5003. 38 C.F.R. § 4.71a. Therefore, the Board finds that, during the same period, the Veteran's right and left limitations of flexion of the hip disabilities did not more nearly approximate the symptomatology required for a next higher rating 20 percent rating for either leg under either Diagnostic Code 5252 or Diagnostic Code 5003. 38 C.F.R. § 4.71a. For that same period, the Board finds that the Veteran's right and left hip disabilities were productive of impairment of thigh symptomatology more nearly approximating the criteria for the currently assigned separate 0 percent ratings and not that required for any rating in excess of 0 percent under Diagnostic Code 5253. The record of evidence for that period contains no indication that the Veteran's hip and thigh disabilities caused a limitation of rotation of either leg so that the Veteran could not toe out more than 15 degrees, or a limitation of adduction in either leg so that the Veteran could not cross the legs. Therefore, during the evidentiary period, the Veteran's right and left impairments of the thigh disabilities did not more nearly approximate that required for a minimum 10 percent rating in either leg under Diagnostic Code 5252 during the period as of June 17, 2023. Moreover, upon testing, the Veteran demonstrated abduction of the right hip to, at worst, 30 degrees, and abduction of the left to, at worst, 35 degrees. The Board finds that these findings were well in excess of the limitation of abduction with motion lost beyond 10 degrees required for an even higher 20 degree rating for either leg under Diagnostic Code 5253. 38 C.F.R. § 4.71a. Therefore, for the period as of June 17, 2023, the Board finds that the Veteran's right and left impairments of the thighs did not more nearly approximate that required for a rating in excess of 0 percent under Diagnostic Code 5253. 38 C.F.R. § 4.71a. Prior to June 17, 2023, the Veteran was assigned separate 10 percent ratings for impairment of the bilateral thighs under Diagnostic Code 5003-5253. By assigning 0 percent ratings for those disabilities as of June 17, 2023, VA essentially reduced the 10 percent ratings assigned for those disabilities to 0 percent. Often, certain procedures must be performed by VA prior to making such rating reductions. Specifically, where a reduction in rating of a service-connected disability is considered warranted, and the lower rating would result in a reduction or discontinuance of compensation payments currently being made, a rating proposing the reduction or discontinuance should be issued setting forth all material facts and reasons. 38 C.F.R. § 3.105(e). In this case, however, the reductions at issue did not result in a reduction in the overall disability rating. Before the reductions, the Veteran's overall disability rating was 60 percent. After the reduction, the overall ratings remained 60 percent. Thus, no reduction in compensation payments occurred that required the procedural protections provided in 38 C.F.R. § 3.105(e). Moreover, under Diagnostic Code 5003, a 10 percent rating is assigned for otherwise noncompensable limitation of motion of a major joint, such as the hip. 38 C.F.R. § 4.71a, Diagnostic Code 5003. For the evidentiary period as of June 17, 2023, the Veteran was compensated for otherwise noncompensable motion of the hips with the separate 10 percent ratings assigned for the limitation of hip flexion under Diagnostic Code 5003-5252. Because the Veteran was being compensated for painful, limited motion of both hips by those ratings, the Board finds that separate or additional ratings for otherwise noncompensable impairment of the thighs under Diagnostic Code 5003-5253 would not have been appropriate. Ratings assigned under Diagnostic Code 5003 cannot be combined with ratings for limitation of motion of the same joint, or with another rating under Diagnostic Code 5003 for the same joint. The critical element for separately assigned ratings for symptoms arising from the same disability is that none of the symptoms which form the basis for evaluation under one Diagnostic Code may be duplicative of or overlapping with the basis of rating under another Diagnostic Code, and if so, whether than common manifestation would be improperly compensated more than once. Esteban v. Brown, 6 Vet. App. 259 (1994). For the evidentiary period as of June 17, 2023, as the Veteran's otherwise noncompensable motion of the hips is the basis for the 10 percent ratings assigned for the limitation of flexion of the hips under the criteria of Diagnostic Code 5252, to also assign any rating for impairment of the thighs under Diagnostic Code 5253 on the basis of otherwise noncompensable painful motion alone would be prohibited, as that would overcompensate actual impairment suffered and be pyramiding, or the rating of the same symptomatology under different ratings, which is prohibited. Lyles v. Shulkin, 29 Vet. App. 107 (2017); 38 C.F.R. § 4.14. For the period as of June 17, 2023, 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. Esteban v. Brown, 6 Vet. App. 259 (1994); 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). During the period in question, the Veteran demonstrated full extension of both hips to 30 degrees, well in excess of the limitation of hip extension to 5 degrees required for a compensable rating under Diagnostic Code 5251. 38 C.F.R. § 4.71a. Moreover, the record of evidence for the period weighed against a finding that the Veteran experienced ankylosis of the hip as required for a rating under Diagnostic Code 5250, a flail joint as required for a rating under Diagnostic Code 5254, or impairment of the femur as required for a rating under Diagnostic Code 5255. 38 C.F.R. § 4.71a. Therefore, for the evidentiary period as of June 17, 2023, the Board finds that the evidence weighed against the grant of a separate rating for the Veteran's hip disabilities under a different Diagnostic Code. The Board acknowledges the Veteran's lay reports of symptoms and the evidence indicating that the Veteran experienced functional loss due to the Veteran's hip disabilities during the evidentiary period as of June 17, 2023. The Board notes the Veteran's reports of difficulties with running and climbing due to the right and left hip disabilities. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degrees of additional limitation reflected by the Veteran's statements did not indicate symptomatology more nearly approximating limitation of flexion in either hip to, at least, 30 degrees, as required for a next higher 20 percent rating under Diagnostic Code 5252. Even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the Veteran's statements did not result in symptomatology more nearly approximating limitation of rotation of either leg so that the Veteran could not toe out more than 15 degrees, or a limitation of adduction in either leg so that the Veteran could not cross the legs as required for a next higher 10 percent rating under Diagnostic Code 5253. 38 C.F.R. § 4.71a. Accordingly, the Board finds that the evidence of record for the evidentiary period as of June 17, 2023, persuasively weighed against ratings in excess of 10 percent for limitations of right and left hip flexion, and 0 percent for impairments of the right and left thighs related to the Veteran's hips disabilities. The Board finds that the weight of the evidence for that period was against the assignment of any higher rating, that the evidence was not in approximate balance, that the criteria for a higher rating were not met or more nearly approximated, and that there was no reasonable doubt to resolve in favor of the Veteran. Therefore, the claims for higher ratings for that period must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. The only probative evidence of record for the entire evidentiary period, lasting from the filing of the claim on April 6, 2023, through the issuance of the July 17, 2023, rating decision consists of the June 17, 2023, VA hip examination report. Because VA provided the examination only two months after the filing of the claim for higher ratings and the record contains no evidence suggesting a great change in the Veteran's hip disabilities during that period, the Board will assume that the that the Veteran's hip disabilities were essentially of the same severity during the entirety of evidentiary period. Therefore, the Board will use the examination results to evaluate the Veteran's symptomatology for the period prior to June 17, 2023, the date of the examination. Having reviewed the record, the Board finds that, during the evidentiary period prior to June 17, 2023, the Veteran's impairments of the right and left thighs symptomatology more nearly approximated that required for the currently assigned separate 10 percent ratings granted for otherwise noncompensable limitation of motion under Diagnostic Code 5003-5253. 38 C.F.R. § 4.71a. The record of evidence for that period contains no indication that the Veteran's hip disabilities caused a limitation of rotation of either leg so that the Veteran could not toe out more than 15 degrees, or a limitation of adduction in either leg so that the Veteran could not cross the legs. Therefore, the Veteran's disability in both legs did not more nearly approximate that required for a minimum 10 percent rating under Diagnostic Code 5253 during the period prior to June 17, 2023. Moreover, upon testing, the Veteran demonstrated abduction of the right hip to, at worst, 30 degrees, and abduction of the left to, at worst, 35 degrees. The Board finds that those findings are well in excess of the limitations of abduction with motion lost beyond 10 degrees required for a 20 degree rating in either leg under Diagnostic Code 5253. 38 C.F.R. § 4.71a. Therefore, because the Veteran's right and left hip impairments of the thighs were productive of otherwise noncompensable limitation of motion during the period prior to June 17, 2023, separate 10 percent ratings are allowed under Diagnostic Code 5003-5252. 38 C.F.R. § 4.71a. Therefore, the Veteran's impairments of the right and left thighs more nearly approximated the criteria for a 10 percent rating under Diagnostic Code 5003-5252 during the evidentiary period prior to June 17, 2023. 38 C.F.R. § 4.71a. Additionally, for the period prior to June 17, 2023, the Board finds that the Veteran's impairment of the right and left thighs symptomatology did not more nearly approximate that required for a higher rating in excess of 10 percent under either Diagnostic Code 5253 or Diagnostic Code 5003. During that period, the disability was not productive of symptomatology more nearly approximating that required for even a minimum 10 percent rating for limitation of motion under Diagnostic Code 5253. Moreover, because the hip is considered a single major joint under Diagnostic Code 5003, a 20 percent rating cannot be assigned under Diagnostic Code 5003, because the impairment of the left and right thighs did not involve two or more major or minor joints as required for a 20 percent rating under that Diagnostic Code. Therefore, for the period prior to June 17, 2023, the Board finds that the evidence weighs against finding that the Veteran's impairments of the right and left thighs disabilities more nearly approximated the symptomatology required for a next higher rating 20 percent rating for either leg under either Diagnostic Code 5253 or Diagnostic Code 5003. 38 C.F.R. § 4.71a. For the same period, the Board also finds that the Veteran's limitation of flexion caused by the right and left hip disabilities symptomatology more nearly approximated the currently separate 0 percent ratings currently assigned under Diagnostic Code 5252 and not that required for any rating in excess of 0 percent. During that period, the Veteran's right and left hip disabilities caused limitations of flexion to, at worst 110 degrees bilaterally. The Board notes that, to qualify for a minimum 10 percent rating under Diagnostic Code 5252, a hip disability must be manifested by a limitation of flexion of the hip to, at least, 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5252. Therefore, during the evidentiary period prior to June 17, 2023, the Veteran's right and left hip disabilities were not productive of the limitation of flexion in either leg required for a next higher 10 percent rating under Diagnostic Code 5252. 38 C.F.R. § 4.71a. Ratings assigned under Diagnostic Code 5003 cannot be combined with ratings for limitation of motion of the same joint, or with another rating under Diagnostic Code 5003 for the same joint. For the evidentiary period prior to June 17, 2023, as the Veteran's otherwise noncompensable motion of the hips was the basis for the 10 percent ratings granted for impairment of the thighs under the criteria of Diagnostic Code 5253, to also assign a rating for limitation of flexion of the hips under Diagnostic Code 5252 on the basis of otherwise noncompensable painful motion alone would be prohibited, as that would overcompensate actual impairment suffered and be pyramiding, or the rating of the same symptomatology under different ratings, which is prohibited. Lyles v. Shulkin, 29 Vet. App. 107 (2017); 38 C.F.R. § 4.14. Therefore, for the period prior to June 17, 2023, additional 10 percent ratings for noncompensable flexion of the hips under Diagnostic Code 5003-5252 cannot be assigned. 38 C.F.R. § 4.71a. For the period prior to June 17, 2023, 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. Esteban v. Brown, 6 Vet. App. 259 (1994); 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). During the period in question, the Veteran demonstrated full extension of both hips to 30 degrees, well in excess of the limitation of hip extension to 5 degrees required for a compensable rating under Diagnostic Code 5251. 38 C.F.R. § 4.71a. Moreover, the record of evidence for the period weighed against a finding that the Veteran experienced ankylosis of the hip as required for a rating under Diagnostic Code 5250, a flail joint as required for a rating under Diagnostic Code 5254, or impairment of the femur as required for a rating under Diagnostic Code 5255. 38 C.F.R. § 4.71a. Therefore, for the evidentiary period prior to June 17, 2023, the Board finds that the evidence weighed against the grant of a separate rating for the Veteran's hip disabilities under a different Diagnostic Code. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to the Veteran's hip disabilities during the evidentiary period prior to June 17, 2023. The Board notes the Veteran's reports of difficulty with running and climbing due to the right and left hip disabilities. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the Veteran's statements did not result in symptomatology more nearly approximating a limitation of abduction with motion lost beyond 10 degrees in either leg required for a 20 degree rating under Diagnostic Code 5253. Even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the Veteran's statements did not result in symptomatology more nearly approximating a limitation of flexion of either leg to 45 degrees as required for a next higher 10 percent rating under Diagnostic Code 5252. 38 C.F.R. § 4.71a. Accordingly, the Board finds that the evidence of record for the evidentiary period prior to June 17, 2023, persuasively weighed against ratings in excess of 10 percent for impairments of the right and left thighs related to the Veteran's hips disabilities, and 0 percent ratings for limitations of right and left hip flexion. The Board finds that the weight of the evidence for that period was against the assignment of any higher rating, that the evidence was not in approximate balance, that the criteria for a higher rating were not met or more nearly approximated, and that there was no reasonable doubt to resolve in favor of the Veteran. Therefore, the claims for higher ratings for that period must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7. REASONS FOR REMAND 1. Entitlement to TDIU is remanded. The Veteran is seeking entitlement to TDIU. The Veteran has reported being unable to work due to service-connected disabilities. Entitlement to TDIU may be assigned, where the schedular rating is less than total, where a veteran is unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. If there is only one service-connected disability, that disability shall be rated 60 percent or more, and, if there are two or more disabilities, there shall be at least one disability rated 40 percent or more and sufficient additional disability to bring the combined service-connected rating to 70 percent or more. 38 C.F.R. § 4.16(a). Under 38 C.F.R. § 4.16(b), where the percentage requirements of 38 C.F.R. § 4.16(a) are not met, TDIU may be assigned in exceptional cases when the Veteran is unable to secure and follow a substantially gainful occupation by reason of service-connected disability. The Board cannot award TDIU under 38 C.F.R. § 4.16(b) in the first instance because that regulation requires that the RO first submit the claim to the Under Secretary for Benefits, Director of the Compensation Service for consideration. 38 C.F.R. § 4.16(b); Bowling v. Principi, 15 Vet. App. 1, 10 (2001). In this instance, the Board finds that a remand for consideration of the assignment of TDIU under 38 C.F.R. § 4.16(b) is appropriate. During the entire evidentiary period, the Veteran did not meet the schedular criteria for entitlement to a TDIU. During that period, the Veteran's combined service-connected disability rating was 60 percent and the Veteran's highest rated disability was a psychiatric disability, rated as 30 percent disabling. Even if the orthopedic disabilities were considered as a single disability, that would still not qualify as a single disability rated 60 percent, and the combined rating was less than 70 percent. In an April 2023 application for TDIU, the Veteran reported having a high school degree. The Veteran reported working for a year as an electrical worker from May 2017 to May 2018; and then working remotely as a computer coder, from May 2018 to November 2022. The Veteran reported missing 100 days of work from that last position due to illnesses. In a June 2023 VA psychiatric examination report, written during the pendency of the appeal, a VA examiner found that the Veteran's diagnosed depressive disorder would cause occasional decreases in work efficiency and intermittent periods of inability to perform occupational tasks. In the June 2023 VA orthopedic examinations of record, a VA examiner found that the Veteran's back and hip disabilities would cause the Veteran to be unable to lift, bend, sit for prolonged periods, or stand for any period over an hour. The Board notes that those findings suggest that the Veteran would experience difficulty performing manual labor, such as electrical work, or coding, which requires sitting for prolonged periods. Considering those factors, the Board finds that a remand for an opinion from the remand for consideration of the assignment of TDIU pursuant to 38 C.F.R. § 4.16(b) is appropriate. The claim for entitlement to TDIU is REMANDED for the following action: Refer the issue of entitlement to a TDIU from to the Under Secretary for Benefits/Director of the Compensation Service for consideration under 38 C.F.R. § 4.16(b). The decision should take into consideration the Veteran's schooling and training, work experience, and the results found in the June 2023 VA examination reports, suggesting that the Veteran would experience difficulty working in positions involving manual labor, standing for over an hour, or sitting for over an hour. Harvey P. Roberts Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Gillett, Todd M. 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.