Citation NR: 9601220 Decision Date: 01/23/96 Archive Date: 02/07/96 DOCKET NO. 94-01 247 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Philadelphia, Pennsylvania THE ISSUES 1. Entitlement to an increased rating for residuals of a stress fracture of the right hip, currently rated 10 percent disabling. 2. Entitlement to service connection for bursitis of the left hip on a direct basis or as secondary to service- connected residuals of a stress fracture of the right hip. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD Vicki L. Bren, Associate Counsel INTRODUCTION The veteran had active service from May 1991 to March 1992. This matter comes before the Board of Veterans’ Appeals (the Board) from two rating actions of the Philadelphia, Pennsylvania Regional Office (RO). In a rating decision of November 1992, the RO granted service-connection for residuals of a stress fracture to the right femoral head and assigned a 10 percent rating effective March 1992. In a rating decision of June 1993, the RO denied service- connection for bursitis of the left hip as secondary to the service-connected right hip disorder. The veteran has appealed the 10 percent rating assigned to her right hip disorder as inadequate and has appealed the denial of entitlement to service-connection for bursitis of the left hip secondary to her right hip disorder. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends, in effect, that the residuals of the stress fracture of her right femoral head are more disabling than currently evaluated. Further, the veteran contends that the RO erred in failing to grant her service-connection for bursitis of the left hip either on a direct basis or as secondary to service-connected residuals of her right hip disorder. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against the claims for an increased evaluation for residuals of stress fracture of the right hip and for service- connection for bursitis of the left hip on either a direct basis or as secondary to service-connected residuals of the right hip condition. FINDINGS OF FACT 1. Residuals of the stress fracture of the right hip are manifested principally by pain. 2. Residuals of the right hip condition do not result in more than slight limitation of motion of the hip or loss of time from employment. 3. The bursitis of the left hip was not manifested in service and is not shown to be related to the veteran’s active miliary service or any incident therein or to have been caused or aggravated by her service-connected right hip condition. 4. No medical evidence has been submitted to relate the veteran’s bursitis of the left hip to her service-connected right hip condition. 5. The disability at issue does not cause an unusual or exceptional disability picture rendering impractical the application of the regular schedular standards. CONCLUSION OF LAW 1. An evaluation in excess of 10 percent for residuals of stress fracture of the right hip is not warranted on either a schedular or extraschedular basis. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321(b)(1), 4.7, 4.40, 4.45, 4.59, 4.71, 4.71(a), and Part 4, Diagnostic Code 5255 (1994). 2. The veteran’s bursitis of the left hip was not incurred in or aggravated in service and is not proximately due to or the result of service-connected residuals of the stress fracture of her right hip. 38 U.S.C.A. §§ 1110, 5107 (West 1991); 38 C.F.R. §§ 3.303(b), 3.310(a) (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSION We find that the veteran’s claims are well grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). That is, we find that she has presented claims which are plausible. We are also satisfied that all relevant facts have been properly developed, and that no further development is required to comply with the duty to assist the veteran mandated by 38 U.S.C.A. § 5107(a) (West 1991). Therefore, it is the determination of the Board that the evidence is sufficient in scope and depth for a fair, impartial, and fully informed appellate decision. I. Entitlement to an increased rating for residuals of right hip condition. Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. The higher of two evaluations will be assigned if the disability more closely approximates the criteria for that rating. Otherwise, a lower rating will be assigned. 38 C.F.R. § 4.7. An extraschedular evaluation will be assigned if the case presents an unusual or exceptional disability picture with such related factors as marked interference with employment or frequent periods of hospitalization such as to render impractical the application of a regular schedular standard. 38 C.F.R. § 3.321(b)(1). Compensation for service-connected injury is limited to claims which show present disability. Where entitlement to compensation has been established, and an increase in rating is at issue, the present level of disability is of a primary concern even though 38 C.F.R. § 4.2 (1994) requires the whole recorded history to be reviewed to make an accurate evaluation. Under 38 C.F.R. § 4.59, painful motion is an important factor of disability and actual painful joints are entitled to at least the minimum of a compensable rating for the joint. In addition, 38 C.F.R. § 4.40 requires consideration of functional disability due to pain and weakness. As regards to the joints, 38 C.F.R. § 4.45 notes that the factors of disability reside in reductions of their normal excursion of movements in different planes. The considerations include more or less movement than normal, weakened movement, excess fatigability, incoordination, impaired ability to execute skilled movements smoothly, pain on movement, swelling, deformity or atrophy of disuse, instability of station, disturbance of locomotion, and interference with sitting, standing, and weight bearing. In sum, functional loss can be caused by pain on use, when supported by adequate evidence of pathology, or limitation of motion and both are compensated at the same rate. Schafrath v. Derwinski, 1 Vet.App. 589, 592 (1991). By a rating action of April 1992, the RO granted service- connection for residuals of right femur fracture, rated as impairment of the femur and assigned a noncompensable rating under Diagnostic Code 5255 of the VA’s Schedule for Rating Disabilities (38 C.F.R. Part 4). In a subsequent November 1992 rating action, the RO increased the disability evaluation of the veteran’s right hip disorder from noncompensable to 10 percent, effective March 1992. The RO based its rating on inservice and post-service findings of right hip pain attributable to a stress fracture of the right femoral neck. Under 38 C.F.R. § 4.71a, impairment of the femur is rated under Diagnostic Code 5255. Malunion of the femur with slight knee or hip disability warrants a 10 percent evaluation. For a 20 percent evaluation, there must be moderate knee or hip disability. Service medical records indicate that the veteran was treated for right hip pain and underwent open pinning of an undisplaced right femoral neck stress fracture in September 1991. The appellant tolerated surgery well and was able to walk with the use of crutches on the first post-operative day. The veteran’s physician indicated that she was expected to make complete recovery from the surgery. After separation from service, the veteran underwent a VA medical examination in May 1992. She indicated that she had not lost any time from work due to her right hip condition. The veteran complained of pain in her upper right leg when walking, especially in cold or damp weather, or when sitting or lying in certain positions. On examination, a four inch incisional scar in the lateral aspect of the right hip was found to be sensitive to presser palpation. Further, pressure palpation over the bursa of the greater trochanter of the right hip caused discomfort. The examiner noted that full range of motion of the veteran’s right hip was possible. An x-ray of the right hip showed no definite abnormalities in the bones and joints. Three long metallic screws were noted through the intertrochanteric region with the tip of the femoral head intact. Thereafter, the veteran underwent another VA examination in May 1993. At such time, the veteran stated that she continued to experience pain and aching in her right hip. She reported that running, walking for extended distances, climbing steps and sleeping on her right side aggravated her right hip pain. The VA physician indicated that the full range of motion of the veteran’s right hip was possible with flexion to 120 degrees and abduction to 45 degrees. Normal ranges of motion for the hip are:flexion 0 to 125 degrees; abduction 0 to 45 degrees. 38 C.F.R. 4.71(a) (1994). The evidence shows that despite complaints of right hip pain, there is only a five degree loss of flexion and there is full abduction without other functional impairment associated with the service connected residuals of the right hip condition. In fact, the clinical examinations disclose no findings of malunion of the right femur. The 10 percent rating in effect is recognition of and takes into account the veteran’s associated symptoms of pain. However, the absence of other manifestations of a right hip disability at the present time precludes, in the judgment of the Board, a conclusion that there is a basis for assignment of an evaluation greater than the 10 percent rating assigned. II. Entitlement to service-connection for bursitis of the left hip on a direct basis or as secondary to service- connected residuals of right femur stress fracture. To establish entitlement to service connection requires that it be shown that the claimed disability is due to disease or injury which was incurred in or aggravated in service. 38 U.S.C.A. § 1110 (West 1991). Service connection may be established on a secondary basis where it is demonstrated that a service-connected disorder directly or proximately caused or aggravated the disorder for which service connection is sought. 38 C.F.R. § 3.310(a)(1994); Allen v. Brown, 7 Vet.App. 439 (1995). During service, the veteran was diagnosed with a right femoral stress fracture after complaining of pain in her right hip. Consequently, the veteran underwent open pinning of the undisplaced right femoral fracture. Service medical records indicate that the veteran tolerated the surgery well and no lasting effects were anticipated. A left hip injury or disorder was not shown at that time; nor was a left hip injury or disorder or abnormality shown at any time in service. Service medical records also show that the appellant received an honorable discharge after it was determined that she was unfit for duty due to her propensity for stress fractures. As a result of such determination, the veteran underwent an examination by the physical evaluation board in January 1992, prior to her separation from service. At such time, no left hip injury or disorder or abnormality was indicated. Treatment records of Dr. Albert Fink, Jr. dated January 1993 indicate that he saw the appellant for bilateral hip pain. While Dr. Fink opined that the veteran may have been suffering from bursitis, he offered no indication that there was a relationship between the veteran’s possible left hip bursitis and her service-connected right hip condition. In March 1993, Dr. Evan K. Bash reported that he had examined the appellant in February 1993. Dr. Bash diagnosed her condition as bilateral trochanteric bursitis. However, Dr. Bash did not offer a statement in support of the veteran’s contention that her left hip bursitis was caused or aggravated by her service-connected right hip condition. In May 1993, the appellant was examined by a VA physician who confirmed that the veteran had bursitis in both hips. During such examination, pressure palpation over the greater trochanter bursa of the veteran’s left hip was found to cause her discomfort, although she still retained the full range of motion in her left hip. The VA examiner was unable to conclude that the veteran’s right hip condition caused or aggravated her left hip bursitis. Addressing first the question of whether the left hip disorder was incurred in service, we find that the evidence does not support such conclusions. The veteran’s service medical records contain no mention of complaints or findings pertaining to the left hip. There is no basis in the record for finding that a left hip disorder was present in service or soon thereafter. As to the veteran’s claim for secondary service connection for her left hip disorder, it is significant that to establish service connection on this basis it must be shown that there is a causal relationship between the left hip bursitis and the service-connected right hip disorder. There is no competent evidence that such a causal relationship exists. The VA examiner in May 1993 was unable to detect such a relationship. The veteran has not submitted any evidence to the contrary. Consequently, service-connection on this basis is not warranted. ORDER 1. Increased rating for residuals of stress fracture of the right hip, currently rated 10 percent disabling, is denied. 2. Service connection for bursitis of the left hip on either a direct basis or as secondary to service-connected residuals of stress fracture of the right hip is denied. EUGENE A. O’NEILL Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals. - 2 -