DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

REBECCA N. POULSON · 2026 · Case ID: A26025560

MIXED

Summary

The veteran, who served in the United States Army from November 1980 to October 1984, appeals the Board of Veterans' Appeals' (BVA) decision regarding the effective dates for increased disability ratings for his lumbar spine and left hip conditions. The veteran sought an earlier effective date for his 40 percent rating for degenerative arthritis of the lumbar spine, arguing the Regional Office (RO) improperly reduced his evaluation from 40% to 20% for a period in 2014-2019. He also appealed the effective dates for increased ratings for his left hip trochanteris pain syndrome and strain, specifically for limitations in extension, flexion, and abduction/adduction. The BVA reviewed the evidence, including VA examinations and the veteran's testimony, noting the veteran's consistent reports of pain, flare-ups, and functional limitations. For the lumbar spine, the Board found that while the veteran's condition approximated forward flexion of 30 degrees or less, warranting a 40 percent rating, the evidence did not support an earlier effective date than October 15, 2019, due to the RO's reduction and subsequent re-increase. For the left hip conditions, the Board found the evidence supported the assigned ratings for limitations in extension (10%), flexion (30%), and abduction/adduction (20%) as of October 15, 2019, but also denied earlier effective dates for these increases. The Board granted the 40% rating for the lumbar spine and the respective ratings for the left hip conditions, but affirmed the October 15, 2019 effective date for these increases.

Rationale

Evidence supports 40% rating for lumbar spine degenerative arthritis.; Pain and limitation of motion during flare-ups considered.; No evidence of ankylosis or functional equivalent found.

Service Branch

ARMY

Special Benefit

EARLIER EFFECTIVE DATE

Docket No.

201214-126042

Full Decision Text

Citation Nr: A26025560
Decision Date: 03/23/26 Archive Date: 03/23/26

DOCKET NO. 201214-126042
DATE: March 23, 2026

ORDER

Entitlement to a 40 percent rating, but no higher, for degenerative arthritis of the lumbar spine from September 23, 2014 to October 15, 2019, is granted.

Entitlement to an initial maximum rating of 10 percent, but no higher, for left hip trochanteris pain syndrome and strain (limitation of extension) from July 31, 2014 to October 15, 2019, is granted.

Entitlement to an initial rating of 30 percent, but no higher, for left hip trochanteris pain syndrome and strain (limitation of flexion) from July 31, 2014 to October 15, 2019, is granted.

Entitlement to an initial maximum rating of 20 percent, but no higher, for left hip trochanteris pain syndrome and strain (limitation of abduction/adduction) from July 31, 2014 to October 15, 2019, is granted.

FINDINGS OF FACT

1. For the period on appeal from September 23, 2014 to October 15, 2019, the Veteran's degenerative arthritis of the lumbar spine has been manifested by pain and limitation of motion most closely approximating forward flexion limited to 30 degrees or less.

2. From July 31, 2014 to October 15, 2019, the Veteran's left hip trochanteris pain syndrome and strain (limitation of extension) have been manifested by extension limited to 5 degrees.

3. From July 31, 2014 to October 15, 2019, the Veteran's left hip trochanteris pain syndrome and strain (limitation of flexion) have been manifested by flexion limited to 20 degrees.

4. From July 31, 2014 to October 15, 2019, the Veteran's left hip trochanteris pain syndrome and strain (limitation of abduction/adduction) have been manifested by limitation of abduction (motion lost beyond 10 degrees).

CONCLUSIONS OF LAW

1. For the period on appeal from September 23, 2014 to October 15, 2019, the criteria for a 40 percent rating, but no higher, for degenerative arthritis of the lumbar spine have been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.102, 4.71a, Diagnostic Code 5242.

2. From July 31, 2014 to October 15, 2019, the criteria for the maximum 10 percent rating for left hip trochanteris pain syndrome and strain (limitation of extension) have been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.102, 4.71a, Diagnostic Code 5251.

3. From July 31, 2014 to October 15, 2019, the criteria for a 30 percent rating, but no higher, for left hip trochanteris pain syndrome and strain (limitation of flexion) have been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.102, 4.71a, Diagnostic Code 5252.

4. From July 31, 2014 to October 15, 2019, the criteria for the maximum 20 percent rating for left hip trochanteris pain syndrome and strain (limitation of abduction/adduction) have been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.102, 4.71a, Diagnostic Code 5253.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served in the United States Army from November 1980 to October 1984, with additional service in the Army Reserve. The Board of Veterans' Appeals (Board) thanks the Veteran for his service to our country.

Procedural History

On July 31, 2014, the Veteran submitted an "informal claim" for an increase in his service-connected disabilities.

On August 4, 2014, VA sent a notification letter informing the Veteran that VA received his informal claim for benefits on July 31, 2014. He was advised that for VA to start processing his claim, he must complete, sign, and return the enclosed application, VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits.

On August 15, 2014
1980 to October 1984, with additional service in the Army Reserve. The Board of Veterans' Appeals (Board) thanks the Veteran for his service to our country.

Procedural History

On July 31, 2014, the Veteran submitted an "informal claim" for an increase in his service-connected disabilities.

On August 15, 2014, the Veteran submitted VA Form 21-526EZ, seeking "reevaluate lower back due to worsening conditions" and service connection for "left hip secondary to [service-connected] left ankle."

In an April 2015 rating decision, the Regional Office (RO) decreased the evaluation of degenerative arthritis of the lumbar spine to 20 percent effective September 23, 2014. The RO also granted service connection for (1) trochanteris pain syndrome and strain, left hip with limitation of adduction, with an evaluation of 10 percent; (2) trochanteris pain syndrome and strain, left hip with limitation of flexion, with an evaluation of 10 percent; and (3) trochanteris pain syndrome and strain, left hip with limitation of extension, with an evaluation of 0 percent. The RO assigned an effective date of July 31, 2014. The Veteran submitted timely substantive appeals.

In October 2018, the Veteran presented sworn testimony during a hearing before a Veterans Law Judge. A transcript of that hearing has been associated with the Veteran's claims file.

In an April 2019 decision, the Board remanded (1) entitlement to an increased rating for a lumbar spine disability, (2) entitlement to an increased rating for a left hip disability with limitation of flexion, (3) entitlement to an increased rating for a left hip disability with limitation of adduction, and (4) entitlement to an increased rating for a left hip disability with limitation of extension.

In an April 2020 rating decision, the Regional Office: (1) increased the evaluation of degenerative arthritis of the lumbar spine to 40 percent effective October 15, 2019; (2) increased the evaluation of trochanteris pain syndrome and strain, left hip with limitation of flexion, to 30 percent effective October 15, 2019; (3) increased the evaluation of trochanteris pain syndrome and strain, left hip with limitation of adduction, to 20 percent effective October 15, 2019; and (4) increased the evaluation of trochanteris pain syndrome and strain, left hip with limitation of extension, to 10 percent effective October 15, 2019.

In a concurrent April 2020 Supplemental Statement of the Case (SSOC), the Regional Office (1) continued the evaluation of degenerative arthritis of the lumbar spine as 20 percent disabling from September 23, 2014 to October 15, 2019; (2) continued the evaluation of trochanteris pain syndrome and strain, left hip with limitation of flexion, as 10 percent disabling from July 31, 2014 to October 15, 2019; (3) continued the evaluation of trochanteris pain syndrome and strain, left hip with limitation of adduction, as 10 percent disabling from July 31, 2014 to October 15, 2019; and (4) continued the evaluation of trochanteris pain syndrome and strain, left hip with limitation of extension, as 0 (zero) percent disabling from July 31, 2014 to October 15, 2019.

Later in April 2020, the Veteran opted into the modernized review system by timely filing a VA Form 20-0996, Decision Review Request: Higher-Level Review.

In the September 2020 higher level review decision on appeal, the Regional Office (1) denied entitlement to an earlier effective date (prior to October 15, 2019) for the increased evaluation of 40 percent assigned for degenerative arthritis of the lumbar spine, (2) denied entitlement to an earlier effective date (prior to October 15, 2019) for the increased evaluation of 30 percent assigned for trochanteris pain syndrome and strain, left hip with limitation of flexion, (3) denied entitlement to an earlier effective date (prior to October 15, 2019) for the increased evaluation of 20 percent assigned for trochanteris pain syndrome and strain, left hip with limitation of adduction, and
2020 higher level review decision on appeal, the Regional Office (1) denied entitlement to an earlier effective date (prior to October 15, 2019) for the increased evaluation of 40 percent assigned for degenerative arthritis of the lumbar spine, (2) denied entitlement to an earlier effective date (prior to October 15, 2019) for the increased evaluation of 30 percent assigned for trochanteris pain syndrome and strain, left hip with limitation of flexion, (3) denied entitlement to an earlier effective date (prior to October 15, 2019) for the increased evaluation of 20 percent assigned for trochanteris pain syndrome and strain, left hip with limitation of adduction, and (4) denied entitlement to an earlier effective date (prior to October 15, 2019) for the increased evaluation of 10 percent assigned for trochanteris pain syndrome and strain, left hip with limitation of extension.

In the December 14, 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket.

A Board hearing was held on May 22, 2024. A transcript of the hearing has been associated with the Veteran's claims file. During the hearing, the undersigned identified the issues on appeal as entitlement to an earlier effective dates. In the interest of simplicity, the Board has characterized the Veteran's issues on appeal as entitlement to increased ratings.

Therefore, the Board may only consider the evidence of record at the time of the April 2020 Supplemental Statement of the Case (SSOC), as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. §?20.302(a). If evidence was submitted either (1) during the period after the agency of original jurisdiction (AOJ) issued the April 2020 SSOC and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted and the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. 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. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Increased Ratings

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule). The percentage ratings in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. When the appeal arises from an initially assigned rating, consideration must be given to whether a "staged" rating should be assigned to reflect entitlement to a higher rating at any point during the pendency of the claim. Fenderson v. West, 12 Vet. App. 119 (1999). Staged ratings are appropriate in any increased rating claim in which distinct periods with different ratable symptoms can be identified. Hart v. Mansfield, 21 Vet. App. 505 (2007).

When there is a question as to which of two evaluations will be assigned, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. Reasonable doubt regarding the degree of disability is to be resolved in favor of the claimant. 38 C.F.R. § 4.3. A claim will only be denied if the weight of the persuasive evidence is against the claim. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

Musculoskeletal Disabilities

In determining the appropriate evaluation for musculoskeletal disability, particular attention is focused on functional loss of use of the affected part(s). Under 38 C.F.R. § 4.40, functional loss may be due to pain, supported by adequate pathology and evidenced by visible behavior on motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Under 38 C.F.R. § 4.45, factors of joint disability include increased or limited motion, weakness, fatigability, or painful movement, swelling, deformity or disuse atrophy. Under 38 C.F.R. § 4.59, painful motion is an important factor of joint disability, and actually painful joints are entitled to at least the minimum compensable rating for the joint.

When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a (musculoskeletal system) or § 4.73 (muscle injury); a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a [or 4.73] criteria."). Moreover, joint testing is to be conducted on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. Correia v. McDonald, 28 Vet. App. 158, 170 (2016).

In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the Veterans themselves, when a flare-up is not observable at the time of the examination.

The provisions of 38 C.F.R. §§ 4.40 and 4.45 permit consideration of ankylosis ratings if a claimant's functional loss is the functional equivalent of ankylosis. Chavis v. McDonough, 34 Vet. App. 1 (2021).

In Ingram v. Collins, 38 Vet. App. 130 (2025), the Court held that the Board is to take due consideration that the beneficial effects of medication are discounted in assessing musculoskeletal ratings as such effects are not contemplated therein and, therefore, taking medication may make a veteran appear less disabled in reality.

1. Entitlement to a rating higher than 20 percent for degenerative arthritis of the lumbar spine from September 23, 2014 to October 15, 2019.

In an October 2013 rating decision, the Regional Office (RO) granted service connection for degenerative arthritis of the lumbar spine with an evaluation of 40 percent effective February 27, 2013. The Veteran submitted an "informal claim" for an increase in his service-connected disability on July 31, 2014. On August 15, 2014, he submitted his completed application (VA Form 21-526EZ) seeking "reevaluation lower back due to worsening conditions."

In an April 2015 rating decision, the evaluation of degenerative arthritis of the lumbar spine was decreased
degenerative arthritis of the lumbar spine from September 23, 2014 to October 15, 2019.

In an April 2015 rating decision, the evaluation of degenerative arthritis of the lumbar spine was decreased to 20 percent effective September 23, 2014. The Veteran submitted a timely substantive appeal.

In an April 2019 decision, the Board remanded entitlement to an increased rating for a lumbar spine disability.

In a subsequent April 2020 rating decision, the evaluation of degenerative arthritis of the lumbar spine was increased to 40 percent effective October 15, 2019. In a concurrent April 2020 SSOC, the RO continued the evaluation of degenerative arthritis of the lumbar spine as 20 percent disabling from September 23, 2014 to October 15, 2019.

In the September 2020 higher level review decision on appeal, the RO denied entitlement to an earlier effective date (prior to October 15, 2019) for the increased evaluation of 40 percent assigned for degenerative arthritis of the lumbar spine. In the December 14, 2020 VA Form 10182.

The Veteran's degenerative arthritis of the lumbar spine is currently rated as 40 percent disabling from February 27, 2013 to September 23, 2014, as 20 percent disabling from September 23, 2014 to October 15, 2019, and as 40 percent disabling thereafter, under 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5242.

The Veteran and his representative maintain the Veteran is entitled to an effective date prior to October 15, 2019, for his 40 percent rating for degenerative arthritis of the lumbar spine. See December 2020 VA Form 10182; see also May 2024 Hearing Transcript. Essentially, the Veteran disagreed with VA's decision to reduce the evaluation from 40 percent disabling to 20 percent effective September 23, 2014. See May 2015 Notice of Disagreement.

Therefore, the relevant period of consideration is from September 23, 2014 to October 15, 2019.

While portions of the Rating Schedule addressing the musculoskeletal system were revised effective February 7, 2021, this diagnostic code was not changed.

Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted when there is 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 when there is 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 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 rating of 100 percent is warranted where unfavorable ankylosis of the entire spine is demonstrated. 38 C.F.R. § 4.71a, Diagnostic Code 5242.

Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. Id.

Note (2): For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum
thoracolumbar spine. A rating of 100 percent is warranted where unfavorable ankylosis of the entire spine is demonstrated. 38 C.F.R. § 4.71a, Diagnostic Code 5242.

Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code. Id.

Note (2): For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Id.

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 (zero degrees) always represents favorable ankylosis. Id. at Note (5).

The requirement of ankylosis in the General Rating Formula for Injuries and Diseases of the Spine can be met with evidence of the functional equivalent of ankylosis (i.e., functional immobility of the joint) during a flare-up. Chavis v. McDonough, 34 Vet. App. 1 (2021).

Factual Background

In November 2013, the Veteran presented to the VA Lawton Outpatient Clinic (OPC) for annual follow-up. The examining physician noted the Veteran's history of back pain. He was on gabapentin, Lortab, methocarbamol and Tylenol. On examination, there was lumbar spine tenderness; pain with flexion; straight leg raise slightly positive on the left; and straight leg raise negative on the right. The examiner assessed back pain and recommended the Veteran discontinue Tylenol; increase gabapentin dose, ordered transdermal ointment and TENS unit.

In December 2013, the Veteran attended a TENS unit class at the Oklahoma City VA Medical Center (VAMC). The physician noted the Veteran's diagnosed low back pain and remarked the Veteran will benefit from use of TENS unit to help manage pain.

In March 2014, the Veteran presented to the VA Lawton OPC. He reported chronic pain in his lower back, at a level of 7/10 in severity. He stated he was not satisfied with the current pain level. The examining physician assessed osteoarthritis, diffuse, low back. The examining physician noted the Veteran's treatment plan: increase hydrocodone and Neurontin; continue methocarbamol and TENS unit; and start Mobic.

The Veteran submitted to a VA Back Conditions examination in September 2014. The examiner diagnosed degenerative arthritis, lumbar spine. The Veteran reported the diagnosed condition began as the result of an injury in the service. His lumbar spine condition had worsened. He reported flare-ups described as pain and difficulty bending and kneeling. His treatment plan included a TENS unit.

On examination, initial range of motion testing demonstrated forward flexion to 60 degrees, extension to 15 degrees, right lateral flexion to 15 degrees, left lateral flexion to 10 degrees, right lateral rotation to 10 degrees, and left lateral rotation to 10 degrees. There was objective evidence of painful motion with forward flexion at 45 degrees, extension at 10 degrees, right lateral flexion at 15 degrees, left lateral flexion at 10 degrees, right lateral rotation at 10 degrees, and left lateral rotation at 10 degrees. Range of motion measurements after repetitive-use testing demonstrated forward flexion to 50 degrees, extension to 10 degrees, right lateral flexion to 15 degrees, left lateral flexion to 10 degrees, right lateral rotation to 10 degrees, and left lateral rotation to 10 degrees. There was functional loss and/or functional impairment of the thoracolumbar spine. Additional factors contributing to his disability included less movement than normal, excess fatigability, pain on movement, and interference with sitting, standing and/or weight-bearing. There was objective evidence of paralumbar tenderness. Muscle strength testing was normal. There was no evidence of muscle atrophy. Reflex exam (deep tendon reflexes) was normal. Sensory exam was normal. Straight leg raising test was negative. There was no evidence of
to 50 degrees, extension to 10 degrees, right lateral flexion to 15 degrees, left lateral flexion to 10 degrees, right lateral rotation to 10 degrees, and left lateral rotation to 10 degrees. There was functional loss and/or functional impairment of the thoracolumbar spine. Additional factors contributing to his disability included less movement than normal, excess fatigability, pain on movement, and interference with sitting, standing and/or weight-bearing. There was objective evidence of paralumbar tenderness. Muscle strength testing was normal. There was no evidence of muscle atrophy. Reflex exam (deep tendon reflexes) was normal. Sensory exam was normal. Straight leg raising test was negative. There was no evidence of radicular pain or other neurological abnormalities (such as bowel or bladder problems/pathologic reflexes). He did not have intervertebral disc syndrome (IVDS) of the thoracolumbar spine. Regarding functional impact, the examiner remarked the Veteran's thoracolumbar spine (back) condition impacted his ability to work.

Lastly, the examiner remarked there are contributing factors of pain, weakness, fatigability and/or incoordination and there is additional limitation of functional ability of the thoracolumbar spine during flare-ups or repeated use over time. Regarding functional impairment of the back joint during flare-ups or extended use, pain and fatigability could significantly limit functional ability during flare-ups or when the joint is used repeatedly over time. Specific degrees of range of motion limitation cannot be provided as direct observation over an extended period of time would be required. As such, providing additional range of motion limitation for the joint is unfeasible.

In an April 2015 VA Lawton OPC physician letter, the Veteran was advised additional test results include: impression: Bony structures show degenerative change of the lower thoracic spine.

In his May 2015 statement, the Veteran expressed disagreement with the evaluation of his service-connected disability. He stated, "my back is not getting any better, only worse. It is hard for me to get around; I cannot sit or stand for very long before the pain becomes too bearable [sic]. I am taking pain medication, but it is getting to the point where it is becoming ineffective." He stated the September 2014 VA examiner did not adequately assess the severity of his back condition. He reported on April 27, 2015, x-rays were done at Reynolds Army Community Hospital, and the bony structures show degenerative change to the lower thoracic spine. See May 2015 Notice of Disagreement.

In June 2015, the Veteran presented to the Oklahoma City VAMC for health maintenance. The examining physician noted the Veteran's history included injury to back, hip and ankle. On examination, lumbar spine demonstrated decreased range of motion. The physician assessed lower back pain and referred the Veteran for x-rays. In a July 2015 VA primary care message, the Veteran was notified his recent lumbar spine x-rays showed "arthritis changes."

In a March 2016 private chiropractic treatment record, the Veteran described moderate constant aching low back pain. Dr. J.T. noted the Veteran's medications included: metformin, hydrocodone, and methocarbamol. He had been assigned the following diagnoses: low back pain, sciatica, right side, and pain in thoracic spine. On examination, there was objective evidence of subluxation of the L3, L4, L5, and S1 segments with a moderate degree of restricted mobility. Muscle hypertonicity was evident to a moderate degree affecting the lumbar region. Numbness was found to a moderate degree affecting the lumbar region. Edema was revealed to a moderate degree affecting the lumbar region. The range of motion in the lumbar region was found to be decreased.

In a June 2016 VA treatment record, the Veteran reported chronic pain in his lower back. He described the pain as dull, sharp, and burning, at a level of 7/10 in severity. The pain was constant, with more frequent breakthroughs and higher intensity than usual. The pain was made worse by walking, standing, sitting, lying down, bending over and exercise. The pain interfered with activities of daily living, his relationships, his mood, concentration, sleep and mobility. He stated, "nothing makes it better."

In a January 2018 VA outpatient note, the Veteran requested consultation for a chiropractor in reference to his back and his hip. In a January 2018 VA orthopaedic surgery e-consult note the physician consulted the Veteran's chart and remarked, "predominantly axial back pain. Patient has not had physical therapy. He has attempted opioids, NSAIDs, chiropractor, and TENS. Operative treatment generally does not improve purely axial back pain in the absence of instability." The physician recommended the Veteran
by walking, standing, sitting, lying down, bending over and exercise. The pain interfered with activities of daily living, his relationships, his mood, concentration, sleep and mobility. He stated, "nothing makes it better."

In a January 2018 VA outpatient note, the Veteran requested consultation for a chiropractor in reference to his back and his hip. In a January 2018 VA orthopaedic surgery e-consult note the physician consulted the Veteran's chart and remarked, "predominantly axial back pain. Patient has not had physical therapy. He has attempted opioids, NSAIDs, chiropractor, and TENS. Operative treatment generally does not improve purely axial back pain in the absence of instability." The physician recommended the Veteran complete conservative management for spinal concerns to include: physical therapy (including pain modalities); neuropathic agents; attempt oral (PO) anti-inflammatories on a daily basis if health allows; attempt to treat with topical analgesics; heating pad, TENs, back brace (only periodic use); neurology outpatient which has a Pain Rehab Program; therapeutic recreation (yoga); osteopathic manipulation, acupuncture, chiropractor, and weight reduction, MOVE.

In a September 2018 VA treatment record, the Veteran reported chronic pain in his lower back. He described the pain as constant, sharp, at a level of 3/10 in severity. The pain was made worse by walking and bending over. The pain interfered with activities of daily living. He stated, "nothing makes it better."

In October 2018, the Veteran presented sworn testimony during a hearing. The Veteran testified his lumbar spine disability had worsened. He reported chronic lower back pain and flare-ups. His treatment plan included pain medication, pain relief gel, TENS unit, muscle relaxers, and chiropractic treatment; he used a cane and lumbar brace. medication, muscle relaxers, and physical therapy; he used a lumbar brace and a cane. See August 2013 Hearing Transcript.

In August 2019, the Veteran presented to the Oklahoma City VAMC for 6-month follow-up. The examining physician noted chronic low back pain, ankle pain, hip pain, been on narcotic (Norco) with diclofenac gel. The physician assessed chronic pain, lower back pain, ankle, hip pain; continue current medications.

Pursuant to the April 2019 Board remand order, the Veteran submitted to a VA Back Conditions examination on October 15, 2019. Based on this examination, the evaluation of degenerative arthritis of the lumbar spine was increased to 40 percent effective October 15, 2019.

As noted above, in May 2024, the Veteran and his spouse presented sworn testimony during a video-conference hearing. The Veteran testified his lumbar spine disability had worsened. The Veteran testified that while conducting range of motion testing, the September 2014 VA examiner failed to instruct the Veteran to "stop when it hurt, or if it hurts," just to move as "far as he could." He stated he was only able to attend the examination because he took his pain medication beforehand. He stated his pain has never gotten any better, in fact, it has progressed. He described the pain as "unbearable" and without the use of medication there is "just no way I could motivate." He required the use of a cane. The Veteran's representative argued that the VA examiner failed to capture the functional impairment the Veteran experienced during flare-ups. Additionally, there was no evidence that the examiner discussed the beneficial effects of the Veteran's medication.

Analysis

Given the totality of the evidence, when considering the Veteran's competent and credible reports of limited thoracolumbar spine motion and pain, combined with his consistent reports of flare-ups, functional loss/functional impairment, and tenderness, the Board finds that a 40 percent rating is warranted for the entire period on appeal from September 23, 2014 to October 15, 2019.

While the Veteran was awarded the increased rating of 40 percent as of the date of the VA Back Conditions examination, effective dates should not be mechanically assigned based solely on the date of the examination but should include consideration of all the facts to determine the date that the increase in the disability was ascertainable. See Swain v. McDonald, 27 Vet. App. 219 (2015).

In reviewing the evidence, the Board has considered functional loss due to pain and weakness that causes additional disability beyond that which is reflected on range of motion measurements. 38 C.F.R. § 4.40; DeLuca, 8 Vet. App. 202. The Board has also considered the effects of less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, impaired ability to execute skilled movements smoothly, and pain on movement, swelling
assigned based solely on the date of the examination but should include consideration of all the facts to determine the date that the increase in the disability was ascertainable. See Swain v. McDonald, 27 Vet. App. 219 (2015).

In reviewing the evidence, the Board has considered functional loss due to pain and weakness that causes additional disability beyond that which is reflected on range of motion measurements. 38 C.F.R. § 4.40; DeLuca, 8 Vet. App. 202. The Board has also considered the effects of less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, impaired ability to execute skilled movements smoothly, and pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45. The Board accepts the Veteran's competent assertions that his thoracolumbar spine is painful and as described in the VA examination and medical records, he has additional loss of motion and pain with repeated use over time and during flare-ups.

In sum, the most probative evidence establishes that the Veteran's lumbar spine disability more nearly approximates forward flexion of 30 degrees or less from September 23, 2014 to October 15, 2019. As such, a rating of 40 percent is warranted. To the extent that the Veteran seeks an even higher rating, the weight of the evidence is against the claim as there is no evidence of ankylosis or the functional equivalent of it. 38 C.F.R. § 4.71a, DC 5242. There is no probative medical or lay evidence supporting a finding of unfavorable ankylosis of the entire thoracolumbar spine, including the "functional equivalent" thereof. See Chavis, 34 Vet. App. at 20. VA examination during this period shows flexion was limited between 30 and 60 degrees.

The Board acknowledges the Veteran's complaint of flare-ups. In rating disability, frequency, severity and duration is of concern. While the Board acknowledges the Veteran's severe limitation of range of motion noted during the Veteran's flare-ups of his thoracolumbar spine disability, the evidence of record does not show the Veteran's thoracolumbar spine was fixed in flexion or extension. Favorable ankylosis is a fixation of a spinal segment in a neutral position (zero degrees), while unfavorable ankylosis is defined by regulation as "a condition in which 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; the restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to the 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." 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (5). Here, the Veteran does not have any of these factors.

Moreover, there is no contention or indication that he is entitled to a higher rating under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. See 38 C.F.R. § 4.71a, DC 5243. The September 2014 VA examiner noted the Veteran did not have IVDS of the thoracolumbar spine.

Based on the foregoing, and resolving all reasonable doubt in the Veteran's favor, the Board finds a 40 percent rating, but no higher, for degenerative arthritis of the lumbar spine from September 23, 2014 to October 15, 2019 is warranted. 38 C.F.R. §§ 3.102, 4.71a; Lynch, 21 F.4th 776.

2. Entitlement to an initial compensable rating for left hip trochanteris pain syndrome and strain (limitation of extension) prior to October 15, 2019.

3. Entitlement to an initial rating higher than 10 percent for left hip trochanteris pain syndrome and strain (limitation of flexion) prior to October 15, 2019.

4. Entitlement to an initial rating higher than 10 percent for left hip trochanteris pain syndrome and strain (limitation of abduction/adduction) prior to October 15, 2019.

3. Entitlement to an initial rating higher than 10 percent for left hip trochanteris pain syndrome and strain (limitation of flexion) prior to October 15, 2019.

4. Entitlement to an initial rating higher than 10 percent for left hip trochanteris pain syndrome and strain (limitation of abduction/adduction) prior to October 15, 2019.

The Veteran and his representative maintain the Veteran is entitled to an effective date prior to October 15, 2019 for his: (i) 10 percent rating for left hip trochanteris pain syndrome and strain (limitation of extension), (ii) 30 percent evaluation for left hip trochanteris pain syndrome and strain (limitation of flexion), and (iii) 20 percent rating for left hip trochanteris pain syndrome and strain (limitation of abduction/adduction). See December 2020 VA Form 10182; see also May 2024 Hearing Transcript. Essentially, the Veteran disagreed with VA's decision to increase the evaluations of his service-connected left hip trochanteris pain syndrome and strain (limitation of extension, limitation of flexion, and limitation of abduction/adduction) effective October 15, 2019. He wants these increased ratings to be effective July 31, 2014.

On August 15, 2014, the Veteran submitted VA Form 21-526EZ, seeking service connection for "left hip secondary to [service-connected] left ankle."

In an April 2015 rating decision, the Regional Office (RO) granted service connection for (1) trochanteris pain syndrome and strain, left hip with limitation of adduction, with an evaluation of 10 percent; (2) trochanteris pain syndrome and strain, left hip with limitation of flexion, with an evaluation of 10 percent; and (3) trochanteris pain syndrome and strain, left hip with limitation of extension, with an evaluation of 0 percent. The RO assigned an effective date of July 31, 2014. The Veteran submitted a timely substantive appeal.

In an April 2019 decision, the Board remanded (1) entitlement to an increased rating for a left hip disability with limitation of flexion, (2) entitlement to an increased rating for a left hip disability with limitation of adduction, and (3) entitlement to an increased rating for a left hip disability with limitation of extension.

In an April 2020 rating decision, the RO: (1) increased the evaluation of trochanteris pain syndrome and strain, left hip with limitation of flexion, to 30 percent; (2) increased the evaluation of trochanteris pain syndrome and strain, left hip with limitation of adduction, to 20 percent; and (3) increased the evaluation of trochanteris pain syndrome and strain, left hip with limitation of extension, to 10 percent. The RO assigned an effective date of October 15, 2019, the date of the VA Hip and Thigh Conditions examination.

In a concurrent April 2020 SSOC, the RO (1) continued the evaluation of trochanteris pain syndrome and strain, left hip with limitation of flexion, as 10 percent disabling from July 31, 2014 to October 15, 2019; (2) continued the evaluation of trochanteris pain syndrome and strain, left hip with limitation of adduction, as 10 percent disabling from July 31, 2014 to October 15, 2019; and (3) continued the evaluation of trochanteris pain syndrome and strain, left hip with limitation of extension, as 0 (zero) percent disabling from July 31, 2014 to October 15, 2019.

In the September 2020 higher level review decision on appeal, the RO (1) denied entitlement to an earlier effective date (prior to October 15, 2019) for the increased evaluation of 30 percent assigned for trochanteris pain syndrome and strain, left hip with limitation of flexion, (2) denied entitlement to an earlier effective date (prior to October 15, 2019) for the increased evaluation of 20 percent assigned for trochanteris pain syndrome and strain, left hip with limitation of adduction, and (3) denied entitlement to an earlier effective date (prior to October 15, 2019) for the increased evaluation of 10 percent assigned for trochanteris pain syndrome and strain, left hip with limitation of extension. In the December 14, 2020 VA Form 10182.

Therefore, the relevant period of consideration is from July 31, 2014 to October 15,
trochanteris pain syndrome and strain, left hip with limitation of flexion, (2) denied entitlement to an earlier effective date (prior to October 15, 2019) for the increased evaluation of 20 percent assigned for trochanteris pain syndrome and strain, left hip with limitation of adduction, and (3) denied entitlement to an earlier effective date (prior to October 15, 2019) for the increased evaluation of 10 percent assigned for trochanteris pain syndrome and strain, left hip with limitation of extension. In the December 14, 2020 VA Form 10182.

Therefore, the relevant period of consideration is from July 31, 2014 to October 15, 2019.

The Veteran's left hip trochanteris pain syndrome and strain (limitation of extension) is currently rated as 0 percent disabling from July 31, 2014 to October 15, 2019, as 10 percent disabling from October 15, 2019 to March 8, 2021, and as 0 percent disabling thereafter, under 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5251.

The Veteran's left hip trochanteris pain syndrome and strain (limitation of flexion) is currently rated as 10 percent disabling from July 31, 2014 to October 15, 2019, as 30 percent disabling from October 15, 2019 to March 8, 2021, and as 20 percent disabling thereafter, under 38 C.F.R. § 4.71a, DC 5252.

The Veteran's left hip trochanteris pain syndrome and strain (limitation of abduction/adduction) is currently rated as 10 percent disabling from July 31, 2014 to October 15, 2019, as 20 percent disabling from October 15, 2019 to March 8, 2021, and as 0 percent disabling thereafter, under 38 C.F.R. § 4.71a, DC 5253.

While portions of the Rating Schedule addressing the musculoskeletal system were revised effective February 7, 2021, this diagnostic code was not changed.

Under DC 5151, extension limited to 5 degrees warrants a 10 percent rating. 38 C.F.R. § 4.71a, DC 5251.

Under DC 5252, flexion limited to 45 degrees warrants a 10 percent rating; flexion limited to 30 degrees warrants a 20 percent rating; flexion limited to 20 degrees warrants a 30 percent rating; and flexion limited to 10 degrees warrants a 40 percent rating. 38 C.F.R. § 4.71a, DC 5252.

Under DC 5253, limitation of rotation of hip (cannot toe-out more than 15 degrees) warrants a 10 percent rating; limitation of adduction (cannot cross legs) warrants a 10 percent rating; and limitation of abduction, motion lost beyond 10 degrees, warrants a 20 percent rating. 38 C.F.R. § 4.71a, DC 5253.

Flexion of the hip to 125 degrees is considered full, and abduction to 45 degrees is considered full. 38 C.F.R. § 4.71a, Plate II.

Factual Background

The Veteran submitted to a VA Hip and Thigh Conditions examination in March 2015. The examiner diagnosed left hip trochanteris pain syndrome (includes trochanteric bursitis) and chronic left hip strain. The Veteran reported the onset of his left hip symptoms in 2011. He reported having trouble with his left hip since his ankle accident. His left hip condition has gotten worse. He reported flare-ups described as "it gets impossible to walk, I am always in pain." He reported functional loss/functional impairment described as "I can't run. Can't walk long distances." He wore a TENS unit for his back disability.

Initial range of motion for left hip flexion was measured from 0 to 40 degrees, extension from 0 to 10 degrees, abduction from 0 to 20 degrees, adduction from 0 to 10 degrees, external rotation from 0 to 20 degrees, and internal rotation from 0 to 10 degrees. Adduction was limited such that the Veteran could not cross legs. There was objective evidence of pain on motion, with weight-bearing, and "over hip joint." The Veteran was unable to perform repetitive use testing with at least three repetitions because it was "too painful to attempt." The examiner was unable to say without mere speculation whether pain, fatigue, lack of endurance, or incoordination could significantly limit functional ability during flare-ups, or when
hip flexion was measured from 0 to 40 degrees, extension from 0 to 10 degrees, abduction from 0 to 20 degrees, adduction from 0 to 10 degrees, external rotation from 0 to 20 degrees, and internal rotation from 0 to 10 degrees. Adduction was limited such that the Veteran could not cross legs. There was objective evidence of pain on motion, with weight-bearing, and "over hip joint." The Veteran was unable to perform repetitive use testing with at least three repetitions because it was "too painful to attempt." The examiner was unable to say without mere speculation whether pain, fatigue, lack of endurance, or incoordination could significantly limit functional ability during flare-ups, or when the joint is used repeatedly over a period of time. Additional factors contributing to his disability included instability of station, disturbance of locomotion, interference with sitting, and interference with standing. Muscle strength testing was normal. There was no evidence of muscle atrophy. There was no ankylosis. There was no malunion or nonunion of femur, flail hip joint or leg length discrepancy. He required the constant use of a cane. Regarding functional impact, the examiner remarked the Veteran's left hip condition impacted his ability to work.

In June 2015, the Veteran presented to the Oklahoma City VAMC for health maintenance. The examining physician noted the Veteran's history included injury to back, hip and ankle.

In his September 2015 statement, the Veteran expressed disagreement with the evaluations of his service-connected disability. He stated, "I believe that my disabilities are considerably more disabling than 70 percent, and each disability is considerably more disabling than what was noted on the VA rating decision." See September 2015 Notice of Disagreement.

In a March 2016 private chiropractic treatment record, the Veteran reported moderately severe constant aching pain in the left hip.

In June 2016, the Veteran presented to the Oklahoma VAMC for yearly follow-up. He reported severe pain in the left hip. He requested to have x-rays and to increase his pain medications if possible. On examination there was decreased range of motion in his left hip. The examining physician assessed left hip pain, ordered x-rays, and increased pain medication (hydrocodone) to 4 pills a day. In a June 2016 addendum, the primary care physician remarked, "please call patient, he has arthritis in hip."

In a July 2017 private chiropractic treatment record, the Veteran reported pain in the left hip. In a November 2017 private chiropractic treatment record, the Veteran reported constant aching pain in the left hip at a 9/10 level of severity.

In a January 2018 VA outpatient note, the Veteran requested consultation for a chiropractor in reference to his back and his hip.

In a February 2018 VA content for long-term opioid therapy for pain treatment note, the physician noted the reason for long-term opioid therapy: left ankle, left knee, and left hip. Location of pain: ankle, hip and knee. Name of current or initial opioid medication: Lortab, 3 to 4 times a day as needed.

In October 2018, the Veteran presented sworn testimony during a hearing. The Veteran testified his left hip disability had worsened. He reported chronic hip pain and flare-ups. He stated his hip "pops" when he walks. He stated his left hip "just hurts all the time." He stated, ". . . I'm allotted pain medication for all the pain that I'm in, and they give me 112 pills a month, and that doesn't last." He reiterated, "it's just a lot of pain." See August 2013 Hearing Transcript.

Pursuant to the April 2019 Board remand order, the Veteran submitted to a VA Hip and Thigh Conditions examination on October 15, 2019. Based on this examination, the evaluation of trochanteris pain syndrome and strain, left hip with limitation of flexion, was increased to 30 percent effective October 15, 2019; the evaluation of trochanteris pain syndrome and strain, left hip with limitation of adduction, was increased to 20 percent effective October 15, 2019; and the evaluation of trochanteris pain syndrome and strain, left hip with limitation of extension, was increased to 10 percent effective October 15, 2019.

As noted above, in May 2024, the Veteran and his spouse presented
and order, the Veteran submitted to a VA Hip and Thigh Conditions examination on October 15, 2019. Based on this examination, the evaluation of trochanteris pain syndrome and strain, left hip with limitation of flexion, was increased to 30 percent effective October 15, 2019; the evaluation of trochanteris pain syndrome and strain, left hip with limitation of adduction, was increased to 20 percent effective October 15, 2019; and the evaluation of trochanteris pain syndrome and strain, left hip with limitation of extension, was increased to 10 percent effective October 15, 2019.

As noted above, in May 2024, the Veteran and his spouse presented sworn testimony during a video-conference hearing. The Veteran testified his left hip disability had worsened. He reported "good days" and "worse days," described as "some days I can't get out of bed." He stated he takes medications for the pain every day and without the use of medication there is "just no way I could motivate." He stated that while conducting range of motion testing, the March 2015 VA examiner failed to ask the Veteran any questions, for example, the examiner never asked the Veteran whether he experienced any pain during the examination and if so, at what point he experienced pain on range of motion testing. He stated he was only able to attend the examination because he took his pain medication beforehand. The Veteran's representative argued that the VA examiner failed to capture the functional impairment the Veteran experienced during flare-ups. Additionally, there was no evidence that the examiner discussed the beneficial effects of the Veteran's medication.

Analysis: Left hip trochanteris pain syndrome and strain (limitation of extension)

Given the totality of the evidence, when considering the Veteran's competent and credible reports of limited left hip motion and pain, combined with his consistent reports of flare-ups and functional loss/functional impairment, the Board finds a 10 percent rating, but no higher, is warranted prior to October 15, 2019.

While the Veteran was awarded the increased rating of 10 percent as of the date of the VA Hip and Thigh Conditions examination, effective dates should not be mechanically assigned based solely on the date of the examination but should include consideration of all the facts to determine the date that the increase in the disability was ascertainable. See Swain, 27 Vet. App. 219.

In reviewing the evidence, the Board has considered functional loss due to pain and weakness that causes additional disability beyond that which is reflected on range of motion measurements. 38 C.F.R. § 4.40, DeLuca, 8 Vet. App. 202. The Board has also considered the effects of less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, impaired ability to execute skilled movements smoothly, and pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45. The Board accepts the Veteran's competent and credible assertions that his left hip is painful and as described in the VA examination and medical records, he has additional loss of motion and pain with repeated use over time and during flare-ups.

In sum, the most probative evidence establishes that the Veteran's left hip trochanteris pain syndrome and strain disability more nearly approximates limitation of extension to 5 degrees prior to October 15, 2019. As such, a maximum rating of 10 percent is warranted.

Based on the foregoing, and resolving all reasonable doubt in the Veteran's favor, the Board finds a 10 percent rating, but no higher, for left hip trochanteris pain syndrome and strain (limitation of extension) from July 31, 2014 to October 15, 2019 is warranted. 38 C.F.R. §§ 3.102, 4.71a; Lynch, 21 F.4th 776.

Analysis: Left hip trochanteris pain syndrome and strain (limitation of flexion)

Given the totality of the evidence, when considering the Veteran's competent and credible reports of limited left hip motion and pain, combined with his consistent reports of flare-ups and functional loss/functional impairment, the Board finds a 30 percent rating, but no higher, is warranted prior to October 15, 2019.

While the Veteran was awarded the increased rating of 30 percent as of the date of the VA Hip and Thigh Conditions examination, effective dates should not be mechanically assigned based solely on the date of the examination but should include consideration of all the facts to determine the date that the increase in the disability was ascertainable. See Swain, 27 Vet. App. 219.

In reviewing the evidence, the Board has considered functional loss due to pain and weakness that causes additional disability beyond that which
and credible reports of limited left hip motion and pain, combined with his consistent reports of flare-ups and functional loss/functional impairment, the Board finds a 30 percent rating, but no higher, is warranted prior to October 15, 2019.

In reviewing the evidence, the Board has considered functional loss due to pain and weakness that causes additional disability beyond that which is reflected on range of motion measurements. 38 C.F.R. § 4.40, DeLuca, 8 Vet. App. 202. The Board has also considered the effects of less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, impaired ability to execute skilled movements smoothly, and pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45. The Board accepts the Veteran's competent and credible assertions that his left hip is painful and as described in the VA examination and medical records, he has additional loss of motion and pain with repeated use over time and during flare-ups.

In sum, the most probative evidence establishes that the Veteran's left hip trochanteris pain syndrome and strain disability more nearly approximates limitation of flexion to 20 degrees prior to October 15, 2019. As such a rating of 30 percent is warranted. To the extent the Veteran seeks an even higher rating, the weight of the evidence is against the claim. Even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by his statements would not result in limitation of motion that more nearly approximate flexion limited to 10 degrees. The record reflects that, at worst, flexion was limited to 20 degrees.

Based on the foregoing, and resolving all reasonable doubt in the Veteran's favor, the Board finds a 30 percent rating, but no higher, for left hip trochanteris pain syndrome and strain (limitation of flexion) from July 31, 2014 to October 15, 2019 is warranted. 38 C.F.R. §§ 3.102, 4.71a; Lynch, 21 F.4th 776.

Analysis: Left hip trochanteris pain syndrome and strain (limitation of abduction/adduction)

Given the totality of the evidence, when considering the Veteran's competent and credible reports of limited left hip motion and pain, combined with his consistent reports of flare-ups and functional loss/functional impairment, the Board finds a 20 percent rating, but no higher, is warranted prior to October 15, 2019.

While the Veteran was awarded the increased rating of 20 percent as of the date of the VA Hip and Thigh Conditions examination, effective dates should not be mechanically assigned based solely on the date of the examination but should include consideration of all the facts to determine the date that the increase in the disability was ascertainable. See Swain, 27 Vet. App. 219.

In reviewing the evidence, the Board has considered functional loss due to pain and weakness that causes additional disability beyond that which is reflected on range of motion measurements. 38 C.F.R. § 4.40, DeLuca, 8 Vet. App. 202. The Board has also considered the effects of less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, impaired ability to execute skilled movements smoothly, and pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45. The Board accepts the Veteran's competent and credible assertions that his left hip is painful and as described in the VA examination and medical records, he has additional loss of motion and pain with repeated use over time and during flare-ups.

In sum, the most probative evidence establishes that the Veteran's left hip trochanteris pain syndrome and strain disability more nearly approximates limitation of abduction (motion lost beyond 10 degrees) prior to October 15, 2019. As such, a maximum rating of 20 percent is warranted.

Finally, the Veteran is not entitled to a higher or separate rating under diagnostic codes 5250, 5254, or 5255. There is no evidence of ankylosis or functional equivalent thereof, flail hip joint, or impairment of the femur.

Based on the foregoing, and resolving all reasonable doubt in the Veteran's favor, the Board finds a 10 percent rating for left hip tro

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