THIGH IMPAIRMENT OF

LEETRA J. HARRIS · 2026 · Case ID: A26031919

MIXED

Summary

The veteran appeals decisions from March 2021 concerning bilateral hip conditions. The veteran sought service connection for left and right hip limitation of flexion, and increased ratings for left and right hip limitation of abduction. The Board reviewed the evidence, including a March 2021 VA examination and testimony from a February 2025 hearing. The VA examination noted no crepitus, muscle atrophy, ankylosis, malunion, flail joint, or leg length discrepancy. Range of motion testing showed some limitations and pain, but the Board found these did not meet the criteria for a compensable rating for flexion limitations or an increased rating for abduction limitations. However, the Board found that the reduction of the veteran's 10 percent ratings for left and right hip limitation of extension due to pain, to 0 percent, was improper. The Board restored the 10 percent ratings for both hips, effective December 21, 2020, as there was no opinion of record regarding the effect of any improvements on the veteran's ability to function. Therefore, the claims for increased ratings for flexion and abduction were denied, while the reduction in extension ratings was overturned, restoring the prior 10 percent ratings.

Rationale

No compensable rating criteria met for flexion limitation; Range of motion limited to 110 degrees

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210623-168590

Full Decision Text

Citation Nr: A26031919
Decision Date: 04/07/26 Archive Date: 04/07/26

DOCKET NO. 210623-168590
DATE: April 7, 2026

ORDER

Entitlement to a compensable rating for left hip limitation of flexion is denied.

Entitlement to a compensable rating for right hip limitation of flexion is denied.

Entitlement to a rating greater than 10 percent for left hip limitation of abduction is denied.

Entitlement to a rating greater than 10 percent for right hip limitation of abduction is denied.

The rating reduction of left hip limitation of extension due to pain from 10 percent disabling to 0 percent disabling was improper; accordingly, the 10 percent rating is restored effective December 21, 2020.

The rating reduction of right hip limitation of extension due to pain from 10 percent disabling to 0 percent was improper; accordingly, the 10 percent rating is restored effective December 21, 2020.

FINDINGS OF FACT

1. During the period on appeal, the Veteran's left hip disability manifested as flexion to 110 degrees at worst.

2. During the period on appeal, the Veteran's right hip disability manifested as flexion to 110 degrees at worst.

3. During the period on appeal, the Veteran's left hip disability manifested as abduction to 30 degrees at worst and limitation of adduction to 10 degrees at worst, preventing the Veteran from crossing her legs.

4. During the period on appeal, the Veteran's right hip disability manifested as abduction to 30 degrees at worst and limitation of adduction to 10 degrees at worst, preventing the Veteran from crossing her legs.

5. In a March 2021 rating decision, the Veteran's left hip limitation of extension due to pain was reduced to 0 percent disabling, effective December 21, 2020. Any improvement shown on the March 23, 2021, hip and thigh examination did not reflect an improvement in the Veteran's ability to function under the ordinary conditions of life and work.

6. In a March 2021 rating decision, the Veteran's right hip limitation of extension due to pain was reduced to 0 percent disabling, effective December 21, 2020. Any improvement shown on the March 23, 2021, hip and thigh examination did not reflect an improvement in the Veteran's ability to function under the ordinary conditions of life and work.

CONCLUSIONS OF LAW

1. The criteria for a compensable rating for left hip limitation of flexion are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.44, 4.45, 4.71a, Diagnostic Code 5252.

2. The criteria for a compensable rating for right hip limitation of flexion are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.44, 4.45, 4.71a, Diagnostic Code 5252.

3. The criteria for a rating greater than 10 percent for left hip limitation of adduction and limitation of abduction are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.44, 4.45, 4.71a, Diagnostic Code 5253.

4. The criteria for a rating greater than 10 percent for right hip limitation of adduction and limitation of abduction are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.44, 4.45, 4.71a, Diagnostic Code 5253.

5. The rating reduction of left hip limitation of extension due to pain from 10 percent disabling to 0 percent was improper; accordingly, the 10 percent rating is restored effective December 21, 2020. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.105,
U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.44, 4.45, 4.71a, Diagnostic Code 5253.

5. The rating reduction of left hip limitation of extension due to pain from 10 percent disabling to 0 percent was improper; accordingly, the 10 percent rating is restored effective December 21, 2020. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.105, 3.344(c), 4.1, 4.2, 4.3, 4.7, 4.10, 4.71a, DC 5253.

6. The rating reduction of right hip limitation of extension due to pain from 10 percent disabling to 0 percent disabling was improper; accordingly, the 10 percent rating is restored effective December 21, 2020. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.105, 3.344(c), 4.1, 4.2, 4.3, 4.7, 4.10, 4.71a, DC 5253.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

These matters come before the Board of Veterans' Appeals (Board) on appeal from a March 2021 rating decision issued by a Department of Veterans Affairs (VA) regional office (RO). In the June 23, 2021, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on February 24, 2025. Therefore, the Board may only consider the evidence of record at the time of the March 26, 2021, agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran 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 AOJ issued the decision on appeal 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 that 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 claim[s], 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 rating criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule) and represent, as far as can practicably be determined, the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body, or the psyche, or a system or organ of the body to function under the ordinary conditions of daily life, including employment. 38 C.F.R. §§ 4.10, 3.321.

In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA compensation, as well as the whole recorded history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; see generally Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question of which of two evaluations shall be applied, the higher evaluation is assigned if the disability more closely approximates the criteria for that rating. 38 C.F.R. § 4.7. Otherwise, the lower rating is assigned. Id.

When there is an approximate balance of positive and negative evidence as to any issue material to the determination of a matter, reasonable doubt is resolved in the claimant's favor. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776
frath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question of which of two evaluations shall be applied, the higher evaluation is assigned if the disability more closely approximates the criteria for that rating. 38 C.F.R. § 4.7. Otherwise, the lower rating is assigned. Id.

Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1994). However, that is not the case where the Veteran has expressed dissatisfaction with the assignment of an initial rating following an initial award of service connection for that disability. Separate ratings may be assigned for separate periods of time based on the facts found-a practice known as "staged rating." Fenderson v. West, 12 Vet. App. 119, 126 (1999).

In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a veteran's service-connected disability. 38 C.F.R. § 4.14. It is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, 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. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994).

Although the Board has an obligation to provide reasons and bases supporting its decision, there is no obligation to discuss, in detail, the extensive evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as it relates to the Veteran's claim.

Hip Disability

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.").

However, a veteran may be entitled to a higher disability evaluation than that supported by mechanical application of the rating schedule where there is evidence that his or her disability causes "additional functional loss i.e., 'the inability... to perform the normal working movements of the body with normal excursion, strength, speed, coordination[,] and
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.").

However, a veteran may be entitled to a higher disability evaluation than that supported by mechanical application of the rating schedule where there is evidence that his or her disability causes "additional functional loss i.e., 'the inability... to perform the normal working movements of the body with normal excursion, strength, speed, coordination[,] and endurance' including as due to pain and/or other factors" or "reduction of a joint's normal excursion of movement in different planes, including changes in the joint's range of movement, strength, fatigability, or coordination." Lyles v. Shulkin, 29 Vet. App. 107, 117-18(2017) (quoting 38 C.F.R. § 4.40 and citing 38 C.F.R. § 4.45); Mitchell v. Shinseki, 25 Vet. App. 32, 36-37 (2011); DeLuca v. Brown, 8 Vet. App. 202, 205-07 (1995).

The intent of the rating schedule is to recognize painful motion with joint and periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or maligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59.

Normal ranges of motion of the hip are hip flexion from 0 degrees to 125 degrees and hip abduction from 0 degrees to 45 degrees. 38 C.F.R. § 4.71, Plate II.

Diagnostic Code 5250 provides for rating the hip on the basis of ankylosis. Favorable ankylosis of the hip in flexion at an angle between 20 degrees and 40 degrees and slight adduction or abduction is rated 60 percent disabling; intermediate ankylosis of the hip is rated 70 percent disabling; and extremely unfavorable ankylosis, with the foot not reaching ground, crutches necessitated, is rated 90 percent disabling, and is entitled to special monthly compensation. 38 C.F.R. § 4.71a.

Diagnostic Code 5251 provides a 10 percent disability rating for limitation of extension of the thigh that is limited to 5 degrees. 38 C.F.R. § 4.71a.

Diagnostic Code 5252 provides ratings based on limitation of flexion of the thigh. A 10 percent disability rating is for flexion of the thigh that is limited to 45 degrees; a 20 percent rating is for flexion of the thigh that is limited to 30 degrees; a 30 percent rating is for flexion of the thigh that is limited to 20 degrees; and a 40 percent rating is for flexion of the thigh that is limited to 10 degrees. 38 C.F.R. § 4.71a.

Diagnostic Code 5253 provides ratings based on impairment of the thigh. Where adduction is limited such that the Veteran cannot cross legs, a 10 percent rating is warranted. Where rotation is limited such that the Veteran cannot toe-out more than 15 degrees of the affected leg, a 10 percent rating is warranted. Where abduction is lost beyond 10 degrees, a 20 percent rating is warranted. 38 C.F.R. § 4.71a.

Diagnostic Code 5254 provides that for a flail joint of the hip, an 80 percent rating is warranted. 38 C.F.R. § 4.71a.

1. Entitlement to a compensable rating for left hip limitation of flexion

2. Entitlement to a compensable rating for right hip limitation of flexion

3. Entitlement to a rating greater than 10 percent for left hip limitation of abduction

4. Entitlement to a rating greater than 10 percent for right hip limitation of abduction

3. Entitlement to a rating greater than 10 percent for left hip limitation of abduction

4. Entitlement to a rating greater than 10 percent for right hip limitation of abduction

In the rating decision on appeal, the Veteran's left and right hip limitation of flexion disability ratings were continued as 0 percent disabling and his left and right hip limitation of abduction/adduction was increased to 10 percent disabling. The Veteran contends that she is entitled to increased ratings. A March 23, 2021, VA examination was conducted in furtherance of the Veteran's claim. In it, no crepitus, muscle atrophy, or ankylosis was appreciated. Additionally, no malunion of femur, flail hip join, or leg length discrepancy was documented. Initial range of motion testing manifested with left hip flexion to 115 degrees, extension to 20 degrees, abduction to 35 degrees and adduction to 15 degrees. Initial range of motion testing also manifested with right hip flexion to 120 degrees, extension to 25 degrees, abduction to 40 degrees, and adduction to 20 degrees. Pain was documented in all ranges of motion in both active and passive range of motion. After three repetitions, additional loss of range of motion was documented in the right hip as flexion to 115 degrees, extension to 20 degrees, abduction to 35 degrees, and adduction to 15 degrees. With repeated use over time and flare-ups, range of motion in both the left and right hip was documented as flexion to 110 degrees, extension to 15 degrees, abduction to 30 degrees, and adduction to 10 degrees. Limitation of adduction during flare-ups was documented as preventing the Veteran from crossing her legs. No malunion of the femur, flail hip joint, or leg discrepancy was appreciated on either the left or right side. And no assistive device was used as a normal mode of locomotion at that time. However, during the February 2025 hearing, the Veteran reported instability and use of a cane, not prescribed, for mobility.

Because left and right hip limitation of flexion was not limited to 45 degrees or less, indeed it was limited to 110 degrees at most, the Veteran's hip disability does not rise to the level required for a compensable disability rating for limitation of flexion. Similarly, because the Veteran's left and right limitation of abduction is not less than 10 degrees, his disability does not rise to the level required for an increased 20 percent rating for limitation of abduction. For the aforementioned reasons, entitlement to a compensable rating for left and right hip limitation of flexion and a rating greater than 10 percent for limitation of abduction is denied.

Disability evaluations are handled to produce the greatest degree of stability. See 38 CF.R. § 3.344(a). When a disability rating has been in effect for less than five years, a rating reduction may be warranted where reexamination of the disability discloses improvement of that disability. 38 C.F.R. § 3.344(c). In making a rating reduction determination, regardless of the rating level or the length of time that the rating has been in effect, VA is required to comply with several regulations. Faust v. West, 13 Vet. App. 342, 349 (2000) (citing 38 C.F.R. §§ 4.1, 4.2, 4.10, Brown v. Brown, 5 Vet. App. 413, 420 (1993)). The general provisions impose a clear requirement that the rating reduction be based upon review of the entire history of the Veteran's disability, thorough examinations, and progress that reflects an improvement in the Veteran's ability to function under the ordinary conditions of life and work. Murphy v. Shinseki, 26 Vet. App. 510, 517 (2014). Even where the assigned rating is less than five years old and 38 C.F.R. § 3.344(c) applies, improvement in a Veteran's ability to function must still be shown under the ordinary conditions of life and work. Brown, 5 Vet. App. at 420-21. Where a reduction in the rating of a service
3)). The general provisions impose a clear requirement that the rating reduction be based upon review of the entire history of the Veteran's disability, thorough examinations, and progress that reflects an improvement in the Veteran's ability to function under the ordinary conditions of life and work. Murphy v. Shinseki, 26 Vet. App. 510, 517 (2014). Even where the assigned rating is less than five years old and 38 C.F.R. § 3.344(c) applies, improvement in a Veteran's ability to function must still be shown under the ordinary conditions of life and work. Brown, 5 Vet. App. at 420-21. Where a reduction in the rating of a service-connected disability is warranted and a lower evaluation would result in a reduction or discontinuance of compensation payments already being made, the Veteran is notified and given 60 days to present additional evidence showing that compensation should be continued at the current level. 38 C.F.R. § 3.105(e).

Here, after some improvement was shown on the March 23, 2021, hip examination, the Veteran's the Veteran's left and right hip limitation of extension ratings were reduced. While the rating was less than five years and prior notification of reduction was not required, there is no opinion of record regarding the effect any improvements may have had upon the Veteran's ability to function under the ordinary conditions of life and work. Thus, the Board finds the reduction in evaluation of service connected left hip limitation of extension from 10 percent to zero percent and right hip limitation of extension from 10 percent to 0 percent improper. Restoration of the 10 percent rating for left hip limitation of extension and 10 percent for right hip limitation of extension is required, effective December 21, 2020.

Leetra J. Harris

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Sloley, Z. N.

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.

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