CERVICAL SPINE LIMITATION OF MOTION

J. B. FREEMAN · 2025 · Case ID: 25011672

MIXED

Summary

The veteran, who served in the U.S. Navy from September 1, 1988, to August 31, 1994, appeals the denial of service connection for a neck disability, right knee disability, left knee disability, right hip disability, and left hip disability, all claimed as secondary to service-connected lumbosacral strain or psychiatric disability. The veteran also appealed the denial of an increased rating for his service-connected lumbosacral strain. The Board denied direct service connection for the neck, knee, and hip conditions, finding no in-service event documented and that the VA examiner's opinion, which found no relation to service, was adequate and probative. The Board also found the veteran's lay statements regarding nexus for these conditions to be incompetent. For the secondary claims, the Board considered a private medical letter from Dr. P. that linked the neck condition to an antalgic gait caused by the service-connected lumbosacral strain. However, the Board found this opinion lacked probative value because multiple VA examinations consistently showed no antalgic gait, a premise the Board deemed false. Subsequent VA opinions in April 2025 also found no proximate relation or aggravation from the service-connected lumbosacral strain or psychiatric disability. The Board granted an increased rating for the lumbosacral strain, finding that while the veteran's range of motion did not meet the criteria for a 20 percent rating prior to May 23, 2023, resolving doubt in his favor due to flare-ups and medication use warranted that rating. For the period after May 23, 2023, the Board granted a 40 percent rating, finding that absent medication, the veteran's forward flexion would be limited to 30 degrees or less, based on his statements and the April 2025 VA examination.

Rationale

No in-service event documented for neck disability.; Adequate VA examiner opinion found no relation to service.; Dr. P.'s opinion lacked probative value due to false premise (no antalgic gait).

Service Branch

U.S. NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

15-46 219

Full Decision Text

Citation Nr: 25011672
Decision Date: 09/12/25 Archive Date: 09/12/25

DOCKET NO. 15-46 219
DATE: September 12, 2025

ORDER

Entitlement to service connection for a neck disability, including as secondary to lumbosacral strain or psychiatric disability is denied.

Entitlement to service connection for a right knee disability, including as secondary to lumbosacral strain or psychiatric disability is denied.

Entitlement to service connection for a left knee disability, including as secondary to lumbosacral strain or psychiatric disability is denied.

Entitlement to service connection for a right hip disability, including as secondary to lumbosacral strain or psychiatric disability is denied.

Entitlement to service connection for a left hip disability, including as secondary to a lumbosacral strain or psychiatric disability is denied.

Entitlement to an increased rating for service-connected lumbosacral strain of 20 percent, but no higher, prior to May 23, 2023, and a 40 percent rating thereafter, is granted.

FINDINGS OF FACT

1. The Veteran's neck disability did not have its onset in service and is not otherwise related to service or caused or aggravated by the service-connected lumbosacral strain or psychiatric disability.

2. The Veteran's right knee disability did not have its onset in service and is not otherwise related to service or caused or aggravated by the service-connected lumbosacral strain or psychiatric disability.

3. The Veteran's left knee disability did not have its onset in service and is not otherwise related to service or caused or aggravated by the service-connected lumbosacral strain or psychiatric disability.

4. The Veteran's right hip disability did not have its onset in service and is not otherwise related to service or caused or aggravated by the service-connected lumbosacral strain or psychiatric disability.

5. The Veteran's left hip disability did not have its onset in service and is not otherwise related to service or caused or aggravated by the service-connected lumbosacral strain or psychiatric disability.

6. Prior to May 23, 2023, the Veteran's lumbosacral strain, at its worst, manifested by a range of forward flexion of the thoracolumbar spine that exceeds 30 degrees, but less than 60, without ankylosis or the like.

7. On and after May 23, 2023, the Veteran's service-connected lumbosacral strain, at its worst, was manifested by forward flexion of the thoracolumbar spine to 30 degrees or less without ankylosis or the like.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for a neck disability, including as secondary to lumbosacral strain or psychiatric disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

2. The criteria for entitlement to service connection for a right knee disability, including as secondary to lumbosacral strain or psychiatric disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

3. The criteria for entitlement to service connection for a left knee disability, including as secondary to lumbosacral strain or psychiatric disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

4. The criteria for entitlement to service connection for a right hip disability, including as secondary to lumbosacral strain or psychiatric disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

5. The criteria for entitlement to service connection for a left hip disability, including as secondary to lumbosacral strain or psychiatric disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

6. Prior to May 23, 2023, the criteria for a 20 percent rating, but no higher, for lumbosacral strain are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code (DC)
, 3.310.

6. Prior to May 23, 2023, the criteria for a 20 percent rating, but no higher, for lumbosacral strain are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code (DC) 5237.

7. From May 23, 2023, the criteria for a 40 percent rating, but no higher, for lumbosacral strain are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5237.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service in the U.S. Navy from September 1, 1988, to August 31, 1994. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

The Veteran testified at a hearing before a Veterans Law Judge (VLJ) in June 2019. An August 2021 letter informed the Veteran that the VLJ who conducted the June 2019 hearing was no longer at the Board. He was also informed of his options for another Board hearing and that if he did not respond to the letter within 30 days the Board would assume that he did not want another Board hearing. The Veteran did not respond. In a September 2021 decision, the Board denied the claims on appeal. In October 2022, pursuant to a Joint Motion for Remand (JMR), the United States Court of Veterans Claims (Court) vacated the September 2021 Board decision and remanded the claims to the Board for action consistent with the terms of the JMR.

In March 2023, the Board, pursuant to the JMR, remanded the claims for additional development. In December 2024, a Supplemental Statement of the Case (SSOC) was issued that denied entitlement for the claims for service connection for a neck disability, a right knee disability, a left knee disability, a right hip disability, and a left hip, all to include as secondary to lumbosacral strain or psychiatric disability, and to an increased rating for service-connected lumbosacral strain, in excess of 10 percent prior to May 23, 2023, and in excess of 20 percent, therefrom. In March 2025, the Board again remanded the claims for additional development. In May 2025, a SSOC was issued that denied entitlement for the claims for service connection for a neck disability, a right knee disability, a left knee disability, a right hip disability, and a left hip, all to include as secondary to lumbosacral strain or psychiatric disability, and denied an increased rating for service-connected lumbosacral strain, in excess of 10 percent prior to May 23, 2023, and in excess of 20 percent, therefrom.

Service Connection

Applicable Law

To establish service connection, it is required that the evidence demonstrates a current disability resulted from an injury or disease incurred or aggravated in active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). In general, service connection requires the following: (1) evidence of a current disability; (2) evidence of an in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a)-(b). Secondary causation exists when, but for the service-connected disability, the non-service-connected was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain. Spicer v. McDonough, 61 F.
and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a)-(b). Secondary causation exists when, but for the service-connected disability, the non-service-connected was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain. Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023) (citations omitted). Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe were it not for a service- connected disability. Id. at 1364.

In making all determinations, the Board must fully consider all the relevant medical evidence as well as lay evidence. Furthermore, it is required to assess the competency and credibility of the relevant evidence, and to consider its probative weight. When considering whether lay evidence is competent, the Board must determine, on a case-by-case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1373, 1376-77 (Fed. Cir 2007).

When determining whether service connection is warranted, VA is responsible for determining whether the evidence persuasively favors one side or the other. See Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021) (en banc). The Veteran is entitled to the benefit of the doubt when the evidence is in approximate balance and does not require that the evidence be in exact equipoise. Id.

The Board has thoroughly reviewed all the evidence in the Veteran's files. In every decision, the Board must provide a statement of the reasons or bases for its determination, adequate to enable the Veteran to understand the precise basis for the Board's decision, as well as to facilitate review by the United States Court of Appeals for Veterans Claims (Court). 38 U.S.C. §7104(d)(1) (2012); see Allday v. Brown, 7 Vet. App. 517, 527 (1995). Although the entire record must be reviewed by the Board, the Board is not required to discuss, in detail, every piece of evidence. See Gonzales v. West, 218 F.3d 1378, 1380-81(Fed. Cir. 2000); Dela Cruz v. Principi, 15 Vet. App. 143, 149 (2001). Rather, the law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran. See Timberlake v. Gober, 14 Vet. App. 122 (2000). The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claims. The Veteran must not assume that the Board has overlooked pieces of evidence that are not explicitly discussed herein. See Timberlake, supra.

1. Entitlement to service connection for a neck disability, including as secondary to lumbosacral strain or psychiatric disability is denied.

The Veteran has submitted his neck disability is related to service, to include as secondary to a lumbosacral strain or psychiatric disability. See VA Form 21-526EZ, dated April 7, 2015. Additionally, in his Appellate Brief (submitted to the Board on June 29, 2025) the Veteran, via his representative, only argued that the disability is secondary to lumbosacral strain or psychiatric disability.

First, as to a direct theory of entitlement, the Veteran has satisfied the first prong of service connection by showing a presently diagnosed neck disability, which was acknowledged in the June 2024 Board decision. The question then turns on whether there is an in-service event and on whether there is a nexus between such an in-service event and the Veteran's neck disability. The Board finds that there is no in-service event regarding the Veteran's neck injury. Specifically, there is no documentation in the service treatment records (STRs) of the Veteran ever having been treated for any neck symptoms. Further, an April 2025 VA examiner, after a review of the record, opined that Veteran's neck disability was not related to service. The Board finds the VA examiner's opinion provides clear conclusions
entitlement, the Veteran has satisfied the first prong of service connection by showing a presently diagnosed neck disability, which was acknowledged in the June 2024 Board decision. The question then turns on whether there is an in-service event and on whether there is a nexus between such an in-service event and the Veteran's neck disability. The Board finds that there is no in-service event regarding the Veteran's neck injury. Specifically, there is no documentation in the service treatment records (STRs) of the Veteran ever having been treated for any neck symptoms. Further, an April 2025 VA examiner, after a review of the record, opined that Veteran's neck disability was not related to service. The Board finds the VA examiner's opinion provides clear conclusions with supporting data and reasoned medical explanations connecting the two. Stefl v Nicholson, 21 Vet. App. at 120, 124-25 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. at 295, 304 (2008). Thus, the Board finds this opinion adequate and very probative.

Additionally, to the extent that the Veteran has argued that his neck disability is related to service in any way, the Board finds that the question of whether a nexus is too complex to be addressed by a layperson. See 38 C.F.R. § 3.159(a)(1). Because the Veteran does not have specialized medical training, experience, or knowledge, his opinion, no matter how sincere, is not competent nexus evidence. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).

Based on the foregoing, the evidence demonstrates persuasively that his neck disability is not related to service and his claim for direct service connection is denied. While a claimant is generally entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence, there is no such doubt to resolve in the Veteran's favor here. See Lynch, 21 F.4th at 781-82.

However, as noted above, secondary service connection may still be granted for a disability that is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310; See Spicer, supra.

As noted above, the Veteran has a neck disability and has argued that it is secondary to his service-connected lumbosacral strain or psychiatric disability. Initially, the Board finds that the Veteran is service-connected for lumbosacral strain and a psychiatric disability.

In support of his secondary claim, the Veteran submitted a December 15, 2015, medical letter from Dr. P. that was received by VA on December 17, 2015. In the letter, Dr. P. stated the Veteran was under his care for several medical conditions, to include neck pain, for several years. Dr. P. then stated that chronic neck pain "is at least as likely as not be secondary to his service connected back condition" and that "[t]he service connected lumbar condition creates and an antalgic gait which has a direct impact on thoracic and cervical sections of the back and creates undue pressure and an unnatural movement of the hips and knees." However, here, the record is clear that throughout the period on appeal (from before and after Dr. P's 2015 letter) the Veteran has consistently been found on numerous VA examinations over the years to not have an antalgic gait or an abnormal gait. See VA examinations/opinions of May 2015, February 2020, May 2023, and September 2024. The Board finds, based on the evidence of record, that the Veteran has not and does not have an antalgic gait. As such, the Board finds Dr. P's nexus is of no probative value as it is based on a false premise. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that an opinion based upon an inaccurate factual premise has no probative value).

Also of record are April 2025 VA opinions in which the examiner, after a review of the record and medical literature, found that the neck disability is not proximately due to, or aggravated by his service-connected lumbosacral strain or his psychiatric disability. The examiner in support of the opinion provided detailed rationale supported by medical principles. The Board finds this opinion adequate and most probative as the VA examiner's opinions provide clear conclusions with supporting data and reasoned medical explanations connecting the two. See Stefl, 21 Vet. App. at 124-25; Nieves-Rodriguez, 22 Vet. App. at 304.

In light of the foregoing, the Board is persuaded that the evidence weighs heavily
).

In light of the foregoing, the Board is persuaded that the evidence weighs heavily against a finding that, but for the service-connected lumbosacral strain or his psychiatric disability, the neck disability would not exist or would be less severe.

Since the most probative evidence of record persuasively weighs against the claim of entitlement to service connection for a neck disability as secondary to lumbosacral strain or psychiatric disability, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); See Lynch, 21 F.4th at 781-82; 38 C.F.R. §§ 3.102, 3.303. Therefore, the claim is denied.

2. Entitlement to service connection for a right knee disability, including as secondary to lumbosacral strain or psychiatric disability is denied.

3. Entitlement to service connection for a left knee disability, including as secondary to lumbosacral strain or psychiatric disability is denied.

The Veteran has submitted that his right knee and left knee disabilities are related to service, to include as secondary to lumbosacral strain disability or psychiatric disability. See VA Form 21-526EZ, dated April 7, 2015. Additionally, in his Appellate Brief (submitted to the Board on June 29, 2025) the Veteran, via his representative, only argued that the disabilities are secondary to lumbosacral strain or psychiatric disability.

First, as to a direct theory of entitlement, the Veteran has satisfied the first prong of service connection by showing a diagnosed of a right knee disability and a left knee disability, which were acknowledged in the June 2024 Board decision. The question then turns on whether there is an in-service event and on whether there is a nexus between such an in-service event and the Veteran's right knee disability and/or a left knee disability. The Board finds that there is no in-service event regarding the Veteran's knees and there is no documentation in the STRs of the Veteran ever having been treated for any knee symptoms. Further, an April 2025 VA examiner, after a review of the record, opined that Veteran's right knee disability and left knee disability are not related to service. The Board finds the VA examiner's opinions provide clear conclusions with supporting data and reasoned medical explanations connecting the two. Stefl, 21 Vet. App. at 120; Nieves-Rodriguez, 22 Vet. App. at 295. Thus, the Board finds the opinions adequate and very probative.

Additionally, to the extent that the Veteran has argued that his knee disabilities are related to service in any way, the Board finds that the question of whether a nexus is too complex to be addressed by a layperson. See 38 C.F.R. § 3.159(a)(1). Because the Veteran does not have specialized medical training, experience, or knowledge, his opinion, no matter how sincere, is not competent nexus evidence. Jandreau, 492 F.3d at 1376-77.

Based on the foregoing, the evidence demonstrates persuasively that his right knee disability and left knee disability are not related to service and his claims for direct service connection are denied. While a claimant is generally entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence, there is no such doubt to resolve in the Veteran's favor here. See Lynch, 21 F.4th at 781-82.

However, as noted above, secondary service connection may still be granted for a disability that is due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310; See Spicer, supra.

As noted above, the Veteran has a right knee disability and a left knee disability and has argued that both are secondary to his service-connected lumbosacral strain or psychiatric disability; the Veteran is service-connected for lumbosacral strain and a psychiatric disability.

In support of his secondary claim, the Veteran submitted a December 15, 2015, medical letter from Dr. P. that was received by VA on December 17, 2015.
at 781-82.

In support of his secondary claim, the Veteran submitted a December 15, 2015, medical letter from Dr. P. that was received by VA on December 17, 2015. In the letter, Dr. P. stated the Veteran was under his care for several medical conditions, for several years. Dr. P. then stated that "[t]he service connected lumbar condition creates and an antalgic gait which has a direct impact on thoracic and cervical sections of the back and creates undue pressure and an unnatural movement of the hips and knees." However, here, the record is clear that throughout the period on appeal (from before and after Dr. P's 2015 letter) the Veteran has consistently been found on numerous VA examinations over the years to not have an antalgic gait or an abnormal gait. See VA examinations/opinions of May 2015, February 2020, May 2023, and September 2024. The Board finds, based on the evidence of record, that the Veteran has not and does not have an antalgic gait. As such, the Board finds Dr. P's nexus is of no probative value as it is based on a false premise. See Reonal, 5 Vet. App. at 461.

Also of record are April 2025 VA opinions in which the examiner, after a review of the record, found that neither the right knee disability, nor the left knee disability is proximately due to, or aggravated by his service-connected lumbosacral strain or his psychiatric disability. The examiner supports the opinions provided detailed rationale supported by medical principles. The Board finds these opinions adequate and most probative as the VA examiner's opinions provide clear conclusions with supporting data and reasoned medical explanations connecting the two. See Stefl, 21 Vet. App. at 124-25; Nieves-Rodriguez, 22 Vet. App. at 304.

In light of the foregoing, the Board is persuaded that the evidence weighs heavily against a finding that, but for the service-connected lumbosacral strain or his psychiatric disability, the right knee disability or left knee disability would not exist or would be less severe.

Since the most probative evidence of record persuasively weighs against the claims of entitlement to service connection for a right knee disability and a left knee disability, both as secondary to lumbosacral strain or psychiatric disability, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); See Lynch, 21 F.4th at 781-82; 38 C.F.R. §§ 3.102, 3.303. Therefore, the claims are denied.

4. Entitlement to service connection for a right hip disability, including as secondary to lumbosacral strain or psychiatric disability is denied.

5. Entitlement to service connection for a left hip disability, including as secondary to lumbosacral strain or psychiatric disability is denied.

The Veteran has submitted his right hip and left hip disabilities are related to service, to include as secondary to a lumbosacral strain or psychiatric disability. See VA Form 21-526EZ, dated April 7, 2015. Additionally, in his Appellate Brief (submitted to the Board on June 29, 2025) the Veteran, via his representative, only argued that the disabilities are secondary to lumbosacral strain or psychiatric disability.

First, as to a direct theory of entitlement, the Veteran has satisfied the first prong of service connection by showing a diagnosed of a right hip disability and a left hip disability, which were acknowledged in the June 2024 Board decision. The question then turns on whether there is an in-service event and on whether there is a nexus between such an in-service event and the Veteran's right hip disability and/or a left hip disability. The Board finds that there is no in-service event regarding the Veteran's hips and there is no documentation in the STRs of the Veteran ever having been treated for any hip symptoms. Further, an April 2025 VA examiner, after a review of the record, opined that Veteran's right hip disability and left hip disability are not related to service. The Board finds the VA examiner's opinions provide clear conclusions with supporting data
showing a diagnosed of a right hip disability and a left hip disability, which were acknowledged in the June 2024 Board decision. The question then turns on whether there is an in-service event and on whether there is a nexus between such an in-service event and the Veteran's right hip disability and/or a left hip disability. The Board finds that there is no in-service event regarding the Veteran's hips and there is no documentation in the STRs of the Veteran ever having been treated for any hip symptoms. Further, an April 2025 VA examiner, after a review of the record, opined that Veteran's right hip disability and left hip disability are not related to service. The Board finds the VA examiner's opinions provide clear conclusions with supporting data and reasoned medical explanations connecting the two. Stefl, 21 Vet. App. at 120; Nieves-Rodriguez, 22 Vet. App. at 295. Thus, the Board finds the opinions adequate and very probative.

Additionally, to the extent that the Veteran has argued that his hip disabilities are related to service in any way, the Board finds that the question of whether a nexus is too complex to be addressed by a layperson. See 38 C.F.R. § 3.159(a)(1). Because the Veteran does not have specialized medical training, experience, or knowledge, his opinion, no matter how sincere, is not competent nexus evidence. Jandreau, 492 F.3d at 1376-77.

Based on the foregoing, the evidence demonstrates persuasively that his right hip disability and left hip disability are not related to service and his claims for direct service connection are denied. While a claimant is generally entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence, there is no such doubt to resolve in the Veteran's favor here. See Lynch, 21 F.4th at 781-82.

As noted above, the Veteran has a right hip disability and a left hip disability and has argued that both are secondary to his service-connected lumbosacral strain or psychiatric disability. The Veteran is service-connected for lumbosacral strain and psychiatric disability.

In support of his secondary claim, the Veteran submitted a December 15, 2015, medical letter from Dr. P. that was received by VA on December 17, 2015. In the letter, Dr. P. stated the Veteran was under his care for several medical conditions for several years. Dr. P. then stated that "[t]he service connected lumbar condition creates and an antalgic gait which has a direct impact on thoracic and cervical sections of the back and creates undue pressure and an unnatural movement of the hips and knees." However, here, the record is clear that throughout the period on appeal (from before and after Dr. P's 2015 letter) the Veteran has consistently been found on numerous VA examinations over the years to not have an antalgic gait or an abnormal gait. See VA examinations/opinions of May 2015, February 2020, May 2023, and September 2024. The Board finds, based on the evidence of record, that the Veteran has not and does not have an antalgic gait. As such, the Board finds Dr. P.'s nexus is of no probative value as it is based on a false premise. See Reonal, 5 Vet. App. at 461.

Also of record are April 2025 VA opinions in which the examiner, after a review of the record and medical literature, found that neither the right knee disability, nor the left knee disability is proximately due to, or aggravated by his service-connected lumbosacral strain or his psychiatric disability. The examiner supports the opinions provided detailed rationale supported by medical principles. The Board finds the opinions adequate and most probative as the VA examiner's opinions provide clear conclusions with supporting data and reasoned medical explanations connecting the two. See Stefl, 21 Vet. App. at 124-25; Nieves-Rodriguez, 22 Vet. App. at 304.

In light of the foregoing, the Board is persuaded that the evidence weighs heavily against a finding that, but for the service-connected lumbosacral strain or his psychiatric disability, the bilateral hip disabilities would not exist or would be less severe.

Since the most probative evidence of record persuasively weighs against the claims of entitlement to service connection for a right hip disability and a left knee disability, both as secondary to lumbosacral strain or psychiatric disability, the benefit-of
the VA examiner's opinions provide clear conclusions with supporting data and reasoned medical explanations connecting the two. See Stefl, 21 Vet. App. at 124-25; Nieves-Rodriguez, 22 Vet. App. at 304.

In light of the foregoing, the Board is persuaded that the evidence weighs heavily against a finding that, but for the service-connected lumbosacral strain or his psychiatric disability, the bilateral hip disabilities would not exist or would be less severe.

Since the most probative evidence of record persuasively weighs against the claims of entitlement to service connection for a right hip disability and a left knee disability, both as secondary to lumbosacral strain or psychiatric disability, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); See Lynch, 21 F.4th at 781-82; 38 C.F.R. §§ 3.102, 3.303. Therefore, the claims are denied.

Increased Rating

Applicable Law

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability ratings is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10.

Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria required for that particular rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When a reasonable doubt arises regarding the degree of disability, that reasonable doubt will be resolved in favor of the veteran. 38 C.F.R. § 4.3.

The Veteran is entitled to the benefit of the doubt when the evidence is in approximate balance and does not require that the evidence be in exact equipoise. See Lynch, 21 F.4th at 781-82.

6. Entitlement to an increased rating of 20 percent, but no higher, prior to May 23, 2023, and 40 percent, but no higher, therefrom for service-connected lumbosacral strain are granted.

The Veteran contends that his lumbosacral strain is more severe than it is rated and that "the VA examination of May 23, 2023, confirmed the level of disability as claimed by the Veteran from the date of claim." See June 29, 2025, Appellate Brief.

The appeal period concerns the Veteran's 10 percent rating for his service-connected lumbosacral strain from January 1, 2015, to May 23, 2023, and 20 percent therefrom. The Veteran's service-connected lumbosacral strain is rated under 38 C.F.R. § 4.71a, DC 5237.

As a preliminary matter the regulations pertaining to rating musculoskeletal disabilities were revised, effective February 7, 2021. Claims pending prior to the effective date will be considered under both old and new rating criteria from that date. VA will apply the rating criteria that is more favorable to the Veteran from the effective date of the change. Here, the Veteran's lumbar spine disability is rated under 38 C.F.R. § 4.71a, DC 5237 and in this appeal, stream dates back to the June 2015 rating decision that denied a rating in excess of 10 percent for it. Disabilities of the spine are rated under either the General Formula for Diseases and Injuries of the Spine (General Formula) or, when applicable, the Formula IVDS Based on Incapacitating Episodes (IVDS Formula). While the diagnostic criteria dealing with degenerative arthritis of the spine and IVDS were updated with the new regulations, the rating criteria of the General Formula and IVDS Formula did not change under the new regulations. See 38 C.F.R. § 4.71a, DC 5235-43 (2021). As such, the rating criteria for the Veteran's lumbosacral strain is unchanged and the Board will proceed with adjudication as the record only demonstrates lumbosacral strain.

The Veteran's lumbosacral strain is rated under 38 C.F.R. § 4.71a. Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but
the new regulations, the rating criteria of the General Formula and IVDS Formula did not change under the new regulations. See 38 C.F.R. § 4.71a, DC 5235-43 (2021). As such, the rating criteria for the Veteran's lumbosacral strain is unchanged and the Board will proceed with adjudication as the record only demonstrates lumbosacral strain.

The Veteran's lumbosacral strain is rated under 38 C.F.R. § 4.71a. Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine.

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; 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).

The final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." Correia v. McDonald, 28 Vet. App. 158 (2016). The spine has no opposite joint. 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 examination. Sharp v. Shulkin, 29 Vet. App. 26 (2017).

In a March 2015 VA examination, the Veteran was diagnosed with lumbar strain. The Veteran reported flare-ups that made it hard to stand, gave him radiating pain, and he stated he wore a back brace occasionally. Range of motion (ROM) testing showed forward flexion to 90 degrees and extension to 10 degrees. Right and left lateral flexion was to 15 degrees. Right and left lateral rotation was to 30 degrees. There was no additional functional loss on repetitive testing. There was no ankylosis of the spine and it was noted he used a brace occasionally.

In June 2019, the Veteran testified before the Board about his lumbosacral strain. He stated he at the March 2015 VA examination his ROM was marked as greater than it was actually because he was in great pain when pushing to get a fuller
hard to stand, gave him radiating pain, and he stated he wore a back brace occasionally. Range of motion (ROM) testing showed forward flexion to 90 degrees and extension to 10 degrees. Right and left lateral flexion was to 15 degrees. Right and left lateral rotation was to 30 degrees. There was no additional functional loss on repetitive testing. There was no ankylosis of the spine and it was noted he used a brace occasionally.

In a February 2020 VA examination report, the Veteran was diagnosed with lumbar strain. The Veteran reported flare-ups. ROM testing showed forward flexion to 90 degrees and extension to 20 degrees. Right lateral flexion was to 25 degrees and left lateral flexion was to 20 degrees. Right and left lateral rotation was to 30 degrees. There was noted pain on forward flexion and no evidence of pain on weightbearing. The examiner found that there was pain, weakness, fatigability or incoordination significantly limited functional ability with repeated use over a period of time. Repeated use over time caused pain and ROM was forward flexion to 90 degrees, extension to 20 degrees, right and left lateral flexion was to 20 and 25 degrees, and right and left lateral rotation was to 30 degrees. There was no muscle atrophy and sensory examinations were normal. There was mild radicular pain and numbness and no ankylosis of the spine. There was no intervertebral disc syndrome (IVDS), and it was noted he used a brace occasionally. There was no evidence of pain on passive motion or non-weight bearing during testing of the back. This examination was found to be inadequate as it failed to consider the Veteran's lay statements as to flare-ups of the lower back. See October 2022 Joint Motion for Remand.

During a May 23, 2023, VA examination, the Veteran was diagnosed with lumbar strain. The Veteran reported continuing to take medications for pain and severe flare-ups at least one a week and could last all day. ROM testing showed forward flexion to 50 degrees and extension to 20 degrees. Right and left lateral flexion were to 20 degrees. Right and left lateral rotation was to 20 degrees. There was pain noted on examination and there was evidence of pain on all ROM testing. Passive ROM was the same as active ROM testing. There was no additional functional loss on repetitive testing. Repeated use over time testing was not done, but the examiner found, via the Veteran's statements, that it was limited due to pain and lack of endurance and estimated the ROM was forward flexion to 45 degrees, extension to 15 degrees, right and left lateral flexion was to 15 degrees, and right and left lateral rotation was to 15 degrees. Flare-ups caused ROM functional loss, forward flexion to 50 degrees, extension to 20 degrees, right and left lateral flexion was to 20 degrees, and right and left lateral rotation was to 20 degrees. Muscle strength testing and sensory examination of the lower extremities were normal. There was moderate radicular pain and numbness. There was no ankylosis of the spine and it was noted he used a cane occasionally.

In a September 2024 VA examination, the Veteran was diagnosed with lumbar strain. The Veteran reported taking medications and muscle relaxants and rated pain as 10/10 from the past 6/10. The Veteran noted sever flare-ups 5 times a week that last 1-3 hours and were 10/10 pain. ROM testing showed forward flexion to 90 degrees and extension to 15 degrees. Right and left lateral flexion was to 30 degrees. Right and left lateral rotation was to 30 degrees. There was pain exhibited on all ROM testing. Passive ROM was the same as active ROM. Repeated use over time caused pain and ROM was forward flexion to 80 degrees, extension to 25 degrees, right and left lateral flexion was to 25 degrees, and right and left lateral rotation was to 25 degrees. Flare-ups ROM functional loss were estimated as forward flexion to 80 degrees, extension to 25 degrees, right and left lateral flexion was to 24 degrees, and right and left lateral rotation was to 25 degrees. Muscle strength testing and sensory examination were normal. There was no radicular pain or numbness of the lower extremities and there was ankylosis of the spine. The Veteran did not have IVDS and did not use any assistive devices. Functional impact was listed
. Repeated use over time caused pain and ROM was forward flexion to 80 degrees, extension to 25 degrees, right and left lateral flexion was to 25 degrees, and right and left lateral rotation was to 25 degrees. Flare-ups ROM functional loss were estimated as forward flexion to 80 degrees, extension to 25 degrees, right and left lateral flexion was to 24 degrees, and right and left lateral rotation was to 25 degrees. Muscle strength testing and sensory examination were normal. There was no radicular pain or numbness of the lower extremities and there was ankylosis of the spine. The Veteran did not have IVDS and did not use any assistive devices. Functional impact was listed as "Difficulty with repetitive back motion and twisting and with heavy lifting on a frequent basis."

In an April 2025 VA opinion, based on a record review, the Veteran was diagnosed with lumbar strain. It was noted that the Veteran reported taking medications and muscle relaxants and rated it at 10/10 and noted severe flare-ups 5 times a week that last 1-3 hours and were 10/10 pain. The examiner noted that flare-ups impair activities such as bending, standing and lifting that the Veteran was taking medication for it. The examiner then stated that the Veteran took medications to manage the pain and muscle spasm and that "Without the relief provided by these medications, it is reasonable to expect that the Veteran would experience increased frequency and severity of muscle spasms, more pronounced sleep disturbances due to pain, and further functional impairment with mobility and self-care activities, especially during flare-ups." The examiner also stated that "The Veteran's report of daily symptoms, exacerbated by even minimal activity, and reliance on prescription pain management supports a finding of moderate to severe functional impairment, even if range of motion may not always meet the strict threshold for the highest schedular rating. The Veteran is competent to describe his symptoms and limitations, and there is no medical basis to doubt his statements."

Period from January 1, 2015, to May 23, 2023

The Veteran is rated at 10 percent for his service-connected lumbosacral strain from January 1, 2015, to May 23, 2023, under 38 C.F.R. § 4.71a, DC 5237. In order to receive the next higher rating, a 20 percent rating, the evidence needs to show 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.

Here, while the evidence of record for this period, namely the March 2015 and February 2020 VA examination reports, do not show the requisite requirements for a 20 percent rating, neither of the reports appear to discount the ameliorative effects of medication. Jones v. Shinseki, 26 Vet. App. 56 (2012). However, it is clear that the Veteran, through his statements and the examiner's notes, experienced significant flare-ups and took medication for his back. As a result, the Board resolves doubt in the Veteran's favor and finds that flare-ups of back pain, absent the ameliorative effects of medication, would result in forward flexion of his lumbar spine being limited to less than 60 degrees. Lynch, 21 F.4th at 781-82; See 38 C.F.R. §§ 4.7. 4.40, 4.45; See Jones, supra., Correia, 28 Vet. App. at 170, Mitchell, 25 Vet. App. at 32; Sharp, 29 Vet. App. 26; DeLuca, 8 Vet. App. at 206-07. Thus, the Board grants an increased disability rating of 20 percent under DC 5237 from January 1, 2015, to May 22, 2023.

The Board also finds that a disability rating in excess of 20 percent under DC 5237 is not warranted. In order for the Veteran to get the next higher rating of 40 percent, the Veteran had to show evidence of forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. Even when considering the Veteran's lay reports of symptoms, medications and flare ups, the evidence of record does not show evidence of forward flexion of the thoracolumbar spine to 30 degrees or less. Further, there is no evidence of any type of ankylosis or functional equivalent of ankylosis and therefore his symptoms do not warrant a higher disability rating. See 38 C.F.R. § 4.71a. See Chavis v. McDonough, 34 Vet. App. 1, 20 (2021). The Board did also consider the May 2023 VA examination report, but finds that it does not describe an increase in disability ascertainable to a date certain prior to the date of the examination. See 38 C.F.R. § 3.400(o)(2); Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010).

Further, the Board has considered whether there are any other applicable DCs but has found none; the Veteran is already service-connected for radiculopathy, left lower extremity associated with lumbosacral strain and radiculopathy, right lower extremity associated with lumbosacral strain. Consideration has also been given to assigning staged ratings. However, at no time during the period in question has the disability warranted a higher schedular rating than that assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007).

On and after May 23, 2023

The Veteran is rated at 20 percent for his service-connected lumbosacral strain on and after May 23, 2023, under 38 C.F.R. § 4.71a, DC 5237. In order to receive the next higher rating, a 40 percent rating, the Veteran had to show evidence of forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine.

Here, while the evidence of record for this period, namely the May 2023, September 2024 and April 2025 VA examination reports, do not show the requisite measurements for a 40 percent rating, neither the May 2023 nor September 2024 reports appear to discount the ameliorative effects of medication. However, the April 2025 VA examination report does and it indicates that without the medication the Veteran would likely have a forward flexion of 30 degrees or less. Thus, the Board finds, based on the Veteran's statements that his back is getting worse and 10/10 pain, as well as the April 2025 examiner's opinion, when resolving doubt in the Veteran's favor, absent the ameliorative effects of medication, forward flexion of his lumbar spine is limited to 30 degrees or less, entitling him to a 40 percent rating. Lynch, 21 F.4th at 781-82; See 38 C.F.R. §§ 4.7. 4.40, 4.45; See Jones, supra., Correia, 28 Vet. App. at 170, Mitchell, 25 Vet. App. at 32; Sharp, 29 Vet. App. 26; DeLuca, 8 Vet. App. at 206-07. Thus, the Board grants an increased rating of 40 percent under DC 5237 from May 23, 2023.

The Board finds that a disability rating in excess of 40 percent under DC 5237 is not warranted. In order for the Veteran to get the next higher rating of 50 percent, the evidence must show unfavorable ankylosis of the entire thoracolumbar spine. Even when considering the Veteran's lay reports of symptoms and flare ups, the evidence of record does not show or equate to any type of ankylosis or functional equivalent of ankylosis and therefore his symptoms do not warrant a higher disability rating. See 38 C.F.R. § 4.71a. See Chavis, 34 Vet. App. 1, 20 (2021).

Further, the Board has considered whether there is any other applicable DC but has found none; the Veteran is already service
5237 is not warranted. In order for the Veteran to get the next higher rating of 50 percent, the evidence must show unfavorable ankylosis of the entire thoracolumbar spine. Even when considering the Veteran's lay reports of symptoms and flare ups, the evidence of record does not show or equate to any type of ankylosis or functional equivalent of ankylosis and therefore his symptoms do not warrant a higher disability rating. See 38 C.F.R. § 4.71a. See Chavis, 34 Vet. App. 1, 20 (2021).

Further, the Board has considered whether there is any other applicable DC but has found none; the Veteran is already service-connected for radiculopathy, left lower extremity associated with lumbosacral strain and radiculopathy, right lower extremity associated with lumbosacral strain. Consideration has been given to assigning staged ratings. However, at no time during the period in question has the disability warranted a higher schedular rating than that assigned. Hart, 21 Vet. App. at 505.

J. B. FREEMAN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Imber, M.

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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