KNEE IMPAIRMENT OF

JENNA BRANT · 2025 · Case ID: A25069290

DENIED

Summary

The veteran, who served in the Army from January 1975 to December 1977 and March 1981 to January 1987, appeals the denial of an increased rating for his service-connected right knee strain and lumbosacral strain with degenerative disc disease and scoliosis. The veteran sought an increase for his right knee strain from 10% to 20%, asserting that pain limited his flexion. For his back condition, he sought an increase from 20% to 40%, claiming severe daily pain, radiating numbness, and monthly flare-ups. The Board reviewed evidence including VA examinations from March 2023 (for the knee) and February 2023 (for the back), as well as private medical records. For the right knee, the VA examiner noted flexion limited to 70 degrees after repetitive use, with pain. Private records also indicated flexion limited to 70 degrees due to pain. The Board found this did not meet the 30-degree flexion limitation required for a 20% rating. For the back, the VA examiner noted thoracolumbar flexion limited to 60 degrees after repetitive use, and 60 degrees during flare-ups, with pain but no abnormal gait or spinal contour. Private records showed lumbar flexion limited to 45 degrees with pain and fixation at the lumbosacral joint. The Board found this did not meet the criteria for a 40% rating, which requires thoracolumbar flexion of 30 degrees or less, or favorable ankylosis. The Board denied both claims for increased ratings.

Rationale

Veteran sought increase from 10% to 20% for right knee strain.; VA exam showed flexion limited to 70 degrees after repetitive use.; Private records also indicated flexion limited to 70 degrees due to pain.; 20% rating requires flexion limited to 30 degrees.; Evidence did not meet criteria for higher rating.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

230615-357631

Full Decision Text

Citation Nr: A25069290
Decision Date: 08/15/25 Archive Date: 08/15/25

DOCKET NO. 230615-357631
DATE: August 15, 2025

ORDER

Entitlement to an initial rating in excess of 10 percent for right knee strain is denied.

Entitlement to an increased disability rating in excess of 20 percent for lumbosacral strain with degenerative disc disease and scoliosis is denied.

FINDINGS OF FACT

1. Throughout the period on appeal, the Veteran's service-connected right knee strain is manifested by painful motion with flexion to no worse than 70 degrees, but not by flexion limited to at least 30 degrees.

2. Throughout the period on appeal, the Veteran's lumbosacral strain with degenerative disc disease and scoliosis was not manifested by forward flexion of the cervical spine to 15 degrees or less, forward flexion of the thoracolumbar spine to 30 degrees, ankylosis, or incapacitating episodes.

CONCLUSIONS OF LAW

1. The criteria for entitlement to an initial rating in excess of 10 percent for right knee strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.27, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5260.

2. The criteria for entitlement to an increased disability rating in excess of 20 percent for lumbosacral strain with degenerative disc disease and scoliosis have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.71a, DC 5242.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from January 1975 to December 1977, and March 1981 to January 1987.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2023 rating decision from a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ).

In the June 2023 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.

Therefore, the Board may only consider the evidence of record at the time of the April 2023 AOJ decision on appeal, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 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 Rating

Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the VA's Schedule for Rating Disabilities (Rating Schedule). See 38 C.F.R. Part 4. The percentage ratings contained 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 the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1.

Where a claimant appeals the initial rating assigned following an award of service connection, evidence contemporaneous with the claim for service connection and with the rating decision granting service connection would be most probative to the degree of disability existing
or her symptomatology with the criteria set forth in the VA's Schedule for Rating Disabilities (Rating Schedule). See 38 C.F.R. Part 4. The percentage ratings contained 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 the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1.

Where a claimant appeals the initial rating assigned following an award of service connection, evidence contemporaneous with the claim for service connection and with the rating decision granting service connection would be most probative to the degree of disability existing at the time the initial rating was assigned and should be the evidence "used to decide whether the [initial] rating on appeal was erroneous." Fenderson v. West, 12 Vet. App. 119, 126 (1999). If later evidence obtained during the appeal indicates that the degree of disability increased or decreased following the assignment of the initial rating, "staged" ratings may be assigned for separate periods of time based on facts found. Id.

In evaluating the severity of a particular disability, it is essential to consider its history. 38 C.F.R. §§ 4.1, 4.2, 4.41; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38.C.F.R. § 4.7. After consideration of the evidence, any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

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).

Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011).

In Correia v. McDonald, 28 Vet. App. 158 (2016), the United States Court of Appeals for Veterans Claims (Court) held that 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."

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 examination.

As a preliminary matter, the regulations pertaining to rating musculoskeletal disabilities were amended, effective February 7, 2021. See 85 Fed. Reg. 76,453 (November 30, 2020). As the applicable rating periods on appeal are after February 7, 2021, the Board will consider the Veteran's claim under the new criteria.

Entitlement to an initial rating in excess of 10 percent for right knee strain is denied.

The Veteran
7), 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 examination.

Entitlement to an initial rating in excess of 10 percent for right knee strain is denied.

The Veteran seeks a higher initial rating for his service-connected right knee strain, which is currently rated as 10 percent disabling under DC 5260. He specifically asserts that his disability evaluation should be assigned a 20 percent rating. See June 2023 VA Form 10182 Notice of Disagreement (NOD). Upon review of the relevant evidence, the Board determines that a disability rating higher than 10 percent for the Veteran's service-connected right knee disability is not warranted.

By way of background, the April 2023 rating decision granted service connection for the Veteran's right knee strain as secondary to the service-connected lumbosacral strain with degenerative disc disease and scoliosis. The AOJ assigned a 10 percent evaluation effective April 5, 2022, for the Veteran's right knee strain with painful motion. See April 2023 Rating Decision. Subsequently, the Veteran filed a VA Form 10182 NOD, requesting a higher initial rating for his service-connected right knee disability. Therefore, the relevant appeal period for this claim begins on April 2022, the effective date of the service-connection grant for the Veteran's right knee disability.

During the appeal period, the Veteran's right knee disability is rated as 10 percent disabling from April 5, 2022, under DC 5260. Under DC 5260, a 10 percent rating is warranted for flexion limited to 45 degrees. Id. A 20 percent rating is warranted for flexion limited to 30 degrees. Id. A maximum 30 percent rating is warranted for flexion limited to 15 degrees. Id.

The normal range of motion of the knee is extension to 0 degrees and flexion to 140 degrees. 38 C.F.R. § 4.71a, DCs 5260, 5261.

Simultaneous compensation under multiple diagnostic codes for the knee is permissible so long as differing symptomatology is being compensated. For example, limitations of flexion and extension may both be rated, but a rating for arthritis cannot be combined with either, as it refers to general limitations of motion and would include both flexion and extension. See 38 C.F.R. § 4.71a, DCs 5010, 5260, 5261. However, other manifestations of the knee disabilities, such as ankylosis and instability, may be rated with limitation of motion, and with each other, so long as differing knee disabilities or manifestations are being compensated. See 38 C.F.R. § 4.71a, DCs 5256 to 5263.

Here, the Board finds the evidence of record persuasively weighs against a rating in excess of 10 percent for the Veteran's right knee strain. Even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements that he experienced pain on motion would not result in limitation of motion more nearly approximating flexion limited to 30 degrees.

Turning to the evidence of record, in March 2023, the Veteran underwent a VA examination for his right knee. The examiner noted a diagnosis of right knee strain. During the examination, the Veteran reported that his knee pain began approximately between 1970 and 1980, during active duty service. He reported intermittent right knee pain that occurs when his low back and right leg radicular symptoms worsen. The Veteran did not report experiencing flare-ups of the right knee. The Veteran reported difficulty with bending, lifting, and standing or walking for prolonged periods. He stated that his treatment consisted of Tramadol taken as needed. Moreover, the Veteran reported that his right knee "sometimes gives out" causing him to nearly fall. See March 2023 C&P Exam.

During the March 2023 VA examination, active and passive range of motion (ROM) testing revealed right knee flexion to 90 degrees and extension to zero degrees. The examiner noted that the Veteran experienced pain during flexion in both active and passive motions, as well as weight-bearing and nonweight-bearing. After repetitive-use testing involving at three repetitions, right knee flexion was limited to 70 degrees. Extension of the right knee remained at zero degrees. Pain was noted during the testing and was found to cause functional loss. The estimated ROM after repeated use over time revealed right knee flexion to 70 degrees, with evidence of pain, that significantly limits functional ability. As noted above, the Veteran did not report experiencing flare-ups of the right knee. Additional contributing factors to the Veteran's right knee disability include interference with standing, and disturbance of locomotion, associated with difficulty bending, lifting, standing, and walking for prolonged periods. There is no indication that the Veteran had surgical procedures or meniscal conditions. Additionally, there was no finding of muscle atrophy, ankylosis, recurrent patellar instability, recurrent subluxation or persistent instability in the right knee. The examiner found no recurrent patellar dislocation, shin splints (medial tibial stress syndrome), stress fractures, or other tibial or fibular impairments of the right knee. The examiner noted that testing of the left knee is not performed because it is an unclaimed, damaged joint. See March 2023 C&P Exam.

In support of his claim, the Veteran submitted a private medical opinion stating that his right knee pain is at least as likely as not related to the constant and chronic compensation and adaptation resulting from weight shifting and an altered gait caused by his lower spine injury and radiculopathy. The clinician noted that the Veteran's knee flexion is limited to 70 degrees due to pain, while extension is "adequate." See February 2023 Medical Treatment Record - Non-Government Facility.

Based on the foregoing, the Board determines that a disability rating higher than 10 percent for the Veteran's service-connected right knee disability is not warranted. For the next-higher 20 percent rating to be warranted, the evidence must demonstrate right knee flexion limited to, at minimum, 30 degrees, or left knee extension limited to, at minimum, 15 degrees. Here, the medical evidence of record does not reflect the necessary criteria to warrant a higher rating in excess of 10 percent for the right knee under DC 5260 or DC 5261.

Specifically, the relevant evidence reflects flexion to no worse than 70 degrees in the right knee. Limitation of extension is documented to be at zero degrees. The Board notes that although the Veteran has complained of pain, his complaints are adequately contemplated in the rating he currently receives. See April 2023 Rating Decision. The Veteran has been provided the highest evaluation possible based on estimated limitation of flexion measurements from the April 2023 VA examination, which was adequate for adjudicative purposes. See Correia, supra; Sharp, supra.

Next, the Board has considered whether any other diagnostic codes related to disabilities of the knee would provide for a higher disability rating. However, the record is silent for evidence of right knee ankylosis (DC 5256), recurrent subluxation or instability of the right knee or patellar instability (DC 5257), dislocated, semilunar cartilage of the right knee with frequent episodes of "locking," pain, and effusion into the joint (DC 5258), impairment of the right leg tibia and fibula (DC 5262), or genu recurvatum (knee hyperextension) (DC 5263). As such, a higher rating under the above-mentioned diagnostic codes is not warranted as to the Veteran's right knee disability.

With respect to the ameliorative effects of medication, the Veteran reported he uses Tramadol as needed for pain relief. Where the rating criteria do not specifically contemplate the effects of medication, a higher rating may not be denied based on relief provided by medication. See Jones v. Shinseki, 26 Vet. App. 56, 63 (2012) (where rating criteria says nothing about medication, the condition is to be evaluated as if without medication). Here, the rating criteria under the assigned Diagnostic Code for the Veteran's right knee does not specifically contemplate the effects of medication. However, the Veteran reported that he treats his symptoms with Tramadol as needed, leading the
warranted as to the Veteran's right knee disability.

With respect to the ameliorative effects of medication, the Veteran reported he uses Tramadol as needed for pain relief. Where the rating criteria do not specifically contemplate the effects of medication, a higher rating may not be denied based on relief provided by medication. See Jones v. Shinseki, 26 Vet. App. 56, 63 (2012) (where rating criteria says nothing about medication, the condition is to be evaluated as if without medication). Here, the rating criteria under the assigned Diagnostic Code for the Veteran's right knee does not specifically contemplate the effects of medication. However, the Veteran reported that he treats his symptoms with Tramadol as needed, leading the Board to believe he reported symptoms prior to any treatment or medication and there is no indication he was on medication at the time of the examination. Therefore, the ameliorative effects of medication have been discounted.

In conclusion, while the Veteran's symptoms are challenging and cause discomfort, the Veteran's right knee disability does not demonstrate limitation of flexion of 30 degrees, as required for the higher disability rating. Therefore, the Board finds that the Veteran's right knee disability rating throughout the period on appeal more closely approximates a 10 percent disability rating based on limitation of flexion and the claim for a disability in excess thereof must be denied.

Entitlement to an increased disability rating in excess of 20 percent for lumbosacral strain with degenerative disc disease and scoliosis is denied.

The Veteran seeks a higher rating for his service-connected lumbosacral strain with degenerative disc disease and scoliosis (back disability), which is currently rated as 20 percent disabling under DC 5242. He specifically asserts that his disability evaluation should be assigned a 40 percent rating. See June 2023 VA Form 10182 NOD. Upon review of the relevant evidence, the Board determines that a disability rating higher than 20 percent for the Veteran's service-connected back disability is not warranted.

By way of background, an April 2021 rating decision granted service connection for lumbosacral strain with degenerative disc disease and scoliosis, and the AOJ assigned a 10 percent evaluation effective January 7, 2021. The Veteran did not appeal this rating decision or file a request for review within one year of this rating decision. As a result, the January 2021 rating decision was not continuously pursued. 38 C.F.R. § 3.2500(c). In February 2023, the Veteran filed a VA 21-526EZ, Fully Developed Claim, requesting a higher rating for his service-connected back disability. In April 2023, a rating decision granted an increased disability rating from 10 percent to 20 percent for the Veteran's service-connected back disability. Therefore, the relevant rating period for the Veteran's increased rating claim for his back disability begins on February 11, 2023, to include the one year look back period. 38 U.S.C. § 5110(b)(3).

During the appeal period, the Veteran's back disability was rated as 20 percent disabling under DC 5242. The Board notes that the diagnostic code for the Veteran's back disability was previously rated under DC 5237 and was changed to DC 5242, effective April 5, 2022. See April 2021 Rating Decision - Codesheet; April 2023 Rating Decision - Codesheet. Nevertheless, regardless of the DC applied, the rating criteria under 38 C.F.R. § 4.71a, General Rating Formula of Disease and Injuries of the Spine, remain unchanged.

Under the General Rating Formula for Disease and Injuries of the Spine (DCs 5235-5243), a 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 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 30 percent rating is warranted for forward flexion of the cervical spine is limited to 15 degrees or less; or favorable ankylosis of the entire cervical spine.

A 40 percent rating is warranted for unfavorable ankylosis of the entire cervical spine; or forward flexion of the thoracolumbar spine 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine.

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than 120 degrees; or, the combined range of motion of the cervical spine not greater than 170 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 30 percent rating is warranted for forward flexion of the cervical spine is limited to 15 degrees or less; or favorable ankylosis of the entire cervical spine.

A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine, while a 100 percent evaluation contemplates unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula of Disease and Injuries of the Spine.

For VA compensation purposes, unfavorable ankylosis is 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; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. at Note 5.

Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1.

After a review of the relevant evidence of record, the Board concludes that a disability rating in excess of 20 percent is not warranted for the Veteran's back disability.

In February 2023, the Veteran underwent a VA examination. The examiner noted diagnoses of lumbosacral strain with degenerative joint disease and scoliosis, and bilateral lumbar radiculopathy. During the examination, the Veteran reported that he injured his lower back when he fell down a hill while in service. The Veteran reported that he began experiencing recurrent low back pain while playing football for the U.S. Army. He also reported that he experiences severe low back pain daily with radiating pain and numbness down his right leg. He stated that his current treatment consists of Tramadol, Meloxicam, and low back injections, all taken as needed. He experiences monthly flare-ups, which he described as severe lasting from two to twenty minutes. These flare-ups are typically triggered by overuse, bending, and twisting, and are alleviated with medication. See February 2023 C&P Exam.

The February 2023 examination report indicated active forward flexion was limited to 70 degrees, and pain was observed during forward flexion, extension right and left lateral flexion, and right and left lateral rotation. Passive ROM testing was not performed due to medical contraindications, as it may cause the Veteran severe pain or the risk of further injury. Evidence of pain was noted on active motion, weight bearing, and nonweight-bearing that causes functional loss. The Veteran was able to perform at least three repetitions, and the examiner reported that ROM for forward flexion, following three repetitions, was limited to 60 degrees. He was not examined immediately after repeated use over time. However, the examiner noted that pain significantly limits the Veteran's functional ability with repeated use over time, with an estimated ROM for forward flexion measured at 60 degrees. The examiner reported that the Veteran was not examined during a flare-up. However, during flare-ups, the examiner noted that the Veteran's estimated ROM was 60 degrees of flexion and 15 degrees of extension. The examination report noted that the Veteran has localized tenderness, guarding or muscle spasm of the thoracolumbar spine but it does not result in abnormal gait or abnormal spinal contour. Muscle strength testing were mostly normal, with knee and great toe extension rated as active movement against some resistance. Sensory and reflex examinations were all normal, with no evidence of muscle atrophy. The examination also confirmed that there was no ankylosis of the spine and no IVDS of the thoracolumbar spine. The examiner noted that the Veteran have radicular pain or any other signs or symptoms due to radiculopathy, but there were no other neurologic abnormalities or findings related to the thoracolumbar spine condition. The Veteran did not report the use of any assistive device. The examiner
, guarding or muscle spasm of the thoracolumbar spine but it does not result in abnormal gait or abnormal spinal contour. Muscle strength testing were mostly normal, with knee and great toe extension rated as active movement against some resistance. Sensory and reflex examinations were all normal, with no evidence of muscle atrophy. The examination also confirmed that there was no ankylosis of the spine and no IVDS of the thoracolumbar spine. The examiner noted that the Veteran have radicular pain or any other signs or symptoms due to radiculopathy, but there were no other neurologic abnormalities or findings related to the thoracolumbar spine condition. The Veteran did not report the use of any assistive device. The examiner noted that the back condition impacts the Veteran's ability to work, specifically causing limitations with bending, lifting, twisting, climbing stairs and ladders, and prolonged standing or sitting. See February 2023 C&P Exam.

The Veteran submitted private medical records documenting complaints of and treatment for back pain. A report of consultation and examination dated December 12, 2022, noted lumbar flexion limited to 45 degrees and lumbar extension limited to 10 degrees, with both movements associated with pain. The clinician reported "[t]here is fixation at the lumbosacral joint with moderate hypertonicity of the superficial and deep musculature at that level." See February 2023 Medical Treatment Record - Non-Government Facility.

Based on the relevant medical evidence of record, the Board determines that a disability rating higher than 20 percent for the Veteran's service-connected back disability is not warranted. For the next-higher 30 percent rating to be warranted, the evidence must demonstrate forward flexion of the cervical spine limited to 15 degrees or less, or favorable ankylosis of the entire cervical spine. Moreover, a 40 percent rating must demonstrate unfavorable ankylosis of the entire cervical spine; or, forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. Here, the medical evidence of record does not reflect the necessary criteria to warrant a higher rating in excess of 20 percent for the spine under DC 5237 or 5242.

Specifically, the relevant evidence reflects forward flexion has been limited, at most, to 45 degrees. See February 2023 Medical Treatment Record - Non-Government Facility. Even during a flare-up, the VA examiners estimated the Veteran's ROM for forward flexion at 70 degrees. As the Veteran's back disability has not been manifested by forward flexion to 30 degrees or less, a higher disability rating based upon limitation of motion is not warranted. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca, 8 Vet. App. 202; Mitchell, 25 Vet. App. 32 (2011).

Moreover, the Board notes that ankylosis or the functional equivalent of ankylosis has not been demonstrated (i.e., that his spine was fixed in flexion or extension, or that it was fixed in a neutral position). See Chavis v. McDonough, 34 Vet. App. 1, 23-24 (2021). The February 2023 VA examiner explicitly noted no ankylosis of the spine. The relevant evidence shows no indication that the spine has been fixed in extension or flexion at any time during the appeal period, thus demonstrating the absence of ankylosis. The Board notes that although the Veteran has complained of pain, his complaints are adequately contemplated in the rating he currently receives. See April 2023 Rating Decision. Here, the Veteran has been provided the highest evaluation possible for the entire period on appeal based on estimated limitation of flexion measurements from the April 2023 VA examination, which is adequate for adjudicative purposes. See Correia, 28 Vet. App. 158; see also Sharp, 29 Vet. App. 26. Therefore, a rating in excess of 20 percent is not warranted under DC 5237 or 5242.

Next, the Board has considered whether any other diagnostic codes related to disabilities of the spine would provide for a higher disability rating. Under DC 5243, an incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, Formula for Rating IVDS based on Incapacitating Episodes, Note 1. Here, the evidence does not demonstrate that the Veteran has IVDS of the thoracolumbar spine or has ever been prescribed bed rest by a physician under the rating criteria for IVDS (DC 5244). The VA examiner specifically found that the Veteran did not have IVDS, and the Veteran has not described any period of such bed rest due to his back disability. See February 2023 C&P Exam. As such, a disability rating in excess of 20 percent is not warranted under DC 5243. There is also no evidence demonstrating complete traumatic paralysis (DC 5244). As such, a disability rating in excess of 20 percent is not warranted under DCs 5243 and 5244.

In reaching this determination, the Board acknowledges that VA is required "to discount beneficial medication effects when relevant rating criteria do not specifically contemplate medication use." Ingram v. Collins, 38 Vet. App. 130 (2025). Although the Veteran reported in his February 2023 VA examination that he takes Tramadol, Meloxicam, or injections on an as-needed basis and states that he experiences monthly flare-ups and Tramadol alleviates his symptoms during flare-ups, the examiner noted he was not being examined during a flare-up. As such, there is no indication that the examiners considered the ameliorative effects of medication in rendering the findings in the report nor did the examiners indicate the Veteran was on any pain medications at the time of the examination. Therefore, the Board finds the examination report adequate to base a decision.

Finally, with respect to whether the Veteran has any neurologic abnormalities associated with his lumbar spine disability, the Board acknowledges that the Veteran has been diagnosed with lumbar radiculopathy in both his lower extremities. See June 2023 Rating Decision - Codesheet. However, the Veteran has already been granted separate compensable ratings for his radiculopathy, and entitlement to increased ratings for those service-connected disabilities are not properly before the Board and will not be addressed herein. Cf. De Hart v. McDonough, 37 Vet. App. 371, 380 (2024) at 2 (holding that "once radiculopathy is recognized by VA as a distinct service-connected disability with its own rating criteria, it is subject to the same general rules that would govern the appeal of any other separately adjudicated issue"). The Board notes that in an April 2021 rating decision, the Veteran was granted service connection for his right lower extremity radiculopathy rated as 20 percent and left lower extremity radiculopathy rated as 10 percent, and the Veteran did not express disagreement with these ratings. Additionally, the Board finds no signs or symptoms of any bladder or bowel disabilities, to warrant separate compensable ratings.

In conclusion, while the Veteran's symptoms are challenging and cause discomfort, the Veteran's back disability does not demonstrate limitation of forward flexion of 30 degrees or less, or favorable ankylosis of the entire thoracolumbar spine as required for the higher disability rating. Therefore, the Board finds that the Veteran's back disability rating throughout the period on appeal more closely approximates a 20 percent disability rating based on limitation of forward flexion and the claim for a disability in excess thereof must be denied.

Jenna Brant

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board A. Gaviola, Associate Counsel

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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