SCARS OTHER NOT OF HEAD FACE OR NECK

PAULETTE VANCE BURTON · 2026 · Case ID: A26000395

MIXED

Summary

The veteran, who served in the United States Marine Corps from September 1985 to July 1988, appeals the denial of service connection for a scar, right lower extremity radiculopathy, and a right foot disability. The Board denied the scar claim, finding it did not meet the criteria for a compensable rating under any applicable diagnostic code, as it was stable, not painful, and did not involve underlying tissue damage or sufficient surface area. For right lower extremity radiculopathy, claimed as secondary to service-connected low back pain, the Board found the evidence weighed against a nexus. While a private opinion suggested a link, the VA examiner opined the condition was less likely than not related to service, attributing it to injuries below the knee rather than the back. The Board found the VA opinion more probative due to its detailed rationale. For the right foot disability, also claimed as secondary to the back condition, the Board found no in-service complaints or evidence supporting direct service connection. The private opinion was again given limited weight due to vagueness, while the VA examiner's opinion, attributing the foot numbness to superficial peroneal neuropathy unrelated to the back, was given significant weight. The Board denied this claim as well. However, the claim for an increased rating for chronic idiopathic low back pain was remanded. The Board found the July 2024 VA examination insufficient because it did not address the severity of the low back pain without medication, nor did it provide an opinion on the difference in functioning with or without medication, as required by recent case law.

Rationale

Scar not compensable under DC 7800 (disfigurement); Scar not compensable under DC 7801 (soft tissue damage); Scar not compensable under DC 7802 (area affected); Scar not unstable or painful for DC 7804

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

7802

Docket No.

250330-532956

Full Decision Text

Citation Nr: A26000395
Decision Date: 01/05/26 Archive Date: 01/05/26

DOCKET NO. 250330-532956
DATE: January 5, 2026

ORDER

Entitlement to an initial compensable rating for scar is denied.

Entitlement to service connection for right lower extremity radiculopathy is denied.

Entitlement to service connection for a right foot disability is denied.

REMANDED

Entitlement to an increased rating more than 10 percent for chronic idiopathic low back pain is remanded.

FINDINGS OF FACT

1. The Veteran's linear vertical scar along the lumbar spine is not associated with underlying soft tissue damage covering an area of at least 6 square inches but less than 12 square inches, nor is it unstable or painful.

2. The evidence is against a finding that the Veteran's right lower extremity radiculopathy is related to his service-connected back disability.

3. The evidence is against a finding that the Veteran's right foot disability is related to his service-connected back disability.

CONCLUSIONS OF LAW

1. The criteria for an initial compensable rating for scar have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, DC 7802.

2. The criteria for entitlement to service connection for right lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

3. The criteria for entitlement to service connection for a right foot disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service in the United States Marine Corps from September 1985 to July 1988.

The rating decision on appeal was issued in September 2024 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In the March 2025 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 September 2024 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran [or 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.

However, because the Board is remanding the claim of entitlement to an increased rating more than 10 percent for chronic idiopathic low back pain, any evidence the Board could not consider will be considered by the AOJ in the adjudication of this claim. 38 C.F.R. § 3.103(c)(2)(ii).

1. Entitlement to an initial compensable rating for scar

The Veteran contends that his linear vertical scar warrants a compensable rating.

The Veteran is in receipt of noncompensable rating for a linear vertical scar under DC 7802 effective May 7, 2024. See September 2024 Codesheet.

Increased Ratings

Disability ratings are based on average impairment in earning capacity resulting from a particular disability and are determined by comparing symptoms shown with criteria in VA's Schedule for Rating Disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities.

Where there is a question as
.F.R. § 3.103(c)(2)(ii).

1. Entitlement to an initial compensable rating for scar

The Veteran contends that his linear vertical scar warrants a compensable rating.

The Veteran is in receipt of noncompensable rating for a linear vertical scar under DC 7802 effective May 7, 2024. See September 2024 Codesheet.

Increased Ratings

Where there is a question as to which of two ratings apply, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. An exception to this rule occurs when the rating criteria are successive. In such a case, all the requirements of the lower levels must be met before a higher level is awarded, so 38 C.F.R. §§ 4.7 and 4.21 do not apply. Johnson v. Wilkie, 30 Vet. App. 245 (2018).

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. It is the policy of VA to administer the law under a broad interpretation, consistent with the facts in each case, with all reasonable doubt to be resolved in favor of the claimant; however, the reasonable doubt rule is not a means for reconciling actual conflict or a contradiction in the evidence. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

With a claim for an increased initial rating, separate staged ratings may be assigned based on facts found. Fenderson v. West, 12 Vet. App. 119 (1999). In a claim for increase in a previously established rating, the present level of disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, where the evidence contains factual findings that demonstrate distinct time periods when the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, staged ratings are to be considered. See Hart v. Mansfield, 21 Vet. App. 505 (2007).

When all of the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in approximate balance, with the veteran prevailing in either event, or whether the evidence is against the claim, in which case the claim is denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990).

The Veteran's statements describing symptoms and condition are competent evidence to the extent that one can describe one's own experiences. However, these statements must be viewed in conjunction with the medical evidence and the pertinent rating criteria. Lay evidence is not competent evidence concerning complex medical questions requiring specialized training or expertise. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board rather than a legal issue to be addressed by the Veterans' Court.).

General Rating Formula for the Skin

The Formula provides these conditions should be rated according to the Formula, as disfigurement of the head, face, or neck (DC 7800), or as scars (DCs 7801-7805), depending upon the predominant disability. 38 C.F.R. § 4.118.

Each applicable body part will find a DC under 38 C.F.R. § 4.118 that gives the highest rating. There cannot be multiple ratings for the same body part absent unique facts. When 38 C.F.R. § 4.118 offers variable methods to evaluate a skin disability, a single evaluation should be assigned using the criteria that results in the highest rating. Separate evaluations are only allowed when the Veteran has separate diagnoses, separate areas of the skin are involved, and the medical evidence clearly indicates that the percentages affected are due solely to each individual diagnosis.

As is relevant to the present appeal, effective August 13, 2018, VA amended the criteria for rating the skin. As this claim was filed after the regulations changes, the Board will only consider the regulations in effect since August 13, 2018.

A note preceding 38 C.F.R. § 4.118 provides that, for the purposes of this section, "system
.R. § 4.118 offers variable methods to evaluate a skin disability, a single evaluation should be assigned using the criteria that results in the highest rating. Separate evaluations are only allowed when the Veteran has separate diagnoses, separate areas of the skin are involved, and the medical evidence clearly indicates that the percentages affected are due solely to each individual diagnosis.

A note preceding 38 C.F.R. § 4.118 provides that, for the purposes of this section, "systemic therapy is treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy is treatment that is administered through the skin."

Under the General Rating Formula, a 10 percent rating is warranted where at least one of the following is present: characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period. Id.

A 30 percent rating is warranted where at least one of the following is present: Characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. Id.

A 60 percent rating is warranted for characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required over the past 12-month period. Id.

With regard to the meaning of "systemic therapy" prior to the new definition of the term in the revised criteria, the United States Court of Appeal for Veterans Claims (Court) in Johnson v. McDonald, 27 Vet. App. 497, 505 (2016) held that use of a topical steroid constituted "systemic therapy" within the meaning of DC 7806. In Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017), the Federal Circuit reversed this decision and determined that "constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs" under DC 7806 is generally not inclusive of topical corticosteroids. The Federal Circuit found that "systemic therapy" means "treatment pertaining to or affecting the body as a whole," whereas topical therapy means "treatment pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied." Thus, according to the Federal Circuit, all applications of topical corticosteroids do not constitute systemic therapy. The Federal Circuit also held that a topical corticosteroid treatment could meet the definition of systemic therapy if it was administered on a large enough scale such that it affected the body as a whole, and the use of a topical corticosteroid could be considered either systemic therapy or topical therapy based on the factual circumstances of each case. In Burton v. Wilkie, 30 Vet. App. 286 (2018), the Court held that there are at least two other potential ways of showing that a topical corticosteroid is systemic: the method by which the treatment works and its side effects.

Under DC 7800, a 10 percent disability rating is warranted for scarring with one characteristic of disfigurement. 38 C.F.R. § 4.118, DC 7800. A 30 percent disability rating is warranted with visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips); or two or three of the characteristics of disfigurement. Id. A 50 percent disability rating is warranted with visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips); or four or five characteristics of disfigurement. Id. An 80 percent disability rating is warranted with visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips); or six or more characteristics of disfigurement. Id.

The eight characteristics of disfigurement for the purposes of rating under 38 C.F.R. § 4.118 are: scar of 5 inches (in.) or more (13 or more centimeters (cm.)) in length; scar at least 1/4 in. (0.6 cm.) wide at its widest part; surface contour of scar elevated or depressed on palpation; scar adherent to underlying tissue; skin hypo- or hyper-pigmented in an area exceeding 6 square inches (39 square cm.); skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding 6 square in. (39 square cm.); underlying soft tissue missing in an area exceeding 6 square in. (39 square cm.); and skin indurated and inflexible in an area exceeding 6 square in. (39 square cm.). Id., Note (1). Id.

DC 7804 provides disability ratings for scars that are unstable or painful. A 10 percent rating is warranted for one or two scars that are unstable or painful. 38 C.F.R. § 4.118, DC 7804. A 20 percent rating is warranted for three or four scars that are unstable or painful. Id. A 30 percent rating is warranted for five or more scars that are unstable or painful. Note (1) states that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Id. Note (2) provides that if one or more scars are both unstable and painful, an additional 10 percent should be added to the evaluation based on the total number of unstable or painful scars. Id. Note (3) states that scars evaluated under diagnostic codes 7800, 7801, 7802, or 7805 may also receive an evaluation under this diagnostic code, when applicable. Id.

DC 7805 provided that other scars (and other effects of scars) evaluated under diagnostic codes 7800, 7801, 7802, or 7804 require the evaluation of any disabling effect(s) not considered in a rating provided under DCs 7800-7804 under an appropriate DC. 38 C.F.R. § 4.118, DC 7805.

Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen.

The assignment of a particular diagnostic code is "completely dependent on the facts of a particular case" and the Board can choose the diagnostic code to apply so long as it is supported by reasons and bases, as well as the evidence. Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, diagnosis, and demonstrated symptomatology. Any change in diagnostic code by a VA adjudicator must be specifically explained. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). It is permissible to switch Diagnostic Codes to reflect more accurately a claimant's current symptoms. See also Read v. Shinseki, 651 F. 3d 1296, 1302 (Fed. Cir. 2011) (holding that service connection for a disability is not severed when the Diagnostic Code associated with it is changed to determine more accurately the benefit
538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual's relevant medical history, diagnosis, and demonstrated symptomatology. Any change in diagnostic code by a VA adjudicator must be specifically explained. See Pernorio v. Derwinski, 2 Vet. App. 625, 629 (1992). It is permissible to switch Diagnostic Codes to reflect more accurately a claimant's current symptoms. See also Read v. Shinseki, 651 F. 3d 1296, 1302 (Fed. Cir. 2011) (holding that service connection for a disability is not severed when the Diagnostic Code associated with it is changed to determine more accurately the benefit to which a veteran may be entitled).

The Board finds that DC 7800 is inapplicable here as it involves scars of the nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips.

DC 7801 contemplates burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage. 38 C.F.R. § 4.118, DC 7801. As the Veteran's skin disability is not considered a burn DC 7801 is not for application.

Turning to the evidence, the Veteran underwent a VA examination in September 2024, where he was noted with one linear vertical scar along the lumbar spine status post lumbar surgery. See September 2024 VA Examination. His scar was noted as stable and not painful. The scar measured 3.5 by 0.2cm, for a total area of 0.7 square centimeters. There was no underlying tissue damage. The scar did not cause limitation of function and there were no other pertinent findings.

The record does not contain any other treatment records with respect to the Veteran's scar.

Under DC 7801, a 10 percent rating is available for scars associated with underlying soft tissue damage and covering an area or areas 6 square inches (39 sq. cm) or greater. In this case, there is no indication of underlying soft tissue damage in the claims file. Additionally, the total area covered by the Veteran's scar does not add up to 39 square centimeters. As such, a compensable rating is not available under DC 7801.

DC 7802 does not require soft tissue damage; however, the scar must be affecting an area or areas of 144 square inches (929 sq. cm.) or greater. As discussed above, the Veteran's scar does not cover a surface area great enough to warrant a compensable rating under DC 7802. It does, however, warrant a noncompensable rating under this diagnostic code.

A rating under DC 7804 is not available because the Veteran's scar is not unstable or painful. The September 2024 examiner noted that the scar had no pain or deep tissue damage, and was stable.

No additionally disabling effects that are not contemplated in a rating provided under DCs 7800-7804 were noted in the claims file. Thus, a rating under DC 7805 is not available.

In conclusion, the Board finds that the Veteran's linear vertical scar does not warrant a compensable rating under any of the applicable diagnostic codes and denies this appeal.

2. Entitlement to service connection for right lower extremity radiculopathy

The Veteran contends that his right lower extremity radiculopathy developed due to his service-connected back disability.

Service Connection

To establish service connection, a veteran must show: (1) a current disability; (2) an in-service incurrence of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred during service, the so-called "nexus" requirement. See 38 U.S.C. §§ 1110 (2018); 38 C.F.R. § 3.303 (2018); see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). All elements must be satisfied before service connection may be achieved.

For veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including hearing loss, are presumed to have been incurred in service if manifest to a compensable degree within one year of discharge from service. 38 C.F.R. §§ 3.307, 3.309. Alternatively, service connection may also be granted for chronic conditions that have manifested continuous symptomology since separation of service. Id.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant.
4). All elements must be satisfied before service connection may be achieved.

Presumptive service connection may be warranted for certain chronic diseases listed at 38 C.F.R. § 3.309 (a), including arthritis, if manifest to a compensable degree within one year from discharge from service. 38 C.F.R. §§ 3.307 (a)(3), 3.309(a). Direct service connection may be warranted if the evidence shows: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship (nexus) between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Although a competent medical opinion is generally required to establish etiology, competent and credible lay evidence of chronicity and continuity of symptomology may also establish etiology. 38 C.F.R. § 3.303 (b); Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Layno v. Brown, 6 Vet. App. 465 (1994).

In Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), the Federal Circuit found that the term "disability" as used in 38 U.S.C. § 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability." The case reversed years of precedent that had held that "pain alone is not a disability for the purposes of VA disability compensation." Sanchez-Benitez v. West, 13 Vet. App. 282 (1999). In other words, where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability.

The Veteran has a current disability of right superficial peroneal neuropathy, satisfying the initial element of secondary service connection. See July 2024 VA Examination.

The second element of secondary service connection, a service-connected disability, has been conceded by the AOJ as the Veteran is service-connected for chronic idiopathic low back pain.

In support of a medical nexus, the Veteran submitted a private medical opinion by Paula Davis, which stated that it is more likely than not that lumbar spine conditions can result in impaired nerve function, ultimately manifesting in chronic radiculopathy symptoms in the lower extremities. See Private Medical Opinion.

The Veteran underwent a July 2024 VA examination for this condition, and the VA examiner opined that the claimed condition is less likely than not (likelihood is less than approximately balanced or nearly equal) proximately due to or the result of the Veteran's service-connected condition, indicating that on examination, the Veteran had objective medical evidence of neuropathy of the right superficial peroneal nerve, but no signs of radiculopathy from the lumbar spine. See July 2024 VA Medical Opinion. The examiner opined that the conditions of right lower extremity radiculopathy nerve condition and low back are not medically related, and that the right lower extremity radiculopathy nerve condition is a separate entity entirely from the low back. A thorough review of medical literature failed to demonstrate a causal relationship. Instead, the examiner opined that the right superficial peroneal neuropathy is related to injuries below the knee and not due to radiculopathy.

Evaluating the evidence, the Board affords only limited probative weight to the opinion of Paula Davis, as this clinician's opinion was too vague to be applicable to the Veteran's specific condition. This clinician does not indicate whether she examined the Veteran or reviewed the claims file. Instead, she provides a blanket statement that lumbar spine conditions can result in impaired nerve function, ultimately manifesting in chronic radiculopathy symptoms in the lower extremities.

The Board
condition is a separate entity entirely from the low back. A thorough review of medical literature failed to demonstrate a causal relationship. Instead, the examiner opined that the right superficial peroneal neuropathy is related to injuries below the knee and not due to radiculopathy.

The Board affords significant probative value to the VA examiner's opinion, because this clinician evaluated the Veteran, reviewed the claims file, and provided a detailed explanation regarding the Veteran's particular diagnosis of superficial peroneal neuropathy, explaining that this condition is related to injuries below the knee and not due to radiculopathy from the back.

As such, the Board finds that the evidence is not in approximate balance and the benefit of the doubt doctrine is inapplicable. 38 C.F.R. § 5.107. The Board finds that the evidence weighs strongly against a finding that the Veteran's right lower extremity radiculopathy is related to his service-connected low back disability and denies service connection on a secondary basis.

As to the theory of direct service connection, the Board does not find any evidence relating to complaints of right lower extremity radiculopathy in service. Without an in-service event, injury, or disease, the claim cannot proceed and must be denied. The Board notes that, although the Veteran sustained a right knee injury in service, X-ray findings of the right knee were essentially normal. See 1989 VA Rating Decision.

The Board finds no evidence that service connection is warranted under any other theory of entitlement.

3. Entitlement to service connection for a right foot disability

The Veteran contends that he developed a right foot disability in service, or, in the alternative, secondary to his service-connected low back disability.

The Veteran has a current diagnosis of right superficial peroneal neuropathy, satisfying the first element of service connection.

A review of the claims file shows no complaints related to the right foot in service, and the Veteran confirmed in a May 2024 lay statement that he was not seen by military medical personnel for this issue. See May 2024 VA Form 21-4138. Thus, no further consideration is warranted under the direct service connection theory of entitlement.

As to secondary service connection, the Veteran has a current service-connected disability of chronic idiopathic low back pain, satisfying the second element.

Finally, in support of a medical nexus, the Veteran submitted a private medical opinion by Paula Davis, which stated that it is more likely than not that lumbar spine conditions can result in impaired nerve function, ultimately manifesting in chronic radiculopathy symptoms in the lower extremities. See Private Medical Opinion.

A July 2024 VA examiner opined that the Veteran's right foot disability is less likely than not caused by his low back disability, and instead, his right foot numbness is due to superficial peroneal neuropathy. See July 2024 VA Examination. At the examination, the Veteran related that he developed right foot numbness and a foot catching after his lumbar surgery. He stated that his foot catches when he is walking on a ramp, and that he fell on uneven ground.

The Board affords significant probative value to the VA examiner's opinion, because this clinician evaluated the Veteran, reviewed the claims file, and provided a detailed explanation regarding the Veteran's particular diagnosis of superficial peroneal neuropathy, explaining that this condition results in right foot numbness and is related to injuries below the knee and not due to radiculopathy from the back.

As such, the Board finds that the evidence is not in approximate balance and the benefit of the doubt doctrine is inapplicable. 38 C.F.R. § 5.107. The Board finds that the evidence weighs strongly against a finding that the Veteran's right foot disability is related to his service-connected low back disability and denies service connection on a secondary basis.

The Board finds no evidence that service connection is warranted under any other theory of entitlement.

REASONS FOR REMAND

1. Entitlement to an increased
explanation regarding the Veteran's particular diagnosis of superficial peroneal neuropathy, explaining that this condition results in right foot numbness and is related to injuries below the knee and not due to radiculopathy from the back.

As such, the Board finds that the evidence is not in approximate balance and the benefit of the doubt doctrine is inapplicable. 38 C.F.R. § 5.107. The Board finds that the evidence weighs strongly against a finding that the Veteran's right foot disability is related to his service-connected low back disability and denies service connection on a secondary basis.

The Board finds no evidence that service connection is warranted under any other theory of entitlement.

REASONS FOR REMAND

1. Entitlement to an increased rating more than 10 percent for chronic idiopathic low back pain is remanded.

The Veteran's service-connected chronic idiopathic low back pain is currently rated 0 percent from July 2, 1988, and 10 percent from May 7, 2024, under Diagnostic Code (DC) 5237. See Codesheet.

Under the AMA, only pre-decisional duty to assist errors, including those related to VA examinations and opinions, are eligible for remand.

In a recent decision, Ingram v. Collins, the United States Court of Appeals for Veterans Claims (Court) found that when diagnostic codes and special regulations do not explicitly contemplate medication use when rating a disability, the Board must discount the beneficial effects of medication when assigning an evaluation for that disability. 2025 U.S. App. Vet. Claims LEXIS 327. The diagnostic code the Veteran's back (DC 5237) is rated under does not explicitly contemplate medication use. Therefore, the holding of Ingram applies to the claims at issue.

In this case, the July 2024 VA examiner noted that the Veteran was taking Ibuprofen and other over-the counter-medication as for his back pain. See July 2024 VA Examination. The Board notes that the July 2024 VA examination does not address the severity of the Veteran's symptoms in the absence of medication, necessitating an addendum opinion. Moreover, the record reflects the Veteran's treatment with muscle relaxers, a cortisone shot, and narcotics over the years. Id. In Jones v. Shinseki, 26 Vet. App. 56 (2012), the United States Court of Appeals for Veterans Claims (Court) held that when a diagnostic code is silent as to the effects of medication, as is the case here, VA may not deny entitlement to a higher disability rating based on the relief provided by the medication.

The Board is not permitted to substitute its own medical judgment for that of medical professionals. Colvin v. Derwinski, 1 Vet. App. 171 (1991) (stating that the Board may consider only independent medical evidence to support their findings and that if the Board finds that the medical evidence of record is insufficiency, then it may supplement the record by seeking an advisory opinion or ordering a medical examination). Here, the July 2024 VA examiner did not provide any opinion as to the difference in the Veteran's functioning or limitations when using medications compared to without, which, per Jones and Ingram, must be considered. As such, the Board finds that a remand is warranted for a VA medical opinion, as the pre-decisional medical record of evidence is insufficient to determine what the symptoms and range of motion of the Veteran's back would be without any of the beneficial effects of his medication.

The matter is REMANDED for the following action:

1. Arrange for an opinion from an appropriately qualified clinician to determine the severity of the Veteran's service-connected right knee disability when discounting any beneficial effects of medication. The necessity for a new VA examination is left to the discretion of the clinician.

(a) After discounting the beneficial effects of medication, the examiner should opine on the severity of the Veteran's low back disability, which will require the examiner to provide an estimate of range of motion findings, without considering the ameliorative effects of medication. The examiner should describe what the baseline severity of the Veteran's back disability would look like without the impact of his medication. The examiner must provide all information required for rating purposes.

The Board notes that the relevant DC used to rate the Veteran's back disability does not contemplate the effects of medication. See Ingram.

In providing the above opinion(s), the examiner must consider the Veteran's use of Ibuprofen and other over-the-counter medication as needed for pain.

2. A complete rationale with discussion of medical literature for any opinion expressed must be provided. If an opinion cannot be expressed without resort to speculation, discuss why this is the case.

Paulette Vance Burton

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board C. Popa

The Board's decision in this

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