BILATERAL HEARING LOSS DISABILITY

JENNA BRANT · 2026 · Case ID: A26009713

MIXED

Summary

The veteran, who served from January 2013 to January 2022, appeals several rating decisions. The Board granted service connection for erectile dysfunction (ED) as secondary to his service-connected low back disability, left lower extremity (LLE) radiculopathy, femoral nerve, and generalized anxiety disorder, resolving reasonable doubt in the veteran's favor due to approximate balance in the evidence. The Board also granted Special Monthly Compensation (SMC) for loss of use of a creative organ due to ED. An increased rating of 70 percent for generalized anxiety disorder was granted, effective October 16, 2023, based on a holistic analysis of symptoms and impairment levels, again resolving reasonable doubt in the veteran's favor. The veteran's claim for an increased rating for headaches was denied, as the evidence did not support a rating higher than the maximum 50 percent schedular rating, and extraschedular consideration was not warranted. Service connection for bilateral hearing loss was denied, as VA examinations indicated normal hearing for VA purposes, and the Board found the private chiropractic examination lacked probative value due to improper testing methods. The claim for an increased rating for LLE radiculopathy, femoral nerve, was denied, as the evidence did not support a rating higher than the 10 percent rating already assigned. The Board remanded claims for increased ratings for bilateral dry eye, right ankle, low back, neck, right knee with shin splints, left knee with shin splints, and right shoulder disabilities, due to contradictory or insufficient medical evidence requiring further VA examination and clarification.

Special Benefit

SMC

Docket No.

250602-551927

Full Decision Text

Citation Nr: A26009713
Decision Date: 02/03/26 Archive Date: 02/03/26

DOCKET NO. 250602-551927
DATE: February 3, 2026

ORDER

Entitlement to service connection for a bilateral hearing loss disability is denied.

Entitlement to service connection for ED as secondary to service-connected low back disability, LLE radiculopathy, femoral nerve, and/or generalized anxiety disorder, is granted.

Entitlement to Special Monthly Compensation (SMC) for loss of use of a creative organ is granted.

Entitlement to an increased rating of 70 percent for generalized anxiety disorder is granted from October 16, 2023.

Entitlement to an initial rating in excess of 50 percent for a headache disability is denied.

Entitlement to an initial rating in excess of 10 percent for left lower extremity (LLE) radiculopathy, femoral nerve, is denied.

Entitlement to an increased rating of 20 percent for a right foot and toe disability is granted from May 30, 2024.

REMANDED

Entitlement to a rating in excess of 10 percent for bilateral dry eye disability is remanded.

Entitlement to an initial rating in excess of 10 percent for a right ankle disability is remanded.

Entitlement to a rating in excess of 10 percent for a low back disability is remanded.

Entitlement to an initial rating in excess of 10 percent for a neck disability is remanded.

Entitlement to an initial rating in excess of 10 percent for a right knee and shin splint disability is remanded.

Entitlement to an initial rating in excess of 10 percent for a left knee and shin splint disability is remanded.

Entitlement to a rating in excess of 20 percent for a right shoulder disability is remanded.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that the Veteran has had a right or left hearing loss disability for VA purposes at any time during or approximate to the pendency of the claim.

2. The evidence of record is in approximate balance regarding whether the Veteran's ED is caused by his service-connected low back disability, LLE radiculopathy, femoral nerve, and/or generalized anxiety disorder.

3. The Veteran's ED results in an inability to have intercourse.

4. The evidence is in approximate balance regarding whether the severity, frequency, and duration of the Veteran's symptoms of generalized anxiety disorder more closely approximate occupational and social impairment with deficiencies in most areas from October 16, 2023.

5. The evidence of record persuasively weighs against a finding that the Veteran's headaches and associated symptomatology presented such an exceptional disability picture that the schedular ratings, as a whole, were inadequate when comparing the level of severity of the Veteran's headaches with the established rating criteria under DC 8100.

6. The Veteran's LLE radiculopathy, femoral nerve, is manifest by no more than mild incomplete paralysis.

7. The evidence is in approximate balance regarding whether the Veteran's right foot and toe disability is manifested by moderately severe symptoms from May 30, 2024.

CONCLUSIONS OF LAW

1. The criteria for service connection for a bilateral hearing loss disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.385, 4.85.

2. The criteria for service connection for an ED disability as secondary to service-connected low back disability, LLE radiculopathy, femoral nerve, and/or generalized anxiety disorder are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for SMC based on loss of use of a creative organ have been met. 38 U.S.C. § 1114(k); 38 C.F.R. § 3.350.

4. Resolving reasonable doubt in favor of the Veteran, the criteria for an increased disability rating of 70 percent for generalized anxiety disorder have been met from October 16, 2023. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9400.

5. The criteria for an initial rating in excess of 50 percent, to include on an extraschedular basis, for headaches, have not been met. 38 U.S.C. §§ 1155; 5107(b), 5110; 38 C.F.R. §§
Resolving reasonable doubt in favor of the Veteran, the criteria for an increased disability rating of 70 percent for generalized anxiety disorder have been met from October 16, 2023. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9400.

6. The criteria for an initial disability rating in excess of 10 percent for LLE radiculopathy, femoral nerve, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8526.

7. Resolving reasonable doubt in favor of the Veteran, the criteria for an increased rating of 20 percent for right foot and toe disability have been met from May 30, 2024. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5284.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from January 2013 to January 2022.

These matters are before the Board of Veterans' Appeals (Board) on appeal from January 31, 2025 (increased rating for a neck disability and service connection for ED), January 10, 2025 (increased ratings for right shoulder, left knee with shin splints, and right knee with shin splints disabilities, and service connection for bilateral hearing loss), and December 2024 (increased rating for low back, LLE radiculopathy, femoral nerve, bilateral dry eye syndrome, right foot and toe, right ankle, anxiety, and headache disabilities) rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO).

In September 2024, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of service connection for bilateral hearing loss, most recently addressed in a February 2022 rating decision. In January 2025, the agency of original jurisdiction (AOJ) issued the supplemental claim decision on appeal, which found that new and relevant evidence had been received and denied the claim based on the evidence of record at the time of that decision.

In the June 2, 2025, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.

Therefore, for the matters of entitlement to an increased rating for low back and LLE radiculopathy, femoral nerve, bilateral dry eye syndrome, right foot and toe, right ankle, anxiety, and headache disabilities, the Board may only consider the evidence of record at the time of the December 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. For the matters of entitlement to increased ratings for right shoulder, left knee with shin splints, and right knee with shin splints disabilities, and service connection for bilateral hearing loss, the Board may only consider the evidence of record at the time of the January 10, 2025, 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. Id. For the matters of entitlement to an increased rating for a neck disability and service connection for ED, the Board may only consider the evidence of record at the time of the January 31, 2025, 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. Id.

If evidence was submitted either (1) during the period
January 10, 2025, 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. Id. For the matters of entitlement to an increased rating for a neck disability and service connection for ED, the Board may only consider the evidence of record at the time of the January 31, 2025, 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. Id.

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 claims of entitlement to an increased rating for right ankle, low back, neck, right shoulder, bilateral dry eye syndrome, right knee and shin splint, and left knee and shin splint disabilities, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Certain chronic diseases, such as other organic disease of the nervous system, will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

Entitlement to service connection for a bilateral hearing loss disability

The Veteran seeks service connection for a bilateral hearing loss disability.

For the purpose of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Additionally, it is noted that the threshold for normal hearing is from 0 to 20 decibels, and higher threshold levels indicate some degree of hearing loss. See Hensley v. Brown, 5 Vet. App. 155, 157 (1993).

An examination for hearing
or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. Additionally, it is noted that the threshold for normal hearing is from 0 to 20 decibels, and higher threshold levels indicate some degree of hearing loss. See Hensley v. Brown, 5 Vet. App. 155, 157 (1993).

An examination for hearing impairment for VA purposes must be conducted by a state-licensed audiologist and must include a controlled speech discrimination test (Maryland CNC) and a puretone audiometry test. 38 C.F.R. § 4.85.

The question for the Board is whether the Veteran has a current bilateral hearing loss disability that meets the VA definition of hearing loss that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The Board concludes that the Veteran does not have hearing loss for VA purposes and has not had hearing loss for VA purposes at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

To assess the severity of the Veteran's hearing loss, he was afforded a VA examination in November 2021 by S.R., a state-licensed audiologist. The examination produced the following audiological results:

HERTZ

500 1000 2000 3000 4000

RIGHT 10 10 15 25 10

LEFT 5 5 15 20 25

Speech audiometry revealed a speech recognition ability of 100 percent in the right ear and 96 percent in the left ear, using the Maryland CNC Test. The examiner found that both ears displayed normal hearing. The examiner found that the Veteran's hearing loss impacts ordinary conditions of daily life, including ability to work. The Veteran stated that he feels like he doesn't hear as well as he used to. He stated that he started using subtitles and has some trouble understanding people over the phone.

A July 2024 private examination by Dr. M.T., a chiropractor, indicated that the Veteran's hearing was tested in a room wherein normal day-to-day noise (air conditioner, computer, and soft background music) was introduced to test functional hearing under normal day-to-day conditions. She stated that 256 cps, 512 cps stimuli were employed along with spoken words at a distance of 5 feet.

She indicated that testing revealed that the Veteran has an estimated bilateral hearing loss under normal conditions of 20% of the right ear and 20% of the left ear. She stated that the Veteran was asked to attend for a pure tone audiogram and have the results sent to her office.

A January 2025 VA examination by S.R., a state-licensed audiologist, produced the following audiological results:

HERTZ

500 1000 2000 3000 4000

RIGHT 20 15 20 30 15

LEFT 20 15 25 30 35

Speech audiometry revealed a speech recognition ability of 100 percent in the right ear and 98 percent in the left ear, using the Maryland CNC Test. The examiner found that there was no hearing loss diagnosis in the right or left ear for VA purposes. The examiner found that the Veteran's hearing loss impacts ordinary conditions of daily life, including ability to work. The Veteran stated that he has started to miss certain noises, and he can hear that someone is talking, but has trouble with comprehension and says "what?" more often.

The Board finds the July 2024 private examination by Dr. M.T., a chiropractor, to be of no probative value because there is no indication that an examination for hearing impairment was conducted by a state-licensed audiologist and included a controlled speech discrimination test (Maryland CNC) and a puretone audiometry test. As stated above, an examination for hearing impairment for VA purposes must be conducted by a state-licensed audiologist and must include a controlled speech discrimination test (Maryland CNC) and a puretone audiometry test. 38 C.F.R. § 4.85. As both the November 2021 and January 2025 VA examinations were conducted by a state-licensed
?" more often.

While the Veteran believes there is a current diagnosis of hearing loss for VA purposes, the Veteran is not competent to provide a diagnosis for VA purposes in this case. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence.

Because the Veteran does not have hearing loss in either ear for VA purposes, the Board must deny service connection for bilateral hearing loss.

Entitlement to service connection for ED as secondary to service-connected low back disability, LLE radiculopathy, femoral nerve, and/or generalized anxiety disorder

The Veteran seeks service connection for ED as secondary to service-connected low back disability, LLE radiculopathy, femoral nerve, and generalized anxiety disorder.

Regarding a current diagnosis, the January 2025 rating decision on appeal found that the Veteran was diagnosed with erectile dysfunction. No clear or unmistakable error has been shown to rebut the AOJ's favorable finding; therefore, the Board is bound by the finding. 38 C.F.R. § 3.104(c). The Veteran is service connected for a low back disability, LLE radiculopathy, femoral nerve, and for generalized anxiety disorder.

Regarding a nexus between the Veteran's ED and his service-connected low back disability, LLE radiculopathy, femoral nerve, and generalized anxiety disorder, the July 2024 private medical examination report by Dr. M.T. indicated that the Veteran's ED is neurogenic and is related to his lumbar spine disability; noted the Veteran's substantial left sciatic pain and paresthesia; and stated that the Veteran would benefit from consultation with a neurosurgeon.

The September 2024 VA male reproductive organ condition examination report stated that the Veteran indicated that his ED began in conjunction with his anxiety, and his current symptoms include being unable to obtain and maintain an erection. The examiner stated that the etiology of the Veteran's ED was unknown. The examiner opined that the Veteran's ED is less likely than not due to his service-connected low back arthritis. She stated that ED is not linked with arthritis of the spine without spinal cord injury, which is not the case here. She indicated that some other causes of erectile dysfunction can include medication and depression symptoms.

A January 2025 VA addendum medical opinion indicated that the Veteran's ED was less likely than not due to his in-service TERAs, and noted that stress and mental health concerns can cause or worsen ED.

A May 2025 report by A.M., a private mental health provider, indicated that the Veteran developed ED possibly as a result of an increase in symptoms of anxiety.

The Board finds the September 2024 VA examiner's medical opinion to be of lessor probative value because it did not address the service-connected nerve injury of LLE radiculopathy, femoral nerve that is associated with the Veteran's service-connected low back disability.

As such, resolving reasonable doubt in favor of the Veteran, the Board finds that the rest of the evidence of record is in approximate balance regarding whether the Veteran's service-connected low back disability, LLE radiculopathy, femoral nerve, and/or generalized anxiety disorder caused his ED. As such, the Board finds that the Veteran's service connection claim for ED should be granted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

Entitlement to SMC for loss of use of a creative organ

The issue of entitlement to SMC based on loss of use of a creative organ has been raised by the record in the context of the Veteran's claim for service connection for ED. See Ak
favor of the Veteran, the Board finds that the rest of the evidence of record is in approximate balance regarding whether the Veteran's service-connected low back disability, LLE radiculopathy, femoral nerve, and/or generalized anxiety disorder caused his ED. As such, the Board finds that the Veteran's service connection claim for ED should be granted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

Entitlement to SMC for loss of use of a creative organ

The issue of entitlement to SMC based on loss of use of a creative organ has been raised by the record in the context of the Veteran's claim for service connection for ED. See Akles v. Derwinski, 1 Vet. App. 118 (1991). The Board notes that it has granted entitlement to service connection for erectile dysfunction. SMC is warranted "if the Veteran, as the result of a service-connected disability, has suffered the anatomical loss of use of one or more creative organs." 38 U.S.C. § 1114(k); see also 38 C.F.R. § 3.350(a).

The July 2024 private report by Dr. M.T. indicated that the Veteran stated that he has ED which does not respond well to Viagra-type medications. The Veteran stated in the September 2024 VA male reproductive organ conditions examination that his ED symptoms include the inability to obtain and maintain erections.

Based on the evidence above, the Board finds that the Veteran has loss of use of a creative organ, and accordingly, SMC based on loss of use of a creative organ is granted. Id.

Increased Ratings

Disability ratings are determined by application of the criteria set forth in VA's Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; see generally 38 C.F.R. § Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating applies. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3.

The veteran's entire history is to be considered when making disability evaluations. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where the question for consideration is the propriety of the initial rating assigned, such as in the matters of an increased rating for right ankle, LLE radiculopathy, femoral nerve, headaches, right knee with shin splints, left knee with shin splints, right shoulder, and neck disabilities, evaluation of the medical evidence since the effective date of the grant of service connection and consideration of the appropriateness of the assignment of different ratings for distinct periods of time, based on the facts found, is required. Fenderson v. West, 12 Vet. App. 119, 126 (1999); Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, such as in the matters of an increased rating for generalized anxiety disorder, bilateral dry eye syndrome, a right foot and toes disability, and a low back disability, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007).

Entitlement to an increased rating of 70 percent for generalized anxiety disorder is granted from October 16, 2023

The Veteran seeks an increased rating of 70 percent for his generalized anxiety disorder.

The Veteran's anxiety is rated at 50 percent disabling under DC 9400 throughout the entire period on appeal. As the Veteran filed an intent to file (ITF) in May 2024 and a fully developed claim in September 2024 for an increased rating for his anxiety disorder, and as the evidence shows a factually ascertainable increase in the Veteran's anxiety on October 16, 2023, the period on appeal starts on October 16, 2023. See 38 C.F.R. § 3.400; see Gaston v. Shinseki, 605 F
October 16, 2023

The Veteran seeks an increased rating of 70 percent for his generalized anxiety disorder.

Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013).

The issue in this appeal is whether the Veteran's associated symptoms caused the level of impairment required for a disability rating of 70 percent.

The Board concludes that the Veteran's symptoms more closely approximated the symptoms associated with a 70 percent rating and resulted in a level of impairment that most closely approximated the level of impairment associated with a 70 percent rating.

A noncompensable rating is assigned when a mental condition has been formally diagnosed, but symptoms are not severe enough to either require continuous medication, or to interfere with occupational and social functioning.

A 10 percent rating is assigned when mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of occasional stress, or symptoms controlled by medication cause occupational and social impairment.

A 30 percent rating is assigned when symptoms such as depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, or recent events), cause occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and normal conversation).

A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity.

A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.

A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name.

VA treatment records dated on October 16, 2023, indicate that the Veteran reports chronic depressive and anxiety symptoms. He stated that his symptoms are variable in frequency and intensity. The Veteran described unpredictable nature of elevations, and he noted that his symptoms can be severe regarding amotivation, apathy, anhedonia, restlessness, and rumination. He stated that he has poor sleep at times and vegetative dysregulation during episodes of low mood.

A July 2024 private evaluation by Dr. P.M., a psychologist, indicates that the Veteran reports mostly
daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name.

A July 2024 private evaluation by Dr. P.M., a psychologist, indicates that the Veteran reports mostly being socially isolated other than having one neighbor friend. Dr. P.M. stated that throughout the evaluation the veteran appeared to be excessively anxious, he spoke in a low tone of voice, and he appeared timid. The report stated that his mood continued to be anxious and depressed throughout the evaluation. The Veteran's affect was congruent to his mood, and he reported occasional passive suicidal thoughts with no intent or plan and firmly denied active or current suicidal thoughts, ideations, intent or plan. The veteran denied any homicidal thoughts, ideations, intent or plan. The Veteran reported loss of interest in previously enjoyed activities such as playing video games. He reports withdrawing from other people, depressed mood, anxiety, feeling irritable, occasional avoidance of leaving his home due to depressive and anxiety symptoms, and avoidance of crowds or places where people tend to gather, as he tends to become hyper-vigilant and hyperalert. The Veteran reported feelings of worthlessness, a deep sense of sadness, helplessness, occasional passive suicidal ideations with no intent or plan, frequent worry, racing thoughts, deceased energy, intrusive memories, difficulties concentrating, occasional nightmares, and occasional panic attacks.

An August 2024 private DBQ from Dr. P.M. indicated that the Veteran has occupational and social impairment in most areas due to his mental health disability. Dr. P.M. listed the Veteran's symptoms as including depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, mild memory loss, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful situations, and inability to establish effective relationships.

August 2024 VA treatment records indicated that the Veteran reported daily anxiety and daily depression. He reported struggling to have close relationships.

A September 2024 VA mental health examination report indicated that the Veteran's mental health disability causes occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. The Veteran reports that he spends most of his time alone in his room and notes going out once or twice a week to spend time with a friend. He indicates that he lives with his parents. The examiner listed the Veteran's symptoms as depressed mood, anxiety, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and suicidal ideation. The examiner indicated that the Veteran's affect was restricted and his mood was anxious.

The VA treatment records, the Veteran's July 2024 private psychological evaluation and August 2024 private DBQ, and the September 2024 VA examination show that the Veteran's generalized anxiety was manifested by symptoms associated with a 70 percent rating, such as suicidal ideation and difficulty in adapting to stressful circumstances. The Veteran also had symptoms that are not listed with a specific rating, such as suspiciousness. The Board finds the severity, frequency, and duration of the Veteran's unlisted symptoms more closely approximate the symptoms contemplated by a 70 percent rating. See 38 C.F.R. § 4.126.

The Board also finds the level of impairment caused by the Veteran's symptoms more closely approximates the level associated with a 70 percent rating. Resolving reasonable doubt in favor of the Veteran, the Board finds that the Veteran experienced occupational and social impairment with reduced reliability and productivity with deficiencies in most areas.

In short, resolving reasonable doubt in favor of the Veteran, the evidence of record is in approximate balance regarding a finding that the severity, frequency, and duration of the Veteran's symptoms resulted in the level of impairment required for an increased 70 percent rating from October 16, 2023. As such, the criteria for an increased 70 percent rating are met, and the appeal must be granted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

Entitlement to an initial rating in excess of 50 percent for a headache disability

The Veteran seeks an increased initial rating of 70 percent
and social impairment with reduced reliability and productivity with deficiencies in most areas.

Entitlement to an initial rating in excess of 50 percent for a headache disability

The Veteran seeks an increased initial rating of 70 percent for his headache disability.

The Veteran's headaches are rated under DC 8100 as 50 percent disabling from May 30, 2024.

Migraine headaches are rated pursuant to 38?C.F.R. §?4.124a, Diagnostic Code (DC) 8100, for migraine. Under DC 8100, a noncompensable rating is warranted for migraines with less frequent attacks. A 10 percent rating is warranted for migraines with characteristic prostrating attacks averaging one in 2 months over the last several months. A 30 percent rating is warranted for migraines with characteristic prostrating attacks occurring on an average once a month over the last several months. A 50 percent rating is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. A 50 percent rating is the highest schedular rating under DC 8100.

The rating criteria of DC 8100 are considered successive, meaning that a claimant cannot fulfill the criteria of the higher rating without fulfilling those of the next lower rating. Johnson v. Wilkie, 30?Vet. App.?245, 252 (2018). This renders 38?C.F.R. §§?4.7 and 4.21 inapplicable. Johnson, 30 Vet. App. at 252.

The phrase "characteristic prostrating attacks" is used in the criteria corresponding to 10 percent and 30 percent ratings under DC 8100 to describe the nature and severity of migraines, but it is not defined in the regulation. Pursuant to Dorland's Illustrated Medical Dictionary 1531 (32d ed. 2012), prostration is defined as "extreme exhaustion or powerlessness." Thus, the phrase "characteristic prostrating attacks" is understood to describe migraine attacks that typically produce extreme exhaustion or powerlessness.

The rating criteria for a 50 percent rating contain several undefined phrases. The descriptive phrase "very frequent" connotes a frequency at least greater than once a month, as is required by the rating criteria corresponding to a lesser 30 percent rating. Johnson, 30 Vet. App. at 253. The phrase "completely prostrating" generally means that the migraines attack must render the veteran entirely powerless. Id. The completely prostrating attacks must also be "prolonged," which is defined as "to lengthen in time: extend duration: draw out: continue, protract." Id. (internal citation omitted). Lastly, the 50 percent rating criteria requires that the very frequent completely prostrating and prolonged attacks be "productive of severe economic inadaptability." Productive can be read as having either the meaning of "producing" or "capable of producing," and, with regard to severe economic inadaptability, nothing in DC 8100 requires that the claimant be completely unable to work in order to qualify for a 50 percent rating. Pierce v. Principi, 18?Vet. App.?440, 445-46 (2004).

Holmes v. Wilkie, 33 Vet. App. 67 (2020) held that DC 8100 contemplates all migraine symptoms. Therefore, to evaluate migraines under DC 8100, VA must consider all symptoms experienced due to migraine attacks and then rate the symptoms based on the frequency, duration, and economic impact of those attacks.

As the Veteran appealed the December 2024 rating decision that granted service connection for headaches and assigned a 50 percent rating from May 30, 2024, the period on appeal starts on March 30, 2024.

The Board notes that during the period on appeal, the Veteran has already been awarded the maximum 50 percent rating available for his headaches. However, as the Veteran seeks a rating in excess of 50 percent, the Board must consider whether referral to the Director, Compensation Service, is warranted for extraschedular consideration.

As a general rule, disability ratings are based upon the average
all symptoms experienced due to migraine attacks and then rate the symptoms based on the frequency, duration, and economic impact of those attacks.

As a general rule, disability ratings are based upon the average impairment of earning capacity resulting from the disability as delineated in the Ratings Schedule. 38 C.F.R. § 3.321(a), Part 4. However, to accord justice, in exceptional cases where the schedular ratings are found to be inadequate, an extraschedular rating commensurate with the average earning capacity impairment due exclusively to the service-connected disability will be awarded. 38 C.F.R. § 3.321(b)(1). For such an award, the case must present such an exceptional or unusual disability picture with related factors such as marked interference with employment or frequent periods of hospitalization as to render the application of the schedular standards impractical. Id.

In that regard, the threshold factor for extraschedular consideration is a finding that the evidence presents such an exceptional disability picture that the schedular ratings, as a whole, are inadequate when comparing the level of severity of the disability with the established rating criteria. 3 8 C.F.R. § 3.321(b)(1); see also Thun v. Peake, 22 Vet. App. 111, 115 (2008), aff'd sub nom., Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009). Extraschedular consideration is not warranted when the disability may be properly evaluated with conventional schedular rating tools. See Morgan v. Wilkie, 31 Vet. App. 162, 168 (2019).

The Board does not have jurisdiction to adjudicate the issue of entitlement to an extraschedular rating in the first instance. Nevertheless, the Board has the authority to determine whether referral to the Director, Compensation Service, is warranted for consideration of an extraschedular rating. 38 C.F.R. § 3.321(b)(1).

A July 2024 private examination by Dr. M.T. indicated that the Veteran stated that he suffers four or more headaches per week, with an average duration of 20-30 minutes. He stated that he suffers from two or more migraines a week with an average duration of 1-2 hours. She stated that the Veteran has associated light sensitivity with migraines and is required to go into a dark room when they occur.

A September 2024 VA headache examination indicated that the Veteran's symptoms include squeezing global pain and stated that he takes over the counter Tylenol. The examiner indicated that the Veteran experiences pain on both sides of his head and has associated sensitivity to light and sound. The examiner indicated that the duration of typical head pain lasts less than a day. The examiner stated that the Veteran has characteristic prostrating attacks of headache pain more than once a month and has completely prostrating and prolonged attacks of migraine pain more than once a month. The examiner stated that the Veteran's disability does not impact his ability to work. While the evidence indicates that the Veteran reported taking a medication for his disability, the Board notes that there is no indication that the VA examiner considered the ameliorative effects of medication in rendering the findings in the report. As such, The Board finds the VA examination report adequate for adjudicative purposes. See Ingram v. Collins, 38 Vet. App. 130 (2025).

The Board finds that neither the lay nor medical evidence of record contains information about any symptoms not contemplated under the rating criteria associated with DC 8100. During the relevant period, the Veteran reported experiencing headache pain and sensitivity to light and sound. Each of these symptoms are symptoms recognized as associated with the Veteran's headaches, and contributed to the finding that he has very frequent prostrating and prolonged attacks more than once a month. As stated above, Holmes v. Wilkie, 33 Vet. App. 67 (2020) held that DC 8100 contemplates all migraine symptoms. For this reason, the Board finds that the evidence of record does not present such an exceptional disability picture that the schedular ratings, as a whole, are inadequate when comparing the level of severity of the Veteran's headaches with the established rating criteria. Accordingly,
criteria associated with DC 8100. During the relevant period, the Veteran reported experiencing headache pain and sensitivity to light and sound. Each of these symptoms are symptoms recognized as associated with the Veteran's headaches, and contributed to the finding that he has very frequent prostrating and prolonged attacks more than once a month. As stated above, Holmes v. Wilkie, 33 Vet. App. 67 (2020) held that DC 8100 contemplates all migraine symptoms. For this reason, the Board finds that the evidence of record does not present such an exceptional disability picture that the schedular ratings, as a whole, are inadequate when comparing the level of severity of the Veteran's headaches with the established rating criteria. Accordingly, the Board finds that a referral to the Director, Compensation Service, for extraschedular consideration is not warranted, and an initial rating in excess of 50 percent for the Veteran's headaches is denied.

Entitlement to an initial rating in excess of 10 percent for LLE radiculopathy, femoral nerve

The Veteran seeks a rating in excess of 10 percent for LLE radiculopathy, femoral nerve.

The Veteran's LLE radiculopathy, femoral nerve, is rated under DC 8526 as 10 percent disabling from May 30, 2024. As the Veteran appealed the December 2024 rating decision that granted service connection for LLE radiculopathy, femoral nerve, and assigned a 10 percent rating from May 30, 2024, the period on appeal starts on March 30, 2024.

Paralysis of the femoral nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8526. Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Severe incomplete paralysis is rated as 30 percent disabling. Complete paralysis includes paralysis of quadriceps extensor muscles and is rated as 40 percent disabling, 38 C.F.R § 4.124a.

The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124.

The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017).

VA's Adjudication Procedures Manual (M21-1) provides benchmarks for mild, moderate, moderately severe, and severe peripheral nerve conditions. However, although the Board is not bound by the M21-1, it is required to discuss any relevant provisions contained in the M21-1 and conduct its own analysis before determining whether the M21-1 provisions may be relied upon to support its decision, thereby fulfilling part of its duty to provide adequate reasons or bases for its decision. See Overton v. Willkie, 30 Vet. App. 257, 263-64 (2018).

The M21-1 indicates that where a peripheral nerve disability is only manifested by sensory impairment, the mild level of evaluation would be more reasonably assigned when sensory symptoms are recurrent but not continuous, assigned a lower medical grade reflecting less impairment, and/or affecting a smaller area in the nerve distribution. It instructs to reserve the moderate level of evaluation for the most significant and disabling cases of sensory-only involvement, such as where the sensory symptoms are continuous, assigned a higher medical grade reflecting greater impairment, and/or they affect a larger area in the nerve distribution. M21-1, V.iii.12.A.2.b. It indicates that this provision does not mean that if there is any impairment that is non-sensory (or involves a non-sensory component) such as a reflex abnormality, weakness, or muscle atrophy, the disability must be evaluated as greater than moderate, as significant and widespread sensory impairment may potentially indicate the same or even more disability than a case involving a minimally reduced or increased reflex or minimally reduced strength. Id.

The M21-1 indicates that "moderately severe" incomplete paralysis is the maximum rating for sciatic nerve neuritis not characterized by the organic changes specified in 38 C.F.R. § 4.123. It states that this term would be appropriate for "[m]otor and/or reflex impairment (for example, weakness or diminished or hyperactive reflexes) at a grade reflecting a high level of limitation or disability. Atrophy may be present. However, for marked muscular atrophy, see the criteria for a severe evaluation under 38 C.F.R. § 4.124a, Diagnostic Code 8520." M21-1, V.iii.12.A.2.c.

The M21-1 further provides, for "severe" incomplete paralysis of a peripheral nerve, "[i]n general, severe incomplete paralysis of a peripheral nerve involves motor and/or reflex impairment (for example atrophy, weakness, or diminished or hyperactive reflexes) at a grade reflecting a very high level of limitation or disability." Id. "Trophic changes may be seen in severe longstanding neuropathy cases. For the sciatic nerve ((38 CFR 4.124a, DC 8520) marked muscular atrophy is expected." Additionally, "the disability picture for severe incomplete paralysis may contain signs/symptoms resembling some of those expected in cases of complete paralysis of the nerve." Furthermore, "neuritis characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain should be rated as high as severe incomplete paralysis of the nerve." Id.

A September 2024 VA back examination report indicated that the Veteran described his disability as achy and sharp, worse with lifting and bending, and better with rest. The examiner indicated that the Veteran takes NSAIDs for his disability. The Veteran's muscle strength testing was normal, and he does not have muscle atrophy. The Veteran's deep tendon reflexes were normal, his sensation to light touch was normal, and his straight leg test was normal. The examiner indicated that the Veteran does not have constant pain, he has severe intermittent pain (usually dull) in the LLE, he has mild LLE numbness, and mild LLE paresthesias and/or dysesthesias. The examiner stated that the Veteran does not have any other signs or symptoms of radiculopathy, and the Veteran does not walk with any assistive devices. While the evidence indicates that the Veteran reported taking a medication for his disability, the Board notes that there is no indication that the VA examiner considered the ameliorative effects of medication in rendering the findings in the report. As such, the Board finds the VA examination report adequate for adjudicative purposes. See Ingram v. Collins, 38 Vet. App. 130 (2025).

The evidence does not indicate that the Veteran has impairment of motor functions, trophic changes, sensory disturbance, loss of reflexes, muscle atrophy, or complete paralysis. Regarding pain, while the Veteran described his back and lower extremity disabilities as a whole as achy and sharp, worse with lifting and bending, and better with rest, the examiner indicated in the radiculopathy portion of the exam that the Veteran does not have constant pain, he has severe intermittent pain (usually dull) in the LLE, he has mild LLE numbness, and mild LLE paresthesias and/or dysesthesias. As the Veteran was referring to both his low back and radiculopathy disabilities and the examiner was referring specifically to the radiculopathy disability, the Board finds the VA examiner's description of pain as more probative.

Based on the above, the Board finds that the disability is primarily manifest by severe
his back and lower extremity disabilities as a whole as achy and sharp, worse with lifting and bending, and better with rest, the examiner indicated in the radiculopathy portion of the exam that the Veteran does not have constant pain, he has severe intermittent pain (usually dull) in the LLE, he has mild LLE numbness, and mild LLE paresthesias and/or dysesthesias. As the Veteran was referring to both his low back and radiculopathy disabilities and the examiner was referring specifically to the radiculopathy disability, the Board finds the VA examiner's description of pain as more probative.

Based on the above, the Board finds that the disability is primarily manifest by severe intermittent (usually dull) pain, and mild numbness and paresthesias and/or dysesthesias. As the M21-1 cited above indicates that for a peripheral nerve disability that is only manifested by sensory impairment, the mild level of evaluation would be more reasonably assigned when sensory symptoms are recurrent but not continuous, and instructs to reserve the moderate level of evaluation for the most significant and disabling cases of sensory-only involvement, such as where the sensory symptoms are continuous, and here the September 2024 VA examiner found that the Veteran's pain is not continuous and his numbness and paresthesias and/or dysesthesias are mild, the Board finds that the level of impairment is most analogous to mild incomplete paralysis.

The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service-connected. Therefore, a separate or higher rating under a different Diagnostic Code is not warranted.

In conclusion, the Board finds that the evidence of record persuasively weighs is against the Veteran's claim for a rating in excess of 10 percent for LLE radiculopathy, femoral nerve. As the evidence of record persuasively weighs against an initial rating in excess of 10 percent, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Entitlement to an increased rating of 20 percent for a right foot and toe disability from May 30, 2024

The Veteran seeks an increased rating of 20 percent for his right foot and toe disability.

The Veteran's right foot and toe disability is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5284, for other foot injuries. The Veteran's right foot and toe disability is rated as noncompensable from January 30, 2022, and as 10 percent disabling from May 30, 2024. As the Veteran filed an ITF on May 30, 2024, and his increased rating claim in September 2024, and the evidence does not demonstrate that a factually ascertainable increase occurred in the one year prior to May 30, 2024, the appeal period starts on May 30, 2024. See 38 C.F.R. § 3.400; see Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010).

Under Diagnostic Code 5284, a 10 percent rating is warranted for moderate other foot injuries. A 20 percent rating is warranted for moderately severe other foot injuries. A 30 percent rating is warranted for severe other foot injuries. A Note to Diagnostic Code 5284 instructs that with actual loss of use of the foot rate as a maximum 40 percent. 38 C.F.R. § 4.71a, Diagnostic Code 5284.

According to MERRIAM WEBSTER, "moderate" means "tending toward the mean or average amount or dimension". See www.merriam-webster.com/dictionary/moderate. "Severe" means "of a great degree." See www.merriam-webster.com/dictionary/severe.

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 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) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria.").

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 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.

A July 2024 examination by Dr. M.T., a private chiropractor, indicated that since the Veteran became service-connected for his right foot and toe disability, his disability has worsened. She stated that the pain and dysfunction of the condition persists to the present. She indicated that he has intermittent pain of the right foot on first weight-bearing in the morning, which inhibits walking for 30 minutes, and there is tenderness on palpation.

A September 2024 VA examination report indicated that the Veteran's diagnosis is right foot and toe sprain. The examiner indicated that the Veteran stated he has sharp, achy pain with weight bearing in his right great toe and medial foot areas, and he uses NSAIDs as treatment. The Veteran did not report flareups. The Veteran indicated that the disability causes the functional impairment of experiencing difficulty on long walks and while running. The examiner indicated that the Veteran experiences his symptoms weekly. The examiner indicated that the severity of the Veteran's disability is mild. The examiner indicated that the Veteran's disability does not chronically compromise weight-bearing and does not require arch supports, custom orthotic inserts, or shoe modifications. The examiner indicated that there was pain upon physical examination, and the pain contributes to functional loss. The examiner indicated that contributing factors of disability included pain and disturbances of locomotion. The examiner stated that with repeated use over a period of time there is functional loss, specifically difficulty with long walks and running. The examiner indicated that there was evidence of pain on weightbearing through the Veteran's facial expression/wincing upon movement. The examiner indicated that the Veteran does not require any assistive devices as a normal mode of locomotion. The examiner indicated that the Veteran's disability does not impact his ability to perform any type of occupational task. While the evidence indicates that the Veteran reported taking a medication for his disability, the Board notes that there is no indication that the VA examiner considered the ameliorative effects of medication in rendering the findings in the report. As such, the Board finds the VA examination report adequate for adjudicative purposes. See Ingram v.
there is functional loss, specifically difficulty with long walks and running. The examiner indicated that there was evidence of pain on weightbearing through the Veteran's facial expression/wincing upon movement. The examiner indicated that the Veteran does not require any assistive devices as a normal mode of locomotion. The examiner indicated that the Veteran's disability does not impact his ability to perform any type of occupational task. While the evidence indicates that the Veteran reported taking a medication for his disability, the Board notes that there is no indication that the VA examiner considered the ameliorative effects of medication in rendering the findings in the report. As such, the Board finds the VA examination report adequate for adjudicative purposes. See Ingram v. Collins, 38 Vet. App. 130 (2025).

The Board finds that resolving reasonable doubt in favor of the Veteran, an increased rating of 20 percent is warranted for the entire period on appeal. The July 2024 examination by the Dr. M.T. indicating that the Veteran's intermittent pain of the right foot on first weight bearing in the morning inhibits walking for 30 minutes and the September 2024 VA examiner's finding of pain upon examination which causes functional loss, factors of pain and locomotion disturbance as factors of the disability, that repeated use over a period of time causes functional loss, and that there was evidence of pain on weightbearing through the Veteran's facial expression/wincing upon movement, show that the evidence is in approximate balance regarding whether the Veteran's right foot and toe symptoms are moderately severe. As such, resolving reasonable doubt in favor of the Veteran, the Board finds that an increased rating of 20 percent for his right toe and foot disability must be granted from May 30, 2024. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

REASONS FOR REMAND

Entitlement to a rating in excess of 10 percent for bilateral dry eye disability is remanded.

The Veteran seeks an increased rating of 20 percent for his bilateral dry eye disability.

The October 2024 VA eye examination additionally diagnosed the Veteran with bilateral meibomian gland dysfunction, bilateral nyctalopia, bilateral posterior subcapsular cataracts, and bilateral angular blepharitis, however, there is no indication if these additional diagnoses are caused by his service or caused or aggravated by the Veteran's service-connected bilateral eye disability. Additionally, the examination indicates that the Veteran "is a glaucoma suspect" but does not clarify if the Veteran has the diagnosis. As such, the Board finds that a remand is necessary to obtain a VA eye examination to confirm whether the Veteran has a glaucoma diagnosis and an addendum medical opinion to determine whether the Veteran's new eye diagnoses are related to his service or caused or aggravated by the Veteran's service-connected bilateral eye disability.