MUSCLE INJURIES OF THE LEG

Summary

The veteran, who served from November 1969 to November 1971 and again from December 1977 to April 2013, appeals the February 2015 rating decision concerning his service-connected bilateral nocturnal leg cramps and a secondary sleep disturbance. The veteran sought increased evaluations for his leg cramps, which had been rated at 10 percent for the period prior to June 5, 2025, and sought a higher rating thereafter. The Board reviewed multiple VA examinations from January 2015 through June 2025, noting consistent complaints of painful cramps, fatigue-pain, and occasional loss of power, particularly impacting sleep and household chores. The Board found that the veteran's symptoms, especially the impact on sleep and household chores, warranted a 10 percent evaluation for both legs for the period prior to June 5, 2025, and a 20 percent evaluation from June 5, 2025, forward, applying the benefit of the doubt doctrine. The Board also considered the claim for a sleep disturbance secondary to the leg cramps. Based on the veteran's consistent reports of sleep disruption due to leg cramps and at least one VA examiner's opinion noting this impact, the Board granted service connection for the sleep disturbance as secondary to the service-connected leg cramps.

Rationale

Consistent complaints of painful cramps and fatigue-pain.; Impact on sleep and household chores noted.; Applied benefit of the doubt doctrine.

Full Decision Text

Citation Nr: 26001003
Decision Date: 01/28/26	Archive Date: 01/28/26

DOCKET NO. 15-23 961
DATE: January 28, 2026

ORDER

For the period beginning May 1, 2013, and ending June 4, 2025, an initial 10 percent evaluation, but no higher, for left leg nocturnal leg cramps is granted. 

Beginning June 5, 2025, an evaluation in excess of 20 percent for left leg nocturnal leg cramps is denied.  

For the period beginning May 1, 2013, and ending June 4, 2025, an initial 10 percent evaluation, but no higher, for right leg nocturnal leg cramps is granted. 

Beginning June 5, 2025, an evaluation of 20 percent, but no higher, for right leg nocturnal leg cramps is granted.  

Service connection for a sleep disturbance disability as secondary to service-connected nocturnal leg cramps is granted. 

FINDINGS OF FACT

1. For the period beginning May 1, 2013, and ending June 4, 2025, the Veteran's bilateral leg cramps manifested as moderate and not as moderately severe.  

2. Beginning June 5, 2025, the Veteran's bilateral leg cramps manifested as moderately severe and not as severe. 

3. The Veteran's nocturnal leg cramps cause his sleep disturbance disability.

CONCLUSIONS OF LAW

1. For the period of May 1, 2013 through June 4, 2025, the criteria for an initial evaluation of 10 percent, but no higher, for left leg nocturnal leg cramps are met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.14, 4.40, 4.56, 4.73, DC 5312.

2. For the period beginning June 5, 2025, the criteria for an evaluation in excess of 20 percent for left leg cramps are not met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.14, 4.40, 4.56, 4.73, DC 5312.

3. For the period of May 1, 2013 through June 4, 2025, the criteria for an initial evaluation of 10 percent, but no higher, for right leg nocturnal leg cramps are met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.14, 4.40, 4.56, 4.73, DC 5312.

4. For the period beginning June 5, 2025, the criteria for a 20 percent evaluation, but no higher, for right leg cramps are met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.14, 4.40, 4.56, 4.73, DC 5312.

5. The criteria for service connection for a sleep disturbance disability as secondary to service-connected bilateral nocturnal leg cramps are met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310(a).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from November 1969 to November 1971 and from December 1977 to April 2013.  

This case comes before the Board of Veterans' Appeals (Board) from a February 2015 rating decision by a U.S. Department of Veterans Affairs (VA) Regional Office (RO), hereinafter the Agency of Original Jurisdiction (AOJ).  The Veteran timely appealed that decision with an April 2015 Notice of Disagreement, VA Form 21-0958.  The Agency of Original Jurisdiction (AOJ) issued a Statement of the Case (SOC) in June 2015.  The Veteran timely submitted a June 2015 Substantive Appeal, VA Form 9.

This case has been before the Board several times, most recently in April 2025, when the Board remanded the matters for an adequate VA examination, specifically to consider of the impact of the Veteran's cramps on his ability to sleep.  After obtaining a new VA examination, the AOJ issued a July 2025 rating decision increasing the evaluation for the Veteran's left leg cramps from
 timely appealed that decision with an April 2015 Notice of Disagreement, VA Form 21-0958.  The Agency of Original Jurisdiction (AOJ) issued a Statement of the Case (SOC) in June 2015.  The Veteran timely submitted a June 2015 Substantive Appeal, VA Form 9.

This case has been before the Board several times, most recently in April 2025, when the Board remanded the matters for an adequate VA examination, specifically to consider of the impact of the Veteran's cramps on his ability to sleep.  After obtaining a new VA examination, the AOJ issued a July 2025 rating decision increasing the evaluation for the Veteran's left leg cramps from June 5, 2025, and a July 2025 Supplemental Statement of the Case (SSOC) as to the remaining issues.

As an initial matter, the Board finds that there has been substantial compliance with the prior remand directives.  See Stegall v. West, 11 Vet. App. 268 (1998) (a remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand order).

The Board further notes that the Veteran previously attended an October 2018 Board hearing with a Veterans Law Judge who has since retired.  In a September 2025 letter, the Board advised the Veteran of the Veterans Law Judge's retirement and offered the Veteran an opportunity to attend a new Board hearing.  To date, no response to this letter has been received from the Veteran.  The Board will therefore adjudicate the claim without further delay.  

INCREASED EVALUATIONS

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4.  The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of, or incident to, military service.  The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations.  38 U.S.C. § 1155; 38 C.F.R. § 4.1.  The basis of disability evaluations is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life, including employment.  38 C.F.R. § 4.10.

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In determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability.  38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991).  If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned.  38 C.F.R. § 4.7.  It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances.  38 C.F.R. § 4.21.  After consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran.  38 C.F.R. § 4.3.  The evaluation of the same disability under various diagnoses, and the evaluation of the same manifestation under different diagnoses, are to be avoided.  38 C.F.R. § 4.14.

Where the question for consideration is the propriety of the initial evaluation assigned, evaluation of the medical evidence since the grant of service connection and consideration of the appropriateness of a "staged rating" (assignment of different ratings for distinct periods of time, based on the facts found) is required.  See Fenderson v. West, 12 Vet. App. 119 (1999).  Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability.  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, 509-10 (2007).

This claim stems from the original assignment of
 based on the facts found) is required.  See Fenderson v. West, 12 Vet. App. 119 (1999).  Where an increase in the level of a service-connected disability is at issue, the primary concern is the present level of disability.  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, 509-10 (2007).

This claim stems from the original assignment of a disability evaluation following the award of service connection.  Accordingly, the appeal period begins on May 1, 2013, which is the initial date of service connection.  See Fenderson, supra.

The Veteran contends he is entitled to increased evaluations for his service-connected bilateral nocturnal leg cramps.  For the period on appeal, the Veteran's left leg cramps have been evaluated as noncompensable prior to May 5, 2022, at 10 percent prior to June 5, 2025, and at 20 percent thereafter, and his right leg cramps have been evaluated at 10 percent from May 5, 2022, under DC 5312.

Muscle injuries of the foot and leg are evaluated under DCs 5310-5312.  Each of these diagnostic codes provides a noncompensable evaluation for slight muscle injuries, a 10 percent evaluation for moderate muscle injuries, a 20 percent evaluation for moderately severe muscle injuries, and a 30 percent evaluation for severe muscle injuries.  38 C.F.R. § 4.73, DCs 5310-5312.

Evaluations of slight, moderate, moderately severe, and severe are determined based upon the criteria found in 38 C.F.R. § 4.56.  Id., Note (2).  This classification, particularly slight and moderate, is determined in significant part by the presence or absence of cardinal signs and symptoms.  For VA rating purposes the cardinal signs and symptoms of muscle disabilities are loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination, and uncertainty of movement.  38 C.F.R. § 4.56(c).  

An evaluation for a slight muscle disability is assigned for a simple wound of the muscle without debridement or infection.  Objective findings for this level of disability include minimal scarring, no evidence of fascial defect, atrophy, or impaired tonus, or no impairment of function or metallic fragments retained in the muscle.  This level of disability is consistent with no cardinal signs or symptoms.  Id. §?4.56(d)(1).  

An evaluation for a moderate muscle disability is assigned for a through-and-through or deep penetrating wound of short track from a single bullet, small shell or shrapnel fragment, without explosive effect of high velocity missile, residuals of debridement, or prolonged infection.  Objective findings for this level of disability include entrance and (if present) exit scars, small or linear, indicating short track of missile through muscle tissue, some loss of deep fascia or muscle substance or impairment of muscle tonus, and loss of power or lowered threshold of fatigue when compared to the sound side.  This level of disability is consistent with one or more of the cardinal signs or symptoms, particularly a lowered threshold of fatigue after average use.  Id. §?4.56(d)(2).  

An evaluation for a moderately severe muscle disability is assigned for a through-and-through or deep penetrating wound by small high velocity missile or large low-velocity missile, with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring requiring hospitalization for a prolonged period for treatment of the wound.  Objective findings include entrance and (if present) exit scars indicating track of missile through one or more muscle groups; indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with sound side; and tests of strength and endurance compared with sound side demonstrating positive evidence of impairment.  This level of disability is consistent with complaints of the cardinal signs and symptoms and evidence of inability to keep up with work requirements.  Id. §?4.56(d)(3).  

Finally, an evaluation for a severe muscle disability is assigned for through-and-through or deep penetrating wound due to high-velocity missile, or large or multiple low velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding and scarring requiring hospitalization for a prolonged period for treatment of
, muscle substance, or normal firm resistance of muscles compared with sound side; and tests of strength and endurance compared with sound side demonstrating positive evidence of impairment.  This level of disability is consistent with complaints of the cardinal signs and symptoms and evidence of inability to keep up with work requirements.  Id. §?4.56(d)(3).  

Finally, an evaluation for a severe muscle disability is assigned for through-and-through or deep penetrating wound due to high-velocity missile, or large or multiple low velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding and scarring requiring hospitalization for a prolonged period for treatment of the wound.  Objective findings include ragged, depressed and adherent scars indicating wide damage to muscle groups in missile track; palpable loss of deep fascia or muscle substance, or soft flabby muscles in wound area; and abnormal muscle swelling and hardening in contraction; tests of strength, endurance, or coordinated movements compared with the corresponding muscles of the uninjured side indicating severe impairment of function.  This level of disability is consistent with complaints of the cardinal signs and symptoms to a worse degree than those shown for moderately severe muscle injuries, including evidence of inability to keep up with work requirements.  Id. §?4.56(d)(4).  

As an initial matter, the Board observes that although the Veteran was first given a separate evaluation for his right leg cramps in May 2022, he was awarded service connection for bilateral leg cramps with an effective date of May 1, 2013.  See February 2015 Rating Decision.  Because this claim stems from the original assignment of a disability evaluation, the propriety of the evaluations for both legs from May 1, 2013, is on appeal.  To this end, unless otherwise noted, the findings described below apply to both legs.  

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Turning to the evidence of record, the Veteran has attended several VA examinations for his service-connected leg cramps.  In a January 2015 VA muscle injuries examination, the examiner noted a diagnosis for bilateral nocturnal leg cramps without history of a penetrating or non-penetrating muscle injury.  The examiner indicated there were no cardinal signs or symptoms attributable to the Veteran's muscle disabilities, though elsewhere in the examination report the examiner noted that the Veteran experienced severe pain at night.  The Veteran's muscle strength was normal, and there was no evidence of a fascial defect, muscle atrophy, or impact to the muscle substance or function.  

The Veteran attended a second VA muscle injuries examination in November 2019.  In this examination report, the Veteran reported that his cramps occur 1 to 4 times a week, mostly while sleeping.  The examiner again noted a diagnosis for bilateral nocturnal leg cramps without history of a penetrating or non-penetrating muscle injury.  The examiner noted consistent fatigue-pain in both legs.  The Veteran's muscle strength was normal, and there was no evidence of a fascial defect, muscle atrophy, or impact to the muscle substance or function.  In terms of functional impact, the examiner explained the Veteran needs to take breaks during cramps to massage his legs.  

The Veteran attended a third VA muscle injuries examination in May 2022.  In this examination report, the Veteran reported that he continues to get leg cramps at night, though the frequency of those cramps is not specified.  The examiner again noted a diagnosis for bilateral nocturnal leg cramps without history of a penetrating or non-penetrating muscle injury.  The examiner noted consistent fatigue-pain and occasional loss of power and weakness in both legs.  The Veteran's muscle strength was normal, and there was no evidence of a fascial defect, muscle atrophy, or impact to the muscle substance or function.  In terms of functional impact, the examiner explained the Veteran does not get a restful night's sleep because the cramps occur at night.  

The Veteran attended a fourth VA muscle injuries examination in August 2024.  In this examination report, the Veteran reported that he continues to get leg cramps that at times make him feel like he wants to have his legs amputated.  The examiner again noted a diagnosis for bilateral nocturnal leg cramps without history of a penetrating muscle injury.  The examiner noted consistent fatigue-pain in both legs.  The Veteran's muscle strength was normal, and there was no evidence of a fascial defect, muscle atrophy, or impact to the muscle substance or function.  In terms of functional impact, the examiner noted the Veteran is not capable of prolonged walking, standing, and sitting, and cannot lift heavy objects.    

The Veteran attended a fifth VA muscle injuries examination in June 2025.  In this examination report, the Veteran reported that he
 reported that he continues to get leg cramps that at times make him feel like he wants to have his legs amputated.  The examiner again noted a diagnosis for bilateral nocturnal leg cramps without history of a penetrating muscle injury.  The examiner noted consistent fatigue-pain in both legs.  The Veteran's muscle strength was normal, and there was no evidence of a fascial defect, muscle atrophy, or impact to the muscle substance or function.  In terms of functional impact, the examiner noted the Veteran is not capable of prolonged walking, standing, and sitting, and cannot lift heavy objects.    

The Veteran attended a fifth VA muscle injuries examination in June 2025.  In this examination report, the Veteran reported that he has a hard time standing.  The examiner again noted a diagnosis for bilateral nocturnal leg cramps without history of a penetrating or non-penetrating muscle injury.  The examiner noted loss of power and fatigue-pain in the left leg at a more severe level and consistent fatigue-pain.  The Veteran's muscle strength was normal, and there was no evidence of a fascial defect, muscle atrophy, or impact to the muscle substance or function.  In terms of functional impact, the examiner explained the Veteran's disabilities interfere with his household chores.  It is not clear why the examiner indicated only the left leg experienced symptoms, but based upon the Veteran's consistent history of complaints of bilateral leg pain, the Board affords the Veteran the benefit of the doubt and finds the symptoms are equally applicable to both legs.  

The Board also acknowledges the Veteran's hearing testimony, in which he described his leg cramps as 100 times more painful than a charley horse. October 2018 Hearing Transcript, p. 28.  He explained that several times per month he experiences intense muscle cramps that draw his lower leg up towards his body, which can last as long as 30 minutes.  Id., p. 26-27.  

Based on the foregoing, the Board finds the Veteran should be awarded an initial evaluation of 10 percent for both legs for the period prior to June 5, 2025.  In this regard, the Veteran has consistently reported experiencing painful cramps, which is consistent with a moderate level of disability based on complaints of one of the cardinal signs or symptoms.  See 38 C.F.R. § 4.56(d)(2)(ii).  At the same time, a higher evaluation is not warranted prior to June 5, 2025, because the evidence of record does not demonstrate any of the objective findings consistent with a moderately severe disability, such as loss of deep fascia, muscle substance, or normal firm resistance of muscles.  See Id. § 4.56(d)(3)(iii).  

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Additionally, beginning June 5, 2025, the Board finds a 20 percent evaluation is warranted for both legs.  The June 2025 VA examination indicates that the Veteran's leg cramps impact his ability to perform household chores, which the Board finds is analogous to an inability to keep up with work requirements.  See 38 C.F.R. § 4.56(d)(3)(ii).  At the same time, a higher evaluation is not warranted from and after June 5, 2025, because the evidence of record does not demonstrate any of the objective findings consistent with a severe disability, such as ragged, depressed, and adherent scars, atrophy, soft flabby muscles, or abnormal muscle swell or contraction.  See Id. § 4.56(d)(4)(iii).  The record also shows complaints for only some, not all, of the cardinal signs and symptoms.  See Id. § 4.56(d)(4)(ii).

Accordingly, the Board finds that initial 10 percent evaluations, but no higher, for the Veteran's bilateral nocturnal leg cramps are warranted by the evidence of record at this time.  38 C.F.R. §§ 4.7, 4.73.  The Board further finds that beginning June 5, 2025, a 20 percent evaluation, but no higher, for the Veteran's bilateral nocturnal leg cramps is warranted by the evidence of record at this time.  In so reaching that conclusion, the Board has appropriately applied the benefit of the doubt doctrine in this case.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

SECONDARY SERVICE CONNECTION

Consistent with VA's duty to maximize benefits, the Board must consider all possible schedular bases for separate ratings, including secondary service connection.  See Morgan v. Wilkie, 31 Vet. App. 162, 167
 evaluation, but no higher, for the Veteran's bilateral nocturnal leg cramps is warranted by the evidence of record at this time.  In so reaching that conclusion, the Board has appropriately applied the benefit of the doubt doctrine in this case.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

SECONDARY SERVICE CONNECTION

Consistent with VA's duty to maximize benefits, the Board must consider all possible schedular bases for separate ratings, including secondary service connection.  See Morgan v. Wilkie, 31 Vet. App. 162, 167 (2018).  In this regard, CAVC has held that under 38 C.F.R. § 3.155(d)(2), a formal claim for secondary service connection need not be filed when entitlement to secondary service connection is raised by the record; rather, VA must consider those "complications" in connection with the claim on appeal.  See Bailey v. Wilkie, 33 Vet. App. 188 (2021).

Based on the foregoing, the Board finds the issue of entitlement to service connection for a sleep disturbance disability is reasonably raised by the record.  More specifically, the Veteran has long maintained that his bilateral leg cramps prevent him from sleeping through the night.  See, e.g., Hearing Transcript, pp. 26-28.  Sleep disturbances are not contemplated by the rating criteria for muscular injuries, so this symptom is not compensated by his current evaluations for leg cramps.  Thus, the Board finds that a claim for service connection for a sleep disturbance disability secondary to bilateral leg cramps is within the scope of this appeal and has taken jurisdiction of that issue.  

Service connection may be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury.  38 C.F.R. § 3.310(a).  Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability.  38 C.F.R. § 3.310(a); Allen v. Brown, 7 Vet. App. 439 (1995).

With regard to the first element, the Board finds that the evidence of record establishes a pattern of sleep disturbances that result in the functional impairment of earning capacity.  See Saunders v. Wilkie.  886 F.3d 1356 (Fed. Cir. 2018) (holding that symptoms alone, including pain, can be service connected provided they result in functional impairment of earning capacity).  More specifically, the Veteran wakes up during the middle of the night up to 4 times a week and is unable to get a good night's rest on these occasions.  See, e.g., November 2019 VA Muscle Injuries Examination.  Sleep is foundational for earning capacity, so a lack of sleep no doubt interferes with that capacity.

The Board also finds that the Veteran's sleep disturbance disability is more likely than not caused by his leg cramps.  In this regard, the Board finds the Veteran is competent to observe that he wakes up due to pain and cramping in his legs.  See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (noting general competence to testify as to symptoms but not to provide medical diagnosis); cf. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (unlike varicose veins or a dislocated shoulder, rheumatic fever is not a condition capable of lay diagnosis).  The Veteran has maintained this to be the case since first filing his claim, and at least one VA examiner has indicated that the Veteran's leg cramps prevent him from obtaining a restful night's sleep; the Board has no reason to doubt these observations and at least the May 2022 VA examiner provided an opinion that indicated that the Veteran's bilateral nocturnal leg cramps cause him to be unable to get a restful night's sleep. Accordingly, the Board finds that service connection for a sleep disturbance disability as secondary to service-connected bilateral leg cramps is warranted by the evidence of record at this time.  See 38 C.F.R. § 3.310(a).  

In so reaching that conclusion, the Board has appropriately applied the benefit of the doubt doctrine in this case.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch, supra. 

 

 

MARTIN B. PETERS


 and at least the May 2022 VA examiner provided an opinion that indicated that the Veteran's bilateral nocturnal leg cramps cause him to be unable to get a restful night's sleep. Accordingly, the Board finds that service connection for a sleep disturbance disability as secondary to service-connected bilateral leg cramps is warranted by the evidence of record at this time.  See 38 C.F.R. § 3.310(a).  

In so reaching that conclusion, the Board has appropriately applied the benefit of the doubt doctrine in this case.  See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch, supra. 

 

 

MARTIN B. PETERS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	A. Kuhns

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