SCARS OTHER NOT OF HEAD FACE OR NECK

Summary

The Veteran, who served in the Army with multiple periods of service from June 1988 to September 2014, appeals the denial of increased disability ratings for several conditions and the denial of separate compensable ratings for others. The Veteran sought increased ratings for mast cell activation syndrome (MCAS) with facial flushing and skin rash, GERD with hiatal hernia, hemorrhoids, right shoulder disability, lumbar spine degenerative disc disease with spondylosis, right ankle fracture residuals, and bilateral foot plantar fasciitis with pes planus. The Veteran also claimed entitlement to separate ratings for respiratory symptoms associated with MCAS, radiculopathy of the right lower extremity secondary to lumbar spine disability, and scars of the trunk and extremities. The Board reviewed the evidence, including VA examinations and treatment records. For MCAS with facial flushing and skin rash, the Board found the Veteran received the maximum schedular evaluation. For respiratory symptoms associated with MCAS, the Board granted a separate rating, finding the criteria met. For GERD and hiatal hernia, the Board denied increased ratings, finding the criteria for more severe impairment were not met. Similarly, increased ratings for hemorrhoids, right shoulder disability, lumbar spine disability, right ankle disability, and scars were denied as the criteria for more severe impairment were not met. The Board granted a separate rating for radiculopathy of the right lower extremity secondary to the lumbar spine disability and a 20 percent rating for right elbow lateral epicondylitis. For bilateral foot disability, the Board granted the maximum schedular evaluation, finding the criteria met from a specific date. The Board denied increased ratings for scars and right ankle disability.

Rationale

Maximum schedular evaluation assigned; No higher rating available under diagnostic codes

Full Decision Text

Citation Nr: 26003911
Decision Date: 03/27/26	Archive Date: 03/27/26

DOCKET NO. 16-52 261
DATE: March 27, 2026

ORDER

Entitlement to an initial disability rating in excess of 60 percent for mast cell activation syndrome with facial flushing and skin rash is denied.

Entitlement to an initial compensable disability rating for respiratory symptoms associated with mast cell activation syndrome is denied. 

Entitlement to a separate disability rating for heart palpitations, memory problems, hot flashes, and sleep disturbances, associated with mast cell activation syndrome is granted.

Entitlement to an initial disability rating in excess of 10 percent for gastroesophageal reflux disease (GERD) and hiatal hernia is denied. 

Entitlement to an initial compensable disability rating for hemorrhoids is denied. 

Entitlement to an initial disability rating in excess of 20 percent for right shoulder status post subacromial decompression (right shoulder disability) is denied. 

Entitlement to an initial disability rating in excess of 40 percent for thoracolumbar spine degenerative disc disease with spondylosis (lumbar spine disability) is denied.

Entitlement to a separate disability rating for radiculopathy of the right lower extremity associated with lumbar spine disability is granted. 

Entitlement to an initial 20 percent disability rating, but no higher, for right elbow lateral epicondylitis (right elbow disability) is granted.

Entitlement to an initial compensable disability rating for scars of the trunk and extremities (scars) is denied.

Entitlement to an initial disability rating in excess of 20 percent for right ankle closed fracture status post open reduction and internal fixation procedure (right ankle disability) is denied.

Entitlement to an initial disability rating of 30 percent, but no higher, for bilateral foot plantar fasciitis with pes planus (bilateral foot disability) is granted.

FINDINGS OF FACT

1. The Veteran has been assigned the maximum schedular evaluation available for facial flushing with skin rash associated with his mast cell activation syndrome; no higher rating is available under any related diagnostic code.

2. The Veteran's mast cell activation syndrome has not been manifested by symptoms of or more nearly approximating polyps, a greater than 50 percent obstruction of nasal passages on both sides, or a complete obstruction on one side; no higher rating is available under any related diagnostic code.

3. The Veteran's mast cell activation syndrome has been manifested by symptoms of heart palpitations, memory problems, hot flashes, and sleep disturbances, not contemplated by the currently assigned diagnostic codes; a separate rating is warranted.

4. The Veteran's GERD and hiatal hernia have not been manifested by esophageal strictures requiring dilation, stent placement, or surgical correction; epigastric symptoms accompanied by substernal or arm or shoulder pain; material weight loss and hematemesis; melena with moderate anemia; or symptoms otherwise productive of considerable or severe impairment of health. 

5. The Veteran's hemorrhoids have not been manifested by large or thrombotic, irreducible hemorrhoids, with excessive redundant tissue, evidencing frequent recurrences; persistent bleeding and anemia; fissures; or episodes of thrombosis.  

6. The Veteran's right shoulder disability has not been manifested by limitation of arm motion to 25 degrees from the side or less.

7. The Veteran's lumbar spine disability has not been manifested by unfavorable ankylosis of the entire thoracolumbar spine.

8. The Veteran experienced mild paresthesias and/or dysesthesias and mild numbness of the right lower extremity associated with his service-connected lumbar spine disability.

9. Resolving reasonable doubt in favor of the Veteran, his right elbow disability has been manifested by pain with normal range of motion, most closely approximating symptoms associated with a 20 percent rating when discounting the ameliorative effects of medication; flexion limited to 55 degrees or less or extension limited to 100 degrees or less has not been shown.

10. The Veteran's scars of the trunk and extremities were not of the head, face, or neck; were not associated with underlying soft tissue damage; were not unstable or painful; and did not affect a total area equal to or greater than 144 square inches (929 square cm).

11. The Veteran has been assigned the maximum schedular evaluation available for right ankle limitation of motion; ankylosis of the ankle has not been shown.

12. Resolving reasonable doubt in favor of the Veteran, prior to August 2, 2024, his bilateral foot disability has been manifested by, at worst, severe flatfoot with pain on use accentuated; from August 2, 2024, he has been assigned the maximum schedular evaluation.


's scars of the trunk and extremities were not of the head, face, or neck; were not associated with underlying soft tissue damage; were not unstable or painful; and did not affect a total area equal to or greater than 144 square inches (929 square cm).

11. The Veteran has been assigned the maximum schedular evaluation available for right ankle limitation of motion; ankylosis of the ankle has not been shown.

12. Resolving reasonable doubt in favor of the Veteran, prior to August 2, 2024, his bilateral foot disability has been manifested by, at worst, severe flatfoot with pain on use accentuated; from August 2, 2024, he has been assigned the maximum schedular evaluation.

CONCLUSIONS OF LAW

1. The criteria for an initial disability rating in excess of 60 percent for mast cell

activation syndrome with facial flushing and a skin rash have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.1-4.14, 4.118, Diagnostic Code 7806.

2. The criteria for an initial compensable disability rating for respiratory symptoms associated with mast cell activation syndrome have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1-4.14, 4.97, Diagnostic Code 6522. 

3. The criteria for a separate disability rating for heart palpitations, memory problems, hot flashes, and sleep disturbances associated with mast cell activation syndrome have been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.102, 3.400, 4.3.

4. The criteria for a disability rating in excess of 10 percent for GERD and hiatal hernia have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.114, Diagnostic Codes 7206, 7346.

5. The criteria for a compensable disability rating for hemorrhoids have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.31, 4.114, Diagnostic Code 7336.

6. The criteria for an initial disability rating in excess of 20 percent for right shoulder disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.27, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5201.

7. The criteria for an initial disability rating in excess of 40 percent for lumbar spine disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5242-5237.

8. The criteria for a separate disability rating for radiculopathy of the right lower extremity associated with lumbar spine disability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.124a.

9. The criteria for an initial disability rating of 20 percent, but no higher, for right elbow disability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5242-5237.

10. The criteria for an initial compensable disability rating for scars of the trunk and extremities have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7802.

11. The criteria for an initial disability rating in excess of 20 percent for right ankle disability have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.71a, Diagnostic Code 5271.

12. The criteria for an initial disability rating of 30 percent, but no higher, for bilateral
-5237.

10. The criteria for an initial compensable disability rating for scars of the trunk and extremities have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7802.

11. The criteria for an initial disability rating in excess of 20 percent for right ankle disability have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.71a, Diagnostic Code 5271.

12. The criteria for an initial disability rating of 30 percent, but no higher, for bilateral foot disabilities have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Codes 5276, 5269.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from June 1988 to August 1988, from November 1990 to July 1991, and from November 1993 to September 2014.  

These matters come before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued February 2015 by a Department of Veterans Affairs (VA) Regional Office.

As an initial matter, the Board notes that in the Veteran's October 2016 VA Form 9, Appeal to Board of Veterans' Appeals, he selected the option to have a Board hearing by live videoconference at a local VA office. In correspondence received in September 2019, the Veteran withdrew his hearing request through his representative and no further request for a hearing has been received in connection with this appeal. Accordingly, the Board finds the Veteran's request for a hearing was withdrawn.

As discussed further below, the instant appeal returns to the Board pursuant to an April 2025 Board remand directing further development by the agency of original jurisdiction (AOJ) as to the issues pertaining to the evaluation of right shoulder, lumbar spine, right elbow, right ankle, and bilateral foot disabilities, and pursuant to a May 2025 Court of Appeals for Veterans Claims (Court) memorandum decision vacating a September 2023 Board decision and remanding the appeal as to the issues pertaining to the evaluation of mast cell activation syndrome, GERD with hiatal hernia, hemorrhoids, and scars.

PROCEDURAL BACKGROUND

In relevant part, in September 2023, the Board denied the Veteran's claims pertaining to increased initial disability ratings for mast cell activation syndrome, GERD with hiatal hernia, hemorrhoids, and scars of the trunk and extremities. The Veteran appealed that decision to the Court, and in a May 2025 memorandum decision, the Court vacated the September 2023 Board decision and remanded those claims to the Board, finding that the Board failed to provide an adequate statement of reasons and bases with regard to whether there was substantial compliance with the January 2020 and July 2022 Board remands, the basis for denying a rating in excess of 10 percent for GERD and hiatal hernia, and the basis for denying a separate compensable rating for mast cell activation syndrome.

In April 2025, the claims pertaining to the evaluation of disabilities of the right shoulder, thoracolumbar spine, right elbow, right ankle, and bilateral feet were remanded by the Board for further development by the agency of original jurisdiction (AOJ), specifically to obtain any outstanding relevant treatment records and addendum medical opinions addressing the nature and severity of the Veteran's disabilities during the appeal period.

Regarding compliance with the prior Board remand directives, the Board notes that the January 2020 Board remand directed the AOJ to obtain any pertinent medical treatment records, with any necessary assistance from the Veteran, and document all attempts to obtain such records in the claims file. Treatment records from the Munson Army Health Center dated from September 2014 were specifically identified. The July 2021 remand did not include any directives related to the issues in the instant appeal. In subsequent development letters, including one sent in December 2023, the Veteran was requested to identify and provide authorization for VA to obtain records from any health care providers who provided treatment for the Veteran's service-connected disabilities. All healthcare providers identified by the Veteran in the subsequent authorization forms were associated with the Army or VA. The record reflects that the AOJ obtained records from the Joint Longitudinal Viewer and Military Treatment Facility (JLV/MTF) in November 2022 and again in April 2024. The records obtained include treatment records for the Munson Army Health Center at Ft. Leavenworth. The record reflects that the AOJ
 2021 remand did not include any directives related to the issues in the instant appeal. In subsequent development letters, including one sent in December 2023, the Veteran was requested to identify and provide authorization for VA to obtain records from any health care providers who provided treatment for the Veteran's service-connected disabilities. All healthcare providers identified by the Veteran in the subsequent authorization forms were associated with the Army or VA. The record reflects that the AOJ obtained records from the Joint Longitudinal Viewer and Military Treatment Facility (JLV/MTF) in November 2022 and again in April 2024. The records obtained include treatment records for the Munson Army Health Center at Ft. Leavenworth. The record reflects that the AOJ obtained multiple sets of updated VA treatment records, to include most recently in July 2025. Accordingly, the Board finds that VA has substantially complied with the prior remand directives requiring VA to obtain pertinent identified medical treatment records, to include from the Munson Army Health Center at Ft. Leavenworth. 

The Board specifically acknowledges the Veteran's representative's argument of December 2025 that VA failed to obtain all of the records directed in the prior Board remand; however, the representative based this argument on the previously sought and obtained records through October 23, 2020 and did not acknowledge the subsequently obtained records in November 2022 and April 2024. Significantly, in arguing for higher ratings for specific disabilities, the brief references only treatment records that have been associated with the record. Accordingly, there is no evidence of record to suggest that there are outstanding relevant medical records, including from Munson Army Health Center at Ft. Leavenworth. 

Further, the record reflects that addendum medical opinions were obtained in July 2025 addressing the nature and severity of the Veteran's right shoulder, lumbar spine, right elbow, right ankle, and bilateral foot disabilities. Considering all the evidence of record, the Board finds that there has been substantial compliance with the prior Board remands, to include specifically as they relate to the issue of obtaining the above referenced medical records. Stegall v. West, 11 Vet. App. 268 (1998).

INCREASED RATINGS

A disability rating is determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record, and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991).

When an unlisted condition is encountered it will be permissible to rate under a closely related disease or injury in which not only the functions affected, but the anatomical localization and symptomatology are closely analogous. 38 C.F.R. § 4.20. When considering rating by analogy, VA may take into consideration the functions affected, the anatomical location, and the symptomatology of the disorders, but may not require that an analogous condition strictly meet the requirements of the chosen code in order to assign a rating. Webb v. McDonough, 71 F.4th 1377, 1380 (Fed. Cir. 2023). Hyphenated diagnostic codes are used when a rating under one diagnostic code requires the use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen.

Where the schedule does not provide a zero percent evaluation for a diagnostic

code, a zero percent evaluation shall be assigned when the requirements for a

compensable evaluation are not met. 38 C.F.R. § 4.31.

Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Fenderson v. West, 12 Vet. App. 119, 126-127 (1999). However, separate ratings may be assigned for separate periods of time based on the facts found. This practice is known as "staged" ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007).

When evaluating musculoskeletal disabilities based on limitation
 the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Fenderson v. West, 12 Vet. App. 119, 126-127 (1999). However, separate ratings may be assigned for separate periods of time based on the facts found. This practice is known as "staged" ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007).

When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[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).

The final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." Correia v. McDonald, 28 Vet. App. 158 (2016). 

VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination. Sharp v. Shulkin, 29 Vet. App. 26 (2017).

When considering a claim for an increased disability rating, the Board must not consider the ameliorative effects of medication unless those effects are explicitly contemplated by the relevant rating criteria. Jones v. Shinseki, 26 Vet. App. 56, 61 (2012). When evaluating musculoskeletal conditions, to the extent possible, the ameliorative effects of medication should be discounted. See Ingram v. Collins, 38 Vet. App. 130, 135 (2025).

When a regulation is amended, the new regulations apply to all applications for benefits received by VA or that are pending before the agency of original jurisdiction on or after the effective date. Claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied. The Board may not apply a current regulation prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). However, the Board is not precluded from applying prior versions of the applicable regulation to the period on or after the effective dates of the new regulation if the prior version was in effect during the pendency of the appeal.

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. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).


 v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). However, the Board is not precluded from applying prior versions of the applicable regulation to the period on or after the effective dates of the new regulation if the prior version was in effect during the pendency of the appeal.

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. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).

1. Entitlement to an increased initial disability rating for mast cell activation syndrome with facial flushing and skin rash.

2. Entitlement to an increased initial disability rating for respiratory symptoms associated with mast cell activation syndrome.

3. Entitlement to a separate disability rating for heart palpitations, memory problems, hot flashes, and sleep disturbances associated with mast cell activation syndrome.

The Veteran contends entitlement to a higher initial disability rating for mast cell activation syndrome, arguing that the currently assigned diagnostic code and rating do not adequately capture all of his symptoms, including facial flushing, heart palpitations, problems with memory, hot flashes, daily sneezing, and requiring continuous prescription medication to manage his sinus and nasal symptoms of constant allergic rhinitis and nasal discharge. 

During the pendency of the appeal, the Veteran was retroactively assigned an initial 60 percent evaluation for mast cell activation syndrome with facial flushing and skin rash under Diagnostic Code 7806 and a noncompensable evaluation for his sinus and nasal symptoms under Diagnostic Code 6599-6522.

As previously discussed, where a particular disability is not listed, it may be rated by analogy to a closely related disease by not only the functions affected, but also where the anatomical location and symptomatology are closely analogous. 38 C.F.R. §§ 4.20, 4.27.

During the period on appeal, the evidence shows that the Veteran's mast cell activation syndrome has been manifested by symptoms affecting multiple body systems. The Veteran's service treatment records (STRs) reflect that, after receiving treatment, he experienced only intermittent sneezing until January 2015 when he reported experiencing a reoccurrence of symptoms of flushing, rashes, and cognitive dysfunction affecting his memory and causing inattention. December 2020 treatment records reflect that the Veteran was prescribed Doxepin, Flonase, Allegra, and Singulair for daily use. The Veteran reported that the Doxepin "keeps my head and skin clear."

October 2014 VA examination reports reflect that the Veteran experienced symptoms of daily sneezing and intermittent facial flushing, heart palpitations, memory problems, and hot flashes. The Veteran reported using Flonase, Allegra, and Singulair to treat his symptoms. The examiner noted a diagnosis of rosacea and that the Veteran did not have any nose, throat, larynx, or pharynx conditions. Regarding skin symptoms, the examiner noted that the Veteran had facial flushing during the examination. The examiner also indicated that the Veteran's mast cell activation syndrome impacted his ability to work because he had less attention to detail, a diminished attention span, and he had to take notes due to memory lapses.

During a May 2016 VA hematologic and lymphatic conditions examination, the

Veteran reported that he had random facial rashes and facial flushing, a lot of

sneezing, a mild tingling in his hands a few times per month, "brain fuzz," and

fatigue if he was unable to sleep eight to nine hours per night. He indicated that he continued to take Singulair, Allegra, Doxepin for memory, and Flonase, and he stated that he had improvement in his symptoms with the medications. The examiner reported that the Veteran's mast cell activation syndrome did not impact his ability to work.

In an October 2020 VA skin diseases examination report, the examiner noted that the Veteran had mast cell activation syndrome with facial flushing and skin rash. The examiner noted that the Veteran's facial flushing affected from his neck up, except around his eyes, and that his skin rash affected his cheeks. The examiner indicated that the Veteran was placed on Doxepin, Singulair, Allegra, and Flonase for his mast cell activation syndrome. The Veteran reported that he experienced daily facial flushing precipitated by stress or any emotion. He stated that his entire head, including his scalp, turned red. He related that he experienced a skin rash on his cheeks a couple of times per month since he restarted Doxepin. The examiner

noted that no skin rash was visible on the Veteran's cheeks at the time of the

examination
 activation syndrome with facial flushing and skin rash. The examiner noted that the Veteran's facial flushing affected from his neck up, except around his eyes, and that his skin rash affected his cheeks. The examiner indicated that the Veteran was placed on Doxepin, Singulair, Allegra, and Flonase for his mast cell activation syndrome. The Veteran reported that he experienced daily facial flushing precipitated by stress or any emotion. He stated that his entire head, including his scalp, turned red. He related that he experienced a skin rash on his cheeks a couple of times per month since he restarted Doxepin. The examiner

noted that no skin rash was visible on the Veteran's cheeks at the time of the

examination. The Veteran indicated that his condition was well-controlled with his

constant current medication regimen. The examiner estimated that the Veteran's

mast cell activation with facial flushing and skin rash affected 5 percent to less

than 20 percent of his total body area and 20 percent to 40 percent of the exposed

area.

Symptoms Related to the Skin

During the pendency of the appeal, the rating criteria for evaluating a skin disorder

under 38 C.F.R. § 4.118 was amended effective August 13, 2018. These amendments revised Diagnostic Code 7806 to state that disabilities evaluated under this diagnostic code should be evaluated under the General Rating Formula for the Skin.

Prior to the regulatory change effective August 13, 2018, Diagnostic Code 7806

stated that a noncompensable evaluation is warranted for dermatitis or eczema

affecting less than 5 percent of the entire body or exposed areas affected, and; no

more than topical therapy required during the past 12-month period. A 10 percent

evaluation is warranted for dermatitis or eczema affecting at least 5 percent, but

less than 20 percent, of the entire body, or at least 5 percent, but less than

20 percent, of exposed areas; or, intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of

less than six weeks during the past 12-month period. A 30 percent evaluation is warranted for dermatitis or eczema affecting 20 to 40 percent of the entire body or

20 to 40 percent of exposed areas; or, systemic therapy such as corticosteroids or

other immunosuppressive drugs required for a total duration of six weeks or more,

but not constantly, during the past 12-month period. A 60 percent evaluation is

warranted for dermatitis or eczema affecting more than 40 percent of the entire

body or more than 40 percent of exposed areas; or, constant or near-constant

systemic therapy such as corticosteroids or other immunosuppressive drugs

required during the past 12-month period. 38 C.F.R. § 4.118, Diagnostic Code 7806.

Diagnostic Code 7806 in effect prior to August 13, 2018, also indicated that the

dermatitis or eczema may also be evaluated as disfigurement of the head, face, or

neck or pursuant to the Diagnostic Codes relevant for rating scars, depending on

the predominant disability.

Under the amended criteria, the General Rating Formula for the Skin provides that

a noncompensable rating is warranted where there is no more than topical therapy

required over the past 12-month period and at least one of the following: characteristic lesions involving less than 5 percent of the entire body affected; or characteristic lesions involving less than 5 percent of exposed areas affected. A

10 percent rating will be warranted where there is at least one of the following:

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.

A 30 percent rating will be warranted where there is at least one of the following:

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
, 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.

A 30 percent rating will be warranted where there is at least one of the following:

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. A 60 percent rating will be

warranted where there is at least one of the following: 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. 38 C.F.R. § 4.118, General Rating Formula for the Skin.

The General Rating Formula further provides that, depending on the predominant

disability, the disability could be rated instead as disfigurement of the head, face, or

neck (Diagnostic Code 7800) or scars (Diagnostic Codes 7801, 7802, 7804, or

7805).

During the pendency of the appeal, the Veteran was assigned a 60 percent disability rating under Diagnostic Code 7806 for his symptoms affecting the skin. Given the evidence regarding the Veteran's treatment, the Veteran's disability was found to be manifested by symptoms most closely approximated as symptoms requiring constant or near-constant systemic therapy, warranting a 60 percent disability rating. Considering all the evidence of record, the Board finds that the Veteran's mast cell activation syndrome with facial flushing and skin rash does not warrant a disability rating in excess of 60 percent under Diagnostic Code 7806 at any time during the period on appeal. In this regard, the Board notes that a 60 percent evaluation is the maximum schedular evaluation available under Diagnostic Code 7806, prior to and after the regulatory change effective August 13, 2018. As the Veteran is already assigned the maximum schedular evaluation of 60 percent under Diagnostic Code 7806, a higher evaluation for mast cell activation syndrome with facial flushing and a skin rash cannot be granted under this diagnostic code. Further, the Board has considered all other relevant diagnostic codes; however, no other diagnostic code would provide a higher rating for the Veteran's mast cell activation syndrome symptoms related to the skin. 

Accordingly, for the Veteran's skin symptoms of mast cell activation syndrome rated under Diagnostic Code 7806, there is no basis to award a rating in excess of 60 percent during the period on appeal, and the Veteran's claim is denied to this extent.

Symptoms Related to the Respiratory System

As noted above, the Veteran is in receipt of a noncompensable rating for the sinus and nasal symptoms of his diagnosed mast cell activation syndrome under Diagnostic Code 6522. A noncompensable rating is assigned when the requirements for a compensable evaluation are not met.

Under 38 C.F.R. § 4.97, Diagnostic Code 6522, a 10 percent rating is warranted for allergic or vasomotor rhinitis without polyps but with greater than 50 percent obstruction of the nasal passage on both sides or complete obstruction on one side. A maximum 30 percent rating is warranted for allergic or vasomotor rhinitis with polyps. 

Considering all the evidence of record, the Board finds that the Veteran's mast cell activation syndrome symptoms of the respiratory system do not warrant a compensable disability rating. During the period on appeal, the Veteran's mast cell activation syndrome was found to cause symptoms of sneezing, nasal discharge, and rhinitis. The evidence of record does not show that the Veteran has experienced greater than 50 percent obstruction of the nasal passage on both sides, complete obstruction on either side, or nasal polyps. 

Further, the Board has considered all relevant diagnostic codes; however, no other diagnostic code would provide a higher rating for the Veteran's mast cell activation syndrome symptoms related to the respiratory system. In this regard, the Board finds the evidence of record does not show that the Veteran's mast cell syndrome has caused symptoms of or more analogous to the symptoms required for a compensable rating under any of the diagnostic codes relevant to the diseases of the nose and throat. 

Accordingly, the Board finds that the Veteran's mast cell activation
 nasal discharge, and rhinitis. The evidence of record does not show that the Veteran has experienced greater than 50 percent obstruction of the nasal passage on both sides, complete obstruction on either side, or nasal polyps. 

Further, the Board has considered all relevant diagnostic codes; however, no other diagnostic code would provide a higher rating for the Veteran's mast cell activation syndrome symptoms related to the respiratory system. In this regard, the Board finds the evidence of record does not show that the Veteran's mast cell syndrome has caused symptoms of or more analogous to the symptoms required for a compensable rating under any of the diagnostic codes relevant to the diseases of the nose and throat. 

Accordingly, the Board finds that the Veteran's mast cell activation syndrome symptoms of the respiratory symptoms do not warrant a compensable disability rating during the period on appeal, and the Veteran's claim is denied to this extent.

Other Symptoms

The Veteran's representative has specifically contended that the Veteran warrants separate disability ratings for heart palpitations, memory problems, hot flashes, and sleep disturbances.

VA's duty to maximize benefits requires it to exhaust all schedular options for rating a disability including secondary service connection, analogous ratings, and separate ratings under multiple diagnostic codes. Morgan v. Wilkie, 31 Vet. App. 162, 167-68 (2019). In doing so, VA is required to avoid pyramiding or evaluating the same disability under various diagnoses. In this regard, both the use of manifestations not resulting from service-connected disease or injury in establishing the service-connected evaluation, and the evaluation of the same manifestation under different diagnoses are to be avoided. 38 C.F.R. § 4.14.

Here, the evidence of record reflects that the Veteran experiences symptoms of heart palpitations, memory problems, hot flashes, and sleep disturbances related to his service-connected mast cell activation syndrome. The Veteran's currently assigned ratings for his service-connected disability address the symptoms related to his skin and respiratory systems. The Veteran's symptoms of heart palpitations, memory problems, hot flashes, and sleep disturbances are not contemplated by the rating criteria of the currently assigned diagnostic codes addressing the Veteran's skin and respiratory symptoms. Accordingly, the Board finds that a separate rating is warranted. Given the procedural history of the appeal, the Board grants entitlement to a separate disability rating for these symptoms with the assignment of the initial rating to be determined by the AOJ in the first instance. 

In sum, considering all the evidence of record and resolving all reasonable doubt in favor of the Veteran, the Board finds that higher initial disability ratings are not warranted for the Veteran's mast cell activation syndrome skin and respiratory symptoms as rated under Diagnostic Codes 7806 and 6522. The Board also finds that a separate disability rating is warranted for the Veteran's mast cell activation syndrome symptoms of heart palpitations, memory problems, hot flashes, and sleep disturbances. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3.

4. Entitlement to an increased initial disability rating for gastroesophageal reflux disease (GERD) and hiatal hernia.

The Veteran contends entitlement to a higher initial disability rating for GERD with hiatal hernia, arguing in a December 2025 brief that his symptoms of pyrosis, reflux, and sleep disturbance due to waking up choking constitute persistently recurrent epigastric distress. In the brief, the Veteran's representative appears to be further arguing that the Veteran's symptoms of waking up choking, having to alter his diet, and heartburn were a considerable impairment of health. 

The Veteran was retroactively assigned an initial 10 percent disability rating for GERD with hiatal hernia under Diagnostic Code 7399-7346.

During the pendency of the appeal, VA amended the schedule of ratings for the digestive system, effective May 19, 2024. Diagnostic Code 7206 for GERD was created. Prior to the amendments, the Veteran's GERD was rated by analogy to hiatal hernia under Diagnostic Code 7346. 

Prior to the amendments, pursuant to Diagnostic Code 7346 under 38 C.F.R. § 4.114, a 10 percent disability rating is warranted for two or more of the symptoms for the 30 percent evaluation of less severity. A 30 percent evaluation is warranted for persistently recurring epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. A maximum 60 percent evaluation is warranted for symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. 38 C.F.R. § 4.114, Diagnostic Code 7346.

The Board acknowledges that certain terms are not defined in the Rating Schedule. Rather than applying a
, a 10 percent disability rating is warranted for two or more of the symptoms for the 30 percent evaluation of less severity. A 30 percent evaluation is warranted for persistently recurring epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. A maximum 60 percent evaluation is warranted for symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. 38 C.F.R. § 4.114, Diagnostic Code 7346.

The Board acknowledges that certain terms are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. Absent an express definition, it is presumed that VA regulations employ words using their ordinary dictionary meanings at the time the regulations were promulgated. See Nielson v. Shinseki, 607 F.3d 802, 805-06 (Fed. Cir. 2010). In this regard, the Board notes that "considerable" is defined as "large in extent or degree." Merriam-Webster's Collegiate Dictionary 267 (11th ed. 2012). Further, "severe" is defined as "very painful or harmful." Id. at 1140.

The amended version of Diagnostic Code 7346 directs to rate hiatal hernia and paraesophageal hernia as stricture of the esophagus under Diagnostic Code 7203. Under Diagnostic Code 7203 for stricture of esophagus and Diagnostic Code 7206 for GERD, a noncompensable rating is warranted for documented history without daily symptoms or requirement for daily medications. A 10 percent rating is warranted for documented history of esophageal stricture(s) that requires daily medications to control dysphagia otherwise asymptomatic. A 30 percent rating is warranted for documented history of recurrent esophageal stricture(s) causing dysphagia which requires dilatation no more than 2 times per year. A 50 percent rating is warranted for documented history of recurrent or refractory esophageal stricture(s) causing dysphagia which requires at least one of the following (1) dilatation 3 or more times per year, (2) dilatation using steroids at least one time per year, or (3) esophageal stent placement. A maximum 80 percent rating is warranted for documented history of recurrent or refractory esophageal stricture(s) causing dysphagia with at least one of the symptoms present: (1) aspiration, (2) undernutrition, and/or (3) substantial weight loss as defined by § 4.112(a) and treatment with either surgical correction or percutaneous esophago-gastrointestinal tube (PEG tube). 38 C.F.R. § 4.114.

In associated notes, recurrent esophageal stricture is defined as the inability to maintain target esophageal diameter beyond 4 weeks after the target diameter has been achieved and refractory esophageal stricture is defined as the inability to achieve target esophageal diameter despite receiving no fewer than 5 dilatation sessions performed at 2-week intervals. 38 C.F.R. § 4.114, Diagnostic Codes 7203, 7206, Notes 4-5.

Turning to the evidence of record, the Veteran's GERD with hiatal hernia has been manifested by symptoms of pyrosis, reflux, and sleep disturbance caused by esophageal reflux. The Veteran's VA treatment records reflect that he reported intermittent GERD and acid reflux symptoms. In a March 2016 VA treatment note, the Veteran reported that he had intermittent GERD symptoms, which were severe at times. He stated that he had taken various medications on and off over the years, including Aciphex. He noted that he was not currently taking any medications, but that he knew what foods to avoid. A subsequent March 2020 treatment note reflects that the Veteran reported intermittent acid reflux but stated it is manageable.

An October 2014 VA examination report reflects that the Veteran reported that he had recent episodic acid reflux which woke him at night. He stated that he took Nexium as needed when he drank alcohol or ate spicy food. He indicated that he had pyrosis, reflux, and sleep disturbance caused by esophageal reflux. He related that he had symptom recurrence four or more times per year and that the episodes lasted less than one day. The examiner noted that the Veteran's GERD did not impact his ability to work. 

During a May 2016 VA esophageal conditions examination,
 but that he knew what foods to avoid. A subsequent March 2020 treatment note reflects that the Veteran reported intermittent acid reflux but stated it is manageable.

An October 2014 VA examination report reflects that the Veteran reported that he had recent episodic acid reflux which woke him at night. He stated that he took Nexium as needed when he drank alcohol or ate spicy food. He indicated that he had pyrosis, reflux, and sleep disturbance caused by esophageal reflux. He related that he had symptom recurrence four or more times per year and that the episodes lasted less than one day. The examiner noted that the Veteran's GERD did not impact his ability to work. 

During a May 2016 VA esophageal conditions examination, the Veteran reported that he had symptoms of reflux at night and periodic heartburn during the day. He related that his acid reflux interfered with his sleep sometimes as he woke choking. He stated that his GERD was aggravated by alcohol and spicy foods. He indicated that he continued to take Nexium as needed, but that it did not help as much as he recalled Aciphex helping in the past. The examination report reflects that the Veteran experienced symptoms of pyrosis, reflux, and sleep disturbance caused by esophageal reflux, occurring four or more times per years lasting less than one day on average. The examiner noted that the Veteran's GERD did not impact his ability to work.

As noted above, during the pendency of the appeal, the Veteran's GERD with hiatal hernia was assigned an initial 10 percent rating retroactively under the pre-amendment criteria. The evidence of record weighs persuasively against any further increased rating during the appeal period. In this regard, the Board notes that the evidence does not show that the Veteran has experienced epigastric symptoms accompanied by substernal or arm or shoulder pain or material weight loss and hematemesis or melena with moderate anemia during the period on appeal. Further, the Veteran's symptom combinations do not seem otherwise productive of severe impairment of health as his symptoms have been described as intermittent, episodic, and lasting less than one day. The Veteran's symptoms do not warrant a higher disability rating under the amended criteria either as the Veteran has not been shown to have esophageal strictures requiring dilation, stent placement, or surgical correction during the period on appeal. Further, the Board has considered all other relevant diagnostic codes; however, no other diagnostic code would provide a higher rating for the Veteran's GERD with hiatal hernia symptoms.

Accordingly, considering all evidence of record, the Board finds that an initial disability rating in excess of 10 percent for the Veteran's GERD with hiatal hernia is not warranted. As the evidence of record weighs persuasively against the claim, the benefit-of-the-doubt doctrine is inapplicable, and the claim for a higher rating is denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7,

5. Entitlement to an increased initial disability rating for hemorrhoids.

The Veteran generally contends entitlement to a higher initial disability rating for hemorrhoids.

The Veteran is in receipt of a noncompensable rating for hemorrhoids under Diagnostic Code 7336.

During the pendency of the appeal, VA amended the schedule of ratings for the digestive system, effective May 19, 2024. Prior to the amendments, under 38 C.F.R. § 4.114, Diagnostic Code 7336, a noncompensable rating is assigned for mild or moderate external or internal hemorrhoids. A 10 percent rating is warranted for external or internal hemorrhoids that are large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences. A maximum 20 percent rating is warranted for external or internal hemorrhoids with persistent bleeding and with secondary anemia, or with fissures. 

In this regard, the Board notes that frequent is defined as "happening at short intervals: often repeated or occurring." see Merriam-Webster Dictionary, https://www.merriam-webster.com/dictionary/frequent (last visited June 16, 2021).

The amended criteria provide for a 10 percent rating for prolapsed internal hemorrhoids with two or less episodes per year of thrombosis; or external hemorrhoids with three or more episodes per year of thrombosis. A maximum 20 percent rating is warranted for internal or external hemorrhoids with persistent bleeding and anemia; or continuously prolapsed internal hemorrhoids with three or more episodes per year of thrombosis. 38 C.F.R. § 4.114, Diagnostic Code 7336.

Turning to the evidence of record, during the period on appeal, the Veteran's disability has been manifested by intermittent flares of self-resolving hemorrhoids. An October 201
/frequent (last visited June 16, 2021).

The amended criteria provide for a 10 percent rating for prolapsed internal hemorrhoids with two or less episodes per year of thrombosis; or external hemorrhoids with three or more episodes per year of thrombosis. A maximum 20 percent rating is warranted for internal or external hemorrhoids with persistent bleeding and anemia; or continuously prolapsed internal hemorrhoids with three or more episodes per year of thrombosis. 38 C.F.R. § 4.114, Diagnostic Code 7336.

Turning to the evidence of record, during the period on appeal, the Veteran's disability has been manifested by intermittent flares of self-resolving hemorrhoids. An October 2014 VA examination report reflects that the Veteran had mild or moderate hemorrhoids, noting a diagnosis of internal hemorrhoids on colonoscopy. The Veteran reported that he had 10 to 15 flare-ups of hemorrhoids over the last 10 to 15 years. He stated that his last flare-up was approximately six months ago and that he experienced them once or twice per year. He related that he experienced a "strain" feeling in his rectum. Examination results were normal with no external hemorrhoids, anal fissures, or other abnormalities noted. The examiner reported that the Veteran's hemorrhoids did not impact his ability to work.

A May 2016 VA examination report reflects that the Veteran reported experiencing intermittent flares of hemorrhoids which self-resolved, that he was not experiencing hemorrhoids at the time of the examination, and that his last flare was approximately one month prior. He reported experiencing flares approximately once every several months and that they seemed to occur when he was more active. He reported treating with Preparation H ointment and by eating more vegetables. Regarding work, he stated that he was a contractor and that he sits all day but takes breaks to walk around during hemorrhoid flares. 

Considering all the evidence of record, the Board finds that the Veteran's hemorrhoid disability does not warrant a compensable disability rating during the period on appeal. In this regard, the Board notes that the Veteran's treatment records reflect notation of internal hemorrhoids diagnosed during an October 2020 colonoscopy and VA examination reports reflect that the Veteran's symptoms were described as intermittent and self-resolving. Notably, the Veteran has not contended any specific basis for a higher disability rating or identified any specific symptomatology warranting such. Accordingly, the Board finds that the evidence of record weighs persuasively against finding that the Veteran's disability has been manifested by hemorrhoids that are large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences, or that the Veteran's disability has been manifested by persistent bleeding, anemia, fissures, or episodes of thrombosis. 

In sum, the Board finds that the evidence of record weighs persuasively against assigning a compensable disability rating for hemorrhoids during the appeal period and the Veteran's claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7.

6. Entitlement to an increased initial disability rating for right shoulder disability.

The Veteran generally contends entitlement to an increased initial disability rating for his right shoulder disability. Notably, the Veteran has not provided any specific argument or identified any symptomatology warranting an increase.

During the pendency of the appeal, the Veteran was retroactively assigned an initial 20 percent disability rating for right shoulder status post subacromial decompression.  

The Veteran's right shoulder disability is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5201, for limitation of motion of the arm. Upper extremity ratings depend on whether the disabled extremity is the major or minor extremity. The major extremity is the one predominantly used by the veteran. Only one extremity may be major. 38 C.F.R. § 4.69. The Veteran is left hand dominant, as reflected in an October 2014 VA examination report, therefore, his right shoulder is considered his minor extremity for rating purposes.

Under Diagnostic Code 5201, limitation of motion of the arm at shoulder level warrants a 20 percent rating for both the major and minor extremity. Limitation of motion of the arm midway between side and shoulder warrants a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity. Limitation of motion of the arm to 25 degrees from side warrants a maximum 30 percent rating for the minor joint and a maximum 40 percent rating for the major joint. 38 C.F.R. § 4.71a, Diagnostic Code 5201.  

Diagnostic Code 5201 "does not provide separate ratings for limitation of motion in the flexion and abduction planes, but rather is addressed gener
Under Diagnostic Code 5201, limitation of motion of the arm at shoulder level warrants a 20 percent rating for both the major and minor extremity. Limitation of motion of the arm midway between side and shoulder warrants a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity. Limitation of motion of the arm to 25 degrees from side warrants a maximum 30 percent rating for the minor joint and a maximum 40 percent rating for the major joint. 38 C.F.R. § 4.71a, Diagnostic Code 5201.  

Diagnostic Code 5201 "does not provide separate ratings for limitation of motion in the flexion and abduction planes, but rather is addressed generically to limitation of motion of the arm." Yonek v. Shinseki, 722 F.3d 1355, 1358 (Fed. Cir. 2013).

Effective February 7, 2021, Diagnostic Code 5201 was amended to reflect that limitation of motion may be shown by flexion and/or abduction and clarified the degrees of limitation of motion that correspond to each rating. Now, limitation of motion at the shoulder level (flexion and/or abduction limited to 90 degrees) warrants a 20 percent rating for both the major and minor extremity. Limitation of motion of the arm midway between side and shoulder level (flexion and/or abduction limited to 45 degrees) warrants a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity. Flexion and/or abduction limited to 25 degrees from the side warrants a maximum 30 percent rating for the minor joint and a maximum 40 percent rating for the major joint.

Turning to the evidence of record, during the period on appeal, the Veteran's right shoulder disability has been manifested by, at most, limitation of motion in flexion to 170 degrees and abduction to 165 degrees, which is above the shoulder level. In December 2025, a VA examiner estimated that the Veteran's flexion would be further reduced to approximately 160 degrees and external rotation to 70 degrees when discounting the ameliorative effects of medication. 

The October 2014 VA examination report reflects that the Veteran reported that his right shoulder "pops and clicks" occasionally, and that he suffers from achiness during and after overuse for 12 to 24 hours. The Veteran did not report flare-ups of either shoulder but did report functional loss or functional impairment in the form of an inability to ride a motorcycle due to pain in both shoulders. Initial range of motion testing revealed normal results for the right shoulder. No pain was noted on examination, evidence of pain with weight bearing, or objective evidence of localized tenderness or pain on palpation. The Veteran was able to perform repetitive use testing with at least three repetitions with no additional functional loss or range of motion after three repetitions. The Veteran was examined immediately after repetitive use over time and the examiner opined that pain, weakness, fatigability, or incoordination do not significantly limit functional ability with repeated use over a period of time. The Veteran did not report flare-ups. There was no reduction in muscle strength, muscle atrophy, or ankylosis noted. No shoulder instability, dislocation, or labral pathology was suspected or clavicle, scapula, acromioclavicular (AC) joint and sternoclavicular joint condition suspected. The Veteran did not have loss of head, nonunion, or fibrous union of the humerus, malunion of the humerus with moderate or marked deformity, and there was no evidence of crepitus. Regarding functional impact, the examiner opined that the Veteran's disability impacts his ability to perform occupational tasks noting that the Veteran stated he cannot type for a long period of time due to arm stiffness and pain from having his arms up and cannot lift things that weigh more than a few pounds up over his head.

A May 2016 VA examination report reflects that the Veteran's right shoulder has arthritic soreness and pain with lifting and working overhead. The Veteran reported right shoulder pain of between 2 and 4 out of 10. The Veteran reported flare-ups of the left shoulder but not the right. Initial range of motion testing revealed right shoulder flexion to 170 degrees, abduction to 165 degrees, external rotation to 75 degrees, and internal rotation to 90 degrees. Range of motion was noted as abnormal but not found to contribute to functional loss. There was no evidence noted of pain with weight bearing, objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue, or objective evidence of crepitus. No additional functional loss or range of motion was noted with repetitive use testing. The Veteran was examined immediately after repetitive use over time and the examiner concluded pain, weakness, fatig
 between 2 and 4 out of 10. The Veteran reported flare-ups of the left shoulder but not the right. Initial range of motion testing revealed right shoulder flexion to 170 degrees, abduction to 165 degrees, external rotation to 75 degrees, and internal rotation to 90 degrees. Range of motion was noted as abnormal but not found to contribute to functional loss. There was no evidence noted of pain with weight bearing, objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue, or objective evidence of crepitus. No additional functional loss or range of motion was noted with repetitive use testing. The Veteran was examined immediately after repetitive use over time and the examiner concluded pain, weakness, fatigability, or incoordination do not significantly limit functional ability with repeated use over a period of time. Muscle strength testing was normal with no muscle atrophy or ankylosis noted. Regarding additional factors contributing to disability, the examiner noted less movement than normal. Testing for suspected rotator cuff conditions revealed negative results. No history of mechanical symptoms or recurrent dislocation or subluxation of the glenohumeral or scapulohumeral joint was noted in the right shoulder. No AC joint condition or other impairment of the clavicle or scapula or condition or impairment of the humerus was reported. Regarding functional impact, the examiner reported that the Veteran's shoulder disabilities would impact his ability to work in occupations which required repetitive heavy lifting or working overhead. 

An August 2024 VA examination report reflects symptoms of intermittent right shoulder pain with prolonged movement of the shoulder and heavy lifting. He reported current treatment as rest, stretching, heating, and topical pain cream as needed. The Veteran denied flare-ups. Regarding functional loss, the Veteran reported intermittent right shoulder pain with prolonged movement of the shoulder and heavy lifting. Initial range of motion measurements were reported as normal with flexion to 180 degrees, abduction to 180 degrees, internal rotation to 90 degrees, and external rotation to 90 degrees on active and passive range of motion. Pain was noted on internal and external rotation. Evidence of pain was noted in weight-bearing, active motion, and passive motion, causing functional loss described as intermittent right shoulder pain with prolonged movement of the shoulder and heavy lifting. No objective evidence of crepitus or localized tenderness or pain on palpation was noted. The Veteran was able to perform repetitive use testing with at least three repetitions with no additional loss of function or range of motion noted. The Veteran was examined immediately after repeated use over time with the examiner noting that pain significantly limited functional ability, estimated as flexion to 180 degrees, abduction to 180 degrees, internal rotation to 90 degrees, and external rotation to 90 degrees. Less movement than normal was noted as an additional factor contributing to disability, described as intermittent right shoulder pain with prolonged movement of the shoulder and heavy lifting. No muscle atrophy or ankylosis was noted. No rotator cuff condition; shoulder instability, dislocation, or labral pathology; clavicle, scapula, acromioclavicular (AC) joint, or sternoclavicular joint condition; or condition or impairment of the humerus was noted. Regarding surgical procedures, a 2003 right shoulder subacromial decompression was reported with residuals described as intermittent mild to moderate right shoulder pain with prolonged movement of the shoulder and heavy lifting. No assistive devices were reported. Regarding diagnostic test findings, a right shoulder MRI from July 2022 was noted with results summarized as chronic supraspinatus tendinosis, subdeltoid/subacromial bursitis. Regarding functional impact, the examiner opined that the Veteran's right shoulder disability impacts his ability to perform occupational tasks, noting that the Veteran reported not missing any work due to pain but that he experiences intermittent right shoulder pain with prolonged movement of the shoulder and heavy lifting and rests his shoulder as needed.

In December 2024, a VA examiner reviewed the evidence of record and provided a retrospective opinion stating that the Veteran was found to have normal active and passive range of motion at the most recent VA examination, with functional loss noted with repetitive use but with normal range of motion estimated, and no functional loss was noted with flare-ups.

Further retrospective opinions were obtained in July 2025 addressing the Veteran's symptoms and level of severity. Regarding the impact of treatment on the Veteran's right shoulder disability, the examiner opined that the Veteran's disability would likely be more symptomatic if left untreated by medication, noting that evidence suggests that treatment contributes meaningfully to his symptom control, therefore, the Veteran's disability would be more severe in terms of pain and functional endurance if untreated by medication. Regarding the Veteran's baseline level of severity, discounting the beneficial effects of medication, the examiner opined that it would likely reflect a mild to moderate increase in pain and functional limitation as compared to
 with repetitive use but with normal range of motion estimated, and no functional loss was noted with flare-ups.

Further retrospective opinions were obtained in July 2025 addressing the Veteran's symptoms and level of severity. Regarding the impact of treatment on the Veteran's right shoulder disability, the examiner opined that the Veteran's disability would likely be more symptomatic if left untreated by medication, noting that evidence suggests that treatment contributes meaningfully to his symptom control, therefore, the Veteran's disability would be more severe in terms of pain and functional endurance if untreated by medication. Regarding the Veteran's baseline level of severity, discounting the beneficial effects of medication, the examiner opined that it would likely reflect a mild to moderate increase in pain and functional limitation as compared to what was observed during examination, concluding that it would likely involve intermittent moderate pain with overhead activity, minor loss of range of motion (such as flexion reduced to approximately 160 degrees and external rotation to 70 degrees) and functional limitations involving lifting or prolonged used.

Accordingly, the Board finds that the evidence of record persuasively weighs against a rating in excess of 20 percent for the Veteran's right shoulder disability. The evidence of record shows that the Veteran's right shoulder is his minor extremity and, during the period on appeal, his disability was manifested by, at worst, limitation of motion of flexion to 170 degrees and abduction to 165 degrees, with an estimated limitation of motion of flexion to 160 degrees when discounting the effect of medication. Therefore, the Veteran's right shoulder disability has not met nor more nearly approximated the symptoms associated with a higher rating at any point during the appeal period. In this regard, the Board specifically acknowledges the Veteran's lay reports of symptoms and noted functional loss; however, considering all the evidence of record, the Veteran's symptoms do not more nearly approximate limitation of motion of the minor extremity of flexion or abduction limited to 25 degrees from the side at any point during the period on appeal.

The Board has also considered whether any other diagnostic codes related to disabilities of the shoulder would provide for a higher disability rating.  However, the evidence does not reflect that the Veteran's symptoms would warrant a higher rating or separate rating under a different diagnostic code. See 38 C.F.R. § 4.71a. Specifically, the evidence of record does not show ankylosis or any of the conditions related to impairment of the humerus or of the clavicle or scapula during the period on appeal.  

In conclusion, the Board finds that the evidence of record persuasively weighs against assigning a rating in excess of 20 percent for the Veteran's right shoulder disability. As the evidence of record persuasively weighs against the claim, the benefit-of-the-doubt rule does not apply, and the Veteran's claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7.

7. Entitlement to an increased initial disability rating for thoracolumbar spine degenerative disc disease with spondylosis.

8. Entitlement to a separate disability rating for radiculopathy of the right lower extremity.

The Veteran generally contends entitlement to a higher initial disability rating for degenerative disc disease of the thoracolumbar spine with spondylosis. Notably, the Veteran has not provided any specific argument in support or identified any specific symptomatology warranting a higher rating.

During the pendency of the appeal, the Veteran was retroactively assigned an initial 40 percent disability rating for degenerative disc disease with spondylosis of the thoracolumbar spine under Diagnostic Code 5242-5237 and an initial 10 percent disability rating for left lower extremity radiculopathy associated with degenerative disc disease with spondylosis of the thoracolumbar spine under Diagnostic Code 8520.

Under 38 C.F.R. § 4.71a, Diagnostic Code 5242 is for degenerative arthritis, degenerative disc disease other than intervertebral disc syndrome and Diagnostic Code 5237 is for lumbosacral or cervical strain. Disabilities of the spine under Diagnostic Codes 5235 to 5234 are rated under the General Rating Formula for Disease and Injuries of the Spine, unless 5234 is evaluated under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes (IVDS Rating Formula).

Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or
 or cervical strain. Disabilities of the spine under Diagnostic Codes 5235 to 5234 are rated under the General Rating Formula for Disease and Injuries of the Spine, unless 5234 is evaluated under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes (IVDS Rating Formula).

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

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

For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Id. at Note 2.

Unfavorable ankylosis is defined as "a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching." Id.  at Note 5. Additionally, fixation of a spinal segment in neutral position (zero degrees) is "always" considered favorable ankylosis. Id.  

For purposes of evaluations under diagnostic code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, Note 1.

Turning to the evidence of record, during the period on appeal, the Veteran's disability of the thoracolumbar spine has been manifested by, at worst, forward flexion to 50 degrees. An October 2014 VA examination report indicates that the Veteran reported pain from the mid-shoulder blades down to the lower part of his back, sometimes into his neck. He stated that he has a constant ache in his back, rated as a 3 to 4 out of 10 that increased to a 6 to 7 out of 10 during cold weather, or when he does too much activity. The Veteran stated that he cannot sit too long in a chair, and that he takes Naproxen twice per day for his back pain. The Veteran did not report flare-ups. Initial range of motion testing revealed flexion to 65 degrees with objective evidence of painful motion at 65 degrees, and extension to 30 degrees
. An October 2014 VA examination report indicates that the Veteran reported pain from the mid-shoulder blades down to the lower part of his back, sometimes into his neck. He stated that he has a constant ache in his back, rated as a 3 to 4 out of 10 that increased to a 6 to 7 out of 10 during cold weather, or when he does too much activity. The Veteran stated that he cannot sit too long in a chair, and that he takes Naproxen twice per day for his back pain. The Veteran did not report flare-ups. Initial range of motion testing revealed flexion to 65 degrees with objective evidence of painful motion at 65 degrees, and extension to 30 degrees or greater with no objective evidence of painful motion. Right and left lateral flexion and rotation were each to 30 degrees or greater with no objective evidence of painful motion. The Veteran was able to perform repetitive use testing with three repetitions with no additional limitation to range of motion. The examiner noted functional loss or impairment of less movement than normal and pain on movement. No localized tenderness or pain to palpation, muscle spasms, guarding, muscle atrophy, or ankylosis was noted. Muscle strength testing revealed normal results. No radicular pain or other signs or symptoms due to radiculopathy were noted. The Veteran was not found to have IVDS or use any assistive devices for locomotion. Regarding functional impact, the Veteran stated he cannot sit in a chair for longer than an hour or do manual labor where he would have to lift things like loading trucks.

A May 2016 VA examination report reflects that the Veteran reported constant pressure and stiffness which ranged from between his shoulder blades to his lower back, treated with gentle stretching and Naproxen. The Veteran did not report flare-ups of his lumbar spine disability, and initial range of motion was recorded as flexion to 80 degrees and extension, right and left lateral flexion, and right and left lateral rotation each to 30 degrees. Pain was noted with each range of motion that did not result in or cause functional loss, and there was no evidence of pain with weight bearing, or objective evidence of localized tenderness or pain on palpation of the joints or associated soft tissue. There was no additional loss of function or range of motion with repetitive use testing. The Veteran was examined immediately after repetitive use over time and the examiner concluded that pain, weakness, fatigability or incoordination did not significantly limit functional ability with repeated use over a period of time. No guarding, muscle spasm, muscle atrophy, or ankylosis was noted. Regarding additional factors contributing to disability, the examiner noted that the Veteran had less movement than normal. Muscle strength was normal. The Veteran did not have radicular pain or other signs or symptoms due to radiculopathy, and the examiner noted that the Veteran did not have IVDS or use an assistive device. The examiner noted the result of the Oswestry Low Back Pain Disability Index reflecting minimal disability due to the Veteran's low back disability. The examiner opined that the Veteran's lumbar spine disability did not impact his ability to work.

An October 2022 VA examination report reflects that the Veteran was diagnosed with degenerative disc disease with spondylosis of the thoracolumbar spine and left lower extremity radiculopathy. At the time of the examination, the Veteran reported seeing a chiropractor, doing physical therapy, and using a heating pad to treat his symptoms. He reported his current symptoms as constant pain in the mid to lower back, described as tight and compressed pain with sharp pains on activity, rated at 4 to 5 out of 10 and maximum pain rated 8 out of 10, increased by sitting, standing, walking, or riding in vehicles for prolonged periods of time, bending, lifting, and carrying objects or rotating to look behind him, requiring rest or frequent repositioning. The Veteran also reported sharp and stabbing pain starting at the left side of the buttock down to the left foot. Flare-ups were described as severe, occurring daily, lasting 24-72 hours with more intense aching and associated sharp and stabbing pains, precipitated by sitting, standing, walking for prolonged periods of time, bending, lifting and carrying objects, or rotating to look behind him with rest and heating pad use alleviating symptoms. During a flare-up or after repeated use over time, the Veteran's functional impairment was described as limited in sitting, standing and walking for prolonged periods of time, bending, lifting and carrying objects, and rotating to look behind him. Initial range of motion measurements were described as abnormal, contributing to a functional loss described as limited in bending and rotating to look behind him. Active range of motion testing revealed forward flexion to 55 degrees, extension to 20 degrees, right lateral flexion to 14 degrees
 with more intense aching and associated sharp and stabbing pains, precipitated by sitting, standing, walking for prolonged periods of time, bending, lifting and carrying objects, or rotating to look behind him with rest and heating pad use alleviating symptoms. During a flare-up or after repeated use over time, the Veteran's functional impairment was described as limited in sitting, standing and walking for prolonged periods of time, bending, lifting and carrying objects, and rotating to look behind him. Initial range of motion measurements were described as abnormal, contributing to a functional loss described as limited in bending and rotating to look behind him. Active range of motion testing revealed forward flexion to 55 degrees, extension to 20 degrees, right lateral flexion to 14 degrees, left lateral flexion to 10 degrees, right lateral rotation to 16 degrees, and left lateral rotation to 12 degrees. Pain was noted on examination in all categories. Passive range of motion testing was not performed as it was noted as medically contraindicated due to the possibility of causing further injury or pain. Evidence of pain was noted on active motion and passive motion that causes functional loss described as limited in sitting, standing and walking for prolonged periods of time, bending, lifting and carrying objects, and rotating to look behind him. No objective evidence of crepitus was noted. Objective evidence of localized tenderness or pain on palpation was noted with a location of thoracic and lumbar para spinal muscles, severity of 4 out of 10, and directly related to the condition. The Veteran was able to perform repetitive use testing with at least three repetitions with no additional loss of function or range of motion after three repetitions. The Veteran was not examined immediately after repeated use over time. The examiner opined that pain would cause further limitation of functional ability with repeated use over time, estimated as forward flexion to 50 degrees, extension to 15 degrees, right lateral flexion to 9 degrees, left lateral flexion to 6 degrees, right lateral rotation to 11 degrees, and left lateral rotation to 7 degrees. The Veteran was not examined during a flare-up. The examiner opined that pain would cause further limitation of functional ability during flare-ups estimated as forward flexion to 50 degrees, extension to 15 degrees, right lateral flexion to 9 degrees, left lateral flexion to 5 degrees, right lateral rotation to 11 degrees, and left lateral rotation to 7 degrees. Localized tenderness not resulting in abnormal gait or abnormal spinal contour was noted, described as thoracic and lumbar para spinal muscles. No additional factors contributing to disability were noted. Muscle strength testing and reflex and sensory examination revealed normal results. No muscle atrophy was noted. The straight leg raising test was positive on the left side. Severe intermittent pain of the left lower extremity was noted with involvement of the sciatic nerve. No ankylosis was noted. The Veteran was not found to have IVDS of the thoracolumbar spine. No assistive devices for locomotion were reported. Regarding other significant diagnostic test findings, the results of a lumbar magnetic resonance imaging (MRI) from June 2021 showing moderate degenerative changes were noted and described as directly related to arthritis. Regarding functional impact, the examiner noted that the Veteran's disability impacts his ability to perform occupational tasks, described as the Veteran is limited in sitting, standing and walking for prolonged periods of time, bending, lifting and carrying objects, and rotating to look behind him. He will have to reposition or rest secondary to the pain as well as to try to prevent flare-ups of the back pain. 

An August 2024 VA examination report reflects that the Veteran was diagnosed with IVDS and degenerative disc disease with spondylosis with symptoms of dull ache back pain with constant pressure and stiffness. The Veteran reported treating his symptoms with chiropractic care, massage therapy as needed, rest, stretching, and over-the-counter pain medication as needed. The Veteran denied flare-ups. Regarding functional loss, the Veteran reported difficulty with heavy lifting, bending and twisting of the back, which cause a lot of pain, and difficulty with chores due to pain. He also reported his grip strength weakens during pain as well. Initial range of motion testing revealed forward flexion to 80 degrees and extension, right lateral flexion, left lateral flexion, right lateral rotation, and left lateral rotation to 20 degrees each in active and passive motion. Pain was noted in all categories on weight-bearing, nonweight-bearing, active motion, passive motion, and rest/non-movement, causing functional loss described as difficulty with heavy lifting, bending and twisting of back and decreased grip strength during pain. No objective evidence of crepitus or localized tenderness or pain on palpation was noted. The Veteran was able to perform repetitive use testing with at least three repetitions with no additional loss of function or range of motion. The
 also reported his grip strength weakens during pain as well. Initial range of motion testing revealed forward flexion to 80 degrees and extension, right lateral flexion, left lateral flexion, right lateral rotation, and left lateral rotation to 20 degrees each in active and passive motion. Pain was noted in all categories on weight-bearing, nonweight-bearing, active motion, passive motion, and rest/non-movement, causing functional loss described as difficulty with heavy lifting, bending and twisting of back and decreased grip strength during pain. No objective evidence of crepitus or localized tenderness or pain on palpation was noted. The Veteran was able to perform repetitive use testing with at least three repetitions with no additional loss of function or range of motion. The Veteran was examined immediately after repeated use over time and the examiner reported pain, fatigability, and weakness significantly limit functional ability with repeated use over time but reported no additional limitation in range of motion. No localized tenderness, guarding, or muscle spasm was noted. Interference with sitting, interference with standing, disturbance of locomotion, and less movement than normal were noted as additional factors contributing to disability. The Veteran reported difficulty with heavy lifting, bending and twisting of back, which causes a lot of pain, decreased grip strength, and difficulty with chores. The Veteran also reported difficulty with prolonged walking, sitting, or standing due to back pain. Muscle strength testing, reflex examination, and sensory examination revealed normal results. No muscle atrophy was noted. The straight leg raising test was positive on the left side. The Veteran was found to have radiculopathy of the sciatic nerve with symptoms of mild constant pain of the left lower extremity, mild bilateral paresthesias and/or dysesthesias, and mild bilateral numbness. No ankylosis was noted. The Veteran was noted to have IVDS of the thoracolumbar spine. No episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment in the preceding 12 months were noted. The Veteran reported the occasional use of a brace on both sides. Regarding significant test findings, the examiner noted a July 2010 MRI of the spinal cord showing mild multilevel degenerative disc with T4/T5 disc protrusion and an October 2014 thoracic and lumbar spine x-ray showing mild spondylosis of mid lower thoracic spine and degenerative disc disease in the midthoracic levels; lumbar spine shows early minimal spondylosis in lower lumbar levels. The relationship of the abnormal findings to the diagnosed conditions was described as mild spondylosis of mid lower thoracic spine and degenerative disc disease in the midthoracic levels; lumbar spine shows early minimal spondylosis in lower lumbar levels can be cause of back pain with radiating symptoms. Regarding functional impairment, the examiner opined that the Veteran's disability impacts his ability to perform occupational tasks, noting that the Veteran reported no missed days of work, but that he uses a sit to stand desk and a mat to help with back pain and that he takes rest breaks and changes positions as needed due to back pain. 

In December 2024, a VA examiner reviewed the evidence of record and provided a retrospective opinion stating that abnormal active and passive range of motion was documented at the most recent VA examination and that additional functional loss was noted with repetitive use but only normal range of motion was estimated. The examiner stated that there were no documented flare-ups or neurologic manifestations in the most recent VA examination report and no functional loss noted with flare-ups. The examiner further opined that there is no form of ankylosis. 

Multiple additional retrospective opinions were provided in July 2025. Regarding the Veteran's level of impairment if untreated, the examiner opined that the Veteran's lumbar spine disability would be more severe if untreated by medication, noting that the Veteran has consistently reported use of nonsteroidal anti-inflammatory drugs (NSAID) such as Naproxen, as well as the use of chiropractic care, physical therapy, massage therapy, and other conservative measures for symptom management. Without these interventions, the examiner suggested it is medically reasonable to conclude that the Veteran would experience increased pain, reduced range of motion and greater functional impairment due to unmitigated mechanic stress and inflammation. Therefore, the examiner opined that in the absence of medication and other current treatment modalities, the Veteran's lumbar spine disability would likely worsen in both symptom severity and functional impact. Regarding the Veteran's baseline level of severity when discounting the beneficial effects of medication, the examiner opined that the Veteran's disability would be moderately worse and would likely include increased pain severity, including more frequent or prolonged flare-ups, reduced range of motion due to unmodulated inflammation and stiffness, greater interference with daily activities including occupational tasks, and more pronounced functional loss including limitations in ambulation
 examiner suggested it is medically reasonable to conclude that the Veteran would experience increased pain, reduced range of motion and greater functional impairment due to unmitigated mechanic stress and inflammation. Therefore, the examiner opined that in the absence of medication and other current treatment modalities, the Veteran's lumbar spine disability would likely worsen in both symptom severity and functional impact. Regarding the Veteran's baseline level of severity when discounting the beneficial effects of medication, the examiner opined that the Veteran's disability would be moderately worse and would likely include increased pain severity, including more frequent or prolonged flare-ups, reduced range of motion due to unmodulated inflammation and stiffness, greater interference with daily activities including occupational tasks, and more pronounced functional loss including limitations in ambulation, posture, and load-bearing tasks. The examiner concluded that the Veteran's baseline level of severity would shift from being mild to moderate to being moderate to severe, particularly during activities involving physical strain or sustained postures. The examiner also opined that there is no evidence that the Veteran's lumbar spine disability has resulted in favorable or unfavorable ankylosis, or the functional equivalent of ankylosis during the period on appeal. Despite the presence of pain, stiffness, and some functional limitations, the Veteran retained mobility and control of spinal movement. 

Lumbar Spine Disability

During the pendency of the claim, the Veteran was assigned a retroactive initial 40 percent disability rating for his lumbar spine disability. The evidence of record persuasively weighs against assigning any further increased rating for the Veteran's lumbar spine disability during the period on appeal. In this regard, the Board notes the Veteran has not contended, nor has the evidence shown, that the Veteran's lumbar spine disability has resulted in symptomatology that more nearly approximates unfavorable ankylosis of the thoracolumbar spine. Specifically, the evidence does not show that the Veteran's disability has been manifested by the entire thoracolumbar spine fixed in flexion or extension with difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching at any point during the appeal period. Therefore, considering all evidence of record, to include the Veteran's lay reports of symptoms and noted functional loss, the Veteran's symptoms have not met or more nearly approximated unfavorable ankylosis of the entire thoracolumbar spine.

Consideration has also been given to assigning a rating under the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes. However, the Veteran has not been shown to have incapacitating episodes or periods of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician during the period on appeal. See 38 C.F.R. § 4.71a, Formula for Rating Invertebral Disc Syndrome Based on Incapacitating Episodes. Accordingly, a higher rating is not warranted under the rating criteria for IVDS based on incapacitating episodes.

As such, the Board finds that the evidence of record weighs persuasively against assigning a rating in excess of 40 percent for the Veteran's lumbar spine disability.

Radiculopathy

Regarding neurological impairment, the Veteran has been granted service connection for left lower extremity radiculopathy. The evidence reflects that, during the pendency of the appeal, the Veteran also developed symptoms of right lower extremity radiculopathy as reflected in the August 2024 VA examination report. Specifically, the Veteran was noted to have mild paresthesias and/or dysesthesias and mild numbness of the right lower extremity. The examination report reflects involvement of the sciatic nerve affecting both sides. Further, regarding the right side radiculopathy, the examiner noted a 2014 lumbar spine x-ray showing early minimal spondylosis in the lower lumbar levels which can cause pain of the lower back and radiculopathy of the lower extremities. 

Accordingly, the Board finds that a separate disability rating is warranted for the Veteran's right lower extremity radiculopathy associated with degenerative disc disease with spondylosis of the thoracolumbar spine. Based on the procedural history of the appeal, the AOJ will assign the initial rating in the first instance.

In sum, for the foregoing reasons, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for an initial disability rating in excess of 40 percent for his degenerative disc disease with spondylosis of the thoracolumbar spine, and the Veteran's claim is denied. The Board also finds that a separate disability
 radiculopathy of the lower extremities. 

Accordingly, the Board finds that a separate disability rating is warranted for the Veteran's right lower extremity radiculopathy associated with degenerative disc disease with spondylosis of the thoracolumbar spine. Based on the procedural history of the appeal, the AOJ will assign the initial rating in the first instance.

In sum, for the foregoing reasons, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for an initial disability rating in excess of 40 percent for his degenerative disc disease with spondylosis of the thoracolumbar spine, and the Veteran's claim is denied. The Board also finds that a separate disability rating is warranted for the Veteran's right lower extremity radiculopathy.   

9. Entitlement to an increased initial disability rating for right elbow disability.

The Veteran generally contends entitlement to a higher initial disability rating for his right elbow disability. Significantly, the Veteran has not expressed any argument in support or identified any symptomatology warranting a higher rating.

During the pendency of the claim, the Veteran was assigned a retroactive initial 10 percent disability rating for right elbow lateral epicondylitis.

With respect to disabilities of the elbow, 38 C.F.R. § 4.71a, Diagnostic Codes 5205 through 5213 set forth relevant provisions. Upper extremity ratings depend on whether the disabled extremity is the major or minor extremity. The Veteran is left hand dominant, as noted in an October 2014 VA examination. Therefore, his right elbow is considered his minor extremity.

Diagnostic Code 5205 evaluates ankylosis of the elbow, Diagnostic Code 5254 evaluates elbow flail joint, Diagnostic Codes 5210, 5211, and 5212 evaluate impairments of the ulna and radius. The medical record does not document any of these conditions. Therefore, these diagnostic codes are not applicable and will not be discussed further.

Diagnostic Code 5206 evaluates limitation of flexion. A 10 percent rating is assigned for flexion in either the major or minor extremity limited to 100 degrees. A 20 percent rating is assigned with flexion in either the major or minor extremity limited to 90 degrees. A 30 percent rating is assigned for flexion in the major extremity limited to 70 degrees and flexion in the minor extremity to 55 degrees. A 40 percent rating is assigned for flexion in the major extremity limited to 55 degrees and flexion in the minor extremity to 45 degrees. A 50 percent rating is assigned in the major extremity limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5206.

Diagnostic Code 5207 evaluates limitation of extension. A 10 percent rating is assigned for extension in either the major or minor extremity limited to 60 degrees. A 20 percent rating is assigned with extension in either the major or minor extremity limited to 75 degrees. A 30 percent rating is assigned for extension in the major extremity limited to 90 degrees and for extension in the minor extremity limited to 100 degrees. A 40 percent rating is assigned for extension in the major extremity limited to 100 degrees and extension in the minor extremity limited to 110 degrees. A 50 percent rating is assigned for extension in the major extremity limited to 110 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5207.

Diagnostic Code 5208 evaluates limitation of flexion and extension. A 20 percent rating is assigned for flexion limited to 100 degrees and extension limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5208.

Diagnostic Code 5213 provides that limitation of supination to 30 degrees or less warrants a 10 percent rating. Pronation lost beyond the last quarter of the arc, where the hand does not approach full pronation, warrants a 20 percent rating. Pronation lost beyond the middle of the arc warrants a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity. Moderate pronation or the hand fixed near the middle of the arc warrants a 20 percent rating. The hand fixed in full pronation warrants a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity. The hand fixed in supination or hyperpronation warrants a 30 percent rating for the minor extremity and a 40 percent rating for the major extremity. 38 C.F.R. § 4.71a, Diagnostic Code 5213.

Normal range of motion of the elbow is from 0 degrees on extension to 145 degrees on flexion with pronation to
 warrants a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity. Moderate pronation or the hand fixed near the middle of the arc warrants a 20 percent rating. The hand fixed in full pronation warrants a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity. The hand fixed in supination or hyperpronation warrants a 30 percent rating for the minor extremity and a 40 percent rating for the major extremity. 38 C.F.R. § 4.71a, Diagnostic Code 5213.

Normal range of motion of the elbow is from 0 degrees on extension to 145 degrees on flexion with pronation to 80 degrees and supination to 85 degrees. 38 C.F.R. § 4.71a, Plate I.

Turning to the evidence of record, during the period on appeal, the Veteran's right elbow disability has been manifested by pain and discomfort with normal range of motion. An October 2014 VA examination report reflects that the Veteran reported

occasional right forearm pain 3 to 4 times a day for the last 8 months to a year. The Veteran did not report flare-ups. Initial range of motion testing revealed normal range of motion with flexion to 145 degrees, and extension to 0 degrees with no objective evidence of painful motion, and no change in range of motion with repetitive use testing. There was no localized tenderness or pain on palpation of the joints or soft tissue, no ankylosis, flail joint, joint fracture, and/or impairment of supination or pronation noted. Muscle strength testing was normal. The examiner noted no history of joint replacement or any other surgical procedure of the right elbow. Regarding functional impact, the examiner reported that the right elbow disability impacts his ability to work as it bothers the Veteran when lifting, typing, and opening and closing doors.

In a May 2016 VA examination report, the Veteran reported discomfort in the

muscles of his forearm, and that he notices the pain primarily when he is lifting,

mowing, or with prolonged keyboarding. He rated the pain as between 2 and 5 out

of 10 and stated that it limits his ability to do things on a normal day to day basis.

The Veteran did not report flare-ups of the elbow or forearm. Range of motion was

normal with flexion to 145 degrees, extension to 0 degrees, supination to 85 degrees, and pronation to 80 degrees. There was no evidence of pain with weight

bearing or objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue or crepitus. No reduction in muscle strength or muscle atrophy was found. The Veteran did not have flail joint, joint fracture, ununited fracture, malaligned fracture, or impairment of supination or pronation. The Veteran reported occasional use of an elbow compression strap. Regarding functional impact, the examiner noted that the Veteran's right elbow disability did not impact his ability to work.

An August 2024 VA examination report reflects that the Veteran reported current symptoms of tenderness and soreness with movement, treated with an elbow brace or rest as needed as well as heat and topical pain relief cream. The Veteran did not report flare-ups. Regarding functional loss, the Veteran reported increased pain with movement of his elbow and loss of grip strength with prolonged use. The Veteran reported pain on extension of his elbow and with heavy lifting. The Veteran also reported painful motion on forearm supination and pronation, described as rotating his elbow in both directions causing pain with repeated use or with heavy lifting. Range of motion testing was normal with pain noted on extension, forearm supination, and forearm pronation. Passive range of motion was the same as active. Evidence of pain was noted on weight-bearing, active motion, and passive motion that causes functional loss. The functional loss was described as he reports that he has increased pain with movement, that rotating his elbow in both directions causes pain with repeated use or with heavy lifting, and that prolonged use causes loss of grip strength during tasks. No objective evidence of crepitus or localized tenderness or pain on palpation was noted. Repetitive use testing revealed no additional loss of function or range of motion after three repetitions. The Veteran was examined immediately after repetitive use over time. The examiner opined that pain, fatigability, and weakness significantly limited functional ability with repeated use over time but reported no further limitation in range of motion measurements. Pain was reported as an additional contributing factor of disability described as he reports that he has increased pain with movement of his elbow and that prolonged use causes loss of grip strength during tasks. No muscle atrophy or ankylosis was noted. The Veteran was not found to have flail joint, joint fracture, ununited fracture, malaligned
 objective evidence of crepitus or localized tenderness or pain on palpation was noted. Repetitive use testing revealed no additional loss of function or range of motion after three repetitions. The Veteran was examined immediately after repetitive use over time. The examiner opined that pain, fatigability, and weakness significantly limited functional ability with repeated use over time but reported no further limitation in range of motion measurements. Pain was reported as an additional contributing factor of disability described as he reports that he has increased pain with movement of his elbow and that prolonged use causes loss of grip strength during tasks. No muscle atrophy or ankylosis was noted. The Veteran was not found to have flail joint, joint fracture, ununited fracture, malaligned fracture, or impairment of supination or pronation. No surgical procedures were noted. The occasional use of a brace was reported. Regarding functional impact, the examiner stated that the Veteran's disability impacts his ability to perform occupational tasks, noting that the Veteran reported no days of work missed but difficulty completing tasks on the farm where he lives that require heavy lifting and with prolonged use of elbow movements, reporting increased pain with movement and loss of grip strength with prolonged use.

In December 2024, a VA examiner reviewed the medical evidence of record and provided a retrospective opinion that the Veteran's range of motion of the right elbow was normal in prior VA examination reports with no reduction with repetitive use or during flare-ups, that the normal range of motion implies that there was no ankylosis, and that there was no mention of flail joint or other impairment of the elbow, radius, or ulna or impairment of supination or pronation of the elbows.

Multiple additional retrospective opinions were provided in July 2025 addressing the Veteran's symptoms during the period on appeal. Regarding the Veteran's baseline level of severity discounting any beneficial effects of medication and conservative management, the examiner opined that the Veteran's baseline severity of right elbow disability would likely include moderate pain with movement and use, pain-limited range of motion, particularly in extension, supination, and pronation, and functional loss of grip strength, fatigue, and weakness with use. The examiner opined that this would have a moderate impact on occupational tasks and daily activities involving arm movement or force. The examiner further expressed that the Veteran's right elbow disability would likely be more symptomatic and functionally impairing if untreated as the use of an elbow brace, rest, topical pain relief, and activity modification provides symptomatic control and limits functional deterioration. In the absence of these interventions, increased pain, reduced grip strength, and more significant occupational impairment would likely result.

Considering all the evidence of record and resolving reasonable doubt in favor of the Veteran, the Board finds that an initial disability rating of 20 percent, but no higher, is warranted for the Veteran's right elbow disability. In this regard, the Board notes that the Veteran's disability has been manifested by, at worst, pain and discomfort with normal range of motion. Regarding the ameliorative effects of medication, a VA examiner opined in July 2025 that without treatment, the Veteran's right elbow disability would likely increase, to include pain-limited range of motion. Accordingly, the Board resolves doubt in favor of the Veteran and finds that, discounting the ameliorative effects of medication, the symptoms of his right shoulder disability warrant an initial 20 percent disability rating, but no higher. 

In this regard, the Board acknowledges consideration of the Veteran's lay reports of symptoms and noted functional loss; however, the evidence does not show that the Veteran's right elbow disability met or more nearly approximated the symptoms associated with the next higher rating. The evidence of record weighs persuasively against finding that the Veteran's right elbow disability has been manifested by flexion limited to 55 degrees or less or extension limited to 100 degrees or less during the appeal period. Further, the Board has considered the other relevant diagnostic codes; however, the Veteran's right elbow disability symptoms do not warrant a higher or separate rating under any other diagnostic code. Specifically, the evidence does not show that the Veteran has had ankylosis or any other listed impairment of the elbow, radius, or ulna. 

In sum, resolving reasonable doubt in favor of the Veteran, the Board finds that an initial 20 percent disability rating, but no higher, is warranted for the Veteran's right elbow disability. To the extent that the Veteran contends entitlement to a higher rating, the most probative evidence of record persuasively weighs against the claim, the benefit-of-the-doubt rule does not apply, and any further increased rating is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7.

10. Entitlement an increased initial disability rating for scars.

The Veteran generally contends entitlement to a higher initial disability rating for his service-connected
 radius, or ulna. 

In sum, resolving reasonable doubt in favor of the Veteran, the Board finds that an initial 20 percent disability rating, but no higher, is warranted for the Veteran's right elbow disability. To the extent that the Veteran contends entitlement to a higher rating, the most probative evidence of record persuasively weighs against the claim, the benefit-of-the-doubt rule does not apply, and any further increased rating is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7.

10. Entitlement an increased initial disability rating for scars.

The Veteran generally contends entitlement to a higher initial disability rating for his service-connected scars. Significantly, the Veteran has not expressed any specific argument in support or identified any symptomatology warranting a higher rating.

The Veteran is in receipt of an initial noncompensable rating for scars of the trunk and extremities rated under Diagnostic Code 7802.

The Board notes that VA amended the criteria for rating skin disabilities, effective from August 13, 2018. Prior to August 13, 2018, Diagnostic Code 7802, was for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that were superficial and nonlinear. Under these criteria, a scar with an area or areas of 144 square inches (929 sq. cm.) or greater warrants a 10 percent rating. 38 C.F.R. § 4.118. Note 1 to Diagnostic Code 7802 instructed that a superficial scar was one not associated with underlying soft tissue damage. Id. 

Since August 13, 2018, Diagnostic Code 7802 is for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. 38 C.F.R. § 4.118. Diagnostic Code 7802 was otherwise unchanged by the August 13, 2018, amendments.

Turning to the evidence of record, an October 2014 VA examination report reflects that the Veteran has service-connected scars that resulted from shoulder surgeries, foot surgeries, and moles taken off his back. The examiner noted that none of the scars were painful; unstable, with frequent loss of covering of skin over the scar; painful and unstable; or due to burns. The VA examiner noted that the Veteran had three linear right shoulder scars, which measured 1 centimeter (cm) by 0.2 cm, 0.8 cm by 0.1 cm, and 2 cm by 0.1 cm, respectively. He had four linear left shoulder scars, which measured 2 cm by 0.2 cm, 1 cm by 0.2 cm, 2 cm by 0.1 cm, and 1.5 cm by 0.5 cm, respectively. He had one linear scar on his right plantar foot, which measured 2 cm by 0.2 cm, and two linear scars on his right ankle, which measured 3.5 cm by 0.2 cm and 11.2 cm by 0.3 cm. One linear scar was noted on the posterior trunk, measuring 2.75 cm by 0.2 cm and four superficial non-linear scars were noted on the posterior trunk, measuring 1.2 cm by 1.5 cm, 1.5 cm by 1.5 cm, 0.8 cm by 0.5 cm, and 0.3 cm by 0.3 cm. No deep non-linear scars were noted. None of the scars resulted in limitation of function or impact the Veteran's ability to work.

A November 2021 VA examination report reflects that the Veteran had scars

on his left shoulder from his left acromial decompression surgery. The examiner

reported that the Veteran did not have any scars or disfigurement of the head, face,

or neck. The Veteran indicated that the left shoulder scars were not painful, unstable with frequent loss of covering of skin over the scars, or due to burns. The

examiner noted that the Veteran had four left shoulder scars, which each

measured 1.5 cm by 0.2 cm. None of the scars were noted as tender to palpation, unstable, or with underlying soft tissue damage. The examiner summarized that

the Veteran's left upper extremity scars without underlying tissue damage affected a total of approximately 1.2 cm squared. The examiner reported that none of the scars resulted in limitation of function, to include limitation of motion. The examiner also opined that the Veteran's scars did not impact his ability to work.

A May 2022 VA examination report notes post-surgical left shoulder scars. The examiner reported
 covering of skin over the scars, or due to burns. The

examiner noted that the Veteran had four left shoulder scars, which each

measured 1.5 cm by 0.2 cm. None of the scars were noted as tender to palpation, unstable, or with underlying soft tissue damage. The examiner summarized that

the Veteran's left upper extremity scars without underlying tissue damage affected a total of approximately 1.2 cm squared. The examiner reported that none of the scars resulted in limitation of function, to include limitation of motion. The examiner also opined that the Veteran's scars did not impact his ability to work.

A May 2022 VA examination report notes post-surgical left shoulder scars. The examiner reported that the Veteran did not have any scars or disfigurement of the head, face, or neck. The left shoulder scars were not found to be painful, unstable with frequent loss of covering of skin, or due to burns. The examiner indicated that the Veteran had three left shoulder scars, which each measured 1 cm by 0.5 cm. None of the scars were noted as tender to palpation, unstable, or with underlying soft tissue damage. The examiner summarized that the Veteran's left upper extremity scars without underlying tissue damage affected a total of approximately 1.5 cm squared. The examiner reported that none of the scars resulted in limitation of function, to include limitation of motion. The examiner also opined that the Veteran's scars did not impact his ability to work.

An August 2024 VA examination report reflects that the Veteran has linear, post-surgical scars on the lateral right shoulder, medial right shoulder, right foot, lateral right ankle, and medial right ankle. No scars were noted on the head, face, or neck. The scars were described as post-surgical and well healed. None of the scars were found to be painful, unstable with frequent loss of covering of skin over the scar, or due to burns. The scars of the right upper extremity were each described as 1 cm by 0.1 cm. The scar of the right foot was described as 9 cm by 0.1 cm. The scar of the lateral right ankle was described as 7 cm by 0.1 cm. The scar of the medial right ankle was described as 5 cm by 0.1 cm. None were found to be tender to palpation, unstable upon inspection, or with underlying soft tissue damage. The examiner summarized that the approximate total area of scars of the right upper extremity without underlying tissue damage was 0.2 cm squared. The approximate total area of scars of the right lower extremity without underlying tissue damage was 1.2 cm squared. The examiner opined that the Veteran's scars did not impact his ability to work.

Accordingly, based on all of the evidence of record, to include the Veteran's lay reports of symptoms, the Board finds that a compensable disability rating is not warranted for the Veteran's scars of the trunk and extremities. The evidence shows that the Veteran's trunk and extremities scars were not of the head, face, or neck; were not associated with underlying soft tissue damage; were not unstable or painful; and did not affect a total area equal to or greater than 144 square inches (929 square cm). No disabling effects were identified during the October 2014, November 2021, May 2022, or August 2024 examinations or reflected in the Veteran's treatment records. As such, the evidence does not show that the Veteran's scars warrant a compensable rating under any of the diagnostic codes pertaining to scars, under the earlier or amended criteria. Further, there are also no other disabling effects to warrant a higher evaluation under Diagnostic Code 7805. 

In conclusion, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for a compensable rating for scars of the trunk and extremities. As the evidence of record persuasively weighs against a compensable rating, the benefit-of-the-doubt rule does not apply, and the Veteran's claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7.

11. Entitlement to an increased initial disability rating for right ankle disability.

The Veteran generally contends entitlement to a higher initial disability rating for his right ankle disability. Significantly, the Veteran has not expressed any specific argument in support or identified any symptomatology warranting a higher rating.

During the pendency of the claim, the Veteran was assigned a retroactive initial 20 percent disability rating for right ankle closed fracture status post open reduction and internal fixation procedure. 

The Veteran's right ankle disability is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5271, for limitation of motion of the ankle. 

During the
(b); 38 C.F.R. §§ 4.3, 4.7.

11. Entitlement to an increased initial disability rating for right ankle disability.

The Veteran generally contends entitlement to a higher initial disability rating for his right ankle disability. Significantly, the Veteran has not expressed any specific argument in support or identified any symptomatology warranting a higher rating.

During the pendency of the claim, the Veteran was assigned a retroactive initial 20 percent disability rating for right ankle closed fracture status post open reduction and internal fixation procedure. 

The Veteran's right ankle disability is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5271, for limitation of motion of the ankle. 

During the pendency of the appeal, the rating criteria for evaluation of musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended, effective February 7, 2021. Under Diagnostic Code 5271 prior to the amendments, a maximum 20 percent rating is warranted for marked limited motion of the ankle.  Id.

Under the amended criteria, a 10 percent rating is warranted for moderate limited motion of the ankle (less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion). A 20 percent rating is warranted for marked limited motion of the ankle (less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion). 38 C.F.R. § 4.71a, Diagnostic Code 5271. 

For VA purposes, normal range of motion of the ankle is dorsiflexion to 20 degrees and plantar flexion to 45 degrees. 38 C.F.R. § 4.71a, Plate II.

Turning to the evidence of record, an October 2014 VA examination report reflects a diagnosis of closed fracture of the right fibula/tibia which the Veteran reported felt arthritic and sore, especially with changes in the weather, running, or walking. He rated the pain as a 5 out of 10 but reported that if he hits his ankle on something, he can have sharp pain up to 10. The Veteran did not report flare-ups that impact the function of his ankle, or functional loss or impairment of the joint. Range of motion was normal, there was no evidence of pain with weight bearing, and no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue or crepitus. There was no additional loss of function or range of motion with repetitive use testing, muscle strength testing was normal, and there was no muscle atrophy or ankylosis of the right ankle. The examiner reported no ankle instability or dislocation, and the Veteran had no history of shin splints, stress fractures, achilles tendonitis, achilles tendon rupture, or malunion of calcaneus or talus, or a talectomy. The Veteran did not report use of any assistive devices. Regarding functional impact, the examiner reported that the Veteran's right ankle disability impacts his ability to perform occupational tasks and noted that the Veteran stated it would slow him down if he had a manual labor job if he had to climb stairs or anything. 

A May 2016 VA examination report reflects that the Veteran reported that his right

ankle "does not work like it used to," and that he fatigues easier now and will start

to limp after prolonged weight-bearing. He reported feelings of instability in the

ankle especially after walking on uneven terrain, and tenderness to the touch "over

the hardware and where hardware used to be." The Veteran described the pain as a 4 out of 10 with stiffness, and dull ongoing pain, at worst a 6 out of 10 with throbbing pain. He reported that he is no longer able to run or fast walk and stated

that he has problems with stairs and with squatting. The examiner noted that the

Veteran reported flare-ups of the ankle and lack of endurance, but the examination

was not administered during a flare-up. Initial range of motion testing revealed dorsiflexion to 15 degrees and plantar flexion to 35 degrees. Pain was noted on examination, but it did not result in or cause functional loss. There was no evidence of pain with weight-bearing, but there was tenderness to palpation of the lateral ankle where hardware is palpable under the skin. There was no objective evidence of crepitus, and no additional functional loss or range of motion with repetitive use testing. Regarding additional factors contributing to disability, the examiner noted less movement than normal and instability of station. There was no muscle atrophy, ankylosis, or reduction in muscle strength. The examiner reported that ankle instability or dislocation was suspected. The Veteran reported the occasional use of an ankle brace for stability. The examiner noted that the
 degrees and plantar flexion to 35 degrees. Pain was noted on examination, but it did not result in or cause functional loss. There was no evidence of pain with weight-bearing, but there was tenderness to palpation of the lateral ankle where hardware is palpable under the skin. There was no objective evidence of crepitus, and no additional functional loss or range of motion with repetitive use testing. Regarding additional factors contributing to disability, the examiner noted less movement than normal and instability of station. There was no muscle atrophy, ankylosis, or reduction in muscle strength. The examiner reported that ankle instability or dislocation was suspected. The Veteran reported the occasional use of an ankle brace for stability. The examiner noted that the Veteran's right ankle disability did not impact his ability to work. 

An August 2024 VA examination report reflects that the Veteran reported constant, chronic stiffness and pain, described as a dull ache, treated by rest and an ankle brace as needed. The Veteran denied flare-ups and reported functional loss in the form of difficulty with prolonged walking due to ankle pain, an inability to run anymore, and the need to take frequent breaks when walking or standing due to pain. No history of instability was noted. Initial range of motion measurements were reported as plantar flexion to 45 degrees and dorsiflexion to 20 degrees with pain noted in both on examination. Passive range of motion was noted as the same as active range of motion. Evidence of pain was noted on weight-bearing, active motion, and passive motion and found to cause functional loss in the form of difficulty walking due to ankle pain, an inability to run anymore, and the need to take frequent breaks when standing due to the pain. Objective evidence of crepitus was noted. No objective evidence of localized tenderness or pain on palpation was noted. The Veteran was able to perform repetitive use testing with no additional loss of function or range of motion after three repetitions. The Veteran was examined immediately after repeated use over time and the examiner reported pain and fatigability significantly limited functional ability with repeated use over time, described as plantar flexion to 45 degrees and dorsiflexion to 20 degrees. Interference with standing and disturbance of locomotion were noted as additional factors contributing to disability. No muscle atrophy or ankylosis of the ankle or subastragalar or tarsal joint was noted. The Veteran was noted to have resolved "shin splints" or medial tibial stress syndrome with treatment for less than 12 consecutive months. The condition was not found to affect range of motion of the knee and current symptoms were described as none/resolved. No surgical procedures were noted. Scars were noted related to the right ankle disability. The occasional use of a right ankle brace was reported. Regarding diagnostic test findings, an April 2014 x-ray of the right ankle was noted with the results described as progression of the heterotopic ossification along the distal interosseous membrane. Regarding the relationship of abnormal findings to the diagnosed condition, the examiner stated that the finding noted on imaging is caused by tibial fracture associated with the ankle. Regarding functional impact, the examiner opined that the Veteran's disability impacts his ability to perform occupational tasks, noting that the Veteran reported no missed work but that he has ankle pain with prolonged standing and walking and that he uses an ankle brace as needed and takes breaks to allow ankle pain to subside.

In December 2024, a VA examiner reviewed the prior evidence of record and provided a retrospective opinion stating that the Veteran had normal active and passive range of motion of the right ankle at the most recent VA examination and there was functional loss noted with repetitive use but only normal range of motion was documented and no functional loss reported with flare-ups.

Multiple retrospective opinions were also provided in July 2025. The examiner opined that, when discounting the beneficial effects of medication, the baseline severity of the Veteran's right ankle disability would likely reflect greater impairment in terms of pain intensity, endurance, and functional capacity, with the rationale that the evidence suggests that medication, while not curative, plays a significant role in the symptom management and functional maintenance of the Veteran's condition. Therefore, the examiner concluded that the Veteran's right ankle disability would likely be moderate to moderately severe, characterized by chronic pain, limited endurance, activity modification, and likely reduced range of motion under dynamic conditions without the beneficial effects of medication. In a separate opinion, the examiner expressed that the Veteran's right ankle disability would likely be more severe if left untreated by medication and conservative management with increased symptoms of chronic pain, stiffness, fatigue, and disturbance of locomotion. The examiner further opined that the Veteran's right ankle disability has not resulted in loss of use of the right foot during the period on appeal, noting that the evidence consistently demonstrates that while the Veteran has ongoing symptoms including right ankle pain, stiffness, instability with
 maintenance of the Veteran's condition. Therefore, the examiner concluded that the Veteran's right ankle disability would likely be moderate to moderately severe, characterized by chronic pain, limited endurance, activity modification, and likely reduced range of motion under dynamic conditions without the beneficial effects of medication. In a separate opinion, the examiner expressed that the Veteran's right ankle disability would likely be more severe if left untreated by medication and conservative management with increased symptoms of chronic pain, stiffness, fatigue, and disturbance of locomotion. The examiner further opined that the Veteran's right ankle disability has not resulted in loss of use of the right foot during the period on appeal, noting that the evidence consistently demonstrates that while the Veteran has ongoing symptoms including right ankle pain, stiffness, instability with uneven terrain, and functional limitations such as difficulty with prolonged walking, standing, stair climbing, and an inability to run, these impairments do not rise to the level of loss of use. 

The Veteran was assigned a retroactive initial disability rating of 20 percent based on symptomatology more nearly approximating marked limitation of motion of the ankle with less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion. As the Veteran is in receipt of the highest schedular rating for limited motion of the ankle, there is no basis to award a higher rating under the currently assigned diagnostic code.

The Board has considered whether any other diagnostic codes related to disabilities of the ankle would provide for a higher disability rating. However, the evidence does not reflect that the symptoms would warrant a higher rating under a different diagnostic code. See 38 C.F.R. § 4.71a. Specifically, the evidence does not show that the Veteran's right ankle disability has been manifested by ankylosis at any point during the period on appeal. In this regard, the Board acknowledges consideration of the Veteran's lay reports of symptoms, noted functional loss, and the December 2025 retrospective opinion regarding the ameliorative effects of medication; however, the Veteran's right ankle symptoms have not met or more nearly approximated ankylosis during the appeal period. 

Accordingly, the evidence of record weighs persuasively against assigning an initial disability rating in excess of 20 percent for the Veteran's right ankle disability. As the evidence persuasively weighs against the Veteran's claim, the benefit-of-the-doubt doctrine is inapplicable and the Veteran's claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7.

12. Entitlement to an increased initial disability rating for bilateral foot disabilities.

The Veteran generally contends entitlement to a higher disability rating for his bilateral foot disabilities. Significantly, the Veteran has not expressed any specific argument in support or identified any symptomatology warranting a higher rating.

The Veteran's bilateral foot plantar fasciitis with pes planus was assigned an initial 10 percent disability rating under Diagnostic Code 5276 from October 1, 2014. During the pendency of the appeal, the Veteran was subsequently assigned a 20 percent disability rating under Diagnostic Code 5269 from February 7, 2021, and a 50 percent disability rating under Diagnostic Code 5269-5276.

Under Diagnostic Code 5276 for acquired flatfoot, a noncompensable rating is warranted for mild acquired flatfoot; symptoms relieved by built-up shoe or arch support. A 10 percent rating is warranted for moderate acquired flat foot; weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet, bilateral or unilateral. A 20 percent rating is assigned for severe unilateral acquired flat foot; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. A 30 percent rating is warranted for severe bilateral acquired flat foot; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. A 30 percent rating is also warranted for pronounced unilateral acquired flatfoot; marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. A maximum 50 percent rating is warranted for bilateral acquired flatfoot; marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, Diagnostic Code 5276.

In February 7, 2021, the rating schedule was amended and Diagnostic Code 5269 for plantar fasciitis was created. Under
 unilateral acquired flatfoot; marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. A maximum 50 percent rating is warranted for bilateral acquired flatfoot; marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, Diagnostic Code 5276.

In February 7, 2021, the rating schedule was amended and Diagnostic Code 5269 for plantar fasciitis was created. Under Diagnostic Code 5269, a 10 percent rating is warranted for plantar fasciitis, otherwise, unilateral or bilateral. A 20 percent rating is warranted for unilateral plantar fasciitis with no relief from both non-surgical and surgical treatment. A maximum 30 percent rating is warranted for bilateral plantar fasciitis with no relief from both non-surgical and surgical treatment. 38 C.F.R. § 4.71a, Diagnostic Code 5269.

Turning to the evidence of record, an October 2014 VA examination report reflects that the Veteran was diagnosed with bilateral plantar fasciitis. The Veteran reported that he had surgery performed in 2013 on his right foot, had recently completed physical therapy, and was experiencing some improvement. He reported occasional periods of aching and soreness, rated as a 2 or 3 out of 10, after an extended period of being on his feet, standing or walking for prolonged periods of time, or when mowing. He described the symptoms in the left foot as aching, from the heel to the arch, with a pain level of 4 to 5 out of 10, occurring in the morning, during and after mowing, and after prolonged periods of rest, lasting for a few hours. The Veteran reported using arch supports. The Veteran did not report flare-ups that impact the function of the foot or any functional loss or functional impairment of either foot. The examiner noted that the Veteran had a right foot plantar fasciotomy in November 2013 with no residual signs or symptoms due to the surgery. Regarding functional impact, the examiner opined that the Veteran's bilateral foot disability impacts his ability to perform occupational tasks and noted that the Veteran stated that if he had a warehouse job requiring walking, he would have pain in his feet.

A May 2016 VA examination report reflects diagnoses of bilateral flat foot or pes planus and plantar fasciitis. The Veteran reported that his right foot symptoms are 75 percent better but that he still experiences cramping in the morning and minor aches and pains, especially if working out in the yard. He reported his left foot symptoms are worse than his right foot, indicating left foot pain ranging from 3 to 10 out of 10 and right foot pain ranging between 0 to 3 out of 10. Regarding current treatment, the Veteran reported using orthotic inserts with some improvement, a left foot brace when sleeping, a roller on the bottom of his feet, and stretching with fair response. The Veteran stated that his plantar fasciitis reduces his ability to run and workout like he used to. The Veteran reported flare-ups of the left foot regularly which he notices when he first gets out of bed and with prolonged weight-bearing activities. Regarding functional loss or impairment, the Veteran described lack of endurance. The Veteran had pain on use of his feet which was accentuated on use. No pain on manipulation, swelling on use, or characteristic calluses were noted. The Veteran reported that orthotics provided relief on the right side but not the left side. The examiner noted that the Veteran did not have extreme tenderness of plantar surfaces on one or both feet or marked deformity of one or both feet. Decreased longitudinal arch height on weight-bearing was noted bilaterally. The Veteran was not found to have marked pronation, a weight-bearing line falling over or medial to the great toe, a lower extremity deformity other than pes planus causing alteration of the weight-bearing line, "inward" bowing of the Achilles tendon, or marked inward displacement and severe spasm of the Achilles tendon on manipulation of one or both feet. There was no pain in either foot upon examination, but the Veteran reported right foot pain with prolonged weight-bearing and left foot pain with first steps out of bed and with prolonged weight-bearing. Regarding contributing factors of disability, pain on weight-bearing was noted for the left foot and lack of endurance bilaterally. The examiner found that pain, weakness, fatigability, or incoordination significantly limited functional ability during flare-ups or when the foot was used repeatedly over a period of time in the left foot, but not the
 deformity other than pes planus causing alteration of the weight-bearing line, "inward" bowing of the Achilles tendon, or marked inward displacement and severe spasm of the Achilles tendon on manipulation of one or both feet. There was no pain in either foot upon examination, but the Veteran reported right foot pain with prolonged weight-bearing and left foot pain with first steps out of bed and with prolonged weight-bearing. Regarding contributing factors of disability, pain on weight-bearing was noted for the left foot and lack of endurance bilaterally. The examiner found that pain, weakness, fatigability, or incoordination significantly limited functional ability during flare-ups or when the foot was used repeatedly over a period of time in the left foot, but not the right foot. The examiner reported that it is not possible without mere speculation to estimate either loss of range of motion or describe loss of function during flares because there is no conceptual or empirical basis for making such a determination without directly observing function under these circumstances. No other functional loss during flare-ups or when the foot is used repeatedly over a period of time was noted. The examiner noted that the Veteran walks independently with normal gait both with shoes and without shoes. Regarding functional impact, the examiner reported that the Veteran's foot disabilities did not impact his ability to perform any occupational task.

An August 2024 VA examination report reflects that the Veteran was diagnosed with bilateral flat foot or pes planus and plantar fasciitis. The Veteran reported current symptoms of some left foot cramping, especially in the morning every day, and right foot cramping about 3 times per week. The Veteran reported that his right foot is much better since the surgery and that his current treatment involved stretches and shoe inserts daily. The Veteran reported left foot pain rated about a 2 out of 10 with cramping in the arch of his foot. The Veteran did not report flare-ups. Regarding functional loss or impairment, the Veteran reported right foot pain about three times per week with cramping in the arch of his foot, especially after prolonged walking and standing and left foot pain every morning requiring him to change positions from standing and sitting and stretch. The Veteran reported pain on use of the feet affecting both sides, accentuated on use and manipulation. No swelling on use or characteristic calluses were noted. The Veteran reported trying arch supports without relief and that both sides remained symptomatic. No extreme tenderness of plantar surfaces was noted. The Veteran was noted to have decreased longitudinal arch height on weight-bearing in both feet. Marked pronation was noted in both feet with improvement by orthopedic shoes or appliances. Both feet were noted to have undergone non-surgical treatment for plantar fasciitis without relief from symptoms. Surgical treatment was noted for the right foot without relief from the symptoms. No functional loss was noted due to plantar fasciitis. The Veteran was not found to have Morton's neuroma, metatarsalgia, hammer toe, hallux valgus, hallux rigidus, acquired pes cavus, or any foot injuries or other foot conditions other than previously described. Regarding surgical procedures, the examiner recorded that the Veteran had right foot plantar fascial release in February 2014 with no residual signs or symptoms noted due to the surgery. The examiner noted no pain on physical examination in either foot with the rationale of subjective only. Regarding functional loss, the examiner noted disturbance of locomotion, interference with standing, and pain as contributing factors of disability for both sides. The examiner opined that procured evidence suggests that pain, fatigability, weakness, lack of endurance, or incoordination significantly limits functional ability during flare-ups or after repeated use over time, described as he reports that he has to change positions from standing and sitting and will have to stretch due to intermittent foot pain. The examiner opined that there is functional loss during flare-ups or after repeated use over time, described as he reports that he has to change positions from standing and sitting and will have to stretch as needed due to foot pain and he has difficulty with prolonged standing and walking. The examiner noted pain in both deet during active motion and on weight-bearing, described as above. The examiner noted the regular use of shoe inserts for pes planus on both sides. Regarding functional impact, the examiner opined that the Veteran's disability impacts his ability to perform occupational tasks, noting that the Veteran reported no work missed due to his foot disabilities but that he changes position as needed and takes breaks after prolonged standing and walking to allow foot pain to subside. 

In December 2024, a VA examiner reviewed all the evidence of record and provided a retrospective opinion summarizing the Veteran's disability symptoms. Further retrospective opinions were provided in July 2025 addressing the Veteran's symptoms during the period on appeal. In considering the impact of medication on the Veteran's symptoms, the examiner opined that the baseline severity of the Veteran's right foot disabilities without the beneficial
 regular use of shoe inserts for pes planus on both sides. Regarding functional impact, the examiner opined that the Veteran's disability impacts his ability to perform occupational tasks, noting that the Veteran reported no work missed due to his foot disabilities but that he changes position as needed and takes breaks after prolonged standing and walking to allow foot pain to subside. 

In December 2024, a VA examiner reviewed all the evidence of record and provided a retrospective opinion summarizing the Veteran's disability symptoms. Further retrospective opinions were provided in July 2025 addressing the Veteran's symptoms during the period on appeal. In considering the impact of medication on the Veteran's symptoms, the examiner opined that the baseline severity of the Veteran's right foot disabilities without the beneficial effects of medication would still be mild to moderate, but likely worse than his current presentation. Regarding the Veteran's left foot disabilities, the examiner opined that the Veteran's disabilities would likely be of moderate to moderately severe baseline severity when the beneficial effects of medication are discounted. The rationale provided was that the Veteran's symptoms are significant but there is no indication that systemic medications are being used regularly as treatment is consistently described as non-pharmacologic. Therefore, as the majority of symptoms control in this case derives from non-pharmacological interventions, not medication, discounting medication does not significantly alter the clinical presentation of his disability. Examiners have noted no structural instability, no Achilles tendon spasms or deformity, and no assistive device use beyond inserts, indicating that while the condition is functionally limiting, it is not incapacitating. The examiner also opined that the Veteran's level of disability did not amount to loss of use for either foot during the period on appeal.

Prior to August 2, 2024, the Veteran's foot disabilities caused pain, including pain accentuated on use, especially with prolonged use, decreased longitudinal arch height on weight-bearing, and was treated without full relief by arch supports, shoe inserts, or orthotics, bilaterally and with surgery and physical therapy for the right foot. Accordingly, resolving reasonable doubt in favor of the Veteran, the Board finds that an initial 30 percent disability rating, but no higher, is warranted. In this regard, the Board finds that the Veteran's bilateral foot disability symptoms prior to August 2, 2024 most closely approximated, at most, severe acquired flatfoot with pain on use accentuated. Significantly, as the May 2016 VA examination report more thoroughly addresses the Veteran's symptoms and the applicable rating criteria than the earlier October 2014 VA examination report, the Board finds the May 2016 report most probative in assessing the Veteran's symptoms for the entire initial period. However, the evidence persuasively weighs against assigning any higher rating for the initial period as the evidence does not show that the Veteran experienced marked pronation, extreme tenderness of plantar surfaces of the feet, or marked inward displacement and severe spasms of the tendo achillis on manipulation not improved by orthopedic shoes or appliances prior to August 2, 2024. Therefore, an initial 30 percent disability rating, but no higher, is warranted.

From August 2, 2024, the Veteran is in receipt of a 50 percent disability rating for his bilateral foot disabilities. This evaluation is the maximum schedular rating for the Veteran's specific diagnoses and for any diagnostic code pertaining to the foot. Accordingly, there is no basis to assign any higher or separate rating. 

In sum, resolving all reasonable doubt in favor of the Veteran, the Board finds an initial 30 percent disability rating, but no higher, is warranted for the Veteran's bilateral foot disabilities prior to August 2, 2024. From August 2, 2024, the Veteran is in receipt of the maximum schedular rating for his bilateral foot disabilities. To the extent that the Veteran contends entitlement to a higher rating, the most probative evidence of record persuasively weighs against the claim, the benefit-of-the-doubt rule does not apply, and any further increased rating is not warranted. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3.

 

Nathaniel Doan

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Lane, J.

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.