OBESITY

R. FEINBERG · 2026 · Case ID: 26005118

MIXED

Summary

The veteran, who served from August 1983 to August 2012, appeals the denial of service connection for lower extremity radiculopathy and neurogenic bladder/bowel disorders, and the grant of service connection for obesity and obstructive sleep apnea (OSA) as secondary conditions. The Board granted service connection for obesity secondary to existing service-connected disabilities, finding that the veteran's service-connected orthopedic and psychiatric conditions likely contributed to his obesity, which in turn caused functional impairment. While the veteran failed to attend a VA examination for obesity, the Board found the existing evidence, including a private medical opinion and other VA opinions, sufficient to grant the claim, resolving reasonable doubt in the veteran's favor. The Board also granted service connection for OSA secondary to obesity, finding that obesity was a substantial factor in causing or aggravating the condition, despite conflicting VA opinions. The Board found the private opinion probative for its reasoned explanation and the favorable portions of later VA opinions, while discounting unfavorable opinions for lacking adequate explanation or failing to consider the full picture. The Board denied separate evaluations for lower extremity radiculopathy prior to August 14, 2023, and for neurogenic bladder/bowel disorders. Competent evidence did not establish these conditions or their nexus to service prior to the relevant dates, and the veteran failed to attend scheduled examinations or provide supporting private treatment records for these claims.

Rationale

Resolving reasonable doubt in veteran's favor; Obesity found to be caused or aggravated by service-connected disabilities; Obesity found to result in functional impairment

Special Benefit

NO SPECIAL BENEFIT

Docket No.

20-17 342

Full Decision Text

Citation Nr: 26005118
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 20-17 342
DATE: April 30, 2026

ORDER

Service connection for obesity as secondary to service-connected disabilities is granted.

Service connection for obstructive sleep apnea (OSA) as secondary to obesity is granted.

A separate evaluation for right or left lower extremity radiculopathy, including sciatic and femoral nerve radiculopathy, prior to August 14, 2023, is denied.

A separate evaluation for a neurogenic bladder or bowel, including rectal sphincter control impairment or voiding dysfunction, is denied.

FINDINGS OF FACT

1. Resolving reasonable doubt in the Veteran's favor, the Veteran's service-connected orthopedic and psychiatric disabilities caused or aggravated his obesity by limiting physical activity, impairing sleep, increasing fatigue, reducing motivation to exercise, and contributing to maladaptive eating behavior, and his obesity resulted in functional impairment.

2. The Veteran's obesity is a substantial factor in causing his OSA.

3. Prior to August 14, 2023, the competent and credible evidence of record does not support a finding of right or left lower extremity radiculopathy secondary to the Veteran's service-connected thoracolumbar spine degenerative arthritis (back disability).

4. The competent and credible evidence of record does not support a finding that the Veteran has had a neurogenic bladder disorder, neurogenic bowel disorder, rectal sphincter control impairment, or voiding dysfunction associated with his back disability at any time during the appeal period.

CONCLUSIONS OF LAW

1. The criteria for service connection for obesity as secondary to service-connected disabilities are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

2. The criteria for service connection for OSA as secondary to obesity are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

3. The criteria for a separate evaluation for right or left lower extremity radiculopathy prior to August 14, 2023, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.310, 3.655, 4.1, 4.2, 4.3, 4.71a, 4.124a.

4. The criteria for a separate evaluation for a neurogenic bladder or bowel are not met. 38 U.S.C. §§ 1110, 1131, 1155, 5107; 38 C.F.R. §§ 3.102, 3.310, 3.655, 4.1, 4.2, 4.3, 4.71a.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from August 1983 to August 2012.

This case is before the Board of Veterans' Appeals (Board), following a September 2025 Board remand, and on appeal from a February 2018 rating decision from a Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ).

In a December 2023 decision, the Board denied the increased rating claim for the back disability and remanded the claim of service connection for OSA.

An October 2024 rating decision separately awarded service connection for bilateral sciatica and femoral nerve radiculopathy as part of the increased rating claim for the back disability, effective August 14, 2023.

The United States Court of Appeals for Veterans Claims (Court) vacated the December 2023 denial of the claim for an increased rating of the back disability in October 2024.

The Board remanded this matter for further development in March 2025. In September 2025, the Board granted an increased rating for the back disability from December 15, 2017, to August 13, 2023, denied an increased rating thereafter, and remanded the remaining matters to allow the Veteran to identify private treatment records, obtain any identified private treatment records, and schedule VA examinations addressing lower extremity radiculopathy, bowel and bladder neurologic abnormalities, obesity, and to obtain an medical opinion addressing OSA as secondary to obesity.

VA sent development letters in September 2025 and October 2025 requesting that the Veteran identify or authorize VA to obtain relevant private treatment records. No additional relevant private treatment records were identified or
this matter for further development in March 2025. In September 2025, the Board granted an increased rating for the back disability from December 15, 2017, to August 13, 2023, denied an increased rating thereafter, and remanded the remaining matters to allow the Veteran to identify private treatment records, obtain any identified private treatment records, and schedule VA examinations addressing lower extremity radiculopathy, bowel and bladder neurologic abnormalities, obesity, and to obtain an medical opinion addressing OSA as secondary to obesity.

VA also scheduled examinations for December 2025 to address bilateral lower extremity radiculopathy, neurogenic bladder or bowel, and obesity. The Veteran failed to report. The record does not show that the Veteran provided good cause for missing the examinations, requested that they be rescheduled, or asserted that he did not receive notice of them. The AOJ obtained a December 2025 medical opinion addressing OSA.

Following the issuance of the December 2025 Supplemental Statement of the Case (SSOC), VA sent a subsequent development letter in February 2026, allowing the Veteran additional time to submit evidence. No evidence was received to cure the deficiencies identified in the remand.

Although the Veteran failed to report to the examinations and identified no private treatment records, the AOJ completed the development that the Board requested in September 2025. The duty to assist is not a one-way street, and to qualify for disability compensation, the Veteran is required, with VA's assistance, to provide the Board with the legally required information to effectuate a grant. See 38 U.S.C. § 5103A(a); Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). It is not the duty of the Board to take a Veteran's disability and develop a claim without aid and information from the Veteran. As such, the Board finds another remand is not warranted. As the requested development has been completed, no other action is required to comply with the remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998).

When entitlement to a benefit cannot be established or confirmed without a current VA examination, and a claimant fails to report for such examination without good cause, VA must apply 38 C.F.R. § 3.655. For an original compensation claim, the claim is decided on the evidence of record. For a claim for an increase, the claim shall be denied. 38 C.F.R. § 3.655(b). Examples of good cause include the claimant's illness or hospitalization, or the death of an immediate family member. 38 C.F.R. § 3.655(a). The Veteran has not provided good cause, requested rescheduling, or alleged nonreceipt of examination notice. The Board therefore adjudicates the appeal on the existing record.

Service Connection

Service connection will be granted for a current disability that resulted from an injury, disease, or aggravation while in active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Generally, service connection requires (1) a present disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a nexus between the present disability and the in-service incurrence or aggravation of a disease or injury. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection may alternatively be granted on a secondary basis for a disability that is proximately due to, the result of (caused), or worsened beyond its natural progression (aggravated) by a service-connected disease or injury. Allen v. Brown, 7 Vet. App. 439, 448-49 (1995) (en banc); 38 C.F.R. § 3.310.

A veteran will be considered to have been in sound condition when examined, accepted, and enrolled for service except for defects, infirmities, or disorders noted at the time or where clear and unmistakable evidence or medical judgment establishes that an injury or disease preexisted service. 38 U.S.C. § 1111, 38 C.F.R. § 3.304(b). When no preexisting medical condition is noted upon entry into service, a veteran is presumed to have been sound upon entry. 38 U.S.C. § 1111;
7 Vet. App. 439, 448-49 (1995) (en banc); 38 C.F.R. § 3.310.

A veteran will be considered to have been in sound condition when examined, accepted, and enrolled for service except for defects, infirmities, or disorders noted at the time or where clear and unmistakable evidence or medical judgment establishes that an injury or disease preexisted service. 38 U.S.C. § 1111, 38 C.F.R. § 3.304(b). When no preexisting medical condition is noted upon entry into service, a veteran is presumed to have been sound upon entry. 38 U.S.C. § 1111; Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004); Bagby v. Derwinski, 1 Vet. App. 225, 227 (1991).

If the presumption of soundness attaches, the burden falls on the government to rebut the presumption by clear and unmistakable evidence that a disorder was both preexisting and not aggravated by service. Wagner, 370 F.3d at 1096; Bagby, 1 Vet. App. at 227.

The Veteran is competent to report symptoms and experiences he can observe. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). VA must give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed Cir. 2009).

A medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions. See Stefl v. Nicholson, 21?Vet. App.?120, 124 (2007). Neither a VA medical examination report nor a private medical opinion is entitled to any weight in a service-connection or rating context if it contains only data and conclusions. Nieves-Rodriguez v. Peake, 22?Vet. App.?295, 304 (2008).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 57-58 (1990); 38 C.F.R. § 3.102.

1. Obesity.

The Veteran contends that chronic pain from his service-connected musculoskeletal and neurologic disabilities reduced his ability to exercise and maintain physical activity. He has also asserted that his service-connected psychiatric disability caused reduced motivation, poor food choices, increased consumption of sweets and comfort foods, and additional weight gain. The Veteran reported weighing approximately 180 pounds at entrance into service, 220 pounds at separation, and approximately 250 pounds thereafter.

The record demonstrates that the criteria for service connection for obesity are met.

The Court has held that obesity may be considered a disability for VA compensation purposes where it causes functional impairment of earning capacity. Adams v. Collins, No. 23-5064, 2025 U.S. App. Vet. Claims LEXIS 922 (Vet. App. July 8, 2025); see also Saunders v. Wilkie, 886 F.3d 1356, 1363-68 (Fed. Cir. 2018). Separately, obesity may be considered an intermediate step between service-connected disability and another claimed disability where service-connected disability caused or aggravated obesity, obesity was a substantial factor in causing or aggravating the claimed disability, and the claimed disability would not have occurred or worsened but for obesity. VAOPGCPREC 1-2017; Walsh v. Wilkie, 32 Vet. App. 300, 306-07 (2020); Garner v. Tran, 33 Vet. App. 241, 247-49 (2021).

The Veteran has the following service-connected disabilities: bilateral pes planus, back disability, adjustment disorder, bilateral ankle sprain, bilateral lower extremity radiculopathy, left cubital tunnel syndrome, scars, umbilical hernia, bilateral tinea pedis and onychomycosis, and restless leg syndrome.

A December 2011 sleep study during active duty recorded a weight of 230 pounds and a body mass index (BMI) of 31.2, and the October 2017 sleep study noted a weight of 240 pounds and a BMI of 32.5.
306-07 (2020); Garner v. Tran, 33 Vet. App. 241, 247-49 (2021).

A December 2011 sleep study during active duty recorded a weight of 230 pounds and a body mass index (BMI) of 31.2, and the October 2017 sleep study noted a weight of 240 pounds and a BMI of 32.5. Accordingly, the record shows the Veteran is currently obese and has been obese since his separation from service.

In December 2017, the Veteran submitted a November 2017 private disability benefits questionnaire and medical opinion. The private clinician opined that the Veteran's service-connected adjustment disorder with depressed mood due to chronic pain syndrome, lumbar spine disability, bilateral ankle disability, associated sleep disturbance, decreased activity, weight gain, and obesity were medically related. The clinician explained that psychiatric symptoms, chronic pain, poor sleep, reduced physical activity, and maladaptive eating behavior can contribute to weight gain and obesity. The clinician supported the opinion with citations to medical literature discussing relationships among depression, anxiety, sleep impairment, reduced activity, increased food intake, weight gain, and obesity.

The Veteran is competent to report observable matters, including pain, limitation of physical activity, reduced exercise, fatigue, poor sleep, eating habits, and weight gain. See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). The Board finds his statements credible. They have been consistent throughout the appeal and are consistent with the nature of his service-connected disabilities, particularly his back disability, bilateral ankle disabilities, bilateral pes planus, and adjustment disorder.

The November 2017 private opinion supports the Veteran's theory. The clinician explained that chronic pain, psychiatric symptoms, sleep disturbance, and reduced activity can contribute to progressive weight gain and obesity. The opinion also discussed the Veteran's specific service-connected disabilities and his history of weight gain. The Board acknowledges that the opinion was not based on an in-person examination and did not include a review of all later-developed medical evidence. Accordingly, the November 2017 opinion is afforded reduced probative weight. Nevertheless, the opinion is not without probative value because it was based on the Veteran's competent lay history, identified the relevant service-connected disabilities, discussed the Veteran's weight gain, and provided a reasoned explanation supported by medical literature. See Nieves-Rodriguez, 22?Vet. App. at 304.

The Board recognizes that the Veteran failed to report for the scheduled December 2025 obesity examination. As such, there is no completely adequate medical opinion regarding the etiology or functional impairment of the Veteran's obesity available in the record. The failure to report does not require automatic denial. The remaining evidence of record is sufficient to decide the claim. 38 C.F.R. § 3.655(b).

In sum, the Veteran's obesity had its onset in service, and competent lay and medical evidence, place the record at least in approximate balance as to whether that obesity was caused or aggravated by his service-connected orthopedic and psychiatric disabilities, and that the Veteran's obesity results in functional impairment. Resolving reasonable doubt in the Veteran's favor, service connection for obesity as secondary to service-connected disabilities is warranted. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 53-56; 38 C.F.R. §§ 3.102, 3.310. The claim is granted.

2. OSA.

The Veteran contends that his obesity caused or aggravated his OSA. He has also reported that symptoms, including snoring, witnessed pauses in breathing, daytime fatigue, and poor sleep, began during or near the end of service.

The record demonstrates that the criteria for service connection for OSA are met.

Service treatment and sleep-laboratory records show that the Veteran had sleep-related symptoms during service. In June 2011, he reported excessive snoring, reported sleep apnea episodes, daytime tiredness, frequent nighttime waking, and poor sleep. A 2011 sleep study found an Apnea-Hypopnea Index (AHI) of 0.7.

An October 2017 home sleep study showed obstructive sleep apnea with an AHI of 23.1, and the Veteran was subsequently prescribed a Continuous Positive Airway Pressure (CPAP) machine; accordingly, competent evidence of a current disability is found.

In December
of service.

The record demonstrates that the criteria for service connection for OSA are met.

In December 2017, the Veteran submitted a November 2017 private disability benefits questionnaire and medical opinion. The private clinician opined that the Veteran's OSA was more likely than not secondary to, related to, or aggravated by his service-connected adjustment disorder, lumbar spine disability, bilateral ankle disability, associated sleep disturbance, decreased activity, weight gain, and obesity. The opinion explained that obesity is a major risk factor for OSA and that the Veteran's service-connected pain and psychiatric disabilities contributed to weight gain and obesity.

In February 2018, a VA examiner provided a negative secondary nexus opinion. The examiner found that the Veteran had an upper airway obstruction, a small oropharynx, a broad-based tongue, a Mallampati class III airway, and a low-hanging uvula. The examiner identified these findings as significant structural risk factors for OSA, even in individuals of normal weight. The examiner discounted the private opinion because it was not based on an in-person examination and did not address the Veteran's structural airway risk factors. However, the February 2018 examiner also stated that the "chief cause" of the Veteran's sleep apnea was weight gain.

In February 2024, VA obtained additional opinions. The examiner opined that the Veteran's service-connected disabilities did not directly cause OSA because chronic pain may cause sleep disruption and lack of restful sleep, but does not itself cause physiologic airway obstruction. The examiner identified risk factors for OSA, including obesity, male gender, age, family history, and smoking. The examiner repeatedly stated that, given the Veteran's weight gain and obesity, those factors likely greatly contributed to his obstructive sleep apnea. Regarding the Veteran's service-connected adjustment disorder, the examiner stated that OSA is due to upper airway soft-tissue abnormalities and obesity.

April and May 2025 VA medical opinions addressed aggravation. The opinions concluded that OSA was not aggravated beyond natural progression. However, those opinions characterized OSA as a "pre-existing" condition that clearly and unmistakably existed prior to service and used language suggesting that permanent aggravation was required. Permanent worsening is not required for service connection on a secondary basis under 38 C.F.R. § 3.310.

In a December 2025 VA addendum opinion, a clinician concluded that the Veteran's OSA was less likely than not caused by obesity. The clinician reasoned that the Veteran was obese in 2011, when he did not have a formal OSA diagnosis, and remained obese in 2017, when OSA was diagnosed. The clinician stated that obesity is a major risk factor for OSA, but that the medical literature does not support obesity alone as the cause of OSA. The clinician also stated that other risk factors, including male sex, older age, genetics or family history, smoking, underlying health conditions, and facial or structural abnormalities, must also be considered.

The Board finds none of the opinions completely adequate on their own; however, the November 2017 private opinion, the February 2018 VA opinion, and the February 2024 VA opinions support a finding that obesity was at least a substantial factor in causing or aggravating the Veteran's OSA.

The Board acknowledges the unfavorable opinions. The February 2018 examiner identified structural airway risk factors and explained the Veteran's anatomic predisposition to OSA. However, the structural airway risk factors do not rule out obesity as a substantial contributing factor.

Secondary service connection does not require that the service-connected disability, or the intermediate condition caused or aggravated by service-connected disability, be the sole cause of the claimed disability. See 38 C.F.R. § 3.310; VAOPGCPREC 1-2017; Walsh, 32 Vet. App. at 306-07.

The Board also affords the December 2025 opinion limited probative weight. The clinician reasoned that obesity did not cause OSA because the Veteran was obese in 2011 without a formal OSA diagnosis. However, risk factors often preced
atomic predisposition to OSA. However, the structural airway risk factors do not rule out obesity as a substantial contributing factor.

The Board also affords the December 2025 opinion limited probative weight. The clinician reasoned that obesity did not cause OSA because the Veteran was obese in 2011 without a formal OSA diagnosis. However, risk factors often precede a disease becoming clinically diagnosable. The clinician did not sufficiently explain why the fact that obesity existed before formal diagnosis establishes that obesity played no substantial role in later causing or worsening OSA. The December 2025 opinion also did not adequately reconcile its conclusion with the favorable portions of the February 2018 and February 2024 VA opinions. Specifically, it did not explain why obesity could not be considered a substantial factor despite the February 2018 examiner's statement that weight gain was the "chief cause" of the Veteran's OSA and the February 2024 examiner's repeated statements that obesity and weight gain likely greatly contributed to OSA.

Further, in 2011, the Veteran reported excessive snoring, reported sleep-apnea episodes, daytime tiredness, frequent nighttime waking, and poor sleep. Although the sleep study conducted in 2011 was negative for sleep apnea, those symptoms support continuity of sleep-related impairment and show that the Veteran's later-diagnosed OSA may have been related to service.

Resolving reasonable doubt in the Veteran's favor, the Board finds that the Veteran's obesity was a substantial factor in causing or aggravating his OSA, and that OSA would not have occurred, or would have been less severe, but for obesity caused or aggravated by service-connected disability. Accordingly, service connection for OSA as secondary to service-connected obesity is warranted. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. at 53-56; 38 C.F.R. §§ 3.102, 3.310. The claim is granted.

3. Separate evaluations for bilateral lower extremity radiculopathy prior to August 14, 2023.

The Veteran seeks separate evaluations for bilateral lower extremity radiculopathy, including sciatic and femoral nerve radiculopathy, prior to August 14, 2023, as associated neurologic abnormalities of his service-connected back disability.

A review of the record demonstrates that separate evaluations for bilateral lower extremity radiculopathy prior to August 14, 2023, are not warranted.

The effective date of an evaluation and award of compensation based on an initial claim or supplemental claim will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400. The earliest date an increase in disability compensation can be granted is the date factually ascertainable based on all evidence of record that an increase in disability had occurred if a complete claim or intent to file a claim is received within one year from that date; otherwise, it is the date of receipt of the claim. When medical records indicate an increase in a disability, receipt of such medical records may be used to establish effective dates for retroactive benefits based on facts found of an increase in a disability only if a complete claim or intent to file a claim for an increase is received within one year of the date of the report of examination, hospitalization, or medical treatment. This paragraph's provisions only apply when such reports relate to an examination or treatment of a disability for which service connection has previously been established. 38 C.F.R. § 3.400(o)(2).

A February 2018 VA examination found that the Veteran had no radicular signs or symptoms.

An August 2022 private disability benefits questionnaire that VA received in October 2022 lists a diagnosis of bilateral lower extremity radiculopathy dated August 13, 2022. It also identifies sciatic nerve involvement and includes checkbox selections indicating moderate, incomplete paralysis of all the listed nerves.

A May 2024 private examiner completed a disability benefits questionnaire and found that the Veteran had moderate sensory symptoms with sciatic and femoral nerves and subjective symptoms of radiculopathy as a result of progression of his back disability. The examiner provided a diagnosis date of May 21, 2024, for the bilateral lower extremity radiculopathy.

The Board finds the February 2018 VA examination and May 2024 private examination probative because they are internally consistent and contain clear conclusions
in October 2022 lists a diagnosis of bilateral lower extremity radiculopathy dated August 13, 2022. It also identifies sciatic nerve involvement and includes checkbox selections indicating moderate, incomplete paralysis of all the listed nerves.

The Board finds the February 2018 VA examination and May 2024 private examination probative because they are internally consistent and contain clear conclusions and supporting data. Nieves-Rodriguez, 22 Vet. App. at 304; Monzingo v. Shinseki, 26 Vet. App. 97, 109 (2012).

The Board finds the August 2022 disability benefits questionnaire inadequate and of no probative weight as it is (1) unclear whether it is based on a correct factual premise, (2) not based on any pertinent medical history or examinations, and (3) it is plagued by internal inconsistency. First, the record contains no treatment records supporting the conclusions in the August 2022 disability benefits questionnaire, and no private treatment records were identified despite multiple requests and opportunities to do so. Second, the disability benefits questionnaire does not identify treatment records, diagnostic testing, or objective clinical findings sufficient to support its neurologic conclusions. Third, the examiner specifically identified sciatic nerve root involvement but then selected moderate incomplete paralysis across all listed nerve groups. Accordingly, no probative weight is afforded to the August 2022 disability benefits questionnaire, as it appears conclusory and internally inconsistent; the absence of corroborating treatment records or lay symptom history further reduces its persuasive value. See Monzingo, 26 Vet. App. at 109.

Further, the Veteran was given the opportunity to identify private treatment records that might support the August 2022 findings. He did not do so. VA then scheduled a peripheral nerve examination specifically to determine the severity of any lower extremity radiculopathies associated with the service-connected back disability, to identify each affected nerve, and to determine the earliest date on or after December 15, 2017, at which the evidence showed at least mild incomplete paralysis. The Veteran failed to report for that examination. As a result, the record remains without an adequate medical assessment addressing the key unresolved questions of onset, nerve involvement, and severity prior to August 14, 2023. The Board must evaluate the claim based on the evidence available. 38 C.F.R. § 3.655.

Although entitlement to radiculopathy is part of the Veteran's claim for an increased rating for his back disability, which has remained in appellate status since December 2017, the record contains no competent and credible diagnosis of lower extremity radiculopathy until May 21, 2024. May 21, 2024, is the date entitlement to service connection for lower extremity radiculopathy arose; service connection cannot be granted for an earlier date. See 38?C.F.R. §?3.400(b)(2). Regardless, the only issue before the Board is entitlement to a separate evaluation prior to August 14, 2023.

Accordingly, separate evaluations for bilateral lower extremity radiculopathy, including sciatic and femoral nerve radiculopathy, prior to August 14, 2023, are not warranted. The claim is denied.

4. Separate evaluations for a neurogenic bladder or bowel.

The Veteran also seeks separate evaluations for neurogenic bladder or bowel impairment, including rectal sphincter control impairment and voiding dysfunction, as neurologic abnormalities associated with his service-connected back disability.

The record demonstrates that the criteria for service connection for a neurogenic bladder or bowel impairment are not met.

An August 2022 private disability benefits questionnaire reported that the Veteran had a sphincter control impairment, voiding dysfunction, and erectile dysfunction secondary to the progression of his service-connected back disability.

The Board notes that the Veteran is already in receipt of service connection for his erectile dysfunction.

The record contains no other evidence of a sphincter control impairment, voiding dysfunction, or other neurogenic bladder or bowel disorders.

The Board affords the August 2022 private disability benefits questionnaire no probative weight as it contains only conclusions without explaining how the examiner determined that any bowel or bladder symptoms were present and were neurologic manifestations of the back disability rather than attributable to another cause. Further, the record contains no treatment records supporting the conclusions in the August 2022 disability benefits questionnaire, and no private treatment records, and the disability benefits questionnaire
impairment, voiding dysfunction, and erectile dysfunction secondary to the progression of his service-connected back disability.

The Board notes that the Veteran is already in receipt of service connection for his erectile dysfunction.

The record contains no other evidence of a sphincter control impairment, voiding dysfunction, or other neurogenic bladder or bowel disorders.

The Board affords the August 2022 private disability benefits questionnaire no probative weight as it contains only conclusions without explaining how the examiner determined that any bowel or bladder symptoms were present and were neurologic manifestations of the back disability rather than attributable to another cause. Further, the record contains no treatment records supporting the conclusions in the August 2022 disability benefits questionnaire, and no private treatment records, and the disability benefits questionnaire does not identify treatment records, diagnostic testing, or objective clinical findings sufficient to support the diagnosis of a sphincter control impairment, voiding dysfunction, or other neurogenic bladder or bowel disorders. See Nieves-Rodriguez, 22?Vet. App. at 304.

The Veteran was afforded an opportunity to identify treatment records that might support his claim for a bowel or bladder impairment. He did not identify such records. VA then scheduled examinations to determine whether the Veteran had a neurogenic bladder or bowel disorder at any time since December 15, 2017, whether any such disorder was caused or aggravated by the service-connected back disability, and when any such disorder was first diagnosed. The Veteran failed to report. The evidence that might have clarified diagnosis, nexus, and onset is therefore unavailable. The Board must evaluate the claim based on the evidence available. 38 C.F.R. § 3.655.

The Board finds that the evidence of record does not establish that the Veteran has had neurogenic bladder or bowel impairment associated with his back disability at any time during the appeal period. The inadequate August 2022 disability benefits questionnaire is outweighed by the absence of supporting medical records, the absence of a reasoned nexus explanation, and the Veteran's failure to report for the examination needed to resolve the medical questions raised by the August 2022 disability benefits questionnaire.

(Continued on the next page)

The Board has considered the benefit-of-the-doubt doctrine; however, it is not applicable as the weight of the evidence is against the claim. Accordingly, separate evaluations for neurogenic bladder or bowel impairment, including rectal sphincter control impairment or voiding dysfunction, are not warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The claim is denied.

R. FEINBERG

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Costa, Stephanie D.

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

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