HEARING LOSS

A. C. MACKENZIE · 2025 · Case ID: A25108787

MIXED

Summary

The Veteran served on active duty from November 1998 to December 2002. The Veteran appeals the denial of service connection for bilateral hearing loss, left hip strain with degenerative joint disease (DJD), irritable bowel syndrome (IBS), and restless leg syndrome in both lower extremities. The Veteran also appeals the denial of an increased rating for left hip strain with DJD and restless leg syndrome in both lower extremities. The Veteran seeks service connection for thoracolumbar spine disorder, cervical pain, and left shoulder pain, claiming the latter two are secondary to cervical pain. The Veteran also appeals the denial of an increased rating for left hip limitation of extension and flexion, and the denial of an initial 10 percent rating for essential tremors in the left hand. The Board reviewed evidence of record at the time of the RO decisions. The Veteran's service treatment records were considered. The Board found no current diagnosis of hearing loss, leading to denial of that claim. For thoracolumbar spine disorder, cervical pain, and left shoulder pain secondary to cervical pain, the Board found the evidence weighed in favor of service connection and granted these claims. For bilateral plantar fasciitis, the Board granted a 20 percent rating, resolving doubt in the Veteran's favor. For left hip limitation of extension and flexion, and essential tremors of the left hand, the Board granted 10 percent ratings, resolving doubt in the Veteran's favor. The Board denied increased ratings for left hip strain with DJD, IBS, and restless leg syndrome in both lower extremities, finding the Veteran already at maximum rating or that the criteria were not met. No TDIU claim was raised.

Rationale

No current diagnosis of hearing loss for VA purposes; Evidence weighs against service connection

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

5253

Docket No.

241226-505764

Full Decision Text

Citation Nr: A25108787
Decision Date: 12/17/25 Archive Date: 12/17/25

DOCKET NO. 241226-505764
DATE: December 17, 2025

ORDER

Entitlement to service connection for bilateral hearing loss is denied.

Entitlement to service connection for thoracolumbar spine disorder is granted.

Entitlement to service connection for cervical pain is granted.

Entitlement to service connection for left shoulder pain, as secondary to a cervical pain disability on a causation basis, is granted.

Entitlement to a 20 percent rating for bilateral plantar fasciitis from July 5, 2023, is granted.

Entitlement to an initial rating in excess of 20 percent for a left hip strain with degenerative joint disease (DJD) from July 5, 2023, is denied.

Entitlement to an initial 10 percent rating for left hip, limitation of extension, from July 5, 2023, is granted.

Entitlement to an initial 10 percent rating for left hip, limitation of flexion, from July 5, 2023, is granted.

Entitlement to an initial rating in excess of 30 percent for irritable bowel syndrome (IBS) from August 19, 2023, is denied.

Entitlement to an initial 10 percent rating for essential tremors, left hand, from August 19, 2023, is granted.

Entitlement to an initial rating in excess of 10 percent for restless leg syndrome, left lower extremity, from July 5, 2023, is denied.

Entitlement to an initial rating in excess of 10 percent for restless leg syndrome, right lower extremity, from July 5, 2023, is denied.

FINDINGS OF FACT

1. The Veteran does not have a diagnosis of hearing loss for VA purposes.

2. The evidence of record weighs in favor of finding that the Veteran's thoracolumbar spine disorder is etiologically related to his service.

3. The evidence of record weighs in favor of finding that the Veteran's cervical pain is etiologically related to his service.

4. The evidence of record weighs in favor of finding that the Veteran's left shoulder pain was caused by his cervical pain disability.

5. Resolving all doubt in the Veteran's favor, for the entire period on appeal his bilateral plantar fasciitis is manifested by symptoms commensurate with no relief from both non-surgical and surgical treatment for plantar fasciitis of one foot.

6. The Veteran is already at the maximum schedular rating for left hip, limitation of adduction; extraschedular consideration is not warranted.

7. Resolving all doubt in the Veteran's favor, for the entire period on appeal his left hip, limitation of extension, is manifested by symptoms commensurate with limitation of extension to 5 degrees.

8. Resolving all doubt in the Veteran's favor, for the entire period on appeal his left hip, limitation of extension, is manifested by symptoms commensurate with limitation of flexion to 45 degrees.

9. The Veteran is already at the maximum schedular rating for IBS; extraschedular consideration is not warranted.

10. Resolving all doubt in the Veteran's favor, for the entire period on appeal his essential tremors, left hand, are manifested by symptoms commensurate with a moderate tic.

11. For the entire period on appeal, the Veteran's restless leg syndrome, left lower extremity, was manifested by mild symptoms.

12. For the entire period on appeal, the Veteran's restless leg syndrome, right lower extremity, was manifested by mild symptoms.

CONCLUSIONS OF LAW

1. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for entitlement to service connection for a thoracolumbar spine disorder have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for entitlement to service connection for cervical pain have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for entitlement to service connection for left shoulder pain, as secondary to a cervical pain disability on a causation basis, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

5. The criteria for entitlement to a 20 percent rating for bilateral plantar fasciitis from
.F.R. §§ 3.102, 3.303.

3. The criteria for entitlement to service connection for cervical pain have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for entitlement to a 20 percent rating for bilateral plantar fasciitis from July 5, 2023, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Code 5269.

6. The criteria for entitlement to an initial rating in excess of 20 percent for a left hip strain with DJD, from July 5, 2023, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5003-5253.

7. The criteria for entitlement to an initial 10 percent rating for left hip, limitation of extension, from July 5, 2023, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5251.

8. The criteria for entitlement to an initial 10 percent rating for left hip, limitation of flexion, from July 5, 2023, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5252.

9. The criteria for entitlement to an initial rating in excess of 30 percent for IBS from August 19, 2023, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.114, Diagnostic Code 7319.

10. The criteria for entitlement to an initial 10 percent rating for essential tremors, left hand, from August 19, 2023, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 8199-8103

11. The criteria for entitlement to an initial rating in excess of 10 percent for restless leg syndrome, left lower extremity, from July 5, 2023, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.7, 4.124a, Diagnostic Code 8199-8520.

12. The criteria for entitlement to an initial rating in excess of 10 percent for restless leg syndrome, right lower extremity, from July 5, 2023, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.7, 4.124a, Diagnostic Code 8199-8520.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from November 1998 to December 2002.

These matters come to the Board of Veterans' Appeals (Board) on appeal from rating decisions issued in May, November, and December 2024 by a Department of Veterans Affairs (VA) Regional Office (RO).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from November 1998 to December 2002.

These matters come to the Board of Veterans' Appeals (Board) on appeal from rating decisions issued in May, November, and December 2024 by a Department of Veterans Affairs (VA) Regional Office (RO).

In the December 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the May, November, and December agency of original jurisdiction (AOJ) decisions on appeal, as well as any evidence submitted by the Veteran or his representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

The Board has considered whether an inferred claim for a total disability based upon individual unemployability (TDIU) has been raised pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009). Neither the Veteran nor his representative alleges that he is unable to secure and maintain substantially gainful employment. The issue of a TDIU does not arise in the context of an increased rating claim when there is no allegation or evidence of unemployability. See Jackson v. Shinseki, 587 F.3d 1106 (Fed. Cir. 2009) (no evidence indicating unemployability, i.e., veteran was employed, a TDIU claim was not raised.) As such, a Rice claim is not raised, and neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017).

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service in the line of duty. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship ("nexus") between the current disability and the disease or injury in service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability connected disability. 38 C.F.R. § 3.310(a). Service connection on a secondary basis may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); Allen v. Brown, 8 Vet. App. 374 (1995). In order to prevail on the issue of secondary service connection, the record must show: (1) a current disability; (2) a service-connected disability; and (3) a nexus between the current disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509 (1998); Allen v. Brown, supra.

Where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. However, subjective pain in and of itself will not establish a current disability. Consideration should be given to the impact
38 C.F.R. § 3.310(b); Allen v. Brown, 8 Vet. App. 374 (1995). In order to prevail on the issue of secondary service connection, the record must show: (1) a current disability; (2) a service-connected disability; and (3) a nexus between the current disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509 (1998); Allen v. Brown, supra.

Where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. However, subjective pain in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Pain in a particular joint may result in functional loss, but only if it limits the ability to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance. Id.; 38 C.F.R. § 4.40.

1. Entitlement to service connection for bilateral hearing loss.

The Veteran asserts that he has a diagnosis of bilateral hearing loss that is etiologically related to service.

Hearing loss is among the chronic disabilities for which a presumption of service connection is warranted if shown to a compensable degree within a year following separation from service. 38 C.F.R. §§ 3.307, 3.309(a). For Veterans with 90 days or more of active service during a war period or after December 31, 1946, certain chronic diseases, including organic diseases of the nervous system such as sensorineural hearing loss, are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. VA considers high frequency sensorineural hearing loss to be an organic disease of the nervous system. See Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. § 3.309(a). Pursuant to 38 C.F.R. § 3.303(b), where a chronic disease such as sensorineural hearing loss is shown as such in service, subsequent manifestations of the same chronic disease are generally service connected. If a chronic disease is noted in service but chronicity in service is not adequately supported, a showing of continuity of symptomatology after separation is required.

For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz (Hz) are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385. An examination for hearing impairment for VA purposes must be conducted by a state-licensed audiologist and must include a controlled speech discrimination test (Maryland CNC) and a pure tone audiometry test. 38 C.F.R. § 4.85(a).

The Veteran's service treatment records (STRs) include audiological testing upon enlistment resulting in pure tone thresholds in the right ear of 5, 0, 0, 0 and 0 decibels, at 500, 1000, 2000, 3000 and 4000 Hz respectively. The pure tone thresholds of the left ear were 0, 0, 5, 0 and 0 decibels, at 500, 1000, 2000, 3000 and 4000 Hz respectively. The separation audiological test resulted in right ear pure tone thresholds of 5, 0, 0, 0, and 5 decibels at 500, 1000, 2000, 3000 and 4000 Hz respectively. The pure tone thresholds of the left ear were 5, 0, 5, 5 and 5 decibels at 500, 1000, 2000, 3000 and 4000 Hz respectively. See STRs.

Additionally, the Veteran's STRs note additional audiological evaluations. November 1998, the baseline audiological evaluation resulted in pure tone thresholds in the right ear of -5, -5,
4000 Hz respectively. The separation audiological test resulted in right ear pure tone thresholds of 5, 0, 0, 0, and 5 decibels at 500, 1000, 2000, 3000 and 4000 Hz respectively. The pure tone thresholds of the left ear were 5, 0, 5, 5 and 5 decibels at 500, 1000, 2000, 3000 and 4000 Hz respectively. See STRs.

Additionally, the Veteran's STRs note additional audiological evaluations. November 1998, the baseline audiological evaluation resulted in pure tone thresholds in the right ear of -5, -5, -5, 0 and 5 decibels, at 500, 1000, 2000, 3000 and 4000 Hz respectively. The pure tone thresholds of the left ear were -5, -5, 10, 0 and 0 decibels, at 500, 1000, 2000, 3000 and 4000 Hz respectively. In June 2001, the baseline audiological evaluation resulted in pure tone thresholds in the right ear of 0, -5, -5, 0 and 0 decibels, at 500, 1000, 2000, 3000 and 4000 Hz respectively. The pure tone thresholds of the left ear were 5, 0, 10, 5 and 0 decibels, at 500, 1000, 2000, 3000 and 4000 Hz respectively.

In December 2023, the Veteran underwent a VA examination for hearing loss. Upon examination, the pure tone thresholds in his right ear were 20, 25, 25, 20, and 15 decibels, at 500, 1000, 2000, 3000 and 4000 Hz respectively. The pure tone thresholds in his left ear were 15, 20, 20, 25, and 15 decibels, at 500, 1000, 2000, 3000 and 4000 Hz respectively. Speech recognition scores were 94 in both ears. The examiner found that the Veteran's hearing was normal in both ears and did not find that the Veteran had hearing loss for VA purposes.

In a June 2023 private opinion, the examiner reported that during his military service, the Veteran states he was exposed to the acoustic trauma of aircraft, artillery fire, machine guns, and other weapons fire. He has suffered from progressive bilateral hearing loss. His hearing is tested in a room wherein normal day to day noise (air conditioner, computer, and soft background music) is introduced to test functional hearing under normal day to day conditions. Testing reveals that the Veteran has an estimated bilateral hearing loss under normal conditions of 30 percent of the right ear and 20 percent of the left ear. It is as likely as not that the Veteran's bilateral hearing loss and tinnitus is directly and causally related to the acoustic trauma discussed herein; thus, it is as likely as not that same is directly and causally related to his military service.

The Board finds the private examination and medical opinion are inadequate for the purposes of determining service connection. The Board would note that the private examiner is a chiropractor with no other qualifications listed that indicate that she is even qualified to diagnose and render an etiological opinion on an audiological disorder, wholly unrelated to a disease or injury to the musculoskeletal or nervous system. The Board also notes that an examination for hearing impairment for VA purposes must be conducted by a state-licensed audiologist and must include a controlled speech discrimination test (Maryland CNC) and a pure tone audiometry test. 38 C.F.R. § 4.85(a). The examiner is a chiropractor and did not perform or provide a speech discrimination test or a pure tone audiometry test. The private examiner also did not consider the audiologic evaluations during service. The examiner based the diagnosed bilateral hearing loss on a functional hearing test which the examiner noted as hearing tested in a room with normal day to day noise with spoken words and whispered words at five feet from the patient. The Board finds this is not the standard hearing test utilized by VA. Id. The Board finds the private medical opinion of much less probative value, as the examiner apparently did not review the medical evidence of record or perform the required audiological evaluations to determine the Veteran's hearing loss for VA purposes.

After a review of the record, the Board finds that the evidence is against the claim of service connection for hearing loss. The Veteran is not found to have a hearing loss disability in either ear for VA purposes under 38 C.F.R. § 3.385. The evidence does not show that
test which the examiner noted as hearing tested in a room with normal day to day noise with spoken words and whispered words at five feet from the patient. The Board finds this is not the standard hearing test utilized by VA. Id. The Board finds the private medical opinion of much less probative value, as the examiner apparently did not review the medical evidence of record or perform the required audiological evaluations to determine the Veteran's hearing loss for VA purposes.

The Board acknowledges the Veteran's contentions that he has hearing loss due to in-service noise exposure. The Board does not doubt the credibility of the Veteran's reports of being exposed to noise during service, as he can attest to factual matters of which he had first-hand knowledge, and noise exposure is consistent with his circumstances of service. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). However, as a lay person, the Veteran does not have specialized training sufficient to render such an opinion as to presence of or the etiology of hearing loss many years after such noise exposure. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007).

Consequently, as the evidence persuasively weighs against the claim for service connection for bilateral hearing loss, the benefit of the doubt rule does not apply, and the claim must be denied. 38 U.S.C § 5107(b).

2. Entitlement to service connection for thoracolumbar spine disorder.

The Veteran asserts that his thoracolumbar spine disorder that is etiologically related to his service.

In the June 2024 rating decision on appeal, the RO conceded that the Veteran has a current diagnosis of a thoracolumbar strain with intervertebral disc syndrome, degenerative disc disease and spondylosis. Additionally, the Veteran credibly asserts that such diagnosis is related to his service. See June 2023 private opinion. Consequently, the only determination remaining before the Board is whether there is a medical link, otherwise known as a "medical nexus," between the Veteran's thoracolumbar spine diagnosis and his service.

A June 2023 private opinion found that the Veteran's thoracolumbar spine disorder was at least as likely as not due to his service. As rationale, the examiner stated that The Veteran was a paratrooper. He had seven jumps throughout his career. Due to the impact from the injuries, he developed chronic pain in his back. It is as likely as not that the Veteran's spine diagnosis is directly and causally related to the injury as discussed.

Here, the Board affords great probative weight to the aforementioned June 2023 private examiner's opinion, as it considered all of the pertinent evidence of record, to include the Veteran's statements and his relevant medical history and provided a complete rationale. Moreover, it offered clear conclusions with supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (it is the factually accurate, fully articulated, sound reasoning for the conclusion that contributes to the probative value of a medical opinion); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A]medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). Further, the opinion is consistent with the contemporaneous medical evidence of record. Bloom v. West, 12 Vet. App. 185, 187 (1999); Black v. Brown, 10 Vet. App. 284, 297 (1997). Notably, there is no opinion on direct service connection to the contrary.

Consequently, the Board as the evidence persuasively weighs in favor of finding that the Veteran's thoracolumbar spine diagnosis is related to his service, entitlement to service connection for such disorder is warranted.

3. Entitlement to service connection for cervical pain.

The Veteran asserts that his diagnosed posttraumatic residual pain of cervical regions (cervical pain) is etiologically related to service.

In the June 2024 rating decision on appeal, the RO conceded the Veteran has a current diagnosis of posttraumatic residual pain of cervical regions. Additionally, the Veteran credibly alleges such was the result of his service. See June 2023 private opinion. Consequently, the only determination remaining before the Board is whether there is a medical link, otherwise known as a "medical nexus," between
ively weighs in favor of finding that the Veteran's thoracolumbar spine diagnosis is related to his service, entitlement to service connection for such disorder is warranted.

3. Entitlement to service connection for cervical pain.

The Veteran asserts that his diagnosed posttraumatic residual pain of cervical regions (cervical pain) is etiologically related to service.

In this regard, a June 2023 private opinion found that the Veteran's cervical pain was at least as likely as not related to his service. As rationale, the examiner stated that the Veteran was a paratrooper. He had seven jumps throughout his career. Due to the impact from the injuries, he developed chronic pain in his neck. Since the injury, the Veteran states he has suffered from progressive pain in the cervicothoracic and upper cervical regions. The pain is daily in varying degrees and intensifies with neck flexion, neck extension, and turning his head side to side.

Where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. However, subjective pain in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on the evidence of functional limitation caused by pain. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). In this regard, the June 2023 private examination notes that the Veteran's cervical pain limits his range of motion to 30 degrees flexion, 30 degrees extension, right rotation to 50 degrees, left rotation to 55 degrees, right lateral flexion to 20 degrees, and left lateral flexion to 25 degrees. Consequently, the Board finds that the Veteran's cervical spine pain causes functional limitations.

Consequently, the Board as the evidence persuasively weighs in favor of finding that the Veteran's cervical pain is related to his service, entitlement to service connection for such disorder is warranted.

4. Entitlement to service connection for left shoulder pain, as secondary to a cervical pain disability on a causation basis.

The Veteran asserts that his diagnosed left shoulder pain was caused or aggravated by a cervical pain disability.

In the June 2024 rating decision on appeal, the RO conceded that the Veteran had a diagnosis of left shoulder pain. Additionally, the Veteran is now service connected for a cervical pain disability. Consequently, the only determination remaining before the Board is whether the Veteran's left shoulder pain was caused or aggravated by his cervical pain disability.

A June 2023 private opinion found that the Veteran's left shoulder disorder was at least as likely as not due to his service. As rationale, the examiner stated that The Veteran was a paratrooper. He had seven jumps throughout his career. Due to the impact from the injuries, he developed chronic pain in his left shoulder. He also suffers from left upper extremity pain and paresthesia which spans the radial and ulnar distributions. It is as likely as not that the Veteran's left shoulder pain is directly and causally related to his cervical pain as discussed.

Where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. However, subjective pain in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on
due to his service. As rationale, the examiner stated that The Veteran was a paratrooper. He had seven jumps throughout his career. Due to the impact from the injuries, he developed chronic pain in his left shoulder. He also suffers from left upper extremity pain and paresthesia which spans the radial and ulnar distributions. It is as likely as not that the Veteran's left shoulder pain is directly and causally related to his cervical pain as discussed.

Where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. However, subjective pain in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on the evidence of functional limitation caused by pain. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). In this regard, the June 2023 private examination notes that the Veteran's cervical pain has caused left upper extremity pain and paresthesia which spans the radial and ulnar distributions. Consequently, particularly in regard to the presence of paresthesia, the Board finds that the Veteran's left shoulder pain causes functional limitations.

Consequently, the Board as the evidence persuasively weighs in favor of finding that the Veteran's left shoulder pain was caused by his cervical pain disability, entitlement to secondary service connection for such disorder on a causation basis is warranted.

Increased Ratings

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. In cases in which a claim for a higher initial evaluation stems from an initial grant of service connection for the disability at issue, multiple ("staged") ratings may be assigned for different periods of time during the pendency of the appeal. See generally Fenderson v. West, 12 Vet. App. 119 (1999). 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 concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, the regulations do not give past medical reports precedence over current findings. See Francisco v. Brown, 7 Vet. App. 55 (1994); 38 C.F.R. § 4.2. Staged ratings are, however, appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. The relevant focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. See generally Hart v. Mansfield, 21 Vet. App. 505 (2007). 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 required for that rating; otherwise, the lower rating will be assigned.

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 to be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement.
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 required for that rating; otherwise, the lower rating will be assigned.

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 to 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 (Fed. Cir. 2016)

Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis. 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis, however. See Burton v. Shinseki, 25 Vet. App. 1 (2011). In Correia v. McDonald, 28 Vet. App. 158 (2016), the United States Court of Appeals for Veterans Claims (Court) held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." The spine has no opposite joint. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination.

5. Entitlement to a 20 percent for bilateral plantar fasciitis from July 5, 2023.

The Veteran asserts that this bilateral plantar fasciitis is so severe as to warrant a rating in excess of 10 percent.

The appeal period before the Board begins July 5, 2023, the date of the Veteran's intent to file for a claim for an increased rating, plus the one-year "look back" period. Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). For the entire period on appeal, the Veteran's plantar fasciitis has been rated at 10 percent under Diagnostic Code 5269, for plantar fasciitis.

Pursuant to Diagnostic Code 5269, a 10 percent rating is assigned for unilateral or bilateral plantar fasciitis; a 20 percent rating is assigned when there is no relief from both non-surgical and surgical treatment for plantar fasciitis of one foot (unilateral); a 30 percent rating is assigned when there is no relief from both non-surgical and surgical treatment for plantar fasciitis of both feet (bilateral). A 40-percent rating is assigned for the actual loss of use of the foot. 38 C.F.R. § 4.71a.

A June 2023 private examination found that the Veteran's bilateral plantar fasciitis progressed to involve daily pain at first weight bearing in the morning and other times after rest which inhibits ambulation for a few hours. He states that orthotics do not help the condition.

A December 2023 VA examination found that the Veteran has bilateral plantar fasciitis. The examiner noted that the Veteran had attempted non-surgical treatment from which he got no relief but had not attempted surgical treatment.

A January 2024 VA examination found that the Veteran has bilateral plantar fasciitis. The examiner noted that the Veteran had attempted non-surgical treatment from which he got no relief but had not attempted surgical treatment.

VA is required "to discount beneficial medication effects when relevant rating criteria do not specifically contemplate medication use." Ingram v. Collins, 38 Vet. App. 130 (2025). Here, while the beneficial effects of medication have not clearly been articulated in the record, what is clear from the record is that the Veteran has used medication for pain management, the primary symptom of his bilateral plantar fasciitis, and yet still demonstrates the type of symptoms warranting his currently assigned 10 percent rating. See CAPRI records. For this reason, the Board will resolve all doubt in the Veteran's favor and grant the next higher evaluation, 20 percent under Diagnostic Code 5269, but no higher, for bilateral plantar fasciitis. A higher determination is not warranted as the Veteran has not been shown to have gotten no relief from both non-surgical and surgical treatment.

The Board has also considered the other Diagnostic Codes pertaining to the foot. Other disability ratings may be assigned only if the symptomatology for a disability is not duplicative or overlapping with the symptomatology of any other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994); see also Lyles v. Shulkin, 29 Vet. App. 107 (2017). In Scott v. Wilkie, the United States Court of Appeals for the Federal Circuit (Federal Circuit) expressly adopted the Court's holding that disabilities specifically listed in the rating schedule may only be rated under Diagnostic Codes which specifically pertain to them. Scott v. Wilkie, 920 F.3d 1375 (Fed. Cir. 2019) (citing Copeland v. McDonald, 27 Vet. App. 333, 336 (2015)). The Federal Circuit also expressly adopted the Court's holding that unlisted conditions may be rated by analogy to Diagnostic Codes that may not describe the unlisted disability but addresses disabilities that may be productive of similar symptoms. Scott (citing Yancy v. McDonald, 27 Vet. App. 484, 493 (2016). Finally, the Federal Circuit concluded that the Board must also consider assigning separate ratings under analogous Diagnostic Codes, when rating an unlisted service-connected foot disability exhibiting distinct manifestations, even when service connection has also been granted for one of the eight conditions listed in the rating schedule. Id.

Here, the Veteran's disability is specifically listed under the rating schedule and therefore cannot be rated under a different Diagnostic Code. The evidence of record does not reflect that the Veteran has any other service-connected foot disabilities that would warrant a separate rating under a different Diagnostic Code. The evidence of record is against a finding that the Veteran's bilateral and plantar fasciitis disabilities have distinct manifestations from those that are already being compensated. See 38 C.F.R. § 4.14. None of the three examinations noted any distinct manifestations from his plantar fasciitis.

In conclusion, the Board resolves all doubt in favor of the Veteran and finds that a 20 percent rating, but no higher, for bilateral plantar fasciitis is warranted from July 5, 2023. 38 U.S.C § 5107(b).

6. Entitlement to an initial rating in excess of 20 percent for a left hip strain with DJD from July 5, 2023.

7. Entitlement to an initial compensable rating for left hip, limitation of extension, from July 5, 2023.

8. Entitlement to an initial compensable rating for left hip, limitation of flexion, from July 5, 2023.

The Veteran asserts that his left hip strain is so severe as to warrant an initial rating in excess of 20 percent for limitation of abduction. Additionally, the Veteran contends that his left hip strain is so severe as to warrant initial compensable ratings for limitation of extension and flexion.

The appeal period before the Board begins July 5, 2023, the date of the Veteran's service connection. For the entire period on appeal, the Veteran's hip disabilities have been rated as stated above.

The Veteran's left hip conditions are currently rated under Diagnostic Codes 5003-5253, 5251, and 5252, respectively. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the rating assigned. The additional code is shown after a hyphen. 38 C.F.R. § 4.27. Diagnostic Code 5003 rates degenerative arthritis, while Diagnostic Code 5251 and Diagnostic Code 5252 are used to rate limitation of extension and flexion of the thigh, respectively. Diagnostic Code 5253 is used to rate impairment of the thigh (movement in abduction or adduction).

Under Diagnostic Code 5003, degenerative arthritis that is established by x-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic code for the specific joint or joints involved. 38 C.F.R. § 4.71a. If the limitation of motion is noncompensable, a rating of 10 percent is for application for each major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. Id. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, a 20 percent evaluation is warranted for x-ray evidence of involvement of two or more major joints or two or more minor joint groups, with occasional incapacitating exacerbations. A 10 percent evaluation is warranted for x-ray evidence of involvement of two or more major joints or two or more minor joint groups. Id. When there is limitation of motion of the specific joint or joints that is compensable (10 percent or higher) under the appropriate diagnostic code, the compensable limitation of motion should be rated under the appropriate diagnostic code for the specific joint or joints involved. Id.

Diagnostic Code 5251 evaluates limitation of extension of the hip. A maximum 10 percent rating is assigned for extension of 5 degrees or greater. 38 C.F.R. § 4.71a.

Diagnostic Code 5252 evaluates limitation of flexion. A 10 percent rating is assigned for flexion limited to 45 degrees. A 20 percent rating is assigned for flexion limited to 30 degrees. A 30 percent rating is assigned for flexion limited to 20 degrees. A maximum 40 percent rating is assigned for flexion limited to 10 degrees. Id.

Diagnostic Code 5253 evaluates an impairment of the thigh. A 10 percent rating is assigned for limitation of rotation to 15 degrees or limitation of adduction resulting in an inability to cross legs. A maximum 20 percent rating is assigned for loss of abduction beyond 10 degrees. Id.

Turning to the medical evidence, a June 2023 private examination found that the Veteran's hip disabilities resulted in daily pain in varying degrees and which intensifies with squatting, standing, sitting, walking, stairs, and changing positions especially in weight bearing. On examinations, severe decreased range of motion is noted with flexion, abduction, internal rotation, and external rotation. Patrick Fabere's Test is positive.

A January 2024 VA examination found the Veteran had a hip strain with degenerative arthritis. The Veteran used anti-inflammatories to treat pain associated with his hip disability. His range of motion was found to be 70 degrees of flexion, 20 degrees of extension, 20 degrees of abduction, 15 degrees of adduction, 10 degrees of external rotation, and 15 degrees of internal rotation. Pain was exhibited on all ranges of motion. Range of motion limitation contributed to functional loss by making it difficult to sit at 90-degree angle or squat down. Passive ranges of motion were the same, except for flexion which was 90 degrees. Pain was exhibited on all passive ranges of motion. Pain was found on weight-bearing, non-weight-bearing, active motion, passive motion, and on rest/non-movement, which resulted in functional impacts of decreased range of motion and an inability to perform activities of daily living. There was localized tenderness or pain on palpation of the joint. There was no additional range of motion loss on repetitive use. On repeated use over time, the examiner estimated the Veteran's range of motion to be 65 degrees of flexion, 15 degrees
motion. Range of motion limitation contributed to functional loss by making it difficult to sit at 90-degree angle or squat down. Passive ranges of motion were the same, except for flexion which was 90 degrees. Pain was exhibited on all passive ranges of motion. Pain was found on weight-bearing, non-weight-bearing, active motion, passive motion, and on rest/non-movement, which resulted in functional impacts of decreased range of motion and an inability to perform activities of daily living. There was localized tenderness or pain on palpation of the joint. There was no additional range of motion loss on repetitive use. On repeated use over time, the examiner estimated the Veteran's range of motion to be 65 degrees of flexion, 15 degrees of extension, 15 degrees of abduction, 10 degrees of adduction, 5 degrees of external rotation, and 10 degrees of internal rotation. On flare-ups, the examiner estimated the Veteran's range of motion to be 60 degrees of flexion, 10 degrees of extension, 10 degrees of abduction, 5 degrees of adduction, 0 degrees of external rotation, and 5 degrees of internal rotation. There was no muscle atrophy, malunion or nonunion of femur, flail hip joint, or leg length discrepancy. The functional impact overall was noted to be difficulty with the ability to perform physical demands of work activities such as prolonged sitting or standing.

Regarding the Veteran's rating under Diagnostic Code 5003-5253 for limitation of abduction, the Veteran is already at the schedular maximum, and the Board cannot find that an extraschedular rating referral is warranted. The Veteran's range of motion limitations are contemplated by the assigned rating to the extent that Diagnostic Code 5253 provides a 20 percent for loss of abduction beyond 10 degrees. Thus, his disability picture is not exceptional based on the rating criteria. Moreover, even if either provision was inadequate, the Veteran has not shown that his condition demonstrates marked interference with employment or frequent hospitalizations warranting referral for extraschedular consideration. 38 C.F.R. § 3.321(b)(1).

Consequently, entitlement to an initial rating in excess of 20 percent under Diagnostic Code 5003-5253, for limitation of adduction, must be denied.

Regarding the Veteran's rating under Diagnostic Code 5251 and 5252, for limitation of extension and flexion, the evidence demonstrates that the Veteran does not meet the specified criteria for an initial compensable rating. In this regard, extension must be limited to 5 degrees for the maximum schedular rating of 10 percent under Diagnostic Code 5251, and flexion must be limited to 45 degrees for the minimum compensable rating of 10 percent under Diagnostic Code 5251.

Nevertheless, VA is required "to discount beneficial medication effects when relevant rating criteria do not specifically contemplate medication use." Ingram v. Collins, 38 Vet. App. 130 (2025). Here, while the beneficial effects of medication have not clearly been articulated in the record, what is clear from the record is that the Veteran has used medication for pain management, the primary symptom of his left hip disability, and yet still demonstrates the type of symptoms warranting his currently assigned noncompensable rating under Diagnostic Code 5251 and 5252. See January 2024 VA examination. For this reason, the Board will resolve all doubt in the Veteran's favor and grant the next higher evaluations, the 10 percent maximum under Diagnostic Code 5251, and a 10 percent rating under Diagnostic Code 5252, but no higher, for left hip extension and flexion, respectively. A higher determination for limitation of flexion is not warranted as the Veteran has not been shown to have limitation to 30 degrees.

The Board has considered other diagnostic codes pertaining to the hip, including Diagnostic Codes 5250 (ankylosis), 5254 (flail joint), and 5255 (impairment of the femur), but finds that such pathology is not supported in this matter, and thus those diagnostic criteria are not for consideration in this appeal.

In conclusion, the Veteran is at the statutory maximum for his rating under Diagnostic Code 5003-5253, and extraschedular consideration under that Code is not warranted, thus the claim for an increased rating with respect to that Code must be denied; however, the Board resolves all doubt in favor of the Veteran and finds that the 10 percent maximum under Diagnostic Code 5251, and a 10 percent rating but no higher, under Diagnostic Code 5252 for left hip limitation of extension and flexion, respectively, is warranted from July 5, 2023. 38 U.S.C § 5107(b).

9. Entitlement to an initial rating in excess of 30 percent for IBS from August 19, 2023.

The Veteran asserts that
statutory maximum for his rating under Diagnostic Code 5003-5253, and extraschedular consideration under that Code is not warranted, thus the claim for an increased rating with respect to that Code must be denied; however, the Board resolves all doubt in favor of the Veteran and finds that the 10 percent maximum under Diagnostic Code 5251, and a 10 percent rating but no higher, under Diagnostic Code 5252 for left hip limitation of extension and flexion, respectively, is warranted from July 5, 2023. 38 U.S.C § 5107(b).

9. Entitlement to an initial rating in excess of 30 percent for IBS from August 19, 2023.

The Veteran asserts that his IBS is so severe as to warrant an initial rating in excess of 30 percent.

The appeal period before the Board begins August 19, 2023, the date of the Veteran's service connection. For the entire period on appeal, the Veteran's IBS has been rated at 30 percent under Diagnostic Code 7319, for IBS.

The rating criteria for digestive disabilities were revised effective May 19, 2024. Schedule for Rating Disabilities: Digestive System, 89 Fed. Reg. 19,735 (March 20, 2024) (codified at 38 C.F.R. § 4.114). Prior to that date, under Diagnostic Code 7319, a 10 percent rating was warranted for IBS manifested by moderate symptoms, described as frequent episodes of bowel disturbance with abdominal distress. A 30 percent rating is warranted where the disability is severe, and there is diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress. A 30 percent rating is the maximum rating under Diagnostic Code 7319. 38 C.F.R. § 4.114.

After that date, Diagnostic Code 7319 was recharacterized to be for IBS. A 10 percent rating is warranted for IBS manifested by abdominal pain related to defecation at least once during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension. A 20 percent rating requires abdominal pain related to defecation for at least three days per month during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension. A 30 percent rating requires abdominal pain related to defecation at least one day per week during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension. 38 U.S.C. § 4.114, Diagnostic Code 7319 (2024).

The Board notes that under either the pre- or post-amendment criteria, the maximum schedular rating for IBS is 30 percent.

Turning to the medical evidence, a July 2024 VA examination found that the Veteran's IBS is manifested by a change in stool frequency, a change in stool form, altered stool passage (straining and/or urgency), abdominal bloating, abdominal pain, cramping, loose stools, and increased frequency (10 a day) alternating with constipation. Functional impact was noted as having to frequently use the restroom during work hours or leave work early due to abdominal pain and cramping. The Veteran asserted that this has had a significant impact on his ability to do his job, as he has to take frequent restroom breaks during diarrhea episodes (up to 10 times daily). The Veteran was noted to have lost 1-2 weeks of work in the last 12 months due to his IBS.

Based on the evidence, the Board cannot find that an extraschedular rating referral for IBS is warranted. The Veteran's symptoms are contemplated by the assigned rating to the extent that the pre- and post-amended Diagnostic Code 7319 provides a 30 percent rating for IBS with alternating diarrhea and constipation and more or less constant abdominal distress. Thus, his disability picture is not exceptional based on the rating criteria, both pre- and post-amendment for IBS. Moreover, even if either provision was inadequate, the Veteran has not shown that his condition demonstrates marked interference with employment or frequent hospitalizations warranting referral for extraschedular consideration. 38
-2 weeks of work in the last 12 months due to his IBS.

Based on the evidence, the Board cannot find that an extraschedular rating referral for IBS is warranted. The Veteran's symptoms are contemplated by the assigned rating to the extent that the pre- and post-amended Diagnostic Code 7319 provides a 30 percent rating for IBS with alternating diarrhea and constipation and more or less constant abdominal distress. Thus, his disability picture is not exceptional based on the rating criteria, both pre- and post-amendment for IBS. Moreover, even if either provision was inadequate, the Veteran has not shown that his condition demonstrates marked interference with employment or frequent hospitalizations warranting referral for extraschedular consideration. 38 C.F.R. § 3.321(b)(1). While the Veteran's IBS does undoubtedly interfere with his work to some degree, the amount of work lost due to IBS indicates that such interference is only during flare-ups of his IBS, not a constant interference, and impact of his IBS on his work is compensated for by his current 30 percent rating.

Consequently, the Board finds the Veteran's IBS is manifested by severe symptoms, as the Veteran experiences alternating diarrhea and constipation and more or less constant abdominal distress enumerated in the pre-amended Diagnostic Code 7319's description of severe symptoms. Therefore, entitlement to an initial rating in excess of 30 percent, the maximum allowable under Diagnostic Code 7319, from August 19, 2023, is not warranted.

10. Entitlement to an initial 10 percent rating for essential tremors, left hand, from August 19, 2023.

The Veteran asserts that his essential tremors, left hand, are so severe as to warrant an initial compensable rating. The Veteran is right-hand dominant. See July 2024 VA examination.

The appeal period before the Board begins August 19, 2023, the date of the Veteran's service connection. For the entire appeal period, the Veteran's essential tremors have been rated as noncompensable under Diagnostic Code 8199-8103. 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 rating assigned. See 38 C.F.R. § 4.27. An unlisted disease, injury, or residual condition is rated by analogy with the first two digits selected from that part of the rating schedule that most closely identifies the part or system of the body involved; the last two digits will be "99" for all unlisted conditions. In this case, 8199 refers to neurological conditions and convulsive disorders, while 8103 refers to the convulsive tic diagnostic code. Benign bilateral essential tremors are not listed in the rating schedule. In this case, the Board finds the use of the hyphenated Diagnostic Code 8199-8103 to be appropriate as the symptoms of the Veteran's bilateral hand tremors are most analogous to rating via the criteria for a convulsive tic in Diagnostic Code 8103.

Thus, the Veteran's benign essential tremors of the bilateral upper extremities are rated by analogy as a compulsive tic under 38 C.F.R. § 4.124a, Diagnostic Code 8103. A mild tic is rated at 0 percent, a moderate tic is rated at 10 percent, and a severe tic is rated at 30 percent. The Note to Diagnostic Code 8103 directs the Board to assign a disability rating depending upon the frequency, severity, and muscle groups involved.

The words "mild," "moderate," and "severe" are not defined in the VA Rating Schedule. For context, as adjectives, "mild" is defined as "gentle in nature or behavior," "not being or involving what is extreme," and "not severe"; "moderate" is defined as "tending toward the mean or average amount of dimension," "not violent, severe, or intense," and "limited in scope or effect"; and "severe" is defined as "causing discomfort or hardship," "very painful or harmful," and "of a great degree." See Merriam-Webster Dictionary Online, https://www.merriam-webster.com/dictionary. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just." See 38 C.F.R. § 4.6. The term "incomplete paralysis," with peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to the partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. Id.

A June
or harmful," and "of a great degree." See Merriam-Webster Dictionary Online, https://www.merriam-webster.com/dictionary. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just." See 38 C.F.R. § 4.6. The term "incomplete paralysis," with peripheral nerve injuries, indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to the partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. Id.

A June 2023 private examination found that the Veteran has suffered tremors of the left hand and has been progressive symptomatic since Gulf War service.

A July 2024 VA examination found that the Veteran's left-hand tremors result in left side weakness and numbness episodes that result in the loss of his latissimus muscle (left side), result in a left winged scapula, with left side numbness and tingling that at times extends into left leg and foot. Current symptoms were noted to be a tremor in his left forearm down to his left hand at random which has worsened in severity and frequency. Functional impact was described as leaving work early due to not being able to type when he experiences his left-hand tremor. The Veteran's grip, deep tendon reflexes, and muscle strength were all normal. No tics were noted as a symptom of the disability, and no other symptoms were reported.

Nevertheless, as the Veteran's essential tremors, left hand, were found to result in left side weakness and numbness episodes that result in the loss of his latissimus muscle (left side), result in a left winged scapula, with left side numbness and tingling that at times extends into left leg and foot and cause functional impact noted as leaving work early due to not being able to type, the Board resolves all doubt in the Veteran's favor and finds that his symptoms are commensurate with a moderate tic; however, the Board finds the frequency, severity, and muscle groups involved in the Veteran's tremors do not amount to a finding that such disability is severe. In this regard, the Board notes that the Veteran has stated he has only lost a week or less of work due to such disability, indicating that the frequency is relatively rare. Consequently, entitlement to an initial 10 percent rating for essential tremors, but no higher, from August 19, 2023, is warranted. 38 U.S.C § 5107(b).

11. Entitlement to an initial rating in excess of 10 percent for restless leg syndrome, left lower extremity, from July 5, 2023.

12. Entitlement to a rating in excess of 10 percent for restless leg syndrome, right lower extremity, from July 5, 2023.

The Veteran contends that his bilateral restless leg syndrome is so severe as to warrant initial ratings in excess of 10 percent. The appeal period before the Board begins July 5, 2023, the date of the Veteran's service connection. For the entire period on appeal, the Veteran's left and right lower extremity restless leg syndrome has been rated at 10 percent under Diagnostic Code 8199-8520. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the rating assigned. The additional code is shown after a hyphen. 38 C.F.R. § 4.27. An unlisted disease, injury, or residual condition is rated by analogy with the first two digits selected from that part of the rating schedule that most closely identifies the part or system of the body involved; the last two digits will be "99" for all unlisted conditions.

Pursuant to Diagnostic Code 8520, a 10 percent rating is warranted for mild incomplete paralysis of the sciatic nerve. A 20 percent rating is warranted for moderate incomplete paralysis of the sciatic nerve. A 40 percent rating is warranted for moderately severe incomplete paralysis of the sciatic nerve. A 60 percent rating is warranted for severe incomplete paralysis with marked muscle atrophy. A maximum 80 percent rating is warranted with complete paralysis of the sciatic nerve. 38 C.F.R. § 4.124(a).

In rating diseases of the peripheral nerves, the term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a.

A June 2023 private examination reported that the Veteran stated he has suffered with restless leg syndrome in bilateral legs and has been progressively symptomatic since Gulf War service.

A July 2024 VA examination found the Veteran had bilateral restless leg syndrome. Current symptoms were noted as needing to move his legs constantly while sleeping. The Veteran's strength, deep tendon reflexes, and muscles were all normal. No other symptoms were reported.

While the Veteran is competent to observe his restless leg syndrome symptoms, he does not have the training or credentials to determine the current nature, extent, and severity of those symptoms. Additionally, he does not have the training or credentials to determine the proper disability evaluation concerning his restless leg syndrome symptoms. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

Thus, the Board finds that the evidence persuasively weighs against initial ratings in excess of 10 percent for right and left lower extremity restless leg syndrome. In this regard, there are no symptoms noted by the Veteran that indicate that his restless leg syndrome rises to the level commensurate with moderate incomplete paralysis. The evidence demonstrates that the Veteran's restless leg syndrome primarily impacts him at night, and no functional impact of restless leg syndrome was noted. Consequently, as the evidence persuasively weighs against the claim, the benefit of the doubt rule does not apply, and the claim for entitlement to an initial rating in excess of 10 percent for right and left lower extremity restless leg syndrome from July 5, 2023, must be denied. 38 U.S.C § 5107(b).

A. C. MACKENZIE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Wood, Paul T.

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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