POSTTRAUMATIC STRESS DISORDER (PTSD)

ANTHONY C. SCIRÉ, JR · 2026 · Case ID: A26012649

MIXED

Summary

The veteran, who served in the United States Air Force from September 2008 to September 2015, appeals the denial of higher disability ratings for several conditions, including PTSD, lumbar spine disability, right hip strain (flexion and extension), scar status post pilonidal cyst excision, and TMJ with bruxism. The Board denied higher ratings for PTSD, lumbar spine disability, right hip strain (both flexion and extension), scar status post pilonidal cyst excision, and TMJ with bruxism. For PTSD, the Board found the veteran's symptoms approximated a 70 percent rating but did not meet the criteria for total occupational and social impairment required for a 100 percent rating. For the lumbar spine disability, the Board found the evidence weighed against a rating higher than 20 percent, noting the veteran's range of motion and lack of incapacitating episodes. For the right hip strain claims, the Board found the evidence did not support ratings higher than the current 0 percent, as the veteran's range of motion limitations did not meet the criteria for a compensable rating. Similarly, the scar status post pilonidal cyst excision was found to be non-compensable as it was not painful, unstable, or of significant size. The TMJ with bruxism was rated at 10 percent, which the Board found appropriate based on passive range of motion findings. The Board remanded claims for service connection for a left wrist disability and entitlement to TDIU due to pre-decisional duty to assist errors.

Rationale

Holistic analysis of symptoms required; Symptoms approximated 70% rating criteria; Did not meet criteria for total occupational and social impairment

Service Branch

AIR FORCE

Special Benefit

TDIU

Diagnostic Code

7802

Docket No.

240304-421155

Full Decision Text

Citation Nr: A26012649
Decision Date: 02/11/26 Archive Date: 02/11/26

DOCKET NO. 240304-421155
DATE: February 11, 2026

ORDER

Entitlement to a disability rating in excess of 70 percent for post-traumatic stress disorder (PTSD) is denied.

Entitlement to a disability rating in excess of 20 percent for lumbar spine intervertebral disc syndrome (IVDS) with lumbosacral strain (lumbar spine disability) is denied.

Entitlement to a compensable disability rating for right hip strain (limitation of flexion) is denied.

Entitlement to a compensable disability rating for right hip strain (limitation of extension) is denied.

Entitlement to a compensable rating for a scar status post pilonidal cyst excision is denied.

Entitlement to a disability rating in excess of 10 percent for temporomandibular joint syndrome (TMJ) with bruxism is denied.

REMANDED

Entitlement to service connection for a left wrist disability is remanded.

Entitlement to a total rating based upon individual disability (TDIU) is remanded.

FINDINGS OF FACT

1. Throughout the appeal period, the severity, frequency, and duration of the Veteran's symptoms of his PTSD more closely approximate occupational and social impairment with deficiencies in most areas.

2. Throughout the appeal period, the Veteran's lumbar spine disability was manifested by forward flexion of the thoracolumbar spine greater than 60 degrees and the Veteran did not have any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months.

3. Throughout the appeal period, the Veteran's service-connected right hip strain (limitation of flexion) was manifested by no worse than flexion of the thigh limited to 120 degrees at worst; ankylosis of the right hip, flail hip joint or impairment of the femur have not been demonstrated.

4. Throughout the entire appeal period, the Veteran's service-connected right hip strain (limitation of extension) was manifested by no worse than extension of the thigh limited to 5 degrees; ankylosis of the right hip, flail hip joint or impairment of the femur have not been demonstrated.

5. The Veteran's scar status post pilonidal cyst excision is not painful, unstable, or at least 39 square centimeters.

6. Throughout the appeal period, the Veteran's TMJ with bruxism manifested with intermittent painful motion of the jaw, clicking, left lateral excursion range of motion greater than 4 millimeters, right lateral excursion limited to 0 to 4 millimeters, and bilateral TMJ interincisal range limited to 30 to 34 millimeters of unassisted vertical opening.

CONCLUSIONS OF LAW

1. The criteria for a rating in excess of 70 percent for PTSD have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.125, 4.126, 4.130, Diagnostic Code 9411.

2. The criteria for a rating in excess of 20 percent for the Veteran's lumbar spine disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Codes 5237, 5243.

3. The criteria for entitlement to a compensable disability rating for right hip strain (limitation of flexion) have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.71a, Diagnostic Code 5252.

4. Throughout the entire period on appeal, the criteria for entitlement to a compensable disability rating for right hip strain (limitation of extension) have not been met. 38 U.S.C. § 1155, 5107; 38C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.71a, Diagnostic Code 5251.

5. The criteria for a rating in excess of 0 percent (noncompensable) for a scar status post pilonidal cyst excision have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1-4.7, 4.118, Diagnostic Code 7802.

6.
to a compensable disability rating for right hip strain (limitation of extension) have not been met. 38 U.S.C. § 1155, 5107; 38C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.71a, Diagnostic Code 5251.

6. The criteria for entitlement to a disability rating in excess of 10 percent for TMJ with bruxism have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.150, Diagnostic Code 9905.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from September 2008 to September 2015 in the United States Air Force.

This appeal comes before the Board of Veterans' Appeals (Board) on appeal from Agency of Original Jurisdiction (AOJ) rating decisions issued in February 2024 (issue of entitlement to a TDIU) and October 2023 (remaining issues on appeal). In the March 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement (NOD)), the Veteran elected the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the October 2023 and February 2024 rating decisions, as well as any evidence submitted by the Veteran 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 rating decisions and prior to receipt of the VA Form 10182, or (2) more than 90 days following receipt of 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.

However, because the Board is remanding the claims of entitlement to service connection for a left wrist disability and TDIU any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

1. Entitlement to a higher rating for PTSD.

The Veteran's acquired psychiatric disorder is rated under 38 C.F.R. § 4.130, Diagnostic Code 9411. Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013).

A 70 percent rating is provided for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work
quez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013).

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

A 100 percent rating is provided for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130, DC 9411.

When rating a mental disorder, VA must consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the claimant's capacity for adjustment during periods of remission. VA shall assign a rating based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126 (a). When rating the level of disability from a mental disorder, VA will consider the extent of social impairment, but shall not assign a rating solely on the basis of social impairment. 38 C.F.R. § 4.126 (b).

A veteran may only qualify for a given disability rating under 38 C.F.R. § 4.130 by demonstrating the presence of the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117-118 (Fed. Cir. 2013). In addition to requiring the presence of the enumerated symptoms, 38 C.F.R. § 4.130 also requires that those symptoms have caused the specified level of occupational and social impairment. Id.

However, the factors listed in the rating schedule are simply examples of the type and degree of symptoms, or their effects, that would justify a particular rating, so the determination should not be limited solely to whether a veteran exhibited the symptoms listed in the rating scheme but should also be based on all of a veteran's symptoms affecting the level of occupational and social impairment. See Mauerhan v. Principi, 16 Vet. App. 436, 442-443 (2002); 38 C.F.R. § 4.126 (a).

The Veteran asserts that his service-connected PTSD should be rated at a 100 percent disability rating for the entire period on appeal. See March 2024 NOD. The Board notes his currently assigned disability rating is 70 percent from September 19, 2022. In the context of the instant appeal, the Board will consider whether the Veteran should be granted a 100 percent disability rating for the entire period on appeal.

Turning to the evidence of record, in September 2023, the Veteran underwent a VA disability benefits questionnaire (DBQ) examination for PTSD. He was diagnosed with PTSD. He reported living with his long-term partner and having a good relationship. He also reported a good relationship with his son and an amicable co-parenting relationship with his mother. He had a good relationship with his grandparents and uncle. He noted positive social networks and military friends. He obtained a bachelor's degree in cyber security with a minor in psychology in 2020. He was working towards a cybersecurity certification. After obtaining his certification, he reported that he would look for employment. His symptoms included depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances (including work or a worklike setting). He endorsed hypervigilance and suicidal ideation in 2020 with plan but without intent. He pursued hobbies and experiences that he enjoys. Upon examination, the Veteran was oriented in all spheres, well-groomed, dressed appropriately, cooperative, polite, coherent, and logical. He was capable of managing his financial affairs. The examiner found that the Veteran had occupational and social impairment with deficiencies in most areas, such as work,
, he reported that he would look for employment. His symptoms included depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances (including work or a worklike setting). He endorsed hypervigilance and suicidal ideation in 2020 with plan but without intent. He pursued hobbies and experiences that he enjoys. Upon examination, the Veteran was oriented in all spheres, well-groomed, dressed appropriately, cooperative, polite, coherent, and logical. He was capable of managing his financial affairs. The examiner found that the Veteran had occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood.

A September 2023 VA mental health questionnaire noted little interest or pleasure for several days, feeling down for several days, trouble sleeping for several days, low energy for several days, poor appetite for several days, feelings of failure and guilt nearly every day, trouble concentrating nearly every day, agitation for several days and no suicidal or homicidal thoughts.

The Board finds the severity, frequency, and duration of the Veteran's symptoms more closely approximate the symptoms contemplated by a 70 percent rating. A higher 100 percent rating is not warranted because at no time during the appeal period did the Veteran exhibit total occupational and social impairment, due to such symptoms as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. He was noted not to have such symptoms nor were any other symptoms compatible with such an extreme lack of functioning shown, such as symptoms reflective of severe cognitive dysfunction, or a basic inability to function.

The Board recognizes that the Veteran had significant mental health symptoms for which he has received regular treatment. Also, the Board is aware that the symptoms listed under the particular percentage evaluations are essentially examples of the type and degree of symptoms for those evaluations, and that the Veteran need not demonstrate those exact symptoms to warrant higher ratings. See Mauerhan, 16 Vet. App. at 436 (2002). In this case, based on the above, the overwhelming weight of the evidence is against a rating of 100 percent.

In sum, the evidence weighs against finding that the severity, frequency, and duration of the Veteran's symptoms resulted in the level of impairment required for a 100 percent rating - that is, total occupational and social impairment. 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

2. Entitlement to a higher rating for a lumbar spine disability.

The Veteran contends that he is entitled to a higher disability rating for his lumbar spine disability. See March 2024 NOD. The Board notes, however, that the October 2023 RO rating decision separately addressed and denied entitlement to higher disability ratings for the Veteran's service-connected bilateral lower extremity radiculopathy associated with his service-connected IVDS with lumbosacral strain. As the Veteran did not appeal these claims by including them in his March 2024 NOD, the Board will not address them as part of this appeal. See 38 C.F.R. § 20.202(a) (providing that "[i]f the [AOJ] decision addressed several issues, the [NOD] must identify the specific decision and issue or issues therein with which the claimant disagrees").

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

Following the criteria set forth in the General Rating Formula for Diseases and Injuries of the Spine, Note (1) provides: evaluate
such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine.

Following the criteria set forth in the General Rating Formula for Diseases and Injuries of the Spine, Note (1) provides: evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.

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

Note (3) provides that in exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted.

Note (4) requires that each range of motion measurement be rounded to the nearest five degrees.

Note (5) provides that for VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.

Note (6) provides that disabilities of the thoracolumbar and cervical spine segments must be separately evaluated, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability.

In October 2023, the Veteran underwent a VA DBQ for back conditions. He was diagnosed with IVDS with lumbosacral strain. He reported intermittent lower back pain aggravated by prolonged sitting. He did not report flare-ups. Range of motion testing revealed forward flexion to 80 degrees, extension to 25 degrees, bilateral lateral flexion to 30 degrees, and bilateral lateral rotation to 30 degrees. Upon examination, there was no objective evidence of pain and range of motion itself did not contribute to functional loss. Passive range of motion was not tested to prevent severe pain or injury. There was no objective evidence of localized tenderness or pain on palpitation of the joint or associated soft tissue. The Veteran was able to perform repetitive use testing with at least three repetitions with no additional function loss or loss of range of motion. Repeated use over time was estimated to measure forward flexion to 70 degrees, extension to 20 degrees, bilateral lateral flexion to 20 degrees, and bilateral lateral rotation to 20 degrees, per the lay statements provided by the Veteran. There were no muscle spasms, tenderness, or guarding. The Veteran had normal muscle strength, a normal sensory examination, no muscle atrophy, and no ankylosis. The Veteran had IVDS but did not have any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. He did not use assistive devices.

Based on the above, the Board finds that the evidence persuasively weighs against a rating in excess of 20 percent for a lumbar disability. The Board acknowledges the Veteran's report of symptoms and that there was functional loss due to pain and
rotation to 20 degrees, per the lay statements provided by the Veteran. There were no muscle spasms, tenderness, or guarding. The Veteran had normal muscle strength, a normal sensory examination, no muscle atrophy, and no ankylosis. The Veteran had IVDS but did not have any episodes of acute signs and symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician in the past 12 months. He did not use assistive devices.

Based on the above, the Board finds that the evidence persuasively weighs against a rating in excess of 20 percent for a lumbar disability. The Board acknowledges the Veteran's report of symptoms and that there was functional loss due to pain and lack of endurance. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements occurred intermittently and varied in severity, which would not have resulted in limitation of motion more nearly approximating forward flexion of the lumbar spine to 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine.

Consideration has also been given to assigning a rating under the Formula for Rating IVDS; however, the evidence of record is against a finding that the Veteran was ever prescribed bed rest by a physician for a duration that meets the criteria for a higher rating. See 38 C.F.R. § 4.71a, Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes.

For the foregoing reasons, the evidence of record persuasively weighs against the Veteran's claim for a rating in excess of 20 percent for a lumbar spine disability. As the evidence of record persuasively weighs against a rating in excess of 20 percent, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (2021).

3. Entitlement to a compensable disability rating for right hip strain (limitation of flexion).

4. Entitlement to a compensable disability rating for right hip strain (limitation of extension).

The Veteran is service connected for right hip strain (limitation of extension) with an evaluation of 0 percent and service connection for right hip strain (limitation of flexion) with an evaluation of 0 percent. He contends that these service-connected conditions warrant higher disability ratings. The Board notes, however, that the October 2023 RO rating decision also denied entitlement to a higher disability rating for the Veteran's service-connected right hip strain (limitation of rotation). As the Veteran did not appeal this claim by including it in his March 2024 NOD, the Board will not address it as part of this appeal. See 38 C.F.R. § 20.202(a).

The Veteran's right hip strain (limitation of extension) is rated pursuant to 38 C.F.R. § 4.71a, Diagnostic Code 5251 and his right hip strain (limitation of flexion) is rated pursuant to Diagnostic Code 5252.

Limitation of thigh extension is rated under Diagnostic Code 5251, which provides for a 10 percent evaluation when thigh extension is limited to 5 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5251.

Limitation of thigh flexion is rated under Diagnostic Code 5252, which provides for 10, 20, 30, and 40 percent evaluations when thigh flexion is limited to 45, 30, 20, and 10 degrees, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5252.

Normal range of motion for the hip is flexion from zero degrees to 125 degrees and abduction from zero degrees to 45 degrees. 38 C.F.R. § 4.71, Plate II.

VA treatment records indicate that the Veteran has reported right hip pain.

The Veteran was afforded a VA hip conditions examination in October 2023. The examiner diagnosed the Veteran with a right hip strain. The Veteran reported experiencing intermittent right hip pain, limited range of motion, as well as clicking and popping with prolonged sitting. He did not report flare-ups. Upon range of motion testing, the Veteran had normal right hip range of motion. There was evidence of pain upon active and passive motion that did not result in or cause functional loss. There was objective evidence of crepitus. There was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The Veteran was able to perform repetitive-use testing with at least three repetitions without any additional loss of function or range of motion. The examiner described repeated
a VA hip conditions examination in October 2023. The examiner diagnosed the Veteran with a right hip strain. The Veteran reported experiencing intermittent right hip pain, limited range of motion, as well as clicking and popping with prolonged sitting. He did not report flare-ups. Upon range of motion testing, the Veteran had normal right hip range of motion. There was evidence of pain upon active and passive motion that did not result in or cause functional loss. There was objective evidence of crepitus. There was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The Veteran was able to perform repetitive-use testing with at least three repetitions without any additional loss of function or range of motion. The examiner described repeated use over time in terms of range of motion of the right hip: flexion limited to 120 degrees, extension limited to 25 degrees, abduction limited to 40 degrees, adduction limited to 20 degrees, external rotation limited to 55 degrees, and internal rotation limited to 35 degrees. An additional factor was interference with sitting. The examiner reported that the Veteran did not have muscle atrophy or ankylosis of the right hip. The examiner also reported that the Veteran did not have malunion or nonunion of the femur, flail hip joint or leg length discrepancy. There were no other pertinent physical findings, complications, conditions, signs and/or symptoms. The Veteran did not use assistive devices.

The Board has thoroughly reviewed the VA examination reports referenced above, in addition to all of the Veteran's VA and private medical records and the lay evidence of record. Based on the totality of the evidence, the Board finds that a compensable disability rating is not warranted for the Veteran's right hip strain (limitation of extension) or his right hip strain (limitation of flexion). Even considering the Veteran's subjective complaints of pain and other symptoms described in Deluca, there is no evidence of extension limited to 5 degrees or flexion limited to 45 degrees at any time during the appeal period such that a higher rating would be warranted pursuant to Diagnostic Code 5251 for the Veteran's right hip strain (limitation of extension) or Diagnostic Code 5252 for the Veteran's right hip strain (limitation of flexion). Thompson v. McDonald, 815 F.3d 781, 786 (Fed. Cir. 2016) (holding that provision describing functional loss due to disability of the musculoskeletal system does not supersede requirements for a higher rating specified in the Rating Schedule). In this regard, extension of the right hip was never limited to 5 degrees or less, flexion of the right hip was limited to 120 degrees at worst, as shown in the October 2023 VA hip examination. Consequently, compensable ratings are not warranted for the Veteran's right hip strain (limitation of extension) or his right hip strain (limitation of flexion) throughout the entire period on appeal. The Board has also considered whether higher or separate ratings can be assigned under Diagnostic Code 5250; however, the October 2023 examination specifically indicated that the Veteran does not suffer from ankylosis, favorable or unfavorable. Accordingly, a higher rating under Diagnostic Code 5250 would not apply. In addition, the examiner determined that the Veteran did not have a flail hip joint or impairment of the femur, and as such, Diagnostic Codes 5254 and 5255 are not for application.

In sum, the most probative evidence is against the assignment of a compensable disability rating for the Veteran's service-connected right hip strain (limitation of extension), rated pursuant to Diagnostic Code 5251 and against the assignment of an initial compensable disability rating for his service-connected right hip strain (limitation of flexion), rated pursuant to Diagnostic Code 5252. In reaching the above, the Board considered the doctrine of reasonable doubt; however, as the weight of the evidence is against assigning ratings in excess of those already assigned, the doctrine is not applicable.

5. Entitlement to a compensable rating for scar status post pilonidal cyst excision.

The Veteran contends that his scar status post pilonidal cyst excision, rated noncompensable under Diagnostic Code 7802, warrants a higher rating. See March 2024 NOD.

In general, scars are rated under one of four diagnostic codes: 7800, 7801, 7802, or 7804. 38 C.F.R. § 4.118. Under Diagnostic Code 7800, one characteristic of disfigurement warrants a 10 percent rating. A scar with visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with two or three characteristics of disfigurement warrants a 30 percent rating. A scar with visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with four or five characteristics of disfigurement warrants a 50 percent rating. A scar with visible or palpable tissue loss and either gross distortion of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with six or more characteristics of disfigurement warrants an 80 percent rating. Id.

Note 1 to Diagnostic Code 7800 list the eight characteristics of disfigurement: a scar 5 or more inches in length; a scar at least one-quarter inch wide at widest part (0.6 cm.); surface contour of scar elevated or depressed on palpation; scar adherent to underlying tissue; skin hypo- or hyper-pigmented in an area exceeding six square inches; skin texture abnormal in an area exceeding six square inches; underlying soft tissue missing in an area exceeding six square inches; and, skin indurated and inflexible in an area exceeding six square inches. Id.

Diagnostic Code 7801 provides ratings for burn scars or scars due to other causes, not of the head, face or neck, that are associated with underlying soft tissue damage. A 10 percent rating is assigned where such scars cover an area or areas of at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.). A 20 percent rating is assigned where they cover an area or areas of at least 12 square inches (77 sq. cm.) but less than 72 square inches (465 sq. cm.). A 30 percent rating is assigned where they cover an area or areas of at least 72 square inches (465 sq. cm.) but less than 144 square inches (929 sq. cm.). A maximum 40 percent rating is assigned where they cover an area or areas of 144 square inches (929 sq. cm.) or greater. 38 C.F.R. § 4.118.

Diagnostic Code 7802 provides a maximum 10 percent rating for burn scars or scars due to other causes, not of the head, face or neck, that are not associated with underlying soft tissue damage. The 10 percent rating is assigned where such scars cover an area or areas of 144 square inches (929 sq. cm.) or greater. Id.

Diagnostic Code 7804 provides ratings for scars that are unstable or painful. A 10 percent rating is assigned for one or two scars that are unstable or painful, a 20 percent rating is assigned for three or four unstable or painful scars, and a maximum 30 percent rating is assigned for five or more unstable or painful scars. Id. An unstable scar is one where, for any reason, there is frequent loss of skin covering over the scar. Diagnostic Code 7804, Note (1). If a scar is both painful and unstable, another 10 percent is added to the evaluation. Id., Note (2).

The most probative evidence in this case is the October 2023 VA examination. The examiner identified a single, stable scar on the buttock status post excision. The scar is not painful, nor unstable, with frequent loss of skin covering over the scar. The scar measured 8.5 x 0.1 centimeters. The approximate total area of the posterior trunk scar was 8.1 square centimeters. There was no underlying tissue damage.

The Board finds the VA examination is adequate for rating purposes, as the examiner interviewed the Veteran, reviewed his electronic claims file (including medical records), performed a physical exam of the affected areas, and reported all signs and symptoms necessary for evaluating his scars disability under the rating criteria.

The Board also considered all other diagnostic codes pertaining to scars but finds that none are applicable. Specifically, the scars are not associated with underlying soft tissue damage (Diagnostic Code 7801), do
not painful, nor unstable, with frequent loss of skin covering over the scar. The scar measured 8.5 x 0.1 centimeters. The approximate total area of the posterior trunk scar was 8.1 square centimeters. There was no underlying tissue damage.

The Board also considered all other diagnostic codes pertaining to scars but finds that none are applicable. Specifically, the scars are not associated with underlying soft tissue damage (Diagnostic Code 7801), do not cover at least 144 square inches (Diagnostic Code 7802), are not unstable or painful (Diagnostic Code 7804), and do not have other disabling effects (Diagnostic Code 7805).

In conclusion, the evidence persuasively shows that the Veteran has a scar status post pilonidal cyst excision on his posterior trunk that is not painful, unstable, or covers an area or areas of 144 square inches (929 sq. cm.) or greater. There is no reasonable doubt to resolve in the Veteran's favor. Lynch, 21 F.4th at 781-82. Accordingly, an initial compensable disability rating for service-connected scar status post pilonidal cyst excision is denied.

6. Entitlement to a higher initial rating for TMJ with bruxism.

The Veteran contends that he is entitled to a higher rating for TMJ with bruxism. See March 2024 NOD.

The Veteran's TMJ with bruxism is currently rated under Diagnostic Code 9905. Under Diagnostic Code 9905, a 10 percent rating is warranted for lateral excursion range of motion from 0 to 4 millimeters (mm.). 38 C.F.R. § 4.150, Diagnostic Code 9905. A 10 percent rating is warranted for interincisal range limited to 30 to 34 mm. of maximum unassisted vertical opening without dietary restriction to mechanically altered foods. Id. A 20 percent rating is warranted for the same degree of limitation with dietary restriction to soft and semi-solid foods. Id. A 30 percent rating is warranted for the same degree of limitation with dietary restriction to full liquid and pureed foods. Id.

A 20 percent rating is warranted for interincisal range limited to 21 to 29 mm. of maximum unassisted vertical opening without dietary restrictions to mechanically altered foods. Id. A 30 percent rating is warranted for the same degree of limitation with dietary restriction to soft and semi-solid foods. Id. A 40 percent rating is warranted for the same degree of limitation with dietary restriction to full liquid and pureed foods. Id.

A 30 percent rating is warranted for interincisal range limited to 11 to 20 mm. of maximum unassisted vertical opening without dietary restrictions to mechanically altered foods. Id. A 40 percent rating is warranted for the same degree of limitation with dietary restriction to all mechanically altered foods. Id.

Finally, a 40 percent rating is warranted for interincisal range limited to 0 to 10 mm. of maximum unassisted vertical opening without dietary restrictions to mechanically altered foods. Id. A 50 percent rating is warranted for the same degree of limitation with dietary restriction to all mechanically altered foods. Id.

Ratings for limited interincisal movement are not to be combined with ratings for limited lateral excursion. Id., Note 1. For VA compensation purposes, the normal maximum unassisted range of cervical jaw opening is from 35 to 50 mm. Id., Note 2. Mechanically altered foods are defined as altered by blending, chopping, grinding, or mashing so that they are easy to chew and swallow. Id., Note 3. There are four levels of mechanically altered foods: full liquid, puree, soft, and semisolid foods. Id. To warranted elevation based on mechanically altered foods, the use of texture modified diets must be recorded or verified by a physician. Id.

The Board has also considered other analogous criteria to afford the Veteran a higher rating; however, the Veteran does not have loss of ramus, condyloid process, hard palate, or teeth due to loss of substance of body of maxilla or mandible. He also does not have nonunion or malunion of the mandible. Bruxism, even with the loss of tooth body, is not compensable in the absence of bone disease or trauma. 38 C.F.R. § 4.150, Code 9913.

In October 2023, the Veteran was afforded a VA examination. The Veteran was diagnosed with TMJ with bruxism. His symptoms included intermittent painful
be recorded or verified by a physician. Id.

In October 2023, the Veteran was afforded a VA examination. The Veteran was diagnosed with TMJ with bruxism. His symptoms included intermittent painful motion of the jaw, radiating pain, and clicking. Pain was aggravated with opening his mouth wide and closing it. He did not treat his symptoms. No flare-ups were reported. The Veteran did not report any functional loss. Upon examination, the Veteran's range of motion was normal bilaterally. His inter-incisal distance was greater than 34 mm. The bilateral lateral excursion was greater than 4 millimeters. Pain was noted upon mouth opening and lateral excursion. Upon passive range of motion testing, the Veteran's inter-incisal distance was 30 to 34 mm and right lateral excursion was 0 to 4 millimeters. There was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The Veteran was able to perform repetitive use testing with at least three repetitions with no additional loss of function or range of motion. The examiner indicated that pain, weakness, fatigability and incoordination do not significantly limit the Veteran's functional ability with repeated use over a period of time. No additional factors contributing to the disability were identified. The examiner indicated that the Veteran does not require a mechanically altered foods diet, which has been physician verified or documented due to TMJ. The examiner indicated that the Veteran's condition does not impact his ability to work.

The Board finds that a disability rating in excess of 10 percent for TMJ with bruxism is not warranted. The evidence of record, specifically the Veteran's lay testimony, reflects that the Veteran's bruxism resulted in TMJ pain. Upon VA examination in October 2023, the Veteran exhibited bilateral TMJ interincisal range limited to 30 to 34 mm upon passive motion. Also, the Veteran exhibited right lateral excursion limited to 0 to 4 millimeters upon passive motion. Thus, the Board finds a 10 percent disability rating is an appropriate rating. Notably, the Veteran does not require a mechanically altered foods diet, which has been physician verified or documented due to TMJ.

In conclusion, there is no reasonable doubt to resolve in the Veteran's favor. Lynch, 21 F.4th at 781-82. Accordingly, a disability rating in excess of 10 percent for service-connected TMJ with bruxism is denied.

REASONS FOR REMAND

7. Service connection for a left wrist disability is remanded.

This matter is remanded to correct a duty to assist error that occurred prior to the rating decision on appeal. VA must ensure any medical examination or opinion it provides is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007).

The Veteran reported falling and injuring his left wrist in service. Notably, the AOJ obtained a medical examination and opinion in October 2023. However, this opinion was inadequate as the examiner did not have access to the Veteran's claims file. Specifically, although the examiner did not find a current diagnosis pertaining to the Veteran's left wrist on examination, the examiner nonetheless noted that the incorrect claims file was uploaded for the Veteran and, therefore, he was unable to confirm a diagnosis or render a medical opinion. While it is well settled that the claims file is "not a magical or talismanic set of documents," here, review of the claims file was clearly relevant to the rendering of a medical opinion as was reflected by the examiner's statement. Nieves-Rodriguez v. Peake, 22 Vet.App. 295, 303 (2008). Moreover, the examiner noted the Veteran's complaints of left wrist pain, but did not address whether such pain, itself, caused a functional impairment in earning capacity and, therefore, could constitute a disability for which service connection could be established. See Saunders v. Wilkie, 886 F.3d 1356, 1368 (Fed. Cir. 2018).

The evidentiary record at the time of the rating decision on appeal did "not contain sufficient medical evidence for the Secretary to make a decision on the claim." 38 U.S.C. § 5103A(d)(2)(C). Accordingly
v. Peake, 22 Vet.App. 295, 303 (2008). Moreover, the examiner noted the Veteran's complaints of left wrist pain, but did not address whether such pain, itself, caused a functional impairment in earning capacity and, therefore, could constitute a disability for which service connection could be established. See Saunders v. Wilkie, 886 F.3d 1356, 1368 (Fed. Cir. 2018).

8. Entitlement to TDIU is remanded.

In December 2023, VA acknowledged an unemployability claim was raised in connection with the May 2023 application for disability compensation. Rice v. Shinseki, 22 Vet. App. 447 (2009); May 2023 VA Form 21-526EZ. The Board finds that the issue of the Veteran's entitlement to a TDIU is inextricably intertwined with the issue remanded herein. Therefore, the issue of entitlement to a TDIU is remanded.

The matters are REMANDED for the following action:

Schedule the Veteran for a VA examination to ascertain the nature and etiology of the Veteran's left wrist disability. The examiner must be provided with access to the Veteran's entire claims file and must specify in the report that the claims file has been reviewed. The examiner must address the following questions:

(a) Please clarify all disabilities affecting the Veteran's left wrist. Please note that for VA purposes, a disability exists even when symptoms are not attributable to an underlying diagnosis if pain manifests in functional impairment.

(b) Provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the left wrist disability began during service or is otherwise related to an in-service injury, event, or disease, to include his reports of left wrist pain during and since active service and resulting from a fall in service.

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A complete and fully explanatory rationale must be provided for any opinion offered. If any opinion cannot be rendered without resorting to speculation, the examiner must explain why.

ANTHONY C. SCIRÉ, JR

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board J. Costello, Counsel

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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