MIGRAINE

MICHELLE L. KANE · 2026 · Case ID: A26012877

DENIED

Summary

The veteran, who served from October 2002 to July 2006, appeals the denial of increased disability ratings for four service-connected conditions: mixed muscle contraction and vascular headaches, posttraumatic stress disorder (PTSD) with depression, irritable bowel syndrome (IBS) with dyspepsia, and lumbar strain with scoliosis. The veteran did not appear for a scheduled Board hearing, limiting the evidence considered to that of record at the time of the May 2020 rating decision and evidence submitted within 90 days following the hearing. The Board found no due process violation regarding the hearing opportunity. The veteran claimed entitlement to higher ratings based on the severity of his symptoms, but the Board found the evidence did not support ratings higher than those already awarded. For headaches, the Board found the veteran's symptoms did not meet the criteria for severe economic inadaptability. For PTSD, while the veteran experienced some symptoms consistent with a 100% rating, the overall occupational and social impairment, including his ability to maintain hygiene and employment, more closely approximated the criteria for a 70% rating. For IBS with dyspepsia, the veteran's symptoms did not meet the criteria for a higher rating under Diagnostic Code 7346, and he was already receiving the maximum rating under Diagnostic Code 7319. For lumbar strain, the Board found no evidence of ankylosis or sufficient limitation of motion to warrant a higher rating than the 20% currently awarded. All claims for increased ratings were denied.

Rationale

Veteran already rated at 30%; Did not meet criteria for 50% rating (very frequent, completely prostrating, prolonged attacks); Headaches lasted less than one day and did not impact work

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

8100

Docket No.

200826-106619

Full Decision Text

Citation Nr: A26012877
Decision Date: 02/11/26 Archive Date: 02/11/26

DOCKET NO. 200826-106619
DATE: February 11, 2026

ORDER

Entitlement to a disability rating higher than 30 percent for service-connected mixed muscle contraction and vascular headaches is denied.

Entitlement to a disability rating higher than 70 percent for service-connected posttraumatic stress disorder with depression is denied.

Entitlement to a disability rating higher than 30 percent for service-connected irritable bowel syndrome and dyspepsia is denied.

Entitlement to a disability rating higher than 20 percent for service-connected lumbar strain with scoliosis is denied.

FINDINGS OF FACT

1. At no time during the period on appeal did the Veteran's service-connected mixed muscle contraction and vascular headaches manifest with very frequent, completely prostrating and prolonged attacks productive of severe economic inadaptability.

2. At no time during the period on appeal did the Veteran's service-connected posttraumatic stress disorder with depression manifest with total social and occupational impairment.

3. Throughout the appeal period, the Veteran's irritable bowel syndrome with dyspepsia manifested with diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal stress, but not weight loss, chest pain, vomiting, or melena; and the established schedular rating criteria adequately describe and contemplate the symptoms and severity of his service-connected condition.

4. At no time during the period on appeal did the Veteran's service-connected lumbar strain with scoliosis manifest with forward flexion of the thoracolumbar spine limited to 30 degrees or less; nor did his service-connected lumbar strain with scoliosis manifest with symptoms approximating ankylosis, favorable or unfavorable, of the thoracolumbar and/or entire spine.

CONCLUSIONS OF LAW

1. The criteria for entitlement to a rating higher than 30 percent for service-connected mixed muscle contraction and vascular headaches have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8100.

2. The criteria for a disability rating higher than 70 percent for service-connected posttraumatic stress disorder with depression have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411.

3. The criteria for entitlement to a disability rating higher than 30 percent for service-connected irritable bowel syndrome and dyspepsia have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321(b)(1), 4.1, 4.3, 4.114, Diagnostic Code 7346-7319.

4. The criteria for entitlement to a disability rating higher than 20 percent for service-connected lumbar strain with scoliosis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Codes 5237.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from October 2002 to July 2006.

The rating decision on appeal was issued in May 2020 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In the August 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A December 5, 2024 notification advised the Veteran that a hearing was scheduled for February 20, 2025. The Veteran did not appear for the scheduled Board hearing. Therefore, the Board may only consider the evidence of record at the time of the May 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran within 90 days following the date of the scheduled hearing. 38?C.F.R. §?20.302(c).

If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date of the scheduled Board hearing, or (2) during the 90-day evidentiary period, but added to the file by VA, not submitted by the Veteran, or (3) more than 90 days following the date of the scheduled hearing, the Board did
Board hearing. Therefore, the Board may only consider the evidence of record at the time of the May 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran within 90 days following the date of the scheduled hearing. 38?C.F.R. §?20.302(c).

If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date of the scheduled Board hearing, or (2) during the 90-day evidentiary period, but added to the file by VA, not submitted by the Veteran, or (3) more than 90 days following the date of the scheduled hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(c), 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, he 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.

VA regulations provide that, "[u]pon request, a claimant is entitled to a hearing on any issue involved in a claim... before VA issues notice of a decision on an initial or supplemental claim." 38 C.F.R. § 3.103(d)(1). That regulation does not indicate that the claimant is entitled to pre-decisional notice of this optional hearing. In fact, 38 C.F.R. § 3.103(b)(1) provides that, following a decision, "[c]laimants and their representatives are entitled to notice of any decision made by VA affecting the payment of benefits or the granting of relief... [including] the right to a hearing on any issue involved in the claim as provided in paragraph (d) of this section...." Read together with § 3.103(d), the only notice § 3.103(b) requires is that a claimant be provided notice of the right for a hearing with notification of the decision (by definition, a post-decisional notice). In November 2022, VA amended VA Form 21-526EZ and in May 2024 VA amended VA Form 20-0995 to inform claimants of the right to a hearing at any time during the claims process. The claim in this appeal was filed prior to the form amendments. However, the Board finds that any error in the failure to inform the Veteran of the right to a pre-decisional hearing before the Regional Office (RO) was harmless error.

In Bowen, the Court found that when a claimant is denied a hearing before the RO, there is no due process violation if he is subsequently offered the opportunity for a hearing before the Board, even if a hearing was not requested or conducted, as long as there is no violation of due process concerning the Board hearing opportunity. Bowen v. Shinseki, 25 Vet. App. 250, 253-4 (2012). The facts in the case can be differentiated on several levels, to include that the Veteran did not actually request an RO hearing and the issue in Bowen was not one of notice. Regardless, the Board cannot find a basis to conclude that the underlying holding and logic of the Bowen case would not lead to the same finding of no prejudicial error under the procedure and facts of this case. The May 18, 2020 notification letter informing the Veteran of the rating decision included a VA Form 20-0998, Your Right to Seek Review of Our Decision, outlining the Veteran's appeal options, to include a hearing before the Board. Additionally, in the August 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran chose to have a hearing before a Veterans Law Judge. Although the Veteran was given notice of the time and date of the hearing, which was scheduled for February 20, 2025, he did not appear for the hearing. Because the Veteran was offered a Board hearing, to which he did not appear, there was no due process violation in the processing of the claim or any suggestion that the Veteran was prejudiced by the failure of VA to provide a hearing at the RO level. See Bowen.

Duty to Assist

The Veteran submitted the claims on appeal under the "Fully Developed Claim Program" (FDC). In the March 2020 VA Form 21-526EZ, the Veteran was advised that, under the FDC program, it was his responsibility to identify any relevant treatment records located at a Federal Facility, such as a VA medical center as well as to submit all relevant treatment records if such records exist. The Court has affirmed that the duty to assist is not a one-way street. Martinez v. Wilkie, 31 Vet. App. 170, 178 (2019). The duty to assist "does not encompass 'a duty to prove a claim with the claimant only in a passive role.'" Hilkert v. West, 12 Vet. App. 145, 151 (1999) (en banc). If a claimant wishes help, he or she cannot passively wait in those circumstances where his or her own actions are essential in obtaining the putative evidence. Hayes v. Brown, 5 Vet. App. 60, 68 (1993). Under VA's regulation and caselaw, a claimant is required to provide enough information to identify and locate the existing records, including the person, company, agency, or other custodian holding the records; the approximate time frame covered by the records; and, in the case of medical treatment records, the condition for which treatment was provided, and provide a release so VA can request the records. 38 C.F.R. § 3.159(c)(1). The regulation clearly puts the burden on the claimant to provide complete information and an authorization form, and VA is only obligated to obtain records once that is done. Required notice and information were provided in the claim form which the Veteran signed, certifying to the fact that such notice was received and further than they have included or identified relevant evidence. Here, the Veteran's VA treatment records indicate that he was receiving psychotherapy at a local Vet Center during the year preceding the filing of the claim. In his March 2020 claim, the Veteran identified the VA medical center at which he received psychiatric treatment, but did not identify the Vet Center where the treatment records suggest he was receiving psychotherapy. While the unidentified records may contain additional information regarding issues on appeal, where the Veteran requested consideration under the FDC program, the AOJ did not have a duty to assist the Veteran in obtaining these records since he did not identify the existence or location of these records so that they could be obtained by the AOJ. The Board observes that the Veteran was a mental health provider who, at one time, was employed with VA and interprets the Veteran's failure to identify these records as an indication that he did not wish the remaining records to be considered by the AOJ. Thus, as it relates to assisting the Veteran in obtaining psychotherapy records, the AOJ fulfilled its duty.

Increased Ratings

The Veteran's increased rating claim was received on March 12, 2020. Therefore, the relevant rating period begins March 12, 2020, the date the Veteran applied for a higher rating, although the Board will generally review evidence from the one year "look back period" preceding the submission of the claim to see if worsening was shown. See 38 U.S.C. § 5110(b); 38 C.F.R. § 3.400(o)(2); Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). However, there is a defined evidentiary record. Here, that is the evidence of record at the time of the May 2020 rating decision plus any evidence properly submitted thereafter (i.e., with, or within 90 days of, the scheduled February 20, 2025 hearing). Under the AMA evidentiary rules, the Board can only consider properly submitted evidence, so other than evidence the Veteran submitted in the 90 days following the February 2025 hearing date, none of the evidence added to the file after the decision on appeal can be considered.

In March 2025, the Veteran filed a claim for pension benefits, noting he was not working and had last worked in November 2024. A claim for a total disability rating based on individual unemployability (TDIU) can be part and parcel of appeals for increased ratings in certain situations. See Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009) (the issue of entitlement to TDIU takes its place as part of an increased rating claim where a claimant or the evidence reasonably raises the possibility that the relevant disability causes or contributes to a claimant's unemployability). Although the Veteran raised the fact he was not working during a proper evidentiary window, TDIU is not raised. There was no allegation in the pension claim that he had stopped working because of service-connected condition(s). The mere fact he is not working is not enough to raise TDIU, where there is no evidence or allegation service-connected condition(s) resulted in unemployability.

Finally, the denials of higher ratings below do not affect the fact the Veteran has been in receipt of a total combined disability rating of 100 percent since August 26, 2020.

1. Entitlement to a disability rating higher than 30 percent for service-connected mixed muscle contraction and vascular headaches

The Veteran seeks a higher rating for his mixed muscle contraction and vascular headaches which are currently rated at 30 percent disabling using Diagnostic Code 8100. Diagnostic Code 8100 is the diagnostic code used for migraines, which most closely approximates the Veteran's headache condition. Under Diagnostic Code 8100, a 30 percent rating is warranted for migraines with characteristic prostrating attacks occurring on an average once a month over the last several months; and a 50 percent rating is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. In rating headaches or migraines, the Board may not consider the ameliorative effects of medication. See Jones v. Shinseki, 26 Vet. App. 56, 63 (1992).

The phrase "characteristic prostrating attacks" is used in the criteria corresponding to the 30 percent rating under Diagnostic Code 8100 to describe the nature and severity of migraines, but it is not defined in the regulation. Pursuant to Dorland's Illustrated Medical Dictionary 1531 (32d ed. 2012), prostration is defined as "extreme exhaustion or powerlessness." In Johnson v. Wilkie, the United States Court of Appeals for Veterans Claims (Court) defined prostrating as "lacking in vitality or will: powerless to rise: laid low," citing to WEBSTER'S THIRD NEW INTERNATIONAL DICTIONARY OF THE ENGLISH LANGUAGE UNABRIDGED 1822 (1966). 30 Vet. App. 245, 252 (2018). The Court further explained that "[b]ecause DC 8100 specifically governs migraine headaches, the phrase 'characteristic prostrating attacks' plainly describes migraine attacks that typically produce powerlessness or a lack of vitality." Id. at 252.

The criteria for a 50 percent rating similarly contain several undefined phrases. The descriptive phrase "very frequent" connotes a frequency at least greater than once a month, as is required by the rating criteria corresponding to a lesser 30 percent rating. Johnson, 30 Vet. App. at 253. The phrase "completely prostrating" generally means that the attack must render the veteran entirely powerless. Id. The completely prostrating attacks must also be "prolonged," which is defined as "to lengthen in time; extend duration; draw out; continue, protract." Id. (internal citation omitted). Lastly, the 50 percent rating criteria requires that the very frequent completely prostrating and prolonged attacks be "productive of severe economic inadaptability." Productive can be read as having either the meaning of "producing" or "capable of producing," and, with regard to severe economic inadaptability, nothing in Diagnostic Code 8100 requires that the claimant be completely unable to work in order to qualify for a 50 percent rating. Pierce v. Principi, 18 Vet. App. 440, 445-46 (2004).

The rating criteria of Diagnostic Code 8100 are considered successive, meaning that a claimant cannot fulfill the criteria of the higher rating without fulfilling those
Id. (internal citation omitted). Lastly, the 50 percent rating criteria requires that the very frequent completely prostrating and prolonged attacks be "productive of severe economic inadaptability." Productive can be read as having either the meaning of "producing" or "capable of producing," and, with regard to severe economic inadaptability, nothing in Diagnostic Code 8100 requires that the claimant be completely unable to work in order to qualify for a 50 percent rating. Pierce v. Principi, 18 Vet. App. 440, 445-46 (2004).

The rating criteria of Diagnostic Code 8100 are considered successive, meaning that a claimant cannot fulfill the criteria of the higher rating without fulfilling those of the next lower rating. Johnson v. Wilkie, 30?Vet. App.?245, 252 (2018). However, Diagnostic Code 8100 contemplates all symptoms associated with the headache condition. See Holmes v. Wilkie, 33 Vet. App. 67 (2020). Thus, in addition to the successive criteria, the Board will consider all symptoms experienced due to headache attacks and then rate the symptoms based on the frequency, duration, and economic impact of those attacks.

The Veteran routinely denied headaches throughout the VA treatment records associated with the period on appeal; however, he did request acetaminophen for "chronic intermittent headache" in an April 2020 telephone encounter with VA providers regarding his IBS condition. In March 2025, the Veteran submitted a claim along with VA treatment records. These records do not contain any additional information regarding the severity of the Veteran's headaches or symptoms associated with his headache condition, but only note headaches in the problem list.

The Veteran attended a VA examination in April 2020. In this examination, the Veteran stated that his headaches had been getting worse. He described them as pounding bilateral head pain in the frontal region of his head. He reported taking Tylenol or ibuprofen as needed to treat his headaches. The VA examiner marked that the Veteran also experienced nausea and sensitivity to light and sound as a result of his headaches. Following examination, the VA examiner recorded that the Veteran's head pain typically lasted less than one day and he did not have characteristic prostrating attacks of headache pain, nor did he have very prostrating and prolonged attacks of headache pain productive of severe economic inadaptability. The VA examiner found that the Veteran's headaches did not impact his ability to work.

The Board finds that the evidence of record weighs persuasively against entitlement to a higher disability rating. The Veteran is already in receipt of a 30 percent rating. The evidence does not show that, during the appeal period, the Veteran experienced headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability, as would warrant a 50 percent rating. Rather, the Veteran stated that he experienced daily headaches, but the VA examiner noted that each headache lasted less than one day, the headaches were not completely prostrating, and they did not result in severe economic inadaptability. This is reinforced by the VA examiner's finding that the Veteran did not have any functional impact due to his headache condition based on the April 2020 examination. Moreover, the Board observes that there is no evidence that his headaches resulted in job loss or severe economic inadaptability. During the 2020 VA mental health examination, he reported working as a therapist for VA since 2019. Since he denied missing work at that time, the headaches clearly did not result in severe economic inadaptability.

In considering the VA treatment records, VA examination, and the Veteran's statements regarding the severity of his headaches, the Board finds that the balance of probative evidence weighs persuasively against a finding that the Veteran is entitled to a disability rating higher than 30 percent. As such, the benefit-of-the-doubt rule is not for application and entitlement to a disability rating higher than 30 percent is denied.

2. Entitlement to a disability rating higher than 70 percent for service-connected posttraumatic stress disorder (PTSD) with depression

The Veteran seeks a higher disability rating for his service-connected psychiatric condition. This condition is presently rated as 70 percent disabling under 38 C.F.R. § 4.130, Diagnostic Code 9411, which applies the rating criteria from the General Rating Formula for Mental Disorders.

Under the General Rating Formula for Mental Disorders, a 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; 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); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood; and a 100 percent (or, total) rating is assigned 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; or memory loss for names of close relatives, own occupation or own name. 38 C.F.R. § 4.130.

When determining the appropriate disability evaluation to assign, 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's primary consideration is a Veteran's symptoms, but it must also make findings as to how those symptoms impact a Veteran's occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Because the use of the term "such as" in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating. Mauerhan, 16 Vet. App. at 442; see also Sellers v. Principi, 372 F.3d 1318, 1326-27 (Fed. Cir. 2004). Nevertheless, all ratings in the general rating formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the Veteran's impairment must be "due to" those symptoms, a Veteran may only qualify for a given disability by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio, 713 F.3d at 118.

During the period on appeal, the Veteran attended a VA examination and was followed by VA treatment providers at a VA medical center (VAMC).

In February 2019, the Veteran attended an appointment with a VA provider. The Veteran reported that he was sleeping better and his depression and anxiety had improved. The Veteran did report, however, 2 to 3 anxiety attacks in the last month while driving and three anxiety attacks in one week. The Veteran denied suicidal and homicidal ideation and did not exhibit any signs or symptoms of depression, mania, or psychosis. He did not complain of headache, memory loss, lethargy, weakness or pain. The provider observed that the Veteran appeared calm, was cooperative, and was oriented to person, place, time, and situation. Moreover, the Veteran had clear and coherent speech, grossly intact recent and remote memory, good concentration, attention, insight and judgement, as well as organized thought. The Veteran denied hallucinations and did not exhibit delusional thought.

In May 2019, the Veteran attended a follow-up appointment with his VA treatment provider. In this encounter, the Veteran reported "notorious" improvement in his mood and anxiety. He denied suicidal and homicidal ideation. The Veteran stated that his relationship with his girlfriend was going well, and he showed no signs or symptoms of mania or psychosis. The Veteran did not complain of headache, lethargy, memory loss, weakness, or pain. The provider observed that the Veteran was appropriately engaged and fairly groomed with fair hygiene. The Veteran was calm, cooperative, oriented to person, place, time, and situation. He had good concentration and attention, grossly intact memory, clear and coherent speech, organized thought process, and a
In May 2019, the Veteran attended a follow-up appointment with his VA treatment provider. In this encounter, the Veteran reported "notorious" improvement in his mood and anxiety. He denied suicidal and homicidal ideation. The Veteran stated that his relationship with his girlfriend was going well, and he showed no signs or symptoms of mania or psychosis. The Veteran did not complain of headache, lethargy, memory loss, weakness, or pain. The provider observed that the Veteran was appropriately engaged and fairly groomed with fair hygiene. The Veteran was calm, cooperative, oriented to person, place, time, and situation. He had good concentration and attention, grossly intact memory, clear and coherent speech, organized thought process, and a "definitely better" mood. The Veteran exhibited good insight and judgment. He denied hallucinations and no delusions were reported or elicited.

The Veteran returned in December 2019 seeking refills of his medication. In this encounter, the Veteran reported that he had been feeling generally depressed, lethargic, and unmotivated. He stated he had been worrying daily, overeating, and having negative thoughts and anhedonia. He noted that, due to overwhelming anxiety, he had been having difficulty concentrating at work. He denied current PTSD nightmares but endorsed increased dizziness. The Veteran did not complain of memory loss, pain, or weakness. On observation, the Veteran appeared calm and cooperative with fair hygiene. He had good attention and concentration, clear and coherent speech, intact memory, organized thought process, and good insight and judgment. The Veteran denied suicidal and homicidal ideation and did not show signs of hallucinations or delusions.

In a February 2020 follow-up, the Veteran reported improvement in depression and anxiety while taking his medication. After stopping his medication, he noticed decreased concentration, anhedonia, decreased energy, and a depressed/anxious mood. In this encounter the Veteran appeared fairly groomed, alert, calm, cooperative, and oriented in all spheres. He had fair attention and concentration, good insight and judgment, and grossly intact memory. The provider observed clear and coherent speech, an organized thought process, and the absence of delusions. The Veteran denied homicidal ideation, suicidal ideation, and hallucinations.

The Veteran attended a VA examination in April 2020. In this examination, the Veteran reported sleeping 4 to 6 hours per night with infrequent nightmares. He also reported experiencing anxiety, intrusive thoughts, hypervigilance when not at home ("feeling on guard"), inability to go to loud or busy places, avoiding crowded areas, mistrust of others, low mood, lack of motivation, to include lack of motivation to maintain personal hygiene, poor self-care, and weak memory and concentration. The Veteran stated that he had been employed full-time since July 2019 and denied missing work due to psychiatric symptoms recently. He did state, however, that he has been "written up for lack of attention to detail." The Veteran had two children with an ex-spouse with whom he shared custody of the children. The Veteran reported, for his part, irritability/aggression was one factor in the dissolution of his marital relationship. He stated that he had been in a subsequent relationship, but it ended in 2019 due to an anxiety attack and arguing. The Veteran stated that he was close with his brother and parents. Following examination, the VA examiner recorded the following symptoms: depressed mood, anxiety, suspiciousness, chronic sleep impairment, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. The VA examiner observed the Veteran to be cooperative, polite, and oriented in all spheres. The Veteran's thought was goal-directed, logical, and coherent; and his insight and judgment were adequate. The VA examiner opined that the Veteran exhibited occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation.

As noted above, the Veteran submitted a claim with additional VA treatment records in March 2025, during the applicable evidentiary window. These VA treatment records do not contain any additional relevant evidence concerning the Veteran's PTSD symptoms. The list of medications shows prescriptions in March 2025 of two medications for mood.

The evidence of record shows that the Veteran's PTSD was manifested by symptoms associated with a 70 percent rating or lower (depressed mood, anxiety, suspiciousness, chronic sleep impairment, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, irritability, panic), and a symptom associated with a 100 percent rating (intermittent inability to perform activities of daily living, including maintenance of
submitted a claim with additional VA treatment records in March 2025, during the applicable evidentiary window. These VA treatment records do not contain any additional relevant evidence concerning the Veteran's PTSD symptoms. The list of medications shows prescriptions in March 2025 of two medications for mood.

The evidence of record shows that the Veteran's PTSD was manifested by symptoms associated with a 70 percent rating or lower (depressed mood, anxiety, suspiciousness, chronic sleep impairment, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, irritability, panic), and a symptom associated with a 100 percent rating (intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene). The Veteran also had symptoms that are not listed with a specific rating, such as nightmares, decreased energy, sweating, palpitations, short temper, impatience, avoidance (triggers, crowds), overeating, reduced concentration, lethargy, anhedonia, mistrust of others, and hypervigilance.

The Board finds the severity, frequency, and duration of the Veteran's unlisted symptoms more closely approximate the symptoms contemplated by a 70 percent rating, which are less severe, less frequent, and shorter in duration than those contemplated by a 100 percent rating. See 38 C.F.R. § 4.126. The Veteran's unlisted symptoms are most similar to symptoms such as disturbances in motivation and mood, anxiety, depression, sleep impairment, irritability, near continuous panic, suspiciousness, and neglect of appearance, which are contemplated by the assigned 70 percent rating.

The Board also finds the level of impairment caused by the Veteran's symptoms does not more closely approximate the level associated with a 100 percent rating. The Veteran experienced occupational and social impairment with deficiencies in most areas, not total social and occupational impairment. Mental status examinations, VA treatment notes, and the VA examination indicate that the Veteran did not have impairment in thought; rather the Veteran had consistently clear and logical thought without delusions or hallucinations and was consistently oriented to time, place, person, and situation. He also was routinely noted as having clear speech, grossly intact memory, and good insight and judgment. The Veteran also routinely denied suicidal and homicidal ideation. While he endorsed some anhedonia, this did not rise to the level of hopelessness/helplessness associated with suicidal ideation, and he did not have plan or intent during the appeal period. Thus, he did not pose a persistent threat to himself or others, as is contemplated by a 100 percent rating.

While the Veteran did experience one symptom contemplated by a 100 percent rating, namely, intermittent inability to perform activities of daily living, the evidence overall does not demonstrate the level of impairment associated with a 100 percent rating. The Veteran stated in the April 2020 VA examination that he sometimes had a lack of motivation to maintain his hygiene, and he further associated this with poor self-care and weight gain (overeating). As noted above, the Veteran's other remaining symptoms were either contemplated by or more consistent with a 70 percent rating. Further, during the period on appeal the Veteran was consistently noted in mental status examinations as being casually dressed and "fairly groomed/hygiene." He was employed throughout the period on appeal, which indicates that he was able to maintain occupational relationships, to include with clients, despite the diminished motivation for maintenance of personal hygiene. This is inconsistent with the level of total occupational and social impairment contemplated by a 100 percent rating. While this symptom of intermittent inability to perform activities of daily living is listed as an example of the type of symptoms associated with a 100 percent rating, the Board does not solely consider whether the Veteran's symptoms check each box in the rating criteria. Rather, the Board's focus is on the level of occupational and social impairment evidenced by these observable symptoms. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013). See also Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). The Board finds that the level of impairment experienced by this Veteran as it related to his intermittent inability to attend to activities of daily living more closely approximated the symptom of disturbance in motivation and mood and/or neglect of personal appearance and hygiene contemplated by the current rating. Additionally, the Veteran was consistently recorded as being calm, oriented, logical, cooperative, and possessing good insight and good judgment. These attributes are diametrically opposed to the symptoms of disorientation, illogical thought, and persistent threat attributed to a 100 percent rating.

The Board concludes that the Veteran's symptoms did not cause the level of impairment required for a disability rating of 100 percent. A disability rating of 100
App. 436, 442 (2002). The Board finds that the level of impairment experienced by this Veteran as it related to his intermittent inability to attend to activities of daily living more closely approximated the symptom of disturbance in motivation and mood and/or neglect of personal appearance and hygiene contemplated by the current rating. Additionally, the Veteran was consistently recorded as being calm, oriented, logical, cooperative, and possessing good insight and good judgment. These attributes are diametrically opposed to the symptoms of disorientation, illogical thought, and persistent threat attributed to a 100 percent rating.

The Board concludes that the Veteran's symptoms did not cause the level of impairment required for a disability rating of 100 percent. A disability rating of 100 percent is reserved for total occupational and social impairment. Here, the Veteran had no demonstrated issues with inappropriate behavior and no obvious impairment of thought or communication. Moreover, he was oriented to time and place and denied delusions, hallucinations, and suicidal/homicidal ideation. Finally, the Veteran did not demonstrate any lapse in recall or memory related to himself, his job, or his close relatives or friends. The Board finds the severity, frequency, and duration of the Veteran's symptoms are less severe, less frequent, and shorter in duration than those contemplated by a 100 percent rating. See 38 C.F.R. § 4.126.

In short, the evidence of record persuasively 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. The criteria for a 100 percent rating are not met and the appeal must be denied.

3. Entitlement to a disability rating higher than 30 percent for service-connected irritable bowel syndrome and dyspepsia

The Veteran seeks a higher disability rating for his service-connected irritable bowel syndrome (IBS) with dyspepsia, which is currently rated as 30 percent disabling under Diagnostic Code 7346-7319.

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 evaluation assigned. 38 C.F.R. §§ 4.20, 4.27.

Both Diagnostic Code 7346 and Diagnostic Code 7319 are located in 38 C.F.R. § 4.114, Schedule of Ratings - digestive system. In May 2024, the rating criteria associated with various digestive system conditions were amended. When a regulation changes during the period on appeal, the Board has a duty to maximize the benefit to the Veteran by considering the applicability of both the original regulation and the amended regulation. However, application of the amended regulation cannot extend prior to the effective date of the change in the law. 38 U.S.C. § 5110. Here, as the May 2020 rating decision was issued prior to the regulatory change, which was not retroactive, the amended rating criteria are not for consideration.

Diagnostic Code 7346 contains the rating criteria applicable to hiatal hernias and is often used, by analogy, to rate symptoms such as dyspepsia. Pursuant to Diagnostic Code 7346, a 30 percent evaluation is warranted for persistently recurring epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. 38 C.F.R. § 4.114. The maximum 60 percent evaluation is warranted for symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. Id.

"Considerable" and "severe" are not defined within 38 C.F.R. Part 4. When interpreting a regulation, the words should be given their ordinary meaning. See Johnson v. Wilkie, 30 Vet. App. 245 (2018). "Considerable" is defined as "significant" or "large in extent or degree." See Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary/considerable. "Severe" is defined as "very painful or harmful," as with a severe wound, or "of a great degree" as with severe depression. See Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary/severe.

Under Diagnostic Code 7319, a 30 percent rating is warranted for severe irritable colon syndrome manifesting with diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress. 38 C.F.R. § 4.114. This is the highest schedular disability rating available under this diagnostic code.

The Veteran's VA treatment records for the relevant period contain mostly denials
erriam-webster.com/dictionary/considerable. "Severe" is defined as "very painful or harmful," as with a severe wound, or "of a great degree" as with severe depression. See Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary/severe.

The Veteran's VA treatment records for the relevant period contain mostly denials of diarrhea, weight changes, constipation, and melena during the period on appeal, with two notable exceptions. In February 2020, the Veteran reported experiencing worsening gastrointestinal upset, specifically stomach cramping and diarrhea lasting at least 10 days. He stated that he had experienced two days of diarrhea, but no vomiting. He reported a continued "upset stomach" which was described as intermittent episodes of constipation and looser stools over the preceding week with an increased need to move bowels, especially right after eating. Lab work completed incident to this visit indicated low levels of Vitamin D, but no other significant abnormality. Again, in April 2020, the Veteran followed up on his February 2020 visit. In the April 2020 telephone encounter, the Veteran requested a refill of his medication but did not offer any additional insight into his symptoms at that time. He did, however, deny melena, weight changes, changes in stool color, diarrhea, abdominal pain, and constipation.

The additional VA treatment records submitted in March 2025 do not add any additional information concerning the Veteran's gastrointestinal and/or digestive symptoms, to include the severity of his service-connected condition. His list of medications includes a probiotic for bowel health, a medication for diarrhea, and a medication for heartburn.

The Veteran attended a VA examination in April 2020. In this examination, the Veteran stated that he experienced symptoms of heartburn, indigestion, diarrhea, abdominal cramping and discomfort. He stated that he was treating the condition with medication (omeprazole) and probiotics. The VA examiner marked that the Veteran experienced "on and off diarrhea" but did not have any episodes of bowel disturbance with abdominal distress or exacerbations or attacks attributable to his IBS with dyspepsia. The VA examiner marked that the Veteran did not exhibit weight loss, malnutrition, serious complications, or other general health effects due to his condition. Moreover, the Veteran did not have any neoplasms or metastases related to his condition. Laboratory testing was conducted as part of the examination; however, there were no significant findings. See April 2020 VA Examination Labs (low MCH). The VA examiner opined that the Veteran's IBS with dyspepsia did not impact his ability to work.

The Board finds that a disability rating higher than 30 percent is not warranted. During the period on appeal, the Veteran exhibited symptoms of heartburn, indigestion, and diarrhea, as well as abdominal pain and cramping. He did not exhibit any melena, substernal pain, vomiting, or weight loss. Therefore, he does not meet the rating criteria for a higher disability rating under Diagnostic Code 7346.

As noted above, the Veteran is already in receipt of the highest disability rating available under Diagnostic Code 7319, which is warranted for symptoms of diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress. The Veteran's service-connected condition manifested with symptoms consistent with these criteria.

The Veteran contends that a rating higher than 30 percent is warranted but did not explicitly raise consideration of entitlement to an extraschedular rating, nor did he identify to the Board any specific symptoms or impairments which justify such consideration. Nevertheless, an extraschedular disability rating is not warranted in this case because the Veteran's symptoms do not present such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization that would render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321 (b)(1). See Thun v. Peake, 22 Vet. App. 111, 115-16 (2008), aff'd sub nom. Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009); Anderson v. Shinseki, 22 Vet. App. 423, 427 (2009).

Finally, there are no other or additional diagnostic codes which more closely approximate the Veteran's condition.

Therefore, entitlement to a higher rating for IBS with dyspepsia
employment or frequent periods of hospitalization that would render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321 (b)(1). See Thun v. Peake, 22 Vet. App. 111, 115-16 (2008), aff'd sub nom. Thun v. Shinseki, 572 F.3d 1366 (Fed. Cir. 2009); Anderson v. Shinseki, 22 Vet. App. 423, 427 (2009).

Finally, there are no other or additional diagnostic codes which more closely approximate the Veteran's condition.

Therefore, entitlement to a higher rating for IBS with dyspepsia is denied. Since the weight of the evidence is against the claim, the benefit of the doubt rule does not apply.

4. Entitlement to a disability rating higher than 20 percent for service-connected lumbar strain with scoliosis

The Veteran seeks a higher disability rating for his service-connected back condition, which is presently rated as 20 percent disabling under 38 C.F.R. § 4.71a, Diagnostic Code 5237, utilizing the General Rating Formula for Diseases and Injuries of the Spine.

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.

Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. 38 C.F.R. § 4.71a, Note (1).

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

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

Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.
to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or § 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria.").

Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011).

In Correia v. McDonald, 28 Vet. App. 158 (2016), the 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."

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.

The rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended, effective February 7, 2021. See 38 C.F.R. § 4.71a; 85 Fed. Reg. 76453 (Nov. 30, 2020); 85 Fed. Reg. 85523 (Dec. 29, 2020); 86 Fed. Reg. 8142 (Feb 4, 2021). Because the present appeal period predates these amendments, only the rating criteria in effect at the time of the May 2020 rating decision are applicable to this appeal, although no substantive changes were made to the applicable diagnostic codes in the February 2021 amendments.

The Veteran did not complain of back pain in the VA treatment records for the applicable period. The additional VA treatment records received in March 2025 provide no additional information concerning the symptoms, to include limited range of motion, of the Veteran's back condition beyond noting low back pain in the problem list.

The Veteran attended a VA examination in April 2020. In this examination, the Veteran's diagnosis of lumbar strain with scoliosis was confirmed. The Veteran described his symptoms as sharp pain, low back pain, stiffness, and limited range of motion. He reported flare ups occurring monthly which varied in severity and duration. The Veteran stated that the flare ups were precipitated by prolonged standing or walking, driving long periods, heavy lifting, bending, and playing sports. He reported having functional impairment to include difficulty with prolonged standing or walking, difficulty with driving long periods, inability to lift heavy items, and difficulty bending. The Veteran's range of motion was measured by the VA examiner. The initial range of motion measurements indicated forward flexion to 75 degrees and extension to 25 degrees. The Veteran exhibited pain with motion in all directions and there was objective evidence of tenderness or pain on palpation. After three repetitions, the Veteran exhibited additional functional loss due to pain and lack of endurance. After three repetitions, range of motion was measured as forward flexion to 70 degrees and extension to 20 degrees. The VA examiner estimated that, due to pain and lack of endurance, the Veteran's range of motion would be further limited in a flare or with repeated use over time. Based on the observed range of motion, as well as the Veteran's statements, the VA examiner estimated that, at its most limited, the Veteran's forward flexion would be limited in a flare to 50 degrees and his extension would be limited to 10 degrees. On examination, the VA examiner found no guarding or muscle spasm of the back. Additionally, muscle strength, reflexes, and sensory examinations yielded normal results. The Veteran did not complain of, nor did he exhibit, any signs or symptoms of radiculopathy and there was no ankylosis of the spine nor other neurological abnormalities (to include bowel or bladder problems) identified on examination. The Veteran did not have intervertebral disc syndrome. The VA examiner noted that the Veteran wore a back brace regularly for additional support. Finally, the VA examiner listed the following functional impacts of the Veteran's back condition: back pain and stiffness, limited range of motion
a flare to 50 degrees and his extension would be limited to 10 degrees. On examination, the VA examiner found no guarding or muscle spasm of the back. Additionally, muscle strength, reflexes, and sensory examinations yielded normal results. The Veteran did not complain of, nor did he exhibit, any signs or symptoms of radiculopathy and there was no ankylosis of the spine nor other neurological abnormalities (to include bowel or bladder problems) identified on examination. The Veteran did not have intervertebral disc syndrome. The VA examiner noted that the Veteran wore a back brace regularly for additional support. Finally, the VA examiner listed the following functional impacts of the Veteran's back condition: back pain and stiffness, limited range of motion, difficulty with prolonged standing or walking over 30 minutes, and difficulty with bending or heavy lifting over 40 pounds.

As an initial matter, the Board finds that the Veteran did not, at any point in the appeal period, have ankylosis, favorable or unfavorable, of the thoracolumbar and/or entire spine. Therefore, a rating higher than 40 percent is not warranted at any point during the appeal period.

As previously discussed, the Veteran is presently in receipt of a 20 percent rating under Diagnostic Code 5237. Under Diagnostic Code 5237, a 40 percent rating is warranted for forward flexion of the thoracolumbar spine 30 degrees or less. Therefore, the Board considers the range of motion of the Veteran's thoracolumbar spine during the period on appeal to determine whether an increased evaluation is warranted.

The Board finds that a disability rating higher than 20 percent is not warranted. The evidence before the Board indicates that, at its most limited, the Veteran's forward flexion of his thoracolumbar spine was limited to 50 degrees. This is significantly less limited than would be required for a higher disability rating.

For the foregoing reasons, the evidence of record persuasively weighs against the Veteran's claim for a rating in excess of 20 percent for his back condition. 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).

MICHELLE L. KANE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board L.C. Reader, Associate 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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