SPINAL STENOSIS

Summary

The veteran, who served in the United States Air Force from January 1970 to July 1992, appeals a July 2024 rating decision that continued his left lower extremity radiculopathy evaluation at 10% and reduced his right lower extremity radiculopathy evaluation from 20% to 10%. The veteran sought service connection for cauda equina secondary to his service-connected back disability. The Board granted service connection for cauda equina, finding that the veteran's service-connected back disability caused the cauda equina, based on a private medical record from June 2023. This record indicated significant degeneration at L3-L4 with severe stenosis compressing the cauda equina and noted bowel incontinence. The Board found this private opinion to be the most probative evidence, as it provided a clear rationale for the secondary causation and was not contradicted by other competent medical evidence. The Board resolved any reasonable doubt in the appellant's favor. The case is remanded for further development regarding the appellant's left and right lower extremity radiculopathy evaluations and for a TDIU claim. The remand is necessary due to a duty to assist error concerning pain medication effects on disability evaluations and the interconnectedness of the radiculopathy and TDIU claims.

Rationale

Private medical record found most probative; No contrary competent medical evidence; Benefit of the doubt resolved in appellant's favor

Full Decision Text

Citation Nr: A26022509
Decision Date: 03/12/26	Archive Date: 03/12/26

DOCKET NO. 240711-455441
DATE: March 12, 2026

ORDER

Entitlement to service connection for cauda equina, to include secondary to lumbar spine degenerative disc disease with intervertebral disc syndrome and spinal stenosis (hereinafter a "back disability"), is granted.

REMANDED

Entitlement to a disability rating in excess of 10 percent for left lower extremity radiculopathy of the sciatic nerve is remanded.

The propriety of the reduction from a 20 percent disability rating to a 10 percent disability rating, effective October 1, 2024, for right lower extremity radiculopathy, is remanded.

Entitlement to a total disability rating for individual employability (TDIU) is remanded.

FINDING OF FACT

The appellant is service-connected for a back disability; the competent medical evidence of record found that the cauda equina was caused by his service-connected back disability.

CONCLUSION OF LAW

The criteria for service connection for cauda equina, to include as secondary to a service-connected back disability, are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310(a).

REASONS AND BASES FOR FINDING AND CONCLUSION

The appellant served in the United States Air Force from January 1970 to July 1992.

Procedural History 

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2024 rating decision of the Department of Veterans Affairs' (VA) Veterans Benefits Administration, the agency of original jurisdiction (AOJ), which continued the appellant's disability evaluation for left lower extremity radiculopathy of the sciatic nerve at 10 percent disabling and decreased the evaluation of the appellant's disability evaluation for right lower extremity radiculopathy of the sciatic nerve, from 20 percent disabling to 10 percent disabling.  The appellant's VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement (NOD)), was received by VA in July 2024.  The appellant elected the Hearing docket. 

The appellant testified before the undersigned Veterans Law Judge in November 2025; a transcript of that proceeding is of record.

This appeal has been advanced on the Board's docket. 38 U.S.C. § 7107(a)(2); 38 C.F.R. § 20.902(c).

Applicable Evidentiary Window

As the appellant elected the Hearing docket, the Board may only consider the evidence of record before the AOJ at the time of its decision on the issues on appeal, evidence submitted by the appellant or his representative at the Board hearing, to include testimony provided at the hearing; and evidence submitted within 90 days following the Board hearing.  38 C.F.R. § 20.300(a), 302(a).  If additional evidence was submitted between the dates of the AOJ decision and the hearing, the Board will not consider it unless it is resubmitted during the 90 days following each of these actions.  If the appellant would like VA to consider any evidence that was added to the claims file that the Board could not consider, the appellant 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 claim(s), considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a supplemental claim are included with this decision.  See also Cook v. McDonough, 36 Vet. App. 175 (2023).

Entitlement to service connection for cauda equina is granted

The appellant contends that he suffers from cauda equina secondary to his service-connected back disability.  See VA Form 21-526EZ Application for Disability Compensation and Related Compensation Benefits, September 9, 2023.

Applicable Law

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303(a).  Service connection may be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d).  The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service
 back disability.  See VA Form 21-526EZ Application for Disability Compensation and Related Compensation Benefits, September 9, 2023.

Applicable Law

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303(a).  Service connection may be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d).  The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). 

Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310(a)-(b). Secondary causation exists when, but for the service-connected disability, the non-service-connected was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain. Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023) (citations omitted). Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe were it not for a service-connected disability. Id. at 1364.

In deciding an appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material favorable to the claimant.  Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994).  Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination about the probative value of the evidence to be made after the evidence has been admitted.  Layno v. Brown, 6 Vet. App. 465, 469 (1994).

In each case where service connection for any disability is being sought, due consideration shall be given to the places, types, and circumstances of each veteran's service as shown by the veteran's service record, the official history of each organization in which the veteran served, the veteran's medical records, and all pertinent medical and lay evidence. 38 U.S.C. § 1154(a). 

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. §5107(b).  It follows that when the evidence persuasively favors one side or the other, the benefit-of-the-doubt rule is not applied. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Analysis

The appellant is service connected for a back disability.  See Codesheet, July 10, 2024.

With respect to the first element of secondary service connection, the appellant submitted a private medical record showing a diagnosis of cauda equina.  See Private Medical Record from Miami Neuroscience Institute, June 26, 2023.  Thus, the first element of service connection is met.  See 38 C.F.R. § 3.310(a)-(b).

With respect to the second element of secondary service connection, that the appellant's service connected back disability caused or aggravated his cauda equina, the only competent medical evidence of record is the June 2023 private medical record submitted by the appellant.  The June 2023 private medical record notes that the appellant's MRI was reviewed and "shows significant degeneration at L3-L4 with loss of disc height and multifactorial degenerative stenosis causing severe canal and lateral recess stenosis with compression of the thecal sac/cauda equina."  See Private Medical Record from Miami Neuroscience Institute, June 26, 2023.  The private medical record also notes that the appellant is experiencing bowel incontinence.  Id.  

The private medical record essentially indicates that the appellant's cauda equina is secondary to his spinal stenosis.  The private medical record is found to be the most probative evidence of record as to the issue of whether the
 appellant.  The June 2023 private medical record notes that the appellant's MRI was reviewed and "shows significant degeneration at L3-L4 with loss of disc height and multifactorial degenerative stenosis causing severe canal and lateral recess stenosis with compression of the thecal sac/cauda equina."  See Private Medical Record from Miami Neuroscience Institute, June 26, 2023.  The private medical record also notes that the appellant is experiencing bowel incontinence.  Id.  

The private medical record essentially indicates that the appellant's cauda equina is secondary to his spinal stenosis.  The private medical record is found to be the most probative evidence of record as to the issue of whether the appellant's cauda equina is secondary to his service-connected back disability; there is no competent opinion of record contrary to this positive evidence.  Resolving any reasonable doubt in the appellant's favor, the June 2023 private medical record is sufficient evidence to show that secondary service connection is warranted for cauda equina.

In sum, the appellant's cauda equina was caused by service-connected bilateral lower extremity radiculopathy.  As such, the criteria for service connection for cauda equina have been met and, to this extent, the appellant's claim is therefore granted.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

REASONS FOR REMAND

Under the Appeals Modernization Act (AMA), VA's duty to assist ends when VA issues the notice of decision on a claim or returned claim and does not recommence unless a supplemental claim is submitted, or a claim is returned to the AOJ for correction of an error. 38 U.S.C. § 5103A(e); 38 C.F.R. § 3.159(c).

Given the limitations of when the duty to assist applies, remand by the Board in the AMA is proper for correction of (1) duty to assist errors occurring prior to the date of the AOJ decision on appeal (i.e., pre-decisional duty to assist errors); and (2) AOJ errors in satisfying a regulatory or statutory duty, if correction of such error would have a reasonable possibility of aiding in substantiating the appellant's claim. 38 C.F.R. § 20.802(a).

While additional delay is regrettable, remand is necessary in order to correct a pre-decisional duty to assist errors discussed below.

Entitlement to a disability rating in excess of 10 percent for left lower extremity radiculopathy is remanded

The propriety of the reduction from a 20 percent disability rating to a 10 percent disability rating, effective October 1, 2024, for right lower extremity radiculopathy, is remanded

In March of 2024, the appellant was afforded VA examinations for his back and peripheral nerve disabilities.  The back conditions disability benefits questionnaire (DBQ) indicates that the appellant takes Tylenol for his back conditions.  See Back Conditions, DBQ, May 4, 2024.  The peripheral nerves conditions examination does not list Tylenol as a medication taken by the appellant.  See Peripheral Nerves DBQ, May 4, 2024.  The appellant testified at his Board hearing that he takes Tylenol daily for his back and radiculopathy disabilities.  See Hearing Transcript, November 7, 2025.  A July 2023 VA medical record notes that the appellant takes 500 mg of acetaminophen three times daily and uses diclofenac topic gel.  See VA Medical Record, July 20, 2023.

As noted, the record shows the appellant takes pain medication for his back and radiculopathy disabilities, and the March 2024 VA peripheral nerve examination does not address and discount any beneficial effects of medication, nor does it evaluate the baseline severity of his disabilities without the benefit of medication.  See Ingram v. Collins, 38 Vet. App. 130, 139 (2025) (finding the Board must discount beneficial medication effects when assigning a disability rating when the relevant rating criteria do not explicitly contemplate medication use, including musculoskeletal disabilities).  As such remand is required so that new VA examinations may be obtained.

Entitlement to a TDIU

The appellant seeks entitlement to a TDIU.  See Hearing Transcript, November 7, 2025.  The claim for a TDIU is inextricably intertwined with the issues of entitlement to an increased rating for left lower extremity radiculopathy and the propriety of the reduction of the rating for right lower extremity radiculopathy, which are both being remanded for new examinations.  Therefore, a final
 (2025) (finding the Board must discount beneficial medication effects when assigning a disability rating when the relevant rating criteria do not explicitly contemplate medication use, including musculoskeletal disabilities).  As such remand is required so that new VA examinations may be obtained.

Entitlement to a TDIU

The appellant seeks entitlement to a TDIU.  See Hearing Transcript, November 7, 2025.  The claim for a TDIU is inextricably intertwined with the issues of entitlement to an increased rating for left lower extremity radiculopathy and the propriety of the reduction of the rating for right lower extremity radiculopathy, which are both being remanded for new examinations.  Therefore, a final decision on the issues of entitlement to TDIU cannot be rendered now.  See Harris v. Derwinski, 1 Vet. App. 180 (1991) (two issues are "inextricably intertwined" when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered). 

The matters are REMANDED for the following action:

1. Schedule a VA examination with an appropriate clinician to assess the current severity of the appellant's bilateral lower extremity radiculopathy disabilities. 

The clinician should provide a full description of the disability and report all signs and symptoms necessary for evaluating the appellant's disability under the rating criteria.  

The clinician must review the claims file and must note that review in the report.  All indicated tests should be conducted.

The clinician must address the ameliorating effects of any medication taken by the appellant for these disabilities.  Specifically, the clinician should discount beneficial medication effects when assigning an evaluation.

All opinions must be supported by a clear rationale.  The clinician is asked to explain in detail the underlying reasoning for his or her opinion, to include citing to relevant evidence, supporting factual data, prior medical opinions, and medical literature, as appropriate.

If any requested opinion cannot be provided without resorting to mere speculation, the clinician must explain why a more definitive response is not possible or feasible.  In other words, merely saying he or she cannot respond will not suffice.

2. After the above development, and any other development deemed necessary, readjudicate the claims.

 

 

K.A. KENNERLY

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Jennifer Sullivan-Brief, 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.