SHOULDER IMPAIRMENT OF

MICHELLE L. KANE · 2026 · Case ID: A26025241

DENIED

Summary

The Veteran served from August 1989 to November 2014. The Veteran appeals the denial of service connection for restless leg syndrome and the denial of an increased rating for his service-connected left shoulder disability. The Board reviewed the evidence of record, including VA examinations from February 2021 and December 2024, and the Veteran's statements. For the left shoulder disability, the Board found that the evidence did not support a rating in excess of the current 20 percent evaluation, as the range of motion limitations did not meet the criteria for a higher rating, nor did the evidence demonstrate functional loss due to pain or flare-ups that would warrant an increased evaluation. The Board also considered the possibility of ankylosis but found no evidence to support it. For restless leg syndrome, the Board found no probative medical evidence of a current diagnosis. While a private consultation noted the condition, it lacked a supporting rationale or findings. Both VA examinations concluded the Veteran did not have a diagnosis of restless leg syndrome or symptoms consistent with it. The Board denied service connection for restless leg syndrome due to the lack of a current, diagnosed disability and the absence of probative medical evidence linking it to service or Gulf War exposures. The Veteran's claims for an increased rating for the left shoulder and service connection for restless leg syndrome were denied.

Rationale

Evidence did not reflect limitation of motion to 25 degrees from the side.; VA examinations showed limitations but did not meet criteria for higher rating.; No evidence of ankylosis or functional loss due to pain/flare-ups.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250424-547053

Full Decision Text

Citation Nr: A26025241
Decision Date: 03/20/26 Archive Date: 03/20/26

DOCKET NO. 250424-547053
DATE: March 20, 2026

ORDER

Entitlement to an evaluation in excess of 20 percent for service-connected left shoulder strain, rotator cuff tendonitis, and acromioclavicular joint osteoarthritis with cortisone shots (left shoulder disability) is denied.

Entitlement to service connection for restless leg syndrome is denied.

FINDINGS OF FACT

1. The Veteran's service-connected left shoulder disability is manifested by complaints of pain, limitation of flexion to no less than 170 degrees, and limitation of abduction to no less than 125 degrees.

2. The most probative evidence of record does not show the Veteran to have a diagnosis of restless leg syndrome that is etiologically related to a disease, injury, or event in service.

CONCLUSIONS OF LAW

1. The criteria for entitlement to a rating in excess of 20 percent for the Veteran's service-connected left shoulder disability have not been met. 38 U.S.C. §§ 1155, 5102, 5103, 5103A, 5107 (West 2014); 38 C.F.R. §§ 3.159, 3.321, 4.71a, Diagnostic Codes 5003, 5201 (2025).

2. The criteria for service connection for restless leg syndrome have not been met. See 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (West 2014); 38 C.F.R. § §§ 3.102, 3.159, 3.303, 3.304, 3.317 (2025).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from August 1989 to November 2014.

In August 2017, the President signed into law the Veterans Appeals Improvement and Modernization Act of 2017 (the Appeals Modernization Act or AMA), Pub. Law 115-55, which created a new claims and appeals process for pursuing VA benefits.

Following a November 2024 Board Remand, on February 26, 2025, the Agency of Original Jurisdiction (AOJ) continued a 20 percent evaluation assigned to the Veteran's service-connected left shoulder disability and denied service connection for restless leg syndrome. On April 24, 2025, the Veteran submitted a Decision Review Request: Board Appeal (Notice of Disagreement) appealing these claims. He requested the "Evidence Submission" lane, indicating that he did not want a Board hearing but that he had additional evidence that he would submit within the next 90 days. In a June 16, 2025, letter, the Board acknowledged the Veteran's appeal request and informed him that the appeal had been placed on the Evidence Submission docket.

Under the AMA, when a claimant seeks appellate review through the Board's Evidence Submission docket, the Board only may consider the evidence of record at the time of the AOJ decision on appeal, as well as any evidence submitted by the Veteran with or within 90 days after his VA Form 10182 was submitted. 38 U.S.C. § 7113 (c); 38 C.F.R. § 20.303. Therefore, the Board may consider the evidence of record at the time of the February 26, 2025, rating decision, as well as any evidence submitted from April 24, 2025, to July 22, 2025. However, the Veteran has submitted no additional evidence and no evidence has been added to the file since the February 2025 rating decision.

The Board has thoroughly reviewed all evidence in the claims file. The analysis below focuses on the most salient and relevant evidence and on what this evidence shows, or fails to show, on the claim, and the Board's reasons for rejecting evidence favorable to the Veteran. The Veteran must not assume the Board has overlooked evidence not explicitly discussed herein.

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 Veteran's claims were filed on older claim form, prior to the amended versions. 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 United States Court of Appeals for Veterans Claims (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 notification letter informing the Veteran of the rating decisions 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 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran was provided with an option to request a hearing with a Veterans Law Judge. The Veteran instead selected evidence submission review by a Veterans Law Judge, and the form explicitly states that by choosing this option, the Veteran does not want a Board hearing. Because the Veteran was provided with notice of the right to appeal to the Board, as well as the right to a Board hearing, there was no due process violation in the processing of the claims or any suggestion that the Veteran was prejudiced by the failure of VA to provide a hearing at the RO level. See Bowen.

Additionally, the Board notes that the Veteran submitted a VA Form 21-22 on November 13, 2025, appointing the Tennessee Department of Veteran Services as his representative. In a November 19, 2025, letter, the Board recognized the Tennessee Department of Veterans Services as the Veteran's representative and informed the representative that the Veteran had at least one appeal pending before the Board. As such, the Board will proceed with the adjudication of these claims, acknowledging the Tennessee Department of Veterans Services as the representative in this case.

The Veteran has not raised any other issues not addressed herein, to include regarding the duty to notify or the duty to assist, nor have any other issues been reasonably raised by the record.

Entitlement to an evaluation in excess of 20 percent for service-connected left shoulder disability is denied.

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable
nor have any other issues been reasonably raised by the record.

Entitlement to an evaluation in excess of 20 percent for service-connected left shoulder disability is denied.

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3.

The Veteran's entire history is reviewed when making a disability determination. See 38 C.F.R. § 4.1. Where the Veteran timely appealed the rating initially assigned for the service-connected disability within one year of the notice of the establishment of service connection for it, VA must consider whether the Veteran is entitled to "staged" ratings to compensate him or her for times since filing his or her claim when his or her disability may have been more severe than at other times during the course of his or her appeal. See Fenderson v. West, 12 Vet. App. 119 (1999). But where service connection has already been established, and increase in the disability rating is at issue, it is the present level of the disability that is of primary concern. See Francisco v. Brown, 7 Vet. App 55 (1994). However, in such cases, when the factual findings show distinct time periods during which a claimant exhibits symptoms of the disability at issue and such symptoms warrant different evaluations, staged evaluations may also be assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007).

Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disabilities in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991).

The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14. The critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 261- 62 (1994).

When evaluating musculoskeletal disabilities, VA may, in addition to applying schedular criteria, consider granting a higher rating in cases in which the claimant experiences additional functional loss due to pain, weakness, excess fatigability, or incoordination, to include with repeated use or during flare-ups, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45; DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1995). The provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45 are to be considered in conjunction with the diagnostic codes predicated on limitation of motion. See Johnson v. Brown, 9 Vet. App. 7 (1996).

In reviewing the Veteran's appeal for an increased rating, the Board has not overlooked the holding of the Court in Rice v. Shinseki, 22 Vet. App. 447 (2009) [holding that claims for higher evaluations also include a claim for entitlement to unemployability (TDIU) when the appellant claims he or she is unable to work due to a service-connected disability]. However, as the Veteran has not asserted and the evidence of record does not suggest that he is unemployable as a result of his service-connected left shoulder disability, the Board finds that this issue should not be construed as being on appeal at this time. See Rice, 22 Vet. App. 447, citing Comer v. Peake, 552 F.3d 1362
Board has not overlooked the holding of the Court in Rice v. Shinseki, 22 Vet. App. 447 (2009) [holding that claims for higher evaluations also include a claim for entitlement to unemployability (TDIU) when the appellant claims he or she is unable to work due to a service-connected disability]. However, as the Veteran has not asserted and the evidence of record does not suggest that he is unemployable as a result of his service-connected left shoulder disability, the Board finds that this issue should not be construed as being on appeal at this time. See Rice, 22 Vet. App. 447, citing Comer v. Peake, 552 F.3d 1362 (Fed. Cir. 2009).

On January 12, 2021, the Veteran submitted a VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, (signed by the Veteran on December 30, 2020) requesting an increased rating for his service-connected left shoulder disability. In a May 26, 2021, rating decision, the AOJ increased the evaluation assigned to this disability to 20 percent, effective December 30, 2020, noting that the effective date was established from the date the claim was received. The Veteran appealed this evaluation in a July 2021 VA Form 10182, and the Board remanded the increased rating claim on November 22, 2024. In the February 26, 2025, rating decision on appeal, the AOJ continued the 20 percent evaluation for the Veteran's service-connected left shoulder disability. As such, the Board finds that the period on appeal begins as of December 30, 2020, as this was the date that the AOJ identified for an increased 20 percent rating in accordance with the Veteran's signature on his January 12, 2021, VA Form 21-526EZ. Additionally, 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).

The Veteran is in receipt of a 20 percent evaluation under Diagnostic Codes 5201-5003. The rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended, effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id. If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110 (g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110 (g) can be no earlier than the effective date of that change.

Prior to February 7, 2021, Diagnostic Code 5201 provided for ratings based on limitation of motion of the arm. Specifically, Diagnostic Code 5201 provided a 20 percent rating for limitation of motion of the minor arm at shoulder level and for limitation of motion of the minor arm midway between side and shoulder level. A 30 percent evaluation is warranted for limitation of motion of the minor arm to 25 degrees from side. 38 C.F.R. § 4.74a, Diagnostic Code 5201 (2020).

Effective February 7, 2021, Diagnostic Code 5201 was altered to clarify that midway between the side and shoulder level would be considered flexion and/or abduction limited to 45 degrees and shoulder level would be considered flexion and/or abduction limited to 90 degrees.

Normal ranges of upper extremity motion are defined by VA regulation as follows: forward elevation (flexion) from zero to 180 degrees; abduction from zero to 180 degrees; and internal and external rotation to 90 degrees. Lifting the arm to shoulder level is lifting it to 90 degrees. See 38 C.F.R. § 4.71, Plate I (2025).

Diagnostic Code 5003 states that degenerative arthritis, or osteoarthritis, when established by x-ray findings, will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints
abduction limited to 45 degrees and shoulder level would be considered flexion and/or abduction limited to 90 degrees.

Diagnostic Code 5003 states that degenerative arthritis, or osteoarthritis, when established by x-ray findings, will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion to be combined, not added under Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a, Diagnostic Code 5003 (2020). Effective February 7, 2021, Diagnostic Code 5003 was recharacterized to evaluate degenerative arthritis, other than posttraumatic, but the criteria did not change. The Veteran is already assigned a 20 percent rating based on limitation of motion for his service-connected left shoulder disability for the entire period of time on appeal. As such, an increased or separate evaluation is not warranted for his left shoulder disability under Diagnostic Code 5003.

The Board has reviewed all relevant post-service medical records, as well as the Veteran's statements. Additionally, the Veteran underwent VA shoulder examinations in February 2021 and December 2024. The evidence of record reflects that the Veteran's right arm is his dominant arm. With regard to Diagnostic Code 5201, in order to warrant a rating in excess of 20 percent, the evidence of record must reflect that the Veteran's left arm (minor arm) manifests with limitation of motion to 25 degrees from the side. The evidence of record does not reflect such a finding.

The Board notes that it was determined in a November 2024 Board remand that the February 2021 VA examination was inadequate, because the VA examiner did not provide actual or estimated range of motion on repeated use over time or during a flare up, and the examiner did not provide an explanation as why range of motion or estimated range of motion was not provided. That does not mean, however, that all the objective findings noted therein are not probative. Notably, the examination is entitled to probative value regarding the other findings in the report, as the deficiency with respect to an inadequate discussion of motion with repeated use or during flare-ups has no obvious impact on the physical findings from the examination. Accord Mozingo v. Shinseki, 26 Vet. App. 97, 107 (2012) ("even if a medical opinion is inadequate to decide a claim, it does not necessarily follow that the opinion is entitled to absolutely no probative weight...[I]f the opinion is merely lacking in detail, then it may be given some weight based upon the amount of information and analysis it contains."). The examination did not reflect the Veteran's limitation of motion of the left arm was limited to 25 degrees from the side. Active and passive range of motion revealed an abduction and a flexion to 170 degrees. No additional loss of function or range of motion was noted after 3 repetitions on repetitive-use testing. The examiner noted that the evidence did not suggest that pain, fatigability, weakness, lack of endurance, or incoordination significantly limited functional ability with repeated use over time or with flare-ups.

Additionally, the December 2024 VA examination report noted a limitation of abduction to 125 degrees and flexion to 170 degrees under active range of motion. Under passive range of motion, limitation of flexion was noted to 170 degrees and limitation of abduction was noted to 160 degrees. No additional limitations were noted after repetitive-use testing with at least 3 repetitions. The examiner specifically noted that the evidence does not suggest that pain, fatigability, weakness, lack of endurance, or incoordination significantly limits functional ability with repeated use over time or with flare-ups. Notably, the Veteran again denied flare ups. When asked about functional loss or functional impairment after repeated use over time, the Veteran reported that he experienced reduced tolerance to repetitive shoulder movements above shoulder level, lifting items over 20 pounds over shoulder level. He made no assertion that he experienced any functional loss or functional impairment with repeated use over time below shoulder level.
noted to 170 degrees and limitation of abduction was noted to 160 degrees. No additional limitations were noted after repetitive-use testing with at least 3 repetitions. The examiner specifically noted that the evidence does not suggest that pain, fatigability, weakness, lack of endurance, or incoordination significantly limits functional ability with repeated use over time or with flare-ups. Notably, the Veteran again denied flare ups. When asked about functional loss or functional impairment after repeated use over time, the Veteran reported that he experienced reduced tolerance to repetitive shoulder movements above shoulder level, lifting items over 20 pounds over shoulder level. He made no assertion that he experienced any functional loss or functional impairment with repeated use over time below shoulder level. In fact, the Veteran specifically reported his symptoms as reduced range of motion due to pain above shoulder level.

There is no other medical evidence of record reflecting a more significant loss of range of motion. Therefore, as there is no medical evidence of record reflecting that the Veteran's left shoulder disability manifests with a limitation of motion to 25 degrees from the side, an increased evaluation is not available under Diagnostic Code 5201.

The Board has reviewed the remaining diagnostic codes relating to shoulder disabilities but finds that they do not provide for an increased or separate rating under the circumstances. See 38 C.F.R. § 4.71a, Diagnostic Codes 5200, 5202, and 5203 (2025). As there is no evidence of ankylosis of the scapulohumeral articulation, flail shoulder, false flail shoulder, fibrous union of the humerus, malunion of the humerus with moderate or marked deformity, or impairment of the clavicle or scapula, an increased or separate rating is not warranted under Diagnostic Codes 5200, 5202, or 5203.

The Board has considered the holding of the Court in Chavis v. McDonough, No. 18-2928 (U.S. Vet. App., April 16, 2021), that ankylosis can be demonstrated by functional equivalent. In this case, the Board finds that the evidence of record demonstrates no such shoulder impairment consistent with the functional equivalent of ankylosis, even considering the Veteran's subjective complaints. See February 2021 and December 2024 VA examination reports. Even when pain and subjective symptoms were considered, the Veteran's left shoulder disability did not manifest with impairment consistent with the functional equivalent of ankylosis. He has not alleged functional impairment comparable to that experienced by an individual with immobility of the shoulder. His symptoms are fully contemplated by the assigned schedular rating. The DeLuca concepts of functional loss, painful motion, etc. are still used to apply the rating criteria found in the diagnostic codes. Thompson v. McDonald, 815 F.3d 781 (Fed. Cir. 2016) and Mitchell v. Shinseki, 25 Vet. App. 32, 36 (2011). The Thompson court explained: "Section 4.40 also makes clear that functional loss may be due to pain and that pain may render a part seriously disabled. When evaluating a disability, § 4.40 provides a broad canvas. However, whatever the background, an applicant for disability benefits is rated based on the criteria set forth in § 4.71a." Thompson, 815 F.3d at 786.

In sum, while the medical evidence of record has indicated that the Veteran's disability affects his mobility, the evidence does not reflect that this limitation is equivalent to ankylosis or that the Veteran does not retain some range of motion. Therefore, the Board finds there is no evidence in the record reflecting that the Veteran's service-connected disability manifests with ankylosis of the left shoulder or with the functional equivalent of ankylosis. An increased evaluation is not warranted under the diagnostic criteria for rating shoulder disabilities on the basis of ankylosis.

With respect to the possibility of assigning a higher rating for any period of time on appeal under 38 C.F.R. §§ 4.40 and 4.45, there is no indication in the medical evidence of record, to include the February 2021 and December 2024 VA shoulder examination reports, that any subjective complaints, such as pain, fatigue, incoordination, or weakness, result in additional limitation of function so as to meet the criteria for a higher evaluation than has already been assigned or for any separate evaluations for any period of time on appeal. As such, an increased rating is not warranted under 38 C.F.R. §§ 4.40 and 4.45 or DeLuca.

In summary, for the reasons and bases set forth above, the Board concludes that the
time on appeal under 38 C.F.R. §§ 4.40 and 4.45, there is no indication in the medical evidence of record, to include the February 2021 and December 2024 VA shoulder examination reports, that any subjective complaints, such as pain, fatigue, incoordination, or weakness, result in additional limitation of function so as to meet the criteria for a higher evaluation than has already been assigned or for any separate evaluations for any period of time on appeal. As such, an increased rating is not warranted under 38 C.F.R. §§ 4.40 and 4.45 or DeLuca.

In summary, for the reasons and bases set forth above, the Board concludes that the preponderance of the evidence is against the claim for an increased rating, and the benefit of the doubt rule enunciated in 38 U.S.C. § 5107 (b) is not for application.

The Veteran has not raised the issue of an extraschedular evaluation through his statements, and the evidence of record does not raise this issue through documentation of symptoms not contemplated by the rating criteria.

Entitlement to service connection for restless leg syndrome is denied.

Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303 (b). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303 (d).

To establish a right to compensation for a present disability, a claimant must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service"-the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

The law provides for compensation for Persian Gulf Veterans who suffer from a chronic disability resulting from an undiagnosed illness or medically unexplained chronic multi-symptom illness that became manifest during active duty in the Southwest Asia theater of operations or became manifest to a compensable degree within the prescribed presumptive period and by history, physical examination, and laboratory tests, cannot be attributed to any known clinical diagnosis. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317. The Board notes that the Veteran qualifies as a Persian Gulf Veteran as he served on active military service in Southwest Asia. See July 2024 VA Memorandum; 38 U.S.C. § 1117 (West 2014); 38 C.F.R. § 3.317 (2024).

The Veteran contends he has restless leg syndrome related to his service in the Persian Gulf. See VA Form 21-526EZ, January 2021.

In a November 2020 private Report of Consultation and Examination, Dr. M.T., D.C., noted that the Veteran has suffered from restless leg syndrome and has been progressive symptomatic since his Gulf War service without hiatus. She determined that "it is as likely as not that the aforementioned is directly and causally related to Gulf War syndrome per the presumptions (neurological) published in the Gulf War. Winter 2016. www.publichealth.va.gov." It is as likely as not that the same is directly and causally related to the Veteran's military service. This is a permanent condition, which had its onset during deployment to the Southwest Asia Theater of Military Operations and has persisted to the present.

In a February 2021 VA examination, it was noted that, for the Veteran's claimed condition of restless leg syndrome, there is no diagnosis, because there are no findings, signs, and/or symptoms to support a diagnosis.

In a December 2024 VA Peripheral Nerves Conditions examination report, the Veteran was noted as not having a peripheral nerve condition or peripheral neuropathy. The examiner noted that the Veteran does not have a diagnosis of a peripheral nerve condition or symptoms consistent with a peripheral nerve condition. The Veteran reported that he began to start moving or bouncing his leg when sitting since 2014 and had leg cramping while in service in both calves. The Veteran reported that his condition continued with repetitive leg movement that he stated is automatic but can stop and start action at will. He denied a workup for condition or functional impact related to the complaints. He denied all common symptoms related to a restless leg or peripheral nerve condition other than the complaint noted above. The examiner noted that symptoms expressed were vague and non-specific to a condition diagnosable on a VA examination without previous workup.

In a December 2024 VA opinion, the VA examiner determined that the claimed condition was less likely than not caused by the indicated toxic exposure risk activities (TERAs), after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all TERAs. There is no medical or scientific evidence available that identifies a causal relationship between the TERAs and the development of the claimed condition of restless leg syndrome. Additionally, the Veteran does not have a diagnosis of a peripheral nerve condition or a condition affecting the extremities that could mirror or have similar symptoms to a restless leg syndrome condition. It is therefore less likely than not that restless leg syndrome is related to service. A nexus has not been established.

The threshold requirement for service connection is competent evidence of the existence of the claimed disability at some point during the course of the appeal or in proximity to the claim. 38 U.S.C. § 1110; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that interpretation of 38 U.S.C. §§ 1110 and 1131 as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary); see also McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

Upon review of the claims file, the Board notes that there is an indication in the November 2020 private Report of Consultation and Examination from Dr. M.T., D.C., that the Veteran has restless leg syndrome. However, the Board finds this evidence is not probative. Specifically, the provider offered no rationale or findings to support such a diagnosis. Moreover, the symptoms that led the provider to this conclusion were not discussed. As such, the Board finds this medical record is not probative in terms of providing a diagnosis of restless leg syndrome.

There is no other medical evidence of record showing that the Veteran has a current diagnosis of restless leg syndrome throughout the period of time on appeal. As noted above, VA examinations from February 2021 and December 2024 both concluded that the veteran did not have a diagnosis related to restless leg syndrome. There is no probative medical evidence of record to the contrary.

The Court has held that the requirement of a current disability is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim. McClain v. Nicholson, 21 Vet. App. 319, 312 (2007). A claimant may be granted service connection even though the disability resolves prior to the Secretary's adjudication of the claim. Id.

In the absence of proof of related current disability, there can be no valid claim. Brammer, 3 Vet. App. at 225. Therefore, as there is no probative evidence reflecting that the Veteran has a current diagnosis of restless leg syndrome, service connection cannot be granted for this claimed disability.

The Board notes that the Veteran is competent to report symptoms such as pain. Historically, symptoms such as pain, without a diagnosed or identifiable underlying malady, were not sufficient to establish a current disability for VA compensation purposes. Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999) (Sanchez-Benitez I). However, in Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), the United States Court of Appeals for the Federal Circuit rejected such a theory, holding that pain can constitute a current disability under 38 U.S.C. § 1110, so long as it results in functional impairment of earning capacity.

Here, the Veteran has not established that he has any symptoms related to his claimed disability that result in a functional impairment which limits his earning capacity in any way. There is simply no medical evidence in the record documenting such. While the Veteran reported at the December 2024 VA examination that he moved or bounced his leg when sitting, he also reported that he can stop and start this repetitive leg movement at will. It does not appear that his claimed condition has required him to seek treatment on any regular basis, nor does he indicate that he has lost work opportunities or that his earning capacity has been impaired as a result of this claimed condition. Consequently, the Board finds that the Veteran has not alleged any specific complaints that would qualify as a current disability for VA purposes under Sanchez-Benitez I and Saunders.

The Board has considered the Veteran's assertion that he should be granted service connection for this claimed disability. However, the Board finds that the Veteran is not competent to diagnose himself with restless leg syndrome, as he has no medical education, training, or expertise. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). As such, the Veteran's opinion is afforded little weight in that regard.

With regard to granting service connection on a presumptive basis under 38 C.F.R. § 3.317, the Board notes that there is currently no probative lay or medical evidence of record documenting related symptoms other than his report of moving or bouncing his leg, which he essentially indicated at the December 2024 VA examination is not an involuntary symptom but something he can stop and start of his own accord. Therefore, service connection cannot be granted as due to an undiagnosed illness on a presumptive basis under 38 C.F.R. § 3.317, given that no current symptoms related to claims of restless leg syndrome have been identified.

Finally, to the extent the Veteran raised complaints about his leg calves cramping, he is already service-connected for this issue.

In summary, for the reasons stated above, the Board finds that the preponderance of the evidence is against the claim for service connection for restless leg syndrome, and the benefit-of-the-doubt rule is not for application.

MICHELLE L. KANE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board L. Durham, 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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