ADJUSTMENT DISORDER

DAVID L. WIGHT · 2026 · Case ID: A26030273

MIXED

Summary

The Veteran, who served in the United States Army across multiple periods including January 1967 to February 1970, March 2002 to August 2002, and September 2002 to March 2009, appeals several denials and remands related to various medical conditions. The Veteran sought service connection or increased ratings for adjustment disorder with mixed anxiety and depressed mood, polychondritis, myelodysplastic syndrome (MDS), coronary artery disease status post myocardial infarction and stent, diabetes mellitus, chronic kidney disease, bilateral lower extremity diabetic peripheral neuropathy, left knee degenerative arthritis, left knee instability with posttraumatic degenerative arthritis, basal cell carcinoma residuals, and hypertension. The Board granted service connection for adjustment disorder with mixed anxiety and depressed mood at 70% and polychondritis at 100%. However, the Board denied claims for MDS, coronary artery disease, diabetes mellitus, chronic kidney disease, bilateral lower extremity diabetic peripheral neuropathy, basal cell carcinoma residuals, and hypertension, finding the criteria for higher evaluations or service connection were not met. The Board also granted special monthly compensation (SMC) based on aid and attendance. The claims for left knee degenerative arthritis and left knee instability with posttraumatic degenerative arthritis were remanded for additional development, specifically for a new VA examination to consider the ameliorative effects of medication on the Veteran's left knee condition.

Rationale

Criteria for 70% rating met; Occupational and social impairment with deficiencies

Service Branch

ARMY

Special Benefit

SMC - AID & ATTENDANCE

Docket No.

251119-629783

Full Decision Text

Citation Nr: A26030273
Decision Date: 04/02/26 Archive Date: 04/02/26

DOCKET NO. 251119-629783
DATE: April 2, 2026

ORDER

Entitlement to an evaluation of 70 percent, but not higher, for adjustment disorder with mixed anxiety and depressed mood is granted.

Entitlement to an evaluation of 100 percent for polychondritis is granted.

Entitlement to an evaluation in excess of 100 percent for myelodysplastic syndrome (MDS) is denied.

Entitlement to an evaluation in excess of 10 percent for coronary artery disease status post myocardial infarction and stent is denied.

Entitlement to an evaluation in excess of 20 percent for diabetes mellitus is denied.

Entitlement to a compensable evaluation for chronic kidney disease is denied.

Entitlement to an evaluation in excess of 10 percent for right lower extremity diabetic peripheral neuropathy; sciatic nerve is denied.

Entitlement to an evaluation in excess of 10 percent for left lower extremity diabetic peripheral neuropathy; sciatic nerve is denied.

Entitlement to a compensable evaluation for basal cell carcinoma, residuals, is denied.

Entitlement to a compensable evaluation for hypertension is denied.

Entitlement to special monthly compensation (SMC) based on aid and attendance is granted.

REMANDED

Entitlement to an evaluation in excess of 10 percent for left knee degenerative arthritis is remanded.

Entitlement to an evaluation in excess of 10 percent for left knee instability with posttraumatic degenerative arthritis is remanded.

FINDINGS OF FACT

1. Throughout the period on appeal, the Veteran's symptoms related to his diagnosed major depressive disorder were manifested by occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking, or mood mainly due to his near continuous depression; total occupational and social impairment is not shown.

2. Throughout the period on appeal, the Veteran's polychondritis manifested in exacerbations with a frequency of three or more times per year producing severe impairment of health.

3. From November 17, 2022, the Veteran's MDS has been assigned a 100 percent evaluation, which is the maximum authorized rating under Diagnostic Code 7725.

4. Throughout the period on appeal, the Veteran's coronary artery disease status post myocardial infarction and stent requires treatment with continuous medication for control, but metabolic equivalent testing (MET) does not show that a workload of 7.0 METs or less results in heart failure symptoms, and there is no evidence of cardiac hypertrophy or dilatation confirmed by echocardiogram or equivalent.

5. Throughout the period on appeal, the Veteran's diabetes mellitus type II did not require one or more daily injections of insulin, restricted diet, and regulation of activities.

6. Throughout the period on appeal, the Veteran's diabetic nephropathy did not manifest with GFR less than 59 mL/min/1.73 m2 for at least three consecutive months during the past twelve months.

7. Throughout the period on appeal, the Veteran's right lower extremity diabetic peripheral neuropathy; sciatic nerve is manifest by no more than mild incomplete paralysis; moderate incomplete paralysis is not shown.

8. Throughout the period on appeal, the Veteran's left lower extremity diabetic peripheral neuropathy; sciatic nerve is manifest by no more than mild incomplete paralysis; moderate incomplete paralysis is not shown.

9. Throughout the period on appeal, the Veteran's basal cell carcinoma, residuals, is not manifested by at least one characteristic of disfigurement or as a scar associated with underlying soft tissue or impairment of function.

10. Throughout the period on appeal, the Veteran's hypertension did not manifest in diastolic pressure predominantly 100 or more; or systolic pressure predominantly 160 or more. Also, the Veteran did not have a history of diastolic pressure predominantly 100 or more that requires continuous medication for control.

11. The evidence is approximately evenly balanced as to whether, due to the effects of service connected disabilities, the Veteran requires the regular aid and attendance of another person.

CONCLUSIONS OF LAW

1. The criteria for entitlement to an evaluation of 70 percent, but not higher, for adjustment disorder with mixed anxiety and depressed mood have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, DC 9440.

2. The criteria for entitlement to an evaluation of 100 percent for polychondritis have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3
regular aid and attendance of another person.

CONCLUSIONS OF LAW

2. The criteria for entitlement to an evaluation of 100 percent for polychondritis have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.88b, DC 6399-6350.

3. The criteria for entitlement to an evaluation in excess of 100 percent for myelodysplastic syndrome (MDS) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.117, DC 7725.

4. The criteria for entitlement to an evaluation in excess of 10 percent for coronary artery disease status post myocardial infarction and stent have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.104, DC 7005-7006.

5. The criteria for entitlement to an evaluation in excess of 20 percent for diabetes mellitus have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.119, DC 7913.

6. The criteria for entitlement to a compensable evaluation for chronic kidney disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.115a, 4.115b, DC 7530.

7. The criteria for entitlement to an evaluation in excess of 10 percent for right lower extremity diabetic peripheral neuropathy; sciatic nerve have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520.

8. The criteria for entitlement to an evaluation in excess of 10 percent for left lower extremity diabetic peripheral neuropathy; sciatic nerve have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520.

9. The criteria for entitlement to a compensable evaluation for basal cell carcinoma, residuals, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.118, DC 7819.

10. The criteria for entitlement to a compensable evaluation for hypertension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.104, Diagnostic Code 7101.

11. The criteria for entitlement to special monthly compensation (SMC) based on aid and attendance have been met. 38 U.S.C. § 1114(l).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served in the United States Army from January 1967 to February 1970, from March 2002 to August 2002, and from September 2002 to March 2009.

In February 2025, the agency of original jurisdiction (AOJ) continued its 10 percent evaluation of coronary artery disease status post myocardial infarction and stent. Also, the AOJ continued its 20 percent evaluation of diabetes mellitus. Moreover, the AOJ granted service connection for chronic kidney disease associated with herbicide exposure with a noncompensable evaluation effective November 17, 2022. In addition, the AOJ granted service connection for bilateral lower extremity diabetic peripheral neuropathy, sciatic nerve (also claimed as bilateral lower extremity radiculopathy) with a 10 percent evaluation effective November 17, 2022. Furthermore, the AOJ continued its 10 percent evaluation for left knee degenerative arthritis. Equally, the AOJ continued its 10 percent evaluation for left knee instability with posttraumatic degenerative arthritis. Likewise, the AOJ continued its noncompensable evaluation for basal cell carcinoma, residuals. Lastly, the AOJ continued its noncompensable evaluation for hypertension.

In March 2025, the AOJ granted service connection for polychondritis with an evaluation of 60 percent effective November 17, 2022. Also, the AOJ granted service connection for adjustment disorder with mixed anxiety and depressed mood with an evaluation of 50 percent effective November 17, 2022.

In September 2025, the AOJ continued its 100 percent evaluation for MDS.

In the November 19, 2025, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.

Therefore, the Board may only consider the evidence of record at the time of the: (1) February 2025 AOJ decision on appeal for the claims related to coronary artery disease, diabetes mellitus, chronic kidney disease, bilateral lower extremity peripheral neuropathy, left knee conditions, basal cell carcinoma, and hypertension; (2) March 2025 AOJ decision on appeal for the claims related to polychondritis and adjustment disorder with mixed anxiety and depressed mood; and (3) September 2025 AOJ decision on appeal for the claim related to MDS, as well as any evidence submitted by the Veteran [or representative] with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

However, because the Board is remanding the claims of increased rating related to the left knee conditions, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

1. Entitlement to an evaluation of 70 percent, but not higher, for adjustment disorder with mixed anxiety and depressed mood is granted.

Disability ratings are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. See 38 C.F.R. § 4.3.

Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. When determining the appropriate disability evaluation to assign, the Board's primary consideration is the veteran's symptoms, but it must also make findings as to how those symptoms impact a veteran's occupational and social impairment. Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). 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. Id. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013)

A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity.

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.

A 100 percent 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.

As a procedural starting point for this claim, on November 17, 2022, the Veteran submitted an intent to file claim followed by a January 2023 fully developed claim for service connection for depression.

In May 2023, the Veteran underwent a mental disorders VA examination. The VA examiner noted a diagnosis of adjustment disorder with mixed anxiety and depressed mood. The VA examiner assessed that the Veteran's condition is best summarized as occupational and social impairment with reduced reliability and productivity. Also, the VA examiner acknowledged the Veteran's report of him spending his days "on the couch looking out the window and going back and forth to the bathroom and bed". Moreover, the VA examiner considered the Veteran's description of feeling "useless" due to his multiple health conditions. In addition, even though the Veteran denied specific suicidal ideation, he stated that sometimes he feels "like giving up" and mentioned that he has contemplated discontinuing medical care and being "put out on the porch" due to him feeling "not good for anything". The VA examiner listed the following symptoms in relation to his mental health condition: depressed mood; chronic sleep impairment; impairment of short and long term memory, for example, retention of only highly learned material, while forgetting to complete task; flattened affect; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships.

In July 2023, the AOJ in its rating decision denied service connection for depression.

In September 2024, the AOJ in its rating decision identified a duty
the Veteran denied specific suicidal ideation, he stated that sometimes he feels "like giving up" and mentioned that he has contemplated discontinuing medical care and being "put out on the porch" due to him feeling "not good for anything". The VA examiner listed the following symptoms in relation to his mental health condition: depressed mood; chronic sleep impairment; impairment of short and long term memory, for example, retention of only highly learned material, while forgetting to complete task; flattened affect; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships.

In July 2023, the AOJ in its rating decision denied service connection for depression.

In September 2024, the AOJ in its rating decision identified a duty to assist error in the claim related to adjustment disorder with depressed mood.

In October 2024, the Veteran underwent a mental disorders VA examination. The VA examiner noted a diagnosis of adjustment disorder with mixed anxiety and depressed mood. The VA examiner assessed that the Veteran's condition is best summarized as occupational and social impairment with reduced reliability and productivity. During the examination, the Veteran described his relationship with his spouse as excellent. Also, the Veteran reported significant depression due to serious medical conditions. The VA examiner listed the following symptoms in relation to his mental health condition: depressed mood; anxiety; suspiciousness; chronic sleep impairment; flattened affect; difficulty in establishing and maintaining effective work and social relationships; and difficulty adapting to stressful circumstances, including work or a work like setting.

In February 2025, the AOJ in its rating decision deferred its decision on entitlement to compensation for adjustment disorder with depressed mood.

In March 2025, the AOJ in its rating decision granted service connection for adjustment disorder with mixed anxiety and depressed mood with an evaluation of 50 percent effective November 17, 2022.

In November 2025, the Veteran submitted a VA Form 10182 Notice of Disagreement.

Upon review of the evidence of record, the Board finds that a 70 percent evaluation for adjustment disorder with mixed anxiety and depressed mood is warranted. As mentioned before, the May 2023 VA examination highlighted the Veteran's report of him spending his days on the couch, looking out the window, and going back and forth from the bathroom to his bed. Also, this examination noted the Veteran's description of feeling "useless" due to his multiple health conditions and his feelings of "giving up" and not continuing with his medical care. Equally, the October 2024 VA examination included the Veteran's report of having significant depression due to his serious medical conditions. In both examinations, the VA examiner duly assessed that the Veteran has symptoms of depressed mood that are encompassed by his mental health diagnosis. Moreover, particularly in the October 2024 VA examination, the examiner determined that the Veteran has difficulty in adapting to stress circumstances, including work or a work like setting. The Board considers that the frequency, duration, and severity of this symptomatology is encompassed by a 70 percent evaluation under Diagnostic Code 9440. The Veteran's report and acknowledgement by the VA examiner clearly demonstrate a degree of symptoms related to near continuous depression, which evidently affects independent, appropriate, or effective function that can be categorized as causing an impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking, or mood.

Furthermore, a 100 percent evaluation is not applicable because the evidence of record demonstrates that the Veteran has not exhibited severe psychotic symptoms that are evidence of disturbances of mind that affect an individual's ability to function normally in society. Active delusions, hallucinations, severe memory loss, homicidal ideation, obsessive rituals that interfere with routine activities and illogical speech would be examples of such symptoms. Objective findings did not include repetitive motions, irregular speech, or the inability to think logically. Also, the Veteran did not make any indication of experiencing disorientation or perpetuating or considering violence against himself or others. Therefore, a review of the record for this period does not indicate total social and occupational impairment.

Given the foregoing, entitlement to an evaluation of 70 percent, but not higher, for adjustment disorder with mixed anxiety and depressed mood is granted.

2. Entitlement to an evaluation of 100 percent for polychondritis is granted.

The Veteran's polychondritis is rated under Diagnostic Code 6399-6350, for lupus erythematosis, systemic (disseminated). Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the rating assigned. The additional code is shown after a hyphen. 38 C.F.R. § 4.27. The AOJ indicated that the Veteran's service connected polychondritis is not specifically listed in the rating schedule. Thus, it is rated analogous to a disability in which not only the functions affected, but anatomical localization and symptoms, are
itlement to an evaluation of 100 percent for polychondritis is granted.

A 10 percent rating is warranted for exacerbations once or twice a year or symptomatic during the past two years. A 60 percent rating is applicable for exacerbations lasting a week or more, 2 or 3 times per year. A 100 percent rating is proper for acute, with frequent exacerbations, producing severe impairment of health, not to be combined with ratings under DC 7809 (discoid lupus erythematosus).

This Diagnostic Code also includes a note which instructs to evaluate this condition either by combining the evaluations for residuals under the appropriate system, or by evaluating DC 6350, whichever method results in a higher evaluation.

The Board notes that the terms "frequent" and "severe impairment of health" are not defined in the rating schedule. Rather than applying a mechanical formula, VA must evaluate all the evidence to the end that its decisions are equitable and just. 38 C.F.R. § 4.6. As with any regulatory interpretation, however, where the terms are not defined in the regulation it is reasonable to presume those terms carry their ordinary dictionary meaning. See Moody v. Wilkie, 30 Vet. App. 329, 336 (2018); see also Kisor v. Wilkie, 139 S. Ct. 2400, 2415 (2019) (holding that where regulatory terms are unambiguous, the plain meaning dictionary definition can be used). According to Merriam Webster's Collegiate Dictionary 999 (11th Ed. 2007), "frequent" means common, unusual, or happening at short intervals: often repeated or occurring or acting or returning regularly or often, and "severe" means very painful or harmful or of a great degree. (Last visited on March 26, 2026).

In July 2023, the AOJ in its rating decision deferred its decision to compensation for polychondritis.

In August 2023, the AOJ in its rating decision denied service connection for polychondritis.

In September 2023, the Veteran submitted a supplemental claim for service connection for polychondritis.

In October 2023, the AOJ in its rating decision continued its previous denial of service connection for polychondritis.

In October 2023, the Veteran submitted a supplemental claim for service connection for polychondritis.

In November 2023, the AOJ in its rating decision continued its previous denial of service connection for polychondritis.

In September 2024, the AOJ in its rating decision identified a duty to assist error in the claims related to polychondritis.

In November 2024, the Veteran underwent a systemic lupus erythematosus (SLE) and other autoimmune diseases VA examination. The VA examiner noted a diagnosis of polychondritis that included a treatment plan of constant/near-constant oral corticosteroids in the twelve months prior to this examination. The VA examiner stated that the impact of this condition has caused a lot of hearing loss and has led to severe flareups impacting all mobility and comfort. In addition, the VA examiner remarked that this condition has impacted the Veteran mentally as well as impacting his ability to do things he used to be able to do or take care of himself. Also, the VA examiner indicated that the Veteran's condition is chronic. Moreover, the VA examiner assessed that the Veteran has an average frequency of more than 3 exacerbations per year that last less than one week. However, the VA examiner considered that the Veteran's condition does not produce severe impairment of health. Lastly, the VA examiner remarked that the Veteran's condition impacts his ability to complete daily activities during flare-ups.

In February 2025, the AOJ in its rating decision deferred its decision on entitlement to compensation for polychondritis.

In March 2025, the AOJ in its rating decision granted service connection for pol
as well as impacting his ability to do things he used to be able to do or take care of himself. Also, the VA examiner indicated that the Veteran's condition is chronic. Moreover, the VA examiner assessed that the Veteran has an average frequency of more than 3 exacerbations per year that last less than one week. However, the VA examiner considered that the Veteran's condition does not produce severe impairment of health. Lastly, the VA examiner remarked that the Veteran's condition impacts his ability to complete daily activities during flare-ups.

In February 2025, the AOJ in its rating decision deferred its decision on entitlement to compensation for polychondritis.

In March 2025, the AOJ in its rating decision granted service connection for polychondritis with an evaluation of 60 percent effective November 17, 2022.

In November 2025, the Veteran submitted a VA Form 10182 Notice of Disagreement.

Upon review of the evidence of record, the Board finds that an evaluation of 100 percent for polychondritis is warranted. As highlighted before, the November 2024 VA examination showed that the Veteran's condition has an average frequency of more than three exacerbations per year. However, the VA examiner determined that the Veteran's polychondritis does not produce severe impairment of health. Notwithstanding, the Board considers that this determination is inconsistent with the examiner's own description of the Veteran's condition. In the examination report, the VA examiner clearly noted that this condition has caused hearing loss and has led to severe flareups impacting all mobility and comfort. The Board assesses that it is clear from this description that the Veteran's condition produces severe impairment of health. Also, the Board interprets the VA examiner's assessment of the Veteran having more than three exacerbations per year to meet the criteria of Diagnostic Code 6350 for the exacerbations to be classified as "frequent". This is the highest available option for frequency in the VA examination template. As commented before, Diagnostic Code 6350 does not have a precise definition of frequency and thus, the Board gives the benefit to the doubt to the Veteran. See, 38 C.F.R. § 4.3.

Given the foregoing, entitlement to an evaluation of 100 percent for polychondritis is granted.

3. Entitlement to an evaluation in excess of 100 percent for myelodysplastic syndrome (MDS) is denied.

The Veteran's myelodysplastic syndrome is currently rated as 0 percent under 38 C.F.R. § 4.117, Diagnostic Code 7725, which pertains to myelodysplastic syndromes. In relevant part under Diagnostic Code 7725, a 30 percent rating is warranted with myelodysplastic syndromes requiring at least 1 but no more than 3 blood or platelet transfusions per 12-month period; infections requiring hospitalization at least 1 but no more than 2 times per 12-month period; or requiring biologic therapy on an ongoing basis or erythropoiesis stimulating agent (ESA) for 12 weeks or less per 12-month period. A 60 percent rating warranted with myelodysplastic syndromes requiring 4 or more blood or platelet transfusions per 12-month period; or infections requiring hospitalization 3 or more times per 12-month period. A 100 percent rating is warranted with myelodysplastic syndromes requiring peripheral blood or bone marrow stem cell transplant; or requiring chemotherapy.

Note 1 states that if the condition progresses to leukemia, evaluate as leukemia under diagnostic code 7703.

Note 2 states a 100 percent evaluation shall be assigned as of the date of hospital admission for peripheral blood or bone marrow stem cell transplant, or during the period of treatment with chemotherapy, and shall continue with a mandatory VA examination six months following hospital discharge or, in the case of chemotherapy treatment, six months after completion of treatment. Any reduction in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) of this chapter. If there has been no recurrence, residuals will be rated under the appropriate diagnostic codes. 38 C.F.R. § 4.117.

As a procedural starting point for this claim, on November 17, 2022, the Veteran submitted an intent to file claim followed by a January 2023 fully developed claim for service connection for MDS.

In November 2024, the AOJ in its rating decision implemented the November 2024 Board decision and granted service connection for MDS with an evaluation of 100 percent effective November 17, 2022. Also, the AOJ indicated that this issue is further deferred to determine the current level of the Veteran's disability.

In September 2025, the AOJ in
If there has been no recurrence, residuals will be rated under the appropriate diagnostic codes. 38 C.F.R. § 4.117.

As a procedural starting point for this claim, on November 17, 2022, the Veteran submitted an intent to file claim followed by a January 2023 fully developed claim for service connection for MDS.

In September 2025, the AOJ in its rating decision continued its 100 percent evaluation for MDS. The AOJ indicated that this is the highest schedular evaluation allowed under the law for myelodysplastic syndromes.

In November 2025, the Veteran submitted a VA Form 10182 Notice of Disagreement.

Upon review of the evidence of record, the Board finds that an evaluation in excess of 100 percent for MDS is not warranted. The Veteran submitted his Notice of Disagreement and noted that he seeks an increased rating for MDS. However, the Veteran has been assigned a 100 percent evaluation for MDS effective November 17, 2022, which is the maximum schedular rating available under Diagnostic Code 7725.

Given the foregoing and since there is no legal basis upon which to award any higher rating for MDS, the Veteran's appeal must be denied. See, Sabonis v. Brown, 6 Vet. App. 426 (1994).

4. Entitlement to an evaluation in excess of 10 percent for coronary artery disease status post myocardial infarction and stent is denied.

The Veteran's coronary artery disease status post myocardial infarction and stent is rated under Diagnostic Code 7005-7006, for myocardial infarction. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the rating assigned. The additional code is shown after a hyphen. 38 C.F.R. § 4.27. Diagnostic Code 7005 rates arteriosclerotic heart disease (coronary artery disease). 38 C.F.R. § 4.104.

Effective November 14, 2021, under 38 C.F.R. § 4.104, DC 7006 is rated in accordance with the General Rating Formula for Diseases of the Heart. A 10 percent rating is warranted where a workload of 7.1-10.0 METs results in heart failure symptoms, or continuous medication is required for control. A 30 percent rating is warranted where a workload of 5.1-7.0 METs results in heart failure symptoms, or where there is cardiac hypertrophy or dilatation confirmed by echocardiogram or equivalent (e.g., multigated acquisition scan or magnetic resonance imaging). A 60 percent rating is warranted where a workload of 3.1-5.0 METs results in heart failure symptoms. A 100 percent rating is warranted where a workload of 3.0 METs or less results in heart failure symptoms.

Under the post-amendment rating criteria, one MET is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. 38 C.F.R. § 4.104, Note (2). When the level of METs at which breathlessness, fatigue, angina, dizziness, or syncope develops is required for evaluation, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in those symptoms may be used. Id.

For purposes of the General Rating Formula for Diseases of the Heart, heart failure symptoms include, but are not limited to, breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope. 38 C.F.R. § 4.104, Note (3).

As a procedural starting point for this claim, on November 17, 2022, the Veteran submitted an intent to file claim followed by a January 2023 fully developed claim for increased rating for coronary artery disease. The appeal period includes the one year look back period prior to the date of the increased rating claim. Gaston v. Shinseki, 605 F. 3d 979, 982 (Fed. Cir. 2010).

In June 2023, the Veteran underwent a heart conditions
, but are not limited to, breathlessness, fatigue, angina, dizziness, arrhythmia, palpitations, or syncope. 38 C.F.R. § 4.104, Note (3).

In June 2023, the Veteran underwent a heart conditions VA examination. The VA examiner noted a diagnosis of coronary artery diseases status post myocardial infarction and stent. Also, the VA examiner highlighted that the condition has been treated with medications such as Metoprolol tartrate 25mg and Nifedipine 30mg. The VA examiner conducted an interview based metabolic equivalents (METs) test. The VA examiner remarked that an exercise stress testing is not required as part of the Veteran's current treatment plan and that this test is not without significant risk. In addition, the VA examiner pointed out that the Veteran reported the following symptoms at his lowest activity level of 1-3 METs: breathlessness and fatigue. The VA examiner did not provide an estimated METs due solely to the cardiac condition.

In July 2023, the AOJ in its rating decision deferred its evaluation of coronary artery disease post myocardial infarction and stent, which is currently 10 percent.

In August 2023, the Veteran underwent a heart conditions VA examination. The VA examiner noted a diagnosis of coronary artery diseases status post myocardial infarction and stent. Also, the VA examiner highlighted that the condition has been treated with medications such as Metoprolol tartrate 50mg, Nifedipine, and Diltizem 60mg. Moreover, the VA examiner indicated that the Veteran had a myocardial infarction in 2003. The VA examiner conducted an interview based metabolic equivalents (METs) test. The VA examiner remarked that an exercise stress testing is not required as part of the Veteran's current treatment plan and that this test is not without significant risk. In addition, the VA examiner pointed out that the Veteran reported the following symptoms at his lowest activity level of 1-3 METs: breathlessness, fatigue, angina, dizziness, and syncope. The VA examiner estimated that the Veteran's METs level due solely to the cardiac condition was more than 7-10 METs.

In August 2023, the AOJ in its rating decision continued its 10 percent evaluation of coronary artery disease status post myocardial infarction and stent.

In September 2023, the Veteran submitted a supplemental claim for an increased rating for coronary artery disease.

In October 2023, the AOJ in its rating decision deferred its decision for the claim for an increased evaluation for coronary artery disease status post myocardial infarction and stent.

In October 2023, the Veteran underwent a heart conditions VA examination. The VA examiner noted a diagnosis of coronary artery diseases status post myocardial infarction and stent. Also, the VA examiner highlighted that the condition has been treated with or by stent placement and with medications such as Metoprolol tartrate 50mg, Nifedipine 30mg, Diltiazem ER 60mg, Brilinta 80mg, and Nitroglycerin. Moreover, the VA examiner indicated that the Veteran had a myocardial infarction in 2003. The VA examiner conducted an interview based metabolic equivalents (METs) test. The VA examiner remarked that an exercise stress testing is not required as part of the Veteran's current treatment plan and that this test is not without significant risk. In addition, the VA examiner pointed out that the Veteran reported the following symptoms at his lowest activity level of 1-3 METs: breathlessness, fatigue, angina, dizziness, and syncope. The VA examiner estimated that the Veteran's METs level due solely to the cardiac condition was more than 7-10 METs.

In November 2023, the AOJ in its rating decision continued its 10 percent evaluation of coronary artery disease status post myocardial infarction and stent.

In September 2024, the AOJ in its rating decision identified a duty to assist error in the claims related to coronary artery disease post myocardial infarction.

In November 2024, the Veteran underwent a heart conditions VA examination. The VA examiner noted a diagnosis of coronary artery diseases status post myocardial infarction and stent. Also, the VA examiner highlighted that
fatigue, angina, dizziness, and syncope. The VA examiner estimated that the Veteran's METs level due solely to the cardiac condition was more than 7-10 METs.

In November 2023, the AOJ in its rating decision continued its 10 percent evaluation of coronary artery disease status post myocardial infarction and stent.

In September 2024, the AOJ in its rating decision identified a duty to assist error in the claims related to coronary artery disease post myocardial infarction.

In November 2024, the Veteran underwent a heart conditions VA examination. The VA examiner noted a diagnosis of coronary artery diseases status post myocardial infarction and stent. Also, the VA examiner highlighted that the condition has been treated with or by stent placement in April 2003 and January 2023 and with medications such as Metoprolol tartrate 25mg, Nifedipine, and Rosuvastatin. Moreover, the VA examiner indicated that the Veteran had a myocardial infarction in May 2003. The VA examiner conducted an interview based metabolic equivalents (METs) test. The VA examiner remarked that an exercise stress testing is not required as part of the Veteran's current treatment plan and that this test is not without significant risk. In addition, the VA examiner pointed out that the Veteran reported the following symptoms at his lowest activity level of 1-3 METs: breathlessness, fatigue, angina, dizziness, and syncope. The VA examiner estimated that the Veteran's METs level due solely to the cardiac condition was more than 7-10 METs.

In February 2025, the AOJ in its rating decision continued its 10 percent evaluation of coronary artery disease status post myocardial infarction and stent.

In November 2025, the Veteran submitted a VA Form 10182 Notice of Disagreement.

Upon review of the evidence of record, the Board finds that an evaluation in excess of 10 percent for coronary artery disease status post myocardial infarction and stent is not warranted. As discussed above, a 30 percent rating is not warranted unless a workload of 5.1-7.0 METs results in heart failure symptoms, or there is cardiac hypertrophy or dilatation confirmed by echocardiogram or equivalent. The various VA examinations show that the Veteran's heart failure symptoms fall within the range of 7-10 METs. Also, the examinations clearly specify that during the period on appeal the Veteran has not had any evidence of hypertrophy or dilatation. Thus, the Board concludes that the Veteran's coronary artery disease status post myocardial infarction and stent did not meet the criteria for at least a 30 percent evaluation.

The Board highlights that the Veteran is competent to report readily observable symptoms. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, the Board finds that while the Veteran is competent to report observable symptoms, in order to determine the precise severity of his heart condition is a medically complex determination that cannot be based on lay observation alone. Instead, such a determination must be made by a medical professional with appropriate expertise. Id. In this regard, the Board finds the objective findings contained in the VA examination reports to be more probative.

Given the foregoing, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for a rating in excess of 10 percent for coronary artery disease status post myocardial infarction and stent. As the evidence of record persuasively weighs against a rating in excess of 10 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 (Fed. Cir. 2021).

5. Entitlement to an evaluation in excess of 20 percent for diabetes mellitus is denied.

The Veteran's diabetes mellitus type II is rated under Diagnostic Code 7913, 38 C.F.R. § 4.119. Diagnostic Code 7913 provides a structured scheme of specific, successive, cumulative criteria. Each higher rating includes the same criteria as the lower rating plus distinct new criteria. Middleton v. Shinseki, 727 F.3d 1172, 1178 (Fed. Cir. 2013). A 10 percent rating is warranted when diabetes is manageable by restricted diet only. A 20 percent rating is applicable when diabetes requires one or more daily injections of insulin and restricted diet, or an oral hypoglycemic agent and restricted diet. A 40 percent rating is warranted when it requires one or more daily injection of
II is rated under Diagnostic Code 7913, 38 C.F.R. § 4.119. Diagnostic Code 7913 provides a structured scheme of specific, successive, cumulative criteria. Each higher rating includes the same criteria as the lower rating plus distinct new criteria. Middleton v. Shinseki, 727 F.3d 1172, 1178 (Fed. Cir. 2013). A 10 percent rating is warranted when diabetes is manageable by restricted diet only. A 20 percent rating is applicable when diabetes requires one or more daily injections of insulin and restricted diet, or an oral hypoglycemic agent and restricted diet. A 40 percent rating is warranted when it requires one or more daily injection of insulin, restricted diet, and regulation of activities. Regulation of activities is defined as avoidance of strenuous occupational and recreational activities. A 60 percent rating is applicable when diabetes requires one or more daily injection of insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately evaluated. A 100 percent rating is warranted when diabetes requires more than one daily injection of insulin, restricted diet, and regulation of activities, with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately evaluated.

Compensable complications of diabetes are evaluated separately unless they are part of the criteria used to support a 100-percent evaluation. Noncompensable complications of diabetes are considered part of the diabetic process. 38 C.F.R. § 4.119, Diagnostic Code 7913 (Note 1).

Because Diagnostic Code 7913 contains successive criteria, the criteria for the lower rating must be met before a higher disability rating may be awarded. A higher rating cannot be granted based on a finding that the Veteran's disability picture more nearly approximates the criteria for the next higher rating. However, reasonable doubt regarding the presence of a criterion may be resolved in the Veteran's favor. Johnson v. Wilkie, 30 Vet. App. 245 (2018).

As a procedural starting point for this claim, on November 17, 2022, the Veteran submitted an intent to file claim followed by a January 2023 fully developed claim for increased rating for diabetes. The appeal period includes the one year look back period prior to the date of the increased rating claim. Gaston v. Shinseki, supra.

In June 2023, the Veteran underwent a diabetes mellitus VA examination. The VA examiner noted a diagnosis of diabetes mellitus type II that has been treated with prescribed oral hypoglycemic agents and insulin with more than one injection per day. Also, the VA examiner indicated that the Veteran does not require regulation of activities as part of medical management of his condition. Moreover, the VA examiner remarked that the Veteran visits his diabetic care provider less than 2 times per month and has not required hospitalization in the twelve months prior to this examination.

In July 2023, the AOJ in its rating decision continued its 20 percent evaluation of diabetes mellitus.

In September 2024, the AOJ in its rating decision identified a duty to assist error in the claims related to diabetes mellitus.

In November 2024, the Veteran underwent a diabetes mellitus VA examination. The VA examiner noted a diagnosis of diabetes mellitus type II that has been treated with prescribed oral hypoglycemic agents and insulin with more than one injection per day. Also, the VA examiner indicated that the Veteran does not require regulation of activities as part of medical management of his condition. Moreover, the VA examiner remarked that the Veteran visits his diabetic care provider less than two times per month and has not required hospitalization in the twelve months prior to this examination.

In February 2025, the AOJ in its rating decision continued its 20 percent evaluation of diabetes mellitus.

In November 2025, the Veteran submitted a VA Form 10182 Notice of Disagreement.

Upon review of the evidence of record, the Board finds that an evaluation in excess of 20 percent for diabetes mellitus type II is not warranted. The main question in this appeal is whether the Veteran's diabetes mellitus type II required one or more daily injections of insulin, restricted diet, and regulation of activities. Regulation of activities is defined as avoidance of strenuous occupational and recreational activities. This criterion requires medical evidence. Camacho v. Nicholson, 21 Vet. App. 360, 364-65 (2007). The medical evidence, particularly the June 2023 and November 2024 VA examinations, indicated that the Veteran's condition has been managed by prescribed oral hypoglycemic. In addition, the VA examination explicitly stated that the Veteran did require more than one daily injection of insulin to treat the condition. However, the VA examiner remarked that the Veteran did not require regulation of activities as part of medical management of diabetes mellitus. Therefore, due to the absence of the third factor (regulation of activities) the criteria for at least a 40 percent evaluation have not been met.

Given the foregoing, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for a rating in excess of 20 percent for diabetes mellitus II. 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, supra.

6. Entitlement to a compensable evaluation for chronic kidney disease is denied.

The Veteran's chronic disease is rated under Diagnostic Code 7530, 38 C.F.R. § 4.115b. Diagnostic Code 7530 instructs to evaluate under 38 C.F.R. § 4.115a, for renal dysfunction. Under § 4.115a, a noncompensable disability rating is warranted where the evidence reflects glomerular filtration rate (GFR) from 60 to 89 mL/min/1.73 m2 and albumin/creatinine ratio (ACR) equal or higher than 30 mg/g for at least 3 consecutive months during the past 12 months; or GFR from 60 to 89 mL/min/1.73 m2 and either recurrent red blood cell (RBC) casts, white blood cell (WBC) casts, or granular casts for at least 3 consecutive months during the past 12 months; or GFR from 60 to 89 mL/min/1.73 m2 and structural kidney abnormalities (cystic, obstructive, or glomerular) for at least 3 consecutive months during the past 12 months. A 30 percent rating is applicable where the evidence reflects chronic kidney disease with GFR from 45 to 59 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months. A 60 percent rating is warranted for chronic kidney disease with GFR from 30 to 44 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months. An 80 percent rating is applicable for chronic kidney disease with GFR from 15 to 29 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months. Lastly, a 100 percent rating is warranted for chronic kidney disease with GFR less than 15 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months; or requiring regular routine dialysis; or eligible kidney transplant recipient warrants a 100 percent rating.

A Note under the criteria states that GFR, estimated GFR (eGFR), and creatinine-based approximations of GFR will be accepted for evaluation purposes under this section when determined to be appropriate and calculated by a medical professional.

In July 2023, the AOJ in its rating decision denied service connection for kidney disease.

In October 2023, the Veteran submitted a supplemental claim for service connection for kidney disease.

In November 2023, the AOJ in its rating decision continued its previous denial of service connection for kidney disease.

In September 2024, the AOJ in its rating decision identified a duty to assist error in the claims related to chronic kidney disease.

In November 2024, the Veteran underwent a kidney conditions VA examination. The VA examiner noted a diagnosis of chronic kidney disease which has
, 2022, the Veteran submitted an intent to file claim followed by a January 2023 fully developed claim for service connection for kidney disease.

In July 2023, the AOJ in its rating decision denied service connection for kidney disease.

In October 2023, the Veteran submitted a supplemental claim for service connection for kidney disease.

In November 2023, the AOJ in its rating decision continued its previous denial of service connection for kidney disease.

In September 2024, the AOJ in its rating decision identified a duty to assist error in the claims related to chronic kidney disease.

In November 2024, the Veteran underwent a kidney conditions VA examination. The VA examiner noted a diagnosis of chronic kidney disease which has impacted the Veteran's sleep quality and forces him to have frequent bathroom breaks. Also, the VA examiner highlighted that the Veteran has renal dysfunction but does not require regular dialysis. Moreover, the VA examiner indicated that laboratory studies show that the glomerular filtration rate (GFR) was 96 in October 2024 and more than 60 in May 2024.

In February 2025, the AOJ in its rating decision granted service connection for chronic kidney disease associated with herbicide exposure with a noncompensable evaluation effective November 17, 2022.

In November 2025, the Veteran submitted a VA Form 10182 Notice of Disagreement.

Upon review of the evidence of record, the Board finds that a compensable evaluation for chronic kidney disease is not warranted. The medical evidence of record shows that throughout the period on appeal, the Veteran's diabetic nephropathy did not manifest with GFR less than 59 mL/min/1.73 m2 for at least three consecutive months during the past twelve months. The most recent laboratory results in May 2024 showed that the Veteran had a GFR of more than 60, while in October 2024 the Veteran had a GFR of 96. Therefore, a 30 percent, 60 percent, 80 percent, or 100 percent evaluation are not applicable as the Veteran's diabetic nephropathy did manifest a GFR less than 59 mL/min/1.73 m2 for at least three consecutive months during the past twelve months. Equally, the Veteran has not required regular routine dialysis or is an eligible kidney transplant recipient which are the criteria for a 100 percent evaluation.

Given the foregoing, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for a compensable rating for chronic kidney disease. As the evidence of record persuasively weighs against a compensable rating, 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, supra.

7. Entitlement to an evaluation in excess of 10 percent for right lower extremity diabetic peripheral neuropathy; sciatic nerve is denied.

8. Entitlement to an evaluation in excess of 10 percent for left lower extremity diabetic peripheral neuropathy; sciatic nerve is denied.

The Veteran's left and right lower extremity diabetic peripheral neuropathy, sciatic nerve are evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8520. Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy is rated as 60 percent disabling. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R § 4.124a.

The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. Merriam-Webster Dictionary defines "mild" as gentle in nature or behavior. https://www.merriam-webster.com/dictionary/mild (last visited March 26, 2026). It defines "moderate" as limited in scope or effect. https://www.merriam-webster.com/dictionary/moderate (last visited March 26, 2026). Lastly, the term "severe" is defined as very painful or harmful. https://www.merriam-webster.com/dictionary/severe (last visited March 26, 2026).

Regulations provide that ratings for peripheral neurological disorders are to be assigned based on the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is
://www.merriam-webster.com/dictionary/mild (last visited March 26, 2026). It defines "moderate" as limited in scope or effect. https://www.merriam-webster.com/dictionary/moderate (last visited March 26, 2026). Lastly, the term "severe" is defined as very painful or harmful. https://www.merriam-webster.com/dictionary/severe (last visited March 26, 2026).

The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017).

As a procedural starting point for these claims, on November 17, 2022, the Veteran submitted an intent to file claim followed by a January 2023 fully developed claim for service connection for lower radiculopathy.

In July 2023, the AOJ in its rating decision denied service connection for bilateral lower extremity radiculopathy.

In October 2023, the Veteran submitted a supplemental claim for service connection for bilateral lower extremity radiculopathy.

In November 2023, the AOJ in its rating decision continued its previous denial of service connection for bilateral lower extremity radiculopathy.

In September 2024, the AOJ in its rating decision identified a duty to assist error in the claims related to bilateral lower extremity radiculopathy.

In November 2024, the Veteran underwent a diabetic sensory-motor peripheral neuropathy VA examination. The VA examiner noted diagnoses for diabetic peripheral neuropathy bilateral lower extremities and for diabetes mellitus. Also, the VA examiner assessed that the Veteran has mild intermittent pain in the right lower extremity, mild paresthesias and/or dysesthesias in bilateral lower extremity, and mild numbness in bilateral lower extremity. Moreover, the VA examiner specified that the Veteran has lower extremity diabetic peripheral neuropathy related to the sciatic nerve which manifests as mild incomplete paralysis. Lastly, the VA examiner determined that the Veteran's condition impacts prolonged standing and ambulation.

In February 2025, the AOJ in its rating decision granted service connection for bilateral lower extremity diabetic peripheral neuropathy, sciatic nerve (also claimed as bilateral lower extremity radiculopathy) with a 10 percent evaluation effective November 17, 2022.

In November 2025, the Veteran submitted a VA Form 10182 Notice of Disagreement.

Upon review of the evidence of record, the Board finds that an evaluation in excess of 10 percent for left and right lower extremity diabetic peripheral neuropathy, sciatic nerve is not warranted. The medical evidence, particularly, the November 2024 VA examination, after evaluating the Veteran and considering his lay statements determined that the Veteran has mild incomplete paralysis in his lower extremities. The Board also finds that the most probative evidence of record is against a finding that the disability is manifest by either moderate, moderately severe, or severe incomplete paralysis. Therefore, an evaluation in excess of 10 percent for left and right lower extremity diabetic peripheral neuropathy, sciatic nerve is not applicable. The Veteran's peripheral nerve condition is manifested by mild tingling sensation and numbness. Physical examination revealed decreased sensory testing for light touch in his lower extremities. Further, physical examination found that strength in his left lower extremity was 5/5 bilateral. Also, the VA examiner commented that the Veteran did not require the use of any assistive devices as a normal mode of locomotion.

The Board acknowledges the lay assertions of the disabilities' impact on the Veteran's daily life including his sex drive and his ability to enjoy foods. However, the Board finds that while the Veteran is competent to report
. Therefore, an evaluation in excess of 10 percent for left and right lower extremity diabetic peripheral neuropathy, sciatic nerve is not applicable. The Veteran's peripheral nerve condition is manifested by mild tingling sensation and numbness. Physical examination revealed decreased sensory testing for light touch in his lower extremities. Further, physical examination found that strength in his left lower extremity was 5/5 bilateral. Also, the VA examiner commented that the Veteran did not require the use of any assistive devices as a normal mode of locomotion.

The Board acknowledges the lay assertions of the disabilities' impact on the Veteran's daily life including his sex drive and his ability to enjoy foods. However, the Board finds that while the Veteran is competent to report observable symptoms, in order to determine the precise severity of the incomplete paralysis of his left and right lower extremity diabetic peripheral neuropathy, sciatic nerve is a medically complex determination that cannot be based on lay observation alone. See Jandreau v. Nicholson, supra. Instead, such a determination must be made by a medical professional with appropriate expertise. Id. In this regard, the Board finds the objective findings contained in the VA examination report to be more probative.

The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service-connected. Therefore, a separate or higher rating under a different Diagnostic Code is not warranted.

Given the foregoing, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for a rating in excess of 10 percent for left and right lower extremity diabetic peripheral neuropathy, sciatic nerve. As the evidence of record persuasively weighs against a rating in excess of 10 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, supra.

9. Entitlement to a compensable evaluation for basal cell carcinoma, residuals, is denied.

The Veteran's basal cell carcinoma is rated under Diagnostic Code 7819. Any condition under Diagnostic Code 7819 must be rated as disfigurement of the head, face, or neck (DC 7800), scars (DCs 7801, 7802, 7804, or 7805), or impairment of function.

Diagnostic code 7800 pertains to disfigurement of the head, face, or neck. 38 C.F.R. § 4.118, Diagnostic Code 7800. Ratings under Diagnostic 7800 are assigned based, in part, on the presence of eight characteristics of disfigurement, including 1) scar 5 or more inches (13 or more cm.) in length; 2) scar at least one-quarter inch (0.6 cm.) wide at widest part; 3) surface contour of scar elevated or depressed on palpation; 4) scar adherent to underlying tissue; 5) skin hypo- or hyper-pigmented in an area exceeding six square inches (39 sq. cm.); 6) skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 sq. cm.); 7) underlying soft tissue missing in an area exceeding six square inches (39 sq. cm.); and, 8) skin indurated and inflexible in an area exceeding six square inches (39 sq. cm.).

Under Diagnostic Code 7800, a 10 percent rating is assigned when there is one characteristic disfigurement of the head, face, or neck.

A 30 percent rating is assigned when there is visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or with two or three characteristics of disfigurement.

A 50 percent rating is assigned when there is visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or with four or five characteristics of disfigurement.

An 80 percent rating is assigned when there is visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or, with six or more characteristics of disfigurement.

More specifically, Diagnostic Code 7801 evaluates burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are associated with underlying
or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or with four or five characteristics of disfigurement.

More specifically, Diagnostic Code 7801 evaluates burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage. Diagnostic Code 7802 evaluates burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. Diagnostic Code 7804 evaluates scars that are unstable or painful. Lastly, Diagnostic Code 7805 evaluates any disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-04 under an appropriate diagnostic code.

As a procedural starting point for this claim, on November 17, 2022, the Veteran submitted an intent to file claim followed by a January 2023 fully developed claim for increased rating for basal cell carcinoma. The appeal period includes the one year look back period prior to the date of the increased rating claim. Gaston v. Shinseki, supra.

In June 2023, the Veteran underwent a skin diseases VA examination. The VA examiner noted a diagnosis for residuals of basal cell carcinoma that has not been treated with medication in the twelve months prior to this examination. Equally, the VA examiner highlighted that the Veteran's has not had any treatments or procedures in the twelve months prior to this examination. The VA examiner assessed that the Veteran had no visible characteristic lesions due to basal cell carcinoma at any total body area. Also, the VA examiner indicated that the Veteran had an exposed area of less than 5 percent.

In July 2023, the AOJ in its rating decision continued its noncompensable evaluation for basal cell carcinoma.

In September 2024, the AOJ in its rating decision identified a duty to assist error in the claim related to basal cell carcinoma.

In November 2024, the Veteran underwent a skin diseases VA examination. The VA examiner noted a diagnosis for residuals of basal cell carcinoma located in the Veteran's face, ears, nose, and arms. The VA examiner pointed out that this condition has not been treated with medication in the twelve months prior to this examination. Equally, the VA examiner highlighted that the Veteran's has not had any treatments or procedures in the twelve months prior to this examination. The VA examiner assessed that the Veteran had no visible characteristic lesions due to basal cell carcinoma in any total body area or exposed area. Moreover, the VA examiner specified that the Veteran has no current lesions and that the condition was service connected for lesion excised right ear lobe. In addition, the VA examiner stated that the Veteran's condition has not caused any scarring or disfigurement of the head, face, or neck.

In February 2025, the AOJ in its rating decision continued its noncompensable evaluation for basal cell carcinoma, residuals.

In November 2025, the Veteran submitted a VA Form 10182 Notice of Disagreement.

Upon review of the evidence of record, the Board finds that a compensable evaluation for basal cell carcinoma, residuals is not warranted. It is important to note that Diagnostic Code 7801 and 7802 are not applicable because the medical evidence does show any type of scar not of the head, face, or neck that is or is not associated with underlying soft tissue damage. Moreover, Diagnostic Code 7804 is not applicable because the medical evidence does not point to the Veteran having an unstable or painful scar in relation to his basal cell carcinoma, residuals.

The medical evidence of record, particularly the June 2023 and November 2024 VA examinations did not show that the Veteran has at least one characteristic of disfigurement. The Veteran's basal cell carcinoma, residuals did not manifest in any scars. Also, the Veteran's condition did not exhibit surface contour of scar elevated or depressed on palpation; scar adherent to underlying tissue; skin hypo- or hyper-pigmented in an area exceeding six square inches (39 sq. cm); skin texture abnormal in an area exceeding six square inches; underlying soft tissue missing in an area exceeding six square inches; or skin indurated and inflexible in an area exceeding six square inches. Thus, a rating of 10 percent is not warranted. Equally, a rating of 30, 50, or 80 percent is not applicable because the evidence of record did not reflect that the
one characteristic of disfigurement. The Veteran's basal cell carcinoma, residuals did not manifest in any scars. Also, the Veteran's condition did not exhibit surface contour of scar elevated or depressed on palpation; scar adherent to underlying tissue; skin hypo- or hyper-pigmented in an area exceeding six square inches (39 sq. cm); skin texture abnormal in an area exceeding six square inches; underlying soft tissue missing in an area exceeding six square inches; or skin indurated and inflexible in an area exceeding six square inches. Thus, a rating of 10 percent is not warranted. Equally, a rating of 30, 50, or 80 percent is not applicable because the evidence of record did not reflect that the Veteran has burn scars of the head, face, or neck; scars of the head face, or neck due to other causes; or other disfigurement of the head, face, or neck that has visible or palpable tissue loss and either gross distortion or asymmetry in lips with at least two or more characteristics of disfigurement.

The Board has considered whether any other Diagnostic Codes related to disabilities of the skin would provide for a higher disability evaluation. However, the evidence does not reflect that the basal cell carcinoma, residuals would warrant a higher rating under a different diagnostic code. See 38 C.F.R. § 4.118. In this case, the Board finds that DC 7819 is the appropriate diagnostic code for rating the Veteran's disability. Equally, it is important to highlight that the medical evidence of record did not show that the Veteran's condition caused any impairment of function.

Given the foregoing, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for a compensable rating for basal cell carcinoma, residuals. As the evidence of record persuasively weighs against a compensable rating, 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, supra.

10. Entitlement to a compensable evaluation for hypertension is denied.

Evaluations for hypertension are rated pursuant to 38 C.F.R. § 4.104, Diagnostic Code (DC) 7101, for hypertensive vascular disease (hypertension and isolated systolic hypertension). Under DC 7101, a 10 percent rating is warranted for diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. In other words, DC 7101 for a 10 percent rating offers three distinct avenues for Veterans to pursue. Wilson v. McDonough, 35 Vet. App. 75, 78 (2021). However, it is important to mention that regarding the history of diastolic pressure, the Veteran can establish current eligibility by presenting readings from the past, and outside the appeal period, before the blood pressure was controlled with medication. Id.

A 20 percent rating is warranted for diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more. A 40 percent rating is warranted for diastolic pressure predominantly 120 or more. A 60 percent rating is warranted for diastolic pressure predominantly 130 or more.

The term "predominant" is not defined in the rating criteria. Merriam-Webster Dictionary defines it as "having superior strength, influence, or authority: prevailing" or "being most frequent or common". See Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary/predominant (last visited March 26, 2026). The Board adopts this definition for purposes of adjudication of this appeal.

As a procedural starting point for this claim, on November 17, 2022, the Veteran submitted an intent to file claim followed by a January 2023 fully developed claim for increased rating for hypertension. The appeal period includes the one year look back period prior to the date of the increased rating claim. Gaston v. Shinseki, supra.

In June 2023, the Veteran underwent a hypertension VA examination. The VA examiner noted that the Veteran's hypertension has been treated with Metoprolol tartrate 25mg and Nifedipine 30mg. Also, the VA examiner highlighted that the impact of the condition is fatigue. The VA examiner took blood pressure readings and these were the following: 147/91, 143/83, and 136/85.

In July 2023, the AOJ in its rating decision continued its noncompensable evaluation of hypertension.

In September 2024, the AOJ
includes the one year look back period prior to the date of the increased rating claim. Gaston v. Shinseki, supra.

In July 2023, the AOJ in its rating decision continued its noncompensable evaluation of hypertension.

In September 2024, the AOJ in its rating decision identified a duty to assist error in the claims related to hypertension.

In November 2024, the Veteran underwent a hypertension VA examination. The VA examiner noted that the Veteran's hypertension has been treated with Metoprolol tartrate 25mg and Nifedipine 30mg. Also, the VA examiner highlighted that the impact of the condition is fatigue. The VA examiner took blood pressure readings, and these were the following: 133/77, 138/73, and 130/77.

In February 2025, the AOJ in its rating decision continued its noncompensable evaluation for hypertension.

In November 2025, the Veteran submitted a VA Form 10182 Notice of Disagreement.

Upon review of the evidence of record, the Board finds that a compensable evaluation for the Veteran's service connected hypertension is not warranted. For the period on appeal, the Veteran's hypertension did not manifest in diastolic pressure predominantly 100 or more, or systolic pressure predominantly 160 or more. Specifically, the June 2023 VA examination blood pressure readings showed that the highest diastolic pressure was 91 and the highest systolic pressure was 147. Also, the November 2024 VA examination blood pressure readings showed that the highest diastolic pressure was 77 and the highest systolic pressure was 138.

The VA examiner determined that the Veteran did not have a history of diastolic pressure predominantly 100 or more who requires continuous medication for control. The Board conducted an analysis of the Veteran's blood pressure medical history. These were the readings of the Veteran's blood pressure contained in the medical records associated with this claims file: (August 6, 2009) 120/61; (March 9, 2009) 130/70, 128/68, 128/72; (March 10, 2008) 138/66; (January 7, 2007) 132/79; (September 25, 2006) 160/78; (September 15, 2006) 120/78; (August 17, 2005) 138/82, (December 17, 2004) 160/94, 168/89; (March 6, 2004) 128/80, 128/70, 130/80; (June 16, 2003) 130/80; (May 24, 2003) 125/63; (May 22, 2003) 132/62, 127/58, 119/60, 117/57, 116/59, 105/46, 104/50, 102/45, 96/45, 101/48, 105/44, 175/91, 168/83, 134/79, 134/75, 196/90; (March 19, 2003) 130/60, 128/59, 131/60; (February 11, 2003) 155/87, 117/78, 161/79, 149/75; (March 2, 2002) 138/88, 136/88; (March 31, 2001) 130/82, 134/80, 130/84; (March 4, 2000) 128/80, 123/78, 132/86; (March 2, 1999) 134/80, 132/80, 134/80; (February 8, 1998) 132/84, 130/82, 132/86; (February 2, 1997) 138/88, 134/84, 136/84; (December 11, 1996) 138/90; (January 7, 1995) 126/80, 114/84, 122/82; (April 15, 199
134/80, 130/84; (March 4, 2000) 128/80, 123/78, 132/86; (March 2, 1999) 134/80, 132/80, 134/80; (February 8, 1998) 132/84, 130/82, 132/86; (February 2, 1997) 138/88, 134/84, 136/84; (December 11, 1996) 138/90; (January 7, 1995) 126/80, 114/84, 122/82; (April 15, 1994) 158/84, 143/80, 143/79, 164/87, 191/86, 130/80; (November 7, 1992) 128/86, 126/86, 124/84; (November 2, 1991) 120/88, 120/86, 122/88; (November 3, 1990) 122/82, 120/78, 122/78; (December 21, 1989) 128/80, 122/74, 126/76; (November 18, 1989) 130/70; (December 8, 1988) 138/88, 132/80, 136/84; (November 7, 1987) 114/82, 110/78, 112/80; (November 1, 1986) 128/84, 124/78, 122/80; (October 5, 1985) 136/84, 140/82, 126/80; (October 13, 1984) 114/80, 110/70, 116/80; (January 15, 1984) 132/80, 134/70, 130/80; (January 15, 1983) 118/78, 112/74, 118/78; (August 15, 1981) 134/86, 124/82, 118/86; (July 26, 1980) 120/80; (March 2, 1970) 140/80; (January 9, 1967) 120/70; (November 15, 1966) 120/70.

As illustrated above, throughout the Veteran's medical history the Veteran's diastolic blood pressure has not surpassed 100. Consequently, it must be concluded that the Veteran does not have a history of diastolic pressure predominantly at 100 or more. Therefore, the criteria for at least 10 percent evaluation have not been met.

Given the foregoing, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for a compensable rating for hypertension. As the evidence of record persuasively weighs against a compensable rating, 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, supra.

11. Entitlement to special monthly compensation (SMC) based on aid and attendance is granted.

38 U.S.C. § 1114(l) authorizes the payment of SMC at the (l) rate if, as a result of service-connected disabilities, the Veteran has such significant disabilities as to be in need of regular aid and attendance.

38 C.F.R. § 3.352(a) requires consideration of the following factors in determining the need for regular aid and attendance: "inability of the claimant to dress or undress himself (herself), or to keep himself (or herself) ordinarily clean and presentable; . . . inability of the claimant to feed himself (herself) through loss of coordination of upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his or her daily environment."

In November 2025, the Veteran's representative submitted an appellate brief. The representative argued that the Veteran is entitled to an SMC based on aid and attendance under 38 U.S.C. § 1114(l). The representative highlighted that the Veteran's spouse has been providing him assistance with almost all activities of daily living since 2022. Also, the representative stated that the evidence demonstrates that the Veteran's service connected MDS, adjustment disorder, diabetes, right knee status
of coordination of upper extremities or through extreme weakness; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his or her daily environment."

In November 2025, the Veteran's representative submitted an appellate brief. The representative argued that the Veteran is entitled to an SMC based on aid and attendance under 38 U.S.C. § 1114(l). The representative highlighted that the Veteran's spouse has been providing him assistance with almost all activities of daily living since 2022. Also, the representative stated that the evidence demonstrates that the Veteran's service connected MDS, adjustment disorder, diabetes, right knee status post arthroscopy, CAD, bilateral lower extremity peripheral neuropathy, and left knee conditions have affected his ability to: dress and undress; bathe; attend to the wants of nature; and protect himself from the hazards of his environment. Thus, the representative insisted that the Veteran is unable to complete even the most basic requirements of self-care without the assistance of his wife.

In November 2025, the Veteran's wife submitted an April 2025 sworn statement in support of claim. The Veteran's wife indicated that since at least 2022 she has provided regular care and assistance to her husband for almost all of his activities of daily living due to the severity of his service connected disabilities. The Veteran's wife cited that due to the pain and weakness in his bilateral lower extremities and knees, as well as the weakness and shortness of breath caused by his MDS and heart condition, the Veteran is unable to dress independently. Also, the Veteran's wife remarked that due to his knees and lower extremities conditions, the Veteran has difficulty pushing himself up off the toilet and requires her help. Moreover, the Veteran's wife intimated that on a weekly basis, the Veteran is too weak to reach back and properly clean himself and she needs to assist him. In addition, the Veteran's wife commented that the Veteran cannot open pill bottles by himself and his service connected conditions make it difficult for him to move around. Furthermore, the Veteran's wife mentioned that the Veteran has fallen multiple times since 2022, and he is unable to get up on his own.

Upon review of the evidence of record, the Board finds that entitlement to SMC(l) because of the Veteran's need of regular aid and attendance is warranted. It is important to reiterate that the Veteran is service connected for the following disabilities: MDS (rated at 100 percent); polychondritis associated with MDS (rated at 100 percent pursuant to this decision); adjustment disorder with mixed anxiety and depressed mood associated with MDS (rated at 70 percent pursuant to this decision); diabetes mellitus (rated at 20 percent); right knee status post arthroscopy (rated at 10 percent); tinnitus (rated at 10 percent); coronary artery disease status post myocardial infarction and stent (rated at 10 percent); right lower extremity diabetic peripheral neuropathy; sciatic nerve associated with diabetes mellitus (rated at 10 percent); left lower extremity diabetic peripheral neuropathy; sciatic nerve associated with diabetes mellitus (rated at 10 percent); left knee instability with posttraumatic degenerative arthritis (rated at 10 percent); left knee degenerative arthritis (rated at 10 percent); left ear hearing loss (rated at a noncompensable level); hypertension (rated at a noncompensable level); erectile dysfunction (rated at a noncompensable level); chronic kidney disease associated with diabetes mellitus (rated at a noncompensable level); and basal cell carcinoma (rated at a noncompensable level).

It is clear from the medical evidence and from the Veteran's wife's sworn statement that the Veteran requires the aid and attendance of another person to accomplish many of the activities listed in 38 C.F.R. § 3.352(a), including dressing, bathing, and attending to the needs of nature. The Board considers that the Veteran's wife's statement is credible and holds a high probative value in these circumstances. Also, it is consistent with the various VA examiner assessments about the effects of the Veteran's service connected disabilities on his daily life. Particularly, the Board highlights the November 2024 polychondritis VA examination which acknowledged that the Veteran's condition has led to severe flareups impacting all mobility and comfort. Also, the VA examiner assessed that the Veteran had difficulty taking care of himself due to his service connected polychondritis.

Given the foregoing, SMC at the rate authorized by 38 U.S.C. § 1114(l) is granted.

REASONS FOR REMAND

1. Entitlement to an evaluation in excess of 10 percent for left knee degenerative arthritis is remanded.

2. Entitlement to an
Also, it is consistent with the various VA examiner assessments about the effects of the Veteran's service connected disabilities on his daily life. Particularly, the Board highlights the November 2024 polychondritis VA examination which acknowledged that the Veteran's condition has led to severe flareups impacting all mobility and comfort. Also, the VA examiner assessed that the Veteran had difficulty taking care of himself due to his service connected polychondritis.

Given the foregoing, SMC at the rate authorized by 38 U.S.C. § 1114(l) is granted.

REASONS FOR REMAND

1. Entitlement to an evaluation in excess of 10 percent for left knee degenerative arthritis is remanded.

2. Entitlement to an evaluation in excess of 10 percent for left knee instability with posttraumatic degenerative arthritis is remanded.

Under the Appeals Modernization Act (AMA), the Board has the duty to remand issues when necessary to correct a pre-decisional duty-to-assist error. Pub. L. No. 115-55 section (2)(d); 38 C.F.R. § 20.802 (a).

The Board finds remand is warranted to correct a pre-decisional duty to assist error that occurred prior to the decision on appeal. Specifically, the Board considers that a new examination shall be afforded to the Veteran that considers the ameliorative effects of medication when evaluating the current severity of the Veteran's left knee condition.

In June 2023, the Veteran underwent a knee conditions VA examination. The VA examiner noted a diagnosis of degenerative arthritis, other than posttraumatic in the left knee. Also, the VA examiner acknowledged that the Veteran takes ice/heat and Tylenol/Aleve (acetaminophen/naproxen) to treat his conditions. During the examination, the Veteran reported flare-ups of the left knee that can last five to seven days and are precipitated by activity. Moreover, the Veteran indicated that he has functional loss or impairment.

The VA examiner assessed that the active, passive, and observed repetitive use range of motion (ROM) measurements for the left knee were: 110 degrees for flexion and 0 degrees for extension. The VA examiner noted that the Veteran exhibited pain in flexion and extension. Also, the VA examiner indicated that the Veteran was not being examined immediately after repeated use over time or during a flare up but estimated the following ROM: 100 degrees for flexion and 0 degrees for extension. Moreover, the VA examiner remarked that there is recurrent subluxation or persistent instability in the left knee. The VA examiner highlighted that there is no recurrent patellar instability or ankylosis. Lastly, the VA examiner determined that the Veteran's condition impacts his ability to perform any type of occupational task.

In November 2024, the Veteran underwent a knee and lower leg VA examination. The VA examiner noted diagnoses of knee instability and degenerative arthritis, other than posttraumatic in the left knee. Also, the VA examiner acknowledged that the Veteran takes ice and Tylenol (acetaminophen) to treat his conditions. During the examination, the Veteran reported severe flare-ups of the left knee that can last three to seven days and are precipitated by activity. Moreover, the Veteran indicated that he has functional loss or impairment because of knee weakness and instability. In addition, the Veteran commented that he cannot bear full weight due to instability.

The VA examiner assessed that the active and passive range of motion (ROM) measurements for the left knee were: 95 degrees for flexion and 0 degrees for extension. The VA examiner noted that the Veteran only exhibited pain in flexion. Also, the VA examiner indicated that the Veteran was not being examined immediately after repeated use over time or during a flare up but estimated the following ROM: 90 degrees for flexion and 0 degrees for extension. Moreover, the VA examiner remarked that there is recurrent subluxation or persistent instability in the left knee. The VA examiner highlighted that there is no recurrent patellar instability or ankylosis. Lastly, the VA examiner determined that the Veteran's condition impacts his ability to perform any type of occupational task such as prolonged standing, running, kneeling, and squatting.

Upon review of the medical examinations, the Board finds that remand is warranted. During the examination, the Veteran reported that he takes various medications such Tylenol and Aleve to treat his knee conditions. Pursuant to the recent United States Court of Appeals for Veterans Claims (CAVC) decision of Ingram v. Collins, 38 Vet. App. 130 (2025), remand is necessary to obtain a medical opinion that addresses whether the Veteran's medications are productive of ameliorative effects on his right ankle. Also, Ingram stated that when diagnostic codes do not explicitly contemplate medications when rating a disability, the Board must discount the beneficial effects of medication when assigning an evaluation for that disability. It is important to note that Diagnostic Codes 5010-5260 and 5010-5257 (for posttraumatic arthritis; limitation of flexion; and other impairment of knee, respectively), do not explicitly contemplate medication use. Therefore, Ingram is applicable to the facts in this case, and an opinion must be rendered by a clinician that provides an estimate of additional functional loss described in degrees of additional loss of ROM without the effects of his medications for the service connected left knee degenerative arthritis and left knee instability with posttraumatic arthritis.

The matters are REMANDED for the following action:

Schedule the Veteran for an examination with an appropriate clinician. The examiner should consider and review the claims file to include this Remand.

The VA examiner must address if any of the medications used by the Veteran including, but not limited to, Tylenol and Aleve produced ameliorative effects on the Veteran's service connected conditions of left knee degenerative arthritis and left knee instability with posttraumatic arthritis.

If the answer is yes, the VA examiner shall list which medications produced ameliorative effects and explain the nature and extent of the Veteran's symptoms and additional limitation of motion without these effects of the medications, to include during flare-ups (if applicable). Any additional functional loss with repetitive use testing or during flare-ups must be expressed in degrees of additional loss of range of motion for the conditions of left knee degenerative arthritis and left knee instability with posttraumatic arthritis.

A complete rationale must be given for all opinions and conclusions expressed. If it is not possible to provide a specific measurement without resorting to mere speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training).

DAVID L. WIGHT

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Colon, Ivan M.

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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