Back to BVA DecisionsMIXEDSpecial Benefit NO SPECIAL BENEFIT Docket No. 250410-536809
RIGHT SHOULDER DISABILITY
HARVEY P. ROBERTS · 2026 · Case ID: A26030975
Summary
The veteran, who served from January 2013 to January 2021, appeals the denial of an initial compensable rating for recurrent acute pancreatitis. The Board reviewed the case based on evidence of record as of the January 2025 rating decision. The veteran sought an increased rating for service-connected pancreatitis, contending it was more severe than the 0% rating assigned. The Board considered both former and amended rating criteria for pancreatitis (Diagnostic Code 7347). Under former criteria, a 10% rating required at least one recurring attack of severe abdominal pain confirmed by studies. Under amended criteria (effective May 19, 2024), a 30% rating requires at least one episode per year of pain needing ongoing outpatient treatment or management of complications, confirmed by diagnostic studies. The December 2024 VA examination noted intermittent abdominal pain treated by the veteran with alcohol cessation and dietary changes, but no ongoing medication or hospitalization. The examiner found three or more episodes of pain per year but no confirmed diagnostic studies, ongoing outpatient treatment, or hospitalizations. The Board found the VA opinion incomplete as it relied solely on the absence of chronic symptoms or treatment in service and lacked confirmation by diagnostic studies. The Board denied an increased rating, finding the evidence did not support a compensable rating under either set of criteria. The Board also remanded claims for service connection for bilateral knee, bilateral shoulder, and lumbar spine disabilities, finding the December 2024 VA opinions incomplete for failing to adequately address etiology and consider subjective or lay evidence. The Board noted that the veteran's contentions regarding these musculoskeletal conditions were not addressed in the rationale.
Full Decision Text
Citation Nr: A26030975 Decision Date: 04/06/26 Archive Date: 04/06/26 DOCKET NO. 250410-536809 DATE: April 6, 2026 ORDER Entitlement to an initial rating in excess of 0 percent for recurrent acute pancreatitis is denied. REMANDED Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a right shoulder disability is remanded. Entitlement to service connection for a left shoulder disability is remanded. Entitlement to service connection for a lumbar spine disability is remanded. FINDING OF FACT 1. Service-connected pancreatitis is not shown to have been productive of at least one recurring attack of typical severe abdominal pain, confirmed as resulting from pancreatitis by appropriate laboratory and clinical studies during the period on appeal. 2. Effective May 19, 2024, service-connected pancreatitis is not shown to have been productive of at least one episode per year of abdominal or mid-back pain that requires ongoing outpatient medical treatment for pain, digestive problems, or management of related complications including but not limited to cyst, pseudocyst, intestinal obstruction, or ascites. CONCLUSION OF LAW The criteria for entitlement to an initial disability rating in excess of 0 percent for recurrent acute pancreatitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.114, Diagnostic Code 7347. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 2013 to January 2021.????? This case comes before the?Board of Veterans' Appeals (Board) on appeal from?a January 2025?rating decision by the Department of Veterans Affairs (VA)?Veterans Benefits Administration?Regional Office (RO)?which is the Agency of Original Jurisdiction (AOJ).? In?April 2025, the Veteran requested a direct docket review of the appeal by the Board. As a result, this appeal stems from the Veteran's?election?of direct review. The Veteran acknowledged that the review will be based on the evidence submitted to VA at the time of the decision on appeal. ?Therefore, only evidence of record as of the date of the?January 2025 rating decision?will be considered. ?VA will not seek?additional?evidence on behalf of the Veteran as part of the review. 1. Entitlement to an initial rating in excess of 0 percent for recurrent acute pancreatitis. The Veteran seeks an initial compensable rating for the service-connected pancreatitis. However, no specific contentions have been advanced in support of a higher rating. For the reasons set forth below, the Board finds that a compensable rating is not warranted at any time during the period on appeal. Disability ratings are determined by evaluating the extent to which a service-connected disability adversely affects a Veteran's ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. In rating a disability, the Board considers the current examination reports in light of the whole recorded history to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. §§ 4.1, 4.2, 4.10. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Reasonable doubt regarding the degree of disability will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). Separate ratings can be assigned for separate periods of time based on the facts found. Fenderson v. West, 12 Vet. App. 119 (1999). Pancreatitis is rated under 38 C.F.R. § 4.114, Diagnostic Code 7347. Under that Diagnostic Code, a 10 Reasonable doubt regarding the degree of disability will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). Separate ratings can be assigned for separate periods of time based on the facts found. Fenderson v. West, 12 Vet. App. 119 (1999). Pancreatitis is rated under 38 C.F.R. § 4.114, Diagnostic Code 7347. Under that Diagnostic Code, a 10 percent rating is assigned for pancreatitis with at least one recurring attack of typical severe abdominal pain in the prior year. A 30 percent rating is assigned for moderately severe pancreatitis, defined as with at least four to seven typical attacks of abdominal pain per year with good remission between attacks. A 60 percent rating is assigned for pancreatitis with frequent attacks of abdominal pain, loss of normal body weight, and other findings showing continuing pancreatic insufficiency between acute attacks. A 100 percent rating is assigned for pancreatitis with frequently recurrent disabling attacks of abdominal pain with a few pain-free intermissions and with steatorrhea, malabsorption, diarrhea, and severe malnutrition. For all ratings, abdominal pain must be confirmed as resulting from pancreatitis by appropriate laboratory and clinical studies. 38 C.F.R. § 4.114, Note 1. The terms mild, moderate, and severe are not defined in the rating criteria. Merriam-Webster Dictionary defines mild as gentle in nature or behavior. https://www.merriam-webster.com/dictionary/mild (last visited March 19, 2026). The term moderate is defined as limited in scope or effect, or as tending toward the mean or average amount or dimension. https://www.merriam-webster.com/dictionary/moderate (last visited March 19, 2026). The term severe is defined as very painful or harmful, or of a great degree. https://www.merriam-webster.com/dictionary/severe (last visited March 19, 2026). During the pendency of the appeal, the criteria for rating gastrointestinal disabilities under 38 C.F.R. § 4.114 were amended, effective May 19, 2024. Under the amended criteria for Diagnostic Code 7347, the 10 percent rating has been eliminated. A 30 percent rating is assigned for pancreatitis with at least one episode per year of abdominal or mid-back pain that requires ongoing outpatient medical treatment for pain, digestive problems, or management of related complications including but not limited to cyst, pseudocyst, intestinal obstruction, or ascites. A 60 percent rating is assigned for three or more episodes of abdominal or mid-back pain per year with at least one episode per year requiring hospitalization for management either of complications related to abdominal pain or complications of tube enteral feeding. A 100 percent rating is assigned for daily episodes of abdominal or mid-back pain that require three or more hospitalizations per year, pain management by a physician, and maldigestion and malabsorption requiring dietary restriction and pancreatic enzyme supplementation. For all ratings, appropriate diagnostic studies must confirm that abdominal pain is the result of pancreatitis. 38 C.F.R. § 4.114, Note 1. In every instance where the rating schedule does not provide a 0 percent rating for a diagnostic code, a 0 percent rating shall be assigned when the requirements for a compensable rating are not met. 38 C.F.R. § 4.31. The Board notes that the amended criteria may not be applied prior to the effective date, May 19, 2024. However, the Board may consider both the former and new rating criteria from May 19, 2024, and will apply the criteria that result in a more favorable outcome for the Veteran. 38 U.S.C. § 5110; Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). The current claim for increased ratings stems from an initial grant of service connection, effective March 4, 2024. Therefore, the period on appeal is March 4, 2024, the effective date of service connection, to January 17, 2025, the date of the rating decision on appeal. The recurrent acute pancreatitis disability has been rated 0 percent, effective March 4, 2024, pursuant to Diagnostic Code?7347. The Veteran contends that?the pancreatic disability is more severe than compensated Veteran. 38 U.S.C. § 5110; Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). The current claim for increased ratings stems from an initial grant of service connection, effective March 4, 2024. Therefore, the period on appeal is March 4, 2024, the effective date of service connection, to January 17, 2025, the date of the rating decision on appeal. The recurrent acute pancreatitis disability has been rated 0 percent, effective March 4, 2024, pursuant to Diagnostic Code?7347. The Veteran contends that?the pancreatic disability is more severe than compensated by the assigned ratings. At a December 2024 VA examination, the examiner noted that the Veteran's reported current symptomatology included intermittent abdominal pain for about three days which the Veteran treated with alcohol cessation and dietary changes. The Veteran was not on continuous medication for the pancreas condition. On examination, the examiner noted chronic pancreatitis that resulted in three or more episodes of abdominal or mid-back pain per year. The Veteran was not found to have ongoing outpatient medical treatment for pain, digestive problems, or management of related complications; nor did the condition result in hospitalization in the past 24 months. The remainder of the record does not show any additional complaints, treatment, symptomology, or findings related to pancreatitis. After review of the evidence, the Board finds a rating in excess of 0 percent is not warranted under the former or new rating criteria. The Veteran's pancreatitis is not shown to have been productive of at least one recurring attack of typical severe abdominal pain in any year during the period on appeal. The Veteran reported intermittent abdominal pain. However, the Board highlights that abdominal pain must be confirmed as resulting from pancreatitis by appropriate laboratory and clinical studies. 38 C.F.R. § 4.114, Note 1. Here, the examiner noted subjective pain that was not confirmed as resulting from pancreatitis by appropriate laboratory and clinical studies. While the Veteran is competent to report symptoms such as pain, providing an opinion attributing this pain to a specific diagnosis of pancreatitis requires medical expertise as the issue is medically complex. Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); Kahana v. Shinseki, 24. Vet. App. 428 (2011). Therefore, the Board finds that the medical evidence provided by the provider with the requisite expertise is considered more probative in this case. The Board finds that the evidence does not support the assignment of a compensable rating under the amended criteria. From May 19, 2024, the Veteran's pancreatitis is not shown to have been productive of at least one episode per year of abdominal or mid-back pain that requires ongoing outpatient medical treatment for pain, digestive problems, or management of related complications including but not limited to cyst, pseudocyst, intestinal obstruction, or ascites. The Veteran competently reported abdominal pain. However, the amended criteria also require that appropriate diagnostic studies must confirm that abdominal pain is the result of pancreatitis. That did not occur, nor is there any evidence of ongoing outpatient medical treatment. The Veteran reported treating the condition with dietary changes and refraining from alcohol consumption. The record does not show continued outpatient treatment nor hospitalization for pancreatitis during the appeal period. The Board is sympathetic to the Veteran's reports and understands that his pancreatitis has adversely affected his life. However, the criteria for a rating in excess of 0 percent have not been met at any time during the period on appeal under the previous or amended rating criteria. Accordingly, the Board finds that the weight of the evidence is against the assignment of an initial disability rating greater than 0 percent for recurrent acute pancreatitis. The Board finds that the evidence is not in approximate balance, the evidence does not more nearly approximate the criteria for higher ratings, and there is no reasonable doubt to resolve in favor of the Veteran. Therefore, the appeal for any higher rating must be denied. 38?U.S.C. §?5107; 38?C.F.R. §?3.102. REASONS FOR REMAND 1. Entitlement to service connection for a left knee disability is remanded. 2. Entitlement to service connection for a right knee disability is remanded. Although the Board regrets the delay, additional development is needed prior to further disposition of the claims of entitlement to service connection for bilateral knee disabilities.?? VA's The Board finds that the evidence is not in approximate balance, the evidence does not more nearly approximate the criteria for higher ratings, and there is no reasonable doubt to resolve in favor of the Veteran. Therefore, the appeal for any higher rating must be denied. 38?U.S.C. §?5107; 38?C.F.R. §?3.102. REASONS FOR REMAND 1. Entitlement to service connection for a left knee disability is remanded. 2. Entitlement to service connection for a right knee disability is remanded. Although the Board regrets the delay, additional development is needed prior to further disposition of the claims of entitlement to service connection for bilateral knee disabilities.?? VA's statutory duty to assist the Veteran includes the duty to conduct a thorough examination so that the evaluation of the claimed disability will be a fully informed one. Green v.?Derwinski,?1?Vet. App.?121 (1991);?Snuffer v. Gober, 10?Vet. App. 400 (1997). Assistance by VA includes providing a medical examination or obtaining a medical opinion when an examination or opinion is necessary to make a decision on a claim. 38?U.S.C. §?5103A;?38?C.F.R. §?3.159.?? The Veteran contends that the current knee disabilities are the result of the physical nature and wear and tear of active service. A January 2025 rating decision found that the Veteran had current bilateral knee disabilities; and that service treatment records from September 2019 noted complaints of ongoing bilateral knee pain. The Board is bound by those favorable findings. At a December 2024 VA examination, after review of the claims file and in-person examination, the examiner opined that the claimed disabilities were less likely than not (likelihood is less than approximately balanced or nearly equal) incurred in or caused by the claimed injury, event, or illness in service. The examiner explained that available post-service medical records were negative for the complaint, assessment, or treatment of any chronic knee condition. The examiner stated that most with patellofemoral pain issues recover with rest and activity modification without adverse long-term effects. October 2020 records noted recurring knee pain, improved with physical therapy. The records did not demonstrate any long-term residuals from noted acute service complaint. There was insufficient medical evidence (subjective reporting, medical records, and/or medical literature) regarding a chronicity of symptoms, complaints, assessment, or treatment of condition to establish a nexus between the service injury or complaint and a currently diagnosed condition. The Board finds the December 2024 VA opinions to be incomplete. An opinion that relies only on the absence of symptoms or treatment during service is incomplete. The opinion appears to have solely relied on the fact that the Veteran was not diagnosed with any chronic knee disabilities during service to support the opinion that the claimed disabilities were not related to service. As the opinion relied on the absence of chronic symptoms or treatment in service for the negative opinion concerning the claimed disabilities, the Board finds the December 2024 opinion to be incomplete. The record now shows bilateral knee disabilities diagnoses and alleged potential causation related to service. However, to date, the Veteran has not been provided adequate VA examination which addresses any etiological relationship between any musculoskeletal disabilities and service. That is a pre-decisional duty to assist error. Because the Veteran may have disabilities that are related to service, the Board finds that the Veteran should be provided a VA examination to determine the nature and etiology of any bilateral knee disabilities. Therefore, on remand an opinion as to the etiology of any bilateral knee disabilities should be requested. McLendon v. Nicholson, 20 Vet. App. 79 (2006); 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. 3. Entitlement to service connection for a right shoulder disability is remanded. 4. Entitlement to service connection for a left shoulder disability is remanded. 5. Entitlement to service connection for a lumbar spine disability is remanded. Although the Board regrets the delay, additional development is needed prior to further disposition of the claims of entitlement to service connection for bilateral shoulder and back disabilities.?? VA's statutory duty to assist the Veteran includes the duty to conduct a thorough examination so that the evaluation of the claimed disability will be a fully informed one. Green v.?Derwinski,?1?Vet. App.?121 (1991);?Snuffer v. Gober, 10?Vet. App. 400 (1997). Assistance by VA includes providing a medical examination or obtaining a medical opinion when an examination or opinion is necessary to make a decision on a claim. 38? connection for a lumbar spine disability is remanded. Although the Board regrets the delay, additional development is needed prior to further disposition of the claims of entitlement to service connection for bilateral shoulder and back disabilities.?? VA's statutory duty to assist the Veteran includes the duty to conduct a thorough examination so that the evaluation of the claimed disability will be a fully informed one. Green v.?Derwinski,?1?Vet. App.?121 (1991);?Snuffer v. Gober, 10?Vet. App. 400 (1997). Assistance by VA includes providing a medical examination or obtaining a medical opinion when an examination or opinion is necessary to make a decision on a claim. 38?U.S.C. §?5103A;?38?C.F.R. §?3.159.?? The Veteran contends that the current disabilities are the result of the physical nature and wear and tear of active service. A January 2025 rating decision found that the Veteran had current bilateral shoulder and back disabilities. The Board is bound by those favorable findings. At a December 2024 VA examination, after review of the claims file and in-person examination, the examiner opined that the claimed disabilities were less likely than not (likelihood is less than approximately balanced or nearly equal) incurred in or caused by the claimed injury, event, or illness in service. For the diagnosed back disability, the examiner reasoned that available service treatment records were negative for the complaint assessment or treatment of a chronic back problem. Available post-service records were negative for the complaint assessment or treatment of a chronic back problem. A symptom of pancreatitis (acute or chronic) included abdomen pain that radiates toward the back. The examiner stated that back pain noted during service was due to pancreatitis. There was insufficient medical evidence (subjective reporting, medical records, and/or medical literature) regarding a chronicity of symptoms, complaints, assessment, or treatment of condition to establish a nexus between the in-service injury or complaint and currently diagnosed condition. For the diagnosed left and right shoulder disabilities, the examiner reasoned that available service and post-service records were negative for the complaint, assessment, or treatment of any chronic shoulder problem. There was insufficient medical evidence (subjective reporting, medical records, and/or medical literature) regarding a chronicity of symptoms, complaints, assessment, or treatment of condition to establish a nexus between the in-service injury or complaint and any currently diagnosed condition. The Board finds the December 2024 VA opinions to be incomplete. An opinion that relies only on the absence of symptoms or treatment during service is incomplete. The opinions appear to have solely relied on the fact that the Veteran was not diagnosed with any shoulder or back disabilities during service to support the opinion that the claimed disabilities were not related to service. As the opinions relied on the absence of chronic symptoms or treatment in service for the negative opinions concerning the claimed disabilities, the Board finds the December 2024 opinions to be incomplete. Additionally, it does not appear that the Veteran's contentions regarding the bilateral shoulder and back disabilities were considered, as those were not addressed in the rationale. The opinions appear to be based solely on the objective?evidence of record. Because the examiner did not discuss or consider whether there was any subjective evidence or lay evidence to support a theory that any musculoskeletal disability is related to service, the Board again finds the VA examination reports to be incomplete. The record now shows bilateral shoulder and back disabilities diagnoses and alleged potential causation related to service. However, to date, the Veteran has not been provided adequate VA examination which addresses any etiological relationship between any musculoskeletal disabilities and service. That is a pre-decisional duty to assist error. Because the Veteran may have disabilities that are related to service, the Board finds that the Veteran should be provided a VA examination to determine the nature and etiology of the Veteran's claimed bilateral shoulder and back disabilities. Therefore, on remand an opinion as to the etiology of any bilateral shoulder and back disabilities should be requested. McLendon v. Nicholson, 20 Vet. App. 79 (2006); 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. In approaching the examinations, the Veteran is reminded that the duty to assist is not a one-way street. A Veteran is required to cooperate with the examiner's efforts to evaluate the nature and current severity of symptomology. Wood v. Derwinski, 1 Vet. App. 190 (1991). The Veteran is notified that it is the Veteran's responsibility to report for any scheduled examination and to cooperate in the development of these claims. The consequences for failure to cooperate with or report for a VA examination without good cause may include denial of the claim. 38 C 79 (2006); 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. In approaching the examinations, the Veteran is reminded that the duty to assist is not a one-way street. A Veteran is required to cooperate with the examiner's efforts to evaluate the nature and current severity of symptomology. Wood v. Derwinski, 1 Vet. App. 190 (1991). The Veteran is notified that it is the Veteran's responsibility to report for any scheduled examination and to cooperate in the development of these claims. The consequences for failure to cooperate with or report for a VA examination without good cause may include denial of the claim. 38 C.F.R. § 3.655. The Veteran is notified that failure to cooperate during the requested VA examination may result in an adverse determination. 38 C.F.R. § 3.655; Connolly v. Derwinski, 1 Vet. App. 566 (1991). The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination with an examiner who has not previously provided an opinion in conjunction with these claims, to obtain opinions regarding the nature and etiology of any bilateral knee, bilateral shoulder, and back disabilities. The examiner must review the claims file, including this Remand and?the Veteran's lay statements, and should indicate review of the file in the report. The examiner is advised that current bilateral knee, bilateral shoulder, and back disabilities have been conceded by VA. For each right knee, left knee, right shoulder, left shoulder, and back disability diagnosed or shown during the pendency of the claim, to include any?pain?resulting in?functional loss that constitutes a disability, the examiner must opine whether it is as likely as not that each disability is etiologically related to active service or any event, disease, or injury during service, including whether any right and left knee, shoulder, or back disability (1) began during active service or is related to any incident during service, (2)?manifested as arthritis within one year after separation from service, (3) was noted during service with continuity of the same symptomatology since service. Please cite to any evidence to support a finding of arthritis within one year following separation from service. The examiner is specifically asked to opine whether it is as likely as not that the physical nature of active-duty service contributed to or caused the claimed disabilities. A clearly stated rationale for each opinion offered must be provided and cannot be solely based on the lack of a record in service of the claimed disability. In providing the opinion, the examiner should refer to?any service medical records indicating treatment in service for knee, shoulder, or back complaints. Harvey P. Roberts Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Mondesir, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.