PES PLANUS

MARCUS N. FULTON · 2026 · Case ID: A26031827

DENIED

Summary

The veteran, who served from September 2007 to September 2023 with multiple periods of active duty, appeals the denial of service connection and increased ratings for several conditions. The primary issues on appeal were bilateral pes planus with plantar fasciitis, irritable bowel syndrome (IBS), bilateral paresthesia of the posterior tibial nerve, tinea unguium, bilateral ankle strain, tinnitus, and yellow fever. The Board denied the claim for an increased rating for pes planus, finding the veteran was already rated at the maximum 50% under DC 5276, with no evidence of more severe symptoms or an earlier effective date. For IBS, the Board denied service connection due to a lack of current diagnosis and insufficient evidence of persistent symptoms, despite a VA examiner noting a medically unexplained chronic multi-symptom illness. The claims for bilateral posterior tibial nerve paresthesia were denied an increased rating, as the evidence showed only mild incomplete paralysis, not meeting the criteria for higher evaluations. The Board also denied an earlier effective date for these conditions, as no prior claims were found. Tinea unguium was denied a compensable rating because the condition affected less than 5% of the body and was treated with topical, not systemic, therapy. Ankle strain claims were denied an increased rating as the evidence did not support marked limitation of motion or ankylosis, and no earlier effective date was warranted due to lack of prior claims. Tinnitus and yellow fever claims were denied due to a lack of current diagnosis and insufficient evidence, with the VA examiner finding the described symptoms inconsistent with tinnitus and yellow fever resolved. All claims were denied.

Rationale

Veteran already rated at maximum 50% for pes planus under DC 5276.; Evidence did not show symptoms warranting a higher rating.; No new and material evidence or substantive appeal for earlier effective date.

Special Benefit

EARLIER EFFECTIVE DATE

Diagnostic Code

5276

Docket No.

250124-518207

Full Decision Text

Citation Nr: A26031827
Decision Date: 04/07/26 Archive Date: 04/07/26

DOCKET NO. 250124-518207
DATE: April 7, 2026

ORDER

Entitlement to an increased evaluation of bilateral pes planus with plantar fasciitis in excess of 50 percent is denied.

Entitlement to an earlier effective date for the grant of service connection for bilateral pes planus with plantar fasciitis is denied.

Entitlement to service connection for irritable bowel syndrome (IBS) with constipation is denied.

Entitlement to an increased initial evaluation for left lower paresthesia of the posterior tibial nerve is denied.

Entitlement to an increased initial evaluation for right lower paresthesia of the posterior tibial nerve is denied.

Entitlement to an earlier effective date for the grant of service connection for left lower paresthesia of the posterior tibial nerve is denied.

Entitlement to an earlier effective date for the grant of service connection for right lower paresthesia of the posterior tibial nerve is denied.

Entitlement to an initial compensable evaluation for tinea unguium is denied.

Entitlement to an increased initial evaluation for left ankle strain (claimed as arthritis) is denied.

Entitlement to an increased initial evaluation for right ankle strain (claimed as arthritis) is denied.

Entitlement to an earlier effective date for the grant of service connection for left ankle strain is denied.

Entitlement to an earlier effective date for the grant of service connection for right ankle strain is denied.

Entitlement to service connection for tinnitus is denied.

Entitlement to service connection for yellow fever is denied.

FINDINGS OF FACT

1. Throughout the period on appeal, the Veteran is already in possession of the maximum schedular rating for his service-connected pes planus.

2. No substantive appeal or new and material evidence was filed within one year of a September 2017 rating decision granting service connection for pes planus, and the decision therefore became final.

3. The evidence of record does not establish a current diagnosis of IBS or any other gastrointestinal disability.

4. Throughout the period on appeal, the Veteran's left lower extremity paresthesia of the posterior tibial nerve is mild in severity and is manifested by mild paresthesias and mild numbness, but no constant or intermittent pain or muscle atrophy.

5. Throughout the period on appeal, the Veteran's right lower extremity paresthesia of the posterior tibial nerve is mild in severity and is manifested by mild paresthesias and mild numbness, but no constant or intermittent pain or muscle atrophy.

6. Prior to the June 2023 VA Form 21-526EZ claim, there was no formal or informal claim for service connection for left lower extremity paresthesia.

7. Prior to the June 2023 VA Form 21-526EZ claim, there was no formal or informal claim for service connection for right lower extremity paresthesia.

8. For the entire appeal period, the Veteran's tinea unguium affects less than 5 percent of the Veteran's total body area, and none of his exposed area, and was not treated with constant or near constant systemic therapy over the past 12-month period.

9. For the entire appeal period, the symptoms of the Veteran's left ankle disability did not more nearly approximate marked limitation of motion, ankylosis or its functional equivalent, os calcis or astragalus, or astragalectomy.

10. For the entire appeal period, the symptoms of the Veteran's right ankle disability did not more nearly approximate marked limitation of motion, ankylosis or its functional equivalent, os calcis or astragalus, or astragalectomy.

11. Prior to the June 2023 VA Form 21-526EZ claim, there was no formal or informal claim for service connection for a left ankle condition.

12. Prior to the June 2023 VA Form 21-526EZ claim, there was no formal or informal claim for service connection for a right ankle condition.

13. The evidence of record does not establish a current diagnosis of tinnitus at any time during or proximate to the pendency of the claim.

14. The evidence of record does not establish a current diagnosis of yellow fever at any time during or proximate to the pendency of the claim.

CONCLUSIONS OF LAW

1. The criteria for an increased evaluation in excess of 50 percent for bilateral pes planus with plantar fasciitis are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1-4.3, 4.7, 4.118, Diagnostic Code 5276
ankle condition.

13. The evidence of record does not establish a current diagnosis of tinnitus at any time during or proximate to the pendency of the claim.

14. The evidence of record does not establish a current diagnosis of yellow fever at any time during or proximate to the pendency of the claim.

CONCLUSIONS OF LAW

2. The criteria for an earlier effective date for entitlement to service connection for pes planus have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.156, 3.157, 3.159, 3.400.

3. The criteria for entitlement to service connection for IBS have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.317.

4. The criteria for an increased initial rating in excess of 10 percent for left lower extremity paresthesia of the posterior tibial nerve have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.120, 4.123, 4.124a, DC 8525.

5. The criteria for an increased initial rating in excess of 10 percent for lower extremity paresthesia of the posterior tibial nerve have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.120, 4.123, 4.124a, DC 8525.

6. The criteria for an earlier effective date for the grant of service connection for left lower extremity paresthesia have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.156, 3.157, 3.159, 3.400.

7. The criteria for an earlier effective date for the grant of service connection for right lower extremity paresthesia have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.156, 3.157, 3.159, 3.400

8. The criteria for a compensable disability rating for tinea unguium are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1-4.3, 4.7, 4.118, Diagnostic Code 7813.

9. The criteria for an initial rating in excess of 10 percent for a left ankle disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.10, 4.71a, DC 5271.

10. The criteria for an initial rating in excess of 10 percent for a right ankle disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.10, 4.71a, DC 5271.

11. The criteria for an earlier effective date for the grant of service connection for a left ankle disability have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.156, 3.157, 3.159, 3.400.

12. The criteria for an earlier effective date for the grant of service connection for a right ankle disability have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.156, 3.157, 3.159, 3.400

13. The criteria for entitlement to service connection for tinnitus
earlier effective date for the grant of service connection for a left ankle disability have not been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.156, 3.157, 3.159, 3.400.

13. The criteria for entitlement to service connection for tinnitus have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.317.

14. The criteria for entitlement to service connection for yellow fever have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.317.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from September 2007 to June 2016, October 2020 to September 2021, October 2021 to September 2022, and October 2022 to September 2023.

This case comes before the Board of Veterans' Appeals (Board) on appeal from a March 2024, April 2024, and July 2024 rating decisions issued by the Department of Veterans Affairs (VA).

In the January 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 agency of original jurisdiction (AOJ) decisions on appeal, as well as any evidence submitted by the Veteran or his 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.

The Board also notes that the Veteran filed a Supplemental Claim for an increased rating for his pes planus and bilateral ankle disabilities, and service connection for his bilateral paresthesia and tinea unguium, while the instant appeal had been certified to the Board, without first withdrawing his Board appeal. In February 2025, the AOJ issued a spurious rating decision. The AOJ restored the 50 percent rating for the pes planus for the entire appeal period, continued the Veteran's 10 percent ratings for his ankle disabilities for the entire appeal period, granted service connection for left and right lower paresthesia at a 10 percent rating, and granted service connection for tinea unguium at a noncompensable rate. The issues have, therefore, been recharacterized to reflect such increase, as it is advantageous to the Veteran.

Finally, the Board observes that, in his January 2025 VA Form 10182, the Veteran also attempted to appeal his claims for an increased rating for allergic rhinitis, and service connection for sleep apnea and tinea pedis, which were denied in a March 2024 rating decision. However, these claims were already listed in an April 2024 VA Form 10182, and will therefore be addressed in a separate Board decision. Furthermore, the Veteran also attempted to appeal the denial of service connection for adenoid hypertrophy, headaches, a bilateral knee disability, sinusitis, varicella zoster virus, bilateral wrist pain, failed vasectomy complications, left ring finger non displaced avulsion fracture, blood clots, deviated nasal septum, post-surgical chronic pain, refractive vision error, and tooth removal pain; however, such claims were most recently denied in July 2017 and December 2017 rating decisions. Thus, as the Veteran did not file a request for an extension of time to submit his notice of disagreement based on good cause in a timely manner, and his notice of disagreement was received more than one year after the issuance of the rating decisions, they are untimely. 38 U.S.C. § 7105; 38 C.F.R. §§ 19.22,
varicella zoster virus, bilateral wrist pain, failed vasectomy complications, left ring finger non displaced avulsion fracture, blood clots, deviated nasal septum, post-surgical chronic pain, refractive vision error, and tooth removal pain; however, such claims were most recently denied in July 2017 and December 2017 rating decisions. Thus, as the Veteran did not file a request for an extension of time to submit his notice of disagreement based on good cause in a timely manner, and his notice of disagreement was received more than one year after the issuance of the rating decisions, they are untimely. 38 U.S.C. § 7105; 38 C.F.R. §§ 19.22, 19.51, 19.52, 20.104. Further, the AOJ has not waived the requirement to timely file a notice of disagreement, and the Board declines to do so. Hall v. McDonough, 34 Vet. App. 329, 332 (2022); Ferko v. McDonough, 37 Vet. App. 262 (en banc); Percy v. Shinseki, 23 Vet. App. 37, 45 (2009). Thus, such matters are not properly before the Board and will not be addressed herein.

Increased Rating

Disability evaluations are determined by comparing a veteran's present symptoms with criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule), which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. In general, it is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21.

"Staged" ratings are appropriate for an increased-rating claim when the factual findings show distinct time periods when the service-connected disability exhibits symptoms warranting different ratings irrespective of whether an initial or established rating. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505, (2007). The effective date of an award of increased compensation should not be assigned mechanically based on the date of an examination. Rather, all of the facts should be examined to determine the earliest date that it is ascertainable that an increase in disability first manifested. Swain v. McDonald, 27 Vet. App. 219, 224 (2015).

1. Entitlement to an increased evaluation of bilateral pes planus with plantar fasciitis in excess of 50 percent.

2. Entitlement to an earlier effective date for the grant of service connection for pes planus.

The Veteran contends he is entitled to an increased evaluation for his pes planus. He is currently rated at 50% from June 2, 2016, under DC 5276. As stated above, the Board notes that a February 2025 rating decision restored the 50 percent rating, and consequently, the Veteran is rated at 50 percent throughout the period on appeal. The Board will therefore address whether the Veteran is entitled to a higher rating and an earlier effective date, as is advantageous to the Veteran.

As this appeal stems from a June 2023 VA Form 21-526EZ, Fully Developed Claim, the period on review is from June 3, 2023, to the present, with consideration of the one-year look back period from June 3, 2022, to June 3, 2023. See 38 U.S.C. § 5110(b)(3); 38 C.F.R. § 3.400(o)(2); Gaston v. Shinseki, 605 F.3d 979, 982-83 (Fed. Cir. 2010) (if it is factually ascertainable that an increase in disability occurred within one year prior to the date a complete claim or intent to file a claim was received, an effective date up to one year prior to the date a complete claim or intent to file a claim was received may be assigned). Further, as in this case, where an increase in the level of a previously service-connected disability is at issue, the primary concern is the present
3. See 38 U.S.C. § 5110(b)(3); 38 C.F.R. § 3.400(o)(2); Gaston v. Shinseki, 605 F.3d 979, 982-83 (Fed. Cir. 2010) (if it is factually ascertainable that an increase in disability occurred within one year prior to the date a complete claim or intent to file a claim was received, an effective date up to one year prior to the date a complete claim or intent to file a claim was received may be assigned). Further, as in this case, where an increase in the level of a previously service-connected disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55, 58 (1999).

DC 5276 provides for a 50 percent rating for bilateral pes planus that is pronounced with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliances; and a 30 percent rating for severe bilateral pes planus with objective evidence of marked deformity, pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. 38 C.F.R. § 4.71a, DC 5276.

Turning to the relevant evidence of record, in November 2023, the Veteran appeared for a VA examination. The examiner noted diagnoses of pes planus and plantar fasciitis. The Veteran reported symptoms at onset of shooting pain through the bottom of his feet to his heels and numbness in his toes, and stated the condition had worsened since onset. The Veteran described foot tenderness and pain with prolonged walking more than one mile and standing for longer than one hour. The Veteran reported severe daily flare ups that last one day which are precipitated by prolonged walking and conducting physical training and are alleviated by pain meds, compresses, and elevation. The examiner noted pain in use and manipulation of both feet, but there was no indication of swelling on use. The Veteran reported bilateral use of arch supports. The Veteran did not have extreme tenderness of plantar surfaces, and decreased longitudinal arch height of both feet on weight-bearing. There was no objective evidence of marked deformity or marked pronation of either foot. Pain on examination caused functional loss, described as interference with standing on both feet. Pain was shown on active motion, passive motion, and weight-bearing, on both feet. The Veteran reported constant use of insoles.

The Board notes that a 50 percent rating is the highest rating available under DC 5276, and no other diagnostic codes related to the foot offer a higher rating. The Veteran is therefore rated at the highest possible rating for the entire period on appeal.

Given the foregoing, the Board finds that a rating in excess of 50 percent is not warranted, and is the highest possible rating under DC 5276.

The Veteran further contends that he is entitled to an earlier effective date for his pes planus, which is currently effective June 2, 2016. By way of procedural history, a September 2017 rating decision granted service connection for pes planus based on an April 2017 claim. The record does not reflect any new and material evidence nor substantive appeal submitted within one year of that rating decision, and the decision became final. Accordingly, an earlier effective date is not warranted.

Service Connection

Service connection will be granted if the evidence demonstrates that a current disability resulted from a disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303.

Generally, to establish service connection, there must be competent and credible evidence demonstrating: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus or link between the in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection may also be warranted for a Persian Gulf veteran who exhibits objective indications of a qualifying chronic disability that became manifest during active military, naval, or air service in the Southwest Asia theater of operations during the Persian Gulf War or to a degree of 10 percent or more not later than December 31, 2026. 38 U.S.C. § 1117; 38 C.F.R. § 3.317. For purposes of § 3.317, there are two types of qualifying chronic disabilities: (1) an undiagnosed illness, and (2) a medically unexplained chronic multisymptom illness (
.3d 1163, 1167 (Fed. Cir. 2004).

An undiagnosed illness is defined as a condition that by history, physical examination, and laboratory tests cannot be attributed to a known clinical diagnosis. There must also be objective indications of chronic disability, which include both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3).

A MUCMI is defined by a cluster of signs or symptoms, such as: (1) chronic fatigue syndrome, (2) fibromyalgia, and (3) functional gastrointestinal disorders (excluding structural gastrointestinal disease). 38 C.F.R. § 3.317(a)(2)(i)(B). The term MUCMI means a diagnosed illness without conclusive pathophysiology or etiology that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. 38 C.F.R. § 3.317(a)(2)(ii). Chronic multisymptom illnesses of partially understood etiology and pathophysiology, such as diabetes and multiple sclerosis, will not be considered medically unexplained. Id.

3. Entitlement to service connection for irritable bowel syndrome (IBS).

The Veteran contends he is entitled to service connection for irritable bowel syndrome.

Turning to the relevant evidence of record, the Veteran's treatment records are silent for any complaints or treatment for symptoms or a diagnosis of IBS or any other gastrointestinal disability. In November 2023, the Veteran underwent a VA examination. The examiner noted constipation from July 2023. The Veteran stated that the condition began in 2008, with symptoms of diarrhea, constipation, and hemorrhoids. The Veteran stated he experiences discomfort and pains when passing bowel movements, and normally has to hold his bowel movements until he gets home. The examiner noted treatment with stool softeners, and current symptoms of alternating diarrhea and constipation, and hemorrhoids. The examiner then opined that the Veteran had a diagnosable but medically unexplained chronic multi-symptom illness of unknown etiology.

In April 2024, the examiner provided an addendum opinion to address conflicting medical evidence that the Veteran's most recent complaint of constipation in VA medical records was in August 2017 and that his April 2020 service treatment record health assessment was negative for constipation. The examiner opined that the Veteran did not have a current diagnosis of constipation for at least six months that could be considered a MUCMI.

An etiological opinion addressing service connection was not provided as there was not a need for such an opinion, as the evidence failed to show a current diagnosis. There is no competent evidence of a diagnosis of IBS or any other gastrointestinal issue at any time during or proximate to the pendency of the Veteran's claim. Further, the Veteran has not submitted any statements describing persistent or recurrent symptoms of IBS. The Board declines to remand for an additional VA medical opinion based on any perceived pre-decisional duty to assist error, as the Board has herein determined that there is no credible evidence that the Veteran suffered a current disability of IBS at any time during the current appeal. McLendon, 20 Vet. App. at 81.

The Board acknowledges the Veteran's contention that his IBS is due to his service-connected acquired psychiatric disorder; however, having found that the threshold requirement of a current diagnosis is not met, it does not reach the in-service or nexus elements of service connection.

Considering the above, the evidence of record persuasively weighs against the claim as the current disability element has not been met. See Lynch, 21 F.4th at 781. Accordingly, service connection for IBS is not warranted.

4. Entitlement to an increased initial evaluation for left lower extremity paresthesia of the posterior tibial nerve.

5. Entitlement to an increased initial evaluation for right lower extremity paresthesia of the posterior tibial
The Board acknowledges the Veteran's contention that his IBS is due to his service-connected acquired psychiatric disorder; however, having found that the threshold requirement of a current diagnosis is not met, it does not reach the in-service or nexus elements of service connection.

4. Entitlement to an increased initial evaluation for left lower extremity paresthesia of the posterior tibial nerve.

5. Entitlement to an increased initial evaluation for right lower extremity paresthesia of the posterior tibial nerve.

6. Entitlement to an earlier effective date for the grant of service connection for left lower extremity paresthesia of the posterior tibial nerve.

7. Entitlement to an earlier effective date for the grant of service connection for right lower paresthesia of the posterior tibial nerve.

The Veteran contends that he is entitled to a higher evaluation for his bilateral paresthesia of the posterior tibial nerve. He is currently rated at 10% bilaterally from September 16, 2023, under DC 8525.

DC 8525 provides that mild incomplete paralysis is rated at 10 percent disabling; moderate incomplete paralysis is rated at 10 percent disabling; severe incomplete paralysis is rated at 20 percent disabling. Complete paralysis of the posterior tibial nerve, which is manifested by paralysis of all muscles of sole of foot, frequently with painful paralysis of a causalgic nature; toes cannot be flexed; adduction is weakened; plantar flexion is impaired, is rated at 30 percent disabling. 38 C.F.R. § 4.124a.

DCs 8625 and 8725 for neuritis and neuralgia of the posterior tibial nerve, respectively, are rated under the same rating criteria set forth under DC 8525 discussed above. 38 C.F.R. § 4.124a , DCs 8525, 8625, 8725.

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. 38 C.F.R. § 4.124a. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. Id.

The words "slight," "moderate," and "severe" are not defined in the VA Schedule for Rating Disabilities; rather than applying a mechanical formula, the Board must evaluate all the evidence so that its decisions are equitable and just. See 38 C.F.R. § 4.6. The Board notes, for reference and illustrative purposes, that "mild" is generally defined as being moderate in effect or not extreme or severe. MERRIAM-WEBSTER, https://www.merriam-webster.com/dictionary/mild (last visited Feb. 6, 2025). "Moderate" is generally defined as being not violent, severe, or intense, or limited in scope or effect. MERRIAM-WEBSTER, https://www.merriam-webster.com/dictionary/moderate (last visited Feb. 6, 2025). "Severe" is generally defined as being very painful or harmful, or to a great degree. MERRIAM-WEBSTER, https://www.merriam-webster.com/dictionary/severe (last visited Feb. 6, 2025). Thus, moderately severe would be something be that is more than limited in scope to a great degree.

The Board "is required to discuss any relevant provisions contained in the M21-1 as part of its duty to provide adequate reasons or bases." Overton v. Wilkie, 30 Vet. App. 257, 264 (2018). Relevant to this case are M21-1 provisions which include detailed definitions of "mild," "moderate," "moderately severe," and "severe" as found in 38 C.F.R. § 4.124a.

The M21-1 describes mild incomplete paralysis as a disability "limited to sensory deficits that are lower graded, less persistent, or affecting a smaller area." Part V, sbpt. iii, ch. 12, sec. A.2.c. Moderate incomplete paralysis, per the M21-1, should be "reserved for the most significant cases of sensory-only impairment," where the sensory involvement covers "a larger area in the nerve distribution." Id. M21-1 examples of a moderate disability include "motor and/or reflex impairment such as weakness or diminished or hyperactive reflexes (with or without sensory impairment) graded as medically moderate." Id. The M21-1 provides that a moderately severe evaluation is available when there is "[m]otor and/or reflex impairment (for example, weakness or diminished or hyperactive reflexes) at a grade reflecting a higher level of limitation or disability." Id. Atrophy may, but need not, be present for a moderately severe rating. Severe incomplete paralysis, per the M21-1, is reserved for a very high level of limitation when there is "motor and/or reflex impairment (for example, atrophy, weakness, or diminished hyperactive reflexes)." Id. Trophic changes may be seen in "severe longstanding neuropathy cases." Even though severe incomplete paralysis should show findings less than representative for complete impairment of the nerve, sign/symptoms resembling some of those expected in cases of complete paralysis of the nerve may be present. In addition, "neuritis characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain" should be rated as high as severe. Id.

Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124.

Neuritis of the peripheral nerves, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum rating equal to severe, incomplete, paralysis. The maximum rating that may be assigned for neuritis not characterized by organic changes referred to in this section will be that for moderate, or with sciatic nerve involvement, for moderately severe, incomplete paralysis. 38 C.F.R. § 4.123.

Neuralgia of a peripheral nerve characterized usually by a dull and intermittent pain, of typical distribution to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. The ratings for the peripheral nerves are for unilateral involvement; when bilateral, combine with application of the bilateral factor. 38 C.F.R. § 4.124.

Turning to the relevant evidence of record, in November 2023, the Veteran was afforded a VA examination. The examiner diagnosed the Veteran with polyneuropathies. The Veteran reported lower extremity pain, tingling, numbness, and difficulty with prolonged walking or standing more than 30 minutes. The Veteran reported no constant or intermittent pain bilaterally, and mild paresthesias and/or numbness bilaterally. Muscle strength testing and a reflex exam were normal. A sensory exam showed decreased sensation in the foot/toes. Mild incomplete paralysis was shown in the posterior tibial nerve bilaterally.

In April 2024, the Veteran was afforded another VA examination. The Veteran reported experiencing tingling and numbness in his feet and toes when sitting, and was diagnosed with polyneuropathies. The Veteran stated his continuing numbness and tingling lasts five to ten minutes a few times weekly. He reported treating with shoe inserts and pain medications as needed. The examiner noted no constant or intermittent pain bilaterally, mild paresthesias bilaterally, and mild numbness bilaterally. Muscle strength testing was normal, and a reflex exam showed normal reflexes. There was normal sensation in the foot/toes. Mild incomplete paralysis was shown in the posterior tibial nerve.

Based on the foregoing, for the entire appeal period, the Board finds that the Veteran's bilateral paresthesia of the posterior tibial nerve is manifested by no more than mild incomplete paralysis. The record reflects the Veteran experiences mild paresthesias and mild numbness bilaterally, but does not experience constant or intermittent pain or muscle atrophy. Furthermore, muscle strength testing and reflexes were normal bilaterally. The evidence of record therefore does not
ally, mild paresthesias bilaterally, and mild numbness bilaterally. Muscle strength testing was normal, and a reflex exam showed normal reflexes. There was normal sensation in the foot/toes. Mild incomplete paralysis was shown in the posterior tibial nerve.

Based on the foregoing, for the entire appeal period, the Board finds that the Veteran's bilateral paresthesia of the posterior tibial nerve is manifested by no more than mild incomplete paralysis. The record reflects the Veteran experiences mild paresthesias and mild numbness bilaterally, but does not experience constant or intermittent pain or muscle atrophy. Furthermore, muscle strength testing and reflexes were normal bilaterally. The evidence of record therefore does not show that the Veteran's bilateral paresthesia of the posterior tibial nerve more nearly approximated severe symptomatology necessary for the next higher 20 percent rating. Accordingly, the claim for an increased initial rating must be denied. See Lynch v. McDonough, 21 F.4th 776, 781-82 (2021) (en banc).

The Veteran further contends that he is entitled to an earlier effective date for the grant of service connection for his bilateral posterior tibial nerve paresthesia. He is currently granted service connection from September 16, 2023, the date he separated from active service, based on a June 2023 VA Form 21-526EZ. The record does not reflect any prior claims for service connection for lower extremity paresthesia. Accordingly, an earlier effective date than September 16, 2023 for the grant of service connection for bilateral paresthesia of the posterior tibial nerve is not warranted.

8. Entitlement to an initial compensable evaluation for tinea unguium.

The Veteran contends he is entitled to an initial compensable evaluation for tinea unguium. As stated above, the Board notes that a February 2025 rating decision granted service connection for tinea unguium and assigned a noncompensable rating. Accepting this favorable finding and to maximize the benefit available to the Veteran, the Board will therefore treat the claim as one for an increased rating.

The Veteran is currently rated as noncompensable under DC 7813, effective September 16, 2023. DC 7813 instructs the rater to evaluate under the General Rating Formula for the Skin.

Effective August 13, 2018, under the General Rating Formula for the Skin, a 10 percent rating is warranted if there is one of the following: characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected or at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required for a total duration less than 6 weeks over the past 12-month period. A 30 percent rating is warranted if there is one of the following: characteristic lesions involving 20 to 40 percent of the entire body affected or 20 to 40 percent of exposed areas affected; or systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. A maximum 60 percent rating is warranted if there is at least one of the following: characteristic lesions involving more than 40 percent of the entire body affected or more than 40 percent of exposed areas affected; or constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period. 38 C.F.R. § 4.118, DC 7813.

Systemic therapy means "treatment pertaining to or affecting the body as a whole," whereas topical therapy means "treatment pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied." See Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017).

Turning to the relevant evidence of record, in November 2023, the Veteran attended a VA examination. The examiner noted a diagnosis of tinea unguium of the left toenails.
uppressive drugs required over the past 12-month period. 38 C.F.R. § 4.118, DC 7813.

Turning to the relevant evidence of record, in November 2023, the Veteran attended a VA examination. The examiner noted a diagnosis of tinea unguium of the left toenails. The Veteran reported that his symptoms at onset consisted of itchiness between the toes and discolored toenails, and that the condition had stayed the same since onset. The Veteran stated he experiences foot pain and discomfort while wearing uniform shoes. The Veteran reported constant or near-constant treatment with over-the-counter topical creams. The examiner noted that the condition affected less than five percent of the Veteran's total body area, and none of the exposed area, and described the condition as yellowed brittle left toenails. The condition did not cause any scarring of the head, face, or neck.

Based on the foregoing, the Board finds that an initial compensable evaluation is not warranted. The November 2023 VA examiner noted the Veteran's condition affects less than 5 percent of the Veteran's total body area, and none of his exposed area, which is not sufficient to warrant the next higher 10 percent evaluation. Furthermore, although he reported constant or near-constant treatment for his condition, he reported treatment with a topical cream, which does not qualify as systemic therapy, as detailed above. Accordingly, an initial compensable rating must be denied. See Lynch v. McDonough, 21 F.4th 776, 781-82 (2021) (en banc).

9. Entitlement to an increased evaluation for left ankle strain.

10. Entitlement to an increased evaluation for right ankle strain.

11. Entitlement to an earlier effective date for the grant of service connection for left ankle strain.

12. Entitlement to an earlier effective date for the grant of service connection for right ankle strain.

The Veteran contends he is entitled to an increased initial evaluation for his service-connected bilateral ankle strain. He is currently rated at 10% bilaterally under DC 5271 from October 1, 2022.

Under DC 5271, as of February 7, 2021, under the amended criteria, a 10 percent rating is warranted for moderate limitation of ankle motion (defined as less than 15 degrees of dorsiflexion or less than 30 degrees of plantar flexion), and a 20 percent rating is warranted for marked limitation of ankle motion (defined as less than 5 degrees of dorsiflexion or less than 10 degrees of plantar flexion).

In addition to DC 5271, the Board has a duty to acknowledge and consider all diagnostic codes that are potentially applicable, including DC 5270, which evaluates an ankle disability with ankylosis. Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). Under DC 5270, 40 percent rating is assigned for presence of ankylosis in plantar flexion at more than 40 degrees, or in dorsiflexion at more than 10 degrees, or with adduction, adduction, inversion or eversion deformity. A 30 percent rating is assigned for presence of ankylosis in plantar flexion, between 30 and 40 degrees, or in dorsiflexion, between 0 and 10 degrees.

A review of the record is silent for any complaints or treatment for an ankle condition. However, in November 2023, the Veteran was afforded a VA examination. The examiner noted a diagnosis of bilateral ankle strain. The Veteran reported stiffness, pain, and difficulty with walking more than one mile or climbing two flights of stairs. In terms of flare ups, the Veteran reported bilateral severe daily flareups which last one day, are precipitated by prolonged walking and conducting physical training, and are alleviated by pain meds, compresses, elevation. The Veteran reported no instability of the ankle. Initial active range of motion testing showed plantar flexion to 45 degrees, and dorsiflexion to 20 degrees bilaterally, with pain shown bilaterally. Passive range of motion was the same as active range of motion. There was evidence of pain on weight-bearing and active and passive motion which did not result in or cause functional loss. There was no evidence of crepitus or localized tenderness. After repetitive use testing, plantar flexion was measured at
. In terms of flare ups, the Veteran reported bilateral severe daily flareups which last one day, are precipitated by prolonged walking and conducting physical training, and are alleviated by pain meds, compresses, elevation. The Veteran reported no instability of the ankle. Initial active range of motion testing showed plantar flexion to 45 degrees, and dorsiflexion to 20 degrees bilaterally, with pain shown bilaterally. Passive range of motion was the same as active range of motion. There was evidence of pain on weight-bearing and active and passive motion which did not result in or cause functional loss. There was no evidence of crepitus or localized tenderness. After repetitive use testing, plantar flexion was measured at 45 degrees and dorsiflexion was measured to 20 degrees, bilaterally, due to pain and lack of endurance. The estimated range of motion for a flare-up was the same as after repetitive use. No muscle atrophy or ankylosis were shown.

Upon review, the Board finds that a rating greater than 10 percent for the Veteran's left ankle disability is not warranted. At the November 2023 VA examination, the Veteran's bilateral ankle disability was limited to no worse than dorsiflexion to 20 degrees and plantar flexion to 45 degrees. However, the record does not reflect evidence of marked limited motion (less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion) to warrant the next higher 20 percent rating, even considering the Veteran's reports of flare ups. Furthermore, there is no evidence of ankylosis or the functional equivalent thereof at any time during this period. Chavis v. McDonough, 34 Vet. App. 1, 23-24 (2021).

Accordingly, the most persuasive evidence supports that the Veteran's bilateral ankle symptoms have most closely approximated the criteria for a 10 percent rating for painful motion under DC 5271.

Further, evaluating the Veteran's ankle disabilities under an alternative DC is unwarranted. There is no evidence of record of any malunion of os calcis or astragalus or any astragalectomy. Thus, a higher rating is not warranted on the basis of these DCs. 38 C.F.R. § 4.71a, DCs 5273-5274.

The Veteran further contends that he is entitled to an earlier effective date for the grant of service connection for his bilateral ankle disabilities, which are currently service-connected effective October 1, 2022, the day after his discharge from active duty. In terms of procedural history, this claim stems from a June 2023 VA Form 21-526EZ. A review of the record is silent for any earlier formal or informal claim for service connection for an ankle condition. Accordingly, an earlier effective date for the grant of service connection for the Veteran's bilateral ankle disability is not warranted.

13. Entitlement to service connection for tinnitus.

The Veteran contends he has tinnitus due to his service.

Turning to the relevant evidence of record, the Board notes that the Veteran's treatment records are also negative for any complaints or treatment for tinnitus. In July 2023, the Veteran was afforded a VA examination. The Veteran stated that he did not hear a ringing, buzzing, or noise in his ears, but rather sometimes felt like there was a plug in his ear and he couldn't hear well, similar to the sensation of not being able to pop your ears on an airplane. He stated that he notices this sensation when he wakes up in the morning, when he lays down, or when he is around a loud noise. The examiner opined that this description was not consistent with tinnitus, and consequently that he did not have a current diagnosis of tinnitus.

Although the Board acknowledges that the Veteran is competent to describe the tinnitus symptoms he is experiencing and has experienced in the past, the July 2023 examiner opined that the symptoms the Veteran described were not consistent with tinnitus, and the Veteran's record does not contain any other opinions, diagnosis, or treatment for tinnitus. See Jandreau, 492 F.3d at 1377; Layno, 6 Vet. App. at 470.

Considering the above, the Board finds that the evidence of record persuasively weighs against a current diagnosis of tinnitus. As a current diagnosis is the threshold requirement for a claim of service connection, the claim must be denied. See Lynch v. McDonough, 21 F.4th 776, 781-82 (2021) (en banc).

14. Entitlement to service connection for yellow fever.

The Veteran contends that he suffers from yellow fever due to his service.

In November 2023, the Veteran was afforded a VA examination. The Veteran reported that his condition began in
Jandreau, 492 F.3d at 1377; Layno, 6 Vet. App. at 470.

14. Entitlement to service connection for yellow fever.

The Veteran contends that he suffers from yellow fever due to his service.

In November 2023, the Veteran was afforded a VA examination. The Veteran reported that his condition began in 2019, with symptoms including fever, headache, nausea, and vomiting. The examiner noted that the condition had since improved, and the Veteran had no symptoms currently. The examiner then opined that there were no findings, signs, or symptoms to support a diagnosis. The Veteran's treatment records are negative for any treatment or complaints of yellow fever at any time during or approximate to the appeal period.

A review of the Veteran's record is silent for any complaints or treatment for yellow fever during the review period.

Although the Board acknowledges that the Veteran is competent to describe the symptoms he is experiencing and has experienced in the past, the July 2023 examiner opined that the condition had since resolved since its onset in service. Furthermore, the record does not reflect that the Veteran has the medical expertise to diagnose a condition such as yellow fever. See Jandreau, 492 F.3d at 1377; Layno, 6 Vet. App. at 470.

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Considering the above, the Board finds that the evidence of record persuasively weighs against a current diagnosis of yellow fever. As a current diagnosis is the threshold requirement for a claim of service connection, the claim must be denied. See Lynch v. McDonough, 21 F.4th 776, 781-82 (2021) (en banc).

Marcus N. Fulton

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Marshall, J.

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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