THORACOLUMBAR SPINE LIMITATION OF MOTION

Summary

The veteran, who served from March 2018 to January 2021, appeals a February 2025 rating decision that reduced his disability evaluation for a service-connected back condition from 40 percent to 20 percent, effective September 1, 2025. The veteran also appeals the denial of an increased rating for his service-connected costochondritis. Regarding the back condition, the Board reviewed VA examinations from January 2021 and January 2025. While the January 2021 exam noted forward flexion limitations to 50 degrees during flare-ups, the January 2025 exam indicated further limitations, with forward flexion restricted to 40 degrees during flare-ups. The Board found that the evidence did not support an improvement in the veteran's back condition; rather, it suggested a worsening. Applying the benefit of the doubt, the Board concluded the reduction was improper and void ab initio, granting the petition to reverse the reduction and restoring the 40 percent rating. For costochondritis, the Board reviewed VA examinations from January 2021 and January 2025. The January 2021 exam found no objective loss of strength or function. The January 2025 exam noted pain with deep breaths but no objective findings of muscle atrophy, fascial defects, or ankylosis. The Board found the evidence did not support a rating higher than 10 percent, as the veteran's condition did not meet the criteria for moderately severe or severe muscle disability. Therefore, the appeal for an increased rating for costochondritis was denied.

Rationale

Reduction improper based on evidence of worsening condition; January 2021 exam showed 50-degree flexion limit during flare-ups; January 2025 exam showed 40-degree flexion limit during flare-ups

Full Decision Text

Citation Nr: A26033759
Decision Date: 04/13/26	Archive Date: 04/13/26

DOCKET NO. 250401-533959
DATE: April 13, 2026

ORDER

The reduction in rating for service-connected back condition from 40 percent to 20 percent, effective September 1, 2025, is improper and is void ab initio; therefore, the petition to reverse the reduction is granted. 

An increased rating in excess of a 10 percent rating for service-connected costochondritis is denied. 

FINDINGS OF FACT

1. The reduction of the rating for the Veteran's back condition from 40 percent to 20 percent, effective September 1, 2025, was not proper as the probative evidence of record did not suggest an improvement in the Veteran's back condition. 

2. The probative evidence of record does not support a finding that the Veteran's costochondritis produces symptoms that are more analogous to a moderately severe or severe impairment of Muscle Group XXI. 

CONCLUSIONS OF LAW

1. The reduction in rating for a service-connected back condition from 40 percent to 20 percent effective September 1, 2025, is improper and is void ab initio; therefore, the criteria for the petition to reverse the reduction have been met. See 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§?3.102, 3.105(e) & (i), 3.321, 3.344, 4.1, 4.2, 4.3, 4.10, 4.13, 4.97. 

2. The criteria for a rating in excess of 10 percent rating for costochondritis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.21, 4.55, 4.56, 4.73, Diagnostic Code 5321. 

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from March 2018 to January 2021. This matter comes before the?Board of Veterans' Appeals?(Board) on appeal from a February 2025 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO).

In March 2025, the Veteran submitted a VA Form 10182 Notice of Disagreement (NOD), selecting the Evidence Lane under the Appeals Modernization Act (AMA), which would include consideration of evidence considered by the AOJ and evidence submitted within 90 days of the NOD. 

1. The reduction in rating for service-connected back condition from 40 percent to 20 percent, effective September 1, 2025, is improper and is void ab initio; therefore, the petition to reverse the reduction is granted.

Legal Criteria

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See?38?U.S.C. §?1155;?38?C.F.R. §?4.1.?? 

During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38?C.F.R. §?4.71a were amended, effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes "to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities." Id.?? 

If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38?U.S.C. §?5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38?U.S.C. §?5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38?U.S.C. §?5110.?? 

While portions of the?rating?schedule addressing the musculoskeletal system were revised effective February 7, 2021, these diagnostic codes were not changed.?? 

A 10 percent?rating?is warranted for forward flexion of the
38?U.S.C. §?5110(g). If the revised version of the regulation is more favorable, the implementation of that regulation under 38?U.S.C. §?5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38?U.S.C. §?5110.?? 

While portions of the?rating?schedule addressing the musculoskeletal system were revised effective February 7, 2021, these diagnostic codes were not changed.?? 

A 10 percent?rating?is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. Id.?? 

A 20 percent?rating?is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, forward flexion of the?cervical?spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, the combined range of motion of the?cervical?spine not greater than 170 degrees; or, for muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Id.?? 

A 40 percent?rating?is warranted for forward flexion of the thoracolumbar spine limited to 30 degrees or less, or, for favorable ankylosis of the entire thoracolumbar spine. Id. A 50 percent?rating?is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent?rating?is warranted for unfavorable ankylosis of the entire spine. Id.?? 

Any associated objective neurologic abnormalities are to be evaluated separately, under an appropriate diagnostic code. Id. at Note (1). For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, normal extension is zero to 30 degrees, normal left and right lateral flexion is zero to 30 degrees, and normal left and right lateral rotation is zero to 30 degrees. Id. at Note (2). The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. Id. All measured ranges of motion are to be rounded to the nearest five degrees. Id. at Note (4).?? 

For VA compensation purposes, unfavorable ankylosis is a condition in which the entire thoracolumbar spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or?cervical?subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. Id. at Note (5).?? 

Under 38 C.F.R. § 3.105 (e), where a reduction in an evaluation of a service-connected disability is considered warranted, and the lower evaluation would result in a reduction or discontinuance of compensation payments currently being made, a rating proposing the reduction or discontinuance must be prepared setting forth all material facts and reasons. In addition, the RO must notify the Veteran that he has 60 days to present additional evidence showing that the compensation should be continued at the present level. The Veteran must be informed that he may request a predetermination hearing, providing that the request is received by VA within 30 days from the date of the notice. If no additional evidence is received within the 60-day period and no hearing is requested, a final rating action will be taken, and the award will be reduced or discontinued effective the last day of the month in which a 60-day period from the date of notice to the Veteran expires.

Factual Background

The Veteran was afforded a January 2021 VA examination; upon range of motion testing of the lumbar spine, he
 In addition, the RO must notify the Veteran that he has 60 days to present additional evidence showing that the compensation should be continued at the present level. The Veteran must be informed that he may request a predetermination hearing, providing that the request is received by VA within 30 days from the date of the notice. If no additional evidence is received within the 60-day period and no hearing is requested, a final rating action will be taken, and the award will be reduced or discontinued effective the last day of the month in which a 60-day period from the date of notice to the Veteran expires.

Factual Background

The Veteran was afforded a January 2021 VA examination; upon range of motion testing of the lumbar spine, he displayed 90 degrees of forward flexion, 30 degrees of extension, 30 degrees of left lateral rotation, 30 degrees of right lateral rotation, 30 degrees of left lateral flexion, and 30 degrees of right lateral flexion. Passive range of motion produced the same results as active. 

The Veteran was able to perform repetitive use testing with at least three repetitions which did not result in any additional loss of function or range of motion.?

The conducting examiner indicated that the Veteran was not being examined during a flare-up or after repeated use over a period of time. The examiner opined that pain would limit the Veteran's ROM of the thoracolumbar spine as follows: 50 degrees of forward flexion, 30 degrees of extension, 20 degrees of left lateral rotation, 20 degrees of right lateral rotation, 20 degrees of left lateral flexion, and 20 degrees of right lateral flexion. 

The conducting examiner indicated that the Veteran did not have ankylosis of the spine. The Veteran had localized tenderness, guarding, or muscle spasm of the thoracolumbar spine, which did not result in abnormal gait or spinal contour. 

The Veteran was afforded a January 2025 VA examination during which he reported pain when bending, lifting, or carrying heavy objects, or walking and standing for periods of time.

Upon range of motion testing of the lumbar spine, he displayed 60 degrees of forward flexion, 20 degrees of extension, 20 degrees of left lateral rotation, 20 degrees of right lateral rotation, 20 degrees of left lateral flexion, and 20 degrees of right lateral flexion. Passive range of motion produced the same results as active.

There was evidence of pain upon forward flexion, right lateral flexion, right lateral rotation, extension, left lateral rotation, and left lateral flexion. 

The Veteran was able to perform repetitive use testing with at least three repetitions which resulted in decreased range of motion. The Veteran displayed 55 degrees of forward flexion, 15 degrees of extension, 15 degrees of left lateral rotation, 15 degrees of right lateral rotation, 15 degrees of left lateral flexion, and 15 degrees of right lateral flexion.

The conducting examiner indicated that the Veteran was not being after repeated use over time. The examiner opined that pain would limit the Veteran's ROM of the thoracolumbar spine after repeated use over time as follows: 50 degrees of forward flexion, 10 degrees of extension, 10 degrees of left lateral rotation, 10 degrees of right lateral rotation, 10 degrees of left lateral flexion, and 10 degrees of right lateral flexion. 

The conducting examiner also indicated that the Veteran was not being during a flare-up. The examiner opined that pain would limit the Veteran's ROM of the thoracolumbar spine during a flare-up as follows: 40 degrees of forward flexion, 10 degrees of extension, 10 degrees of left lateral rotation, 10 degrees of right lateral rotation, 10 degrees of left lateral flexion, and 10 degrees of right lateral flexion. 

The conducting examiner indicated that the Veteran did not have ankylosis of the spine. The Veteran had localized tenderness, guarding, or muscle spasm of the thoracolumbar spine, which did not result in abnormal gait or spinal contour. 

The RO sent the Veteran a letter on February 26, 2025, informing him of the proposal to reduce his back rating to 20 percent.

The February 2025 rating decision informed the Veteran that a 20 percent evaluation would be assigned effective 60 days from the date of the decision. The Veteran was offered a predetermination hearing and afforded 60 days to submit additional evidence. 

In June 2025, the AOJ issued a rating decision effectuating the reduction, effective September 1, 2025. Thus, the RO complied with the procedural guidelines necessary before a rating reduction may be implemented. 38 C.F.R. §3.105(e).

Analysis 

The Board finds the AOJ satisfied the procedural requirements of 38 C.F.R. §3
 February 26, 2025, informing him of the proposal to reduce his back rating to 20 percent.

The February 2025 rating decision informed the Veteran that a 20 percent evaluation would be assigned effective 60 days from the date of the decision. The Veteran was offered a predetermination hearing and afforded 60 days to submit additional evidence. 

In June 2025, the AOJ issued a rating decision effectuating the reduction, effective September 1, 2025. Thus, the RO complied with the procedural guidelines necessary before a rating reduction may be implemented. 38 C.F.R. §3.105(e).

Analysis 

The Board finds the AOJ satisfied the procedural requirements of 38 C.F.R. §3.105 (e) for the rating reduction. That being said, even if the AOJ complies with the procedural and notice requirements detailed above, the Board also concludes that the reduction at issue does not accord with the evidence of record. Prior to reducing a Veteran's disability rating, VA is required to comply with several regulations applicable to all rating-reduction cases, regardless of the rating level or the length of time that the rating has been in effect. See 38 C.F.R. §§ 4.1, 4.2, 4.10, 4.13; see Brown v. Brown, 5 Vet. App. 413, 420 (1993). 

These provisions impose a clear requirement that VA rating reductions be based upon review of the entire history of a Veteran's disability. See Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). Such review requires VA to ascertain, based upon review of the entire recorded history of the condition, whether the evidence reflects an actual change in the disability and whether the examination reports reflecting such change are based upon thorough examinations. Thus, in any rating-reduction case, not only must it be determined that an improvement in a disability has actually occurred but also that that improvement actually reflects an improvement in the Veteran's ability to function under the ordinary conditions of life and work. See Faust v. West, 13 Vet. App. 342, 350 (2000).

The Board notes that the provisions of 38 C.F.R. § 3.344 (c) concerning disabilities that have not stabilized are applicable, as the evaluation for the Veteran's back condition was not in place for at least 5 years. This regulation provides that reexaminations disclosing improvement will warrant a rating reduction. In any rating reduction case, not only must it be determined that an improvement in disability has occurred, but also that the improvement in disability actually reflects an improvement in the appellant's ability to function under the ordinary conditions of life and work. See Faust at 349.

In considering the propriety of a reduction, the Board must focus on the evidence available to the AOJ at the time the reduction was effectuated (although post-reduction medical evidence may be considered in the context of considering whether actual improvement was demonstrated). Dofflemyer v. Derwinski, 2 Vet. App. 277, 281-82 (1992). The Veteran need not demonstrate that he is entitled to retain the higher evaluation. Rather, it must be shown that the AOJ's reduction was warranted. See Kitchens v. Brown, 7 Vet. App. 320, 324 (1995).

Here, the Board notes that the probative evidence of record does not support a finding that the Veteran's service-connected back condition had improved. Rather, the record indicates that the Veteran's condition has worsened. 

The Board notes that the January 2021 VA examination indicated that the Veteran's forward flexion of his thoracolumbar spine would be limited to 50 degrees during a flare-up or with repeated use over time. The January 2025 VA examiner indicated that the Veteran's forward flexion of his thoracolumbar spine would be limited to 40 degrees during a flare-up. 

As such, the Board resolves all reasonable doubt in the Veteran's favor and finds that the discontinuance of the 40 percent rating for his back condition, effective September 1, 2025, was improper and is void ab initio.

2. An increased rating in excess of 10 percent rating for service-connected costochondritis is denied. 

Legal Criteria

Costochondritis is a disability that is not listed under VA's rating schedule. Where a particular service-connected disability is not listed, it may be rated by analogy to a closely related disease in which not only the functions affected, but also the anatomical location and symptomatology, are closely analogous. 38 C.F.R. §§ 4.20, 4.27; cf. Copeland v. McDonald, 27 Vet. App. 333, 337 (2015)
40 percent rating for his back condition, effective September 1, 2025, was improper and is void ab initio.

2. An increased rating in excess of 10 percent rating for service-connected costochondritis is denied. 

Legal Criteria

Costochondritis is a disability that is not listed under VA's rating schedule. Where a particular service-connected disability is not listed, it may be rated by analogy to a closely related disease in which not only the functions affected, but also the anatomical location and symptomatology, are closely analogous. 38 C.F.R. §§ 4.20, 4.27; cf. Copeland v. McDonald, 27 Vet. App. 333, 337 (2015) ("when a condition is specifically listed in [VA's schedule for rating disabilities], it may not be rated by analogy.").

The Veteran's costochondritis has been evaluated pursuant to Diagnostic Code 5231, which outlines the rating criteria for injuries of the muscles of respiration. 

For VA rating purposes, the cardinal signs and symptoms of muscle disability are loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination, and uncertainty of movement. 38 C.F.R. § 4.56 (c).

A slight disability of muscles comprises simple wound of muscle without debridement or infection. Objective findings include minimal scar; no evidence of fascial defect, atrophy, or impaired tonus; and no impairment of function or metallic fragments retained in muscle tissue. 38 C.F.R. § 4.56 (d)(1).

A moderate muscle disability comprises a through-and-through or deep penetrating wound of short track from a single bullet, small shell or shrapnel fragment, without explosive effect of high velocity missile, residuals of debridement, or prolonged infection. Objective findings should include entrance and (if present) exit scars; small or linear, indicating short track of missile through muscle tissue; some loss of deep fascia or muscle substance or impairment of muscle tonus; and loss of power or lowered threshold of fatigue when compared to the sound side. 38 C.F.R. § 4.56 (d)(2).

A moderately severe muscle disability comprises a through-and-through or deep open penetrating wound by a small high-velocity missile or a large low-velocity missile, with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring. There should be a history of hospitalization for a prolonged period for treatment of the wound, with a record of consistent complaints of cardinal signs and symptoms of muscle disability, and, if present, evidence of inability to keep up with work requirements. Objective findings should include entrance and (if present) exit scars indicating track of missile through one or more muscle groups; and indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with sound side. Tests of strength and endurance compared with sound side should demonstrate positive evidence of impairment. 38 C.F.R. § 4.56 (d)(3).

A severe muscle disability contemplates through-and-through or deep penetrating wounds due to high-velocity missile, or large or multiple low-velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding and scarring. There should be a history of hospitalization for a prolonged period for treatment of the wound, with consistent complaints of cardinal signs and symptoms of muscle disability, worse than those shown for moderately severe muscle injuries, and, if present, evidence of inability to keep up with work requirements. Objective findings should include ragged, depressed and adherent scars indicating wide damage to muscle groups in missile track; palpable loss of deep fascia or muscle substance, or soft flabby muscles in wound area; and abnormal muscle swelling and hardening in contraction; tests of strength, endurance, or coordinated movements compared with the corresponding muscles of the uninjured side indicate severe impairment of function. 38 C.F.R. § 4.56 (d)(4).

Factual Background

The Veteran was afforded a January 2021 VA examination during which he was diagnosed with chondrocostal junction syndrome and chest pain. The Veteran reported that he has constant chest wall pain, which he treats with ibuprofen. The examiner noted that the Veteran's condition results in constant fatigue and/or pain.

The conducting examiner noted that the Veteran did not have any known fascial defects or evidence of fascial defects associated with any muscle injuries. The examiner also noted that the Veteran's muscle injury did not affect muscle substance or function. The Veteran did not have any muscle atrophy of the injured muscle group. 

The Veteran was then afforded a February 2025 VA examination during which the conducting examiner noted that he has pain while taking a deep breath. The
 afforded a January 2021 VA examination during which he was diagnosed with chondrocostal junction syndrome and chest pain. The Veteran reported that he has constant chest wall pain, which he treats with ibuprofen. The examiner noted that the Veteran's condition results in constant fatigue and/or pain.

The conducting examiner noted that the Veteran did not have any known fascial defects or evidence of fascial defects associated with any muscle injuries. The examiner also noted that the Veteran's muscle injury did not affect muscle substance or function. The Veteran did not have any muscle atrophy of the injured muscle group. 

The Veteran was then afforded a February 2025 VA examination during which the conducting examiner noted that he has pain while taking a deep breath. The examiner further noted that the Veteran has not undergone rib removal or resection. The examiner also indicated that the Veteran has not undergone removal of the coccyx. 

Analysis 

The Board finds that the probative evidence of record does not support a finding that the Veteran's costochondritis produces symptoms that are more analogous to a moderately severe or severe impairment of Muscle Group XXI, thereby warranting the next higher rating of 20 percent.  

The Board notes clinical testing revealed no objectively apparent loss of strength or function, and he has no muscular atrophy or similar evidence of impaired muscle tone or loss of deep fascia or muscle substance.  

As such, the next higher rating based on evidence of a moderately severe or severe muscle injury is not warranted.  Thus, a rating in excess of 10 percent for the Veteran's costochondritis is not warranted. 

 

 

Thomas L. English

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Bahus, Alexander

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.