PERIPHERAL NERVE DISORDERS OF THE LOWER EXTREMITY

A. ISHIZAWAR · 2026 · Case ID: A26035406

MIXED

Summary

The veteran, who served from December 2007 to December 2011, appeals the denial of service connection for right lower extremity radiculopathy and an increased rating for chronic lumbar strain. The Board denied service connection for right lower extremity radiculopathy, finding no current diagnosis or evidence of such in the veteran's service treatment records, post-service treatment records, or the November 2020 VA examination. While the veteran reported some radiating pain and numbness, the VA examiner found no objective signs of radiculopathy, normal strength and reflexes, and negative straight leg raising tests. The Board found the VA examination more probative than the veteran's lay assertions, concluding the evidence did not support a current diagnosis or functional impairment of earning capacity. For the chronic lumbar strain, the Board denied an increased rating beyond 10 percent, finding the objective evidence did not support the criteria for a higher rating. Although the veteran reported flare-ups and functional limitations, the objective range of motion testing and examination findings did not meet the thresholds for higher ratings, and the Board found the VA examiner's assessment adequate. The case is remanded for further development regarding entitlement to service connection for migraines and Meniere's disease, as the Board found the existing treatment records and lay reports warranted VA examinations to assess the nature and etiology of these conditions, noting a pre-decisional error in failing to schedule these examinations.

Rationale

No current diagnosis of right lower extremity radiculopathy; Service treatment records and post-service records are silent for radiculopathy; VA examination found no objective signs of radiculopathy

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210525-161883

Full Decision Text

Citation Nr: A26035406
Decision Date: 04/16/26 Archive Date: 04/16/26

DOCKET NO. 210525-161883
DATE: April 16, 2026

ORDER

Service connection for right lower extremity radiculopathy is denied.

A rating in excess of 10 percent for chronic lumbar strain is denied.

REMANDED

Entitlement to service connection for migraines is remanded.

Entitlement to service connection for Meniere's disease is remanded.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that the Veteran has had right lower extremity radiculopathy at any time during or approximate to the pendency of the claim.

2. For the period on appeal, the weight of the evidence is against a finding that the Veteran's chronic lumbar strain was manifested by forward flexion greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis.

CONCLUSIONS OF LAW

1. The criteria for service connection for right lower extremity radiculopathy have not been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

2. The criteria for a rating in excess of 10 percent for chronic lumbar strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.6, 4.7, 4.71a, Diagnostic Code 5237.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from December 2007 to December 2011.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a January 2021 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO) under the Appeals Modernization Act (AMA).

In the May 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. The requested hearing was scheduled for July 26. 2024; however, in a statement received on July 25, 2024, the Veteran's attorney withdrew the hearing request.

Therefore, the Board may only consider the evidence of record at the time of the January 2021 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his attorney within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 20.801.

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

However, because the Board is remanding the claims of entitlement to service connection for migraines and Meniere's disease, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Service Connection

1. Entitlement to service connection for right lower extremity radiculopathy

The Veteran contends that service connection for right lower extremity radiculopathy is warranted due to his time in service or, alternatively, as a result of his service-connected chronic lumbar strain.

Service Connection

1. Entitlement to service connection for right lower extremity radiculopathy

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

Secondary service connection is also warranted where there is sufficient evidence to show that: (1) a current disability exists and (2) the current disability was either (a) caused by or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310. Secondary causation exists when, but for the service-connected disability, the non-service-connected disability was caused by a service-connected disability either in a direct, etiological way or via multiple steps in a causal chain. Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023) (citations omitted). Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe were it not for a service-connected disability. Id. at 1364. For example, secondary aggravation may be established where the natural progression of the non-service-connected disability could have been arrested or improved but for the service-connected disability. Id.

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The Board concludes that the Veteran does not have a current diagnosis of right lower extremity radiculopathy and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

The Veteran's service treatment records (STRs) and post-service treatment records are silent for any complaints, findings, treatment, or diagnosis related to right lower extremity radiculopathy or other neurological disorder of the right lower extremity. The Board acknowledges that during an annual VA appointment in June 2020, the Veteran reported worsened back pain that was now "in [his] right lower back." He also reported that when laying down on his right side for a prolonged period of time, he would experienced numbness radiating down the right leg to the knee. However, chronic low back pain with radiation to the right knee was assessed with no formal diagnosis of radiculopathy made.

Significantly, the Veteran was provided a VA Back (Thoracolumbar Spine) Conditions examination in November 2020. The Veteran reported chronic low back pain without identifying any radicular symptoms, including during flare-ups or as a functional loss/impairment. Moreover, the clinical evaluation found normal strength and reflexes throughout the Veteran's right lower extremity and no deficits of sensation. Straight leg raising test results were also negative for the right extremity. The examiner thus found that the Veteran did not have any radicular pain or any other signs or symptoms due to radiculopathy, and a diagnosis of such was not rendered for the right lower extremity.

The Board has considered the Veteran's general claim for service connection. However, while the Veteran is competent to attest to his symptoms, he and his attorney are not competent as lay people to provide a diagnosis. The diagnosis of radiculopathy requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). For these reasons, the Board finds more probative the medical evidence of record. As indicated above, both the November 2020 VA examination and the Veteran's post-service treatment records are silent for a diagnosis of right lower extremity radiculopathy.

The Board emphasizes
general claim for service connection. However, while the Veteran is competent to attest to his symptoms, he and his attorney are not competent as lay people to provide a diagnosis. The diagnosis of radiculopathy requires specialized medical education and the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). For these reasons, the Board finds more probative the medical evidence of record. As indicated above, both the November 2020 VA examination and the Veteran's post-service treatment records are silent for a diagnosis of right lower extremity radiculopathy.

The Board emphasizes that at the November 2020 VA examination, the Veteran described symptoms associated with his lower back but did not describe symptoms associated with his right lower extremity. Upon examination, the examiner also found that the Veteran did not have any indication of right lower extremity radiculopathy or other lower extremity neurological disorder. The Veteran has not presented evidence to demonstrate that any symptoms of radiating pain that he may experience to his right lower extremity has reached the level of a functional impairment of earning capacity sufficient to be reasonably interpreted as a current disability under the governing statutes and regulations. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018).

In making the above finding, the Board acknowledges the arguments from the Veteran's attorney as to the adequacy of the November 2020 VA examination report. However, as will be discussed in more detail below, the Board does not find a reason to question the validity of the VA examiner's objective testing and findings related to the Veteran's lower extremities.

In the absence of competent evidence of a current disability, there is no basis upon which service connection may be granted. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Accordingly, the claim for service connection for a right lower extremity radiculopathy must be denied.

Increased Rating

Disability evaluations are determined by comparing a Veteran's present symptoms with criteria set forth in the 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 determining the severity of a disability, the Board is required to consider the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran's disability. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991).

Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. 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.

Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). In deciding this appeal, the Board will consider whether separate ratings for different periods of time based on the facts found within the record is warranted. This is a practice of assigning ratings referred to as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2008).

In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomatology. Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if: (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case-by-case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau, 492 F.3d at 1376-77.

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. The benefit of the doubt rule does not apply when the evidence persuasively favors one side or the other. Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021).

2. Entitlement to a rating in excess of 10 percent for chronic lumbar strain

The Veteran contends that the symptoms associated with his chronic lumbar strain warrant a disability rating higher than 10 percent under Diagnostic Code 5237.

VA regulations provide spine disabilities are rated under either the General Rating Formula for Diseases and Injuries of the Spine or the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes, whichever would result in a higher rating. 38 C.F.R. § 4.71a.

Under the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent disability rating is warranted for forward flexion of the thoracolumbar (lumbar) 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. A 20 percent disability rating is assigned for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent disability rating is assigned for forward flexion of the thoracolumbar spine of 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent disability rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent disability rating is assigned for unfavorable ankylosis of entire spine. 38 C.F.R. § 4.71a.

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 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. 38 C.F.R. § 4.71a, Diagnostic Code 5242
of entire spine. 38 C.F.R. § 4.71a.

Under the Formula for Rating IVDS Based on Incapacitating Episodes, a 10 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months. A 20 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent disability rating is warranted for IVDS with incapacitating episodes having a total duration of at least 4 weeks, but less than 6 weeks during the past 12 months and a higher 60 percent disability rating is warranted for IVDS with incapacitating episodes having a total duration of at least six weeks during the past 12 months. Id. An incapacitating episode is defined as a period of acute signs and symptoms due to intervertebral disc syndrome that requires bedrest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, Note 1 following Formula for Rating IVDS Based on Incapacitating Episodes. However, in this case, there has been no evidence of IVDS. Therefore, these rating criteria will not be addressed further.

When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and therefore, not be reflected on range-of-motion testing. Additionally, 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in §§ 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or § 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria.").

Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1 (2011).

In Correia v. McDonald, 28 Vet. App. 158 (2016), the United States Court of Appeals for Veterans Claims (Court) held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." The spine has no opposite joint.

In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination.

Lastly, as the rating criteria for evaluating musculoskeletal disabilities do not explicitly contemplate medication use, the beneficial effects of the medication taken for a musculoskeletal disability
of motion testing "for pain on both active and passive motion [and] in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." The spine has no opposite joint.

Lastly, as the rating criteria for evaluating musculoskeletal disabilities do not explicitly contemplate medication use, the beneficial effects of the medication taken for a musculoskeletal disability must be discounted and the symptoms of the musculoskeletal disability must be evaluated at their baseline without the beneficial effects of the use of medication. Ingram v. Collins, 38 Vet. App. 130 (2025); see also Jones v. Shinseki, 26 Vet. App. 56, 63 (2012) (the effects of medication should be taken into account when determining the appropriate disability rating for irritable bowel syndrome (IBS) under the current version of Diagnostic Code 7319 as it does not contemplate the effects of medication in controlling irritable colon syndrome (or, by analogy, IBS)); Cf. McCarroll v. McDonald, 28 Vet. App. 267, 273 (2016) (holding that as the plain language of Diagnostic Code 7101 contemplates the effects of medication on hypertension, it is not required that the effects of the medication be discounted when considering whether a higher rating is warranted for hypertension).

Turning to the evidence for the period at issue, the Veteran underwent a VA examination for his lumbar spine in November 2020. The Veteran was diagnosed with lumbosacral strain and scoliosis. His current symptoms were described as chronic low back pain, which he treated with over-the-counter medications. Flare-ups of the spine were reported with weather and overexertion. Additionally, the Veteran reported suffering from functional loss, including an inability to sit, stand or walk for prolonged time and an inability to bend, lift or carry.

On examination, the Veteran's range of motion testing showed his forward flexion was limited to 80 degrees and his extension, bilateral lateral flexion and bilateral lateral rotation was limited to 25 degrees. Pain was noted on examination with forward flexion and extension but did not result in or cause functional loss. There was objective evidence of mild to moderate localized tenderness in his lumbar paravertebral muscles caused by his underlying lumbar strain. Evidence of pain with weight-bearing was also noted by the examiner. Regarding repetitive use testing, the Veteran was able to perform at least three repetitions, and there was no additional loss of function or range of motion. The Veteran was not examined immediately after repetitive use over time, or during a flare-up, but the examiner opined that pain, fatigue and weakness would cause functional loss. The examiner estimated the additional functional loss in terms of range of motion as forward flexion limited to 75 degrees and extension, bilateral lateral flexion and bilateral lateral rotation limited to 20 degrees. The Veteran did not have any guarding or muscle spasms of his thoracolumbar spine and there were no additional factors contributing to the disability. Muscle strength testing was normal, and he did not have any muscle atrophy. His reflex examination was normal, and straight leg testing results were negative. The Veteran did not have ankylosis of the spine, and there were no additional neurologic abnormalities related to the spine. Moreover, he did not have a diagnosis of IVDS. Functionally, it was indicated that the Veteran could not sit, stand or walk for prolonged time and could not bend, lift or carry.

Contemporaneous VA treatment records document the Veteran's ongoing reports of chronic back pain. In September 2019, within one year of the Veteran's July 2020 increased rating claim, his back was reported to have normal range of motion (including for flexion) and strength in the lower extremity.

After reviewing the foregoing medical and lay evidence, the Board finds that the criteria for a rating in excess of 10 percent have not been met.

Although the Veteran reports worsening symptoms of his back pain, and limited functional ability during a flare-up, the objective evidence of record does not support the finding that the Veteran's symptoms have increased to the point that a higher disability rating should now be assigned. As outlined above, it is not shown that the Veteran has lumbar spine limitation of flexion greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. In fact, the objective evidence of record showed the Veteran's forward flexion was most limited to 75 degrees, even with consideration of his estimated ability to function with repetitive use and during flare-ups.

In October 2024, the Veteran's attorney submitted written argument in which she questioned the adequacy of the November 2020 VA examination. Specifically, she stated that the VA examiner had noted that the Veteran suffered from flare-ups of his back condition and that the examination was not being conducted during a flare-up. The attorney then stated, "[T]he examiner claims, because the limitations of [the Veteran's] back during a flare up are no different than the limitations of his back during any other time. This is not true." The attorney also stated, "In the examination, the examiner note[d] that pain, fatigue, and weakness significantly limit [the Veteran's] functional ability during flare ups of his condition. If this is the case, then it cannot be the case that [the Veteran's] capabilities are the same as when he is not experiencing a flare-up. Thus, this examination . . . is insufficient." The Board is not persuaded by this argument, however, as the Veteran's attorney overlooks that after acknowledging the functional limitations caused by repeated use over time and flare-ups, the examiner estimated that the Veteran would suffer an additional 5-degree reduction in range of flexion and extension. This demonstrates that the November 2020 VA examiner did take the Veteran's pain, fatigue, and weakness in consideration when estimating what his range of motion would be like during a flare-up or after repeated use over time. As such, the Board does not find a reason to question the adequacy of the November 2020 VA examination and its objective findings.

The Board has also considered whether a higher rating should be assigned pursuant to 38 C.F.R. §§ 4.40, 4.45, 4.59, DeLuca, and Mitchell criteria but determines that a higher rating is not warranted based on the Veteran's disability picture. The range of motion testing conducted during the medical evaluation considered the thresholds at which pain limited motion, although the rating criteria for diseases and injuries of the spine contemplates pain. The Veteran reported flare-ups at the November 2020 VA examination. However, despite the Veteran's subjective report, repetitive use testing did not result in any additional loss of function or range of motion after three repetitions. Additionally, while the examiner did find evidence suggestive of pain, fatigability, and weakness causing limitations with functional ability with repeated use over time or during flare-ups, that limitation was estimated to be a loss of an additional 5 degrees of flexion and extension. There was also no evidence of guarding and muscle spasms on examination, and his muscle strength was normal. Based on this evidence, higher ratings under 38 C.F.R. §§ 4.40, 4.45, 4.59, DeLuca, and Mitchell criteria are not approximated in the Veteran's case.

VA regulations require neurologic abnormalities associated with back conditions, including bowel and bladder function, to be rated separately. Here, the Veteran is not shown to have any neurological abnormalities associated with his lumbar spine disability.

Finally, the Board has also considered Ingram v. Collins, 38 Vet. App. 130 (2025), which held that the Board is to take due consideration that the beneficial effects of medication are discounted in assessing musculoskeletal ratings as such effects are not contemplated therein and, therefore, taking medication may make a veteran appear less disabled than in reality. The record reflects that the Veteran uses over the counter medication for his lumbar spine symptoms. However, the record does not show that Veteran's lumbar spine pain would be worse but for the relief provided by his use of pain medication (which the Veteran also takes for other conditions, such as his tension headaches). Accordingly, a rem
abnormalities associated with his lumbar spine disability.

Finally, the Board has also considered Ingram v. Collins, 38 Vet. App. 130 (2025), which held that the Board is to take due consideration that the beneficial effects of medication are discounted in assessing musculoskeletal ratings as such effects are not contemplated therein and, therefore, taking medication may make a veteran appear less disabled than in reality. The record reflects that the Veteran uses over the counter medication for his lumbar spine symptoms. However, the record does not show that Veteran's lumbar spine pain would be worse but for the relief provided by his use of pain medication (which the Veteran also takes for other conditions, such as his tension headaches). Accordingly, a remand to obtain a current examination that complies with Ingram would not be useful and is not warranted in this case. See Soyini v. Derwinski, 1 Vet. App. 540, 546 (1991).

In summary, the evidence persuasively weighs against the claim for a rating in excess of 10 percent for the Veteran's chronic lumbar strain. The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application. See also Lynch v. McDonough, 21 F. 4th 776 (2021).

REASONS FOR REMAND

1. Entitlement to service connection for migraines and Meniere's disease is remanded.

In October 2024 written argument from the Veteran's attorney, it was contended that the Veteran suffered from migraines that were related to his military service, or in the alternative, are a result of his service-connected posttraumatic stress disorder (PTSD). Separately, it was contended that the Veteran suffered from Meniere's disease as a result of his military service.

At the outset, the Board observes that both conditions have somewhat overlapping symptomology. In this regard, post-service VA treatment records show the Veteran has complained of symptoms including chronic headaches and has had positive vertigo screens for dizziness. These symptoms can be attributed to both migraines and/or Meniere's disease. For instance, VA treatment records from September 2018 to July 2020 include reports of chronic headaches. During a July 2020 telephone encounter for his PTSD, it was documented that the Veteran had a history of "multiple exposures to explosions while deployed and working as a combat engineer", chronic headaches as well as exposure to burn pits in Afghanistan. Regarding dizziness, an August 2018 vertigo screen was positive for dizziness. Further, the records indicate the Veteran was exposed to improvised explosive device (IED) blasts in Afghanistan but never lost consciousness. Instead, he reported feeling "foggy" or "fuzzy" like he had to shake off the feeling following exposure to the blasts.

Despite the aforementioned VA treatment record notations, no VA examination was afforded to the Veteran for either his migraines or Meniere's disease claim. The Board finds, however, that these records along with the Veteran's lay reports of headaches and vertigo were sufficient to reach the low threshold for scheduling a VA examination to assess the nature and etiology of the claimed conditions. See McLendon v. Nicholson, 20 Vet. App. 79, 81-84 (2006); see also 38 C.F.R. § 3.159(c). Not doing so was a pre-decisional error. Accordingly, a remand is warranted to obtain a VA medical examination with corresponding medical opinions to determine whether the Veteran suffers from migraine headaches and/or Meniere's disease which are related to his military service or caused or aggravated by his service-connected PTSD.

The matters are REMANDED for the following action:

Arrange for a VA examination(s) from an appropriate examiner(s) to assess the nature and etiology of the Veteran's claimed migraines and Meniere's disease.

Upon review of the record and examination of the Veteran, the clinician must address the following:

(a) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, or higher) that the Veteran has Meniere's disease (or other disorder manifested by dizziness/vertigo) that had its onset in service or is otherwise due to or caused by the Veteran's service, including exposures to IED blasts?

(b) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, or higher) that the Veteran has a headache disorder/migraines that had its onset in service or is otherwise due to or caused by the Veteran's service?

(c) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, or higher) that the Veteran's service-connected PTSD caused or aggravated his headache disability/migraines? For the
nearly equal, or higher) that the Veteran has Meniere's disease (or other disorder manifested by dizziness/vertigo) that had its onset in service or is otherwise due to or caused by the Veteran's service, including exposures to IED blasts?

(c) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, or higher) that the Veteran's service-connected PTSD caused or aggravated his headache disability/migraines? For the purposes of secondary service connection, the clinician is advised that aggravation is defined as any increase in disability.

The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports, made both at the examination and in the written record, must be acknowledged and considered in formulating any opinion. If his reports are discounted, the examiner should provide a reason for doing so.

A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question.

A. ISHIZAWAR

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Churchwell, Kate

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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