PROSTATE GLAND DISEASE OF

J. PARKER · 2026 · Case ID: A26036491

MIXED

Summary

The Veteran, who served from August 1966 to August 1986, appeals multiple rating decisions from July, October, November 2025, and January and March 2026. The Veteran sought service connection for various conditions including benign prostatic hyperplasia (BPH), right and left ankle disorders, bilateral hearing loss, vertigo, right and left knee strains, right and left hip osteoarthritis, gastroesophageal reflux disease (GERD), headaches, Monoclonal Gammopathy of Undetermined Significance (MGUS), lumbosacral strain, left elbow disability, and hypertension. The Veteran also appealed for increased ratings for diabetes mellitus type II, headaches, MGUS, lumbosacral strain, and left elbow disability, as well as earlier effective dates for several conditions and special monthly compensation (SMC) for loss of use of a creative organ. The Board granted service connection for BPH as secondary to service-connected diabetes mellitus, type II, with an effective date of July 6, 2022. Service connection for erectile dysfunction was also granted secondary to diabetes mellitus, type II, with an earlier effective date of July 6, 2022. An increased rating to 10 percent for the left elbow disability was granted effective July 6, 2022. All other claims for service connection and increased ratings were denied due to insufficient evidence or failure to meet the criteria for service connection or aggravation. The Board found no current ankle, hearing loss, or vertigo disabilities, nor did it find the knee or hip conditions to be related to service or aggravated by the service-connected lumbosacral strain. GERD was not found to be related to service or toxin exposure. The Board also denied earlier effective dates for diabetes, headaches, MGUS, lumbosacral strain, and left elbow disability, as well as higher ratings for these conditions.

Rationale

Current diagnosis of BPH established; BPH caused or worsened by service-connected diabetes mellitus, type II; Resolving reasonable doubt in Veteran's favor

Special Benefit

EARLIER EFFECTIVE DATE; SMC

Docket No.

260316-637301

Full Decision Text

Citation Nr: A26036491
Decision Date: 04/20/26 Archive Date: 04/20/26

DOCKET NO. 260316-637301
DATE: April 20, 2026

ORDER

Service connection for benign prostatic hyperplasia (BPH), as secondary to the service-connected diabetes mellitus, type II, is granted.

Service connection for a right ankle disorder is denied.

Service connection for a left ankle disorder is denied.

Service connection for a bilateral hearing loss disorder is denied.

Service connection for a vertigo disorder is denied.

Service connection for a right knee strain, including as secondary to the service-connected lumbosacral strain, is denied.

Service connection for a left knee strain, including as secondary to the service-connected lumbosacral strain, is denied.

Service connection for right hip osteoarthritis, including as secondary to the service-connected lumbosacral strain, is denied.

Service connection for left hip osteoarthritis, including as secondary to the service-connected lumbosacral strain, is denied.

Service connection for gastroesophageal reflux disease (GERD), including as due to exposure to toxins, is denied.

An earlier effective date of July 6, 2022, for service connection for erectile dysfunction is granted.

An earlier effective date of July 6, 2022, for special monthly compensation (SMC) based on loss of use of a creative organ is granted.

An effective date prior to July 6, 2022, for service connection for diabetes mellitus, type II, is denied.

An effective date prior to July 6, 2022, for service connection for headaches is denied.

An effective date prior to November 13, 2023, for service connection for Monoclonal Gammopathy of Undetermined Significance ("MGUS") is denied.

An effective date earlier than July 6, 2022, for service connection for a lumbosacral strain is denied.

An effective date earlier than February 11, 2026, for a staged rating of 20 percent for the lumbosacral strain is denied.

An effective date earlier than July 23, 2025, for service connection for healed head of left radius fracture limitation of extension ("left elbow limitation of extension disability") is denied.

An effective date earlier than July 6, 2022, for service connection for unspecified depressive disorder to include anxiety, depression, and posttraumatic stress disorder (PTSD) ("psychiatric disability") is denied.

An effective date earlier than August 10, 2022, for service connection for hypertension is denied.

An increased disability rating of 10 percent for the service-connected healed head of left radius fracture ("left elbow disability") from July 6, 2022, is granted.

A higher initial disability rating in excess of 10 percent for diabetes mellitus, type II, from July 6, 2022, is denied.

A higher (compensable) initial disability rating for headaches from July 6, 2022, is denied.

A higher (compensable) initial disability rating for MGUS from November 13, 2023, is denied.

An initial disability rating in excess of 10 percent for the lumbosacral strain is denied.

A staged rating in excess of 20 percent for the lumbosacral strain from February 11, 2026, is denied.

A higher (compensable) initial disability rating for left elbow limitation of extension from July 23, 2025, is denied.

A higher initial disability rating in excess of 30 percent for the psychiatric disability from July 6, 2022, is denied.

A higher initial disability rating in excess of 10 percent for hypertension from August 10, 2022, is denied.

FINDINGS OF FACT

1. The evidence shows a current diagnosis of BPH; the BPH was caused or worsened by the service-connected diabetes mellitus, type II.

2. The evidence does not show current right or left ankle or bilateral hearing loss disabilities or symptoms of a vertigo disability that is not already compensated by the Department of Veterans Affairs (VA).

3. The evidence shows current diagnoses of right and left knee strains, right and left hip osteoarthritis, and GERD; there was chest pain and exposure to toxins but no knee or hip injury, disease, or events, or "chronic" symptoms of hip arthritis during service.

4. Symptoms of right and left hip osteoarthritis were not continuous since service and did not manifest to a compensable degree within one year of service separation.

5. The current right and left knee and hip disabilities were not caused or worsened by the service-connected lumbosacral strain.

6. The current GERD and BPH were
symptoms of a vertigo disability that is not already compensated by the Department of Veterans Affairs (VA).

4. Symptoms of right and left hip osteoarthritis were not continuous since service and did not manifest to a compensable degree within one year of service separation.

5. The current right and left knee and hip disabilities were not caused or worsened by the service-connected lumbosacral strain.

6. The current GERD and BPH were not caused by exposure to toxins during service; the GERD is not related to the in-service chest pain.

7. The current right and left knee and hip disabilities and BPH are not otherwise etiologically related to service.

8. The Veteran submitted an Intent to File (VA Form 21-0966) for service connection for erectile dysfunction on July 6, 2022, followed by a claim for service connection (VA Form 21-526EZ) on August 2, 2022, and service connection for erectile dysfunction was granted secondary to the diabetes mellitus, type II, which is effective July 6, 2022.

9. Service connection for erectile dysfunction is in effect from July 6, 2022.

10. The Veteran submitted an Intent to File (VA Form 21-0966) for service connection for diabetes and headaches on July 6, 2022, followed by a claim for service connection (VA Form 21-526EZ) on August 2, 2022; entitlement to service connection for diabetes arose in on January 30, 2004, and entitlement to service connection for headaches arose on August 9, 2006.

11. The Veteran submitted an Intent to File (VA Form 21-0966) for service connection for MGUS on November 13, 2023, followed by a claim for service connection (VA Form 21-526EZ) on March 15, 2024; entitlement to service connection arose in 2021.

12. The Veteran submitted an Intent to File (VA Form 21-0966) for service connection for a back condition on July 6, 2022, followed by a claim for service connection (VA Form 21-526EZ) on August 2, 2022; entitlement to service connection arose on July 23, 2003; entitlement to a 20 percent staged rating arose on February 11, 2026.

13. The Veteran submitted an Intent to File (VA Form 21-0966) for an increased rating for the left elbow disability on July 6, 2022, followed by a claim for service connection (VA Form 21-526EZ) on August 2, 2022; entitlement to service connection for left elbow limitation of extension arose on November 18, 2025.

14. The Veteran submitted an Intent to File (VA Form 21-0966) on July 6, 2022, followed by a claim for service connection for a mental health condition (VA Form 21-526EZ) on August 2, 2022; entitlement to service connection arose on August 9, 2006.

15. The Veteran submitted an Intent to File (VA Form 21-0966) on July 6, 2022, followed by a claim for service connection for hypertension (VA Form 21-526EZ) on August 2, 2022; entitlement to service connection arose on August 10, 2022.

16. From July 6, 2022, the left elbow disability manifested in intermittent pain and noncompensable limitation of supination and pronation but no malunion of the radius with bad alignment.

17. From July 6, 2022, the diabetes disability manifested in a restricted diet only.

18. From July 6, 2022, the headache disability manifested in less frequent attacks of head pain and symptoms.

19. From November 13, 2023, there was MGUS that did not require treatment; there was not symptomatic multiple myeloma.

20. From July 6, 2022, considering all functional limitations due to joint limiting factors, forward flexion of the thoracolumbar spine was limited to 70 degrees and the total combined range of motion was 170 degrees; from February 11, 2026, the lumbosacral strain manifested in forward flexion of the thoracolumbar spine was limited to 50 degrees at worst and the total combined range of motion was 130 degrees with no ankylosis.

21. From
headache disability manifested in less frequent attacks of head pain and symptoms.

19. From November 13, 2023, there was MGUS that did not require treatment; there was not symptomatic multiple myeloma.

21. From July 23, 2025, the left elbow limitation of extension disability manifested in left forearm extension limited to 10 degrees at worst.

22. From July 6, 2022, the psychiatric disability manifested in occupational and social impairment with symptoms including anxiety, forgetfulness, and some strained relationships with siblings but did not manifest in disturbances of motivation and mood, impaired memory, or suicidal ideation.

23. From August 10, 2022, the hypertension manifested in systolic pressure predominantly 160 or more and required continuous medication for control.

CONCLUSIONS OF LAW

1. Resolving reasonable doubt in the Veteran's favor, the criteria for service connection for BPH as secondary to the service-connected diabetes mellitus, type II, are met. 38?U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38?C.F.R. §§?3.102, 3.159, 3.303, 3.310(a).

2. The criteria for service connection for a right ankle disorder are not met. 38?U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38?C.F.R. §§?3.102, 3.159, 3.303.

3. The criteria for service connection for a left ankle disorder are not met. 38?U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38?C.F.R. §§?3.102, 3.159, 3.303.

4. The criteria for service connection for a bilateral hearing loss disability are not met. 38 U.S.C. §§ 1110, 1112, 1131; 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.385.

5. The criteria for service connection for a vertigo disorder are not met. 38?U.S.C. §§?1110, 1131, 5107;?38?C.F.R. §§?3.102, 3.159, 3.303, 4.14.?

6. The criteria for service connection for a right knee strain, including as secondary to the service-connected lumbosacral strain, are not met. 38 U.S.C. §§ 1110, 1131 1154, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310(a).

7. The criteria for service connection for a left knee strain, including as secondary to the service-connected lumbosacral strain, are not met. 38 U.S.C. §§ 1110, 1131 1154, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310(a).

8. The criteria for service connection for right hip osteoarthritis, including as secondary to the service-connected lumbosacral strain, are not met. 38 U.S.C. §§ 1110, 1112, 1131 1154, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310(a), 3.307, 3.309(a).

9. The criteria for service connection for left hip osteoarthritis, including as secondary to the service-connected lumbosacral strain, are not met. 38 U.S.C. §§ 1110, 1112, 1131 1154, 5103, 5103A, 5107; 38 C.F.R. §§ 3.
.S.C. §§ 1110, 1112, 1131 1154, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310(a), 3.307, 3.309(a).

10. The criteria for service connection for GERD, including as due to exposure to toxins, are not met. 38 U.S.C. §§ 1110, 1112, 1131, 1154, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303.

11. As a matter of law, the criteria for an earlier effective date of July 6, 2022, for service connection for erectile dysfunction are met. 38 U.S.C. § 5110(a);?38 C.F.R. § 3.400(o)(1).

12. As a matter of law, the criteria for an effective date of July 6, 2022, for SMC based on loss of use of a creative organ are met. 38 U.S.C. § 1114(k); 38 C.F.R. § 3.350(a)(1).

13. As a matter of law, the criteria for an effective date earlier than July 6, 2022, for service connection for diabetes mellitus, type II, are not met. 38 U.S.C. § 5110(a);?38 C.F.R. § 3.400(o)(1).

14. As a matter of law, the criteria for an effective date earlier than July 6, 2022, for service connection for headaches are not met. 38 U.S.C. § 5110(a);?38 C.F.R. § 3.400(o)(1).

15. As a matter of law, the criteria for an effective date earlier than November 13, 2023, for service connection for MGUS are not met. 38 U.S.C. § 5110(a);?38 C.F.R. § 3.400(o)(1).

16. As a matter of law, the criteria for an effective date earlier than July 6, 2022, for service connection for a lumbosacral strain are not met. 38 U.S.C. § 5110(a);?38 C.F.R. § 3.400(o)(1).

17. As a matter of law, the criteria for an effective date earlier than February 11, 2026, for a staged rating of 20 percent for the lumbosacral strain are not met. 38 U.S.C. § 5110(a);?38 C.F.R. § 3.400(o)(1).

18. As a matter of law, the criteria for an effective date earlier than July 23, 2025, for service connection for the service-connected left elbow limitation of extension disability are not met. 38 U.S.C. § 5110(a);?38 C.F.R. § 3.400(o)(1).

19. As a matter of law, the criteria for an effective date earlier than July 6, 2022, for service connection for the psychiatric disability are not met. 38 U.S.C. § 5110(a);?38 C.F.R. § 3.400(o)(1).

20. As a matter of law, the criteria for an effective date earlier than July 6, 2022, for service connection for hypertension are not met. 38 U.S.C. § 5110(a);?38 C.F.R. § 3.400(o)(1).

21. Resolving reasonable doubt in the Veteran's favor, the criteria for an increased disability rating of 10 percent for the service-connected left elbow disability from July 6, 2022, are met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.155(b), 3.159,
. As a matter of law, the criteria for an effective date earlier than July 6, 2022, for service connection for hypertension are not met. 38 U.S.C. § 5110(a);?38 C.F.R. § 3.400(o)(1).

21. Resolving reasonable doubt in the Veteran's favor, the criteria for an increased disability rating of 10 percent for the service-connected left elbow disability from July 6, 2022, are met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.155(b), 3.159, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DCs 5212, 5213.

22. The criteria for an initial disability rating in excess of 10 percent for diabetes mellitus, type II, are not met. 38?U.S.C. §§?1110, 1155, 5107; 38?C.F.R. §§?4.1, 4.2, 4.3, 4.7, 4.119, DC 7913.

23. The criteria for a higher (compensable) initial disability rating for headaches from July 6, 2022, are not met. 38?U.S.C. §§?1155, 5103, 5103A, 5107;?38?C.F.R. §§?3.102, 4.3, 4.7, 4.124a, DC 8100.

24. The criteria for a higher (compensable) initial disability rating for MGUS from November 13, 2023, are not met. 38?U.S.C. §§?1155, 5103, 5103A, 5107;?38?C.F.R. §§?3.102, 4.3, 4.7, 4.117, DC 7712.

25. The criteria for an initial disability rating in excess of 10 percent for the lumbosacral strain from July 6, 2022, are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.155(b), 3.159, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DCs 5003-5237.

26. The criteria for a staged rating in excess of 20 percent for the lumbosacral strain from February 11, 2026, are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.155(b), 3.159, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, DC 5237.

27. The criteria for a higher (compensable) initial disability rating for left elbow limitation of extension from July 23, 2025, are not met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.155(b), 3.159, 4.1, 4.2, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71A, DC 5207.

28. The criteria for a higher initial disability rating in excess of 30 percent for the psychiatric disability from July 6, 2022, are not met. 38?U.S.C. §§?1155, 5103, 5103A, 5107;?38?C.F.R. §§?3.102, 3.159, 3.321, 4.3, 4.7, 4.10, 4.21, 4.130, DC 9435.

29. The criteria for a higher initial disability rating in excess of 10 percent for hypertension from August 10, 2022, are not
.71A, DC 5207.

29. The criteria for a higher initial disability rating in excess of 10 percent for hypertension from August 10, 2022, are not met. 38?U.S.C. §§?1155, 5107; 38?C.F.R. §§?3.102, 3.321, 4.1-4.4, 4.21, 4.115a, DC 7101.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran, who is the appellant, had active service from August 1966 to August 1986.

These matters come to the Board of Veterans' Appeals (Board) on appeal from July, October, and November 2025 and January and March 2026 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO).

The Veterans Appeals Improvement and Modernization Act, also known as the Appeals Modernization Act (AMA) or modernized review system, created a new framework of review for veterans who disagree with VA's decision on their claim. In the March 2026 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct docket.

In this AMA case, the Board may only consider the evidence of record at the time of the agency of original jurisdiction (AOJ) decisions on appeal (July 21, 2025; October 21, 2025; November 25, 2025; January 7, 2026; and March 9, 2026). 38 C.F.R. § 20.303. The Board cannot consider evidence submitted during the period after the AOJ issued the decision on appeal. 38 C.F.R. § 20.303.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider for the issues denied in this decision, 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.

This claim is advanced on the Board's docket on account of the Veteran's advanced age. 38 C.F.R. § 20.900(ca). 38 U.S.C. § 7107(a)(b).

SERVICE CONNECTION LEGAL AUTHORITY

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service.

Under applicable regulation, the term "disability" means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1. See Allen v. Brown, 7 Vet. App. 439 (1995). The U.S. Court of appeals for the Federal Circuit held, however, that the term "disability" as used in 38 U.S.C. § 1110 and § 1131 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability," but not all pain rises to the level of impairment of working ability. Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain. Saunders v. Wilkie
4.1. See Allen v. Brown, 7 Vet. App. 439 (1995). The U.S. Court of appeals for the Federal Circuit held, however, that the term "disability" as used in 38 U.S.C. § 1110 and § 1131 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability," but not all pain rises to the level of impairment of working ability. Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain. Saunders v. Wilkie, 886 F.3d, 1356, 1368 (Fed. Cir. 2018).

For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz (Hz) is 40 decibels (dB) or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. See 38 C.F.R. § 3.385.

In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with?38?C.F.R. §?4.25. ?Pyramiding, the rating of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a veteran's service-connected disabilities. ?38?C.F.R. §?4.14. It is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several DCs; however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition.? Esteban?v. Brown, 6?Vet. App.?259, 261-62?(1994); Lyles v. Shulkin,?29?Vet. App.?107?(2017) (holding that?38?C.F.R. §?4.14?prohibits compensating a veteran twice for the same symptoms or functional impairment).

In this case, the evidence shows a current diagnosis of osteoarthritis in both hips which is a "chronic disease" listed under 38?C.F.R. §?3.309(a); therefore, the "chronic disease" presumptive provisions at 38?C.F.R. §?3.303(b) apply. Walker v. Shinseki,?708 F.3d 1331?(Fed. Cir. 2013); see also Fountain v. McDonald, 27?Vet. App.?258, 271?(2015) (holding that where there is evidence of acoustic trauma, the presumptive provisions of?38?C.F.R. §?3.309(a) include?sensorineural hearing loss as an organic disease of the nervous system).

Where the evidence shows a "chronic disease" in service or "continuity of symptoms" after service, the disease shall be presumed to have been incurred in service. For the showing of "chronic" disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of "continuity of symptoms" after service is required for service connection. 38 C.F.R. § 3.303(b).

Additionally, where a veteran served 90 days or more of active service, and certain chronic diseases, such as arthritis, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38?U.S.C. §§?1101, 1112, 1113, 1137; 38?C.F.R. §§?3.307, 3.309(a). While the disease need not be diagnosed within the presumption
service is required for service connection. 38 C.F.R. § 3.303(b).

Additionally, where a veteran served 90 days or more of active service, and certain chronic diseases, such as arthritis, become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred in service, even though there is no evidence of such disease during the period of service. 38?U.S.C. §§?1101, 1112, 1113, 1137; 38?C.F.R. §§?3.307, 3.309(a). While the disease need not be diagnosed within the presumption period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. Id. 38?U.S.C. §§?1101, 1112, 1113, 1137; 38?C.F.R. §§?3.307, 3.309(a).

Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability.

On August 10, 2022, the President of the U.S. signed into law The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act). See P.L. 117-168. The PACT Act provides presumptions of service connection for certain respiratory disabilities for veterans affected by exposure to burn pits and other toxins and toxic exposure risk activities (TERA), but does not include presumptions of service connection for the GERD that is alleged to be caused by exposure to toxins in this case. See 38?U.S.C. §?1120(b). The conditions caused by physical trauma on appeal in this case, the ankle and hip disabilities, are considered exceptions to the requirement under the PACT Act of obtaining VA medical opinions. Thus, VA TERA medical opinions have been obtained as to the claim for service connection for GERD.

1. Service connection for BPH is granted.

The Veteran appeals for service connection for BPH, diagnosed by VA in March 2024, as directly related to service, including as due to exposure to toxins. See March 2026 substantive appeal to the Board.

The evidence is at least in relative equipoise on the question of whether the current BPH was caused or worsened by the service-connected diabetes mellitus, type II. Service connection for diabetes was granted in a September 2023 rating decision.

In May 2024, a VA examiner opined that the current BPH was not due to exposure to toxins during service and explained that exposure to toxins/TCDD does not generally adversely affect male reproductive health. However, the examiner explained that a risk factor for the Veteran's BPH is his diabetes. The examiner explained that BPH arises due to the loss of homeostasis between prostatic cellular proliferation and apoptosis or cell death, and this imbalance favors cellular proliferation without intervention. The examiner explained that the result is increased numbers of prostatic periurethral epithelial and stromal cells, which can be seen histopathologically, and that diabetes and the use of antidiabetic medications, particularly insulin, appear to increase the risk of BPH. VA treatment records from November 2023 and June 2024 show the Veteran was taking insulin to treat the diabetes.

The Board finds that this evidence is sufficient to find that the BPH was caused or worsened by the service-connected diabetes and the medication taken for it. Resolving reasonable doubt in the Veteran's favor, the Board grants secondary service connection for BPH. The grant of secondary service connection moots all other theories of service connection, including direct to service and to exposure to toxins.

2. Service connection for a right ankle disorder is denied.

3. Service connection for a left ankle disorder is denied.

4. Service connection for a bilateral hearing loss disorder is denied.

5. Service connection for a vertigo disorder is denied.

The Veteran appeals for service connection for bilateral ankle, vertigo, and bilateral hearing loss disorders as directly related to service. See March 2026 substantive appeal to the Board.

The persuasive weight of the lay and medical evidence is against findings of current bilateral ankle, vertigo, or bilateral hearing loss disabilities. The December 2023 VA examination report shows the Veteran reported
The grant of secondary service connection moots all other theories of service connection, including direct to service and to exposure to toxins.

2. Service connection for a right ankle disorder is denied.

3. Service connection for a left ankle disorder is denied.

4. Service connection for a bilateral hearing loss disorder is denied.

5. Service connection for a vertigo disorder is denied.

The Veteran appeals for service connection for bilateral ankle, vertigo, and bilateral hearing loss disorders as directly related to service. See March 2026 substantive appeal to the Board.

The persuasive weight of the lay and medical evidence is against findings of current bilateral ankle, vertigo, or bilateral hearing loss disabilities. The December 2023 VA examination report shows the Veteran reported that the ankle condition began in 1968 when he injured the right ankle after stepping in a hole and twisting it and he was put on crutches. On examination, there was no ankle pain, no functional loss reported, normal range of motion measurements, and no other relevant ankle symptoms. The examiner indicated there was no current ankle diagnosis and, therefore, could not provide a nexus opinion. VA treatment records from December 2001 to February 2026 do not show ankle symptoms or treatment other than those related to the vascular system.

As the lay and medical evidence does not show a diagnosis of or the existence of a right or left ankle condition manifesting in pain or functional impairment of earning capacity or activities of daily living, the alleged disorders do not constitute "disabilities" for VA purposes. Saunders, 886 F.3d, at 1368; 38?U.S.C. §?1110; Allen,?7?Vet. App. at 439 (pain alone may qualify as a "disability" if it causes functional impairment). As there are no current right or left ankle disorders, it is unnecessary to address the remaining elements of the claim for service connection; therefore, the appeals as to those issues must be denied.?

Regarding service connection for bilateral hearing loss, the persuasive weight of the evidence is against a finding of current hearing loss "disability" for VA compensation purposes under 38 C.F.R. § 3.385 (describing hearing loss disability as hearing impairment).

Per the July 2006 VA audiometric examination report, pure tone thresholds measured in decibels (dB) at certain frequencies in Hz were as follows:

Hz 500 1000 2000 3000 4000 Speech Discrim. Score (percent)

Right Ear 5 5 5 10 15 96

Left Ear 5 5 0 5 10 96

Per a February 2008 VA treatment record, pure tone thresholds measured in dB at certain frequencies in Hz were as follows:

Hz 500 1000 2000 3000 4000 Speech Discrim. Score (percent)

Right Ear 5 5 5 10 15 within normal limits (WNL)

Left Ear 5 5 0 5 10 WNL

Per a September 2023 VA examination report, pure tone thresholds measured in dB at certain frequencies in Hz were as follows:

Hz 500 1000 2000 3000 4000 Speech Discrim. Score (percent)

Right Ear 15 15 15 15 25 WNL

Left Ear 10 10 15 15 35 WNL

For all audiometric examinations, there were no single thresholds of 40 dB or greater at any of the five frequencies and no three or more frequencies tested were 26 dB or greater. The speech recognition scores were not less than 94 percent. The recorded thresholds miss the required 26 dB or greater in three frequencies by at least six dB and miss the required 40 dB or greater by at least five dB so as to qualify as a current disability for VA compensation purposes. 38 C.F.R. § 3.385. VA treatment records from December 2001 to February 2026 also do not show audiometric results that meet the required values under 38 C.F.R. § 3.385.

For the foregoing reasons, the Board finds that the persuasive weight of the evidence is against the claim for service connection for a bilateral hearing loss as no current disability for VA compensation purposes under 38 C.F.R. § 3.385 has been established; therefore, the appeal must be denied.

Regarding service connection for vertigo, the evidence does not show symptoms or functional impairment of a vertigo disorder that is not already being compensated by VA. The Veteran has reported symptoms of ligh
38 C.F.R. § 3.385. VA treatment records from December 2001 to February 2026 also do not show audiometric results that meet the required values under 38 C.F.R. § 3.385.

Regarding service connection for vertigo, the evidence does not show symptoms or functional impairment of a vertigo disorder that is not already being compensated by VA. The Veteran has reported symptoms of lightheadedness and dizziness and feeling like the floor is moving both when he first stands up and after walking for a few minutes. See September 2022, September 2023, and May 2024 VA examination reports. In a September 2023 rating decision, the RO granted service connection for hypertension and assigned a noncompensable initial disability rating from August 10, 2022, based on findings from an October 2024 VA medical opinion and examination. That examination occasional lightheadedness as a symptom of the service-connected hypertension. The lay and medical evidence does not show symptoms or functional impairment of a separate vertigo disorder, including VA treatment records from December 2001 to February 2026. The Board notes that September 2022 and May 2024 VA examination reports show no diagnosis of an ear or peripheral vestibular condition.

As the RO previously granted service connection for hypertension, to include the lightheadedness for which the Veteran now claims service connection, the Board cannot now compensate the Veteran separately for such a disability. Compensating the Veteran for lightheadedness would result in the Veteran twice receiving compensation for the same symptoms caused by the service-connected hypertension and would constitute impermissible pyramiding (double payment) of compensation. See 38 C.F.R. § 4.14; see also Esteban, 6 Vet. App. at 261-62; Lyles, 29 Vet. App. at 107. As such, service connection for a separate vertigo disorder must be denied.

6. Service connection for a right knee strain is denied.

7. Service connection for a left knee strain is denied.

8. Service connection for right hip osteoarthritis is denied.

9. Service connection for left hip osteoarthritis is denied.

10. Service connection for GERD is denied.

The Veteran appeals for service connection for right and left knee strains, diagnosed by VA in October 2025; right and left hip osteoarthritis, diagnosed by VA in June 2024; and for GERD, diagnosed by VA in March 2024, as directly related to service. See March 2026 substantive appeal to the Board. The Veteran alternatively contends that the ankle and hip disabilities were caused by the service-connected lumbosacral strain and that the GERD was caused by exposure to toxins during service. See January 2024 correspondence to VA.

The persuasive weight of the evidence is against a finding of right or left knee or hip injury, disease, or event during service or "chronic" symptoms of hip arthritis during service. The complete service treatment records show treatment for elevated right hemidiaphragm, ringing in the ears, a viral stomach illness, pneumonia, an upper respiratory infection, left elbow pain, lung issues, recurrent right anterior chest pain and low grade fever worse with coughing in May 1983, pain in the lower left rib cage, left wrist pain, a pruritic scalp, headaches, a back strain, tinea cruris, a hypoglycemia episode, a finger fracture, diffuse lung disease, and tonsillitis, but no similar reports or symptoms or treatment for a knee or hip event or injury.

As the Veteran sought treatment for a variety of symptoms including joint pains and joint injuries, knee or hip pain or symptoms would have ordinarily been recorded during service had it occurred; therefore, the lay and medical evidence generated contemporaneous to service is likely to reflect accurately the Veteran's physical condition, so provides evidence against a finding of a knee or hip injury or disease during service. See Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011) (stating that VA may use silence in the service treatment records as evidence contradictory to a veteran's assertions if the service treatment records appear to be complete and the injury, disease, or symptoms involved would ordinarily have been recorded had they occurred) (Lance, J., concurring). Such service treatment records additionally show that symptoms of hip arthritis cannot be "chronic" during service.

In
during service had it occurred; therefore, the lay and medical evidence generated contemporaneous to service is likely to reflect accurately the Veteran's physical condition, so provides evidence against a finding of a knee or hip injury or disease during service. See Kahana v. Shinseki, 24 Vet. App. 428, 438 (2011) (stating that VA may use silence in the service treatment records as evidence contradictory to a veteran's assertions if the service treatment records appear to be complete and the injury, disease, or symptoms involved would ordinarily have been recorded had they occurred) (Lance, J., concurring). Such service treatment records additionally show that symptoms of hip arthritis cannot be "chronic" during service.

In the July 2025 rating decision on appeal, the RO found an in-service "event" of chest pain in May 1983. Additionally, TERA memoranda from November 2023 and October 2025 show exposure to toxins (herbicides) during service.

The persuasive weight of the evidence is against a finding that symptoms of right and left hip osteoarthritis were continuous since service separation. The February 1986 service retirement examination report shows no reports of a hip condition or injury. The Veteran first reported hip pain to VA in December 2001, which is several decades after separation from service.

The Board finds that the statement made in December 2001 in the course of receiving medical treatment for the hips is of high probative value in showing post-service injuries unrelated to service because a person seeking treatment would be expected to report an accurate medical history in order to receive good medical care and treatment. See Fed. R. Evid. 803 (4) (statements made for medical diagnosis or treatment are an exception to the rule against hearsay, which supports the proposition that statements reporting medical history for treatment purposes are probative); Harvey v. Brown, 6 Vet. App. 390, 394 (1994) (Board decision properly assigned more probative value to a private hospital record that included lay history that was made for treatment purposes than to subsequent statements made for compensation purposes). The Board relies on this statement to find that symptoms of right and left hip osteoarthritis, which manifested many years after service, were not continuous since service separation. Such evidence additionally shows that symptoms of hip arthritis did not manifest to a compensable degree within one year of service separation.

As to the?secondary?service connection theory (38?C.F.R. §?3.310(a)) for the knee and hip disabilities, the persuasive weight of the evidence is against a finding that the current right and left knee strains and right and left hip osteoarthritis disabilities were caused or worsened in severity by (38 C.F.R. § 3.310(a)) the service-connected lumbosacral strain. Service connection for the lumbosacral strain was first granted by VA in a November 2022 rating decision. The Veteran contends that the lumbosacral strain caused pain radiating to the hips and legs and caused an altered gait which has damaged the hips and knees. See January 2024 correspondence to VA.

In May 2024, a VA examiner provided a negative secondary service connection opinion (regarding proximate cause) for both the knees and hips and explained that there is no clear evidence from review of orthopedic literature to suggest that an injury to one joint would have any significant impact on another or opposite uninjured joint or limb unless the injury resulted in a major muscle or nerve damage causing partial or complete paralysis, or shortening of the injured limb resulting in length discrepancy of more than five centimeters (cm.) so that the individual's gait pattern has been altered to the extent that clinically there is an obvious Trendelenburg gait. The examiner explained that this level of severity was not supported by the Veteran's history or current examination. The examiner explained that it is not unusual for two joints to share properties in the same person, but one joint's disease does not 'spread' to another or cause damage to it.

In October 2025, a VA examiner provided a negative secondary service connection opinion (regarding aggravation) for the knees and explained that there is no supporting evidence that the lumbosacral strain caused a compensatory gait leading to knee strain and there is no medical evidence indicating that the lumbosacral strain forced the Veteran to change gait or compensate for back pain. In November 2025, a VA examiner provided a negative secondary service connection opinion (regarding proximate cause) for the knees and explained that there is a lack of causal relationship between the two conditions because there is no medical literature to support a connection.

In August 2025, a VA examiner provided a negative secondary service connection opinion (regarding proximate cause
2025, a VA examiner provided a negative secondary service connection opinion (regarding aggravation) for the knees and explained that there is no supporting evidence that the lumbosacral strain caused a compensatory gait leading to knee strain and there is no medical evidence indicating that the lumbosacral strain forced the Veteran to change gait or compensate for back pain. In November 2025, a VA examiner provided a negative secondary service connection opinion (regarding proximate cause) for the knees and explained that there is a lack of causal relationship between the two conditions because there is no medical literature to support a connection.

In August 2025, a VA examiner provided a negative secondary service connection opinion (regarding proximate cause) for the hips and explained that per medical literature, the conditions do not share a causative relationship because the greatest risk for osteoarthritis is age and the Veteran's osteoarthritis is a normal finding when age-adjusted and compared to the general population. In September 2025, a VA examiner provided a negative secondary service connection opinion (regarding aggravation) for the hips and explained that there is no medical evidence found to support a nexus between the conditions or to support the assertion that the hip conditions were aggravated by the service-connected lumbosacral strain beyond a natural progression.

The Board affords probative weight to the foregoing secondary medical opinions to find that the service-connected lumbosacral strain did not cause or worsen the knee or hip disabilities. The examiners considered the theory a causative relationship, which would be an altered gait, but concluded that the lumbosacral strain has not caused a Trendelenburg gait (when the pelvis tilts out of alignment when walking or standing on one leg; the hips sway). VA treatment records show the Veteran's gait has always been within normal limits with the exception of a report of a "wide-based gait" in July 2022 when the Veteran could still walk unassisted and the examiner indicated the gait was still "normal...with good turns." While the May 2024, October 2025, and November 2025 VA examiners did not specifically comment on this one report of a wide-based gait, the examiners generally assessed that the Veteran's gait has never been so severe as to amount to a gait that would affect the lower extremities (Trendelenburg gait). Thus, the evidence medical evidence supports these medical opinions. The Board also affords probative weight to the August and September 2025 VA medical opinions because the examiners considered the Veteran's specific medical history and considered medical evidence to find no connection between the service-connected lumbosacral strain and the current hip arthritis disabilities.

Regarding service connection for GERD, the persuasive weight of the evidence is against a finding that the current GERD was caused by exposure to toxins during service or otherwise caused by service. In March 2024, a VA examiner provided a negative nexus opinion and explained that the current GERD, which manifested about 10 years prior, is unrelated to service because the in-service chest pain was instead related to a 17-years of smoking. The Board affords probative weight to this medical opinion because the examiner considered the etiology of the in-service chest/breathing issues and differentiated such from the current GERD, which manifested many years after service.

While the examiner did not specifically comment on exposure to herbicides during service, the Board finds that remand for a TERA medical opinion is not warranted because this examiner has found that the GERD manifested around 2012, several decades after service separation, and found it unrelated to in-service chest pain which was related to lung problems caused by smoking. Thus, the Board finds that there is no reasonable indication of an association between the GERD and the in-service TERAs which occurred many decades prior to the manifestation of GERD and remand for a medical opinion is not warranted. See 38 U.S.C. § 1168(b).

The persuasive weight of the evidence is against a finding that the current right and left knee strain and right and left hip arthritis are etiologically related to service.? As the Board has found no in-service knee or hip injury, disease, event, or symptoms, there is no in-service injury, disease, or event to which the later diagnosed strains and arthritis could be directly related, and direct service connection must be denied. The duty to assist under the direct service connection theory ends, and examination and/or opinion is not required because the persuasive weight of the evidence shows no in-service injury, disease, or event to which the current diagnoses could be related by further medical opinion. See Bardwell v. Shinseki,?24?Vet. App.?36?(2010) (holding that where VA finds
and left knee strain and right and left hip arthritis are etiologically related to service.? As the Board has found no in-service knee or hip injury, disease, event, or symptoms, there is no in-service injury, disease, or event to which the later diagnosed strains and arthritis could be directly related, and direct service connection must be denied. The duty to assist under the direct service connection theory ends, and examination and/or opinion is not required because the persuasive weight of the evidence shows no in-service injury, disease, or event to which the current diagnoses could be related by further medical opinion. See Bardwell v. Shinseki,?24?Vet. App.?36?(2010) (holding that where VA finds no in-service injury or disease during service, the claim will be denied on the merits, and there is no further duty to assist with examination or medical opinion).

Asking a VA examiner to link the current diagnoses to service would be a futile exercise, creating purported opinions of no probative value because they would be based on inaccurate factual assumptions that some knee or hip injury, disease, or event occurred during service. Such factual assumptions would be inaccurate as they would be contrary to the Board's findings in this case (based on a weighing of all lay and medical evidence). Such factual inaccuracies would render the purported opinions of no probative value. See Reonal v. Brown,?5?Vet. App.?458, 461?(1993) (holding that an opinion based on an inaccurate factual premise has no probative value).

For the foregoing reasons, the Board finds that the criteria are not met for service connection for right and left knee strains, right and left hip osteoarthritis, and GERD on direct, presumptive, and secondary service connection bases; therefore, the appeals must be denied.

EFFECTIVE DATE LEGAL AUTHORITY

Generally, the effective date of compensation based on an initial claim or supplemental claim will be the date of the claim or the date entitlement arose, whichever is the later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. The effective date provisions regarding revision of a decision based on a supplemental claim are addressed in 38 C.F.R. § 3.2500. If VA receives a complete application form prescribed by the Secretary appropriate to the benefit sought within one year of receipt of the intent to file a claim, VA will consider the complete claim filed as of the date the intent to file a claim was received. See 38 C.F.R. § 3.155(b).

DISABILITY RATINGS LEGAL AUTHORITY

Where there is a question as to which of two disability ratings shall be applied, the

higher rating will be assigned if the disability picture more nearly approximates the

criteria required for that rating. Otherwise, the lower rating will be assigned.

38 C.F.R. § 4.7. It is the defined and consistently applied policy of VA to

administer the law under a broad interpretation, consistent, however, with the facts

shown in every case. When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such

doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3.

The Veteran has appealed for higher initial ratings for erectile dysfunction, diabetes, headaches, MGUS, lumbosacral strain, left elbow limitation of extension, psychiatric disability, and hypertension. See March 2026 substantive appeal to the Board. In Fenderson v. West, 12 Vet. App. 119, 125-26 (1999), the U.S. Court of Appeals for Veterans Claims (Court) addressed a similar appeal and directed that such appeal of the initial rating assigned following a grant of service connection was specifically not a claim for an increased disability rating. Separate ratings may be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. 38 C.F.R. § 4.2.

The Veteran has also appealed for an increased disability rating for the service-connected left elbow disability. Where an increase in an existing disability rating based on established entitlement to compensation is at issue, such as the current left elbow disability on appeal, the present level of disability is of primary concern.? Francisco?v. Brown,?7?Vet. App.?55, 58?(1994). The relevant temporal focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim (in the case of the left elbow disability, the relevant appeal period is from July 6, 2021).
4.2.

The service-connected diabetes mellitus, type II, is rated under?38?C.F.R. §?4.118 and DC?7913. Under DC?7913,?diabetes mellitus?requiring insulin and restricted diet, or oral hypoglycemic agent and restricted diet, is rated at 20 percent.? Diabetes mellitus?requiring insulin, restricted diet, and regulation of activities (avoidance of strenuous occupational and recreational activities) is rated at?40 percent.? Diabetes mellitus?requiring insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring one or two hospitalizations per year, or twice a month visits to a diabetic care provider, plus complications that would not be compensable if separately rated, is rated at 60 percent.? Diabetes mellitus?requiring more than one daily injection of insulin, restricted diet, and regulation of activities with episodes of ketoacidosis or hypoglycemic reactions requiring at least three hospitalizations per year or weekly visits to a diabetic care provider, plus either progressive loss of weight and strength or complications that would be compensable if separately rated, is rated at 100 percent.

In light of the conjunctive "and" in the criteria for 40, 60, or 100 percent disability ratings under DC 7913, all criteria must be met to establish entitlement to a 40 percent rating, to include regulation of activities. Camacho v. Nicholson,?21?Vet. App.?360, 366?(2007); cf. Johnson v. Brown,?7?Vet. App.?95, 97?(1994) (holding that "or" in the rating criteria shows that each is an independent basis for granting that rating).

Note (1) to DC?7913?provides that compensable complications of?diabetes mellitus?are to be rated separately unless they are part of the criteria used to support a 100 percent rating (under DC?7913). Noncompensable complications are considered part of the diabetic process under DC?7913. Note (2) provides that, when?diabetes mellitus?has been conclusively diagnosed, the adjudicator is not to request a glucose tolerance test solely for rating purposes.? 38?C.F.R. §?4.119.

The service-connected headaches are rated analogously to migraines under 38?C.F.R. § 4.124a for neurological conditions and convulsive disorders and DC 8100. Under DC 8100, a noncompensable rating is warranted for migraines with less frequent attacks. A 10 percent rating is warranted for migraines with?characteristic prostrating attacks?averaging one in two months over the last several months. A 30 percent rating is warranted for migraines with?characteristic prostrating attacks occurring on an average once a month over the last several months. A 50 percent rating requires very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability.? 38?C.F.R. §?4.124a. The rating criteria of DC 8100 are considered successive, meaning that a claimant cannot fulfill the criteria of the higher rating without fulfilling those of the next lower ratings. Johnson v. Wilkie,?30?Vet. App.?245, 252?(2018). This renders 38?C.F.R. §§?4.7?and 4.21 inapplicable. See id. at 252.

The phrase "characteristic prostrating attacks" is used in the criteria corresponding to 10 percent and 30 percent ratings under DC 8100 to describe the nature and severity of migraines, but it is not defined in the regulation. Pursuant to Dorland's Illustrated Medical Dictionary 1531 (32d ed. 2012), prostration is defined as "extreme exhaustion or powerlessness." Thus, the phrase "characteristic prostrating attacks" is understood to describe migraine attacks that typically produce extreme exhaustion or powerlessness. Further, in Johnson, the Court held that the phrase "characteristic prostrating attacks" plainly describes headaches that typically produce powerlessness or a lack of vitality. Similarly, "prostrate," as an adjective, is defined as completely overcome and lacking vitality, will, or power to rise. See Merriam-Webster Dictionary, merriamwebster.com/dictionary-/prostrating, (last visited Jan. 27, 2025). Although prostrating attacks are not defined in the rating criteria, medical guidance used by the VA Compensation Service suggests that such an attack causes one a lack of strength to the point of exhaustion. See VA Compensation Service's Medical Electronic Performance Support System.

The service-connected MGUS is rated under 38 C.F.R. § 4.117 for hemic and lymphatic disorders and DC 7712 for multiple myeloma. Under DC 7712, a noncompensable (zero percent) rating is warranted for asymptomatic multiple myeloma, smoldering, or MGUS. A 100 percent rating is warranted for symptomatic multiple myeloma.

Note (1) to DC 7712 indicates that current validated biomarkers of symptomatic multiple myeloma and asymptomatic multiple myeloma, smoldering, or MGUS are acceptable for the diagnosis of multiple myeloma as defined by the American Society of Hematology (ASH) and International Myeloma Working Group (IMWG). Note (2) to DC 7712 indicates that a 100 percent evaluation shall continue for five years after the diagnosis of symptomatic multiple myeloma, at which time the appropriate disability evaluation shall be determined by mandatory VA examination. Any reduction in evaluation based upon that or any subsequent examination shall be subject to the provisions of § 3.105(e) and § 3.344 (a) and (b) of this chapter.

When rating disabilities of the musculoskeletal system, 38 C.F.R. § 4.40 allows for consideration of functional loss due to pain and weakness causing additional disability beyond that reflected on range of motion measurements. DeLuca v. Brown, 8 Vet. App. 202 (1995). Further, 38 C.F.R. § 4.45 provides that consideration also be given to decreased movement, weakened movement, excess fatigability, incoordination, and pain on movement, swelling, and deformity or atrophy of disuse. Painful motion is considered limited motion at the point that pain actually sets in. See VAOPGCPREC 9-98.

The Court held in Correia v. McDonald, 28 Vet. App. 158 (2016) that "to be adequate, a VA examination of the joints must, wherever possible, include the results of the range of motion testing described in the final sentence of" 38 C.F.R. § 4.59. The referenced portion of 38 C.F.R. § 4.59 states that "[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint." Also, the Court stated in Sharp v. Shulkin, 29 Vet. App. 26 (2017), in regard to a VA examination report's discussion of flare-ups, that because "the VA examiner did not estimate the veteran's functional loss due to flares based on all the evidence of record including the veteran's lay information nor explain why she could not do so, the examination was inadequate."

With any form of arthritis, painful motion is an important factor of disability, the facial expression, wincing, etc., on pressure or manipulation, should be carefully noted and definitely related to affected joints. Muscle spasm will greatly assist the identification. Sciatic neuritis is not uncommonly caused by arthritis of the spine. The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. Crepitation either in the soft tissues such as the tendons or ligaments, or crepitation within the joint structures should be noted carefully as points of contact which are diseased. Flexion elicits such manifestations. The joints involved should be tested for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with the range of the opposite undamaged joint. 38 C.F.R. § 4.59.

Additionally, painful motion is an important factor of disability, and joints that are actually painful, unstable, or malaligned, due to healed injury, should be entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. Although pain may cause a functional loss, pain itself does not constitute functional loss. Pain must affect some aspect of "the normal working movements of the body" such as "excursion, strength, speed, coordination, and endurance," in order to constitute functional loss. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011).

Where a claimant has a full range of motion with pain, or a noncompensable limitation of motion that is accompanied by pain, a 10 percent rating may be appropriate. See Burton v. Shinseki, 25 Vet. App. 1, 5 (2011); see also Mitchell, 25 Vet. App. at 39. Painful motion should be considered to determine whether a higher rating is warranted on such basis, whether or not arthritis is present. See Burton, 25 Vet. App. at 5.

The service-connected lumbosacral strain is rated under 38 C.F.R. § 4.71a, DC 5003 for degenerative arthritis, and DC 5237 for a lumbosacral strain. All are rated under the General Rating Formula for Diseases and Injuries of the Spine for Diagnostic Codes 5235 to 5243, unless 5243 is rated under the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Rating Formula). Ratings under the General Rating Formula are made with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease.

A 10 percent rating is assigned for forward flexion of the thoracolumbar spine greater than 60 degrees, but not greater than 85 degrees; or, forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 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 rating is assigned for forward flexion of the thoracolumbar spine greater than 30 degrees, but not greater than 60 degrees; 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.??

The General Rating Formula provides a 40 percent rating for forward flexion of the thoracolumbar spine limited 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
for forward flexion of the thoracolumbar spine greater than 30 degrees, but not greater than 60 degrees; 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.??

Note (1) to the rating formula specifies that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be separately rated under an appropriate diagnostic code.

Note (2) (See also Plate V) provides that, for VA compensation purposes, normal forward flexion of the lumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. 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. The normal combined range-of-motion of the lumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range-of-motion.

Note (3) provides that, in exceptional cases, an examiner may state, that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range-of-motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range-of-motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range-of-motion is normal for that individual will be accepted.

Note (4) instructs to round each range-of-motion measurement to the nearest five degrees.

Note (5) provides that, for VA compensation purposes, unfavorable ankylosis is a condition in which the entire lumbar spine, or the entire 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.

Because the DCs for the lumbosacral strain do not expressly contemplate the ameliorative effects of medication, the Board must discount these effects when rating. See Jones v. Shinseki, 26 Vet. App. 56, 63 (2012) ("Absent a clear statement setting out whether or how the Board should address the effects of medication, the Board erred in taking those effects into account when evaluating the [veteran's] disability, rather than limiting itself to the symptoms expressly contemplated by" the Diagnostic Code). Recently, in Ingram v. Collins, 38 Vet. App. 130 (2025), the Court reaffirmed its central holding in Jones and held that, since the applicable diagnostic codes and special regulations pertaining to musculoskeletal disabilities do not explicitly contemplate medication use, the Board must discount the beneficial effects of medication when assigning a rating for a musculoskeletal disability.

The service-connected left elbow disability is rated under 38 C.F.R. § 4.71a and DCs 5212 (radius impairment, from September 1, 1986, to July 14, 2025) and 5213 (impairment of supination and pronation from July 14, 2025). DC 5212 provides a 10 percent disability rating for radius malunion with bad alignment (for both the major and minor radius) and a 20 percent rating for radius nonunion in upper half (for both the major and minor radius). DC 5213 provides a 10 percent rating for limitation of supination to 30 degrees or less (for both the major and minor radius). The Note to DC 5213 indicates that in all forearm and wrist injuries from DCs 5205 to 5213
impairment, from September 1, 1986, to July 14, 2025) and 5213 (impairment of supination and pronation from July 14, 2025). DC 5212 provides a 10 percent disability rating for radius malunion with bad alignment (for both the major and minor radius) and a 20 percent rating for radius nonunion in upper half (for both the major and minor radius). DC 5213 provides a 10 percent rating for limitation of supination to 30 degrees or less (for both the major and minor radius). The Note to DC 5213 indicates that in all forearm and wrist injuries from DCs 5205 to 5213, multiple impaired finger movements due to tendon tie-up, muscle or nerve injury, are to be separately rated and combined not to exceed a rating for loss of use of the hand.

In this decision, the Board will rate the left elbow disability pursuant to the substantive criteria of DC 5003 (inaccurately coded as DCs 5212 and 5213 for malunion and compensable limitation of supination of the left arm). In this case, the left elbow has always been rated on the basis of painful, noncompensable limitation of motion.? Even though the RO labeled the early disability ratings with DCs 5212 and 5213, the rating actually applied was under the criteria of DC 5003 because the evidence has always shown left elbow pain with limitation of supination and extension to a noncompensable degree.?

DC 5003 provides ratings for degenerative arthritis and DC 5010 provides ratings for post-traumatic arthritis (which then rates the same as DC 5003).? Degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate DCs (such as 5260 and 5261) for the specific joint or joints involved.? When there is some limitation of motion of the specific joint or joints involved that is noncompensable under the appropriate DCs, DC 5003 provides a rating of 10 percent for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under DC?5003.? Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion.? A 10 percent rating is warranted for noncompensable limitations of motion and function of major joints such as the elbow, including those due to orthopedic factors such as pain and stiffness.? 38?C.F.R. §§?4.59, 4,40, and 4.45; Burton?at 5; Mitchell?at 39.

The service-connected left elbow limitation of extension disability is rated under 38 C.F.R. § 4.71a and DC 5207 (limitation of extension of the forearm). A 10 percent rating is warranted for limitation of extension of the dominant forearm between 45 and 74 degrees.

The service-connected psychiatric disability is rated under 38 C.F.R. § 4.130 for mental conditions and for DC 9435 for unspecified depressive disorder. Under DC 9435, a 30 percent rating will be assigned for a mental disability which is productive of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, recent events).

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

A 70 percent rating will be assigned?for?occupational?and?social impairment?with deficiencies in most areas such as work, school, family relations, judgment, thinking, or mood due to symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting
judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships.

A 70 percent rating will be assigned?for?occupational?and?social impairment?with deficiencies in most areas such as work, school, family relations, judgment, thinking, or mood due to symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and an inability to establish and maintain effective relationships.

A 100 percent rating will be assigned for total?occupational?and?social impairment?due to symptoms such as gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, a persistent danger of hurting herself or others, an intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene), disorientation to time or place, and memory loss for names of close relatives, own?occupation, or own name.? 38?C.F.R. §?4.130.

The Secretary of VA, acting within the authority to adopt and apply a schedule of ratings, chose to create one general rating formula for mental disorders. ?38?U.S.C. §?1155; see?38?U.S.C. §?501; 38?C.F.R. §?4.130. By establishing one general formula to be used in rating more than 30 psychiatric disorders, there can be no doubt that the Secretary of VA anticipated that any list of symptoms justifying a particular rating would in many situations be either under- or over inclusive. The Secretary's use of the phrase "such symptoms as," followed by a list of examples, provides guidance as to the severity of symptoms contemplated for each rating, in addition to permitting consideration of other symptoms, particular to each veteran and disorder, and the effect of those symptoms on the claimant's social and work situation. This construction is not inconsistent with Cohen v. Brown,?10?Vet. App. 128?(1997). See Mauerhan v. Principi,?16?Vet. App.?436, 442?(1992).

The evidence considered in determining the level of impairment under?38?C.F.R. §?4.130?is not restricted to the symptoms provided in the diagnostic code. Instead, the rating specialist is to consider all symptoms of a claimant's condition that affect the level of occupational and social impairment, including, if applicable, those identified in the?American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). See?38?C.F.R. §?4.126. If the evidence demonstrates that a claimant suffers symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the diagnostic code, the appropriate, equivalent rating will be assigned. The schedular rating criteria rate by analogy psychiatric symptoms that are "like?or?similar to" those explicitly listed in the schedular rating criteria. Mauerhan?v. Principi, 16 Vet. App. at 436. The U.S. Court of Appeals for the Federal Circuit (Federal Circuit) has embraced the Mauerhan interpretation of the criteria for rating psychiatric disabilities. Sellers v. Principi,?372 F.3d 1318, 1326?(Fed. Cir. 2004).

In Vazquez-Claudio v. Shinseki,?713 F.3d 112, 117?(2013), the Federal Circuit held that VA "intended the General Rating Formula to provide a regulatory framework for placing veterans on a disability spectrum based upon their objectively observable symptoms." The Federal Circuit stated that "a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration." It was further noted that "§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas." See also Bankhead v. Shulkin,?29?Vet. App.?10?(2017) (indicating that the Board should consider the severity, frequency, and duration of the signs and symptoms of a mental disorder when determining the appropriate rating).

The service-connected hypertension is rated under 38 C.F.R. § 4.104 for diseases of the heart and DC 7101. Under DC 7101, a 10 percent
particular symptoms associated with that percentage, or others of similar severity, frequency, and duration." It was further noted that "§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas." See also Bankhead v. Shulkin,?29?Vet. App.?10?(2017) (indicating that the Board should consider the severity, frequency, and duration of the signs and symptoms of a mental disorder when determining the appropriate rating).

The service-connected hypertension is rated under 38 C.F.R. § 4.104 for diseases of the heart and DC 7101. Under DC 7101, a 10 percent rating is warranted for diastolic pressure predominantly 100 or more; systolic pressure predominantly 160 or more; or a history of diastolic pressure predominantly 100 or more that requires continuous medication for control. A 20 percent rating is warranted for diastolic pressure predominantly 110 or more or systolic pressure predominantly 200 or more. A 40 percent rating is warranted for diastolic pressure predominantly 120 or more and a maximum 60 percent rating is warranted for diastolic pressure predominantly 130 or more. In McCarroll, the Court clarified that the whole history of an individual's hypertensive disorder, including historical blood pressure readings, must be considered in determining the appropriate disability rating. See McCarroll v. McDonald, 28 Vet. App. 267, 274 (2016).

Note (2) instructs VA to evaluate hypertension due to aortic insufficiency or hyperthyroidism, which is usually the isolated systolic type, as part of the condition causing it rather than by a separate evaluation. Note (3) instructs VA to evaluate hypertension separately from hypertensive heart disease and other types of heart disease.

11. An earlier effective date of July 6, 2022, for service connection for erectile dysfunction is granted.

12. An effective date of July 6, 2022, for SMC based on loss of use of a creative organ is granted.

13. An effective date prior to July 6, 2022, for service connection for diabetes mellitus, type II, is denied.

14. An effective date prior to July 6, 2022, for service connection for headaches is denied.

15. An effective date prior to November 13, 2023, for service connection for MGUS is denied.

16. An effective date earlier than July 6, 2022, for service connection for a lumbosacral strain is denied.

17. An effective date earlier than February 11, 2026, for a staged rating of 20 percent for the lumbosacral strain is denied.

18. An effective date earlier than July 23, 2025, for service connection for the left elbow limitation of extension disability is denied.

19. An effective date earlier than July 6, 2022, for service connection for the psychiatric disability is denied.

20. An effective date earlier than August 10, 2022, for service connection for hypertension is denied.

The Veteran generally appeals for an earlier effective date for service connection for erectile dysfunction prior to August 2, 2022. See March 2026 substantive appeal to the Board.

The Board finds that an effective date of July 6, 2022, for service connection is the proper effective date. The date of claim for service connection is at the earliest July 6, 2022, as the Veteran submitted an Intent to File (on a VA Form 21-0966) on July 6, 2022. Less than one year later, on August 2, 2022, the Veteran submitted a complete claim for service connection for erectile dysfunction (on a VA Form 21-526EZ).

The date entitlement to service connection arose is in the early 2000s when the erectile dysfunction began as reported by the Veteran at the December 2023 VA examination. Pursuant to DC 7522, a noncompensable disability rating is warranted for erectile dysfunction with or without penile deformity. In the October 2025 rating decision, the RO granted service connection for erectile dysfunction as secondary to the diabetes mellitus, type II, which is effective July 6, 2022.

The later of the two dates - entitlement arose or date of claim - is July 6, 2022 (claim date), which, according to 38 U.S.C. § 5110(a) and 38 C.F.R. § 3.400, is the earliest effective date for the grant of service connection for erectile dysfunction. Thus, the appeal for an earlier effective date to July 6, 2022
2, a noncompensable disability rating is warranted for erectile dysfunction with or without penile deformity. In the October 2025 rating decision, the RO granted service connection for erectile dysfunction as secondary to the diabetes mellitus, type II, which is effective July 6, 2022.

SMC based on loss of use of a creative organ (based on erectile dysfunction) was assigned in an October 2025 rating decision effective August 2, 2022. As service connection for erectile dysfunction is now in effect from July 6, 2022, the effective date for SMC based on loss of use of a creative organ will also be assigned as of July 6, 2022.

The Veteran appeals for effective dates prior to July 6, 2022, for service connection for diabetes mellitus, type II, and headaches. See March 2026 substantive appeal to the Board.

The Board finds that effective dates earlier than July 6, 2022, for service connection are not warranted. The Board finds that the date of the claims for service connection is July 6, 2022. While the Veteran submitted earlier claims for service connection for diabetes in September 2007 and February 2019, those claims resulted in denials in February 2008 and May 2019 rating decisions and those decisions became final. On July 6, 2022, the Veteran submitted an Intent to File (VA Form 21-0966) followed by a complete claim for service connection for diabetes and headaches on August 2, 2022 (on a VA Form 21-526EZ). The claims were continuously pursued until the RO granted service connection for diabetes in a September 2023 rating decision and for headaches in a November 2022 rating decision.

The Board finds that entitlement to service connection for diabetes arose on January 30, 2004. A January 30, 2004, VA treatment record shows a diagnosis of diabetes. The Board finds that entitlement to service connection for headaches arose on August 9, 2006. An August 9, 2006, VA treatment record shows reports of headaches.

The later of the two dates - entitlement arose or claim - is July 6, 2022 (claim date), which, according to 38 U.S.C. § 5110(a) and 38 C.F.R. § 3.400, is the earliest effective date for the grants of service connection for diabetes mellitus and for headaches. Thus, the appeals for earlier effective dates must be denied.

The Veteran appeals for an effective date prior to November 13, 2023, for service connection for MGUS. See March 2026 substantive appeal to the Board. The Board finds that an effective date earlier than November 13, 2023, for service connection is not warranted. The Board finds that the date of claim for service connection is November 13, 2023. On November 13, 2023, the Veteran submitted an Intent to File (VA Form 21-0966) followed by a complete claim for service connection for MGUS on March 15, 2024 (on a VA Form 21-526EZ). The claims were continuously pursued until the RO granted service connection in a July 2024 rating decision

The Board finds that entitlement to service connection for MGUS arose in 2021. A December 2023 VA examination report shows that the MGUS was diagnosed in 2021. The later of the two dates - entitlement arose or claim - is November 13, 2023 (claim date), which, according to 38 U.S.C. § 5110(a) and 38 C.F.R. § 3.400, is the earliest effective date for the grant of service connection for MGUS. Thus, the appeal for an earlier effective date must be denied.

The Veteran appeals for earlier effective dates for service connection for the lumbosacral strain prior to July 6, 2022, and for a 20 percent rating prior to February 11, 2026. See March 2026 substantive appeal to the Board.

The Board finds that an effective date earlier than July 6, 2022, for service connection for the lumbosacral strain is not warranted. The date of claim
according to 38 U.S.C. § 5110(a) and 38 C.F.R. § 3.400, is the earliest effective date for the grant of service connection for MGUS. Thus, the appeal for an earlier effective date must be denied.

The Board finds that an effective date earlier than July 6, 2022, for service connection for the lumbosacral strain is not warranted. The date of claim for service connection for the lumbosacral strain is at the earliest July 6, 2022. The Veteran submitted an Intent to File (on a VA Form 21-0966) on July 6, 2022. Less than one year later, on August 2, 2022, the Veteran submitted a complete claim for service connection (on a VA Form 21-526EZ). The date entitlement arose to service connection for the lumbosacral strain is at the earliest July 23, 2003 (submitted to VA on April 18, 2019). A July 23, 2003, VA treatment record shows an initial report of back pain. Pursuant to DC 5003, a minimum 10 percent rating is warranted for painful motion of the back.

The later of the two dates - entitlement arose or claim - is July 6, 2022 (claim date), which, according to 38 U.S.C. § 5110(a) and 38 C.F.R. § 3.400, is the earliest effective date for the grant of service connection for the lumbosacral strain. Thus, the appeal for an earlier effective date must be denied.

The Board finds that an effective date earlier than February 11, 2026, for a 20 percent staged rating for the lumbosacral strain is not warranted. As aforementioned, the date of claim for service connection is July 6, 2022. The evidence shows that entitlement to a 20 percent staged rating arose on February 11, 2026. The February 2026 VA examination shows forward flexion of the thoracolumbar spine to 50 degrees and combined range of motion to 130 degrees with no ankylosis, measurements which warrant a 20 percent rating under DC 5237. See 38 C.F.R. § 4.71a. VA treatment records prior to February 11, 2026, do not show entitlement to a 20 percent rating.

The later of the two dates - entitlement arose or claim - is February 11, 2026 (entitlement date), which, according to 38 U.S.C. § 5110(a) and 38 C.F.R. § 3.400, is the earliest effective date for the assignment of a 20 percent staged rating for the lumbosacral strain. Thus, the appeal for an earlier effective date must be denied.

The Veteran appeals for an earlier effective date for service connection for the left elbow disability prior to July 6, 2022. See March 2026 substantive appeal to the Board.

The Board finds that an effective date earlier than July 6, 2022, for service connection is not warranted. The Board considers the date of claim as of July 6, 2022, the Intent to File for an increased disability for the left elbow disability because the Veteran later submitted a complete claim for service connection on August 2, 2022. The Board finds that the date entitlement to service connection for left elbow limitation of extension is November 18, 2025, the VA examination showing left forearm extension was limited to 10 degrees (warranting a noncompensable disability rating under DC 5207). VA treatment records do not support limitation of forearm extension prior to the date of the November 2025 VA examination.

The later of the two dates - entitlement arose or claim - is November 18, 2025 (entitlement date). As this date is subsequent to the current effective date (July; 23, 2025), the Board will not disturb the current effective date. Thus, the appeal for an earlier effective date must be denied.

The Veteran appeals for an effective date prior to July 6, 2022, for service connection for the psychiatric disability. See March 2026 substantive appeal to the Board.

The Board finds that an effective date earlier than July 6, 2022, for service connection is not warranted. The
limitation of forearm extension prior to the date of the November 2025 VA examination.

The Veteran appeals for an effective date prior to July 6, 2022, for service connection for the psychiatric disability. See March 2026 substantive appeal to the Board.

The Board finds that an effective date earlier than July 6, 2022, for service connection is not warranted. The Board finds that the date of claim for service connection is July 6, 2022. On July 6, 2022, the Veteran submitted an Intent to File (VA Form 21-0966) followed by a complete claim for service connection for a mental health condition on August 2, 2022 (on a VA Form 21-526EZ). The claims were continuously pursued until the RO granted service connection in a June 2024 rating decision.

The Board finds that entitlement to service connection for the psychiatric disability arose on August 9, 2006. An August 2006 VA treatment record shows a diagnosis of mixed anxiety.

The later of the two dates - entitlement arose or claim - is July 6, 2022 (claim date), which, according to 38 U.S.C. § 5110(a) and 38 C.F.R. § 3.400, is the earliest effective date for the grant of service connection for the psychiatric disability. Thus, the appeal for an earlier effective date must be denied.

The Veteran appeals for an effective date prior to August 10, 2022, for service connection for hypertension. See March 2026 substantive appeal to the Board.

The Board finds that an effective date earlier than August 10, 2022, for service connection is not warranted. The Board finds that the date of claim for service connection is July 6, 2022. On July 6, 2022, the Veteran submitted an Intent to File (VA Form 21-0966) followed by a complete claim for service connection for a mental health condition on August 2, 2022 (on a VA Form 21-526EZ).

The Board finds that entitlement to service connection for hypertension arose on August 10, 2022. While the RO found that the hypertension was diagnosed in 2002, the Veteran was not entitled to service connection until August 10, 2022, the effective date of the PACT Act when the hypertension was considered presumptively caused by exposure to herbicides. Another theory of service connection that may provide for an earlier date of entitlement, such as direct service connection, is not warranted because the service treatment records do not show elevated blood pressure readings or a direct nexus to service prior to August 10, 2022.

The later of the two dates - entitlement arose or claim - is August 10, 2022 (entitlement date), which, according to 38 U.S.C. § 5110(a) and 38 C.F.R. § 3.400, is the earliest effective date for the grant of service connection for hypertension. Thus, the appeal for an earlier effective date must be denied.

21. An increased disability rating of 10 percent for the left elbow disability from July 6, 2022, is granted.

The Veteran appeals for an increased disability rating for the service-connected left elbow disability from July 6, 2022. See March 2026 substantive appeal to the Board.

After a review of all evidence, lay and medical, the evidence is at least in relative equipoise on the question of whether the symptoms and functional impairments of the service-connected left elbow disability more nearly approximate an increased disability rating of 10 percent under DCs 5212 and 5213. From July 6, 2022, the left elbow disability manifested in intermittent pain and noncompensable limitation of supination and pronation but no malunion of the radius with bad alignment.

A November 2025 VA examination report shows reports of left elbow pain that became sharp once per week, pain on and off with certain movements, sharp, achy pain for a few hours to a day, and occasional flare-ups once every three months with constant throbbing pain for a day or two. The Veteran reported taking Tylenol two to three times per day as needed for pain and Icy Hot for pain as needed but reported taking no medication prior to this examination. Flare-ups were precipitated by overuse of the arm and using a riding lawnmower
, the left elbow disability manifested in intermittent pain and noncompensable limitation of supination and pronation but no malunion of the radius with bad alignment.

A November 2025 VA examination report shows reports of left elbow pain that became sharp once per week, pain on and off with certain movements, sharp, achy pain for a few hours to a day, and occasional flare-ups once every three months with constant throbbing pain for a day or two. The Veteran reported taking Tylenol two to three times per day as needed for pain and Icy Hot for pain as needed but reported taking no medication prior to this examination. Flare-ups were precipitated by overuse of the arm and using a riding lawnmower and were alleviated by Tylenol, rest, and Icy Hot gel. The Veteran reported that increased pain limited activity tolerance, and an inability to lift anything with the left arm including performing chores, cooking, or doing laundry and interference with sleep during flare-ups.

For active and passive range of motion, forearm supination was to 85 degrees (normal) and forearm pronation was to 80 degrees (normal) with no pain. The Veteran was able to perform repetitive use testing with at least three repetitions and there was no additional loss of function or range of motion after three repetitions. The Veteran was not being examined immediately after repeated use over time or during a flare-up but procured evidence from the Veteran suggested that pain, fatigability, and weakness significantly limited functional ability under those conditions. The examiner estimated forearm supination to 75 degrees and pronation to 70 degrees after repeated use over time and during a flare-up. There was less movement than normal and weakened movement. There was no impairment of supination or pronation, malaligned fracture, or malunion of the radius with bad alignment.

The examiner explained that the medication taken for the left elbow disability relieves or reduces the severity of the symptoms being evaluated but indicated that since the Veteran did not take medication prior to this examination and denied flare-ups or pain, the evaluation was done in an unmedicated state and the pain and flare-ups were intermittent according to activity.

VA treatment records from July 2022 to November 2025 show reports of left elbow pain.

After a review of all the evidence, the Board finds that an increased rating of 10 percent is warranted. The November 2025 VA examination report shows supination limited to 75 degrees at worst which is noncompensable if evaluated under DC 5213. Similarly, there was no malunion of the radius, which is noncompensable if rated under DC 5212. However, a 10 percent rating is warranted for pain on movement (to a noncompensable degree) under the substantive rating criteria of DC 5003 (10 percent for painful, noncompensable limitation of a major joint), as reported to VA from July 2022 to November 2025, even though range of motion measurements would be noncompensable on their own. 38?C.F.R. §§?4.59, 4,40, and 4.45; Burton?at 5; Mitchell?at 39.?

A higher increased rating of 20 percent is not warranted because the lay and medical evidence does not show nonunion in the upper half (dominant arm) (DC 5212) or motion lost beyond the last quarter of arc and the hand not approaching full pronation or the hand being fixed near the middle of the arc or moderate pronation (dominant arm) (DC 5213).

The Board notes that, although the Veteran reported taking medication on occasion for left elbow pain, the Veteran did not report taking such prior to assessment in November 2025; therefore, the range of motion measurements captured are considered as being in an unmedicated state. As such, there are no ameliorative effects of medication to discount when rating this disability. See Jones at 63; Ingram at 130.

For the foregoing reasons, and resolving reasonable doubt in the Veteran's favor, the Board finds that the criteria are met for an increased disability rating of 10 percent for the left elbow disability from July 6, 2022, the date of the Intent to File for an increased rating; therefore, the appeal is granted.

22. A higher initial disability rating in excess of 10 percent for diabetes from July 6, 2022, is denied.

The Veteran appeals for a higher initial disability rating in excess of 10 percent for the service-connected diabetes from July 6, 2022. See March 2026 substantive appeal to the Board.

After a review of all evidence, lay and medical, the persuasive weight of the evidence is against a finding that the symptoms and functional impairment of the diabetes mellitus disability
Board finds that the criteria are met for an increased disability rating of 10 percent for the left elbow disability from July 6, 2022, the date of the Intent to File for an increased rating; therefore, the appeal is granted.

22. A higher initial disability rating in excess of 10 percent for diabetes from July 6, 2022, is denied.

The Veteran appeals for a higher initial disability rating in excess of 10 percent for the service-connected diabetes from July 6, 2022. See March 2026 substantive appeal to the Board.

After a review of all evidence, lay and medical, the persuasive weight of the evidence is against a finding that the symptoms and functional impairment of the diabetes mellitus disability more nearly approximate the criteria for an initial 20 percent rating under DC 7913. From July 6, 2022, the diabetes mellitus disability required only a restricted diet.

An August 2023 VA examination report shows the diabetes was managed with a restricted diet but did not require regulation of activities. The Veteran visited his diabetic care provider less than two times per month for episodes of ketoacidosis and hypoglycemia.

An October 2025 VA examination report shows the diabetes required no treatment and the Veteran visited his diabetic care provider less than two times per month for episodes of ketoacidosis and hypoglycemia. No regulation of activities was required. The examiner indicated that there was no renal involvement.

VA treatment records from January 2023 to January 2024 show the Veteran was educated on a healthy diet, exercise, and tight glucose control. November 2023 and June 2024 VA treatment records show the Veteran was prescribed insulin injections when he was inpatient at a hospital for a short period of time. Otherwise, VA treatment records indicate the Veteran was stable on only diet and exercise for the diabetes.

The Board finds that a 10 percent initial rating, and no higher, is warranted for diabetes from July 6, 2022. The evidence shows a restricted diet was used to control the diabetes but does not show that the Veteran required one or more injections of insulin per day plus a restricted diet, or the need for oral hypoglycemic agents in addition to a restricted diet, which would be required for a 20 percent rating pursuant to DC 7913. The foregoing evidence shows that the use of insulin in November 2023 and June 2024 was solely when the Veteran was hospitalized and does not support a finding that the Veteran used one or more injection of insulin daily to control the diabetes.

A higher initial rating is not warranted under a different DC, including when considering a rating separately for chronic kidney disease. A higher rating for renal dysfunction under 38 C.F.R. § 4.115b (30 percent) is warranted for chronic kidney disease with GFR from 45 to 59 mL/min/1.73 m2 for at least 3 consecutive months during the past 12 months. August 2022, August 2023, January 2024, and July 2025 VA treatment records show GFR levels of 42, 49, 45, and 44 mL/min/1.73 m2, respectively. Such values do not meet the threshold requirement for a 30 percent rating under 38 C.F.R. § 4.115b.

For the foregoing reasons, the Board finds that the criteria are not met for a higher initial disability rating in excess of 10 percent for diabetes from July 6, 2022; therefore, the appeal is denied.

23. A higher (compensable) initial disability rating for headaches from July 6, 2022, is denied.

The Veteran appeals for a higher (compensable) initial disability rating for the service-connected headaches from July 6, 2022. See March 2026 substantive appeal to the Board.

After a review of all evidence, lay and medical, the persuasive weight of the evidence is against a finding that the symptoms and functional impairment of the headache disability more nearly approximate the criteria for an initial 10 percent rating under DC 8100. From July 6, 2022, the headache disability manifested in less frequent attacks of head pain and symptoms.

A September 2022 VA examination report shows daily headache pain for which the Veteran takes Tylenol as needed. The Veteran described throbbing or pulsating pain on both sides of the head for less than one day and changes in vision. The examiner indicated there were no characteristic prostrating attacks of headache pain. The Veteran did not report functional impairment due to the headaches.

An October 2025 VA examination report shows reports of recurrent left side headaches that are not debilitating for which the Veteran takes Tylenol as needed. The Veteran described pain localized to one side of the
rating under DC 8100. From July 6, 2022, the headache disability manifested in less frequent attacks of head pain and symptoms.

An October 2025 VA examination report shows reports of recurrent left side headaches that are not debilitating for which the Veteran takes Tylenol as needed. The Veteran described pain localized to one side of the head for one to two days, nausea, and sensitivity to light. The examiner indicated there were no characteristic prostrating attacks of headache pain. The Veteran reported being unable to stay on task or socialize due to headaches which impact occupational tasks.

VA treatment records show reports of headache pain scoring a five out of 10 that interrupt some activities and a morning headache that resolves. See November 2023 and December 2024 VA treatment records.

The Board finds that a noncompensable initial disability rating is warranted. The evidence shows that from July 6, 2022, there was headache pain that caused some functional impairments and changes in vision and nausea, but does not show characteristic prostrating attacks. The evidence does not show that the headaches caused extreme exhaustion and powerlessness, preventing the ability to perform any activities, which would be characterized as a "prostrating attack." See Dorland's Illustrated Medical Dictionary 1531 (32d ed. 2012); Merriam-Webster Dictionary, merriamwebster.com/dictionary-/prostrating. Instead, the evidence shows "less frequent attacks" of headache pain for which the Veteran took Tylenol to alleviate as needed. Thus, a higher rating of 10 percent under DC 8100 is not warranted.

For the foregoing reasons, the Board finds that the criteria are not met for a higher (compensable) initial disability rating for headaches from July 6, 2022; therefore, the appeal is denied.

24. A higher (compensable) initial disability rating for MGUS from July 6, 2022, is denied.

The Veteran appeals for a higher (compensable) initial disability rating for MGUS from July 6, 2022. See March 2026 substantive appeal to the Board.

After a review of all evidence, lay and medical, the persuasive weight of the evidence is against a finding that the symptoms and functional impairment of the MGUS more nearly approximate the criteria for a 10 percent initial rating under DC 7712. From July 6, 2022, there was MGUS that did not require treatment; there was not symptomatic multiple myeloma.

A December 2023 VA examination report shows the Veteran reported taking ferrous sulfate for anemia. The examiner indicated that no continuous medication was required and that the status of multiple myeloma was indicated as MGUS. A March 2024 VA examination report shows no current treatment for the MGUS with no impact on functional activities. The status of multiple myeloma was indicated as MGUS. VA treatment records show a diagnosis of MGUS with no follow-up with oncology needed but show related anemia.

After reviewing all the evidence, the Board finds that a noncompensable initial disability is warranted. The evidence shows the presence of MGUS, which warrants a noncompensable rating under DC 7712, even in the presence of related anemia. A higher rating of 100 percent is not warranted because the evidence does not show symptomatic multiple myeloma; rather, the evidence shows that the "status" of multiple myeloma was instead MGUS. For the foregoing reasons, the Board finds that the criteria are not met for a higher (compensable) initial disability rating for MGUS from July 6, 2022; therefore, the appeal is denied.

25. An initial disability rating in excess of 10 percent for the lumbosacral strain is denied.

26. A staged rating in excess of 20 percent for the lumbosacral strain from February 11, 2026, is denied.

The Veteran appeals for higher initial disability ratings, in excess of 10 percent from July 6, 2022, and in excess of 20 percent from February 11, 2026, for the service-connected lumbosacral strain. See March 2026 substantive appeal to the Board.

After a review of all evidence, lay and medical, the persuasive weight of the evidence is against a finding that the symptoms
; therefore, the appeal is denied.

25. An initial disability rating in excess of 10 percent for the lumbosacral strain is denied.

26. A staged rating in excess of 20 percent for the lumbosacral strain from February 11, 2026, is denied.

After a review of all evidence, lay and medical, the persuasive weight of the evidence is against a finding that the symptoms and functional impairment of the lumbosacral strain more nearly approximate the criteria for an initial 20 percent rating under DCs 5003-5237. From July 6, 2022, with consideration of all joint limiting factors, forward flexion of the thoracolumbar spine was limited to 70 degrees and the total combined range of motion was 170 degrees.

A September 2022 VA examination report shows worsening back pain treated with Tylenol as needed. The Veteran did not report flare-ups or functional loss/impacts. On examination, active range of motion of the thoracolumbar spine was forward flexion to 70 degrees (90 degrees is normal), extension to 10 degrees (30 degrees is normal), right and left lateral flexion to 15 degrees each (30 degrees is normal), and right and left lateral rotation to 30 degrees each (30 degrees is normal) with pain on all motions. Passive range of motion testing was contraindicated due to pain on active range of motion. There was mild localized tenderness over the paralumbar area. The Veteran was able to perform repetitive use testing with at least three repetitions with no additional loss of function or range of motion after three repetitions. The Veteran was not being examined immediately after repeated use over time and procured evidence from the Veteran did not suggest that pain, fatigability, weakness, lack of endurance, or incoordination significantly limited functional ability with repeated use over time. There was no muscle spasm or guarding, muscle atrophy, strength weakness, abnormal reflexes, or ankylosis.

The evidence shows that not higher than a 10 percent initial disability rating is warranted. Forward flexion was limited to 70 degrees at worst on active range of motion and combined range of motion of the thoracolumbar spine was 170 degrees, measurements which warrant a 10 percent rating under DCs 5003-5237, even considering pain on use of the back. 38?C.F.R. §§?4.71a, 4.59, 4,40, and 4.45; Burton?at 5; Mitchell?at 39. A higher rating of 20 percent is not warranted because the evidence does not show forward flexion limited to greater than 30 degrees but not greater than 60 degrees or combined range of motion not greater than 120 degrees. The evidence also does not show muscle spasm or guarding. See DC 5237; 38?C.F.R. §?4.71a. VA treatment records for this initial rating period additionally do not show more severe range of motion measurements or muscle spasm or guarding that may warrant a higher rating.

The Board also considers the ameliorative effects of Tylenol taken occasionally for back pain. Flare-ups are indications of when the back pain and limitation of motion would be at its worst or would be the level of pain reached prior to alleviation with medication. In this case, the Veteran has not reported flare-ups of back pain or any functional loss or limitation caused by the lumbosacral strain. By rating the Veteran based on reports of back pain without flare-ups, which is the case at the September 2022 VA examination, the Board is effectively discounting the beneficial effects of medication taken to treat the back disability. Thus, remand is not warranted for the Board or for the September 2022 VA examiner to determine the level of severity of the back disability if the Veteran had not taken Tylenol occasionally for pain. See Jones, 26 Vet. App. at 63; Ingram, 38 Vet. App. at 130. For the foregoing reasons, the appeal for an initial rating in excess of 10 percent must be denied.

Regarding a higher staged rating in excess of 20 percent from February 11, 2026, after a review of all evidence, lay and medical, the persuasive weight of the evidence is against a finding that the symptoms and functional impairment of the lumbosacral strain more nearly approximate
. Thus, remand is not warranted for the Board or for the September 2022 VA examiner to determine the level of severity of the back disability if the Veteran had not taken Tylenol occasionally for pain. See Jones, 26 Vet. App. at 63; Ingram, 38 Vet. App. at 130. For the foregoing reasons, the appeal for an initial rating in excess of 10 percent must be denied.

Regarding a higher staged rating in excess of 20 percent from February 11, 2026, after a review of all evidence, lay and medical, the persuasive weight of the evidence is against a finding that the symptoms and functional impairment of the lumbosacral strain more nearly approximate the criteria for a staged 40 percent rating under DC 5237. From February 11, 2026, the lumbosacral strain manifested in forward flexion of the thoracolumbar spine was limited to 50 degrees at worst and the total combined range of motion was 130 degrees with no ankylosis.

The February 2026 VA examination report shows daily back pain with general use that worsened with lifting and walking for extended periods of time that was treated with Tylenol as needed. The Veteran did not report flare-ups. On examination, active range of motion of the thoracolumbar spine was forward flexion to 50 degrees, extension to 10 degrees, right and left lateral flexion to 15 degrees each, and right and left lateral rotation to 20 degrees each with pain on all motions. Passive range of motion testing was contraindicated due to pain on active range of motion. The Veteran was able to perform repetitive use testing with at least three repetitions with no additional loss of function or range of motion after three repetitions. The Veteran was not being examined immediately after repeated use over time and procured evidence from the Veteran did not suggest that pain, fatigability, weakness, lack of endurance, or incoordination significantly limited functional ability with repeated use over time. There was no muscle spasm or guarding, muscle atrophy, strength weakness, abnormal reflexes, or ankylosis.

The evidence shows that not higher than a 20 percent staged disability rating is warranted. Forward flexion was limited to 50 degrees at worst on active range of motion and combined range of motion of the thoracolumbar spine was 130 degrees, measurements which warrant a 20 percent rating under DCs 5003-5237, even considering pain on use of the back. 38?C.F.R. §§?4.71a, 4.59, 4,40, and 4.45; Burton?at 5; Mitchell?at 39. A higher rating of 40 percent is not warranted because the evidence does not show favorable ankylosis (or any ankylosis) of the entire thoracolumbar spine. The Veteran reported a continued ability to use the back but exhibited pain on prolonged use of the back, so the spine was not fixed (ankylosed). See DC 5237; 38?C.F.R. §?4.71a. VA treatment records for this initial rating period additionally do not show more severe range of motion measurements or muscle spasm or guarding that may warrant a higher rating.

The Board again considers the ameliorative effects of Tylenol taken occasionally for back pain, but notes that the Veteran still did not report flare-ups, which is when the back pain and limitation of motion would be at its worst. By rating the Veteran based on reports of back pain without flare-ups, which is the case at the February 2026 VA examination, the Board is effectively discounting the beneficial effects of medication taken to treat the back disability. Thus, remand is not warranted for the Board or for the February 2026 VA examiner to determine the level of severity of the back disability if the Veteran had not taken Tylenol occasionally for pain. See Jones at 63; Ingram at 130.

For the foregoing reasons, the appeal for a staged rating in excess of 20 percent must be denied.

27. A higher (compensable) initial disability rating for left elbow limitation of extension from July 23, 2025, is denied.

The Veteran appeals for a higher (compensable) initial disability rating for the service-connected left elbow limitation of extension disability from July 23, 2025. See March 2026 substantive appeal to the Board.

After a review of all evidence, lay and medical, the persuasive weight of the evidence is against a finding that the symptoms and functional impairment of the service-connected left elbow limitation of extension disability more nearly approximate the criteria required for an initial 10 percent rating. From July 23,
, the appeal for a staged rating in excess of 20 percent must be denied.

27. A higher (compensable) initial disability rating for left elbow limitation of extension from July 23, 2025, is denied.

After a review of all evidence, lay and medical, the persuasive weight of the evidence is against a finding that the symptoms and functional impairment of the service-connected left elbow limitation of extension disability more nearly approximate the criteria required for an initial 10 percent rating. From July 23, 2025, the left elbow limitation of extension disability manifested in left forearm extension limited to 10 degrees at worst.

The November 2025 VA examination report shows left forearm limitation of extension to 10 degrees. VA treatment records from July 23, 2025, do not show more severe limitation of extension.

The Board finds that a noncompensable initial disability rating is warranted for the left elbow limitation of extension disability. The evidence shows that left forearm extension was limited to 10 degrees at worst, which is noncompensable under DC 5207. A 10 percent rating was granted for general left elbow pain pursuant to Burton and Mitchell, so the Board cannot now assign a separate 10 percent rating for pain caused by the left elbow limitation of extension. A higher rating of 10 percent is not warranted because the evidence does not show left forearm extension limited to 45 to 74 degrees at worst. Although the Veteran reported taking medication on occasion for left elbow pain at the November 2025 VA examination, the Veteran did not report taking such prior to medical assessment at this examination, so the range of motion measurements captured are considered as being in an unmedicated state. As such, there are no ameliorative effects of medication to discount when rating this disability. See Jones at 63; Ingram at 130.

For the foregoing reasons, the Board finds that the criteria are not met for a higher (compensable) initial disability rating for the left elbow limitation of extension disability from July 23, 2025; therefore, the appeal is denied.

28. The criteria for an initial disability rating in excess of 30 percent for the psychiatric disability from July 6, 2022, is denied.

The Veteran appeals for an initial disability rating in excess of 30 percent for the service-connected psychiatric disability from July 6, 2022. See March 2026 substantive appeal to the Board.

After a review of all evidence, lay and medical, the persuasive weight of the evidence is against a finding that the symptoms and functional impairment of the psychiatric disability more nearly approximate the criteria for an initial 50 percent rating under DC 9435. From July 6, 2022, the psychiatric disability manifested in occupational and social impairment with symptoms including anxiety, forgetfulness, and some strained relationships with siblings but did not manifest in disturbances of motivation and mood, impaired memory, or suicidal ideation.

A December 2023 VA examination report for PTSD shows an assessment of occupational and social impairment due to mild or transient symptoms which decrease work efficiency and the ability to perform occupational tasks, although the Veteran was generally functioning satisfactorily with normal routine behavior, self-care, and conversation. The Veteran reported being married for his first wife for almost 10 years and has been married to his second wife for 41 years. The Veteran reported having a co-custody agreement with his grandson whom he sees every other weekend. The Veteran reported having a good relationship with his wife, having some friends that come and go, and previously being a member of the local fine arts association. The Veteran reported spending his days at home watching television and caring for animals and that he was last employed about 20 years prior. The Veteran reported that prior medication taken for tremors caused suicidal ideation and he has since stopped that medication. On examination, there was anxiety, chronic sleep impairment, and disturbances of motivation and mood. The Veteran was oriented to person, place, and things and his mood was within normal limits. The Veteran denied suicidal or homicidal ideation or psychosis. The Veteran reported an inability to remember names and dates, sleeping around four hours per night, less interest in sexual activity, and increased irritability.

A December 2023 VA examination report for mental disorders shows an assessment of occupational and social impairment due to mild or transient symptoms which decrease work efficiency and the ability to perform occupational tasks only during periods of significant stress or symptoms controlled by medication. The Veteran reported being close with his son and his son's family but that he does not get along with his siblings. The Veteran reported leisure activities including
and disturbances of motivation and mood. The Veteran was oriented to person, place, and things and his mood was within normal limits. The Veteran denied suicidal or homicidal ideation or psychosis. The Veteran reported an inability to remember names and dates, sleeping around four hours per night, less interest in sexual activity, and increased irritability.

A December 2023 VA examination report for mental disorders shows an assessment of occupational and social impairment due to mild or transient symptoms which decrease work efficiency and the ability to perform occupational tasks only during periods of significant stress or symptoms controlled by medication. The Veteran reported being close with his son and his son's family but that he does not get along with his siblings. The Veteran reported leisure activities including painting, gardening, fishing, and being near water. The Veteran denied a history of suicidal or homicidal ideation and reported taking Sertraline for depression. The Veteran reported current symptoms of his mood being "not great," not being able to participate in leisure activities and his health conditions, sleeping about five to six hours per night, normal appetite, and a "weak" memory and concentration. On examination, there was anxiety, chronic sleep impairment, and disturbances of motivation and mood. The Veteran was oriented in all spheres, had a goal-directed, logical, and coherent thought process, had adequate judgment and insight, normal speech, and normal psychomotor activity.

VA treatment records show the Veteran had a good relationship with his wife, had intact memory and normal speech, some worry and restlessness, fatigue, denial of suicidal ideation, a desire to return to art, meditation, and journaling, and normal thought processes and judgment. See August, September, October, and November 2023 and February 2024 VA treatment records. The Veteran has reported spending time at home watching television and spending time with his dog. See July 2025 VA treatment record.

The Board finds that from July 6, 2022, the frequency, severity, and duration of the psychiatric symptoms are consistent with an overall 30 percent rating under DC 9435. The evidence shows symptoms including sleep impairment and anxiety, which are enumerated under DC 9435 for a 30 percent rating. The evidence also shows symptoms of fatigue, worry, restlessness, some anhedonia, and forgetfulness of names and dates but does not show that such symptoms prevented the Veteran from performing activities of daily living or participating in leisure activities such as caring for animals, art, gardening, fishing, and spending time with family.

A higher rating of 50 percent is not warranted because the evidence does not show occupational and social impairment with reduced reliability to include symptoms such as panic attacks, impaired speech, affect, or through processes, or disturbances of motivation and mood. The indication of forgetfulness of names and dates does not equate to short- and long-term memory loss, which might warrant a 50 percent rating, because the evidence does not show the Veteran could only retain highly learned material or forgot to complete tasks. Additionally, the Veteran's relationships with family shows that the Veteran did not have difficulty in establishing and maintaining effective work and social relationships. While the evidence shows suicidal ideation as a previous side effect of medication, the evidence does not show, for this initial appeal period overall, suicidal ideation at any other time or that which interfered with daily functioning. Such evidence shows an overall disability picture of occupational and social impairment with occasional decrease in work efficiency but the Veteran was generally functioning despite his psychiatric symptoms.

For the foregoing reasons, the Board finds that the criteria are not met for a higher initial disability rating in excess of 30 percent for the psychiatric disability from July 6, 2022; therefore, the appeal is denied.

29. The criteria for an initial disability rating in excess of 10 percent for hypertension from August 10, 2022, is denied.

The Veteran appeals for a higher initial disability rating in excess of 10 percent from August 10, 2022, for hypertension. See March 2026 substantive appeal to the Board.

After a review of all evidence, lay and medical, the persuasive weight of the evidence is against a finding that the symptoms and functional impairment of the hypertension disability more nearly approximate the criteria for an initial 20 percent rating under DC 7101. From August 10, 2022, the hypertension manifested in systolic pressure predominantly 160 or more and required continuous medication for control.

A September 2023 VA examination report shows reports of uncontrolled hypertension that was stable on several medications (taken continuously) and that caused occasional lightheadedness. The examiner indicated that there was no history of a diastolic blood pressure predominantly 100 or more.

An October 2025 VA examination report shows the Veteran was taking four different antihypertensive medication. The examiner
, the persuasive weight of the evidence is against a finding that the symptoms and functional impairment of the hypertension disability more nearly approximate the criteria for an initial 20 percent rating under DC 7101. From August 10, 2022, the hypertension manifested in systolic pressure predominantly 160 or more and required continuous medication for control.

An October 2025 VA examination report shows the Veteran was taking four different antihypertensive medication. The examiner indicated that there was no history of a diastolic blood pressure predominantly 100 or more.

VA treatment records from August 10, 2022, to present show at least 54 blood pressure readings that average to a reading of 158/76. VA treatment records prior to August 10, 2022, show blood pressure readings below 200/110.

The Board finds that a 10 percent initial disability rating is warranted. The evidence shows that multiple medications were required to control the hypertension and show an average systolic pressure predominantly around 160, which is consistent with a 10 percent disability rating under DC 7101.

A higher rating of 20 percent is not warranted because the evidence does not show systolic pressure predominantly 200 or more and does not show diastolic pressure predominantly 110 or more. The September 2023 and October 2025 VA examiners confirmed no history of a diastolic blood pressure predominantly 100 or more; a history of diastolic pressure predominantly 110 or more may warrant a higher rating. For the foregoing reasons, the Board finds that the criteria are not met for a higher initial disability rating in excess of 10 percent for hypertension from August 10, 2022; therefore, the appeal is denied.

J. PARKER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board I. Comis

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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