HYPERTENSION

Summary

The veteran, who served in the United States Army from May 2019 to February 2025, appeals the denial of service connection for chronic chest pain, chronic rectal bleeding, numbness in the jaw, and tinea pedis. The veteran also sought initial compensable disability ratings for left hip limitation of extension and left hip thigh impairment. The Board reviewed the evidence of record from the April 2025 AOJ decision, as the veteran elected the Direct Review docket and the appeal period for docket switching had passed. For the service connection claims, the Board found no competent medical evidence of a current diagnosis or functional impairment related to earning capacity for any of the claimed conditions. VA examinations in October 2024 documented no current diagnoses for chest pain, rectal bleeding, jaw numbness, or tinea pedis, despite the veteran's reported symptoms. Service treatment records also did not support the claims. For the hip claims, the Board reviewed the October 2024 VA hip examination, which showed the veteran's left hip extension was limited to 20 degrees, falling short of the 5 degrees required for a compensable rating under DC 5251. Similarly, the hip's range of motion did not meet the criteria for limitation of rotation, abduction, adduction, or thigh impairment under DC 5253. While pain was noted on motion, the Board found this was already compensated by the 10% rating for limitation of flexion under DC 5252 and separate ratings for painful motion are precluded by the rule against pyramiding. Consequently, all claims were denied.

Rationale

No current diagnosis of chest disability or pain with functional impairment.; VA examinations and service treatment records did not document the condition.; Veteran's reported pain did not result in functional loss affecting earning capacity.

Full Decision Text

Citation Nr: A26036837
Decision Date: 04/21/26	Archive Date: 04/21/26

DOCKET NO. 250422-535976
DATE: April 21, 2026

ORDER

Entitlement to service connection for chronic chest pain is denied.

Entitlement to service connection for chronic rectal bleeding is denied.

Entitlement to service connection for numbness in the jaw is denied.

Entitlement to service connection for tinea pedis is denied.

Entitlement to an initial compensable disability rating for left hip limitation of extension is denied.

Entitlement to an initial compensable disability rating for left hip thigh impairment is denied.

FINDINGS OF FACT

1. The evidence of record does not show a diagnosis of a chest disability or chronic chest pain that results in functional impairment of earning capacity during or near the period on appeal.

2. The evidence of record does not show a diagnosis of a rectal disability during or near the period on appeal.

3. The evidence of record does not show a diagnosis of a jaw disability during or near the period on appeal.

4. The evidence of record does not show a diagnosis of tinea pedis during or near the period on appeal.

5. Throughout the period on appeal, the Veteran's left hip extension was not limited to five degrees.

6. Throughout the period on appeal, the Veteran's left hip thigh impairment did not manifest in the limitation of rotation and the inability to toe-out more than 15 degrees, in the limitation of abduction and motion lost beyond 10 degrees, or in the limitation of adduction and the inability to cross the legs.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for chronic chest pain have not been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.1.

2. The criteria for entitlement to service connection for chronic rectal bleeding have not been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.1.

3. The criteria for entitlement to service connection for numbness in the jaw have not been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.1.

4. The criteria for entitlement to service connection for tinea pedis have not been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.1.

5. The criteria for entitlement to an initial compensable disability rating for left hip limitation of extension have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.14, 4.71a, Diagnostic Code 5251.

6. The criteria for entitlement to an initial compensable disability rating for left hip thigh impairment have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.14, 4.71a, Diagnostic Code 5253.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from May 2019 to February 2025.

The rating decision on appeal was issued in April 2025 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In the April 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.  Therefore, the Board of Veterans' Appeals (Board) may only consider the evidence of record at the time of the April 2025 agency of original jurisdiction (AOJ) decision on appeal.  38 C.F.R. § 20.301.  Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board.  38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence.  38 C.F.R. § 3.2501.  If the
 of Veterans' Appeals (Board) may only consider the evidence of record at the time of the April 2025 agency of original jurisdiction (AOJ) decision on appeal.  38 C.F.R. § 20.301.  Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board.  38 C.F.R. §§ 20.300, 20.301, 20.801.

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

The Board is cognizant of the recent decision issued by the United States Court of Appeals for Veterans Claims (Court) in the case of Williams v. McDonough, 37 Vet. App. 305 (2024).  There, the Court held, in essence, that the Board must refrain from deciding a case until the case proceeds to the point where a docket switch is no longer permitted under the terms of 38 C.F.R. § 20.202(c)(2).  In this case, a docket switch is no longer permitted under the terms of 38 C.F.R. § 20.202(c)(2) as it is more than one year from the date that the AOJ mailed notice of the decision on appeal, and it is more than 60 days from the date that the Board received the April 2025 VA Form 10182.  Therefore, the Board will proceed with adjudication.

As a final preliminary matter, the Board notes that a claim for entitlement to a total disability rating based on individual unemployability (TDIU) can be inferred from a claim for an increased rating where there is evidence of unemployability.  See Rice v. Shinseki, 22 Vet. App. 447 (2009).  Here, however, the Veteran does not contend, and the record does not otherwise reflect, that he is unable to work due to his service-connected left hip disability.  Thus, because the issue of a TDIU has not been raised by the record, the Board will not address it further herein.

Service Connection

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

The requirement of a current disability, the first element in the service connection test noted above, is satisfied when the veteran has a disability at the time he files his claim for service connection or during the pendency of that claim, even if the disability resolves prior to the adjudication of the claim.  McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).  However, when the record contains a recent diagnosis of disability prior to the veteran's filing of a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency.  Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013).  The term "disability" means impairment in earning capacity resulting from diseases and injuries and their residual conditions.  See 38 C.F.R. § 4.1; see also Saunders v. Wilkie, 886 F.3d 1356, 1362-68 (Fed. Cir. 2018).

Pursuant to 38 C.F.R. § 3.156(c)(1), at any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, VA will reconsider the claim.  Relevant official service department records include service records that are related to a claimed in-service event, injury, or disease.  38 C.F.R. § 3.156(c)(1)(i).

Increased
 § 4.1; see also Saunders v. Wilkie, 886 F.3d 1356, 1362-68 (Fed. Cir. 2018).

Pursuant to 38 C.F.R. § 3.156(c)(1), at any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, VA will reconsider the claim.  Relevant official service department records include service records that are related to a claimed in-service event, injury, or disease.  38 C.F.R. § 3.156(c)(1)(i).

Increased Ratings

Disability evaluations are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule) found at 38 C.F.R. Part 4.  The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations.  38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1.

When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing.  38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement.  See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011).  Painful motion is an important factor of disability, and 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.  See 38 C.F.R. § 4.59; see also Burton v. Shinseki, 25 Vet. App. 1, 3-5 (2011).  Nevertheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate.  See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria.").

When there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria for that rating.  Otherwise, the lower rating will be assigned.  38 C.F.R. § 4.7.  Separate ratings may be assigned for separate periods of time based on the facts found.  In other words, the evaluations may be staged.  Hart v. Mansfield, 21 Vet. App. 505 (2007).

When the evidence is in approximate balance in the veteran's favor or nearly equal regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the veteran.  38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side, or another is the benefit of the doubt doctrine not for application).

1. Entitlement to service connection for chronic chest pain.

2. Entitlement to service connection for chronic rectal bleeding.

3. Entitlement to service connection for numbness in the jaw.

4. Entitlement to service connection for tinea pedis.

The Veteran seeks entitlement to service connection for chronic chest pain, chronic rectal bleeding, numbness in the jaw due to oral surgery, and tinea pedis.  See April 2025 Notice of Disagreement.

Following a review of the claims file, and as discussed below, the Board finds that the persuasive evidence of record does not show
en banc) (only when the evidence persuasively favors one side, or another is the benefit of the doubt doctrine not for application).

1. Entitlement to service connection for chronic chest pain.

2. Entitlement to service connection for chronic rectal bleeding.

3. Entitlement to service connection for numbness in the jaw.

4. Entitlement to service connection for tinea pedis.

The Veteran seeks entitlement to service connection for chronic chest pain, chronic rectal bleeding, numbness in the jaw due to oral surgery, and tinea pedis.  See April 2025 Notice of Disagreement.

Following a review of the claims file, and as discussed below, the Board finds that the persuasive evidence of record does not show a diagnosis of a chest, rectal, jaw, or skin disability or pain that results in functional impairment of earning capacity during or near the period on appeal.

Turning to the evidence of record, during the Veteran's VA skin examination in October 2024, the examiner indicated that the Veteran did not have a current skin condition.  The Veteran reported that his tinea pedis onset in 2020.  He further reported that his current symptoms include intermittent itching, fissuring, and pain between his toes.  The VA examiner remarked that, on the day of the examination, there was insufficient objective evidence to warrant a diagnosis.

During his VA rectum examination in October 2024, the examiner indicated that the Veteran did not have a current diagnosis associated with his claimed condition of chronic rectal bleeding.  The Veteran reported that his condition onset in 2023 and he currently experiences intermittent rectal bleeding.  The VA examiner indicated that the Veteran declined examination of the rectal area but denied any external hemorrhoids or abnormalities.  The examiner further remarked that, on the day of examination, there was insufficient objective evidence to warrant a diagnosis.

During a VA temporomandibular disorder examination in October 2024, the examiner indicated that the Veteran did not currently have, and has never had, a temporomandibular joint condition.  The Veteran reported an onset of jaw numbness after having a cavity filled in 2023.  He further reported current symptoms of numbness and sensitivity to cold foods on the left side of his jaw.  The examiner remarked that, on the day of examination, there was insufficient objective evidence to warrant a diagnosis.

During a chest X-ray in October 2024, the Veteran's lungs were clear without acute consolidation or effusion.  No pneumothorax was demonstrated and the Veteran's cardiomediastinal silhouette size was within normal limits.  The Board notes that the Veteran separately filed for entitlement to service connection for shortness of breath, and an October 2024 VA respiratory examination documented no current respiratory diagnosis.

An August 2024 Self-Assessment, associated with the Veteran's Separation Health Assessment, documents the Veteran's reports of frequent bleeding in the rectum, occasional chest pains when engaging in physical training, such as running, occasional pounding of the heart, athlete's foot, and possible nerve damage in his left lower jaw due to a cavity repair.  During his Separation Health Assessment in October 2024, clinical evaluation of the Veteran's head, face, neck, and scalp; mouth and throat; heart; lungs and chest; skin, lymphatics; anus and rectum; and dental were all documented as normal.  The VA examiner further noted that there was no objective evidence for diagnosis of jaw numbness, tinea pedis, shortness of breath or chronic chest pain, and chronic rectal bleeding.

Upon further review of the Veteran's service treatment records, a March 2024 record documents no chest pain.  A February 2024 service treatment record demonstrates that the Veteran's skin was warm and no rashes were noted.  A November 2023 service treatment record indicates that the Veteran's temporomandibular joint was within normal limits.

The Veteran's VA treatment records do not provide any additional information.

The Board notes that the Veteran has asserted that he has chest pain, rectal bleeding, numbness in his jaw, and tinea pedis.  The Board acknowledges the Veteran's assertions; however, the Veteran has not shown that he has the medical training, experience, or expertise to be competent to diagnose medical conditions.  "Competent medical evidence" is evidence that is provided by a person qualified through education, training, or experience to offer medical diagnoses, statements, or opinions.  38 C.F.R. § 3.159(a)(1); see also Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011).  Rather, the medical evidence of record does not document diagnoses for the claimed conditions by a medical provider during or near the period on appeal.

The Board is cognizant that for musculoskeletal disabilities pain alone which causes
 acknowledges the Veteran's assertions; however, the Veteran has not shown that he has the medical training, experience, or expertise to be competent to diagnose medical conditions.  "Competent medical evidence" is evidence that is provided by a person qualified through education, training, or experience to offer medical diagnoses, statements, or opinions.  38 C.F.R. § 3.159(a)(1); see also Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011).  Rather, the medical evidence of record does not document diagnoses for the claimed conditions by a medical provider during or near the period on appeal.

The Board is cognizant that for musculoskeletal disabilities pain alone which causes functional impairment can be a disability, even if there is no identified diagnosis.  In Saunders v. Wilkie, the United States Court of Appeals for the Federal Circuit (Federal Circuit) held that pain can constitute a disability under 38 U.S.C. § 1110.  Saunders, 886 F.3d at 1368.  However, the Federal Circuit did not hold that a veteran could demonstrate service connection simply by asserting subjective pain.  Rather, to establish a disability, a veteran will need to show that his pain reaches the level of functional impairment of earning capacity.  Id. at 1367-68.

In Wait v. Wilkie, the Court of Appeals for Veterans Claims (Court) clarified that, under Saunders v. Wilkie, there must be competent evidence demonstrating that the claimed symptoms result in functional impairment that affects the veteran's earning capacity.  In determining whether a veteran's impairment rises to a level affecting earning capacity, VA can consider manifestations of similar severity, frequency, and duration as those VA has determined by regulation would cause impaired earning capacity in an average person.  Wait v. Wilkie, 33 Vet. App. 8, 17 (2020).

In this case, the Board finds that the Veteran has not presented any competent evidence that his chest pain results in functional impairment that in fact affects his earning capacity.  Although the Veteran has reported chest pain while engaging in physical activity, the Board finds that this did not result in functional loss.  In fact, no treatment records associated with the Veteran's claims file indicate that he was receiving treatment for his chest pain during the period on appeal.  As such, there is no competent medical evidence to indicate any functional impairment.

In sum, the Veteran has not presented, identified, or alluded to the existence of any medical evidence of a current chest, rectal, jaw, or skin disability.  Here, no underlying disabilities have been clinically diagnosed during or near the period on appeal.  See McClain, 21 Vet. App. at 321; see also Romanowsky, 26 Vet. App. at 294.

Lastly, the Board acknowledges that service treatment records were received and associated with the Veteran's claims file in September 2025 following the April 2025 rating decision on appeal.  As noted above, if VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, VA will reconsider the claim.  The Federal Circuit has provided that the term "relevant official service department record" means "noncumulative and pertinent to the matter at issue in the case."  See Kisor v. Shulkin, 869 F.3d 1360 (Fed. Cir. 2017).  In this case, however, the Board finds that the newly associated service treatment records are not relevant.  Although the records include the Veteran's separation report of medical history, the Veteran's reported symptoms regarding the claimed conditions documented therein are similar to the reported symptoms documented in his August 2024 Self-Assessment.  The newly associated service department records do not otherwise document diagnosis of or treatment for the Veteran's claimed conditions.  As such, the Board finds such records cumulative, and reconsideration based on receipt of relevant service department records under 38 C.F.R. § 3.156(c) is not warranted.

Accordingly, the Veteran's claims for entitlement to service connection for chronic chest pain, chronic rectal bleeding, numbness in the jaw, and tinea pedis must be denied.  As the evidence of record persuasively weighs against the Veteran's claim, the benefit-of-the-doubt rule does not apply.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see Lynch, 21 F.4th at 776.

5. Entitlement to an initial compensable disability rating for left hip limitation of extension.

6. Entitlement to an initial compensable disability rating for left hip thigh impairment.

The Veteran seeks initial compensable disability ratings for his service-connected left hip acetab
 Veteran's claims for entitlement to service connection for chronic chest pain, chronic rectal bleeding, numbness in the jaw, and tinea pedis must be denied.  As the evidence of record persuasively weighs against the Veteran's claim, the benefit-of-the-doubt rule does not apply.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see Lynch, 21 F.4th at 776.

5. Entitlement to an initial compensable disability rating for left hip limitation of extension.

6. Entitlement to an initial compensable disability rating for left hip thigh impairment.

The Veteran seeks initial compensable disability ratings for his service-connected left hip acetabular chondromalacia for limitation of extension and thigh impairment.  See April 2025 Notice of Disagreement.

Effective February 12, 2025, the Veteran's service-connected left hip acetabular chondromalacia is rated as 10 percent disabling under Diagnostic Code (DC) 5252 (limitation of flexion), noncompensable under Diagnostic Code (DC) 5251 (limitation of extension), and noncompensable under Diagnostic Code (DC) 5253 (limitation of abduction/adduction).  The Board notes that the Veteran did not appeal the 10 percent evaluation for limitation of flexion assigned under DC 5252.

Under DC 5251, a maximum 10 percent disability rating is warranted for limitation of extension of the thigh to 5 degrees.  38 C.F.R. § 4.71a, DC 5251.

Under DC 5253, a 10 percent disability rating is warranted for limitation of thigh rotation with the inability to toe-out in excess of 15 degrees, or for limitation of adduction with the inability to cross the legs.  38 C.F.R. § 4.71a, DC 5253.  A maximum 20 percent disability rating is warranted for limitation of abduction where motion is lost beyond 10 degrees.  Id.

Normal ranges of motion of the hip include hip abduction from zero to 45 degrees.  38 C.F.R. § 4.71, Plate II.

VA can assign separate ratings under the hip diagnostic codes for limitation of extension, flexion, and abduction, adduction, or rotation without violating the rule against "pyramiding."  This rule prohibits VA from paying compensation twice (or more) for the same symptoms or functional impairment.  38 C.F.R. § 4.14.

However, only one compensable rating can be assigned where there is painful but otherwise noncompensable limitation of movement.  38 C.F.R. § 4.59 does not permit separate compensable ratings for each joint movement that results in painful motion.  Rather, it provides that painful motion warrants at least the minimum compensable evaluation for the joint.  See Mitchell, 25 Vet. App. at 32; see also Burton, 25 Vet. App. at 1.  In other words, separate compensable ratings based solely on painful motion are precluded by the rule against pyramiding.

Following a review of the claims file, and as discussed below, the Board finds that the Veteran's left hip disability did not manifest in limitation of extension of the thigh to 5 degrees, and did not manifest in limitation of rotation and the inability to toe-out more than 15 degrees, in limitation of abduction and motion lost beyond 10 degrees, or in limitation of adduction and the inability to cross the legs.

Turning to the evidence of record, during his VA hip examination in October 2024, the Veteran was diagnosed with left hip acetabular chondromalacia and right hip strain.  The Veteran reported current symptoms of decreased range of motion and intermittent pain in both of his hips, and that he takes ibuprofen as needed.  He further reported no flare-ups or functional loss.  Upon examination of the Veteran's left hip, the Veteran was capable of flexion to 70 degrees, extension to 20 degrees, abduction to 25 degrees, adduction to 20 degrees, external rotation to 50 degrees, and internal rotation to 30 degrees for both active and passive motion.  The examiner noted pain with all ranges of motion.  The VA examiner further noted that limitation in adduction did not prevent the Veteran from crossing his legs and indicated that there was evidence of pain with active and passive motion that did not result in or cause functional loss.  There was no evidence of crepitus or localized tenderness.  The Veteran was capable of repetitive use testing without additional loss in range of motion and procured evidence did not suggest that the Veteran's functional ability would be significantly limited with repeated use over time.  The VA examiner further noted no muscle atrophy,
 25 degrees, adduction to 20 degrees, external rotation to 50 degrees, and internal rotation to 30 degrees for both active and passive motion.  The examiner noted pain with all ranges of motion.  The VA examiner further noted that limitation in adduction did not prevent the Veteran from crossing his legs and indicated that there was evidence of pain with active and passive motion that did not result in or cause functional loss.  There was no evidence of crepitus or localized tenderness.  The Veteran was capable of repetitive use testing without additional loss in range of motion and procured evidence did not suggest that the Veteran's functional ability would be significantly limited with repeated use over time.  The VA examiner further noted no muscle atrophy, ankylosis, femur or flail hip joint impairment, or functional impact.

After a thorough review of the record, the Board first finds that a compensable rating for the Veteran's left hip limitation of extension is not warranted under DC 5251.  Notably, under DC 5251, a 10 percent disability rating requires limitation of extension of the thigh to 5 degrees.  The evidence of record during the appeal period, however, does not demonstrate such limitation.  Rather, the Veteran's left hip extension has been limited, at worst, to 20 degrees as shown on the October 2024 VA examination report.  As such, the most persuasive evidence of record weighs against the assignment of a compensable rating for the Veteran's left hip acetabular chondromalacia under DC 5251.

The Board additionally finds that a compensable rating for left hip impairment of the thigh is not warranted under DC 5253.  Pursuant to DC 5253, a 10 percent disability rating requires limitation of rotation and the inability to toe-out more than 15 degrees, limitation of abduction and motion lost beyond 10 degrees, or limitation of adduction and the inability to cross the legs.  In this case, however, the evidence of record does not show such limitations during or near the period on appeal.  Indeed, during the Veteran's October 2024 VA examination, he was capable of abduction to 25 degrees, adduction to 20 degrees, external rotation to 50 degrees, and internal rotation to 30 degrees and his limitation in adduction did not prevent him from crossing his legs.  Thus, the persuasive evidence of record also weighs against the assignment of a compensable rating for the Veteran's left hip disability under DC 5253.

The Board acknowledges that the October 2024 VA examination documents pain on extension, abduction, adduction, external rotation, and internal rotation on both active and passive motion.  The Veteran's painful motion of the left hip, however, is already compensated by the 10 percent disability rating assigned under DC 5252.  See April 2025 Rating Decision; see also 38 C.F.R. § 4.71a, DC 5252.  As noted above, separate compensable ratings based solely on painful motion are precluded by the rule against pyramiding.  Therefore, compensable evaluations under DC 5251 or DC 5253 are not warranted based on the Veteran's painful motion.

The Board has also considered whether higher or separate ratings could be assigned under any other diagnostic codes pertaining to the hip and thigh.  However, as the evidence does not demonstrate a flail hip joint, impairment of the femur manifested by fracture of the shaft or anatomical neck, or malunion of the femur, higher or separate ratings under Diagnostic Codes 5254 or 5255 are not warranted here.

With respect to Diagnostic Code 5250, the Board notes that there is neither objective nor subjective evidence that the Veteran's left hip is functionally ankylosed.  See Chavis v. McDonough, 34 Vet. App. 1 (2021).  There was no evidence of ankylosis in the October 2024 VA examination, nor did the Veteran's symptoms equate to the functional equivalent of ankylosis.

The Board further acknowledges that VA is required "to discount beneficial medication effects when relevant rating criteria do not specifically contemplate medication use."  See Ingram v. Collins, 38 Vet. App. 130 (2025).  With regard to Ingram, although the October 2024 VA examiner noted the Veteran's report that he takes ibuprofen as needed, there is no indication that the examiner considered the ameliorative effects of medication in rendering the findings in the examination report, nor did the Veteran indicate he was on any pain medication at the time of the examination.  As such, the Board concludes that the examination of record is adequate to support a decision.

Accordingly, the Board finds that entitlement to initial compensable ratings for left hip limitation of extension and left hip impairment of the thigh must be denied.  As
 rating criteria do not specifically contemplate medication use."  See Ingram v. Collins, 38 Vet. App. 130 (2025).  With regard to Ingram, although the October 2024 VA examiner noted the Veteran's report that he takes ibuprofen as needed, there is no indication that the examiner considered the ameliorative effects of medication in rendering the findings in the examination report, nor did the Veteran indicate he was on any pain medication at the time of the examination.  As such, the Board concludes that the examination of record is adequate to support a decision.

Accordingly, the Board finds that entitlement to initial compensable ratings for left hip limitation of extension and left hip impairment of the thigh must be denied.  As the evidence of record persuasively weighs against the Veteran's claim, the benefit-of-the-doubt rule does not apply.  38 U.S.C. § 5107(b); Lynch, 21 F.4th at 776.   

 

H.M. WALKER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Caitlin B.

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.