MIGRAINE

DANETTE MINCEY · 2026 · Case ID: A26037012

MIXED

Summary

The veteran, who served in the U.S. Army from October 2013 to February 2018, appeals a May 2021 rating decision that granted service connection for traumatic brain injury (TBI) with migraine headaches, lumbosacral strain, and bilateral snapping hip syndrome, but denied claims for cervical strain, left knee strain, and left ankle deltoid ligament sprain. The veteran also sought an increased rating for lumbosacral strain and sought service connection for right and left snapping hip syndrome with limitations and impairments, as well as for right and left sciatic radiculopathy. The Board reviewed evidence of record up to the May 2021 decision, excluding evidence submitted after the hearing or more than 90 days following it. The veteran's initial claims in February 2019 for various conditions were denied in May 2019 due to lack of service connection or failure to show clinical diagnosis. Subsequent supplemental claims in February 2020 and May 2020 were also denied as the evidence was not new and relevant. The Board found that the criteria for withdrawal of entitlement to a compensable rating for TBI with migraine headaches were met. Service connection for cervical strain, left knee strain, and left ankle deltoid ligament sprain were denied due to lack of service connection. The claim for an increased rating for lumbosacral strain was denied as the veteran did not meet the criteria for a higher evaluation. However, service connection for right and left snapping hip syndrome, with limitations and impairments, was granted. The claims for right and left sciatic radiculopathy were denied at the 10% level.

Rationale

No characteristic prostrating attacks found; No competent evidence of service connection for prostrating migraine headaches

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

8100

Docket No.

210707-170588

Full Decision Text

Citation Nr: A26037012
Decision Date: 04/21/26 Archive Date: 04/21/26

DOCKET NO. 210707-170588
DATE: April 21, 2026

ORDER

Entitlement to a compensable rating for traumatic brain injury with migraine headaches has been dismissed.

Entitlement to service connection for cervical strain is denied.

Service connection for left knee strain is denied.

Entitlement to service connection for left ankle deltoid ligament sprain is denied.

Entitlement to an initial rating in excess of 10 percent for lumbosacral strain is denied.

Entitlement to an initial compensable rating for right side snapping hip syndrome is granted.

Entitlement to an initial compensable rating for left side snapping hip syndrome is granted.

Entitlement to service connection for right side snapping hip syndrome, with limitation of extension, is granted.

Entitlement to service connection for left side snapping hip syndrome, with limitation of extension, is granted.

Entitlement to service connection for right side snapping hip syndrome, with impairment, is granted.

Entitlement to service connection for left side snapping hip syndrome, with impairment, is granted.

Entitlement to an initial rating in excess of 10 percent for right lower extremity sciatic radiculopathy is denied.

Entitlement to an initial rating in excess of 10 percent for left lower extremity sciatic radiculopathy is denied.

Entitlement to an initial compensable rating for traumatic brain injury (TBI) is denied.

Entitlement to an initial compensable rating for migraine headaches is denied.

FINDINGS OF FACT

1. The Veteran has a current diagnosis of a cervical strain but there is no competent evidence showing the Veteran's claimed cervical strain is etiologically related to his military service.

2. There is no competent evidence showing the Veteran's left knee strain is etiologically related to his military service.

3. There is no competent evidence showing the Veteran's left ankle deltoid ligament sprain is etiologically related to his military service.

4. For the entire period on appeal, the Veteran's lumbar spine did not more nearly approximate forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis.

5. For the entire period on appeal, the Veteran had objective evidence of localized tenderness or pain on palpitation of the joint or associated soft tissue of the right hip.

6. For the entire period on appeal, the Veteran had objective evidence of localized tenderness or pain on palpitation of the joint or associated soft tissue of the left hip.

7. For the entire period on appeal, the Veteran had right hip extension, at worst to 20 degrees.

8. For the entire period on appeal, the Veteran had left hip extension, at worst to 20 degrees.

9. For the entire period on appeal, the Veteran had right hip abduction, at worst to 35 degrees.

10. For the entire period on appeal, the Veteran had left hip abduction, at worst to 35 degrees.

11. For the entire period on appeal, the Veteran's right lower extremity sciatic radiculopathy more nearly approximated, at most, "mild" incomplete paralysis of the sciatic nerve.

12. For the entire period on appeal, the Veteran's left lower extremity sciatic radiculopathy more nearly approximated, at most, "mild" incomplete paralysis of the sciatic nerve.

13. For the entire period on appeal, the Veteran's traumatic brain injury (TBI) has as no residuals.

14. For the entire period on appeal, the Veteran's migraine headaches have had no characteristic prostrating attacks.

CONCLUSIONS OF LAW

1. The criteria for withdrawal of entitlement to a compensable rating for traumatic brain injury with migraine headaches by the appellant through his authorized representative have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

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

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

4. The criteria for entitlement to service connection for left ankle deltoid ligament sprain
38 U.S.C. § 7105; 38 C.F.R. § 20.205.

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

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

4. The criteria for entitlement to service connection for left ankle deltoid ligament sprain have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

5. The criteria for entitlement to a rating in excess of 10 percent for lumbosacral strain have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.97, Diagnostic Code 5237.

6. The criteria for entitlement to a compensable rating for right side snapping hip syndrome have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.97, Diagnostic Code 5252.

7. The criteria for entitlement to a compensable rating for left side snapping hip syndrome have been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.97, Diagnostic Code 5252.

8. The criteria for entitlement to service connection for right side snapping hip syndrome, with limitation of extension, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304; Diagnostic Code 5251.

9. The criteria for entitlement to service connection for left side snapping hip syndrome, with limitation of extension, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304; Diagnostic Code 5251.

10. The criteria for entitlement to service connection for right side snapping hip syndrome, with impairment, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304; Diagnostic Code 5253.

11. The criteria for entitlement to service connection for left side snapping hip syndrome, with impairment, have been met 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304; Diagnostic Code 5253.

12. The criteria for entitlement to a rating in excess of 10 percent for right lower extremity sciatic radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.97, Diagnostic Code 8520.

13. The criteria for entitlement to a rating in excess of 10 percent for left lower extremity sciatic radiculopathy have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59,
4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.97, Diagnostic Code 8520.

14. The criteria for entitlement to a compensable rating for traumatic brain injury (TBI) have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.97, Diagnostic Code 8045.

15. The criteria for entitlement to a compensable rating for migraine headaches have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.97, Diagnostic Code 8100.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from October 2013 to February 2018.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2021 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO), which granted service-connection for traumatic brain injury with migraine headaches, lumbosacral strain, bilateral snapping hip syndrome and bilateral lower extremity radiculopathy but denied the claimed cervical strain, left knee strain and left ankle deltoid ligament sprain.

In the July 7, 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on October 28, 2024; a transcript is enclosed. Therefore, the Board may only consider the evidence of record at the time of the May 2021 agency of original jurisdiction (AOJ/RO) decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 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.

By way of procedural background, the Veteran initially submitted a claim for service connection in February 2019, which included claims for bilateral ankle condition, bilateral knee condition, bilateral hip condition, back condition, neck condition and TBI. A rating decision was issued in May 2019, which deferred the claims pending medical opinions. A rating decision was issued in May 2019, which denied the claims of back condition, left ankle condition, and neck condition as they neither occurred in nor were caused by service. The May 2019 rating decision denied the left and right hip claims as the medical evidence of record failed to show the disabilities had been clinically diagnosed.

In February 2020, the Veteran sought a supplemental claim seeking service connection for the claimed disorders. A rating decision was issued in March 2020, which confirmed and continued the previous denials as the evidence submitted was not new and relevant.

The Veteran sought a supplemental claim in May 2020 for the claimed conditions
decision was issued in May 2019, which deferred the claims pending medical opinions. A rating decision was issued in May 2019, which denied the claims of back condition, left ankle condition, and neck condition as they neither occurred in nor were caused by service. The May 2019 rating decision denied the left and right hip claims as the medical evidence of record failed to show the disabilities had been clinically diagnosed.

The Veteran sought a supplemental claim in May 2020 for the claimed conditions. A rating decision was issued in July 2020 which confirmed and continued the previous denials as the evidence submitted was not new and relevant.

The Veteran sought a higher level review in September 2020 seeking service connection for the claimed conditions. A rating decision was issued in January 2021 which identified a duty to assist error and deferred for VA examinations and/or medical opinions. Because new development was sought, the claims were considered as a supplemental claim. A rating decision was issued in May 2021, which granted service connection for lumbosacral strain and assigned a 10 percent rating; granted noncompensable service connection for bilateral snapping hip syndrome; noncompensable traumatic brain injury with migraine headaches; and granted service connection for bilateral lower extremity radiculopathy secondary to lumbosacral strain and assigned a 10 percent rating to each. The May 2021 rating decision denied service connection for service strain, left ankle deltoid ligament sprain and left knee strain. The rating decision found new and relevant evidence had been received for each claimed condition and reconsidered each claim. Under the AMA, favorable findings made by the RO are binding on the Board as there is no evidence to the contrary. 38?C.F.R. §?3.104(c). As such, the Board will accept each claim as reconsidered and will not revisit the same.

The Veteran timely submitted a notice of disagreement (10182/NOD) in July 2021, seeking review of the claim. As such, the claims for entitlement for a compensable rating for traumatic brain injury with migraine headaches; entitlement to service connection for cervical strain; entitlement to a rating in excess of 10 percent for lumbosacral strain; entitlement to a compensable rating for right side snapping hip syndrome; entitlement to a compensable rating for left side snapping hip syndrome; entitlement to service connection for left knee strain; entitlement to service connection for left ankle deltoid ligament sprain; entitlement to a rating in excess of 10 percent for right lower extremity sciatic radiculopathy; and entitlement to a rating in excess of 10 percent for left lower extremity sciatic radiculopathy are properly before the Board for adjudication.

The Board notes that the undersigned Veterans Law Judge (VLJ) is not the VLJ who conducted the Veteran's October 2024 Board hearing. However, under the modernized review system (AMA), the VLJ who conducted a Board hearing is not required to participate in the decision on that claim, and VA is not prohibited from allowing a VLJ other than the one who conducted a hearing to decide an appeal. As such, there is no bar to proceeding with a decision in the appeal by the undersigned VLJ at this time. Frantzis v. McDonough, No. 20-5236, 2022 U.S. App. Vet. Claims LEXIS 935 (Vet. App. June 21, 2022).

Service Connection Laws and Regulations

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; 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). Only chronic diseases listed under 38 C.F.R. § 3.309 (a) are entitled to the presumptive service connection provisions of 38 C.F.R. § 3.303 (b). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden
service. 38 C.F.R. § 3.303 (d). Only chronic diseases listed under 38 C.F.R. § 3.309 (a) are entitled to the presumptive service connection provisions of 38 C.F.R. § 3.303 (b). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

The U.S. Court of Appeals for Veterans Claims (Court) has held that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. In the absence of proof of a present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also Rabideau v. Derwinski, 2 Vet. App. 141, 143-44 (1992).

Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disability. See 38 C.F.R. § 3.310 (a). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. See 38 C.F.R. § 3.310 (a); Harder v. Brown, 5 Vet. App. 183, 187 (1993). The controlling regulation has been interpreted to permit a grant of service connection not only for disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995).

In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify").

Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the claims file. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, as well as a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382(1998); see also Claiborne v. Nicholson, 19 Vet. App. 181, 186 (2005) (rejecting medical opinions that did not indicate whether the physicians actually examined the veteran, did not provide the extent of any examination, and did not provide any supporting clinical data). The Court has held that a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998).

A significant factor to be considered for any opinion is the accuracy of the factual predicate, regardless of whether the information supporting the opinion is obtained by review of medical records or lay reports of injury, symptoms and/or treatment, including by a veteran. See Harris v. West,
. 181, 186 (2005) (rejecting medical opinions that did not indicate whether the physicians actually examined the veteran, did not provide the extent of any examination, and did not provide any supporting clinical data). The Court has held that a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998).

A significant factor to be considered for any opinion is the accuracy of the factual predicate, regardless of whether the information supporting the opinion is obtained by review of medical records or lay reports of injury, symptoms and/or treatment, including by a veteran. See Harris v. West, 203 F.3d 1347, 1350-51 (Fed. Cir. 2000) (examiner's opinion based on accurate lay history deemed competent medical evidence in support of the claim); Kowalski v. Nicholson, 19 Vet. App. 171, 177 (2005) (holding that a medical opinion cannot be disregarded solely on the rationale that the medical opinion was based on history given by the veteran); Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual basis).

When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in approximate balance, with the veteran prevailing in either event, or whether the weight of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102.

Entitlement to service connection for cervical strain.

The Veteran asserts that he has a cervical strain that is the result of his military service and service connection is warranted. Specifically, the Veteran asserts that "due to infantryman parachutist injured on many jumps and landings" and "TBI due to in service head injury" service connection is warranted. See February 2019 claim for benefits.

A review of the Veteran's service treatment records (STRs) are silent for any complaints, diagnosis or treatment for his neck or upper spine. At the Veteran's December 2017 report of medical history at separation, the Veteran reported "no" recurrent back pain or any back problems; numbness or tingling; or swollen or painful joint(s). At the Veteran's December 2017 separation examination, the Veteran was noted to have "no health concerns to discuss with the provider about at this time. SM (Service member) is currently in good health. Patient is NOT currently on a profile/limited duty chit." The examiner noted the Veteran had no back pain and "normal" spine and neurologic examinations.

During a post-service VA primary care April 2019 nursing treatment, the Veteran reported pain in mid-back but did not report a problem with his neck or cervical spine. In a May 2019 letter to the Veteran, his primary care provider noted, "The x-rays of your neck, back, hips, left ankle and left knee were read as normal." See Oklahoma VAMC.

The Veteran was afforded a May 2019 general medical VA examination. The VA examiner noted: "The Veteran reports that he first had neck issues in 2014 after a rough landing. He states that he did not seek treatment. He states he was seen for his neck and back complaints last year in Nevada. He was given Flexeril and was prescribed 2 days of rest. He has not followed up again. The neck pain is not constant. He has pain first thing in the morning. If he turns his head quickly this sometimes causes neck pain. The neck sometimes pops. He does not take any medication for his neck pain."

The Veteran was afforded a May 2019 VA neck examination. The VA examiner noted a diagnosis of neck strain. The Veteran reported that he first had neck issues in 2014 after a rough landing but did not seek treatment. The Veteran reported he was seen for his neck and back complaints last year in Nevada and was given Flexeril and prescribed 2 days of rest but did not follow up again. The neck pain was not constant; and he had pain first thing in the morning. The Veteran reported that he turned his head quickly, sometimes it caused neck pain. The neck sometimes popped. He did not take any medication for his neck pain. The examination of the Veteran's neck was normal and the VA examiner found no functional impact.

In a separate May 2019 medical opinion, the VA examiner opined that is was less likely than not that neck strain is related to a specific exposure event experienced by the veteran during service in southwest Asia. The VA examiner reasoned: "Neck strain is a distinct condition with
back complaints last year in Nevada and was given Flexeril and prescribed 2 days of rest but did not follow up again. The neck pain was not constant; and he had pain first thing in the morning. The Veteran reported that he turned his head quickly, sometimes it caused neck pain. The neck sometimes popped. He did not take any medication for his neck pain. The examination of the Veteran's neck was normal and the VA examiner found no functional impact.

In a separate May 2019 medical opinion, the VA examiner opined that is was less likely than not that neck strain is related to a specific exposure event experienced by the veteran during service in southwest Asia. The VA examiner reasoned: "Neck strain is a distinct condition with clear and specific etiologies and diagnosis. This condition has not been associated with the illnesses or exposures described in Veteran's returning from the Gulf War in medical research published in peer-reviewed medical journals."

In a May 2019 medical opinion regarding direct service connection, the VA examiner opined, "It is less likely than not that the veterans claimed neck condition was incurred in or caused by his parachutist badge. There is no competent medical evidence of a cervical spine condition while the veteran was on active duty. There was no complaint regarding his neck when he was being treated for other orthopedic problems, specifically his right ankle. There was no indication at the time of the report of medical history on December 13, 2017 that he had a neck condition. Lacking such documentation, a nexus between his parachute activities and his current neck symptoms is not established."

During an October 2020 primary care treatment, the Veteran reported chronic left middle back pain, but a nontender cervical thoracic lumbar spine with good side-to-side and bending over movements. See Oklahoma VAMC.

The Veteran was afforded a March 2021 VA examination. The VA examiner noted a diagnosis of cervical strain. The Veteran reported onset of neck pain in 2014 following a rough landing during training jump. The Veteran reported he had neck pain following a rough landing after training jump in 2014; reported he did not seek treatment for this in the military. Veteran also reported being in an MVA [motor vehicle accident] in 2015, in which he was stationary and was T-boned by car traveling approximately 40mph and his car was totaled. Veteran stated he did not seek treatment following this accident. On examination, the VA examiner noted the Veteran had normal range of motion but had guarding but no functional impact.

In a separate March 2021 medical opinion, the VA examiner opined that the claimed neck condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The VA examiner reasoned, "No chronic diagnosis is made. A duty to assist error has been identified during the Higher Level Review for cervical strain. P1052, 12/2017: ETS/separation physical review of symptoms (ROS) was negative for claimed condition, physical examination (PE) was negative for objective findings, FROM without pain all joints, spine, and neck. pp1144-1146 separation physical form, Section 77: 'Summary of defects: provider notes NONE.' Objective exam is normal. Symptoms are subjective only. A Nexus has not been established."

During the Veteran's October 2024 Board hearing, the Veteran did not testify directly about his neck, but noted that if he did not keep his "neck tucked properly, then your head can whip back," during a parachute landing, causing a sensation like whiplash. The Veteran testified: "If I look up for too long, I can feel tension in the back of my neck." The Veteran testified that his neck still bothers him.

In November 2024, the Veteran provided a private medical opinion from J.H., M.D. The private provider noted that the Veteran's "Neck strain should be myofascial pain syndrome and degenerative disc disease first developed neck pain in 2014 on a hard parachute landing. Because of the military mentality he simply persisted without seeking care only to have periodical reinjury." The private provider also stated, "It is well understood that when a person strikes their head hard enough to lose consciousness that their cervical spine is strained as well."

The November 2024 private provider opined: "The claimant's neck pain is chronic myofascial strain and early degenerative disc disease. Advanced imaging (MRI) would show early degeneration that started with disc annulus microtrauma and progressed from there. He has as a residual functional loss of range of motion and enough pain to be limiting especially with repetitive use as agreed by the DBQ examiners. DC5242 degenerative disc disease is the best code for his rating. The minimum service connected rating is 10% which is reasonable in his case although quite conservative."

The private provider
, "It is well understood that when a person strikes their head hard enough to lose consciousness that their cervical spine is strained as well."

The private provider noted, "My opinions are based on review of the records provided, my personal training and my 30 years of experience as an Orthopedic Surgeon practicing general Orthopedics. My opinions are based on the principle of a reasonable degree of medical certainty and, when causation nexus is in question, the principle of as likely as not." However, the private provider did not provide any medical authority, other than his own upon which he relied. The private examiner did not examine the Veteran, yet he has provided a report that mimics an examination report under the guise of a medical opinion. The private provider did not provide any medical treatise, study or other peer reviewed work. As such, the Board finds that the private provider's opinion is inadequate as he did not provide a clear rationale with a sufficient explanation. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302 (2008); see also Miller v. West, 11 Vet. App. 345, 348 (1998) (a bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record).

Additionally, the private examiner appears to be making a determination regarding the description of the Veteran's symptoms to determine the assignment of diagnostic codes to determine service connection in order to meet the rating criteria. The private provider assumes arthritis when there is no evidence of the same. The opinion is, therefore, tainted for attempting to make factual findings and legal determinations. In this regard, it is important to stress that any examiner's opinion must be confined to medical ones, because the ultimate determination as to what disability rating to assign is a legal one. Such a legal determination is solely within the Board's adjudicative authority, rather than an examiner's. See 38 C.F.R. § 4.2 ("It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history"); Withers v. Wilkie, 30 Vet. App. 139, 146 (2018); Floore v. Shinseki, 26 Vet. App. 376, 381 (2013). Because the Board cannot otherwise rely on a medical expert's opinion on a legal matter, the probative value of this private opinion has been weighed as only one more piece of evidence to be considered in reaching the ultimate legal determination. See Sizemore v. Principi, 18 Vet. App. 264, 275 (2004); Colayong v. West, 12 Vet. App. 524, 534-35 (1999) (remanding the claim for a new independent medical examination because the previous examination was obtained by "tainted process"); Bielby v. Brown, 7 Vet. App. 260, 268-69 (1994).

The Veteran's representative provided a January 2025 argument in which the representative repeated the Board hearing and repeated the November 2024 private medical opinion. The January 2025 argument included a list of "service medical records and medicals after discharge." The STRs include in the list reference to the Veteran's already service-connected right knee and ankle that are not before the Board. There is a September 2016 note the Veteran had left knee crepitus but the Veteran was not diagnosed with a left knee disorder. Likewise, the provided STRs included mental health and optometry citations which are not before the Board. The argument included a May 2018 emergency room visit for which the Veteran sought treatment for his back among other records that have been discussed here.

Additionally, the Veteran provided articles of general evidence including "Static Line Parachuting Injuries Seen by the Airborne Battalion Provider" and "Iliotibial Band (IT Band) Syndrome." As the name implies, the former article is a primer for medical providers of airborne soldiers. In the Veteran's argument, the Veteran's representative attempts to opine that "back, high impact landings cause back injuries, shoulders, overuse to shoulder joints among paratroopers, head and neck, backwards falls on landing or jarring impact
health and optometry citations which are not before the Board. The argument included a May 2018 emergency room visit for which the Veteran sought treatment for his back among other records that have been discussed here.

Additionally, the Veteran provided articles of general evidence including "Static Line Parachuting Injuries Seen by the Airborne Battalion Provider" and "Iliotibial Band (IT Band) Syndrome." As the name implies, the former article is a primer for medical providers of airborne soldiers. In the Veteran's argument, the Veteran's representative attempts to opine that "back, high impact landings cause back injuries, shoulders, overuse to shoulder joints among paratroopers, head and neck, backwards falls on landing or jarring impact when the head whips back causes injury to the head and neck." However, the Veteran had not provided a medical opinion of the same nor has the Veteran provided an opinion linking the provided article with this specific Veteran and his particular experience. Without a medical opinion, the Board finds the provided article to be overly broad and to lack probative value to this particular Veteran.

The Veteran's representative argued that "VA ignored 38 C.F.R. 3,324" and "the rating agency is authorized to apply a 10% percent rating." However, the Veteran's representative misunderstands how 38 C.F.R. § 3.324 is applied. The benefit under 38 C.F.R. § 3.324 is based on the existence solely of noncompensable service-connected disabilities, as the regulation clearly states that the 10 percent evaluation may not be combined with another rating. See Butts v. Brown, 5 Vet. App. 532, 541 (1993). Accordingly, the Board finds there is no entitlement under the law to a 10 percent rating under 38 C.F.R. § 3.324 as the Veteran was service-connected for other compensable disabilities, including tinnitus for which the Veteran was in receipt of a 10 percent rating evaluation. Because the Veteran was in receipt of a compensable rating under the 1945 Schedule for Rating Disabilities, 38 C.F.R. § 3.324 was not, and remains, applicable.

In his argument to the Board, the Veteran's representative states, "Reasons and basis cut and paste boilerplate language that the DeLuca factors have been considered are not adequate." The Veteran's representative makes a statement but provides no argument or explanation as to what the Veteran intends Board to consider. Therefore, the Board is unable to respond.

Returning to the Veteran's claim for service connection for his cervical strain, the Veteran's STRs are silent for any complaints, diagnosis or treatment for his neck or cervical spine. While the Veteran reports that he hurt his neck following a parachute landing, the Veteran did not seek treatment during his military service or after he was separated from service. At his Board hearing, the Veteran testified that he did not seek treatment because of a stigma in his unit to "drink water and move on." However, the Veteran's STRs show he sought treatment for his right ankle in 2013, mental health complaints in 2014, his eyes in 2016 and his right knee in 2016, in addition to the required military medical services. As such, the Board notes the Veteran did not avoid medical treatment entirely due to a "stigma." While the Board acknowledges the Veteran's statements, it is also noted that the Veteran's post-service treatment records are also silent for any complaints, diagnosis or treatment until his May 2019 VA examination even though he sought treatment for his right ankle during service and his back following his military service.

The Board has considered the Veteran's statements regarding his belief that his spine disorder is related to an in-service injury. The Board has also considered the Veteran's statements regarding his belief that his neck disorder is related to his military job as an infantryman parachutist. However, as a lay person, the Veteran does not have the requisite medical knowledge, training, or experience to be able to render a competent medical opinion regarding the etiology of the medically complex disorder of the cervical spine. See Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011). The cervical spine is a medically complex process because of its multiple possible etiologies and requires specialized testing to diagnose (e.g., x-rays and/or MRI). Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007).

The Board acknowledges that the Veteran is competent to describe his symptoms without any specialized knowledge or training. Layno v. Brown, 6 Vet. App. 465; Kahana v. Shinseki, 24 Vet. App. 428, 437 (s2011), Woehlaert v. Nicholson, 21 Vet. App.
v. Shinseki, 24 Vet. App. 428, 437 (2011). The cervical spine is a medically complex process because of its multiple possible etiologies and requires specialized testing to diagnose (e.g., x-rays and/or MRI). Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007).

The Board acknowledges that the Veteran is competent to describe his symptoms without any specialized knowledge or training. Layno v. Brown, 6 Vet. App. 465; Kahana v. Shinseki, 24 Vet. App. 428, 437 (s2011), Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). Furthermore, the Board finds that the Veteran is competent to report symptoms and neck pain that the Veteran experienced, as it would be readily apparent. See Horowitz v. Brown, 5 Vet. App. 217, 221-22 (1993) (lay statements are competent on in-service and post-service symptoms).

While the Veteran is competent to report his service experiences and his sincere belief his cervical spine disorder is related to his military service, the Veteran's contentions are outweighed by the opinion of the VA examiners who reviewed his service records, recognized his back disorder, but still concluded that the Veteran's cervical spine disorder was not related to his military service. As the weight of the medical opinions addressing the etiology of the Veteran's current cervical spine disorder is negative, there is no benefit of the doubt that could be resolved in the Veteran's favor. See 38 U.S.C. § 5107 ; 38 C.F.R. § 3.102.

For these reasons, and based on the evidence of record, the Board finds that the weight of the competent, credible, and probative evidence is against a finding of a relationship between the Veteran's cervical spine disorder and service. Therefore, the claim for service connection for a cervical strain is denied.

Entitlement to service connection for left knee strain.

The Veteran asserts that his left knee strain is the result of his military service and service connection is warranted. Specifically, the Veteran asserts that "due to infantryman parachutist injured on many jumps and landings" service connection is warranted. See February 2019 claim for benefits.

A review of the Veteran's STRs are silent for any complaints, diagnosis or treatment for his left knee. At the Veteran's December 2017 report of medical history at separation, the Veteran reported "no" knee trouble; or swollen or painful joint(s). At the Veteran's December 2017 separation examination, the Veteran was noted to have "no health concerns to discuss with the provider about at this time. SM (Service member) is currently in good health. Patient is NOT currently on a profile/limited duty chit." The examiner noted the Veteran had "normal" lower extremities.

During a post-service VA primary care April 2019 nursing treatment, the Veteran reported pain in mid-back but did not report a problem with his left knee. In a May 2019 letter to the Veteran, his primary care provider noted, "The x-rays of your neck, back, hips, left ankle and left knee were read as normal." See Oklahoma VAMC.

The Veteran was afforded a May 2019 general medical VA examination. The VA examiner addressed the "bilateral knees" but described the symptoms of the Veteran's right knee. The examiner stated, "He is a welder and has to squat during the day and has to squat with one leg straight to avoid bending of the knee." The Board finds that the Veteran was bending his left knee to avoid bending his right knee.

The Veteran was afforded a May 2019 VA knee examination. The VA examiner noted a diagnosis of bilateral knee strain. The Veteran was subsequently service-connected for his right knee. The Veteran reported that he first had knee pain following his "first jump" in 2014. He was seen several months later and stated that he was diagnosed with bursitis. Currently, he described his knee pain as swelling and sharp pain along the lateral edge of the knees and peripatellar pain. The knee pain was worse with any running, prolonged walking, prolonged standing, bending or squatting. He was a welder and had to squat during the day and had to squat with one leg straight to avoid bending of the knee. He had not been seen for his knees since his discharge. He stated that he used Epsom salt and warm compresses when he had knee pain and swelling. On examination, the Veteran's left knee was normal with no instability.

In a separate May 2019 medical opinion, the VA examiner noted that it was less likely than not that the left knee strain was related to a specific exposure event experienced by the veteran during
swelling and sharp pain along the lateral edge of the knees and peripatellar pain. The knee pain was worse with any running, prolonged walking, prolonged standing, bending or squatting. He was a welder and had to squat during the day and had to squat with one leg straight to avoid bending of the knee. He had not been seen for his knees since his discharge. He stated that he used Epsom salt and warm compresses when he had knee pain and swelling. On examination, the Veteran's left knee was normal with no instability.

In a separate May 2019 medical opinion, the VA examiner noted that it was less likely than not that the left knee strain was related to a specific exposure event experienced by the veteran during service in southwest Asia. The VA examiner reasoned, "Left knee conditions strain is a distinct condition with clear and specific etiologies and diagnosis. This condition has not been associated with the illnesses or exposures described in Veteran's returning from the Gulf War in medical research published in peer-reviewed medical journals."

In a May 2019 medical opinion regarding direct service connection, the VA examiner opined, "It is less likely than not that the veteran's claimed left knee condition was incurred in or caused by his parachutist badge. There is no competent medical evidence of a left knee complaint while on active duty. He did make reference to other orthopedic problems, specifically his right ankle when he was in the military however, there was no indication of a left knee condition over complaint of, diagnosed or treated. There were no complaints regarding left knee at the time of his report of medical history on December 13, 2017."

The Veteran was afforded a March 2021 VA knee examination. The VA examiner noted a normal left knee. The Veteran reported pain in the right knee, but reported no functional loss or impairment of the left knee. On examination, the Veteran had a normal left knee and no functional impact. The VA examiner noted the Veteran had a normal left knee, with a normal physical examination, reported no complaints of injury or treatment during service or following service, and had subjective symptoms only.

In a separate March 2021 medical opinion, the VA examiner opined that the claimed left knee condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The VA examiner reasoned, "No chronic diagnosis is made for left knee strain. Veteran served 4 years as airborne infantry, was deployed for combat. States pain in bilateral knees began in 2014, 'after my first jump'. Reported R knee pain on post-deployment health assessment, 9/1/2016. Was dx with 'jumper's knee'. No report of or diagnosis for left knee was made during service. Objective exam is normal. Symptoms are subjective only. A Nexus has not been established."

During the Veteran's October 2024 Board hearing, the Veteran testified broadly about his experience as a parachutist. The Veteran also testified that he was stationed at Fort Bragg and he ran every day on hard ground without proper shoes and in boots. The Veteran further testified that he did not go to sick call because "there was a strong stigma in my unit where if you were hurt, you just drank some water and moved on, just tough it up really." After the Veteran got out of service, he testified that he did seek treatment for his knee due to pain.

As noted above, in November 2024, the Veteran submitted a private medical opinion from J.H., M.D. The private examiner addressed the Veteran's claimed left knee in the context of "bilateral knee pain accepted as knee strain" and provided a discussion that did not distinguish between the Veteran's already service-connected right knee and the claimed left knee that is before the Board. The private examiner stated, "It must also be pointed out that the iliotibial band syndrome involves the musculotendinous anatomy of the gluteus maximus muscle as it blends into the iliotibial tract which is a strong tendon traveling distally to insert at the lateral proximal tibia just below the knee joint. The snapping hip syndrome, or IT band syndrome usually causes painful snapping at the hip and a bursitis pain at the lateral aspect of the knee. The claimant's knee pain is therefore accurately confirmed as IT bursitis and patellar compression syndrome. It is indeed bilateral and is a direct result of overuse and injury during his years in service." The private examiner further opined: "The claimant's right knee has been better documented in his treatment records and a rating of 10% granted. This is a minimal number for this chronic knee pain. It could be easily argued that 20% for the right knee is more accurate. Recall that both knees have x-ray evidence of prior trauma and his credible history describes bilateral knee pain longstanding. He should be granted service connected status for his
causes painful snapping at the hip and a bursitis pain at the lateral aspect of the knee. The claimant's knee pain is therefore accurately confirmed as IT bursitis and patellar compression syndrome. It is indeed bilateral and is a direct result of overuse and injury during his years in service." The private examiner further opined: "The claimant's right knee has been better documented in his treatment records and a rating of 10% granted. This is a minimal number for this chronic knee pain. It could be easily argued that 20% for the right knee is more accurate. Recall that both knees have x-ray evidence of prior trauma and his credible history describes bilateral knee pain longstanding. He should be granted service connected status for his left knee of at least 10% and arguably 20%."

Again, the Board notes that the private examiner did not distinguish between the right and the left knees. Only the left knee is before the Board for purposes of the Veteran seeking service connection. Rather than providing an opinion in support of the Veteran's claim for service connection for his left knee, the private examiner provided an opinion for a higher rating for his already service-connected right knee. As such, the Board does not find the November 2024 private opinion to be probative in support of the Veteran's left knee claim.

Additionally, as stated above, the private examiner appears to be making a legal determination regarding the rating criteria of the Veteran's knees. The opinion is, therefore, tainted for attempting to make factual findings and legal determinations. In this regard, it is important to stress that any examiner's opinion must be confined to medical ones, because the ultimate determination as to what disability rating to assign is a legal one. Such a legal determination is solely within the Board's adjudicative authority, rather than an examiner's. See 38 C.F.R. § 4.2 ("It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history"); Withers v. Wilkie, 30 Vet. App. 139, 146 (2018); Floore v. Shinseki, 26 Vet. App. 376, 381 (2013). Because the Board cannot otherwise rely on a medical expert's opinion on a legal matter, the probative value of this private opinion has been weighed as only one more piece of evidence to be considered in reaching the ultimate legal determination. See Sizemore v. Principi, 18 Vet. App. 264, 275 (2004); Colayong v. West, 12 Vet. App. 524, 534-35 (1999) (remanding the claim for a new independent medical examination because the previous examination was obtained by "tainted process"); Bielby v. Brown, 7 Vet. App. 260, 268-69 (1994).

As stated above, the Veteran's representative provided a January 2025 argument in which the representative repeated the Board hearing and repeated the November 2024 private medical opinion. The January 2025 argument included a list of "service medical records and medicals after discharge." As noted above, the STRs include in the list reference to the Veteran's already service-connected right knee and ankle that are not before the Board; a September 2016 note the Veteran had left knee crepitus but the Veteran was not diagnosed with a left knee disorder; and mental health and optometry STR citations which are not before the Board. The January 2025 argument provided no argument or theory regarding the Veteran's claim for service connection for his left knee.

With the January 2025 argument, the Veteran provided an article entitled "Iliotibial Band (IT Band) Syndrome," which appears to be a definition and description of the medical condition provided by "OrthoInfo." The Veteran's legal representative appears to draw a medical conclusion that "medical treatise research on the iliotibial band syndrome generally confirms Veteran's description of pain and popping." The Veteran's representative offers no argument or other explanation. As such, because the Board finds this article to be overly board and not specific to this Veteran as no medical opinion accompanies it, the Board finds the article has little probative value.

Regarding the Veteran's representative's argument that "VA ignored 38 C.F.R. 3,324" and "the rating agency is authorized to apply a 10% percent rating," the Board refers to the explanation provided above that the Veteran had been service-connected and assigned a compensable rating for other disabilities such that 38 C.F.R. § 3.324 did not apply.

Likewise, regarding the Veteran's representative statement that: "Reasons and basis cut and paste boilerplate language that the DeLuca factors have been considered are not adequate." The Board is again unable to respond for lack of an argument or explanation
this Veteran as no medical opinion accompanies it, the Board finds the article has little probative value.

Returning to the Veteran's claim for service connection for his left knee strain, the Veteran's STRs are silent for any complaints, diagnosis or treatment for his left knee. While the Veteran reports that he hurt his left knee following a parachute landing, the Veteran did not seek treatment during his military service or after he was separated from service. As stated above, at his Board hearing, the Veteran testified that he did not seek treatment because of a stigma in his unit to "drink water and move on." However, the Veteran's STRs show he sought treatment for his right ankle in 2013, mental health complaints in 2014, his eyes in 2016 and his right knee in 2016, in addition to the required military medical services. As such, the Board notes the Veteran did not avoid medical treatment entirely due to a "stigma." While the Board acknowledges the Veteran's statements, it is also noted that the Veteran's post-service treatment records are also silent for any complaints, diagnosis or treatment of his left knee until his May 2019 VA examination.

The Board has also considered the Veteran's statements regarding his belief that his left knee strain is related to an in-service injury. The Board has also considered the Veteran's statements regarding his belief that his left knee pain is related to his military job as an infantryman parachutist. However, as a lay person, the Veteran does not have the requisite medical knowledge, training, or experience to be able to render a competent medical opinion regarding the etiology of the medically complex disorder of the knee. See Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011). The knee is a medically complex process because of its multiple possible etiologies and requires specialized testing to diagnose (e.g., x-rays and/or MRI). Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007).

The Board acknowledges that the Veteran is competent to describe his symptoms without any specialized knowledge or training. Layno v. Brown, 6 Vet. App. 465; Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011), Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). Furthermore, the Board finds that the Veteran is competent to report symptoms and knee pain that the Veteran experienced, as it would be readily apparent. See Horowitz v. Brown, 5 Vet. App. 217, 221-22 (1993) (lay statements are competent on in-service and post-service symptoms).

While the Veteran is competent to report his service experiences and his sincere belief his left knee strain is related to his military service, the Veteran's contentions are outweighed by the opinion of the VA examiner who reviewed his service records, recognized his knee strain, but still concluded that the Veteran's left knee strain was not related to his military service. As the weight of the medical opinion addressing the etiology of the Veteran's current left knee strain is negative, there is no benefit of the doubt that could be resolved in the Veteran's favor. See 38 U.S.C. § 5107 ; 38 C.F.R. § 3.102.

For these reasons, and based on the evidence of record, the Board finds that the weight of the competent, credible, and probative evidence is against a finding of a relationship between the Veteran's left knee strain and service. Therefore, the claim for service connection for a left knee strain is denied.

Entitlement to service connection for left ankle deltoid ligament sprain.

The Veteran asserts that his left ankle sprain is the result of his military service and service connection is warranted. Specifically, the Veteran asserts that "due to infantryman parachutist injured on many jumps and landings" service connection is warranted. See February 2019 claim for benefits.

A review of the Veteran's STRs are silent for any complaints, diagnosis or treatment for his left ankle. In November 2013, the Veteran sought treatment for right ankle pain and was diagnosed with ankle
ative evidence is against a finding of a relationship between the Veteran's left knee strain and service. Therefore, the claim for service connection for a left knee strain is denied.

Entitlement to service connection for left ankle deltoid ligament sprain.

A review of the Veteran's STRs are silent for any complaints, diagnosis or treatment for his left ankle. In November 2013, the Veteran sought treatment for right ankle pain and was diagnosed with ankle joint pain. The Veteran did not report pain in his left ankle. The Veteran returned in December 2013, again reporting ankle pain. At the Veteran's December 2017 report of medical history at separation, the Veteran reported "no" swollen or painful joint(s). At the Veteran's December 2017 separation examination, the Veteran was noted to have "no health concerns to discuss with the provider about at this time. SM (Service member) is currently in good health. Patient is NOT currently on a profile/limited duty chit." The examiner noted the Veteran had "normal" lower extremities.

During a post-service VA primary care April 2019 nursing treatment, the Veteran reported pain in mid-back but did not report a problem with his left ankle. In a May 2019 letter to the Veteran, his primary care provider noted, "The x-rays of your neck, back, hips, left ankle and left knee were read as normal." See Oklahoma VAMC.

The Veteran was afforded a May 2019 general medical VA examination. The VA examiner addressed the "bilateral ankles" but described the symptoms of the Veteran's right ankle. The examiner stated, "The Veteran reports that during basic training he rolled his right ankle during a road march. He states he tightened his shoe and kept going. He did seek treatment for the right ankle condition after this occurred and he remembers he had x-rays." The Veteran reported pain in both ankles when running.

The Veteran was afforded a May 2019 VA ankle examination. The VA examiner noted a diagnosis of bilateral ankle deltoid ligament sprain. The Veteran reported that during basic training he rolled his right ankle during a road march. The Veteran reported that he now has pain in both ankles, they popped and were painful during running. The Veteran reported he was not seen for this condition since his discharge. On examination, the Veteran's left ankle was normal and the Veteran had no functional impact on his ability to perform any type of occupational task, such as standing, walking, lifting, sitting, etc.

In a separate May 2019 medical opinion, the VA examiner noted that it was less likely than not that left ankle condition strain was related to a specific exposure event experienced by the veteran during service in southwest Asia. The VA examiner reasoned, "Left ankle conditions strain is a distinct condition with clear and specific etiologies and diagnosis. This condition has not been associated with the illnesses or exposures described in Veteran's returning from the Gulf War in medical research published in peer-reviewed medical journals."

In a May 2019 medical opinion regarding direct service connection, the VA examiner opined:

It is less likely than not that the veteran's claimed left ankle condition was incurred in or caused by his parachutist badge. There is no competent medical evidence of a left ankle condition while in the military. There was no complaints regarding the left ankle at the time of the reported medical history prior to separation in December 2017. Without any documentation, it is less likely than not the left ankle condition is related to his parachutist patch. It is at least as likely as not that the veteran's claimed right ankle condition was incurred in or caused by his parachutist badge. The veteran sustained a right ankle injury while in the military. This was diagnosed as a lateral ankle sprain and persisted to be problematic for him. It is unclear how the nurse practitioner arrived at the diagnosis of a deltoid ligament sprain, which would be on the medial aspect, however, this is not the veteran's fault. It appears as though the ankle continues to be symptomatic and a nexus does appear to exist between the right ankle condition and his parachutist badge.

The Veteran was afforded a March 2021 VA ankle examination. The VA examiner noted a diagnosis of right ankle lateral collateral ligament sprain, but noted no diagnosis of the left ankle. The Veteran reported no treatment for the left ankle, but now reported pain in both ankles but no specific history of injury to the left ankle. The Veteran reported that his left ankle sometimes hurt. On examination, the VA examiner noted a normal left ankle and noted no functional impact. The VA examiner also remarked
ament sprain, which would be on the medial aspect, however, this is not the veteran's fault. It appears as though the ankle continues to be symptomatic and a nexus does appear to exist between the right ankle condition and his parachutist badge.

The Veteran was afforded a March 2021 VA ankle examination. The VA examiner noted a diagnosis of right ankle lateral collateral ligament sprain, but noted no diagnosis of the left ankle. The Veteran reported no treatment for the left ankle, but now reported pain in both ankles but no specific history of injury to the left ankle. The Veteran reported that his left ankle sometimes hurt. On examination, the VA examiner noted a normal left ankle and noted no functional impact. The VA examiner also remarked that the Veteran's left ankle was normal, with a normal physical examination, no evidence of pain on exam, no history of treatment and subjective symptoms only.

In a separate March 2021 medical opinion, the VA examiner opined that the claimed left ankle condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The VA examiner reasoned, "No chronic diagnosis is made for Left ankle strain. No evidence of L ankle complaint, injury or treatment during service. The veteran has not received and is not currently receiving any treatment for an ankle condition. Normal PE. Objective exam is normal. Symptoms are subjective only. A Nexus has not been established."

As noted above, in November 2024, the Veteran submitted a private medical opinion from J.H., M.D. The private examiner addressed the Veteran's claimed left knee in the context of "bilateral ankle sprain/strain." The private examiner noted the Veteran "also reports pain and popping in the left ankle that first started in physical training marches and was exacerbated by several hard parachute landings." The private examiner states, "[The Veteran] provides a credible report of pain and popping in both ankles beginning in service clearly forming a nexus for ankle sprain/strain bilateral that should be service connected." However, this is contrary to the evidence.

The Veteran's STRs are silent for any evidence of the Veteran's complaints of pain or popping of the left ankle. Rather, the Veteran sought and received treatment for his right ankle but did not report any complaints of his left ankle. While the Veteran testified that his unit discouraged medical treatment, he sought treatment for his right ankle in November 2013 and again in December 2013. On neither occasion did the Veteran report complaints of his left ankle. Therefore, the Board finds the opinion of the November 2024 medical examiner to be inadequate as it is premised on an inaccurate factual premise. Sklar v. Brown, 5 Vet. App. 140 (1993); Reonal v. Brown, 5 Vet. App. 458 (1993).

Furthermore, the November 2024 private examiner opined that the Veteran's "left ankle should be service connected at 10% since it is service related and equivalent

to the right ankle condition." Again, as stated above, the private examiner appears to be making a legal determination regarding the rating criteria of the Veteran's left ankle. The opinion is, therefore, tainted for attempting to make factual findings and legal determinations. In this regard, it is important to stress that any examiner's opinion must be confined to medical ones, because the ultimate determination as to what disability rating to assign is a legal one. Such a legal determination is solely within the Board's adjudicative authority, rather than an examiner's. See 38 C.F.R. § 4.2 ("It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history"); Withers v. Wilkie, 30 Vet. App. 139, 146 (2018); Floore v. Shinseki, 26 Vet. App. 376, 381 (2013). Because the Board cannot otherwise rely on a medical expert's opinion on a legal matter, the probative value of this private opinion has been weighed as only one more piece of evidence to be considered in reaching the ultimate legal determination. See Sizemore v. Principi, 18 Vet. App.
ative authority, rather than an examiner's. See 38 C.F.R. § 4.2 ("It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history"); Withers v. Wilkie, 30 Vet. App. 139, 146 (2018); Floore v. Shinseki, 26 Vet. App. 376, 381 (2013). Because the Board cannot otherwise rely on a medical expert's opinion on a legal matter, the probative value of this private opinion has been weighed as only one more piece of evidence to be considered in reaching the ultimate legal determination. See Sizemore v. Principi, 18 Vet. App. 264, 275 (2004); Colayong v. West, 12 Vet. App. 524, 534-35 (1999) (remanding the claim for a new independent medical examination because the previous examination was obtained by "tainted process"); Bielby v. Brown, 7 Vet. App. 260, 268-69 (1994).

Regarding the Veteran's representative argument that "VA ignored 38 C.F.R. 3,324" and "the rating agency is authorized to apply a 10% percent rating." The Board refers to the explanation provided above that the Veteran had been service-connected and assigned a compensable rating for other disabilities such that 38 C.F.R. § 3.324 did not apply.

Returning to the Veteran's claim for service connection for his left ankle sprain, the Veteran's STRs are silent for any complaints, diagnosis or treatment for his left ankle. While the Veteran reports that he hurt his left ankle either following a parachute landing or while running, the Veteran did not seek treatment during his military service or after he was separated from service. As noted above, at his Board hearing, the Veteran testified that he did not seek medical treatment because of a stigma in his unit to "drink water and move on." However, the record shows that in November and December 2013, the Veteran sought treatment for his right ankle. Likewise, the Veteran's STRs show he sought treatment for mental health complaints in 2014, his eyes in 2016 and his right knee in 2016, in addition to the required military medical services. As such, the Board does not find the Veteran avoided medical treatment due to a "stigma." As such, the Board notes the Veteran did not avoid medical treatment entirely due to a "stigma." While the Board acknowledges the Veteran's statements, it is also noted that the Veteran's post-service treatment records are also silent for any complaints, diagnosis or treatment of his left ankle until his May 2019 VA examination.

The Board has also considered the Veteran's statements regarding his belief that his left ankle sprain is related to an in-service injury. The Board has also considered the Veteran's statements regarding his belief that his left ankle sprain is related to his military job as an infantryman parachutist. However, as a lay person, the Veteran does not have the requisite medical knowledge, training, or experience to be able to render a competent medical opinion regarding the etiology of the medically complex disorder of the ankle. See Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011). The ankle is a medically complex process because of its multiple possible etiologies and requires specialized testing to diagnose (e.g., x-rays and/or MRI). Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007).

The Board acknowledges that the Veteran is competent to describe his symptoms without any specialized knowledge or training. Layno v. Brown, 6 Vet. App. 465; Kahana v. Shinseki, 24 Vet. App. 428, 437
render a competent medical opinion regarding the etiology of the medically complex disorder of the ankle. See Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011). The ankle is a medically complex process because of its multiple possible etiologies and requires specialized testing to diagnose (e.g., x-rays and/or MRI). Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007).

The Board acknowledges that the Veteran is competent to describe his symptoms without any specialized knowledge or training. Layno v. Brown, 6 Vet. App. 465; Kahana v. Shinseki, 24 Vet. App. 428, 437 (2011), Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007). Furthermore, the Board finds that the Veteran is competent to report symptoms and ankle pain that the Veteran experienced, as it would be readily apparent. See Horowitz v. Brown, 5 Vet. App. 217, 221-22 (1993) (lay statements are competent on in-service and post-service symptoms).

While the Veteran is competent to report his service experiences and his sincere belief his left ankle sprain is related to his military service, the Veteran's contentions are outweighed by the opinion of the VA examiner who reviewed his service records, recognized his left ankle sprain, but still concluded that the Veteran's left ankle sprain was not related to his military service. As the weight of the medical opinion addressing the etiology of the Veteran's current left ankle sprain is negative, there is no benefit of the doubt that could be resolved in the Veteran's favor. See 38 U.S.C. § 5107 ; 38 C.F.R. § 3.102.

For these reasons, and based on the evidence of record, the Board finds that the weight of the competent, credible, and probative evidence is against a finding of a relationship between the Veteran's left ankle sprain and service. Therefore, the claim for service connection for a left ankle sprain is denied.

Increased Disability Ratings Laws and Regulations

Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Each disability must be viewed in relation to its history, and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of a veteran working or seeking work. 38 C.F.R. § 4.2. Reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating is assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is assigned. 38 C.F.R. § 4.7.

Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, the Board must also consider staged ratings. Staged ratings are appropriate when the evidence establishes that the claimed disability manifested symptoms that would warrant different ratings for distinct time periods during the appeal. Hart v. Mansfield, 21 Vet. App. 505, 509- 10 (2007).

Pyramiding, that is the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when evaluating a veteran's service-connected disability. 38 C.F.R. § 4.14 (2020). However, it is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes; the critical element in permitting the assignment of several evaluations 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. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994).

Disability of the musculoskeletal system is primarily the inability, due to
, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when evaluating a veteran's service-connected disability. 38 C.F.R. § 4.14 (2020). However, it is possible for a veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes; the critical element in permitting the assignment of several evaluations 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. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994).

Disability of the musculoskeletal system is primarily the inability, due to damage or infection of parts of the musculoskeletal system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. The functional loss may be due to absence of part, or all, of the necessary bones, joints, and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995).

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). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a (musculoskeletal system) or § 4.73 (muscle injury); 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 [or 4.73] criteria.").

It is the intention to recognize actual painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59.

In rendering a decision on appeal, the Board must also analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify").

Entitlement to an initial rating in excess of 10 percent for lumbosacral strain.

The Veteran asserts that a rating in excess of 10 percent is warranted for his lumbosacral strain. The Veteran's lumbosacral strain has been evaluated as 10 percent disabling for
has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) ("although interest may affect the credibility of testimony, it does not affect competency to testify").

Entitlement to an initial rating in excess of 10 percent for lumbosacral strain.

Disabilities of the spine are rated under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula) (for DCs 5235 to 5243, unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes (IVDS 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. The disabilities of the spine that are rated under the General Rating Formula include vertebral fracture or dislocation (DC 5235), sacroiliac injury and weakness (DC 5236), lumbosacral or cervical strain (DC 5237), spinal stenosis (DC 5238), unfavorable or segmental instability (DC 5239), ankylosing spondylitis (DC 5240), spinal fusion (DC 5241), and degenerative arthritis of the spine (DC 5242) (for degenerative arthritis of the spine, see also DC 5003).

The General Rating Formula provides a 10 percent rating 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; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is assigned forward flexion of the thoracolumbar spine 30 degrees or less; or, unfavorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is assigned for unfavorable ankylosis of entire spine.

The Notes following the General Rating Formula provide further guidance in rating diseases or injuries of the spine. Note (1) provides that any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be rated separately under an appropriate diagnostic code.

Note (2) provides that, for VA compensation purposes, normal forward flexion of the thoracolumbar 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 thoracolumbar 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.

DC 5243 provides that IVDS is to be rated either under the General Rating Formula or under the IVDS Formula, whichever method results in the higher rating when all disabilities are combined under 38 C.F.R. § 4.25. The IVDS Formula provides a 20 percent rating for IVDS with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months; a 40 percent rating
and left and right rotation. The normal combined range of motion of the thoracolumbar 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.

DC 5243 provides that IVDS is to be rated either under the General Rating Formula or under the IVDS Formula, whichever method results in the higher rating when all disabilities are combined under 38 C.F.R. § 4.25. The IVDS Formula provides a 20 percent rating for IVDS with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months; a 40 percent rating for IVDS with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months; and a 60 percent rating for IVDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months.

Diagnostic Code 5243 provides that intervertebral disc syndrome (IVDS) is to be assigned only when there is disc herniation with compression and/or irritation of the adjacent nerve root; otherwise, the diagnostic code 5242 is assigned for all other disc diagnoses.

Note (1) to DC 5243 provides that, for purposes of ratings under DC 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician.

Note (2) provides that, if intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, each segment is to be rated on the basis of incapacitating episodes or under the General Rating Formula, whichever method results in a higher evaluation for that segment. 38 C.F.R. § 4.71a.

Diagnostic Code 5243 provides that intervertebral disc syndrome (IVDS) is to be rated either under the General Rating Formula for Diseases and Injuries of the Spine or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher rating when all disabilities are combined under 38 C.F.R. § 4.25.

The Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes provides a 10 percent disability rating for IVDS with incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months; a 20 percent disability rating for IVDS with incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months; a 40 percent disability rating for IVDS with incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months; and a 60 percent disability rating for IVDS with incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. 38 C.F.R. § 4.71a.

Note (1) to Diagnostic Code 5243 provides that, for purposes of ratings under Diagnostic Code 5243, an incapacitating episode is a period of acute signs and symptoms due to intervertebral disc syndrome that requires bed rest prescribed by a physician and treatment by a physician.

Note (2) provides that, if intervertebral disc syndrome is present in more than one spinal segment, provided that the effects in each spinal segment are clearly distinct, each segment is to be rated on the basis of incapacitating episodes or under the General Rating Formula for Diseases and Injuries of the Spine, whichever method results in a higher evaluation for that segment. 38 C.F.R. § 4.71a.

Effective February 7, 2021, VA's Schedule, 38 C.F.R. Part 4, was amended with regard to rating musculoskeletal disorders. Fed. Reg. 76453 (November 30, 2020) (codified at 38C.F.R. §4.71a). The current rating scheduled reflects those changes.

Turing to the evidence, during post-service VA treatment in April 2019, the Veteran reported pain in his mid-back. On examination, the Veteran had no tenderness on palpation and was able to complete a straight leg lift. In a May 2019 letter to the Veteran from his primary care provider, the Veteran was notified: "The x-rays of your neck, back, hips, left ankle and left knee were read as normal." See Oklahoma VAMC.

The Veteran was afforded a May 2019 VA examination. The VA examiner noted a diagnosis of lumbosacral strain. The Veteran reported that he began to have low back pain in
§4.71a). The current rating scheduled reflects those changes.

The Veteran was afforded a May 2019 VA examination. The VA examiner noted a diagnosis of lumbosacral strain. The Veteran reported that he began to have low back pain in 2014 around February while in airborne school, spoke with the battalion medic, was given a light duty profile for 2 weeks but was not seen again for the low back condition while on active duty. The Veteran reported he was seen for his neck and back complaints the year prior to the exam in Nevada, given Flexeril and was prescribed two days of rest, but had not followed up again. The Veteran reported the low back pain was in the mid spine and was constant, was worse with prolonged standing or if stood upright for prolonged periods of time. The Veteran described the pain as tense and burning and tried to pop his back on his own and sometimes it helped his pain. The Veteran reported no flare-ups.

On initial examination, the Veteran had flexion to 90 degrees, extension to 30 degrees, right lateral flexion to 30 degrees, left lateral flexion to 30, right lateral rotation to 30 degrees and left lateral rotation to 30 degrees. The examiner noted pain on exam that did not result in or cause functional loss. The Veteran had no additional loss on observed repetitive use or repeated use over time. As noted above, the Veteran did not report flare-ups. The VA examiner noted the Veteran had no guarding or muscle spasms, normal muscle strength, no muscle atrophy, normal reflexes, normal senses, no radiculopathy, no ankylosis, no neurologic abnormalities, no intervertebral disc syndrome (IVDS), and did not require the use of any assistive device. The VA examiner noted the Veteran's functional impact was described as: "He would be limited in those occupations that require heavy or unassisted lifting; repetitive rotation of the back; carrying, pushing, or pulling heavy objects; vibrational stresses; overhead work; and prolonged sitting. He is limited in prolonged standing and walking and would need allowance for rest periods every 60-120 minutes."

During an October 2020 primary care treatment, the Veteran reported chronic left middle back pain. The Veteran's post-service treatment records did not include any range of motion testing of the Veteran's lumbar spine. See Oklahoma VAMC.

The Veteran was afforded a March 2021 VA examination. The VA examiner noted a diagnosis of lumbar radiculopathy. The Veteran reported onset in 2014, when he was given a profile. The examiner noted such profile or history of back condition was not located in the record or in the Veteran's STRs. The Veteran stated that his back condition onset after a rough landing in service. He also had a history of MVA [motor vehicle accident] in 2015, where he was T-boned and his vehicle was totaled. The Veteran stated that he was unsure whether this was reported to command. The Veteran reported that his back pain slowly worsened and he reported no flare-ups, but a functional loss or impairment as "pain with bending."

On initial range of motion, the Veteran had flexion to 80 degrees, extension to 20 degrees, right lateral flexion to 20 degrees, left lateral flexion to 20 degrees, right lateral rotation to 20 degrees and right lateral rotation to 20 degrees. The examiner noted no pain on motion. The Veteran had no additional loss on observed repetitive use. On repeated use over time, the Veteran had flexion to 75 degrees, extension to 20 degrees, right lateral flexion to 20 degrees, left lateral flexion to 20 degrees, right lateral rotation to 20 degrees and right lateral rotation to 20 degrees. The Veteran denied flare ups. The Veteran had no localized tenderness, guarding or muscle spasm of the thoracolumbar spine; normal muscle strength, no muscle atrophy, normal reflexes, normal senses, no ankylosis, no intervertebral disc syndrome (IVDS) and required no assistive device. The VA examiner noted the Veteran's functional impact was described as "Veteran's Lumbar radiculopathy limits forward flexion, lifting."

At his October 2024 Board hearing, the Veteran testified that he had a hard time bending at the waist, squatting down for long periods of time,
flexion to 20 degrees, right lateral rotation to 20 degrees and right lateral rotation to 20 degrees. The Veteran denied flare ups. The Veteran had no localized tenderness, guarding or muscle spasm of the thoracolumbar spine; normal muscle strength, no muscle atrophy, normal reflexes, normal senses, no ankylosis, no intervertebral disc syndrome (IVDS) and required no assistive device. The VA examiner noted the Veteran's functional impact was described as "Veteran's Lumbar radiculopathy limits forward flexion, lifting."

At his October 2024 Board hearing, the Veteran testified that he had a hard time bending at the waist, squatting down for long periods of time, sitting for long periods of time and had to constantly adjust back and forth.

As noted above, in November 2024, the Veteran submitted a private medical opinion from J.H., M.D. The private examiner noted that the Veteran "has never been consistently pain free in his lumbar spine since 2014." The private examiner opined, "It is necessary to utilize Subpart B -Disability Ratings section 4.40 functional loss and 4.45 weakened, painful movement with excessive fatiguability since isolated range of motion in a passive exam maneuver underestimates the impairment significantly. A rating of 20% is appropriate for the spine itself using DC5242. He has also been rated 10% for sciatic nerve impairment in each leg which is reasonable."

As stated above, the private examiner appears to be making a legal determination regarding the rating criteria of the Veteran's lumbar spine. The opinion is, therefore, tainted for attempting to make factual findings and legal determinations. In this regard, it is important to stress that any examiner's opinion must be confined to medical ones, because the ultimate determination as to what disability rating to assign is a legal one. Such a legal determination is solely within the Board's adjudicative authority, rather than an examiner's. See 38 C.F.R. § 4.2 ("It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history"); Withers v. Wilkie, 30 Vet. App. 139, 146 (2018); Floore v. Shinseki, 26 Vet. App. 376, 381 (2013). Because the Board cannot otherwise rely on a medical expert's opinion on a legal matter, the probative value of this private opinion has been weighed as only one more piece of evidence to be considered in reaching the ultimate legal determination. See Sizemore v. Principi, 18 Vet. App. 264, 275 (2004); Colayong v. West, 12 Vet. App. 524, 534-35 (1999) (remanding the claim for a new independent medical examination because the previous examination was obtained by "tainted process"); Bielby v. Brown, 7 Vet. App. 260, 268-69 (1994). As there is no arthritis shown, an alternate diagnostic code is not appropriate.

The Board finds that a rating for the Veteran's lumbar spine disability higher than 10 percent is not warranted. At worst, the Veteran had flexion to 80 degrees on initial range of motion at his March 2021 VA examination and 75 degrees on repeated use over time. The Veteran had an initial combined range of motion of the thoracolumbar spine of 200 degrees and 175 degrees on repeated use over time. Therefore, a rating of 10 percent is properly assigned. The Veteran did not have guarding, muscle spasm or abnormal spinal contour that would warrant a higher rating. Moreover, there is no evidence of incapacitating episodes of intervertebral disc syndrome and the VA examiners noted the Veteran did not have intervertebral disc syndrome (IVDS) requiring physician-prescribed bed rest.

For these reasons, the Board finds that a 10 percent rating, but no higher, for the Veteran's lumbar spine disability is warranted for the entire rating period on appeal.

The Board has also considered the Veteran's reported impairment of function, such as low back pain, and has considered additional limitations of motion due to pain. Even considering additional limitation of motion or function of the lumbar spine due to pain or other symptoms such as weakness, fatigability, weakness, or incoordination (see 38 C.F.R. §§ 4.40, 4.45, 4.59, DeLuca), the evidence still does not show that the lumbar spine disability more nearly approximates the criteria for a higher rating. Upon repetitive testing and during flare-ups, range of motion did not reveal any additional loss of range of motion of the cervical or lumbar spine. See May 2019 and March 2021 VA examination reports. The Board finds that the limitation of motion and functional loss due to pain is contemplated in the 10 percent rating already assigned. Based on the objective medical evidence of record, there is no basis for the assignment of a higher rating pursuant to 38 C.F.R. §§ 4.40 and 4.45.

For these reasons, the Board finds that the weight of the evidence is against the assignment of disability evaluations in excess of 10 percent for the lumbar spine disability for the entire appeal period.

For these reasons, the Board finds that the evidence weighs persuasively against the claim for a higher rating for the Veteran's lumbar strain. Because the evidence weighs substantially against the claims, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Accordingly, the claim for a rating in excess of 10 percent for lumbosacral strain is denied.

Entitlement to an initial compensable rating for right side snapping hip syndrome.

Entitlement to an initial compensable rating for left side snapping hip syndrome.

Entitlement to service connection for right side snapping hip syndrome, with limitation of extension.

Entitlement to service connection for left side snapping hip syndrome, with limitation of extension.

Entitlement to service connection for right side snapping hip syndrome, with impairment.

Entitlement to service connection for left side snapping hip syndrome, with impairment.

The Veteran asserts that a rating in excess of 10 percent is warranted for his bilateral hip disability.

Initially, the Board notes that the Veteran has been service connection for his bilateral hips pursuant to Diagnostic Code (DC) 5252 and has been evaluated as a noncompensable rating evaluation for each hip. As will be described below, the Board finds that a 10 percent is warranted for each hip for pain, and finds that the Veteran is entitled to an additional noncompensable rating under Diagnostic Code (DC) 5251, for limitation of extension and Diagnostic Code (DC) 5253, for impairment, specifically for limitation of abduction.

Limitation of flexion of the hip is governed by DC 5252. Under DC 5252, a 10 percent rating is assigned when flexion is limited to 45 degrees. A 20 percent rating is assigned when flexion is limited to 30 degrees. A 30 percent rating is assigned when flexion is limited to 20 degrees. A 40 percent rating is assigned when flexion is limited to 40 degrees. 38 C.F.R. § 4.71a, DC 5252.

DC 5251 contemplates limitation of extension of the thigh or hip. A 10 percent rating is assigned for extension limited to 5 degrees. This is the highest rating available under DC 5251. 38 C.F.R. § 4.71a, DC.

Impairment of the thigh impacting abduction is governed by DC 5253. Under DC 5253, a 10 percent rating is assigned for limitation of rotation of the thigh such that the affected leg cannot toe-out more than 15 degrees, or limitation of adduction such that one cannot cross one's legs. A 20 percent rating is assigned for limitation of abduction such that motion is lost beyond 10 degrees. 38 C.F.R. § 4.71a, DC 5253.

Turning to the evidence, a review of the Veteran's post-service treatment is silent for any complaints, diagnosis or treatment for the Veteran's hips. In a May 2019 letter from the Veteran's VA primary care provider, the Veteran was informed that "The x-rays of your neck, back, hips, left ankle and left knee were read as normal." See Oklahoma VAMC.

The Veteran sought private treatment for his back but did not report any issue with his hips
, or limitation of adduction such that one cannot cross one's legs. A 20 percent rating is assigned for limitation of abduction such that motion is lost beyond 10 degrees. 38 C.F.R. § 4.71a, DC 5253.

The Veteran sought private treatment for his back but did not report any issue with his hips. See Orthopedic Surgery Spine.

The Veteran was afforded a May 2019 VA hip examination. The VA examiner noted no hip diagnosis. The Veteran reported that he began to have hip pain in 2017 during deployment. He was not aware of an injury to the hips. The pain was located along the lateral trochanter. He states that if he walks all day he will have hip pain. He states that the hips popped frequently when walking. He had never been seen by a medical provider regarding his bilateral hip pain. The VA examiner noted a normal hip examination with no functional impact. Pain was noted on exam of right hip but did not result in/cause functional loss.

The Veteran was afforded a March 2021 VA hip examination. The VA examiner noted a diagnosis of bilateral snapping hip syndrome. The Veteran reported onset in 2017, during deployment when he began to have bilateral hip pain, worsened by walking or running distances. The Veteran reported he was not seen in service for this condition. The Veteran reported bilateral hip flare-ups described as "pain and snapping in my outer hip when I walk or run too far," occurring twice a month, lasting a one to four hours in his right hip and lasting a few hours in his left hip, with lateral hip pain and "popping sensation," precipitated by extended ambulation, alleviated by rest and Tylenol and characterized as mild. The Veteran reported his functional loss or impairment as: "hurts when I walk or run a long way."

On initial range of motion for each hip, the Veteran had flexion to 125 degrees, extension to 30 degrees, abduction to 45 degrees, adduction to 25 degrees, external rotation to 60 degrees and internal rotation to 40 degrees. The examiner noted no pain on motion. There was no additional loss on observed repetitive use. On repeated use over time, the Veteran had flexion to 115 degrees, extension to 20 degrees, abduction to 35 degrees, adduction to 20 degrees, external rotation to 50 degrees and internal rotation to 30 degrees. The Veteran had no additional loss on flare-up. The Veteran had objective evidence of localized tenderness or pain on palpation of the joint or associate soft tissue in each hip. The Veteran had no muscle atrophy, no ankylosis, no femur or flail hip joint impairment, did not require an assistive device and no other pertinent physical findings, complications, signs, symptoms or scars. The VA examiner noted the Veteran's functional impact was described as: "Pain from the Veteran's right hip and left snapping hip syndrome limits ambulation >1 mile."

At the Veteran's October 2024 hearing, the Veteran testified that his hips were "painful some days. I wouldn't say it's painful all the time. Some days it's just kind of, I have a high pain tolerance, so kind of used to it at this point."

The Veteran submitted a November 2024 private medical opinion from J. H.,M.D. The private examiner noted that "Service connected status was granted but the rating of 0% used the wrong diagnostic codes and significantly underestimated the severity of this impairment." The private examiner opined:

Bilateral snapping hip syndrome, otherwise called iliotibial band syndrome, causing painful snapping in the hip and lateral knee consistent with this diagnosis: The iliotibial band syndrome is a type of tendinitis with underlying bursitis of the hip. The diagnostic code is 5024 describing tenosynovitis, tendinitis, tendinosis, Or tendinopathy. It is painful and limiting to the hip and knee bilaterally. In order to truly assess this impairment, one must use DC5314, group XIV pelvic girdle and thigh and DC5317, muscle group XVII. These two diagnostic codes specifically describe abnormal tension in the iliotibial tract anatomically which is musculature providing hip extension and knee extension. With heavy or repetitive use these two muscle groups function poorly and create a clearly ratable dysfunction. On page 438 of the CFR, muscle group dysfunction combining 5314 and
tendinitis with underlying bursitis of the hip. The diagnostic code is 5024 describing tenosynovitis, tendinitis, tendinosis, Or tendinopathy. It is painful and limiting to the hip and knee bilaterally. In order to truly assess this impairment, one must use DC5314, group XIV pelvic girdle and thigh and DC5317, muscle group XVII. These two diagnostic codes specifically describe abnormal tension in the iliotibial tract anatomically which is musculature providing hip extension and knee extension. With heavy or repetitive use these two muscle groups function poorly and create a clearly ratable dysfunction. On page 438 of the CFR, muscle group dysfunction combining 5314 and 5,317 would be a minimum of 20% service connected status for each hip.

The Board notes that the November 2024 private examiner provided an opinion regarding a general rating of "snapping hip syndrome." The private provider did not provide a medical explanation of why a higher rating was warranted or the medical reasoning in support of the Veteran's claim. Rather, the private examiner appears to be making a legal determination regarding the rating criteria of the Veteran's bilateral hips. The opinion is, therefore, tainted for attempting to make factual findings and legal determinations. In this regard, it is important to stress that any examiner's opinion must be confined to medical ones, because the ultimate determination as to what disability rating to assign is a legal one. Such a legal determination is solely within the Board's adjudicative authority, rather than an examiner's. See 38 C.F.R. § 4.2 ("It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history"); Withers v. Wilkie, 30 Vet. App. 139, 146 (2018); Floore v. Shinseki, 26 Vet. App. 376, 381 (2013). Because the Board cannot otherwise rely on a medical expert's opinion on a legal matter, the probative value of this private opinion has been weighed as only one more piece of evidence to be considered in reaching the ultimate legal determination. See Sizemore v. Principi, 18 Vet. App. 264, 275 (2004); Colayong v. West, 12 Vet. App. 524, 534-35 (1999) (remanding the claim for a new independent medical examination because the previous examination was obtained by "tainted process"); Bielby v. Brown, 7 Vet. App. 260, 268-69 (1994). It is for the adjudicative authority to consider the entire record and assign a diagnostic code and rating.

As noted above, the Veteran's representative provided a January 2025 argument in which the representative repeated the Board hearing and repeated the November 2024 private medical opinion, but did not provide any argument in support of a higher rating for the Veteran's bilateral hip disability.

The Board notes that the intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5. Here, the Veteran reported pain at his May 2019 and April 2021 VA hip examinations. Likewise, the Veteran reported intermittent pain at his October 2024 Board hearing. Therefore, the Board finds that the minimum compensable rating is warranted for both the Veteran's right and left hip. Accordingly, a 10 percent rating is granted for the Veteran's right side snapping hip syndrome and a 10 percent rating is granted for the Veteran's left side snapping hip syndrome.

Additionally, the March 2021 VA hip examination found that on repeated use over time, the Veteran had extension to 20 degrees and abduction to 35 degrees. Given that normal extension is 30 degrees and normal abduction is 45 degrees, this represents a loss of motion. While this is not a compensable loss of motion, the Veteran is entitled to service connection to additional loss of motion for both his right and left hips. Accordingly, service connection for right and left side snapping hip syndrome with limitation of extension is warranted. Likewise, service connection for right side and left side snapping hip syndrome with impairment is also warranted.

Additionally, the May 2019 and the April 2021 VA examinations did not show that the Veteran had extension limited to 5 degrees, flexion limited to 30 degrees, limitation of abduction lost beyond 10 degrees, limitation of adduction such that the Veteran could not cross his legs or limitation of rotation such that the Veteran could not toe-out more than 15 degrees of each leg. Therefore
this is not a compensable loss of motion, the Veteran is entitled to service connection to additional loss of motion for both his right and left hips. Accordingly, service connection for right and left side snapping hip syndrome with limitation of extension is warranted. Likewise, service connection for right side and left side snapping hip syndrome with impairment is also warranted.

For these reasons, the Board finds that a 10 percent rating, but no higher, for the Veteran's right side snapping hip syndrome is warranted for the entire rating period on appeal. Additionally, the Board finds that a 10 percent rating, but no higher, for the Veteran's left side snapping hip syndrome is warranted for the entire rating period on appeal.

The Board has also considered the Veteran's reported impairment of function, such as pain, and has considered additional limitations of motion due to pain. Even considering additional limitation of motion or function of the bilateral hips due to pain or other symptoms such as weakness, fatigability, weakness, or incoordination (see 38 C.F.R. §§ 4.40, 4.45, 4.59, DeLuca), the evidence still does not show that the bilateral hip disability more nearly approximates the criteria for a higher rating. Upon repetitive testing and during flare-ups, range of motion did not reveal any additional loss of range of motion of the bilateral hips. See May 2019 and March 2021 VA examination reports. The Board finds that the limitation of motion and functional loss due to pain is contemplated in the 10 percent rating already assigned here. Based on the objective medical evidence of record, there is no basis for the assignment of a higher rating pursuant to 38 C.F.R. §§ 4.40 and 4.45.

For these reasons, the Board finds that the weight of the evidence is against the assignment of disability evaluations in excess of 10 percent for the limitation of flexion of the Veteran's bilateral hips disability for the entire appeal period.

However, the Board finds that a rating of 10 percent is warranted for the Veteran's right side snapping hip syndrome limitation of flexion and left side snapping hip syndrome. The Board further finds that noncompensable ratings are warranted for the Veterans right side snapping hip syndrome, limitation of extension; left side snapping hip syndrome, limitation of extension; right snapping hip syndrome with impairment and left side snapping hip syndrome with impairment.

Entitlement to an initial rating in excess of 10 percent for right lower extremity sciatic radiculopathy.

Entitlement to an initial rating in excess of 10 percent for left lower extremity sciatic radiculopathy.

The Veteran asserts that higher ratings for his bilateral lower extremity sciatic radiculopathy is warranted. The Veteran's bilateral lower extremity sciatic radiculopathy has been evaluated as 10 percent disabling for each sciatic nerve for the entire appeal period, pursuant to Diagnostic Code 8520.

Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. Ratings for nerve disabilities are considered under the rating schedule for Diseases of the Peripheral Nerves, Diagnostic Codes 8510 to 8540. The Diagnostic Codes (DC) for the lower extremities are 8520 to 8540, that include paralysis, neuritis and neuralgia. 38 C.F.R. 4.124a.

The Diagnostic Codes for the lower extremities provide ratings for incomplete paralysis of the sciatic nerve. 38 C.F.R. § 4.124a, DC 8520. Disability ratings of 10, 20, and 40 percent are warranted, respectively, for mild, moderate, and moderately severe incomplete paralysis of the sciatic nerve. 38 C.F.R. § 4.124, DC 8520. A disability rating of 60 percent is warranted for severe incomplete paralysis with marked muscle atrophy. An 80 percent rating is warranted with complete paralysis of the sciatic nerve. Id. Likewise, disability ratings of 10, 20 and 30 percent are warranted, respectively, for mild moderate and severe incomplete paralysis of the tibial and femoral nerves. 38 C.F.R. § 4.124, DC 8542 and 8526. A disability rating of 40 percent is warranted for the complete paralysis of the tibial or femoral nerves. Id.

The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. 38 C.F.R. § 4.124a. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. Id.

As an initial matter, neither the Diagnostic Code nor the overall rating schedule defines "mild," "moderate," "moderately severe," or "severe." However, "mild" is generally defined as "gentle in nature or behavior," "not being or involving what is extreme," or "not severe." Merriam-Webster's Collegiate Dictionary, 1173 (11th ed. 2003). "Moderate" is defined as "tending toward the mean or average amount." Id. at 798. "Severe" is generally defined as "of a great degree." Id. at 1140. Therefore, "moderately severe" can be defined as between "tending toward the mean or average amount" and "of a great degree."

The Board notes that words such as "severe" and "moderate" are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence, to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, it is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for an increased disability rating. 38 U.S.C. § 7104 ; 38 C.F.R. §§ 4.2, 4.6.

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

The Board notes that neither the Rating Schedule nor the regulations provide definitions for descriptive words such as "mild," "moderate," "moderately severe," and "severe." Spellers v. Wilkie, 30 Vet. App. 211, 219 (2018) ("DC 8520 does not define 'mild,' 'moderate,' 'moderately severe,' or 'severe,' or generally associate those terms with specific symptoms"). Although the Board has at times attempted to define these terms using dictionary definitions, those definitions are problematic because they "do little to explain the Board's understanding of these terms and do not 'disclos[e] that benchmark it employed to reach [its] conclusion.'" Casey v. McDonough, No. 21-7569, slip op. at 3 (Vet. App. Jan. 24, 2023) (mem dec) (Falvey, J.) (quoting Johnson v. Wilkie, 30 Vet. App. 245, 255 (2018) (discussing the Board's attempt to define the terms slight, mild, moderate, and severe in DC 8515). See also Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (single judge decisions may be relied upon for any persuasiveness or reasoning they contain). With regard to DC 8520, although 38 C.F.R. § 4.120, 4.123, and 4.124 are "helpful in framing
Jan. 24, 2023) (mem dec) (Falvey, J.) (quoting Johnson v. Wilkie, 30 Vet. App. 245, 255 (2018) (discussing the Board's attempt to define the terms slight, mild, moderate, and severe in DC 8515). See also Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (single judge decisions may be relied upon for any persuasiveness or reasoning they contain). With regard to DC 8520, although 38 C.F.R. § 4.120, 4.123, and 4.124 are "helpful in framing the analysis, [they] are not alone sufficient to explain the Board's decision absent an articulated connection to specific evidence." Lemon v. McDonough, No. 21-3949, 2022 U.S. App. Vet. Claims LEXIS 1998, *7 (Dec. 16, 2022) (mem dec) (Toth, J.). As explained in Lemon, these regulations leave gaps in defining the relevant terms that are filled by VA's Adjudication Manual, M21-1.

The Board "is required to discuss any relevant provisions contained in the M21-1 as part of its duty to provide adequate reasons or bases," Overton, 30 Vet. App. at 264. Clearly relevant to this case are M21-1 provisions regarding evaluations of paralysis of the sciatic nerve. The M21-1 describes mild incomplete paralysis as a disability "limited to sensory deficits that are lower graded, less persistent, or affecting a smaller area." Part V, Subpart. iii, Chapter. 12, sec. A.2.c. Moderate incomplete paralysis, per the M21-1, should be "reserved for the most significant cases of sensory-only impairment," where the sensory involvement covers "a larger area in the nerve distribution." Id. M21-1 examples of a moderate disability include "motor and/or reflex impairment such as weakness or diminished or hyperactive reflexes (with or without sensory impairment) graded as medically moderate." Id. The M21-1 provides that a moderately severe evaluation (that is, a 40% rating) is available when there is "[m]otor and/or reflex impairment (for example, weakness or diminished or hyperactive reflexes) at a grade reflecting a higher level of limitation or disability." Id. Atrophy may, but need not, be present for a moderately severe rating.

As concluded by the Court in Lemon, given the relevance of these provisions to rating disabilities of the peripheral nerves, "the Board's failure to mention the M21-1's relevant guidance in this area constitutes clear error." Lemon, at *7-*8. See also Bethea, 2 Vet. App. at 254. The Board will therefore mention, and apply, these definitions in the instant case. See also Boothe v. McDonough, No. 21-4488, 2023 U.S. App. Vet. Claims LEXIS 121, *2 (Jan. 27, 2023) (Nonprecedential Panel Order) (granting a Joint Motion for Remand in which the parties "agree[d] that the Board erred when it refused to consider relevant portions of the VA Adjudication Procedures Manual").

Stated another way and in relevant part, VA's Adjudication Manual, M21-1 V.iii.12.A.2.c. provides general guidance under the Assigning Level of Incomplete Paralysis, Neuritis or Neuralgia topic. It provides descriptions for each level of incomplete paralysis of the upper and lower peripheral nerves as detailed below.

Degree of Incomplete Paralysis Description

Moderate

" Moderate is the maximum evaluation reserved for the most significant cases of sensory-only impairment (38 C.F.R. § 4.124a).

o Symptoms will likely be described by the claimants and medically graded as significantly disabling.

o In such cases a larger area in the nerve distribution may be affected by sensory symptoms.

" Other sign/symptom combinations that may fall into the moderate category include:

o combinations of significant sensory changes and reflex or motor changes of a lower degree, or

o motor and/or reflex impairment such as weakness or diminished or hyperactive reflexes (with or without sensory impairment) graded as medically moderate.

" Moderate is also the maximum evaluation that can be assigned for:

o neuritis not characterized by organic changes referred to in 38 C.F.R. § 4.123, or

o neuralgia characterized usually by a dull and intermittent pain in the distribution of a nerve (38 C.F.R. § 4.
area in the nerve distribution may be affected by sensory symptoms.

" Other sign/symptom combinations that may fall into the moderate category include:

o combinations of significant sensory changes and reflex or motor changes of a lower degree, or

o motor and/or reflex impairment such as weakness or diminished or hyperactive reflexes (with or without sensory impairment) graded as medically moderate.

" Moderate is also the maximum evaluation that can be assigned for:

o neuritis not characterized by organic changes referred to in 38 C.F.R. § 4.123, or

o neuralgia characterized usually by a dull and intermittent pain in the distribution of a nerve (38 C.F.R. § 4.124).

Moderately Severe

" The moderately severe evaluation level is only applicable for involvement of the sciatic nerve.

" This is the maximum rating for sciatic nerve neuritis not characterized by the organic changes specified in 38 C.F.R. § 4.123.

" Motor and/or reflex impairment (for example, weakness or diminished or hyperactive reflexes) at a grade reflecting a high level of limitation or disability is expected.

" Atrophy may be present. However, for marked muscular atrophy see the criteria for a severe evaluation under 38 C.F.R. § 4.124a, DC 8520.

Severe

" In general, expect motor and/or reflex impairment (for example, atrophy, weakness, or diminished or hyperactive reflexes) at a grade reflecting a very high level of limitation or disability.

" Trophic changes may be seen in severe longstanding neuropathy cases.

" For the sciatic nerve (38 C.F.R. § 4.124a, DC 8520) marked muscular atrophy is expected.

" Even though severe incomplete paralysis cases should show findings substantially less than representative findings for complete impairment of the nerve, the disability picture for severe incomplete paralysis may contain signs/symptoms resembling some of those expected in cases of complete paralysis of the nerve.

Neuritis characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain should be rated as high as severe incomplete paralysis of the nerve (38 C.F.R. § 4.123). See VA's Adjudication Manual, M21-1 V.iii.12.A.2.c (updated Sept. 14, 2023).

Turning to the evidence, during a June 2020 private new consult for initial evaluation, the Veteran reported years of back pain with intermittent pain down his bilateral legs with numbness and tingling. See Orthopedic Surgery Spine.

A review of the Veteran's post-service VA treatment is silent for any complaint, diagnosis or treatment for radiculopathy, numbness or tingling. See Oklahoma VMAC.

The VA examiner noted the Veteran had signs or symptoms of radiculopathy to include no constant pain, no intermittent pain or numbness. However, the Veteran had mild paresthesias and/or dysesthesias of both the right and left lower extremities. The examiner noted the Veteran had involvement of both lower sciatic nerves. The VA examiner noted there was no record of treatment for the Veteran's back condition in service, however, the Veteran had an MVA [motor vehicle accident] 2015 per the Veteran's report. 2019 x-rays were normal and an MRI 2020 notes mild neuroforaminal narrowing at L3-4, L4-5. The VA examiner noted the Veteran's functional impact was described as "Veteran's Lumbar radiculopathy limits forward flexion, lifting."

At the Veteran's October 2024 Board hearing, the Veteran testified that
aresthesias and/or dysesthesias of both the right and left lower extremities. The examiner noted the Veteran had involvement of both lower sciatic nerves. The VA examiner noted there was no record of treatment for the Veteran's back condition in service, however, the Veteran had an MVA [motor vehicle accident] 2015 per the Veteran's report. 2019 x-rays were normal and an MRI 2020 notes mild neuroforaminal narrowing at L3-4, L4-5. The VA examiner noted the Veteran's functional impact was described as "Veteran's Lumbar radiculopathy limits forward flexion, lifting."

At the Veteran's October 2024 Board hearing, the Veteran testified that his radiculopathy manifested first "like a warm sensation. And then it'll be a (INAUDIBLE) pain, and then it'll just be a dull pain until I'm able to either pop my back or lay down for a second on the floor." The Veteran testified that he would have numbness and tingling "just on the back of my legs, through my butt into my, into the side of my knee."

The November 2024 private examiner did not address the Veteran's radiculopathy. Likewise, the Veteran's January 2025 argument did not provide any argument in support of a higher rating for the Veteran's bilateral sciatic radiculopathy rating.

Based on the above, the Board finds that the Veteran's bilateral sciatic radiculopathy is primarily manifested by pain and mild paresthesias and/or dysesthesias. The Board finds that the most probative evidence of record is against a finding that the disability is manifest by impairment of motor functions, trophic changes, loss of reflexes, muscle atrophy, or complete paralysis. The Board thus finds that the level of impairment is most analogous to mild incomplete paralysis.

The Board has also considered, throughout the appeal, whether higher ratings are available under the regulations pertaining to neuritis and neuralgia for the Veteran's sciatic nerve disabilities. In terms of neuritis, the March 2021 VA examiner did not endorse findings of muscle atrophy or constant pain, thus, a higher evaluation under the regulations pertaining to neuritis is not warranted for the Veteran's sciatic nerve disability.

Similarly, in terms of neuralgia, while the March 2021 VA examiner found the Veteran had mild paresthesias and/or dysesthesias as to each disability, these findings would not provide for a higher evaluation as the Veteran was already assigned evaluations equal or higher ratings throughout the appeal period.

The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves. Therefore, a separate or higher rating under a different Diagnostic Code is not warranted.

For these reasons, the Board finds that the evidence weighs persuasively against the claim for a higher rating for the Veteran's bilateral sciatic radiculopathy. Because the evidence weighs substantially against the claims, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Accordingly, the claim for a rating in excess of 10 percent for right lower extremity sciatic radiculopathy is denied. Likewise, the claim for a rating in excess of 10 percent for left lower extremity sciatic radiculopathy is denied.

Entitlement to an initial compensable rating for traumatic brain injury (TBI).

Entitlement to an initial compensable rating for migraine headaches.

The Veteran asserts that he is entitled to an initial compensable rating for TBI with migraine headaches.

Initially, the Board notes that during the October 2024 Board hearing, the Veteran testified that he wished to withdraw the issue of entitlement to a compensable rating for traumatic brain injury with migraine headaches from appellate review. Specifically, when asked if the Veteran was "withdrawing the claim of the increased rating for the TBI with headaches." The Veteran responded, "Yes, ma'am." When asked if the Veteran "understand[s] by withdrawing that claim, the Board will not be making a decision, and that issue is done." Again, the Veteran, responded, "Yes, ma'am."

An oral withdrawal of an appeal, such as one made at a hearing, must be (1) explicit, (2) unambiguous, and (3) done with a full understanding of the consequences of such action on the part of the claimant. DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011); see Acree v. O'Rourke, 891 F.3d 1009, 1014 (Fed. Cir. 2018) (the Board must address all three prongs of the DeL
, the Board will not be making a decision, and that issue is done." Again, the Veteran, responded, "Yes, ma'am."

Additionally, in a letter dated October 29, 2024, the Veteran's representative stated, "We were before you yesterday for Virtual Video hearing. As stated at hearing, Veteran requests dismissal of issue of increase TBI."

Even though the Veteran may have attempted to withdraw his claim for an increased rating, the oral withdrawal does not indicate the Veteran had a full understanding of the consequences of withdrawing the claim for increased rating for TBI. There is no evidence in the hearing transcript that the hearing VLJ fully explained the full consequences of withdrawing the claim. Accordingly, the Board finds that the oral withdrawal was not sufficient. Likewise, the October 2024 written withdrawal referred to the Board testimony and the claim, but did not provide the docket number or enough specificity to effectuate a withdrawal of a claim.

The Board acknowledges that in a letter dated January 22, 2025, the Veteran's representative sought a "request to reinstate" the Veteran's claim for an increased rating for TBI. The Veteran's representative stated, "Error in Letter to Dismiss Increase 30 percent Issue with Undersigned Inadvertently also asking dismissal increase TBI 0 percent with migraine headaches. Veteran respectfully requests [the VLJ] to reinstate issue TBI 0 percent with migraine headache."

An "unambiguous written withdrawal" is effective upon receipt, and "an inquiry into the appellant's subjective understanding is not required when there is an unambiguous written withdrawal." Martinez v. McDonough, 36 Vet. App. 320, 330-331 (2023) citing Hembree v. Wilkie, 33 Vet. App. 1 (2020). Because the Board has determined neither the oral withdrawal nor the written withdrawal are effective, the request to "reinstate" is redundant. The Board, however, will consider the included argument.

As noted above, a May 2021 rating decision granted service connection for traumatic brain injury with migraine headaches and assigned a noncompensable rating. In July 2021, the Veteran sought Board review for a rating "in excess of zero percent."

The Veteran's service-connected TBI is rated as 0 percent disabling in accordance with the General Rating Formula for the Neurological System. 38 C.F.R. § 4.124a, DC 8045.

Disability ratings are determined by applying the criteria set forth in the VA Schedule of Rating Disabilities (Rating Schedule) and are intended to represent the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability, 38 C.F.R. § 4.2; resolving any reasonable doubt regarding the degree of disability in favor of the claimant, 38 C.F.R. § 4.3; where there is a questions as to which of two evaluations apply, assigning a higher of the two where the disability pictures more nearly approximates the criteria for the next higher rating, 38 C.F.R. § 4.7; and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disability upon the person's ordinary activity, 38 C.F.R. § 4.10. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991).

A claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Thus, separate ratings can be assigned for separate periods of time based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield,
7; and, evaluating functional impairment on the basis of lack of usefulness, and the effects of the disability upon the person's ordinary activity, 38 C.F.R. § 4.10. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991).

Under Diagnostic Code 8045, there are three main areas of dysfunction that may result from TBI and have profound effects on functioning: cognitive (which is common in varying degrees after TBI), emotional/behavioral, and physical. Each of these areas of dysfunction may require evaluation.

Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Executive functions are goal setting, speed of information processing, planning, organizing, prioritizing, self-monitoring, problem solving, judgment, decision making, spontaneity, and flexibility in changing actions when they are not productive. Not all of these brain functions may be affected in a given individual with cognitive impairment, and some functions may be affected more severely than others. In a given individual, symptoms may fluctuate in severity from day to day. Evaluate cognitive impairment under the table titled "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified."

Subjective symptoms may be the only residual of TBI or may be associated with cognitive impairment or other areas of dysfunction. Evaluate subjective symptoms that are residuals of TBI, whether or not they are part of cognitive impairment, under the subjective symptoms facet in the table titled "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified." However, separately evaluate any residual with a distinct diagnosis that may be evaluated under another diagnostic code, such as migraine headache or Meniere's disease, even if that diagnosis is based on subjective symptoms, rather than under the "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified" table.

Evaluate emotional/behavioral dysfunction under § 4.130 (Schedule of ratings-mental disorders) when there is a diagnosis of a mental disorder. When there is no diagnosis of a mental disorder, evaluate emotional/behavioral symptoms under the criteria in the table titled "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified."

Evaluate physical (including neurological) dysfunction based on the following list, under an appropriate diagnostic code: Motor and sensory dysfunction, including pain, of the extremities and face; visual impairment; hearing loss and tinnitus; loss of sense of smell and taste; seizures; gait, coordination, and balance problems; speech and other communication difficulties, including aphasia and related disorders, and dysarthria; neurogenic bladder; neurogenic bowel; cranial nerve dysfunctions; autonomic nerve dysfunctions; and endocrine dysfunctions.

The preceding list of types of physical dysfunction does not encompass all possible residuals of TBI. For residuals not listed here that are reported on an examination, evaluate under the most appropriate diagnostic code. Evaluate each condition separately, as long as the same signs and symptoms are not used to support more than one evaluation, and combine under § 4.25 the evaluations for each separately rated condition. The evaluation assigned based on the "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified" table will be considered the evaluation for a single condition for purposes of combining with other disability evaluations.

Consider the need for special monthly compensation for such problems as loss of use of an extremity, certain sensory impairments, erectile dysfunction, the need for aid and attendance (including for protection from hazards or dangers incident to the daily environment due to cognitive impairment), being housebound, etc.

Diagnostic Code 8045 directs VA to evaluate symptoms under another appropriate code whenever possible, to include for any subjective residual symptom with a distinct diagnosis, diagnosed mental disorders, and any physical dysfunction.

There is additional detailed instruction on how to evaluate cognitive impairment and subjective symptoms under Diagnostic Code 8045, when they are not otherwise appropriate to evaluate under a separate diagnostic code. In relevant part, those instructions are as follows:

The table titled "Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified" contains 10 important facets of TBI related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 5th level, the highest level of impairment
directs VA to evaluate symptoms under another appropriate code whenever possible, to include for any subjective residual symptom with a distinct diagnosis, diagnosed mental disorders, and any physical dysfunction.

However, not every facet has every level of severity. The Consciousness facet, for example, does not provide for an impairment level other than "total," since any level of impaired consciousness would be totally disabling. Assign a 100-percent evaluation if "total" is the level of evaluation for one or more facets. If no facet is evaluated as "total" assign the overall percentage evaluation based on the level of the highest facet as follows: 0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent. For example, assign a 70 percent evaluation if 3 is the highest level of evaluation for any facet.

Note (1): There may be an overlap of manifestations of conditions evaluated under the table titled "Evaluation Of Cognitive Impairment And Other Residuals Of TBI Not Otherwise Classified" with manifestations of a comorbid mental or neurologic or other physical disorder that can be separately evaluated under another diagnostic code. In such cases, do not assign more than one evaluation based on the same manifestations. If the manifestations of two or more conditions cannot be clearly separated, assign a single evaluation under whichever set of diagnostic criteria allows the better assessment of overall impaired functioning due to both conditions. However, if the manifestations are clearly separable, assign a separate evaluation for each condition.

Note (2): Symptoms listed as examples at certain evaluation levels in the table are only examples and are not symptoms that must be present in order to assign a particular evaluation.

Note (3): "Instrumental activities of daily living" refers to activities other than self-care that are needed for independent living, such as meal preparation, doing housework and other chores, shopping, traveling, doing laundry, being responsible for one's own medications, and using a telephone. These activities are distinguished from "Activities of daily living," which refers to basic self-care and includes bathing or showering, dressing, eating, getting in or out of bed or a chair, and using the toilet.

Note (4): The terms "mild," "moderate," and "severe" TBI, which may appear in medical records, refer to a classification of TBI made at, or close to, the time of injury rather than to the current level of functioning. This classification does not affect the rating assigned under diagnostic code 8045.

Turning to the evidence, a review of the Veteran's post-service treatment records are silent for any complaint, diagnosis or treatment for any head injury. At an April 2019 VA primary care treatment, the Veteran had a negative TBI screening. See Oklahoma VAMC.

The Veteran was afforded a March 2021 VA TBI examination. The VA examiner noted a diagnosis of traumatic brain injury (TBI). The VA examiner noted the TBI claim was denied owing to lack of relevant records. However, the Veteran's discharge records note that he has a parachute badge. The two injuries occurred during parachute training at the Holland Drop Zone on Ft. Bragg. The first was a nighttime jump; the Veteran hit the ground, his weapons case hit his shoulder, and then his shoulder struck him in the head and knocked him out for a period of seconds. The Veteran was dazed and had headaches for approximately two days. The Veteran told a physician about it, and he was given ibuprofen. The second incident occurred in 2015 when he landed on his head. The Veteran was not sure whether he had loss of consciousness, but he was dazed for about 20 minutes and had headaches for approximately two weeks. The VA examiner noted the Veteran had headaches that began during his term of service, but they are not as severe now as they have been in the past.

On examination, the Veteran had no complaints of impairment of memory, attention, concentration, or executive functions; normal judgement; social interaction was routinely appropriate; the Veteran was always oriented to person, time, place, and situation; had normal motor activity; had normal visual spatial orientation; had no subjective symptoms; had no neurobehavior effects; was able to communicate by spoken and written language (expressive communication) and to comprehend spoken and written language;
The Veteran was not sure whether he had loss of consciousness, but he was dazed for about 20 minutes and had headaches for approximately two weeks. The VA examiner noted the Veteran had headaches that began during his term of service, but they are not as severe now as they have been in the past.

On examination, the Veteran had no complaints of impairment of memory, attention, concentration, or executive functions; normal judgement; social interaction was routinely appropriate; the Veteran was always oriented to person, time, place, and situation; had normal motor activity; had normal visual spatial orientation; had no subjective symptoms; had no neurobehavior effects; was able to communicate by spoken and written language (expressive communication) and to comprehend spoken and written language; and the Veteran was conscious. The VA examiner noted the Veteran had no residuals, no other pertinent physical findings, scars, complications, conditions, signs and/or symptoms, and had no functional impact attributable to the TBI.

Because the Veteran presented with no noted abnormalities for each category, a 0 was assigned for each facet. In order to warrant a higher evaluation, the Veteran's TBI would need to show the assignment of at least a level of 1 in one of the facets or more. No such findings have been shown in the medical evidence of record.

The evidence of record does not warrant a rating in excess of the 0 percent assigned for the Veteran's TBI at any time during the period pertinent to this appeal. 38 U.S.C. § 5110.

Regarding the headaches, the Veteran's migraine headache disability is rated under 38 C.F.R. § 4.124a, Diagnostic Code 8100, for migraines.

Under DC 8100, a compensable rating of 10 percent is assigned for migraines with characteristic prostrating attacks averaging one in 2 months over last several months. A 30 percent rating is assigned for migraines with characteristic prostrating attacks occurring on an average once a month over the previous several months. A maximum 50 percent rating is assigned for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. See 38 C.F.R. § 4.124a, DC 8100 (2019); see also Pierce v. Principi, 18 Vet. App. 440, 445 (2004) (finding rating criteria do not define "severe economic inadaptability," but nothing in DC 8100 requires that Veteran be completely unable to work to qualify for 50 percent rating; "productive of economic inadaptability" can be read as either "producing" or "capable of producing.").

The Rating Schedule does not define "prostrating." However, "prostration" has been defined as "complete physical or mental exhaustion." Merriam-Webster's New Collegiate Dictionary 999 (11th ed. 2007). "Prostration" has also been defined as "extreme exhaustion or powerlessness." Dorland's Illustrated Medical dictionary, 32nd Edition (2012), p. 1531. According to Stedman's Medical Dictionary, 27th Edition (2000), p. 1461, "prostration" is defined as "a marked loss of strength, as in exhaustion." See, e.g., Eady v. Shinseki, No. 11-3223, 2013 WL 500460 (Vet. App. Feb. 12, 2013). Additionally, "characteristic prostrating attacks" means "migraine attacks that typically produce powerlessness or a lack of vitality." Johnson v. Wilkie, 30 Vet. App. 245, 252 (2018).

As to the term "productive of economic inadaptability," such term could have either the meaning of "producing" or "capable of producing" economic inadaptability. Pierce v. Principi, 18 Vet. App. 440, 445 (2004). Thus, migraines need not actually produce severe economic inadaptability to warrant the 50 percent rating. See Pierce, 18 Vet. App. at 445-46. Further, "economic inadaptability" does not mean unemployability, as such would undermine the purpose of regulations pertaining to TDIU. See Pierce, 18 Vet. App. at 446; see also 38 C.F.R. § 4.16. The Board notes, however, that the migraines must be, at a minimum, capable of producing severe economic inadaptability.

Words such as "very frequently" are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6.

In assigning
18 Vet. App. at 445-46. Further, "economic inadaptability" does not mean unemployability, as such would undermine the purpose of regulations pertaining to TDIU. See Pierce, 18 Vet. App. at 446; see also 38 C.F.R. § 4.16. The Board notes, however, that the migraines must be, at a minimum, capable of producing severe economic inadaptability.

In assigning a disability rating, "the Board may not deny entitlement to a higher rating on the basis of relief provided by medication when those effects are not specifically contemplated by the rating criteria." Jones v. Shinseki, 26 Vet. App. 56, 63 (2012). As the rating criteria under 38 C.F.R. § 4.124a, Diagnostic Code 8100, do not explicitly contemplate the ameliorative effects of medication, the assigned rating for migraine headaches should contemplate the frequency of characteristic prostrating attacks that would occur without medication.

In Holmes v. Wilkie, 33 Vet. App. 67 (2020), the Court held that Diagnostic Code 8100 contemplates all migraine symptoms. The Court held that VA must "consider all the symptoms the veteran experiences because of his migraine attacks, and then rate those symptoms based on the frequency, duration, severity, and economic impact of those attacks." It also held that "migraines include more than just headaches," which means that VA must consider symptoms beyond head pain. Id. at 76. Therefore, to evaluate migraines under Diagnostic Code 8100, VA must consider all symptoms experienced due to migraine attacks and then rate the symptoms based on the frequency, duration, and economic impact of those attacks. The Court commented that this analysis is similar to that used to assign ratings for psychiatric disabilities under 38 C.F.R. § 4.130.

Turning to the evidence, a review of the Veteran's post-service treatment records are silent for any complaint, diagnosis or treatment for any headaches. At an April 2019 VA primary care treatment, the Veteran denied headaches. See Oklahoma VAMC.

The Veteran was afforded a March 2021 VA headache examination. The VA examiner noted a diagnosis of migraine including migraine variants. The Veteran reported the onset of his headaches was in 2016 and he developed headaches during his term of service. He could not relate this to any specific incident, cause or injury. The Veteran reported the headaches were worse in the past, now they were about one every two months, lasting up to two days, occasionally severe. The Veteran reported the pain was bitemporal and bicipital and denied aura. The Veteran reported he often just waited them out instead of trying to treat them. The Veteran reported he treated the headaches with over the counter ibuprofen as needed at times. On examination, the VA examiner noted the Veteran did not have characteristic prostrating attacks of migraine/non-migraine headache pain and did not have very prostrating and prolong attacks of migraines/non-migraine pain productive of severe economic inadaptability. The VA examiner noted the Veteran did not have any other pertinent physical findings, complications, conditions, signs, symptoms or scars as a result of the headaches and the headache condition did not impact the Veteran's ability to work.

Because the Veteran had no characteristic prostrating attacks, a noncompensable rating was assigned.

In his January 2025 argument, the Veteran's representative asserted that the March 2021 TBI and headache examinations contained inaccurate information. However, the Veteran's representative offered information that was not provided by the record. Therefore, the Board cannot determine the veracity of the claimed errors. Additionally, the Veteran's representative argued that the VA TBI examiner relied on an inappropriate cognitive test. The Board may only rely on independent medical evidence and may not substitute its own medical opinion for that of competent medical professionals. See Colvin v. Derwinski, 1 Vet. App. 171, 172 (1991). This includes commenting upon the relative severity, common symptomatology, and usual treatment of a disability without citing to any independent medical evidence to support its finding. See Kahana v. Shinseki, 24 Vet. App. 428, 434 (2011). The Board notes that the TBI examination was completed by a neurologist who is considered competent to complete the examination. Therefore, without evidence to the contrary, the Board must rely on the independent medical opinion provided.

Based on the foregoing, the Board finds the evidence weighs persuasively against the claims for
own medical opinion for that of competent medical professionals. See Colvin v. Derwinski, 1 Vet. App. 171, 172 (1991). This includes commenting upon the relative severity, common symptomatology, and usual treatment of a disability without citing to any independent medical evidence to support its finding. See Kahana v. Shinseki, 24 Vet. App. 428, 434 (2011). The Board notes that the TBI examination was completed by a neurologist who is considered competent to complete the examination. Therefore, without evidence to the contrary, the Board must rely on the independent medical opinion provided.

Based on the foregoing, the Board finds the evidence weighs persuasively against the claims for initial compensable ratings for both the Veteran's TBI and headaches. Because the evidence weighs substantially against the claims, the benefit of the doubt doctrine is not for application. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Accordingly, the claim for an initial compensable rating for traumatic brain injury (TBI) is denied. Likewise, the Board finds that the claim for an initial compensable rating for migraine headaches is denied.

Danette Mincey

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Melnyk, H.

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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