Case A26037036

MARIAH N. SIM · 2026 · Case ID: A26037036

MIXED

Summary

The veteran, who served in the U.S. Navy from August 1967 to September 1969, appeals the Board of Veterans' Appeals (BVA) decision regarding the effective date for service connection of a right lower extremity above-knee amputation and its associated scar, as well as the initial rating for these conditions. The veteran sought an earlier effective date than the February 14, 2024, date assigned by the agency of original jurisdiction (AOJ), asserting entitlement based on an April 2022 amputation. The Board reviewed the claim under the Appeals Modernization Act and found that the veteran's initial claim for the amputation was received on February 13, 2024, via VA Form 21-526EZ. While the veteran had submitted an intent to file on November 14, 2022, no claim was received within the subsequent year. The Board granted an earlier effective date of February 13, 2024, for both the amputation and its scar, finding the AOJ's instruction about needing a proper form for a previously denied claim to be incorrect, as no prior denial existed. The Board denied the veteran's claim for an increased rating above 60 percent for the above-knee amputation, noting that the VA examination documented amputation of the middle or lower third of the thigh, which corresponds to the 60 percent rating under Diagnostic Code 5162, and did not meet the criteria for higher ratings based on upper third amputation or disarticulation. For the right thigh amputation scar, the Board denied a compensable rating, finding the scar measured 54 sq. cm., was not painful or unstable, lacked underlying soft tissue damage, and did not meet the 144 sq. cm. threshold for a compensable rating under Diagnostic Code 7802. The Board found the evidence persuasively weighed against the claims for higher ratings, and thus the benefit-of-the-doubt rule did not apply.

Rationale

Claim received Feb 13, 2024 via VA Form 21-526EZ; Amputation occurred in April 2022; Service connection granted as related to service-connected peripheral arterial disease

Service Branch

NAVY

Special Benefit

EARLIER EFFECTIVE DATE

Diagnostic Code

5162

Docket No.

260205-630258

Full Decision Text

Citation Nr: A26037036
Decision Date: 04/21/26 Archive Date: 04/21/26

DOCKET NO. 260205-630258
DATE: April 21, 2026

ORDER

Entitlement to an earlier effective date of February 13, 2024, but no earlier, for the grant of service connection for right lower extremity above-knee amputation is granted.

Entitlement to an earlier effective date of February 13, 2024, but no earlier, for the grant of service connection for right thigh amputation scar is granted.

Entitlement to an initial rating higher than 60 percent for right lower extremity above-knee amputation is denied.

Entitlement to an initial compensable rating for right thigh amputation scar is denied.

FINDINGS OF FACT

1. VA initially received a claim for service connection for right lower extremity above-knee amputation on February 13, 2024; there is no record of an earlier written communication that can be construed as an earlier unadjudicated claim.

2. The Veteran's right leg is amputated at the middle or lower third of the right thigh.

3. The Veteran's right thigh amputation scar measures 54 square (sq.) centimeters (cm.), is not painful or unstable, and does not have any underlying soft tissue damage.

CONCLUSIONS OF LAW

1. The criteria for entitlement to an earlier effective date of February 13, 2024, but no earlier, for the grant of service connection for right lower extremity above-knee amputation have been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.400.

2. The criteria for entitlement to an earlier effective date of February 13, 2024, but no earlier, for the grant of service connection for right thigh amputation scar have been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.400.

3. The criteria for entitlement to an initial rating higher than 60 percent for right lower extremity above-knee amputation have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.14, 4.71a, Diagnostic Code 5162.

4. The criteria for entitlement to an initial compensable rating for right thigh amputation scar have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.14, 4.118, Diagnostic Code 7802.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Navy from August 1967 to September 1969.

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

In the February 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the July 2025 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

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

The Board notes that less than one year has elapsed since the July 2025 mailing of notice of the rating decision on appeal. Generally, the Board may not decide an appeal prior to the expiration of the one-year period. Williams v. McDonough, 37 Vet. App. 305 (2024). However, this appeal has been advanced on the Board's docket (AOD) pursuant to 38 C.F.R. § 20.902(c) based on the Veteran's age. The Board interprets the AOD status as reflecting an intent to have this matter reviewed in an expeditious manner, which the Board finds to be an implicit
. Specific instructions for filing a Supplemental Claim are included with this decision.

The Board notes that less than one year has elapsed since the July 2025 mailing of notice of the rating decision on appeal. Generally, the Board may not decide an appeal prior to the expiration of the one-year period. Williams v. McDonough, 37 Vet. App. 305 (2024). However, this appeal has been advanced on the Board's docket (AOD) pursuant to 38 C.F.R. § 20.902(c) based on the Veteran's age. The Board interprets the AOD status as reflecting an intent to have this matter reviewed in an expeditious manner, which the Board finds to be an implicit waiver of his right to change dockets under Williams.

Effective Date Claims

Except as otherwise provided, the effective date of an evaluation and award of compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. If a claim is received within one year after separation from service, the effective date for the grant of service connection is the day following separation from service; otherwise, it is the date of receipt of the claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(b)(2)(i).

A claimant or his or her duly authorized representative may indicate a claimant's desire to file a claim for benefits by submitting an intent to file a claim to VA. 38 C.F.R. § 3.155(b). An intent to file a claim must provide sufficient identifiable or biographical information to identify the claimant. Id. Upon receipt of the intent to file a claim, VA will furnish the claimant with the appropriate application form. Id. If VA receives a complete application form within 1 year of receipt of the intent to file a claim, VA will consider the complete claim filed as of the date the intent to file a claim was received. 38 C.F.R. § 3.155(b)(1)(i)-(iii) specifies that an intent to file be submitted (i) electronically, (ii) in writing on the paper intent to file form proscribed by VA and signed and dated, or (iii) orally communication to VA personnel. Only one complete claim for a benefit (e.g., compensation, pension) may be associated with each intent to file, and if multiple claims are filed within one year of an intent to file, only the first claim filed will be associated with the intent to file a claim. 38 C.F.R. § 3.155(d)(1)(ii).

1. Entitlement to an earlier effective date of February 13, 2024, but no earlier, for the grant of service connection for right lower extremity above-knee amputation is granted.

2. Entitlement to an earlier effective date of February 13, 2024, but no earlier, for the grant of service connection for right thigh amputation scar is granted.

The Veteran asserts that he should be entitled to an earlier effective date for the grant of service connection for right lower extremity above-knee amputation and the associated scar because his right above-knee amputation occurred in April 2022. See correspondence attached to VA Form 10182.

By way of history, on February 13, 2024, VA received a VA Form 21-526EZ for "Filing For Benefits Under Section 1151 (Right Leg Amputated To The Knee)." On February 14, 2014, a VA letter informed the Veteran that a proper form must be used for a previously denied claim. On February 14, 2024, VA received a VA Form 21-0996, an intent to file a claim form. On January 29, 2025, VA received a VA Form 21-526EZ for "Amputation Right Knee Above Knee" and "Leg Amputation Filed Under Section 1151."

In the July 2025 rating decision on appeal, the AOJ granted service connection for right lower extremity above-knee amputation and the associated scar, effective February 14, 2024. The AOJ noted that although the Veteran submitted a Section 1151 claim, as the medical evidence shows that gangrene caused by the service-connected right ankle peripheral arterial disease necessitated the amputation of right leg above the knee, service connection is established as related to the service-connected right ankle peripheral arterial disease. The AOJ noted that the grant is effective February 14, 2024, because it is the date the intent to file a claim form was received.

Upon review, the Board finds that entitlement to
Under Section 1151."

Upon review, the Board finds that entitlement to an effective date of February 13, 2014, but no earlier, is warranted for the grant of service connection for right lower extremity above-knee amputation and the associated scar.

The Veteran initially submitted a claim for service connection for right above-knee amputation on February 13, 2024. While the VA informed the Veteran that a proper form needs to be submitted for a previously denied claim, the instruction was incorrect as the AOJ had not previously denied a claim for right above-above knee amputation. Thus, the February 13, 2024 VA Form 21-526EZ was valid for the claim for right above-knee amputation, and February 13, 2024 is the date VA initially received the claim. Accordingly, the Veteran is entitled to an earlier effective date of February 13, 2024 for the grant of service connection for right above-knee amputation and the associated scar based on VA's receipt of the VA Form 21-526EZ for right above-knee amputation on February 13, 2024, and not based on the receipt of the intent to file a claim the next day on February 14, 2024.

Prior to February 13, 2024, there is no record of an earlier written communication that can be construed as an earlier unadjudicated claim. The record shows the Veteran had submitted an intent to file a claim on November 14, 2022. However, no claim was received within a year from that date. As the evidence of record fails to show any claim for right above-above knee amputation prior to February 13, 2024, entitlement to an effective date prior to February 13, 2024, for right above-above knee amputation and the associated scar is not warranted.

In sum, entitlement to an earlier effective date of February 13, 2024, but no earlier, for the grant of service connection for right lower extremity above-knee amputation and its associated scar is granted. 38 U.S.C. § 5110; 38 C.F.R. § 3.400.

Increased Ratings

Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her 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.

Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Reasonable doubt as to the degree of disability will be resolved in the veteran's favor. 38 C.F.R. § 4.3. It is permissible to switch diagnostic codes to reflect more accurately a claimant's current symptoms. See Read v. Shinseki, 651 F. 3d 1296, 1302 (Fed. Cir. 2011).

Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994).

Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they
rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994).

Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the veteran, as well as the entire history of the veteran's disability in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991).

Separate ratings can be assigned for separate periods based on the facts found - a practice known as "staged" ratings. Francisco v. Brown, 7 Vet. App. 55, 58 (1994); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id.

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

The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10.

The veteran is competent to report symptoms and experiences observable by his senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a).

Although the Board has an obligation to provide reasons and bases supporting its decision, there is no obligation to discuss, in detail, the extensive evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that the Board must review the entire record but does not have to discuss each piece of evidence). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's analysis will focus specifically on what the evidence shows, or fails to show, as it relates to the Veteran's claim.

When there is an approximate balance of positive and negative evidence as to any issue material to the determination of a matter, VA will resolve reasonable doubt in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

3. Entitlement to an initial rating higher than 60 percent for right lower extremity above-knee amputation is denied.

In the July 2025 rating decision, the AOJ granted service connection for right lower extremity above-knee amputation with an initial 60 percent rating effective February 14, 2024. The Board herein granted an earlier effective date of February 13, 2024. The Veteran asserts that he is entitled to an initial rating higher than 60 percent. See March 2026 Appellate Brief.

Diagnostic Codes 5160-5165, address amputation of the thigh. Here, the Veteran's right above-knee amputation is evaluated under Diagnostic Code 5162. This diagnostic code provides for an evaluation of 60 percent for amputation of the middle or lower third of the femur. 38 C.F.R. § 4.71a.

Under Diagnostic Code 5160, which applies to complete amputation of lower extremity, trans-pelvic amputation (in
14, 2024. The Board herein granted an earlier effective date of February 13, 2024. The Veteran asserts that he is entitled to an initial rating higher than 60 percent. See March 2026 Appellate Brief.

Under Diagnostic Code 5160, which applies to complete amputation of lower extremity, trans-pelvic amputation (involving complete removal of the femur and intrinsic pelvic musculature along with any portion of the pelvic bones) is assigned a rating of 100 percent, and disarticulation (involving complete removal of the femur and intrinsic pelvic musculature only) is assigned a 90 percent rating. Under Diagnostic Code 5161, amputation of the upper third of the femur (one-third of the distance from perineum to knee joint measured from perineum) is assigned a rating of 80 percent. Under Diagnostic Code 5163, a below-the-knee amputation with a defective stump, with thigh amputation recommended, is assigned a rating of 60 percent. Under Diagnostic Code 5164, a below-the-knee amputation, which is not improvable by prosthesis, controlled by natural knee action, is assigned a rating of 60 percent. Under Diagnostic Code 5165, a below-the-knee amputation at a lower level, permitting prosthesis, is assigned a rating of 40 percent. 38 C.F.R. § 4.71a.

In order to substantiate a higher evaluation, the evidence must show amputation of the upper third of the femur (one-third of the distance from the perineum to knee joint measured from perineum) or disarticulation of the thigh with loss of extrinsic pelvic girdle muscles.

The July 2025 VA examination for amputation documents assessment of a right above-knee amputation to the middle or lower third of the right thigh. Amputation of the upper third, one-third of the distance from the perineum to the knee joint, measured from the perineum, was not shown upon examination. Further, disarticulation (involving complete removal of the femur and intrinsic pelvic musculature only) nor trans-pelvic amputation (involving complete removal of the femur and intrinsic pelvic musculature along with any portion of the pelvic bones) were shown. Under these circumstances, a 60 percent, but no greater evaluation is warranted for amputation of the middle or lower third of the femur. 38 C.F.R. § 4.71a, 5162.

Further review of the record shows that the Veteran receives VA treatment providers for various disabilities. However, there is no indication from the treatment notes of record that the Veteran has reported amputation symptoms that are worse than those noted above.

The Board has considered whether staged ratings under Hart v. Mansfield, supra is appropriate; however, the Board finds that his symptomatology was been stable throughout the period on appeal. Therefore, assigning staged ratings is not warranted. The Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017).

Additionally, the Board has considered whether an inferred claim for a TDIU has been raised pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009). The Veteran's current employment status is unknown. The Veteran has also not alleged, and the record does not suggest that he is unable to obtain and maintain employment due solely to his service connected right leg amputation. As such, a Rice claim is not raised.

In so finding the above, the Board acknowledges the Veteran's contentions that his right leg amputation is more severe than contemplated by the current rating assigned. The Veteran is competent to report symptoms such as pain because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). However, he is not considered competent to medically attribute or assess the severity of his right leg amputation as required in the
, the Board acknowledges the Veteran's contentions that his right leg amputation is more severe than contemplated by the current rating assigned. The Veteran is competent to report symptoms such as pain because this requires only personal knowledge, not medical expertise, as it comes to him through his senses. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). Lay testimony is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). However, he is not considered competent to medically attribute or assess the severity of his right leg amputation as required in the Diagnostic Code. See Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Therefore, his statements do not constitute competent evidence and, the Board assigns more probative weight to the competent medical evidence of record.

In conclusion, the Board finds that the evidence of record persuasively weighs against the claim for an initial rating higher than 60 percent for right above-knee amputation. As the evidence of record persuasively weighs against the claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

4. Entitlement to an initial compensable rating for right thigh amputation scar is denied.

In the July 2025 rating decision, the AOJ granted service connection for right thigh amputation scar as associated to the service-connected right lower extremity above-knee amputation, with zero percent rating effective February 14, 2024. The Board herein granted an earlier effective date of February 13, 2024. The Veteran asserts that he is entitled to an initial compensable rating for right thigh amputation scar. See March 2026 Appellate Brief.

The Veteran's right thigh amputation scar is rated under Diagnostic Code 7802. Under Diagnostic Code 7802, a maximum 10 percent rating is warranted for burn scars or scars due to other causes, not of the head, face, or neck, that are superficial (not associated with soft tissue damage) and nonlinear, affecting an area or areas of 144 inches2 (929 cm2) or greater.

Diagnostic Code 7802 is for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. 38 C.F.R. § 4.118.

The Board finds that the evidence of record persuasively weighs against the assignment of a compensable rating under Diagnostic Code 7802 because the Veteran's scar is not manifested by an area or areas of 144 square inches (929 sq. cm.) or greater. The July 2025 VA examination for scars resulted in the diagnosis of right thigh stump scar due to right above-knee amputation. On examination, the scar was not painful or unstable, and did not have frequent loss of covering of skin over the scar. The scar measured 27 cm. x 2 cm. (54 sq. cm.), was not tender to palpation, was not unstable on inspection, and did not have underlying soft tissue damage. Further, the scar did not result in limitation of function, to include limitation of motion.

The Board has also considered the other diagnostic codes pertaining to scars. However, the Veteran's scar is not of the head, face, or neck, is not deep and non-linear, and is not associated with underlying soft tissue damage. Moreover, the Veteran's scar is not unstable or painful. Finally, the evidence of record shows there are no other disabling effects not considered in a rating provided under Diagnostic Codes 7800-04.

Further review of the record shows that the Veteran receives VA treatment providers for various disabilities, to include his scars. However, there is no indication from the treatment notes of record that the Veteran has reported scar symptoms that are worse than those noted above.

Additionally, the Board has considered whether an inferred claim for a TDIU has been raised pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009
Veteran has reported scar symptoms that are worse than those noted above.

Additionally, the Board has considered whether an inferred claim for a TDIU has been raised pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009). The Veteran's current employment status is unknown. The Veteran has also not alleged, and the record does not suggest, that he is unable to obtain and maintain employment due solely to his service connected scars. As such, a Rice claim is not raised.

The Board acknowledges that the Veteran believes that the disability on appeal has been more severe than the assigned disability rating reflects. Moreover, the Veteran is competent to report observable symptoms. Jandreau, 492 F.3d at 1377. However, medical treatment records do not show that the scar is manifested by an area or areas of 144 square inches (929 sq. cm.) or greater, or that there is soft tissue damage. The VA examination report and its objective findings are more competent and probative than the Veteran's assertion.

In conclusion, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for an initial compensable rating for right thigh amputation scar. As the evidence persuasively weighs against a compensable rating, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Mariah N. Sim

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board B. Jake Choi, Attorney Advisor

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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