MIGRAINE

M. MILLS · 2026 · Case ID: A26037081

MIXED

Summary

The veteran, who served in the U.S. Navy from April 2011 to April 2020, appeals the April 2025 rating decision concerning several conditions. The appeal focuses on claims for increased ratings for headaches, residuals of left hip fractures (including limitation of adduction, flexion, and extension), and tinnitus, as well as the propriety of a reduction in the rating for left lower extremity sensory peripheral neuropathy. The Board denied the claim for a higher rating for headaches, finding they did not meet the criteria for completely prostrating attacks, and affirmed the 30 percent rating. For the left hip residuals, the Board found the current 10 percent rating for limitation of adduction appropriate, and the noncompensable ratings for limitation of flexion and extension were also affirmed, as the evidence did not support higher evaluations. The Board found the reduction of the left lower extremity sensory peripheral neuropathy rating from 20 percent to 10 percent was improper, as the evidence did not demonstrate sustained material improvement, and therefore restored the 20 percent rating. The claim for an initial compensable rating for left lower extremity sensory peripheral neuropathy of the internal saphenous nerve was denied, as the symptoms were deemed mild and consistent with a noncompensable rating. Finally, the claim for a higher rating for tinnitus was denied, as the current 10 percent evaluation is the maximum schedular rating.

Rationale

Headaches not completely prostrating or prolonged; No severe economic inadaptability; 30 percent rating affirmed

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

8100

Docket No.

250506-545506

Full Decision Text

Citation Nr: A26037081
Decision Date: 04/21/26 Archive Date: 04/21/26

DOCKET NO. 250506-545506
DATE: April 21, 2026

ORDER

The claim for an initial rating higher than 30 percent for headaches is denied.

The claim for a rating higher than 10 percent for residuals of left hip fractures to the left acetabular and left pubic rami with limitation of adduction is denied.

The claim for an initial compensable rating for left thigh limitation of flexion is denied.

The claim for an initial compensable rating for left thigh limitation of extension is denied.

The claim for restoration of a 20 percent rating for left lower extremity sensory peripheral neuropathy effective February 24, 2025 is granted.

The claim for an initial compensable rating for left lower extremity sensory peripheral neuropathy of the internal saphenous nerve is denied.

The claim for a rating higher than 10 percent for tinnitus is denied.

FINDINGS OF FACT

1. The Veteran's headaches most nearly approximate characteristic prostrating attacks occurring on average once a month; the migraines do not manifest very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability.

2. The Veteran's residuals of fractures to the left acetabular and left pubic rami manifest impairment of the thigh with limitation of adduction to 10 degrees preventing him from crossing his legs; abduction is retained past 10 degrees and rotation does not prevent toe-out more than 15 degrees even with consideration of functional loss.

3. The Veteran's residuals of left hip fractures manifest limitation of left thigh flexion to 110 degrees or better, even with consideration of functional loss.

4. The Veteran's residuals of left hip fractures manifest limitation of left thigh extension to 20 degrees or better, even with consideration of functional loss.

5. The evaluation assigned the Veteran's service-connected left lower extremity sensory peripheral neuropathy was reduced in an April 2025 rating decision from 20 percent to 10 percent effective February 24, 2025.

6. The reduction of the rating assigned the left lower extremity sensory peripheral neuropathy did not reduce the Veteran's overall amount of compensation and VA was not required to provide a rating reduction proposal or provide the Veteran an opportunity to submit additional evidence in response.

7. At the time of the reduction, the 20 percent rating for the left lower extremity sensory peripheral neuropathy was in effect for a period less than five years.

8. The reduction of the 20 percent rating assigned the left lower extremity sensory peripheral neuropathy in the April 2025 rating decision was not proper as there was no sustained material improvement in the symptoms attributable to the disability and no improvement in the Veteran's ability to function under the ordinary conditions of life and work.

9. The Veteran's left lower extremity sensory peripheral neuropathy of the internal saphenous nerve manifests sensory deficits with intermittent pain, paresthesias, and loss of sensation in the left foot and toes. There is no reduction in muscle strength, reflexes, or sensation that most nearly approximates moderate paralysis of the internal saphenous nerve.

10. The Veteran's tinnitus manifests bilateral tinnitus; he is receiving the maximum schedular rating for tinnitus.

CONCLUSIONS OF LAW

1. The criteria for an initial rating higher than 30 percent for headaches are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, Diagnostic Code 8100.

2. The criteria for an initial rating higher than 10 percent for residuals of left hip fractures to the left acetabular and left pubic rami with limitation of adduction are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.13, 4.40, 4.45, 4.71a, Diagnostic Code 5253.

3. The criteria for an initial compensable rating for left thigh limitation of flexion are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.13, 4.40, 4.45, 4.71a, Diagnostic Code 5252.

4. The criteria for an initial compensable rating for left thigh limitation of extension are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1,
4.45, 4.71a, Diagnostic Code 5253.

4. The criteria for an initial compensable rating for left thigh limitation of extension are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.13, 4.40, 4.45, 4.71a, Diagnostic Code 5251.

5. The criteria for restoration of a 20 percent rating for left lower extremity sensory peripheral neuropathy from February 24, 2025 are met. 38 U.S.C. §§ 5107, 5112; 38 C.F.R. §§ 3.102, 3.105, 3.343, 3.344, 4.1, 4.2, 4.3, 4.124a, Diagnostic Codes 8520-8527.

6. The criteria for an initial compensable rating for left lower extremity sensory peripheral neuropathy of the internal saphenous nerve are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.14, 4.123, 4.124, 4.124a, Diagnostic Code 8527.

7. There is no schedular basis for the assignment of a rating higher than 10 percent for tinnitus. 38 U.S.C. § 1155; 38 C.F.R. §§ 38 C.F.R. § 3.321(b)(1), 4.87, Diagnostic Code 6260.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty with the United States Navy from April 2011 to April 2020. This case comes before the Board of Veterans' Appeals (Board) on appeal from an April 2025 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO).

The Appeals Modernization Act (AMA) automatically applies to all claims for which VA issues notice of an initial decision on or after February 19, 2019. See 38 C.F.R. § 3.2400(a)(1). This appeal stems from an April 2025 rating decision issued by the agency of original jurisdiction (AOJ) in a response to the Veteran's February 2025 claims for service connection and increased ratings; therefore, the AMA applies.

The April 2025 rating decision awarded service connection for headaches, lower extremity sensory peripheral neuropathy of the internal saphenous nerve, and limitation of extension and flexion of the left thigh. The rating decision also continued 10 percent evaluations for a left hip disability and tinnitus, while decreasing the rating assigned the left lower extremity sensory peripheral neuropathy of the internal popliteal nerve to 10 percent disabling from February 24, 2025. Notice of the rating decision and the Veteran's right to appeal was mailed to the Veteran on April 1, 2025.

In response, the Veteran filed a VA Form 10182 (Decision Review Request: Board Appeal) on May 6, 2025 appealing the initial ratings assigned his headaches, neuropathy of the internal saphenous nerve, and left thigh limitation of extension and flexion. The Veteran also disagreed with the continuation of the ratings for his left hip disability, tinnitus, and decreased evaluation for neuropathy of the internal popliteal nerve. He elected to place his appeal on the Board's Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the April 1, 2025 rating decision on appeal. 38 C.F.R. § 20.301.

In other words, the Board cannot consider evidence submitted after April 1, 2025, the date the AOJ provided notice to the Veteran of the April 2025 rating decision.

In October 2025, the Veteran requested that the Board advance his case on the docket due to severe financial hardship. Advancement of the docket (AOD) may be granted if the appellant is seriously ill or is under severe financial hardship, or if other sufficient cause is shown. 38 C.F.R. §
Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the April 1, 2025 rating decision on appeal. 38 C.F.R. § 20.301.

In other words, the Board cannot consider evidence submitted after April 1, 2025, the date the AOJ provided notice to the Veteran of the April 2025 rating decision.

In October 2025, the Veteran requested that the Board advance his case on the docket due to severe financial hardship. Advancement of the docket (AOD) may be granted if the appellant is seriously ill or is under severe financial hardship, or if other sufficient cause is shown. 38 C.F.R. § 20.902(c). The Board denied the Veteran's motion to advance his case on the docket in a ruling issued on December 11, 2025.

The Veteran's May 2025 VA Form 10182 also attempted to initiate an appeal with respect to the April 1, 2025 AOJ's decision to defer adjudication of the claim for service connection for a right hip disability. This was not a final action by the AOJ. The claim for service connection for a right hip disability was later adjudicated (and granted) in a rating decision issued on May 7, 2025. However, the earlier April 1, 2025 rating decision did not take any action regarding service connection for the right hip disability and is not appealable. The Board cannot review deferred actions of the AOJ, and the deferred claim for service connection for a right hip disability was not docketed at the Board and is not part of the current appeal.

Similarly, the Veteran also listed various other claims and rating decisions on the May 2025 VA Form 10182 in an apparent attempt to initiate appeals with respect to these adjudications. The October 2021 and May 2020 rating decisions identified by the Veteran were clearly issued more than a year before receipt of the May 2025 VA Form 10182, which renders the appeal untimely. See 38 C.F.R. §§ 19.52, 20.203. The Board has therefore not docketed these claims and they are also not part of the current appeal before the Board.

Increased Ratings

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.

Where the evidence contains factual findings that demonstrate distinct time periods in which the service-connected disability exhibits symptoms that would warrant different evaluations at any point during the appeal, the assignment of staged ratings is appropriate. See Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007).

For disabilities evaluated based on limitation of motion, VA is required to apply the provisions of 38 C.F.R. §§ 4.40, 4.45, pertaining to functional impairment. DeLuca v. Brown, 8 Vet. App. 202 (1995); Johnston v. Brown, 10 Vet. App. 80, 84-5 (1997); 38 C.F.R. § 4.59; see also Chavis v. McDonough, 34 Vet. App. 1 (2021) (ankylosis may be met by evidence demonstrating the functional equivalent of ankylosis).

1. Entitlement to an initial rating higher than 30 percent for headaches.

Service connection for headaches associated with a traumatic brain injury (TBI) was granted in the April 2025 rating decision on appeal with an initial 30 percent evaluation assigned effective February 24, 2025. The Veteran contends that an initial rating higher than 30 percent is warranted for headaches, though the Board notes he has not provided any specific argument in support of his claim.

The Board finds that the Veteran's headaches most nearly approximate the criteria associated with the current 30 percent evaluation throughout the relevant rating period.

The Veteran's headaches are currently rated as 30 percent disabling under Diagnostic Code 8100 pertaining to migraine headaches. Migraine headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability are rated 50 percent disabling. Migraine headaches with characteristic prostrating attacks occurring on average once a month over the last several months are rated 30 percent disabling. Migraine headaches with characteristic prostrating attacks averaging one in two months over the last several months are rated 10 percent disabling
, though the Board notes he has not provided any specific argument in support of his claim.

The Board finds that the Veteran's headaches most nearly approximate the criteria associated with the current 30 percent evaluation throughout the relevant rating period.

The Veteran's headaches are currently rated as 30 percent disabling under Diagnostic Code 8100 pertaining to migraine headaches. Migraine headaches with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability are rated 50 percent disabling. Migraine headaches with characteristic prostrating attacks occurring on average once a month over the last several months are rated 30 percent disabling. Migraine headaches with characteristic prostrating attacks averaging one in two months over the last several months are rated 10 percent disabling. Less frequent attacks are rated as noncompensably disabling. 38 C.F.R. § § 4.124a.

The Board notes that the term "prostrating" is not defined in VA regulation. For reference purposes, the Board notes that "prostration" is defined as "extreme exhaustion or powerlessness." Dorland's Illustrated Medical Dictionary, 1531 (32nd ed. 2012). Although not binding on the Board, VA's Adjudication Procedures Manual defines prostrating under Diagnostic Code 8100 as "causing extreme exhaustion, powerlessness, debilitation or incapacitation with substantial inability to engage in ordinary activities." See M21-1, pt. V, Subpt. iii, Ch. 12, Sec. A(3)(b).

In Johnson v. Wilkie, 30 Vet. App. 245 (2018), the Court of Appeals for Veterans Claims (Court) also provided a definition of prostrating. In Johnson, the Court stated that "prostrating" was "lacking in vitality or will: powerless to rise: laid low," citing Webster's Third New International Dictionary. It also stated that Diagnostic Code 8100 set forth successive rating criteria, and since characteristic prostrating attacks plainly described migraines that typically produce powerlessness or a lack of vitality, to be "completely prostrating" meant that the headaches must "render the veteran entirely powerless." Johnson, 30 Vet. App. at 252.

The Board finds that the current 30 percent evaluation is appropriate for the Veteran's headaches as they most nearly approximate characteristic prostrating attacks occurring on average once a month during the relevant rating period. This finding is based on a holistic analysis, with consideration of all the symptoms produced by the migraines and the frequency, duration, severity, and economic impact of those symptoms.

Upon VA examination in March 2025, the Veteran described having headaches occurring every other day, lasting for 30 to 60 seconds, or sometimes several minutes. The VA examiner found these headaches produced characteristic prostrating attacks of pain occurring more than once a month, but no completely prostrating or prolonged attacks of pain. The Veteran denied receiving any treatment for headaches or any specific evaluation with a healthcare provider. The functional impact of the Veteran's headaches was characterized as "difficult to function" at his work in sales for a firearms company as his work involved interacting with clients and using a computer.

Based on the above, the Board finds that the Veteran's migraines do not most nearly approximate very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability and a maximum 50 percent evaluation under Diagnostic Code 8100. The March 2025 VA examiner specifically found that the Veteran's headaches were not completely prostrating or prolonged, with the Veteran himself stating that they lasted less than a minute or "several minutes" at the most. The functional impact of the headaches is also clearly not of the degree contemplated by a maximum rating under Diagnostic Code 8100. The Veteran and the VA examiner stated that it was difficult for him to perform his work in sales when he was having a headache. However, given the short duration of the headaches, as well as the lack of treatment and absence of any economic impact associated with the headaches, it is clear the Veteran's headaches are not "completely prostrating and prolonged" in accordance with the definitions provided above. In short, the evidence does not establish that the Veteran's migraines "render [him] entirely powerless." Johnson, 30 Vet. App. at 252.

The Board has considered the Veteran's general contentions regarding his headaches, but notes that he has not provided any specific argument in support of his claim. He has not described missing any work due to migraines, nor does the evidence establish any specific economic or functional impact resulting from his headaches. The Board acknowledges that the Veteran experiences multiple headaches a week, but they are not truly "prostrating." The Board cannot find that such episodes most nearly approximate "extreme exhaustion" as contemplated by the dictionary and M21-1 definitions, nor do they render the Veteran "
above. In short, the evidence does not establish that the Veteran's migraines "render [him] entirely powerless." Johnson, 30 Vet. App. at 252.

The Board has considered the Veteran's general contentions regarding his headaches, but notes that he has not provided any specific argument in support of his claim. He has not described missing any work due to migraines, nor does the evidence establish any specific economic or functional impact resulting from his headaches. The Board acknowledges that the Veteran experiences multiple headaches a week, but they are not truly "prostrating." The Board cannot find that such episodes most nearly approximate "extreme exhaustion" as contemplated by the dictionary and M21-1 definitions, nor do they render the Veteran "powerless," as defined by the Court in Johnson. Id.

The lay and medical evidence therefore establishes that the Veteran's headaches are not of the same severity, frequency, duration, or economic impact as "very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability." The Board therefore finds that the service-connected headaches most nearly approximate the criteria associated with the current 30 percent evaluation with characteristic prostrating attacks occurring on average once a month. The Board has also considered whether there is any other schedular basis for granting a higher rating, but has found none. In addition, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable because the evidence significantly and substantially weighs against the claim for a higher rating. 38 U.S.C. § 5107(b); see also Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

2. Entitlement to a rating higher than 10 percent for residuals of left hip fractures to the left acetabular and left pubic rami with limitation of adduction.

3. Entitlement to an initial compensable rating for left thigh limitation of flexion.

4. Entitlement to an initial compensable rating for left thigh limitation of extension.

Service connection for a left hip disability characterized as "left hip s/p fracture repair with hardware" was granted in a May 2020 rating decision with an initial noncompensable evaluation assigned effective April 30, 2020. An increased 10 percent evaluation was granted in an October 2021 rating decision, effective August 10, 2021. The April 2025 rating decision on appeal recharacterized the service-connected left hip disability to "left hip s/p acetabular fracture repair with hardware, left pubic rami fracture with limitation of adduction" and continued the current 10 percent evaluation. Service connection was also granted for left thigh limitation of flexion and left thigh limitation of extension as residuals of the service-connected left hip fractures. Separate noncompensable (0 percent) ratings were assigned for limitation of flexion and extension effective February 24, 2025.

The Veteran's left hip fracture residuals are therefore assigned three separate disability ratings during the relevant rating period: a 10 percent rating for left hip limitation of adduction, a noncompensable rating for left hip limitation of flexion, and a noncompensable rating for left hip limitation of extension. The Veteran contends that higher evaluations are warranted for his left hip disability, though the Board observes he has not provided any specific statements or argument in support of the claims.

Normal ranges of motion of the hip are hip flexion from 0 degrees to 125 degrees and hip abduction from 0 degrees to 45 degrees. 38 C.F.R. § 4.71, Plate II. Limitation of motion of the hip or thigh may be rated under Diagnostic Code 5250 (ankylosis of the hip), Diagnostic Code 5251 (limitation of extension), 5252 (limitation of flexion), or Diagnostic Code 5253 (impairment of the thigh). As noted above, the Veteran is in receipt of three ratings for each hip based on limitation of extension, impairment of the thigh (as limitation of adduction), and limitation of flexion.

As an initial matter, the Board notes that the Veteran has never manifested ankylosis of the left hip and none of the medical evidence (including the report of a March 2025 VA examination) demonstrates the presence of ankylosis or its functional equivalent. Similarly, there is also no evidence of a flail joint of the hip or impairment of the femur with any nonunion, malunion, or fracture. Rather, the Veteran generally contends that his pain and limited motion results in functional impairment that most nearly approximates the criteria associated with higher disability evaluations. The Board therefore finds that Diagnostic Codes 5250, 5254, and 5255, pertaining to hip ankylosis, a flail joint, and impairment of the femur are not for application in this case and will now turn
kylosis of the left hip and none of the medical evidence (including the report of a March 2025 VA examination) demonstrates the presence of ankylosis or its functional equivalent. Similarly, there is also no evidence of a flail joint of the hip or impairment of the femur with any nonunion, malunion, or fracture. Rather, the Veteran generally contends that his pain and limited motion results in functional impairment that most nearly approximates the criteria associated with higher disability evaluations. The Board therefore finds that Diagnostic Codes 5250, 5254, and 5255, pertaining to hip ankylosis, a flail joint, and impairment of the femur are not for application in this case and will now turn to the rating criteria pertaining to limitation of motion.

The Veteran's left hip fracture residuals are currently rated under three diagnostic codes: 5253 for impairment of the hip (i.e., limitation of adduction), 5252 for limitation of flexion, and 5251 for limitation of extension.

Turning first to the Veteran's limitation of adduction, this aspect of the service-connected disability is initially rated as 10 percent disabling. Under Diagnostic Code 5253, impairment of the thigh may be rated based on limitation of abduction, limitation of adduction, or limitation of rotation. A 10 percent rating will be assigned for limitation of rotation where the individual cannot toe-out more than 15 degrees on the affected leg, or for limitation of adduction where the individual cannot cross the legs. A 20 percent rating will be assigned for limitation of abduction where there is motion lost beyond 10 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5253.

The Veteran's adduction of the right hip was most limited at the March 2025 VA examination when it was measured to 10 degrees based on the examiner's estimate of additional motion lost with repeated use of the left hip over time. The VA examiner also found that the Veteran was prevented from crossing his legs due to limited adduction. This finding is specifically contemplated by the current 10 percent evaluation assigned the disability under Diagnostic Code 5253. A higher 20 percent rating is possible with limitation of abduction when there is motion lost beyond 10 degrees. However, abduction was most limited in this case at the March 2025 VA examination when it was measured to 25 degrees with repeated use over time and with flare-ups of symptoms. The Veteran therefore manifested abduction greater than that required for an increased rating under Diagnostic Code 5253.

With respect to functional factors and functional loss, the Board notes that the March 2025 VA examiner reported the point at which pain began during range of motion testing, and estimated the additional loss that would occur following repeated use of the left hip over time and with flares-ups of symptoms. The Board has considered these reports and the examiner's loss of motion estimate in the finding that left hip adduction was at most limited to 10 degrees with abduction limited to 25 degrees. The Board also notes that there was no additional loss of motion with repetitive testing during the VA examination. The VA examiner also considered the Veteran's reports of intermittent and seemingly random episodes of sharp left hip and pelvic pain associated with the service-connected disability. The Veteran did not describe any other functional impairment due to the left hip condition; in fact, he reported that his intermittent hip pain was not associated with any specific movement or activity. Thus, even with consideration of relevant functional factors and functional loss, it is clear that the Veteran's hip disability manifests impairment of the hip that most nearly approximates a 10 percent evaluation for limitation of adduction.

The Board has also considered whether a higher evaluation is warranted for the left hip disability under Diagnostic Code 5252 pertaining to limitation of flexion. The Veteran's limitation of flexion of the left hip was estimated to 110 degrees at the March 2025 VA examination with consideration of repeated use of the joint over time and with flares. This amount of flexion is noncompensable under Diagnostic Code 5252. 38 C.F.R. § 4.71a, Diagnostic Code 5252.

With respect to functional factors and functional loss, as with impairment of the hip, the Board has considered the VA examiner's estimate of additional loss of motion with repeated use over time and with flares. As noted above, there was also no additional loss of motion with repetitive testing during the VA examination. Thus, even with consideration of relevant functional factors and functional loss, it is clear that the Veteran's hip disability manifests noncompensable limitation of flexion under Diagnostic Code 5252.

The Veteran's final left hip evaluation is assigned for impairment to extension under Diagnostic Code 5251. This diagnostic code provides a 10 percent disability rating for extension of the thigh limited to 5 degrees. 38 C.F.R. § 4.71a.
to functional factors and functional loss, as with impairment of the hip, the Board has considered the VA examiner's estimate of additional loss of motion with repeated use over time and with flares. As noted above, there was also no additional loss of motion with repetitive testing during the VA examination. Thus, even with consideration of relevant functional factors and functional loss, it is clear that the Veteran's hip disability manifests noncompensable limitation of flexion under Diagnostic Code 5252.

The Veteran's final left hip evaluation is assigned for impairment to extension under Diagnostic Code 5251. This diagnostic code provides a 10 percent disability rating for extension of the thigh limited to 5 degrees. 38 C.F.R. § 4.71a. Extension of the thigh was estimated as 20 degrees by the March 2025 VA examiner. The 20 degrees of extension was reported based on consideration of functional factors such as repeated motion of the hip over time, and based on the Veteran's reports of intermittent episodes of sharp pain. Thus, the limitation of thigh extension manifested by the Veteran throughout the relevant rating period is noncompensable under Diagnostic Code 5251 and a higher rating is not possible based on limitation of extension.

The Board has also considered the ameliorative effects of any medication as set forth by the Court in Jones v. Shinseki, 26 Vet. App. 56, 63 (2012) and Ingram v. Collins, 38 Vet. App. 130 (2025). In Jones, the Court found that 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 at 61. The more recent case, Ingram, held that Jones applies to the Board's review of ratings under the diagnostic codes for rating musculoskeletal disabilities. Ingram, supra. The Court also held that, with regard to these and other diagnostic codes that do not reference medication, "the Board must discount beneficial medication effects when assigning an evaluation." Id. Thus, in the current case, the Board must acknowledge, discuss, and discount the beneficial effects of the medication used to treat the Veteran's hip disability.

In this case, the Veteran has not reported receiving any specific treatment for his hip condition during the relevant rating period, to include using any medication for pain relief or to increase the function of the joint. In fact, the Veteran denied taking any medication or engaging in any treatment for the disability at the March 2025 VA examination. As the lay and medical evidence does not establish the Veteran's range of motion as demonstrated on physical examination during the relevant rating period is improved by the use of medication, the Board finds that an award of a higher rating based on limitation of motion is not appropriate.

In sum, the Veteran's left hip fracture residuals are properly rated during the relevant rating period as follows: a 10 percent evaluation for left hip limitation of adduction, a noncompensable evaluation based on limitation of flexion, and a noncompensable evaluation based on left hip limitation of extension.

The Board has considered whether there is any basis for granting higher ratings, but has found none. The Board has also considered the statements of the Veteran describing episodes of intermittent sharp pain in the left hip and pelvis. The type of impairment reported by the Veteran is contemplated by the multiple ratings assigned his left hip disability, to include pain and limitation of motion of the hip in various directions. In determining the appropriate ratings for the left hip, the Board has also considered functional factors such as those reported by the VA examiner, to include impairment associated with repeated motion. In addition, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable because the substantial weight of the evidence is against the claims for any increased ratings. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.7, 4.21.

5. Whether the reduction of the service-connected left lower extremity sensory peripheral neuropathy from 20 percent disabling to 10 percent disabling was proper.

Service connection for left lower extremity sensory peripheral neuropathy was granted in a May 2020 rating decision with an initial 10 percent evaluation assigned effective April 30, 2020. In October 2021, an increased 20 percent evaluation was granted for the left lower extremity neuropathy effective August 10, 2021. The April 2025 rating decision on appeal awarded a separate noncompensable (0 percent) evaluation for sensory peripheral neuropathy of the left lower extremity affecting the internal saphenous nerve effective February 24, 2025. The March 2025 rating decision also reduced the disability rating assigned the previously service-connected left lower extremity sensory neuropathy from 20 percent to 10 percent, also effective February 24, 2025.

The Veteran generally
a May 2020 rating decision with an initial 10 percent evaluation assigned effective April 30, 2020. In October 2021, an increased 20 percent evaluation was granted for the left lower extremity neuropathy effective August 10, 2021. The April 2025 rating decision on appeal awarded a separate noncompensable (0 percent) evaluation for sensory peripheral neuropathy of the left lower extremity affecting the internal saphenous nerve effective February 24, 2025. The March 2025 rating decision also reduced the disability rating assigned the previously service-connected left lower extremity sensory neuropathy from 20 percent to 10 percent, also effective February 24, 2025.

The Veteran generally contends that the reduction of his left lower extremity peripheral neuropathy from 20 percent to 10 percent was improper. The Board observes that the Veteran has not provided any specific argument or evidence in support of his claim.

The Board finds that the reduction of the rating assigned to the peripheral neuropathy of the left lower extremity in the April 2025 rating decision on appeal was not proper as the evidence does not demonstrate sustained material improvement in the disability.

Before reducing the rating assigned a service-connected disability, VA must generally follow certain procedural guidelines. Where reduction in the evaluation of a service-connected disability is considered warranted and the lower evaluation would result in a reduction of current compensation payments, certain due process protections must be followed. 38 C.F.R. § 3.105(e).

VA's General Counsel has held that 38 C.F.R. § 3.105(e) does not apply where there is no reduction in the amount of compensation payable. It is only applicable where there is both a reduction in evaluation and a reduction or discontinuance of compensation payable. Therefore, where the evaluation of a specific disability is reduced, but the amount of compensation is not reduced, section 3.105(e) is not applicable. See VAOPGCPREC 71-91 (Nov. 1991) ("Where the evaluation of a specific disability is reduced but the amount of compensation is not reduced because of a simultaneous increase in the evaluation of one or more other disabilities, section 3.105(e) is not applicable."); Stelzel v. Mansfield, 508 F.3d 1345, 1347-49 (Fed.Cir.2007) (holding that provisions of § 3.105 (e) do not apply when there is no change in the overall disability rating).

In this case, the AOJ reduced the disability evaluation assigned the service-connected peripheral neuropathy without first notifying the Veteran or providing him an opportunity to submit additional evidence in response to a rating reduction proposal. However, the amount of compensation paid to the Veteran did not change because of the rating reduction; in fact, his overall rate of compensation increased due to other awards in the same rating decision. As his overall amount of compensation was not reduced, the procedural protections of § 3.105(e) are not applicable in the current case.

Additionally, the provisions of 38 C.F.R. § 3.344(a) and (b) apply to claims for rating reductions. These regulations provide that where a Veteran's schedular rating has been both continuous and stable for five years or more, the rating may be reduced only if the examination upon which the reduction is based is at least as full and complete as the examination used to establish the higher evaluation. The rating for a disease that is subject to temporary or episodic improvement that has been in effect for more than five years will not be reduced on any one examination, except in those instances where all the evidence of record clearly warrants the conclusion that sustained improvement has been demonstrated. The rating agency must also take into consideration whether the evidence makes it reasonably certain that the improvement will be maintained under the ordinary conditions of life. See 38 C.F.R. § 3.344 (a).

The provisions of 38 C.F.R. § 3.344(c) specify that the above considerations are required for ratings which have continued for long periods at the same level (five years or more), and that they do not apply to disabilities which have not become stabilized and are likely to improve. In this instance, the 20 percent evaluation assigned to the Veteran's peripheral neuropathy was in effect from August 10, 2021 to February 24, 2025, a period shorter than 5 years. Hence, the preceding paragraphs (a) and (b) do not apply to the current case.

The Board must now determine whether the evidence of record properly supported the reduction of the Veteran's disability rating in the April 2025 rating decision on appeal. In Brown v. Brown, 5 Vet. App. 413 (1993), the Court identified general regulatory requirements applicable to all rating reductions, including those which have been in effect for less than five years. Id at 417. Pursuant to 38 C.F.R. § 4.1, it is essential, both in the examination and in the evaluation of the disability, that each disability be viewed in relation to its history. Id at 420. Similarly, 38 C.F.R. § 4.2, establishes that "[i]t is the responsibility of the rating specialist to interpret reports of examination in light of the whole record history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of the disability present." Id. The Court has held that these provisions "impose a clear requirement" that rating reductions be based on the entire history of the veteran's disability. Id.

Furthermore, 38 C.F.R. § 4.13 provides that the rating agency should assure itself that there has been an actual change in the condition, for better or worse, and not merely a difference in the thoroughness of the examination or in use of descriptive terms. Additionally, in any rating reduction case, the Board must determine whether an improvement in a disability has occurred, but also whether such improvement reflects improvement in ability to function under ordinary conditions of life and work. See Brown at 420-421; see also 38 C.F.R. §§ 4.2, 4.10. A claim as to whether a rating reduction was proper must be resolved in the Veteran's favor unless VA concludes that the balance of the evidence weighs against the claim. Brown at 421.

The Veteran's peripheral neuropathy of the left lower extremity is currently rated under Diagnostic Code 8524 pertaining to paralysis of the internal popliteal nerve. However, the Board notes that the AOJ has often changed the diagnostic code used to rate the service-connected disability. Following the May 2020 award of service connection, the disability was rated as 10 percent disabling under Diagnostic Code 8521 pertaining to the external popliteal nerve (common peroneal). Then, in October 2021, when an increased 20 percent evaluation was assigned for the left lower extremity neuropathy, the diagnostic code used to rate the disability was changed to Diagnostic Code 8520 applying to the sciatic nerve. The April 2025 rating decision on appeal now utilizes Diagnostic Code 8524, as noted above.

Diagnostic Code 8524 pertaining to the internal popliteal nerve provides for a 10 percent evaluation for incomplete paralysis of the nerve, a 20 percent evaluation for moderate incomplete paralysis of the nerve, and a 30 percent evaluation for severe incomplete paralysis of the nerve. A maximum 40 percent evaluation is assigned for complete paralysis of the nerve when plantar flexion is lost, frank adduction of the foot is impossible, flexion and separation of the toes is abolished; no muscle in the sole can move; lesions of the nerve are high in popliteal fossa, and plantar flexion of the foot is lost. 38 C.F.R. § 4.124a, Diagnostic Code 8524.

The Board finds that the reduction of the rating assigned the Veteran's left lower extremity peripheral neuropathy was not proper as the evidence does not establish sustained material improvement of the condition. The Veteran's disability evaluation was reduced based on the AOJ's interpretation of the March 2025 VA examination generally and the examiner's specific finding that the Veteran manifested mild incomplete paralysis of the internal popliteal (tibial) nerve. The Board notes that the April 2025 rating decision only referenced the March 2025 VA examination in the evidence portion of the decision, and did not address any of the other findings of the VA examiner. The AOJ also did not find conclude that the service-connected peripheral neuropathy had improved; rather, it merely noted that the examiner characterized the Veteran's incomplete paralysis as "mild."

The Board acknowledges that the March 2025 VA examination does not indicate the presence of incomplete paralysis of the internal popliteal nerve consistent with a 20 percent rating. However, the Board also acknowledges that the three VA examinations provided the Veteran's peripheral nerves (dated in March 2020, September
popliteal (tibial) nerve. The Board notes that the April 2025 rating decision only referenced the March 2025 VA examination in the evidence portion of the decision, and did not address any of the other findings of the VA examiner. The AOJ also did not find conclude that the service-connected peripheral neuropathy had improved; rather, it merely noted that the examiner characterized the Veteran's incomplete paralysis as "mild."

The Board acknowledges that the March 2025 VA examination does not indicate the presence of incomplete paralysis of the internal popliteal nerve consistent with a 20 percent rating. However, the Board also acknowledges that the three VA examinations provided the Veteran's peripheral nerves (dated in March 2020, September 2021, and March 2025) have little agreement among them, to include the specific nerves affected in the left lower extremity. The March 2020 VA examination did not specify the degree of impairment present in any nerve, and while the September 2021 VA examination noted mild incomplete neurological paralysis of the left lower extremity, the internal saphenous nerve was identified, not the internal popliteal nerve. The April 2025 rating decision on appeal awarded service connection and a separate noncompensable evaluation for the internal saphenous nerve, while presumably finding the underlying VA examination report supported a reduction for the internal popliteal nerve, despite the March 2025 VA examiner making no mention of this specific nerve.

Furthermore, the evidence of record in April 2025 did not show improvement in the ability to function under ordinary conditions of life and work due to the left lower extremity neurological impairment. The Veteran denied having any loss of function or impact on his activities due to the disability at the March 2020 and September 2021 VA examinations. In contrast, he reported having occasional pain in the left leg at the March 2025 VA examination that required he "stop what he is doing until it resolves." The Board therefore finds that the functional impairment reported and demonstrated by the Veteran at the March 2025 VA examination does not establish sustained improvement.

Based on the above, the Board finds that the reduction of the Veteran's left lower extremity sensory peripheral neuropathy in the April 2025 rating was not proper as the evidence does not establish actual improvement under the ordinary conditions of life and work. As such, the Board cannot conclude that the disability demonstrated true sustained material improvement at the time of the April 2025 rating decision. Accordingly, restoration of the 20 percent evaluation under Diagnostic Code 8524 is warranted for the disability effective February 24, 2025.

6. Entitlement to an initial compensable rating for left lower extremity sensory neuropathy of the internal saphenous nerve.

As noted above, service connection and a separate noncompensable evaluation was granted for left lower extremity neuropathy of the internal saphenous nerve in the April 2025 rating decision on appeal effective February 24, 2025. The Veteran contends that a higher initial evaluation is warranted, though he has not provided any specific contentions in support of the claim.

The Veteran's sensory peripheral neuropathy is currently rated under Diagnostic Code 8527 for paralysis of the internal saphenous nerve. Diagnostic Code 8527 provides that mild to moderate paralysis of the internal saphenous nerve is rated as noncompensably disabling. Paralysis of the internal saphenous nerve that is severe to complete is rated as 10 percent disabling. 38 C.F.R. § 4.124a, Diagnostic Code 8527.

Disability involving a neurological disorder is ordinarily rated in proportion to the impairment of motor, sensory, or mental function. When the involvement is wholly sensory, the rating should be for the mild, or, at most, the moderate degree. 38 C.F.R. §§ 4.120, 4.124a.

The words "mild," "moderate," "moderately severe," and "severe" as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all the evidence, to the end that its decisions are equitable and just. 38 C.F.R. § 4.6.

The adjective "mild" is defined as "gentle in nature or behavior" and "not being or involving what is extreme." Mild, Merriam-Webster Dictionary Online, https://www.merriam-webster.com/dictionary/mild, Definitions 1 and 2(b) (last visited April 1, 2026). "Moderate" is defined as "not violent, severe, or intense;" and "limited in scope or effect." Moderate, Merriam-Webster Dictionary Online, https://www.merriam-webster.com/dictionary
the Board must evaluate all the evidence, to the end that its decisions are equitable and just. 38 C.F.R. § 4.6.

The adjective "mild" is defined as "gentle in nature or behavior" and "not being or involving what is extreme." Mild, Merriam-Webster Dictionary Online, https://www.merriam-webster.com/dictionary/mild, Definitions 1 and 2(b) (last visited April 1, 2026). "Moderate" is defined as "not violent, severe, or intense;" and "limited in scope or effect." Moderate, Merriam-Webster Dictionary Online, https://www.merriam-webster.com/dictionary/moderate, Definitions 3 and 5 (last visited April 1, 2026). "Severe," as an adjective, is defined as "causing discomfort or hardship;" "very painful or harmful;" "of a great degree." Severe, Merriam-Webster Dictionary Online, https://www.merriam-webster.com/dictionary/severe, Definitions 6a, 6b, and 8 (last visited April 1, 2026).

"Moderately severe" is not defined in the referenced dictionary but is understood to capture symptomatology between moderate and severe. For illustrative purposes, it is interpreted to mean an injury of such severity it causes more than average pain with more than average functional impairment, such as limited ability to perform physical activities.

It is noted that the Veteran has not provided any definitions of those terms for the Board's consideration.

Additionally, the Board has also reviewed the provisions of the VA Adjudication Procedures Manual, M21-1 (M21-1). See Overton v. Wilke, 30 Vet. App. 257, 263-4 (2018). The M21-1 provides definitions for "mild," "moderate," and "severe" incomplete paralysis as follows:

"Mild incomplete paralysis" - Disability limited to sensory deficits that are lower graded, less persistent, or affecting a small area. A very minimal reflex or motor abnormality could also be consistent with mild incomplete paralysis.

"Moderate incomplete paralysis" - Symptoms described by the claimant and medically graded as significantly disabling; or combinations of significant sensory changes and reflex or motor changes of a lower degree; or motor and/or reflex impairment such as weakness or diminished or hyperactive reflexes (with or without sensory impairment) graded as medically moderate.

"Moderately severe paralysis" - This term is only applicable for involvement of the sciatic nerve and is the maximum rating for sciatic nerve neuritis not characterized by organic changes. 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 with or without muscle atrophy.

"Severe incomplete paralysis" - 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. For the sciatic nerve (Diagnostic Code 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. See M21-1, V.iii.12.A.2.c.

Regulations provide that the ratings for peripheral neurological disorders are assigned based on the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. Thus, the Board must determine the relative severity of the neurological disability based on all the factors above, as well as the amount of impairment resulting from the condition.

It should also be noted that use of terminology such as "severe" by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6.

The Board finds that the initial noncompensable evaluation is appropriate to rate the peripheral neuropathy of the internal saphenous nerve. The competent medical and lay evidence during the relevant rating period establishes neurological impairment that is no more than mild with pain and some objective sensory loss characterized by the Veteran as
the factors above, as well as the amount of impairment resulting from the condition.

The Board finds that the initial noncompensable evaluation is appropriate to rate the peripheral neuropathy of the internal saphenous nerve. The competent medical and lay evidence during the relevant rating period establishes neurological impairment that is no more than mild with pain and some objective sensory loss characterized by the Veteran as an "electrical impulse" sensation. There is no objective evidence of reduced strength, reduced reflexes or vibratory sense, or impairment that most nearly approximates a severe disability or complete paralysis under Diagnostic Code 8527.

The report of a March 2025 VA examination demonstrates the presence of left leg peripheral neuropathy affecting the internal saphenous nerve that is no more than mild. The VA examiner specifically identified the presence of mild incomplete paralysis of the internal saphenous nerve. The Veteran reported symptoms of severe intermittent pain, paresthesias, and moderate numbness. Physical examination of the left lower extremity demonstrated decreased sensation in the feet and toes, with full strength and reflexes. Sensation in the upper parts of the left leg was also present and full. The Veteran reported having no treatment for his neurological impairment, and the only functional impact identified by the VA examiner was that the Veteran would need to stop his activities when he felt an "electrical current sensation" in his leg.

Based on the above, the Board finds that the Veteran's peripheral neuropathy of the left internal saphenous nerve most nearly approximates the current noncompensable rating for mild symptoms. During the rating period under review, the Veteran's disability manifested symptoms that are only sensory in nature with complaints of pain and loss of sensation. There was no objective evidence of weakness, muscle atrophy, or diminished reflexes due to neuropathy. The pertinent regulations specifically provide that nerve involvement that is wholly sensory is considered mild, or at most moderate, in severity. See 38 C.F.R. §§ 4.120, 4.124a.

Additionally, the functional impact described by the Veteran is limited to a temporary pause in activities until the "electrical current sensation" he feels in his left leg resolves. The Veteran described this sensation as occurring for less than two minutes on a weekly basis at the March 2025 VA examination. Thus, the Veteran only experiences approximately two minutes of impairment once a week due to his peripheral neuropathy. The Board finds this level of impairment is consistent with a disability that is "not extreme" or "less persistent" and therefore most nearly approximates a mild disability.

As the Veteran's symptoms are limited to sensory loss and pain that result in only momentary functional impairment, the Board finds that they are contemplated by the current noncompensable evaluation under Diagnostic Code 8527.

The Board has considered the Veteran's reports that his symptoms are more severe than reflected by the rating above, but the Board finds the competent medical evidence, based on objective testing and medical expertise, is more probative regarding the severity of the service-connected disability. The Board has also considered whether there is any other schedular basis for granting a higher rating, but has found none. In addition, the Board has considered the doctrine of reasonable doubt but has determined that it is not applicable because the evidence significantly and substantially weighs against the claim for an initial compensable rating for left lower extremity sensory peripheral neuropathy. 38 U.S.C. § 5107(b); see also Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

7. Entitlement to a rating higher than 10 percent for tinnitus.

Service connection for tinnitus was granted in a May 2020 rating decision with an initial 10 percent evaluation assigned effective April 30, 2020. The April 2025 rating decision on appeal continued the 10 percent evaluation for the disability. The Veteran contends that a higher rating is warranted but has not provided any specific argument in support of his claim.

The current 10 percent evaluation is the maximum schedular rating available for tinnitus, whether the sound is heard in one ear, both ears, or the head. 38 C.F.R. § 4.87, Diagnostic Code 6260.

The Veteran has not provided any specific argument in support of the claim for a higher rating, to include alleging any kind of exceptional symptoms, impairment, or other manifestations of the disabilities sufficient to render the available schedular evaluations inadequate. The Veteran has also not alleged that he experiences marked interference with employment or frequent hospital
2025 rating decision on appeal continued the 10 percent evaluation for the disability. The Veteran contends that a higher rating is warranted but has not provided any specific argument in support of his claim.

The current 10 percent evaluation is the maximum schedular rating available for tinnitus, whether the sound is heard in one ear, both ears, or the head. 38 C.F.R. § 4.87, Diagnostic Code 6260.

The Veteran has not provided any specific argument in support of the claim for a higher rating, to include alleging any kind of exceptional symptoms, impairment, or other manifestations of the disabilities sufficient to render the available schedular evaluations inadequate. The Veteran has also not alleged that he experiences marked interference with employment or frequent hospitalization due to his service-connected tinnitus. In other words, none of the medical or lay evidence of record reasonably raises a claim for an extraschedular rating under 38 C.F.R. § 3.321(b)(1).

(Continued on the next page)

Thus, a rating higher than 10 percent is not warranted and there is no legal basis upon which to award a higher evaluation for tinnitus. The Veteran's appeal must be denied. See Sabonis v. Brown, 6 Vet. App. 426 (1994).

M. MILLS

Veterans Law Judge

Board of Veterans' Appeals

M. Riley, Attorney for the Board of Veterans' Appeals

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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