ANXIETY DISORDER

J. JACK · 2026 · Case ID: A26037278

MIXED

Summary

The Veteran, who served in the Navy from October 2002 to October 2019, appeals the denial of service connection for hemorrhoids/anal fissure, left and right knee disabilities, cervical strain, fibromyalgia, hypertension, and colon polypectomy. The Veteran also sought an increased rating for his service-connected lumbar spine disability and cervical strain, and a higher rating for fibromyalgia and hypertension. The Board granted service connection for insomnia and generalized anxiety disorder (GAD), noting the Veteran's existing service connection for major depressive disorder. Service connection for supraventricular arrhythmia, claimed as chest pain, was also granted, with the Board applying the benefit of the doubt due to the proximity of the diagnosis to service and the Veteran's in-service symptoms. Service connection for hemorrhoids/anal fissure and both knee conditions was denied due to a lack of current diagnosis or functional impairment, with the Board finding the persuasive evidence against the claims. The Veteran's claim for an increased rating for lumbar spine disability was granted at 50 percent, finding the functional loss equivalent to unfavorable ankylosis. Claims for higher ratings for cervical strain and fibromyalgia were denied, as the evidence did not meet the criteria for higher evaluations. Hypertension and colon polypectomy claims for higher ratings were also denied based on the medical evidence and rating criteria. The Board denied an earlier effective date for Dependents' Educational Assistance (DEA) benefits, as the requested date preceded the Veteran's separation from service. The issue of Total Disability based on Individual Unemployability (TDIU) was remanded for further development, specifically to obtain the Veteran's Social Security earnings records to assess his employability during the appeal period.

Rationale

Diagnosis of insomnia disorder; Related to active duty service per VA examiner; Criteria for service connection met

Service Branch

NAVY

Special Benefit

TDIU

Diagnostic Code

5025

Docket No.

210816-179838

Full Decision Text

Citation Nr: A26037278
Decision Date: 04/21/26 Archive Date: 04/21/26

DOCKET NO. 210816-179838
DATE: April 21, 2026

ORDER

Service connection for insomnia and generalized anxiety disorder (GAD) is granted.

Service connection for supraventricular arrhythmia, claimed as chest pain, is granted.

Service connection for hemorrhoids/anal fissures is denied.

Service connection for left knee pain is denied.

Service connection for right knee pain is denied.

A 50 percent rating for thoracolumbar degenerative disc disease with lumbar paraspinal venous malformation (lumbar spine disability) is granted.

A rating higher than 10 percent for cervical strain is denied.

A rating higher than 10 percent for fibromyalgia is denied.

A compensable rating for hypertension is denied.

A compensable rating for colon polypectomy is denied.

An effective date prior to November 1, 2019, for the grant of Dependents' Educational Assistance (DEA) is denied.

REMANDED

Entitlement to a total rating based on individual unemployability due to service-connected disability (TDIU) is remanded.

FINDINGS OF FACT

1. The Veteran has a diagnosis of insomnia and anxiety disorder which has been related to his active duty service.

2. The Veteran has a diagnosis of supraventricular arrhythmia for which he sought service connection within a year of his separation from active duty.

3. The Veteran does not have a diagnosis hemorrhoids/anal fissure.

4. The Veteran does not have a diagnosis of either a left or right knee disability and his knee pain has not been found or shown to cause any functional impairment or impact.

5. The Veteran's lumbar spine disability flare-ups more closely approximate unfavorable ankylosis of his lumbar spine.

6. The Veteran's cervical spine had flexion at worst to 40 degrees.

7. The Veteran's fibromyalgia is not episodic, with exacerbations often precipitated by environmental or emotional stress or by overexertion, but that are present more than one-third of the time, or constant or nearly so, and refractory to therapy.

8. The Veteran's hypertension did not manifest in diastolic pressure predominantly 100 or more, or systolic pressure predominantly 160 or more. Also, the Veteran did not both have a history of diastolic pressure predominantly 100 or more and require continuous medication for control.

9. The Veteran's colon polypectomy did not result in abdominal pain related to defecation at least once during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension.

10. The Veteran has been granted DEA benefits as of the first day after his separation from active duty service.

CONCLUSIONS OF LAW

1. The criteria for service connection for insomnia and GAD have been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309.

2. The criteria for service connection for supraventricular arrhythmia have been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309.

3. The criteria for service connection for hemorrhoids/anal fissure have not been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309.

4. The criteria for service connection for a left knee disability have not been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309.

5. The criteria for service connection for a right knee disability have not been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309.

6. The criteria for a 50 percent rating
3.309.

4. The criteria for service connection for a left knee disability have not been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309.

5. The criteria for service connection for a right knee disability have not been met. 38 U.S.C. §§ 1101, 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.307, 3.309.

6. The criteria for a 50 percent rating for a lumbar spine disability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code (DC) 5242.

7. The criteria for a rating higher than 10 percent for a cervical spine disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5237.

8. The criteria for a rating higher than 10 percent for fibromyalgia have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, DC 5025.

9. The criteria for a compensable rating for hypertension have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.31, 4.104, DC 7101.

10. The criteria for a compensable rating for colon polypectomy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.21, 4.31, 4.114, DC 7319.

11. The criteria for an effective date for DEA benefits prior to November 1, 2019, have not been met. 38 U.S.C. §§ 3500, 3501, 3510; 38 C.F.R. § 21.3021.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from October 2002 to October 2019. His service decorations include the Navy and Marine Corps Achievement Medal and the Sea Service Deployment Ribbon.

In the August 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on September 17, 2024.

Therefore, the Board may only consider the evidence of record at the time of the June 2021 agency of original jurisdiction (AOJ) 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 decisions 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 claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v.
new and relevant, VA will issue another decision on the claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

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

Insomnia/Anxiety

The record shows that the Veteran has a diagnosis of insomnia disorder and generalized anxiety disorder (GAD). See April 2021 VA examination. The Board notes that the Veteran also has a diagnosis of major depressive disorder (MDD) for which he is service connected as of his first day after separation from service.

The April 2021 VA examiner also found that the Veteran's insomnia and GAD were related to the Veteran's active duty service. Thus, service connection for insomnia and GAD is warranted.

Thus, service connection for insomnia and GAD are granted.

Chest Pain/Supraventricular Arrhythmia

The Veteran sought service connection for chest pain in September 2019, while he was still on active duty service. A VA examination conducted in April 2021 diagnosed the Veteran with supraventricular arrhythmia. The Veteran stated that he had experienced chest pain on and off in service and had been treated during service for his chest pain. June 2004 and July 2016 service treatment records (STRs) show that the Veteran did treat for chest pain while on active duty. Thus, the Board finds that the first and second elements of service connection are met.

As for a nexus to service, the VA examiner found that the Veteran's supraventricular arrhythmia was less likely than not related to his active duty as the condition was not diagnosed until the VA examination. However, the Board cannot find that a delay in providing a VA examination to the Veteran is cause to deny service connection for a condition when the Veteran experienced in-service symptoms and sought service connection while still on active duty. Had a VA examination been conducted within closer proximity to the Veteran's 2019 claim and separation from service, his condition could have reasonably been diagnosed within a year of his separation from service. As it stands, his supraventricular arrhythmia was diagnosed within 17 months of his separation from service. The Board will afford reasonable doubt to the Veteran and find that his supraventricular arrhythmia diagnosis had such proximity to service to warrant service connection.

Service connection for supraventricular arrhythmia, then, is granted.

Hemorrhoids/Anal Fissure

The Veteran sought service connection for hemorrhoids/anal fissure.

The first requirement for any service connection claim is evidence of a disability. Boyer v. West, 210 F.3d 1351 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223 (1992).

A VA examination conducted in May 2021 did not diagnose the Veteran with hemorrhoids or an anal fissure. The Veteran was found to have a colon polypectomy, for which he was granted service connection as of his separation from service. There are no other medical records of evidence which establish that the Veteran had hemorrhoids or an anal fissure during the period on appeal for which service connection can be granted.

Service connection may not be granted for symptoms unaccompanied by a diagnosed disability. Sanchez-Benitez v. Principi, 259 F.3d 1356 (Fed. Cir. 2001); Sanchez-Benitez v. West, 13 Vet. App. 282 (1999). In the absence of a diagnosis of a current disability, or any abnormality which is attributable to some identifiable disease or injury during service, an award of service connection is not warranted. Brammer, 3 Vet. App. 223. Moreover, in assessing whether a current disability exists, the Board must consider reports of the Veteran's pain, even if there is no diagnosed condition. "Disability," as used in 38 U.S.C. 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability." Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Therefore, "[p]ain alone
. 282 (1999). In the absence of a diagnosis of a current disability, or any abnormality which is attributable to some identifiable disease or injury during service, an award of service connection is not warranted. Brammer, 3 Vet. App. 223. Moreover, in assessing whether a current disability exists, the Board must consider reports of the Veteran's pain, even if there is no diagnosed condition. "Disability," as used in 38 U.S.C. 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability." Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Therefore, "[p]ain alone, without an accompanying diagnosis of a present disease, can qualify as a disability." Id. However, the pain must functionally impair the veteran to constitute a disability. Saunders, 886 F.3d at 1368. While pain "can cause functional impairment," its presence does not always "reach[ ] the level of a functional impairment of earning capacity" necessary to "establish the presence of a disability." Saunders, 886 F.3d at 1367-68.

In this case, upon examination, the examiner did not find any evidence of a fissure or hemorrhoid during the period on appeal; therefore, there is no credible or competent evidence of a disability with functional impairment. While the Veteran noted symptoms in service occurring sporadically and intermittently, post-service, there have been no continued assertions of pain or symptoms. In fact, upon examination, the condition was noted to no longer be present. Additionally, the Veteran has been service connected for the diagnosed disability to which his symptoms have been attributed. Thus, while the Veteran may believe he has hemorrhoids or an anal fissure, the medical evidence of record contradicts that opinion. The Veteran has not been shown to be competent to provide a diagnosis in this case. Diagnosing a disability requires specialized medical education which the Veteran has not been shown to possess. See Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007).

Accordingly, the Board finds that the persuasive evidence of record is against finding that the Veteran has diagnoses of either hemorrhoids or an anal fissure for which service connection can be granted. As the persuasive evidence of record is against the claim, the benefit-of-the-doubt rule is not for application, and the claim must be denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

Knees

Similar to his hemorrhoids, the Veteran's current medical records do not show that he has a diagnosis of a knee condition for which service connection can be granted. While the Veterans' STRs show complaint of knee pain and diagnosis of patellofemoral pain syndrome, his current medical records do not show that he has a diagnosed disorder of either of his knees. An April 2021 VA examination did not diagnose a knee disability of either his left or right knee. The Board recognizes that pain alone can constitute a disability for VA purposes when such pain amounts to functional impairment of earning capacity. Saunders v. Wilkie, 886 F.3d 1356, 1368 (Fed. Cir. 2018). However, while the Veteran did report pain on use of his knees, he did not report any functional impairment due to his knee pain and no functional impact was found by the examiner in the April 2021 VA examination.

As such, the Board is unable to find that the Veteran has a diagnosed disability of either his left or right knee for which service connection can be granted. As noted above, service connection may not be granted for symptoms unaccompanied by a diagnosed disability. Sanchez-Benitez, 259 F.3d 1356; Sanchez-Benitez, 13 Vet. App. 282. In the absence of a diagnosis of a current disability, or any abnormality which is attributable to some identifiable disease or injury during service, an award of service connection is not warranted. Brammer, 3 Vet. App. 223. Here, there is no evidence which shows that the Veteran has diagnosis of a knee disability during the period on appeal. Thus, while the Veteran may believe he has a knee disability, the medical evidence of record contradicts that opinion. The Veteran has not been shown to be competent to provide a diagnosis in this case. Diagnosing a disability requires specialized medical education which the Veteran has not been shown to possess. See Jandreau, 492 F.3d at 1377 n.4.

Accordingly, the
of a diagnosis of a current disability, or any abnormality which is attributable to some identifiable disease or injury during service, an award of service connection is not warranted. Brammer, 3 Vet. App. 223. Here, there is no evidence which shows that the Veteran has diagnosis of a knee disability during the period on appeal. Thus, while the Veteran may believe he has a knee disability, the medical evidence of record contradicts that opinion. The Veteran has not been shown to be competent to provide a diagnosis in this case. Diagnosing a disability requires specialized medical education which the Veteran has not been shown to possess. See Jandreau, 492 F.3d at 1377 n.4.

Accordingly, the Board finds that the persuasive evidence of record is against finding that the Veteran has diagnoses of a disability of his left or right knee for which service connection can be granted. Accordingly, as the persuasive evidence of record is against the claims, the benefit-of-the-doubt rule is not for application, and the claims must be denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49.

Increased Ratings

Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability is resolved in favor of the Veteran. 38 C.F.R. § 4.3.

Where the question for consideration is the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection and consideration of the appropriateness of a "staged" rating is required. See Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). VA adjudicators must consider whether to assign different ratings at different times during the rating period to compensate the Veteran for times when the disability may have been more severe than at others. The Court of Appeals for Veterans Claims (Court) has since extended this practice even to established ratings, not just initial ratings. See Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007).

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.").

Lumbar Spine

The Veteran has been service connected for his lumbar spine disability and assigned a 20 percent rating pursuant to DC 5242. The regulations pertaining to rating musculoskeletal disabilities were revised, effective February 7, 2021. However, DC 5242 was not subject to any of the 2021 revisions.

Pursuant to the General Rating Formula for Diseases and Injuries of the Spine, the next higher rating for a lumbar spine disability is a 40 percent rating, which is assigned if forward flexion of the thoracolumbar spine is 30 degrees
after which a rating is determined based on the § 4.71a [or 4.73] criteria.").

Lumbar Spine

Pursuant to the General Rating Formula for Diseases and Injuries of the Spine, the next higher rating for a lumbar spine disability is a 40 percent rating, which is assigned if forward flexion of the thoracolumbar spine is 30 degrees or less, or there is favorable ankylosis of the entire thoracolumbar spine.

A 50 percent evaluation is warranted if there is unfavorable ankylosis of the entire thoracolumbar spine.

A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine.

Note (5) to the General Rating Formula defines unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.

The Veteran has specifically asserted that his lumbar spine flare-ups equate to functional ankylosis of his entire thoracolumbar spine. See September 2024 hearing testimony. The Veteran has stated that when he is experiencing a flare-up of lumbar spine pain he must lie flat on the ground on his back for an extended period of time. He testified that he is immobile during a flare-up and cannot move or perform any activities.

The record shows that the Veteran had VA examinations in March 2019 and April 2021. In March 2019, the Veteran reported that he had increasing low back pain and had been diagnosed with venous malformation requiring sclerosing therapy he was found to have very limited ambulation and could not lift or carry. In April 2021, the Veteran reported flare-ups as occurring sometimes once a day and can encompass the Veteran passing out due to pain as well as being unable to walk due to his pain and limitations. He reported use of a wheelchair.

In April 2021, the Veteran submitted a statement from his employer, who is a VA employee, that reported she has been the Veteran's supervisor since October 2020. She stated that she witnessed the Veteran experiencing a lumbar spine flare which required his wife to come get him from work as he was unable to move or drive; he was unable to return to work for a week after the flare-up. She reported that he has experienced a few instances where the Veteran was unable to physically complete his job and needs help from others. She stated she had witnessed the Veteran struggling to walk down the hallway or stand from his chair. She also noted that the Veteran has to often use a wheelchair.

Considering the foregoing, the Board finds that the Veteran's lumbar spine disability equates to the functional equivalent of unfavorable ankylosis of the entire thoracolumbar spine, which warrants a 50 percent rating. While the Veteran does not have a clinical diagnosis of ankylosis of his lumbar spine, in Chavis v. McDonough, 34 Vet. App. 1, 1-2 (2021), the U.S. Court of Appeals for Veterans Claims (Court), held that consideration under the General Rating Formula of an evaluation based on ankylosis is permitted if a claimant's functional loss is consistent with that contemplated by ankylosis in other words, if impairment is the functional equivalent of ankylosis.

Here, the Veteran's lumbar spine shows the functional equivalent of unfavorable ankylosis in that his lumbar spine becomes fixed and impacts his ability to walk. In resolving any doubt in the Veteran's favor, the Board find that this is the functional equivalent of unfavorable ankylosis of the thoracolumbar spine. There is no evidence, including the Veteran's own testimony, that his cervical spins is impacted in the same fashion such that a 100 percent rating for unfavorable ankylosis of
General Rating Formula of an evaluation based on ankylosis is permitted if a claimant's functional loss is consistent with that contemplated by ankylosis in other words, if impairment is the functional equivalent of ankylosis.

Thus, a 50 percent rating throughout the period on appeal for the Veteran's lumbar spine disability is granted.

Cervical Spine

The Veteran's cervical strain has been assigned a 10 percent rating pursuant to DC 5237 under the General Rating Formula for Diseases and Injuries of the Spine. The Veteran has sought a higher rating. The regulations pertaining to rating musculoskeletal disabilities were revised, effective February 7, 2021. However, DC 5237 was not subject to any of the 2021 revisions.

Pursuant to that formula, a 20 percent rating is assigned for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the cervical spine not greater than 170 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 30 percent rating is assigned for forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine.

A 40 percent rating is assigned for unfavorable ankylosis of the entire cervical spine and a 100 percent rating is assigned for unfavorable ankylosis of the entire spine.

The Veteran has undergone a VA examination regarding the severity of his cervical spine disability in April 2021. He reported pain symptoms and flare-ups. His flare-ups were noted to make him try not to move his neck and usually lasted a day, sometimes more. On examination, his at worst forward flexion was found to be to 40 degrees during a flare-up. He did not have muscle spasm, abnormal spinal contour, or muscle atrophy. He was not found to have ankylosis and did not have use of an assistive device. There was no functional loss reported by the Veteran due to his cervical spine disability or symptoms, but the examiner noted that he could not perform frequent head turning. While the Veteran reported having tried various therapies and medications to treat his flare-ups, he reported that he had not found any such treatment which alleviated his symptoms.

After review of the record, the Board finds that the persuasive evidence of record is against finding that the Veteran's cervical spine disability has met the criteria for a higher rating. The Veteran's at worst documented flexion was to 40 degrees during a flare-up, which is 10 degrees greater than the measurement required for the next higher rating. The evidence also does not support a finding that the Veteran had ankylosis of his cervical spine or the functional equivalent of such. Though the examiner noted limited frequent head turning, the examiner did not note that during a flare-up or otherwise the Veteran's cervical spine was in a fixed position. Without such evidence, the Board cannot find that the evidence supports a higher rating.

The Board is mindful that the Veteran complained of neck pain. Although VA may consider any demonstrated functional loss attributable to pain, weakness, excess fatigability, or incoordination, to include with repeated use or during flare-ups, in conjunction with the rating criteria, the overall level of disability demonstrated by the Veteran was not commensurate with the degree of motion loss required for a rating higher than 10 percent even with consideration of pain. Moreover, to the extent that the Veteran did report pain, the VA examiner did not note or find any significant loss of motion or function that would support a higher rating. The Board finds that a rating higher than 10 percent may not be granted under the pertinent rating criteria. Thus, with consideration of all pertinent disability factors, there remains no appropriate basis for assigning a rating higher than 10 percent for the functional impairment of the Veteran's cervical spine at any point during the period on appeal.

Accordingly, as the persuasive evidence of record is against the claim, the benefit-of-the-doubt rule is not for application, and the claim must be denied. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49.

Fibromyalgia

The Veteran's fibromyalgia has been assigned a 10 percent rating pursuant to DC 5025. The Veteran has sought a higher rating.

DC 5025 provides for a 20 percent rating for fibromyalgia with widespread musculoskeletal pain and tender points, with or without associated fatigue, sleep disturbance, stiffness, paresthesias, headache, irritable bowel symptoms, depression, anxiety, or Raynaud's-like symptoms that is episodic, with exacerbations often precipitated by environmental or emotional stress or by overexertion, but that are present more than one-third of the time.

A 40 percent rating is assigned for fibromyalgia with widespread musculoskeletal pain and tender points, with or without associated fatigue, sleep disturbance, stiffness, paresthesias, headache, irritable bowel symptoms, depression, anxiety, or Raynaud's-like symptoms that is constant, or nearly so, and refractory to therapy.

DC 5025 defines widespread pain as pain in both the left and right sides of the body, that is both above and below the waist, and that affects both the axial skeleton (i.e., cervical spine, anterior chest, thoracic spine, or low back) and the extremities.

The Veteran underwent a VA examination regarding his fibromyalgia in April 2021. He was noted to have a diagnosis of fibromyalgia which required him to take constant medication. He was not currently undergoing treatment and his fibromyalgia was not refractory to therapy. He had muscle weakness and headaches which were episodic but were not present more than one-third of the time or precipitated by environmental or emotional stress or by overexertion. He did not have widespread musculoskeletal pain and tender points.

Based on the foregoing, the Board finds that the persuasive evidence of record is against assigning a higher rating for the Veteran's fibromyalgia. In order to support a higher rating, the criteria mandate that the Veteran must have exacerbations often precipitated by environmental or emotional stress or by overexertion, but that are present more than one-third of the time or have symptoms which were refractory to therapy. There is no evidence of record which indicates that the Veteran had such severity of his fibromyalgia and the VA examination specifically found that he did not have such severity of symptomology.

The Board finds that though the Veteran is competent to report observable symptoms he experienced through his senses, he is not competent to identify a specific level of disability according to the appropriate diagnostic codes. Layno, 6 Vet. App. 465. The identification of the severity of fibromyalgia requires medical expertise that the Veteran has not shown he possesses. The medical findings, as provided in the examination report, directly address the criteria under which his disability is rated. The Board finds that evidence is the most persuasive and outweighs any lay statement in support of his claim for a higher rating. Additionally, neither the Veteran nor his representative have indicated that the VA examination provided in April 2021 was inadequate in any manner or did not fully and adequately describe his fibromyalgia. Finally, the Veteran has not testified or provided
through his senses, he is not competent to identify a specific level of disability according to the appropriate diagnostic codes. Layno, 6 Vet. App. 465. The identification of the severity of fibromyalgia requires medical expertise that the Veteran has not shown he possesses. The medical findings, as provided in the examination report, directly address the criteria under which his disability is rated. The Board finds that evidence is the most persuasive and outweighs any lay statement in support of his claim for a higher rating. Additionally, neither the Veteran nor his representative have indicated that the VA examination provided in April 2021 was inadequate in any manner or did not fully and adequately describe his fibromyalgia. Finally, the Veteran has not testified or provided any statement regarding his fibromyalgia or that his fibromyalgia otherwise met the criteria for a higher rating.

Hypertension

The Veteran's hypertension has been assigned a non-compensable rating pursuant to DC 7101. The Veteran has sought a higher rating.

DC 7101 assigns a 10 percent rating for diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; it is the minimum evaluation for an individual with a history of diastolic pressure predominantly 100 or more who requires continuous medication for control.

A 20 percent rating is assigned for diastolic pressure predominantly 110 or more, or systolic pressure predominantly 200 or more.

A 40 percent rating is assigned for diastolic pressure predominantly 120 or more.

The term "predominant" is not defined in the rating criteria. Merriam-Webster defines predominant to mean "being most frequent or common." See, e.g., "predominant," Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary/predominant.

The record shows that the Veteran had a VA examination in April 2021 in which his blood pressure was recorded. His recorded pressure readings were 120/90, 118/88, and 120/88. He was not shown to have diastolic pressure predominantly 100 or more, or systolic pressure predominantly 160 or more. Furthermore, while the Veteran was noted to be on continuous medication for treatment of his hypertension, there is no evidence that the Veteran had a history of diastolic pressure predominantly 100 or more during the period on appeal. Indeed, the April 2021 VA examination specifically found that the Veteran did not have such a history.

As such, the Board finds that the persuasive evidence of record is against a compensable rating for the Veteran's hypertension. There is no evidence of record which indicates that the Veteran has met the criteria necessary for a compensable rating at any time during the period on appeal. The Board finds that though the Veteran is competent to report observable symptoms he experienced through his senses, he is not competent to identify a specific level of disability according to the appropriate diagnostic codes. Layno, 6 Vet. App. 465. The medical findings, as provided in the examination report, directly address the criteria under which his disability is rated. The Board finds that evidence is the most persuasive and outweighs any lay statement in support of his claim for a higher rating. Additionally, neither the Veteran nor his representative have indicated that the VA examination provided in April 2021 was inadequate in any manner or did not fully and adequately describe his hypertension. Finally, the Veteran has not testified or provided any statement regarding his hypertension or that his hypertension otherwise met the criteria for a higher rating.

Colon Polypectomy

The Veteran's colon polypectomy has been assigned a non-compensable rating pursuant to DC 7319. The Veteran has sought a higher rating.

DC 7319 addresses irritable bowel syndrome (IBS). A note to DC 7319 states that the diagnostic code may include functional digestive disorders (see § 3.317 of this chapter), such as dyspepsia, functional bloating and constipation, and diarrhea.

Under DC 7319 a 10 percent rating is assigned for abdominal pain related to defecation at least once during the previous three
b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49.

Colon Polypectomy

The Veteran's colon polypectomy has been assigned a non-compensable rating pursuant to DC 7319. The Veteran has sought a higher rating.

Under DC 7319 a 10 percent rating is assigned for abdominal pain related to defecation at least once during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension.

A 20 percent rating is assigned for abdominal pain related to defecation for at least three days per month during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension.

A 30 percent rating is assigned for abdominal pain related to defecation at least one day per week during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension.

A February 2020 VA medical record showed the Veteran denied rectal bleeding. A VA examination regarding the Veteran's colon polypectomy was conducted in April 2021. He reported persistent anal bleeding and abdominal pain. He was noted to be on medication for his symptoms. He was found to have intermittent diarrhea and rectal bleeding with a benign neoplasm.

Based on the foregoing, the Board finds that the persuasive evidence of record is against finding that the Veteran's colon polypectomy meets the criteria for a compensable rating. While the Veteran does have abdominal pain reported to be related to defecation and a change in stool form, there were no findings that he had a change in stool frequency, altered stool passage, mucorrhea, abdominal bloating, or subjective distension such to support a compensable rating.

Additionally, the Board has considered if the Veteran's condition is better rated pursuant to a different diagnostic code. However, DC 7336 which addresses hemorrhoids mandates that a 10 percent rating is assigned for internal hemorrhoids with two or less episodes per year of thrombosis; or external hemorrhoids with three or more episodes per year of thrombosis. A 20 percent rating is assigned for Internal or external hemorrhoids with persistent bleeding and anemia; or continuously prolapsed internal hemorrhoids with three or more episodes per year of thrombosis. As the Veteran has not been found to have any thrombosis or anemia, rating the Veteran's colon polypectomy pursuant to DC 7336 by analogy would not result in a compensable rating for his condition.

This, the persuasive evidence is against assigning a compensable rating for the Veteran's colon polypectomy. The Board finds that though the Veteran is competent to report observable symptoms he experienced through his senses, he is not competent to identify a specific level of disability according to the appropriate diagnostic codes. Layno, 6 Vet. App. 465. The medical findings, as provided in the examination report, directly address the criteria under which his disability is rated. The Board finds that evidence is the most persuasive and outweighs any lay statement in support of his claim for a compensable rating. Additionally, neither the Veteran nor his representative have indicated that the VA examination provided in April 2021 was inadequate in any manner or did not fully and adequately describe his colon polypectomy symptoms. Finally, the Veteran has not testified or provided any statement regarding his colon polypectomy or that his colon polypectomy otherwise met the criteria for a higher rating.

DEA Benefits

For purposes of entitlement to DEA benefits under 38 U.S.C. Chapter 35,
1 was inadequate in any manner or did not fully and adequately describe his colon polypectomy symptoms. Finally, the Veteran has not testified or provided any statement regarding his colon polypectomy or that his colon polypectomy otherwise met the criteria for a higher rating.

DEA Benefits

For purposes of entitlement to DEA benefits under 38 U.S.C. Chapter 35, basic eligibility exists if, among other things, a veteran was discharged from service under conditions other than dishonorable and is rated permanently and totally disabled due to service-connected disabilities. 38 U.S.C. § 3501; 38 C.F.R. §§ 3.807, 21.3021.

The Veteran has been granted DEA benefits as of November 1, 2019. The Veteran has sought an earlier effective date for the assignment of his DEA benefits. However, the record shows that the Veteran separated from service on October 31, 2019. Thus, November 1, 2019, is the earliest date upon which he can receive DEA benefits.

An effective date prior to November 1, 2019, then, for the assignment of DEA benefits is denied.

REASONS FOR REMAND

TDIU

The Veteran has sought a TDIU, specifically as due to his back disability. See September 2024 hearing testimony. However, the Veteran's VA examinations regarding his MDD indicate that he was employed and attending school during the period on appeal. See April 2019 and March 2021 VA examinations. The Veteran testified that he did not earn over the poverty threshold during the period on appeal. See September 2024 hearing testimony. Prior to the issuance of the rating decision on appeal, the Veteran's social security administration records were sought, but not obtained or associated with the record. The Board finds that this is a pre-decisional duty to assist error which must be corrected on remand. Knowledge of the Veteran's earnings during the period on appeal is necessary to determine his TDIU eligibility. Thus, while the Veteran seeks TDIU and hopes to then meet the standard for SMC, the Board must remand the issue of TDIU prior to making a decision.

The matters are REMANDED for the following action:

Obtain a complete copy of the Veteran's Social Security records regarding his earnings during the appeal period. Moreover, ask the Veteran to submit documents verifying his annual income.

J. JACK

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board A.P.

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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