Case A26037337

H.M. WALKER · 2026 · Case ID: A26037337

MIXED

Summary

The Veteran, who served in the U.S. Army across multiple periods between January 1986 and March 2018, appeals the January 2021 and March 2021 rating decisions. The appeal primarily concerns denials and remands for various conditions, including degenerative arthritis in the knees and hips, obstructive sleep apnea (OSA), restless leg syndrome (RLS), plantar fasciitis, and hypertension. The Veteran also sought service connection for erectile dysfunction, irritable bowel syndrome (IBS), prostate gland issues, bilateral testicular conditions, and tension headaches, all of which were denied. Tinnitus was granted service connection. Several issues were withdrawn by the Veteran prior to the Board's decision, including higher ratings for knee and hip degenerative arthritis, OSA, left ankle strain, erectile dysfunction, IBS, prostate gland, bilateral testicular conditions, and tension headaches. The Board granted service connection for tinnitus, finding it related to service with all doubt resolved in the Veteran's favor. However, claims for adjustment disorder with mixed anxiety and depressed mood, RLS, vasomotor rhinitis, multilevel degenerative disc disease (lumbar spine), cervical spine degenerative changes with cervicalgia, left foot plantar fasciitis, tension headaches, fibromyalgia, and a right hand condition were denied due to failure to meet entitlement criteria. The case was remanded for hypertension and right foot plantar fasciitis due to inadequate medical opinions regarding their pre-service or in-service onset and aggravation. Additionally, the case was remanded for a lumbar spine disability rating and for TDIU, as the existing evidence was insufficient to adjudicate these claims.

Service Branch

ARMY

Special Benefit

TDIU

Diagnostic Code

5243

Docket No.

210708-170911

Full Decision Text

Citation Nr: A26037337
Decision Date: 04/21/26 Archive Date: 04/21/26

DOCKET NO. 210708-170911
DATE: April 21, 2026

ORDER

Entitlement to an initial rating higher than 10 percent for left knee degenerative arthritis has been withdrawn.

Entitlement to an initial rating higher than 10 percent for right knee degenerative arthritis has been withdrawn.

Entitlement to an initial rating higher than 10 percent for left hip degenerative arthritis has been withdrawn.

Entitlement to an initial rating higher than 10 percent for right hip degenerative arthritis has been withdrawn.

Entitlement to an initial rating higher than 50 percent for obstructive sleep apnea (OSA) has been withdrawn.

Entitlement to an initial rating higher than 10 percent for left ankle strain has been withdrawn.

Entitlement to service connection for erectile dysfunction has been withdrawn.

Entitlement to service connection for irritable bowel syndrome (IBS) has been withdrawn.

Entitlement to service connection for prostate gland has been withdrawn.

Entitlement to service connection for bilateral testicular condition has been withdrawn.

Entitlement to service connection for tinnitus is granted.

Entitlement to an initial rating higher than 30 percent prior to November 9, 2020, and higher than 50 percent thereafter for adjustment disorder with mixed anxiety and depressed mood (acquired psychiatric disorder) is denied.

Entitlement to a rating higher than 10 percent prior to November 9, 2020, and higher than 20 percent thereafter for left restless leg syndrome (RLS) is denied.

Entitlement to a rating higher than 10 percent prior to November 9, 2020, and higher than 20 percent thereafter for right RLS is denied.

Entitlement to an initial compensable rating for vasomotor rhinitis is denied.

Entitlement to rating higher than 40 percent from November 9, 2020, for multilevel degenerative disc disease (lumbar spine disability) is denied.

Entitlement to a rating higher than 10 percent prior to November 9, 2020, and higher than 30 percent thereafter for degenerative changes of cervical spine with cervicalgia (neck disability) is denied.

Entitlement to a rating higher than 10 percent for left foot plantar fasciitis is denied.

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

Entitlement to service connection for fibromyalgia is denied.

Entitlement to service connection for a right hand condition is denied.

REMANDED

Entitlement to service connection for hypertension is remanded.

Entitlement to service connection for right foot plantar fasciitis is remanded.

Entitlement to a rating higher than 20 percent prior to November 9, 2020, for a lumbar spine disability is remanded.

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

FINDINGS OF FACT

1. On July 10, 2025, prior to the promulgation of a decision in the appeal, the Board received correspondence from the Veteran, requesting withdrawal of the appeal as to the issue of entitlement to an initial rating higher than 10 percent for left knee degenerative arthritis.

2. On July 10, 2025, prior to the promulgation of a decision in the appeal, the Board received correspondence from the Veteran, requesting withdrawal of the appeal as to the issue of entitlement to an initial rating higher than 10 percent for right knee degenerative arthritis.

3. On July 10, 2025, prior to the promulgation of a decision in the appeal, the Board received correspondence from the Veteran, requesting withdrawal of the appeal as to the issue of entitlement to an initial rating higher than 10 percent for left hip degenerative arthritis.

4. On July 10, 2025, prior to the promulgation of a decision in the appeal, the Board received correspondence from the Veteran, requesting withdrawal of the appeal as to the issue of entitlement to an initial rating higher than 10 percent for right hip degenerative arthritis.

5. On July 10, 2025, prior to the promulgation of a decision in the appeal, the Board received correspondence from the Veteran, requesting withdrawal of the appeal as to the issue of entitlement to an initial rating higher than 50 percent for obstructive sleep apnea (OSA).

6. On July 10, 2025, prior to the promulgation of a decision in the appeal, the Board received correspondence from the Veteran, requesting withdrawal of the appeal as to the issue of entitlement to an initial rating higher than 10 percent for left ankle strain.

7. On July 10, 2025, prior to the promulgation of a decision in the appeal, the Board
hip degenerative arthritis.

7. On July 10, 2025, prior to the promulgation of a decision in the appeal, the Board received correspondence from the Veteran, requesting withdrawal of the appeal as to the issue of entitlement to service connection for erectile dysfunction.

8. On July 10, 2025, prior to the promulgation of a decision in the appeal, the Board received correspondence from the Veteran, requesting withdrawal of the appeal as to the issue of entitlement to service connection for IBS.

9. On July 10, 2025, prior to the promulgation of a decision in the appeal, the Board received correspondence from the Veteran, requesting withdrawal of the appeal as to the issue of entitlement to service connection for prostate gland.

10. On July 10, 2025, prior to the promulgation of a decision in the appeal, the Board received correspondence from the Veteran, requesting withdrawal of the appeal as to the issue of entitlement to service connection for bilateral testicular conditions.

11. Resolving all doubt in the Veteran's favor, his tinnitus is related to service.

12. Prior to November 9, 2020, the Veteran's acquired psychiatric disorder most nearly approximated occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks; prior to November 9, 2020, the Veteran's acquired psychiatric disorder did not manifest by occupational and social impairment with reduced reliability and productivity. Although the Veteran noted experiencing suicidal ideation, this symptom, coupled with his other symptoms, were not of the severity, duration, and frequency to cause occupational and social impairment with reduced reliability and productivity

13. From November 9, 2020, the Veteran's acquired psychiatric disorder most nearly approximated occupational and social impairment with reduced reliability and productivity; the Veteran's acquired psychiatric disorder did not manifest by occupational and social impairment with deficiencies in most areas. Although the Veteran noted experiencing suicidal ideation, this symptom, coupled with his other symptoms, were not of the severity, duration, and frequency to cause occupational and social impairment with deficiencies in most areas.

14. Prior to November 9, 2020, the Veteran's left RLS manifested by, at worst, mild incomplete paralysis. From November 9, 2020, the Veteran's left RLS manifested by, at worst, moderate incomplete paralysis.

15. Prior to November 9, 2020, the Veteran's right RLS manifested by, at worst, mild incomplete paralysis. From November 9, 2020, the Veteran's right RLS manifested by, at worst, moderate incomplete paralysis.

16. The Veteran does not have nasal polyps, greater than 50 percent obstruction of his nasal passage on both sides, nor complete nasal obstruction on one side.

17. From November 9, 2020, at worst, the Veteran's thoracolumbar spine forward flexion was limited to 15 degrees. At no point has the evidence of record shown ankylosis, IVDS that required bed rest prescribed by a physician, or any associated neurological abnormalities.

18. Prior to November 9, 2020, at worst, the Veteran's cervical spine forward flexion was limited to 35 degrees. From November 9, 2020, the Veteran's neck disability was manifested by forward flexion of the cervical spine 15 degrees or less. At no point has the evidence of record shown unfavorable ankylosis of the entire cervical spine.

19. At no point throughout the rating period on appeal did the Veteran's left foot plantar fasciitis manifest in objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, or characteristic callosities.

20. At no point throughout the rating period on appeal did the Veteran's tension headaches manifest in characteristic prostrating attacks averaging one in 2 months over the last several months.

21. The Veteran does not have a current diagnosis for fibromyalgia that is related to service.

22. The Veteran does not have a current diagnosis for a right hand condition that is related to service.

CONCLUSIONS OF LAW

1. The criteria for withdrawal of entitlement to an initial rating higher than 10 percent for left
did the Veteran's left foot plantar fasciitis manifest in objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, or characteristic callosities.

20. At no point throughout the rating period on appeal did the Veteran's tension headaches manifest in characteristic prostrating attacks averaging one in 2 months over the last several months.

21. The Veteran does not have a current diagnosis for fibromyalgia that is related to service.

22. The Veteran does not have a current diagnosis for a right hand condition that is related to service.

CONCLUSIONS OF LAW

1. The criteria for withdrawal of entitlement to an initial rating higher than 10 percent for left knee degenerative arthritis by the Veteran and his authorized representative have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

2. The criteria for withdrawal of entitlement to an initial rating higher than 10 percent for right knee degenerative by the Veteran and his authorized representative have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

3. The criteria for withdrawal of entitlement to an initial rating higher than 10 percent for left hip degenerative by the Veteran and his authorized representative have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

4. The criteria for withdrawal of entitlement to an initial rating higher than 10 percent for right hip degenerative by the Veteran and his authorized representative have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

5. The criteria for withdrawal of entitlement to an initial rating higher than 50 percent for OSA by the Veteran and his authorized representative have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

6. The criteria for withdrawal of entitlement to an initial rating higher than 10 percent for left ankle strain by the Veteran and his authorized representative have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

7. The criteria for withdrawal of entitlement to service connection for erectile dysfunction by the Veteran and his authorized representative have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

8. The criteria for withdrawal of entitlement to service connection for IBS by the Veteran and his authorized representative have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

9. The criteria for withdrawal of entitlement to service connection for prostate gland by the Veteran and his authorized representative have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

10. The criteria for withdrawal of entitlement to service connection for bilateral testicular by the Veteran and his authorized representative have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

11. The criteria for entitlement to service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

12. The criteria for entitlement to an initial rating higher than 30 percent prior November 9, 2020, and higher than 50 percent thereafter for adjustment disorder with mixed anxiety and depressed mood (acquired psychiatric disorder) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9440.

13. The criteria for entitlement to a rating higher than 10 percent prior to November 9, 2020, and higher than 20 percent thereafter for left RLS have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520.

14. The criteria for entitlement to a rating higher than 10 percent prior to November 9, 2020, and higher than 20 percent thereafter for right RLS have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520.

15. The
, and higher than 20 percent thereafter for left RLS have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520.

15. The criteria for entitlement to an initial compensable rating for vasomotor rhinitis have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.97, Diagnostic Code 6522.

16. The criteria for entitlement to a rating higher than 40 percent from November 9, 2020, for a lumbar spine disability have not been met. 38 U.S.C. §§ 1155, 5107, 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.7, 4.71a, Diagnostic Code 5242.

17. The criteria for entitlement to a rating higher than 10 percent prior to November 9, 2020, and higher than 30 percent thereafter for a neck disability have not been met. 38 U.S.C. § 1155, 5107(b); 38 C.F.R. §§ 3.321(b)(1), 4.2, 4.7, 4.10, 4.14, 4.21, 4.40, 4.41, 4.45, 4.59, Diagnostic Code 5242.

18. The criteria for entitlement to a rating higher than 10 percent for left foot plantar fasciitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.59, 4.71a, Diagnostic Code 5276.

19. The criteria for entitlement to an initial compensable rating for tension headaches have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8100.

20. The criteria for entitlement to service connection for fibromyalgia have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

21. The criteria for entitlement to service connection for a right hand condition have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active duty service in the United States Army from January 1986 to June 1986, April 1988 to April 1997, January 2016 to April 2016, and June 2016 to March 2018. This matter comes before the Board of Veterans' Appeals (Board) on appeal from January 2021 and March 2021 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO), which is the Agency of Original Jurisdiction (AOJ).

In September 2020, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of an October 2019 decision. In January 2021, for all issues on appeal except for tinnitus, the AOJ issued the HLR decision on appeal, which considered the evidence of record at the time of the prior October 2019 decision. Therefore, the Board may only consider the evidence of record at the time of the October 2019 decision, and any evidence submitted during an applicable evidentiary window.

For the issue of tinnitus, although the Veteran initially requested Higher-Level Review when submitting the September 2020 VA Form 20-0996, Decision Review Request: Higher-Level Review, the Higher-Level Reviewer determined that there had been a duty to assist error and transferred the claim to the Supplemental
of an October 2019 decision. In January 2021, for all issues on appeal except for tinnitus, the AOJ issued the HLR decision on appeal, which considered the evidence of record at the time of the prior October 2019 decision. Therefore, the Board may only consider the evidence of record at the time of the October 2019 decision, and any evidence submitted during an applicable evidentiary window.

In the July 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on April 14, 2025 with the undersigned Veterans Law Judge.

Therefore, for all issues except tinnitus, the Board may only consider the evidence of record at the time of the October 2019 AOJ decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran, or his representative, at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision, which was subsequently subject to higher-level review 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.

For the issue of tinnitus, the Board may only consider the evidence of record at the time of the March 2021 AOJ supplemental claim decision on appeal, as well as any evidence submitted by the Veteran, or his 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 supplemental claim decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the 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.

However, because the Board is remanding the claims of entitlement to TDIU, entitlement to service connection for hypertension and right foot plantar fasciitis, and entitlement to a higher rating for a low back disability prior to November 9, 2020, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

At the outset, the Board notes that the Veteran resubmitted his December 2021 VA examinations during an applicable evidentiary window thus allowing the Board to consider than in adjudication of his claims.

1. Entitlement to an initial rating higher than 10 percent for left knee degenerative arthritis.

2. Entitlement to an initial rating higher than 10 percent for right knee degenerative arthritis.

3. Entitlement to an initial rating higher than 10 percent for left hip degenerative arthritis.

4. Entitlement to an initial rating higher than 10 percent for right hip degenerative arthritis.

5. Entitlement to an initial rating higher than 50 percent for OSA.

6. Entitlement to an initial rating higher than 10 percent for left ankle strain.

7. Entitlement to service connection for erectile dysfunction.

8. Entitlement to service connection for IBS.

9. Entitlement to service connection for prostate gland.

10. Entitlement to service connection for a bilateral testicular condition.

The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. §
Entitlement to an initial rating higher than 50 percent for OSA.

6. Entitlement to an initial rating higher than 10 percent for left ankle strain.

7. Entitlement to service connection for erectile dysfunction.

8. Entitlement to service connection for IBS.

9. Entitlement to service connection for prostate gland.

10. Entitlement to service connection for a bilateral testicular condition.

The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.205. Withdrawal may be made by the appellant or an authorized representative. Id.

In the present case, in July 2025 correspondence, the Veteran indicated his desire to withdraw his appeal for the issues of entitlement to higher ratings for bilateral knee degenerative arthritis, bilateral hip degenerative arthritis, OSA, a left ankle strain, erectile dysfunction, IBS, prostate gland, and bilateral testicular condition.

Accordingly, the appeals for those issues are dismissed.

11. Entitlement to service connection for tinnitus.

The Veteran contends that his tinnitus began in service.

Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995).

A Veteran is competent to describe symptoms that he experienced in service or at any time after service, when the symptoms he perceived or experienced were directly through the senses. 38 C.F.R. § 3.159; Layno v. Brown, 6 Vet. App. 465, 469-71 (1994). Lay evidence may establish a diagnosis of a simple medical condition, a contemporaneous medical diagnosis, or symptoms that later support a diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).

In the March 2021 rating decision, the AOJ found the Veteran has a current diagnosis of tinnitus. The AOJ also found the Veteran was exposed to noise during military service when he served as a Health Care Admin. The Board is bound by these favorable findings and the first two elements of service connection are met. See 38 C.F.R. § 3.104(c).

Thus, the Board turns to the third element: whether there is a nexus between the Veteran's tinnitus and his time in service.

A March 2019 VA examiner diagnosed the Veteran with tinnitus noting the Veteran did not otherwise have any occupational or recreational noise exposure. However, the examiner noted they could not provide a nexus opinion until the rest of the Veteran's service treatment records were available.

In March 2021, a VA examiner opined that the Veteran's tinnitus was less likely than not related to service because

there is objective evidence that his hearing was [within normal limits] 7 months after his last active duty period and there is no objective evidence of noise injury during or within a year of separation from any active duty period.

Resolving all doubt in the Veteran's favor, the Board finds it at least as likely as not his tinnitus was caused by his conceded in-service noise exposure. The March 2021 VA medical opinion relies on the lack of contemporaneous evidence in service treatment records in their rationale which is improper. Additionally, the examiner does not address the Veteran's own contentions that his tinnitus began in service.

Additionally, the Veteran's entrance examination reflects his hearing was normal; nothing in the Veteran's entrance examination suggests he suffered from tinnitus. As discussed above, the Veteran testified that his tinnitus symptoms first began while in service. Further, the March 2019 VA examiner noted that the Veteran did not have occupational or recreational noise exposure outside his conceded noise exposure in service.

Upon review of the record, the Board finds that there is an approximate balance of positive and negative evidence, and therefore finds that the benefit-of-the-doubt doctrine applies. After resolving all doubt in favor of the Veteran, the Board finds it as least as likely as not
examiner does not address the Veteran's own contentions that his tinnitus began in service.

Upon review of the record, the Board finds that there is an approximate balance of positive and negative evidence, and therefore finds that the benefit-of-the-doubt doctrine applies. After resolving all doubt in favor of the Veteran, the Board finds it as least as likely as not the Veteran's tinnitus is related to service. Thus, service connection for tinnitus is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

12. Entitlement to an initial rating higher than 30 percent prior to November 9, 2020, and higher than 50 percent thereafter for an acquired psychiatric disorder.

The Veteran contends that he is entitled to higher ratings for his acquired psychiatric disorder. The Veteran's acquired psychiatric disorder is rated 30 percent disabling prior to November 9, 2020, and 50 percent thereafter under Diagnostic Code 9440.

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). A 30 percent rating is warranted where the disorder is manifested by occupational and social impairment with an occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), and chronic sleep impairment, mild memory loss (such as forgetting names, directions, and recent events). A 50 percent rating is warranted if it is productive of occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating contemplates occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); and an inability to establish and maintain effective relationships. Lastly, a 100 percent evaluation is warranted for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name.

When evaluating a
, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); and an inability to establish and maintain effective relationships. Lastly, a 100 percent evaluation is warranted for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name.

When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran's capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner's assessment of the level of disability at the moment of the examination. When evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126.

The use of the term "such as" in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002).

In determining whether a 70 percent rating is warranted, the focus is on whether there are deficiencies in most of the areas of work, school, family relations, judgement, thinking and mood. Bowling v. Principi, 15 Vet. App. 1 (2001).

Although a veteran's symptomatology is the primary consideration in assessing a veteran's disability rating based on a mental disorder, the regulation also requires an ultimate factual conclusion as to the veteran's level of impairment in "most areas" for the 70 percent rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013); 38 C.F.R. § 4.130.

In Bankhead, citing from various sources, the Court first looked at how the term "suicidal ideation" is defined. See Bankhead v. Shulkin, 29 Vet. App. 10, 19 (2017). The Court summed it up stating that "both passive and active suicidal ideation are comprised of thoughts: passive suicidal ideation entails thoughts such as wishing that you were dead, while active suicidal ideation entails thoughts of self-directed violence and death." Id. at 20. In applying the meaning of suicidal ideation to the rating criteria, the Court noted that suicidal ideation is only listed as a symptom in the criteria for a 70 percent disability rating. Id. There are no analogues at the lower evaluation levels and there are no descriptors, modifiers or indicators as to suicidal ideation in the 70 percent criteria (including no specific mention of "active" suicidal ideation, "passive" suicidal ideation, suicidal "intent," suicidal "plan," suicidal "preparatory behavior," hospitalization, or past suicide attempts). Id. Thus, the Court found "the language of the regulation indicates that the presence of suicidal ideation, alone, that is, a veteran's thoughts of his or her own death or thoughts of engaging in suicide-related behavior, may cause occupational and social impairment with deficiencies in most areas." Id.

The Court then turned to the specifics of the case in Bankhead. The Court found that, insofar as the Board required evidence of more than thought or thoughts to establish the symptom of suicidal ideation, it erred. Id. at 20. The Court found that the Board erroneously grafted the risk of self-harm onto the symptom of suicidal ideation in the criteria for a 70 percent evaluation. In other words, a veteran need not be at a risk, whether a high or low risk, of self-harm to establish the criteria of suicidal ideation. Id. at 20-21. The Court also found that the Board erred in applying "hospitalization" as the standard for assessing the severity of that symptom. Id. at 21. Rather, the evaluation of mental disorders requires consideration of the effects of each of the veteran's mental symptoms on his or her social and occupational situation to determine the severity of
. at 20. The Court found that the Board erroneously grafted the risk of self-harm onto the symptom of suicidal ideation in the criteria for a 70 percent evaluation. In other words, a veteran need not be at a risk, whether a high or low risk, of self-harm to establish the criteria of suicidal ideation. Id. at 20-21. The Court also found that the Board erred in applying "hospitalization" as the standard for assessing the severity of that symptom. Id. at 21. Rather, the evaluation of mental disorders requires consideration of the effects of each of the veteran's mental symptoms on his or her social and occupational situation to determine the severity of the symptom. Id.

Put differently, although suicidal ideation alone may cause occupational and social impairment with deficiencies in most areas, it does not follow that suicidal ideation automatically warrants a 70 percent disability rating. The focus is on whether those suicidal ideations and his other symptoms are of the severity and frequency to cause occupational and social impairment with deficiencies in most areas.

The Veteran was first afforded a VA examination for his acquired psychiatric disorder in March 2019 and diagnosed with adjustment disorder with mixed anxiety and depressed mood. The examiner opined that the Veteran suffered occupational and social impairment with occasional decrease in work efficiency. The examiner noted the Veteran recently moved to San Antonio for work in the reserves, enjoyed cooking and grilling out, and had a good support network with his children. The Veteran reported taking psychotropic medication for his acquired psychiatric disorder and further reported difficulty concentrating, but denied any significant irritability. The examiner noted symptoms of depressed mood, anxiety, and chronic sleep impairment. The examiner noted the Veteran was casually dressed and adequately groomed, fully oriented, and cooperative throughout the examination without evidence of psychosis. The examiner noted that the Veteran affirmatively denied any suicidal or homicidal ideation, intent, or plan.

The Veteran was afforded another VA examination for his acquired psychiatric disorder in December 2021 and diagnosed with adjustment disorder with mixed anxiety and depressed mood. The examiner opined that the Veteran suffered occupational and social impairment with occasional decrease in work efficiency. The Veteran noted that he tended to keep his issues to himself, but had social support from his brother, daughter, and ex-girlfriend. The Veteran affirmatively denied any past or present suicidal or homicidal ideation. The examiner noted the following symptoms: depressed mood, anxiety, chronic sleep impairment, disturbances in motivation and mood, difficulty adapting to stressful circumstances, irritability, and mild social withdrawal. The examiner noted the Veteran was partially cooperative during the evaluation, alert, and oriented to person, place, time, and situation. His affect was topic congruent, his mood was anxious, his speech was of normal rate, tone, and volume, and his thought processes were goal-directed and logical. The examiner noted the Veteran was dressed casually and he displayed good personal hygiene.

The Board notes the VA examination reports are consistent with the Veteran's treatment records. There is nowhere in the Veteran's treatment records that indicate he experienced suicidal or homicidal ideation.

In his April 2025 Board hearing, the Veteran testified that he gets into a bad depressive state about once a week that has affected relationships with his family and dating life. The Veteran reported that he will sometimes go for two or three days without showering during a depressive episode and does not regularly brush his teeth. When his representative asked him if it was true that he experienced some suicidal ideation going back to 2018, he responded "There -- there have been those -- those -- those thoughts have been there. It's -- it's -- yes." The Veteran also reported memory problems, hypervigilance, limiting himself socially, and losing a lot of money on the stock market. The Veteran noted significant issues with colleagues while in service that explained several service treatment records noting his symptoms were interfering with his ability to handle responsibilities.

In July 2025 correspondence, the Veteran noted his increased struggles in service with his physical disabilities and issues with people he worked with. He reported that he answered "all PHA and Mental Health screens honestly" and was "honest with [his] provider." He noted that he reported suicidal ideations to his VA psychiatrist and reported symptoms of

not bathing for days, not worry about brushing my teeth at night and morning, not shaving, no going outside for days at a time, just about zero exercise except walks on beach occasionally.

In a section of his correspondence labeled suicidal ideation, the Veteran notes "while I have thought about death and the journey towards it, I don't think I ever really thought about leaving early. At Ft. Sam there were times when I just wanted to completely give up.

Thus, in this correspondence and his Board hearing the Veteran
He reported that he answered "all PHA and Mental Health screens honestly" and was "honest with [his] provider." He noted that he reported suicidal ideations to his VA psychiatrist and reported symptoms of

not bathing for days, not worry about brushing my teeth at night and morning, not shaving, no going outside for days at a time, just about zero exercise except walks on beach occasionally.

Thus, in this correspondence and his Board hearing the Veteran mentioned suicidal ideations. The question therefore becomes whether these suicidal ideations, along with the Veteran's other symptoms, rise to the level as to cause occupational and social impairment with deficiencies in most areas. Although the Board acknowledges that suicidal ideations alone, whether active or passive, may rise to the level of impairment contemplated by the 70 percent rating, the Board finds that in this case, they do not.

Prior to November 2020, the March 2019 VA examiner noted the Veteran had a solid support system, enjoyed some physical activity, and was working in the reserves. After November 2020, the Veteran still reported he had social support from his brother, daughter, and ex-girlfriend, acknowledging that not working was impacting his mental health. The Board's decision is by no means meant to minimize the struggles the Veteran has faced with his acquired psychiatric disorder. Rather, the Board notes that, instead of demonstrating symptoms such as intermittently illogical or obscure speech, near continuous panic or depression affecting his ability to function independently, neglect of personal appearance and hygiene, and an inability to maintain and establish effective relationships, the Veteran maintained several relationships and was noted to be appropriately groomed, with his judgment intact.

Prior to November 2020, there is simply not sufficient evidence to indicate the Veteran's occupational and social impairment more closely approximated occupational and social impairment with reduced reliability and productivity. The Veteran repeatedly reports that his work in the Army helped give him a sense of purpose and cope with his acquired psychiatric disorder. Thus, it makes sense that his symptoms got worse, which is reflected in his 50 percent rating from November 2020. However, there is still not sufficient evidence to show the Veteran's occupational and social impairment more closely approximated deficiencies in most areas from November 2020.

The Board appreciates the statements and reports submitted by the Veteran and acknowledges his belief that his symptoms have remained consistent since 2018 and that he is entitled to higher ratings. The statements made in the course of treatment or evaluation of his mental health disability are more persuasive than the Veteran's current statements reporting the same symptoms now as in 2018.

Further, although the Veteran has reported passive suicidal ideations in the past, the evidence overwhelmingly suggests he does not experience these ideations on a persistent basis. There are numerous instances in VA medical examinations and treatment records in the Veteran's file that affirmatively deny any suicidal or homicidal ideations. Again, the Board does not mean to minimize any difficulties the Veteran faces with his acquired psychiatric disorder and acknowledges his own reports of symptoms he experiences, but notes the first mentions of suicidal ideation are in statements he made while seeking VA benefits. In other words, prior to November 9, 2020, the Veteran's mental health symptoms were of the same severity, frequency, and duration as those associated with a 30 percent rating and from November 9, 2020, his mental health symptoms were of the same severity, frequency, and duration as those associated with a 50 percent rating.

Accordingly, the Board finds that a rating higher than 30 percent prior to November 9, 2020, and higher than 50 percent thereafter for an acquired psychiatric disorder is denied. As the evidence of record persuasively weighs against the Veteran's claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

13. Entitlement to a rating higher than 10 percent prior to November 9, 2020, and higher than 20 percent thereafter for left RLS.

14. Entitlement to a rating higher than 10 percent prior to November 9, 2020, and higher than 20 percent thereafter for right RLS.

The Veteran contends he is entitled to higher ratings for his bilateral RLS, which are rated under Diagnostic Code 8520. His bilateral RLS is rated as 10
§ 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

13. Entitlement to a rating higher than 10 percent prior to November 9, 2020, and higher than 20 percent thereafter for left RLS.

14. Entitlement to a rating higher than 10 percent prior to November 9, 2020, and higher than 20 percent thereafter for right RLS.

The Veteran contends he is entitled to higher ratings for his bilateral RLS, which are rated under Diagnostic Code 8520. His bilateral RLS is rated as 10 percent disabling prior to November 9, 2020, and 20 percent thereafter.

Under DC 8520, a 10 percent disability rating is warranted for mild incomplete paralysis of the sciatic nerve; a 20 percent disability rating is warranted for moderate incomplete paralysis; a 40 percent disability rating is warranted for moderately severe incomplete paralysis; and a 60 percent disability rating is warranted for severe incomplete paralysis with marked muscle atrophy. Finally, an 80 percent disability rating is warranted for complete paralysis, where the foot dangles and drops, there is no active movement possible of the muscles below the knee, and flexion of the knee is weakened or (very rarely) lost. See 38 C.F.R. § 4.124a, DC 8520.

The words "mild," "moderate," and "severe" as used in the various diagnostic codes are not defied in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based on the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.102. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124.

According to Merriam-Webster's Dictionary, "mild" means not very severe. See Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary/mild. "Moderate" means limited in scope or effect. See Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary/moderate. "Severe" means very painful or harmful or of a great degree. See Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary/severe. Although a medical examiner's use of descriptive terminology such as "mild" is an element of evidence to be considered by the Board, it is not dispositive of an issue. The Board must evaluate all evidence in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6.

The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376, 380 (2017).

The Board acknowledges that the VA Adjudicative Procedures Manual M21-1 (hereinafter M21-1) contains provisions regarding rating peripheral nerve disabilities. The United States Court of Appeals for the Federal Circuit has held that the Board is not bound by the provisions of the M21-1 and the manual does not "carry the force of law." DAV v. Sec'y of Veterans Affairs, 859 F.3d 1072, 1077 (Fed. Cir. 2017). It is "an internal manual used to convey guidance to VA adjudicators. It is not intended to establish substantive rules beyond those contained in statute and regulation." DAV, 859 F.3d at 1077. The M21-1 provisions do not go through the regular rulemaking procedures and are little more than evidence as to how the Veterans Benefits Administration (VBA) applies law and regulation
the Federal Circuit has held that the Board is not bound by the provisions of the M21-1 and the manual does not "carry the force of law." DAV v. Sec'y of Veterans Affairs, 859 F.3d 1072, 1077 (Fed. Cir. 2017). It is "an internal manual used to convey guidance to VA adjudicators. It is not intended to establish substantive rules beyond those contained in statute and regulation." DAV, 859 F.3d at 1077. The M21-1 provisions do not go through the regular rulemaking procedures and are little more than evidence as to how the Veterans Benefits Administration (VBA) applies law and regulation in practice. It is not binding on the Board because it is not a regulation, instruction of the Secretary, or Office of General Counsel (OGC) opinion. 38 U.S.C. § 7104(c); see also DAV, 859 F.3d at 1077. The regulations further clarify that the Board "is not bound by Department manuals, circulars, or similar administrative issues." 38 C.F.R. § 20.105.

Nevertheless, the Court in Overton v. Wilkie held that the Board is required to discuss "any relevant provisions contained in the [M21-1] as part of its duty to provide adequate reasons or bases, but because it is not bound by those provisions, it must make its own determination before it chooses to rely on an [M21-1] provision as a factor to support its decision." 30 Vet. App. 257, 264 (2018). More recently, in Wilson v. McDonough, the Court elaborated that, in the context of relevant guidance documents, the Board can "neither merely invoke nor ignore a relevant guidance provision to support its decision but must provide an independent rationale relating its decision to the relevant guidance document." 35 Vet. App. 75, 80 (2021).

Pursuant to Wilson, the Board finds that VA's M21-1 does contain guidance relevant to the adjudication of the issues currently on appeal. Specifically, Part V, Subpart iii, Chapter 12, Section A(c) of the M21-1 provides "general guidelines" for the terms "mild," "moderate," "moderately severe," and "severe" in the context of evaluating incomplete paralysis of the upper and lower peripheral nerves.

Under the M21-1, "mild" is described as the lowest level of evaluation based on the symptoms, however slight, as long as they were sufficient to support a diagnosis of the peripheral nerve impairment. Generally, "mild" is limited to a disability limited to sensory deficits that are lower graded, less persistent, and affecting a small area and/or a very minimal reflex or motor abnormality.

"Moderate" in the M21-1 is described as the maximum evaluation reserved for the most significant cases of sensory-only impairment. The M21-1 further elaborates that the following "sign/symptom combinations" may fall into the moderate category: 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.

The M21-1 provides that "moderately severe" is only applicable for involvement of the sciatic nerve and is described as motor and/or reflex impairment (for example, weakness or diminished or hyperactive reflexes) at a grade reflecting a high level of limitation or disability. Atrophy may be present with moderately severe peripheral neuropathy.

"Severe," in general, is expected to include 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 with severe longstanding neuropathy. 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.

The Veteran was first afforded a VA examination for his RLS in March 2019. The examiner noted his RLS began in 2012 in service and gradually worsened over time. The examiner noted the Veteran takes continuous medication, Mirapex, for his RLS which helps his symptoms to some degree. His symptoms were described as "unpleasant/uncomfortable" creating the "need to move, crawling, restless, creeping, and discomfort." The Veteran's March 2019 VA examination for his back did not note any signs or symptoms of radiculopathy nor that his sci
the disability picture for severe incomplete paralysis may contain signs/symptoms resembling some of those expected in cases of complete paralysis of the nerve.

The Veteran was afforded another VA examination for his RLS in December 2021, the examiner again noting that his condition had gotten worse over the years. The examiner noted mild intermittent pain, numbness, and paresthesias and/or dysesthesias for bilateral upper and lower extremities. The examiner noted moderate incomplete paralysis of both the left and right sciatic nerve. The examiner further noted the Veteran did not take medication for his bilateral RLS. The Veteran's treatment records present a similar disability picture.

The Board acknowledges the Veteran testified in his April 2025 Board hearing that he has been experiencing the same RLS symptoms since March 2018. However, both the March 2019 and December 2021 VA examination reports note the Veteran's RLS condition has gotten worse over time. Thus, his testimony is directly contradicted by the findings in the VA examination reports. The Board finds the VA medical opinions highly probative. The examiners considered the Veteran's entire medical history as well as his lay statements and provided a clear conclusion with supporting rationale. Further, although the Board acknowledges the Veteran is competent to report symptoms he experiences, the statements made by the Veteran while seeking VA benefits are far outweighed by the competent medical evidence of record showing a different disability picture. Based on the foregoing, the Board finds that the currently assigned ratings for the Veteran's bilateral RLS are appropriate.

Thus, prior to November 9, 2020, a rating higher than 10 percent is not warranted for the Veteran's bilateral RLS. The March 2019 VA examination report indicates the Veteran's symptoms were mostly mild. As noted above, mild symptoms warrant a 10 percent rating, which the Veteran is currently assigned. Therefore, a higher rating is not warranted.

From November 9, 2020, a rating higher than 20 percent is not warranted for the Veteran's bilateral RLS. The December 2021 VA examiner characterized the Veteran's disability as mild incomplete paralysis of both sciatic nerves. Nothing noted in the examination suggests the Veteran's disability rises to the level of moderately severe incomplete paralysis of the sciatic nerves. Even considering the Veteran's lay statements and treatment records throughout the appeal period, nothing in the Veteran's file suggests that his bilateral RLS rises to the level of moderately severe incomplete paralysis of the sciatic nerves.

The Board acknowledges the March 2019 VA examiner reported that the Veteran takes medication for his bilateral RLS which helped "to some degree." However, there is no competent medical opinion, or other competent evidence, demonstrating that the Veteran would meet additional criteria for a higher rating but for the use of such medication. Further, the Veteran was not taking any medication when he was examined in December 2021.

Additionally, the Board has considered whether the Veteran is entitled to separate ratings for neuritis and neuralgia for his nerve disabilities and finds he is not.

Thus, the Board finds the evidence weighs against ratings higher than 10 percent prior to November 9, 2020, and higher than 20 percent thereafter for the Veteran's bilateral RLS. As the evidence of record persuasively weighs against the Veteran's claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

15. Entitlement to an initial compensable rating for vasomotor rhinitis.

The Veteran contends that he is entitled to a compensable rating for his vasomotor rhinitis. The Veteran's non-allergic rhinitis is rated under Diagnostic Code 6522.

Under Diagnostic Code 6522, allergic or vasomotor rhinitis without polyps, but with greater than 50 percent obstruction of nasal passage on both sides or complete obstruction on one side, warrants a 10 percent rating. With polyps, a 30 percent rating is warranted.
4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

15. Entitlement to an initial compensable rating for vasomotor rhinitis.

The Veteran contends that he is entitled to a compensable rating for his vasomotor rhinitis. The Veteran's non-allergic rhinitis is rated under Diagnostic Code 6522.

The Veteran was afforded a VA examination for his vasomotor rhinitis in March 2019. The examiner noted that the Veteran takes Claritin, Flonase, a decongestant, and uses a neti bottle with Bactroban as needed. The examiner found the Veteran did not have greater than 50 percent obstruction of the nasal passage on both sides due to rhinitis, complete obstruction on either side due to rhinitis, and did not have nasal polyps.

The Veteran was afforded another VA examination in December 2021. The examiner noted the Veteran takes prescription Fluticasone and Claritin D. The examiner found the Veteran did not have greater than 50 percent obstruction of the nasal passage on both sides due to rhinitis, complete obstruction on either side due to rhinitis, and did not have nasal polyps. The Veteran's treatment records present a similar disability picture.

In making the above findings, the Board is cognizant of the fact that the Veteran has used medication to treat his rhinitis. The Court of Appeals for Veteran's Claims (Court) has held that in assigning a disability rating, VA may not consider the ameliorative effects of medication where such effects are not explicitly contemplated by the rating criteria. See Jones v. Shinseki, 26 Vet. App. 56 (2012). Here, however, there is no competent medical opinion, or other competent evidence, demonstrating that the Veteran would meet additional criteria for a higher rating (i.e. greater than 50 percent obstruction of the nasal passage or nasal polyps) but for the use of such medication.

The Board acknowledges the Veteran's July 2025 correspondence discussing the symptoms he experiences including stuffy nose, postnasal drip, thick discharge, itchy and watery eyes, sneezing, and frontal headaches. The Veteran is competent to report the symptoms he experiences, and the Board does not dispute that his rhinitis symptoms are frustrating and impact his life. However, to qualify for a compensable rating under DC 6522, the Veteran's rhinitis would have to specifically manifest in greater than 50 percent obstruction of nasal passage on both sides, complete obstruction on one side, or nasal polyps. It has not.

Thus, the Veteran's claim for an initial compensable rating for his vasomotor rhinitis must be denied. As the evidence of record persuasively weighs against the Veteran's claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

16. Entitlement to a rating higher than 40 percent from November 9, 2020, for a lumbar spine disability.

The Veteran contends he is entitled to a higher rating for his lumbar spine disability.

The Veteran's lumbar spine disability is rated under DC 5242. He is currently assigned a 20 percent rating prior to November 9, 2020, and a 40 percent rating thereafter. As discussed below, the Board is remanding entitlement to a rating higher than 20 percent prior to November 9, 2020.

Currently, all spinal disabilities are evaluated under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula). Degenerative arthritis of the spine is to be evaluated either under the General Rating Formula or the Formula for Rating Intervertebral Disc Syndrome (IVDS) Based on Incapacitating Episodes (DC 5243), whichever method results in a higher evaluation. 38 C.F.R. § 4.71a.

Under the General Formula, a 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or, the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine.

The General Formula also provides that VA must evaluate any associated objective neurological abnormalities separately under an appropriate Diagnostic Code. Id., Note 1.

Normal ranges of motion of the thoracolumbar spine are flexion from 0 to 90 degrees, extension from 0 to 30 degrees, lateral flexion from 0 to 30 degrees, and lateral rotation from 0 to 30 degrees. The normal combined range of motion of the thoracolumbar spine is 240 degrees. 38 C.F.R. § 4.71a, Note 2; see also Plate V.

For VA compensation purposes, unfavorable ankylosis is a condition in which 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. 38 C.F.R. § 4.71a , General Rating Formula, Note 5.

The Court held that the requirement of ankylosis in the General Rating Formula for Injuries and Diseases of the Spine can be met with evidence of the functional equivalent of ankylosis (i.e., functional immobility of the joint) during a flare-up. Chavis v. McDonough, 34 Vet. App. 1 (2021).

As discussed above, spinal disabilities can also be rated under the Formula for Rating IVDS Based on Incapacitating Episodes. A 20 percent rating is warranted for IVDS with incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past 12 months. A 40 percent rating is assigned when IVDS causes incapacitating episodes having a total duration of at least four weeks but less than six weeks during the past 12 months. A 60 percent rating is assigned when IVDS causes incapacitating episodes having a total duration of at least six weeks during the past 12 months.

An incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. 38 C.F.R. § 4.71a, Formula for Rating IVDS Based on Incapacitating Episodes, at Note 1.

Considering the competent evidence of record in light of the applicable rating criteria and considerations discussed above, the Board finds, for the following reasons, a rating higher than 40 percent from November 9, 2020, for his lumbar spine disability is not warranted.

The Veteran was first afforded a VA examination for his lumbar spine disability in March 2019 and diagnosed with multilevel degenerative disc disease. As discussed below, this examination is inadequate and the Board is remanding the Veteran's claim prior to November 9, 2020.

The Veteran was afforded another VA examination for his lumbar spine disability in December 2021 and diagnosed with multilevel degenerative disc disease and bilateral lower extremity radiculopathy. The Veteran is separately service connected for his radiculopathy. The Veteran reported taking over the counter medication and noted his condition "has worsened over the years." The Veteran reported daily moderate flare-ups that last several hours precipitated by prolonged sitting, standing, bending, twisting, and lifting heavy weight and alleviated by time and rest. The Veteran reported functional loss after repeated use over time. On ROM testing, he had forward flexion to 30 degrees, extension to 15 degrees, right and left lateral flexion to 15 degrees, and right and left lateral rotation to 15 degrees. The examiner noted pain on examination in all ROMs in active and passive motion that did cause functional loss, described as limited range of motion, difficulty with heavy lifting, bending, prolong walking or climbing stairs. After repetitive use testing, the Veteran had forward flexion to 25 degrees, extension to 15 degrees, right and left lateral flexion to 15 degrees, and right and left lateral rotation to 15 degrees. After repeated use over time, the Veteran had forward flexion to 20 degrees, extension to 10 degrees, right and left lateral flexion to 10 degrees, and right and left lateral rotation to 10 degrees. The examiner estimated that, during a flare-up, the Veteran would have forward flexion to 15 degrees, extension to 5 degrees, right and left lateral flexion to 5 degrees, and right and left lateral rotation to 5 degrees. The examiner noted the Veteran did not have guarding or muscle spasms, ankylosis, IVDS, or any other neurologic abnormalities. The examiner also noted that the Veteran did not regularly use any assistive devices.

The Veteran's treatment records present a similar disability picture. There are no treatment records that report any ankylosis, physician prescribed bedrest for IVDS, or forward flexion limited beyond the estimates in the VA examination reports.

In his April 2025 Board hearing, the Veteran testified that, during a lumbar spine flare-up, it was difficult to bend, change positions of his back, or tie his shoes. In July 2025 correspondence, he reported that spinal injections and medication do not relieve his symptoms and that most movement causes pain and discomfort.

The Veteran's lumbar spine disability does not warrant a rating higher than 40 percent from November 9, 2020, because the Veteran does not have IVDS with incapacitating episodes, nor has the evidence shown unfavorable ankylosis of the entire thoracolumbar spine. All the VA examinations of record unequivocally report the Veteran does not have ankylosis. Further, at no point during the appeal period has the Veteran demonstrated any level of ankylosis or its functional equivalent.

The Court has recently held that when evaluating a disability under VA's General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula), the criteria for a rating based on ankylosis may be met by evidence demonstrating the functional equivalent of ankylosis i.e., functional loss consistent with that contemplated by ankylosis. See Chavis v. McDonough, 34 Vet. App. 1, 29 (2021); 38 C.F.R. §§ 4.40, 4.45; Mitchell v. Shinseki, 25 Vet. App. 32 (2011); DeLuca v. Brown, 8 Vet. App. 202 (1995).

As noted above, ankylosis is defined, for VA compensation purposes, as a condition in which all or part of the spine is fixed in flexion or extension. The Veteran has consistently reported, though his abilities are limited by his pain, he is able to stand, sit, and bend for limited periods of time. It is reasonable to assume that these activities require him to move his back. Further, although the Veteran reported pain in all motions, he did not describe the level of pain being so severe that he essentially could not move his back at all. As such, the Board finds that at no point during the appeal period has the Veteran demonstrated an
, 8 Vet. App. 202 (1995).

In reaching these conclusions, the Board has considered whether there is additional functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40, 4.45, and 4.59. The Board has also considered the Veteran's lay statements of pertinent symptomatology. The Veteran is competent to report symptoms he experiences, including pain. After reviewing all relevant evidence, including the Veteran's lay statements, the Board finds that any functional loss is contemplated in the currently assigned 40 percent rating. Specifically, the December 2021 VA examination provided estimates of the Veteran's range of motion measurements after repeated use over time, which accounts for pain, fatigue, and weakness under this specific circumstance. These estimates were based on the Veteran's lay reports regarding functional loss. Thus, even when considering the impact of pain and range of motion limitations after repeated use over time and during flare-ups, the evidence does not support entitlement to a higher rating.

The Board acknowledges the Veteran's lay reports regarding his lumbar spine disability and his sincere belief that a higher rating is warranted. To the extent the Veteran argues that his symptomatology is more severe, his statements must be weighed against the other evidence of record. Here, the specific examination findings of trained health care professionals and contemporaneous lay statements are of greater probative weight than more generalized lay assertions that a higher rating is warranted. The Board has considered the Veteran's lay reports in rendering a decision on appeal. The Board concludes that the medical findings on examinations are of greater probative value than the Veteran's allegations regarding the severity of his disability. The symptomatology noted in the medical and lay evidence has been adequately addressed by the evaluations assigned and do not more nearly approximate the criteria for a rating higher than 40 percent for the Veteran's lumbar spine disability.

The Board has also considered whether a higher rating could be assigned under the Formula for Rating IVDS Based on Incapacitating Episodes. In this case, there is no evidence that the Veteran had incapacitating episodes as defined by VA regulations. Rather, the Veteran has not alleged, nor does the evidence show, that he has a diagnosis of IVDS that resulted in medically prescribed bedrest. As such, the Board finds that at no point during the appeal period is a higher rating under DC 5237 warranted for the Veteran's lumbar spine disability. Additionally, the evidence does not show any associated objective neurologic abnormalities related to the thoracolumbar spine that are not already service connected. See 38 C.F.R. § 4.71a, DC 5242, Note 1.

The Board acknowledges the December 2021 VA examiner and the Veteran both report that he takes medication for his lumbar spine disability. Here, however, there is no competent medical opinion, or other competent evidence, demonstrating that the Veteran would meet additional criteria for a higher rating but for the use of such medication. Further, the Veteran stated in his July 2025 correspondence that such medication does not relieve his symptoms.

In conclusion, the Veteran's claim for a rating higher than 40 percent from November 9, 2020, for his lumbar spine disability must be denied. As the evidence of record persuasively weighs against the Veteran's claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

17. Entitlement to a rating higher than 10 percent prior to November 9, 2020, and higher than 30 percent thereafter for a neck disability.

The Veteran contends that he is entitled to a higher rating for his neck disability.

The Veteran's neck disability is rated under Diagnostic Code 5242 as 10 percent disabling prior to November 9, 2020
ively weighs against the Veteran's claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

17. Entitlement to a rating higher than 10 percent prior to November 9, 2020, and higher than 30 percent thereafter for a neck disability.

The Veteran contends that he is entitled to a higher rating for his neck disability.

The Veteran's neck disability is rated under Diagnostic Code 5242 as 10 percent disabling prior to November 9, 2020, and 30 percent thereafter.

Under the General Rating Formula, a 10 percent rating is warranted where forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or muscle spasm, guarding or localized tenderness not resulting in abnormal gait or abnormal spinal contour or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted where forward flexion of the cervical spine is greater than 15 degrees, but not greater than 30 degrees; or where the combined range of motion of the cervical spine is not greater than 170 degrees; or where muscle spasm or guarding is 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 warranted where forward flexion of the cervical spine is 15 degrees or less; or where there is favorable ankylosis of the entire cervical spine. A 40 percent rating is warranted for unfavorable ankylosis of the entire cervical spine. The other provisions discussed above for the Veteran's lumbar spine disability are also applicable here and will be discussed as relevant.

The Veteran was first afforded a VA examination for his neck disability in March 2019 and diagnosed with degenerative changes of cervical spine and cervicalgia. The Veteran reported constant aching pain that has worsened gradually over time. Range of motion testing revealed flexion to 35 degrees, extension to 40 degrees, right and left lateral flexion to 40 degrees, and right and left lateral rotation to 75 degrees. The examiner noted pain on examination in all ROMs that did cause functional loss. The Veteran was able to perform repetitive use testing without additional loss of function. The examiner noted:

Function and condition is based upon a careful and complete review of C-file and other available records, in addition to today's assessment and exam, it would only be speculative to report additional ROM loss and whether pain, weakness, fatigability, or incoordination could significantly limit functional ability during flare-ups, or when the joint is used repeatedly over a period of time when it has not been documented in the actual records However, per the subjective reporting of the veteran, there are limitations related to the pain in the back of neck. Veteran reported the following limitations: neck twisting, neck bending, pushing, pulling, straining, and lifting more than 20 pounds. The Veteran was felt to be a credible person. Therefore, since the history provided by the Veteran was felt to be reliable and given, my evaluation, I agree with the above mentioned limitations.

The examiner noted the Veteran did not have guarding or muscle spasms, radiculopathy, ankylosis, IVDS, or any other neurologic abnormalities. The examiner also noted that the Veteran did not regularly use any assistive devices.

The Veteran was afforded another VA examination in December 2021 and diagnosed with degenerative changes of cervical spine with cervicalgia and bilateral upper extremity radiculopathy. The Veteran is separately service connected for his radiculopathy. The Veteran reported over the counter medication and that his condition has "worsened over the years." The Veteran reported daily flare-ups of the neck that are moderate to severe precipitated by turning head to far left/right, strenuous exercises, and sit-ups and alleviated by time, rest, and stretching. Range of motion testing revealed flexion to 30 degrees, extension to 30 degrees, right and left lateral flexion to 30 degrees, and right and left lateral rotation to 50 degrees. The examiner noted pain on examination in all ROMs active and passive that did cause functional loss described as limited range of motion and difficulty with heavy lifting. After repetitive use testing, the Veteran had forward flexion to 25 degrees, extension to 25 degrees, right and left lateral flexion to 25 degrees, and right and left lateral rotation to 45 degrees.
are moderate to severe precipitated by turning head to far left/right, strenuous exercises, and sit-ups and alleviated by time, rest, and stretching. Range of motion testing revealed flexion to 30 degrees, extension to 30 degrees, right and left lateral flexion to 30 degrees, and right and left lateral rotation to 50 degrees. The examiner noted pain on examination in all ROMs active and passive that did cause functional loss described as limited range of motion and difficulty with heavy lifting. After repetitive use testing, the Veteran had forward flexion to 25 degrees, extension to 25 degrees, right and left lateral flexion to 25 degrees, and right and left lateral rotation to 45 degrees. After repeated use testing, the Veteran had forward flexion to 20 degrees, extension to 20 degrees, right and left lateral flexion to 20 degrees, and right and left lateral rotation to 40 degrees. During flare-ups, the Veteran had forward flexion to 15 degrees, extension to 15 degrees, right and left lateral flexion to 15 degrees, and right and left lateral rotation to 35 degrees. The examiner noted the Veteran did not have guarding or muscle spasms, ankylosis, IVDS, or any other neurologic abnormalities. The examiner also noted that the Veteran did not regularly use any assistive devices.

In July 2025 correspondence, the Veteran discussed his neck symptoms. He noted his neck pain has progressively gotten worse, specifically reporting that he has had "significant pain since mid-2017 that has increased in severity." The Board notes that most of the symptoms the Veteran describes in this correspondence relates to his radiculopathy which is separately service connected and not currently on appeal before the Board.

The Veteran's neck disability does not warrant a rating higher than 10 percent prior to November 9, 2020, and higher than 30 percent thereafter. Prior to November 9, 2020, at worst, the Veteran's forward flexion was limited to 35 degrees. Further, at no point throughout the appeal period has the evidence shown IVDS with incapacitating episodes, nor has the evidence shown any ankylosis. All the VA examinations of record unequivocally report the Veteran does not have ankylosis. Further, at no point during the appeal period has the Veteran demonstrated any level of ankylosis or its functional equivalent.

The Board acknowledges that, in his April 2025 Board hearing, the Veteran testified that his neck symptoms have been the same since 2018 and he is thus entitled to a higher rating prior to November 2020. However, unlike his lumbar spine symptoms, there is no evidence he was being treated for flare-ups prior to November 2020. The March 2019 VA examiner considered the Veteran's own contentions, noted the Veteran was an accurate historian of his symptoms, and specifically noted the Veteran did not experience flare-ups. Further, both the March 2019 and December 2021 VA examiners and the Veteran's own July 2025 lay statements report the Veteran's neck disability has progressively gotten worse over time, accounting for the lower rating prior to November 2020. Accordingly, although the Board acknowledges the Veteran is competent to report symptoms he experiences, the statements made by the Veteran while seeking VA benefits are far outweighed by the competent medical evidence of record that considered the objective evidence in conjunction with the subject evidence/lay statements reported by the Veteran.

As noted above, ankylosis is defined, for VA compensation purposes, as a condition in which all or part of the spine is fixed in flexion or extension. Although the Veteran reported pain in all motions, he did not describe the level of pain being so severe that he essentially could not move his neck at all. As such, the Board finds that at no point during the appeal period has the Veteran demonstrated ankylosis or the functional equivalent of ankylosis.

In reaching these conclusions, the Board has considered whether there is additional functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40, 4.45, and 4.59. The Board has also considered the Veteran's lay statements of pertinent symptomatology. The Veteran is competent to report symptoms he experiences, including pain. After reviewing all relevant evidence, including the Veteran's lay statements, the Board finds that any functional loss is contemplated in the currently assigned 10 and 30 percent ratings. Specifically, the VA examination provided estimates of the Veteran's range of motion measurements after repeated use over time, which accounts for pain, fatigue, and weakness under this specific circumstance. These estimates were based on the Veteran's lay reports regarding functional loss. Thus, even when considering the impact of pain and range of motion limitations after repeated use over time and during flare-ups, the evidence does not support entitlement to a higher rating.

The Board acknowledges the Veteran's lay reports regarding his neck disability and his sincere belief that a higher rating is warranted. To the extent the Veteran argues that his symptomatology is more severe, his statements must be weighed against the other evidence of record. Here, the specific examination findings of trained health care professionals and contemporaneous lay statements are of greater probative weight than more generalized lay assertions that a higher rating is warranted. The Board has considered the Veteran's lay reports in rendering a decision on appeal. The Board concludes that the medical findings on examinations are of greater probative value than the Veteran's allegations regarding the severity of his disability. The symptomatology noted in the medical and lay evidence has been adequately addressed by the evaluations assigned and do not more nearly approximate the criteria for higher ratings.

The Board has also considered whether a higher rating could be assigned under the Formula for Rating IVDS Based on Incapacitating Episodes. In this case, there is no evidence that the Veteran had incapacitating episodes as defined by VA regulations. Rather, the Veteran has not alleged, nor does the evidence show, that he has a diagnosis of IVDS that resulted in medically prescribed bedrest. As such, the Board finds that at no point during the appeal period is a higher rating under DC 5237 warranted for the Veteran's neck disability. Additionally, the evidence does not show any associated objective neurologic abnormalities related to the cervical spine that are not already service connected. See 38 C.F.R. § 4.71a, DC 5242, Note 1.

The Board acknowledges the December 2021 VA examiner and the Veteran both report that he takes over the counter medication for his neck disability. Here, however, there is no competent medical opinion, or other competent evidence, demonstrating that the Veteran would meet additional criteria for a higher rating but for the use of such medication.

In conclusion, the Veteran's claim for a rating higher than 10 percent prior to November 9, 2020, and higher than 30 percent thereafter for his neck disability must be denied. As the evidence of record persuasively weighs against the Veteran's claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

18. Entitlement to a rating higher than 10 percent for left foot plantar fasciitis.

The Veteran contends he is entitled to a higher rating for his left foot plantar fasciitis. His left foot plantar fasciitis is rated as 10 percent disabling under Diagnostic Code 5276.

Under Diagnostic Code 5276, a 10 percent, or "moderate" rating is warranted for weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet, bilateral or unilateral. A 30 percent bilateral or 20 percent unilateral "severe" rating is warranted for objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, or characteristic callosities. A 50 percent bilateral or 30 percent unilateral "pronounced" rating is warranted for marked pronation, extreme tenderness of plantar surfaces of the feet, or marked inward displacement and severe spasm of the tendo achillis on manipulation that is not improved by orthopedic shoes or appliances.

The Veteran was afforded a VA examination for his left foot in March 2019 and diagnosed
o achillis, pain on manipulation and use of the feet, bilateral or unilateral. A 30 percent bilateral or 20 percent unilateral "severe" rating is warranted for objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, or characteristic callosities. A 50 percent bilateral or 30 percent unilateral "pronounced" rating is warranted for marked pronation, extreme tenderness of plantar surfaces of the feet, or marked inward displacement and severe spasm of the tendo achillis on manipulation that is not improved by orthopedic shoes or appliances.

The Veteran was afforded a VA examination for his left foot in March 2019 and diagnosed with bilateral pes planus and left foot plantar fasciitis. The Veteran reported severe left heel pain with running and flare-ups when he returned to the military that resulted in additional functional loss described as having to walk instead of run. The examiner noted pain accentuated on use with his left foot. The examiner found the Veteran did not have pain on manipulation of the feet, swelling on use, characteristic callouses, extreme tenderness of plantar surfaces, decreased longitudinal arch height, objective evidence of marked deformity, nor marked pronation, the weight-bearing line did not fall over or medial to the great toe, there was no lower extremity deformity other than pes planus causing alteration of the weight-bearing line, no inward" bowing of the Achilles tendon, nor did the Veteran have marked inward displacement and severe spasm of the Achilles tendon (rigid hindfoot) on manipulation. The Veteran uses orthotics for his left foot condition.

The Veteran's treatment records present a similar disability picture.

The Board finds that a rating higher than 10 percent is not warranted. A higher rating under Diagnostic Code 5276 requires objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, or characteristic callosities. The March 2019 VA examination found the Veteran did not experience any of these manifestations. Further, the Veteran does not specifically contend he experiences any of these manifestations. The Board finds the Veteran's symptoms are adequately contemplated by the current 10 percent rating and these symptoms do not rise to the levels required for a higher unilateral 20 percent rating under Diagnostic Code 5276.

The evidence does not show, and the Veteran does not contend, that he takes medication to treat his left foot plantar fasciitis.

In addition to the foregoing, the Board has considered the other DCs pertaining to the feet. However, in Scott v. Wilkie, the U.S. Court of Appeals for the Federal Circuit (Federal Circuit) expressly adopted the Court's holding that disabilities specifically listed in VA's rating schedule may only be rated under DC which specifically pertain to them. Scott v. Wilkie, 920 F.3d 1375 (Fed. Cir. 2019) (citing Copeland v. McDonald, 27 Vet. App. 333, 336 (2015)). Here, the Veteran's disability is specifically listed under the rating schedule. Therefore, it cannot be rated under a different DC. As the evidence of record persuasively weighs against the Veteran's claim for a rating higher than 10 percent for his left foot plantar fasciitis, the benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

19. Entitlement to an initial compensable rating for tension headaches.

The Veteran contends he is entitled to a compensable rating for his tension headaches. His tension headaches are rated under Diagnostic Code 8100.

Under DC 8100, a noncompensable rating is warranted for headaches with less frequent attacks. A 10 percent rating is warranted for headaches with characteristic prostrating attacks averaging one in 2 months over the last several months. A 30 percent rating is warranted for headaches with characteristic prostrating attacks occurring on an average once a month over the last several months. A 50 percent rating is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. A 50 percent rating is the highest schedular rating under DC 8100.

The rating criteria of DC 8100 are considered successive, meaning that a claimant cannot fulfill the criteria of the higher rating without fulfilling those of the next lower rating. See Johnson v. Wilkie, 30 Vet. App. 245, 252 (2018).
prostrating attacks averaging one in 2 months over the last several months. A 30 percent rating is warranted for headaches with characteristic prostrating attacks occurring on an average once a month over the last several months. A 50 percent rating is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. A 50 percent rating is the highest schedular rating under DC 8100.

The phrase "characteristic prostrating attacks" is used in the criteria corresponding to 10 percent and 30 percent ratings under DC 8100 to describe the nature and severity of headaches, but it is not defined in the regulation. Pursuant to Dorland's Illustrated Medical Dictionary 1531 (32d ed. 2012), prostration is defined as "extreme exhaustion or powerlessness." Thus, the phrase "characteristic prostrating attacks" is understood to describe headache attacks that typically produce extreme exhaustion or powerlessness.

Additionally, the terms "productive of severe economic adaptability" have not been clearly defined by regulations or by case law. The Court has noted that "productive of" can either have the meaning of "producing" or "capable of producing." Pierce v. Principi, 18 Vet. App. 440, 445 (2004). Thus, migraines need not actually "produce" severe economic inadaptability to warrant the 50 percent rating. Id., at 445-46. Further, "economic inadaptability" does not mean unemployability, as such would undermine the purpose of regulations pertaining to a total disability rating based on individual unemployability. Id. at 446; see also 38 C.F.R. § 4.16. The migraines must be, at a minimum, capable of producing "severe" economic inadaptability. Furthermore, because the ameliorative effects of medication are not contemplated by the rating criteria under Code 8100, they should not be considered. See Jones v. Shinseki, 26 Vet. App. 56 (2012).

The Veteran was afforded a VA examination for his tension headaches in March 2019. The examiner noted the Veteran reported constant aching and tightness and took Tylenol, motrin, and Goody's powder as needed. The examiner noted the medication helped the headaches "to some degree," but the Veteran was not on any preventative medication for his headaches. The examiner further noted the Veteran experienced constant head pain on both sides of his head but did not have characteristic prostrating attacks of headache pain or prolonged attacks of migraine headaches productive of severe economic inadaptability.

The Veteran was afforded another VA examination for his headaches in December 2021. The examiner noted that the Veteran was no longer taking any medication for his headaches. The examiner noted pulsating or throbbing head pain with sensitivity to light and sound in the back of his head that lasted less than one day. Again, the examiner noted the Veteran did not have characteristic prostrating attacks of headache pain or prolonged attacks of migraine headaches productive of severe economic inadaptability. The Veteran's treatment records present a similar disability picture.

In July 2025, the Veteran submitted correspondence noting he experienced migraines 3-5 times per week requiring him to lie down in a quiet space and wait out the symptoms. In his affidavit, he specifically contends

I experience prostrating headaches an average of four to five times per week. That these headaches require me to lay down in a dark room while waiting for them to subside. That I take medication and wait over an hour for the medicine to relieve the pain. That I have experienced these symptoms since my discharge in 2018.

The Board finds the Veteran's own self reports of prostrating attacks are inconsistent with the VA examination reports and contemporaneous treatment records. Accordingly, although the Board acknowledges the Veteran is competent to report symptoms he experiences, the statements made by the Veteran while seeking VA benefits are far outweighed by the competent medical evidence of record. In other words, the Veteran's statements as to the severity of his headache disability since 2018 lack credibility and are far outweighed by the clinical evidence showing less severe symptomatology.

After reviewing the competent evidence of record, the Board concludes that, during the appeal period, the Veteran did
over an hour for the medicine to relieve the pain. That I have experienced these symptoms since my discharge in 2018.

After reviewing the competent evidence of record, the Board concludes that, during the appeal period, the Veteran did not have tension headaches with characteristic prostrating attacks averaging one in 2 months over the last several months. Rather, the Veteran experiences tension headaches less frequently, corresponding to the criteria for a noncompensable rating under DC 8100. The Board acknowledges the March 2019 VA examiner and the Veteran both report that he takes medication for his tension headaches. Here, however, there is no competent medical opinion, or other competent evidence, demonstrating that the Veteran would meet additional criteria for a higher rating but for the use of such medication. Further, the Veteran was not taking any medication when he was examined in December 2021.

The Veteran's claim for an initial compensable rating for his tension headaches must be denied. As the evidence of record persuasively weighs against the Veteran's claim, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

20. Entitlement to service connection for fibromyalgia.

21. Entitlement to service connection for a right hand condition.

The Veteran contends that he is entitled to service connection for fibromyalgia and a right hand condition.

Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C.§§ 1110, 1131; 38 C.F.R. § 3.303. Generally, establishing service connection requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009).

However, nothing in the Veteran's treatment records indicates that he has a current diagnosis for fibromyalgia or a right hand condition. The Veteran was afforded VA examinations for both conditions in March 2019. Both examinations specifically considered the Veteran's own contentions regarding his symptoms but ultimately opined he did not have diagnoses for either fibromyalgia or a right hand condition. There is no competent evidence to the contrary.

This is consistent with the other medical evidence of record. There are numerous VA and private treatment records in the Veteran's file, and none suggest a diagnosis for either fibromyalgia or a right hand condition.

In a July 2025 affidavit, the Veteran reported that his right hand condition claim was due to numbness, stemming from his cervical spine condition, and that his "myalgia" began during his second period of active duty and was treated with hydrocodone. The Veteran did not address either of these conditions in his April 2025 Board hearing. Notably, the Veteran is already in receipt of service connection benefits for bilateral upper extremity radiculopathy secondary to his service-connected neck disability. The persuasive evidence does not show that the Veteran's has a separate right hand disability from his already service-connected right upper extremity radiculopathy.

The Board acknowledges the Veteran's sincere belief that he has current diagnoses for a right hand condition and fibromyalgia that were caused by service. The Veteran is competent to report his experiences during service, and the Board does not dispute as much. However, he has not shown that he has the necessary medical expertise to provide a medical diagnosis or an opinion regarding the etiology of his conditions and his opinions on the matter lack probative weight.

The Board notes that, because the Veteran does not have a separate diagnosis for a right hand condition, it need not further address the Veteran's secondary service connection claim for his right hand.

Accordingly, because there is no persuasive evidence the Veteran has a current diagnosis for fibromyalgia or a right hand condition, his claims must be denied. As the evidence
a right hand condition and fibromyalgia that were caused by service. The Veteran is competent to report his experiences during service, and the Board does not dispute as much. However, he has not shown that he has the necessary medical expertise to provide a medical diagnosis or an opinion regarding the etiology of his conditions and his opinions on the matter lack probative weight.

Accordingly, because there is no persuasive evidence the Veteran has a current diagnosis for fibromyalgia or a right hand condition, his claims must be denied. As the evidence of record persuasively weighs against the Veteran's claims, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

REASONS FOR REMAND

1. Entitlement to service connection for hypertension.

2. Entitlement to service connection for right foot plantar fasciitis.

The Veteran contends he is entitled to service connection for hypertension and right foot plantar fasciitis. Neither hypertension nor right foot plantar fasciitis were reported in the Veteran's entrance examination reports, but the AOJ found that his hypertension and right foot plantar fasciitis clearly and unmistakably preexisted service. However, it is unclear from the medical evidence/VA examinations whether these disabilities clearly and unmistakably preexisted any period of active duty service.

The Veteran was provisionally diagnosed with plantar fasciitis in October 1994 service treatment records and mild plantar fasciitis was first noted in the Veteran's service treatment records in May 2000. A July 1997 VA examiner noticed the Veteran's blood pressure was slowly getting higher, but he had not ever been treated for high blood pressure.

The Veteran was afforded VA examinations for his hypertension and right foot plantar fasciitis in March 2019. The examiner noted the Veteran was diagnosed with hypertension in February 2017, specifically noting "Veteran was already treated for hypertension in 2014/2015--prior to last period of active service." The examiner then opined his hypertension was less likely than not related to service because "the Veteran was not on hypertension treatment in the year 2000. He was on antihypertensive therapy by 2014, prior to active service period 2016-2018."

Similarly, the examiner noted the Veteran was diagnosed with bilateral plantar fasciitis in 1997, opining his right foot plantar fasciitis was less likely than not related to service because "Per record review the right foot condition appears to have existed prior to active duty (Consult request 11/3/2016)."

The Board notes the Veteran had several periods of active duty in his military career, beginning in January 1986. Thus, although VA examiners opined his hypertension and right foot plantar fasciitis preexisted service, the same examiners also opined his hypertension and right foot plantar fasciitis had their onset in 2014 or 2015, well after his first period of active duty. It is unclear whether these disabilities indeed preexisted a period of active duty, and if so, whether they were aggravated therein.

Thus, there is not an adequate medical opinion of record addressing the etiology of the Veteran's hypertension and right foot plantar fasciitis. Failure to obtain an adequate examination is a pre-decisional duty to assist error and remand is necessary to adjudicate the Veteran's claim. See El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013).

3. Entitlement to a rating higher than 20 percent prior to November 9, 2020, for a lumbar spine disability.

The Veteran contends that he has been experiencing lumbar spine flare-ups since he was discharged in 2018.

The United States Court of Appeals for Veterans Claims (Court) held that, to be adequate, a VA examination of the joints must, wherever possible, include the results of the range of motion testing described in the final sentence of 38 C.F.R. § 4.59. See Correia v. McDonald, 28 Vet. App. 158 (2016). 38 C.F.R. § 4.59 (2016) states that "[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with the range of the opposite undamaged joint." As such, pursuant to Correia, an adequate VA joints examination must, wherever possible, include range of motion testing on active and passive motion and in weight-bearing and non-weight-bearing conditions. An additional relevant opinion pertaining to flare-ups was also issued by the Court in Sharp v. Shulkin, 29 Vet. App. 26 (2017).

In the Veteran's March 2019 VA examination, the examiner noted he did not report flare-ups. However, in his April 2025 Board hearing, the Veteran reported he was on hydrocodone and prednisone for his low back flare-ups during service. As discussed above, the December 2021 VA examination noted the Veteran experienced lumbar spine flare-ups.

Thus, the March 2019 VA examination does not comply with Correia and Sharp. Failure to obtain an adequate examination is a pre-decisional duty to assist error. As such, the opinion is inadequate to adjudicate the Veteran's case and a remand is necessary. See El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013).

4. Entitlement to a TDIU.

The Veteran specifically contends that he is unable to work due to his service-connected disabilities. As the issue of a TDIU has been raised by the record, the Board must address it.

A TDIU is provided where the combined schedular rating for service-connected diseases and disabilities is less than total, or 100 percent. 38 C.F.R. § 4.16(a). A TDIU is considered a lesser benefit than the 100 percent rating, and the grant of a 100 percent rating generally renders moot the issue of entitlement to a TDIU for the period when the 100 percent rating is in effect.

The Veteran's combined disability rating is 90 percent from March 2018 and 100 percent from November 2020. In this decision, the Board has granted service connection for tinnitus and remanded entitlement to service connection for hypertension and right foot planters fasciitis and a higher rating for his low back disability prior to November 2020; the Veteran's claim for a TDIU is inextricably intertwined with the AOJ's implementation of the award and his remanded claims. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (issues are 'inextricably intertwined' when they are so closely tied together that a final Board decision cannot be rendered unless both are adjudicated). As such, this issue must be remanded.

The matters are REMANDED for the following action:

1. Obtain a VA medical opinion from an appropriate clinician to determine the nature and likely etiology of the Veteran's hypertension. The Veteran has indicated he does not wish to be scheduled for any further VA examinations. An opinion is requested anyway.

(a.) Did the Veteran's hypertension clearly and unmistakably preexist any period of active duty service? Why or why not?

(b.) If any currently diagnosed hypertension clearly and unmistakably pre-existed a period of active service, the examiner should offer another opinion as to whether it is clear and unmistakable that the hypertension did NOT worsen beyond the normal progression during his period of active duty service. Why or why not?

(c.) If the examiner finds that the Veteran's hypertension either did not clearly and unmistakably pre-exist a period of service or was not clearly and unmistakably aggravated by service, the Veteran is presumed sound on entry into service.

If presumed sound on entry:

(d.) The examiner should provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any diagnosed hypertension had its onset in or is otherwise related to service.

A detailed rationale is requested for all opinions.

2. Obtain a VA medical opinion from an appropriate clinician to determine the nature and likely etiology of the Veteran's right foot plantar fasciitis.
Why or why not?

If presumed sound on entry:

A detailed rationale is requested for all opinions.

2. Obtain a VA medical opinion from an appropriate clinician to determine the nature and likely etiology of the Veteran's right foot plantar fasciitis. The Veteran has indicated he does not wish to be scheduled for any further VA examinations. An opinion is requested anyway.

(a.) Did the Veteran's right foot plantar fasciitis clearly and unmistakably preexist any period of active duty service? Why or why not?

(b.) If any currently diagnosed right foot plantar fasciitis clearly and unmistakably pre-existed a period of active service, the examiner should offer another opinion as to whether it is clear and unmistakable that the right foot plantar fasciitis did NOT worsen beyond the normal progression during his period of active duty service. Why or why not?

(c.) If the examiner finds that the Veteran's right foot plantar fasciitis either did not clearly and unmistakably pre-exist a period of service or was not clearly and unmistakably aggravated by service, the Veteran is presumed sound on entry into service.

If presumed sound on entry:

(d.) The examiner should provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any diagnosed right foot plantar fasciitis had its onset in or is otherwise related to service.

A detailed rationale is requested for all opinions.

3. Obtain a VA medical opinion from an appropriate clinician to determine the nature and severity of the Veteran's lumbar spine disability prior to November 9, 2020. The Veteran has indicated he does not wish to be scheduled for any further VA examinations. On review of the record (to include this Remand), the examiner should opine whether the Veteran was experiencing lumbar spine flare-ups prior to November 9, 2020, and, if so, the examiner must express an opinion on whether the flare-ups are associated with additional functional loss and estimate the degree of lost motion during such flare-ups.

It would be most helpful for rating purposes if the examiner specifically opined whether any additional functional loss prior to November 9, 2020, manifested in forward flexion of the thoracolumbar spine 30 degrees or less.

(Continued on the next page)

A complete rationale for any medical opinion must be provided. The examiner is advised the Veteran's first period of active duty began in January 1986.

H.M. WALKER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board S. Feistritzer, Associate Counsel

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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