PARALYSIS OF SCIATIC NERVE OR EXTERNAL POPLITEAL NERVE

ANN K. MINAMI · 2026 · Case ID: A26038152

MIXED

Summary

The veteran, who served in the U.S. Army from February 2014 through July 2022, including Gulf War Era service, appeals the denial of service connection for bilateral lower extremity sciatica, neck strain, and an increased evaluation for left shoulder disability and thoracolumbar spine degenerative arthritis. The Board denied the sciatica claims, finding no current diagnosis of the condition and insufficient evidence to establish service connection. For the neck strain claim, the Board noted the veteran failed to attend a scheduled VA examination without good cause and that the evidence of record did not show a diagnosed neck condition, leading to denial. Regarding the left shoulder disability, the Board found the veteran's range of motion limitations, even during flare-ups, did not meet the criteria for an increased evaluation beyond the current 20 percent rating. Similarly, for the thoracolumbar spine, the Board found no evidence of record within the appeal period to support an increased evaluation, and the veteran failed to attend a scheduled examination. The Board remanded the claim for pruritus due to a pre-decisional duty to assist error, as the veteran had not received a VA medical examination or opinion for this condition, and lay evidence suggested a possible service connection. The Board advised the veteran of his duty to cooperate with VA's efforts to adjudicate his claim.

Rationale

No current diagnosis of bilateral lower extremity sciatica; Insufficient evidence to establish service connection; Weight of evidence against the claim

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250521-546875

Full Decision Text

Citation Nr: A26038152
Decision Date: 04/23/26 Archive Date: 04/23/26

DOCKET NO. 250521-546875
DATE: April 23, 2026

ORDER

Entitlement to service connection for left lower extremity sciatica is denied.

Entitlement to service connection for right lower extremity sciatica is denied.

Entitlement to service connection for neck strain is denied.

Entitlement to an increased evaluation in excess of 20 percent for left shoulder acromioclavicular joint separation with degenerative arthritis, other than post-traumatic, is denied.

Entitlement to an increased evaluation in excess of 10 percent for degenerative arthritis of the thoracolumbar spine is denied.

REMANDED

Entitlement to service connection for pruritus is remanded.

FINDINGS OF FACT

1. The Veteran has not been shown to have left lower extremity sciatica for which disability benefits may be awarded since he filed his claim or within close proximity thereto.

2. The Veteran has not been shown to have right lower extremity sciatica for which disability benefits may be awarded since he filed his claim or within close proximity thereto.

3. The Veteran has not been shown to have a neck condition for which disability benefits may be awarded since he filed his claim or within close proximity thereto.

4. Throughout the period on appeal, the Veteran's left shoulder acromioclavicular joint separation with degenerative arthritis was productive of painful motion and limited at shoulder level to 150 degrees for flexion and abduction, but was not limited to midway between side and shoulder level of the major arm, productive of actual or functional limitation of motion of the major arm to 25 degrees from his side, nor was there evidence of malunion, recurrent dislocation, fibrous union, nonunion, or loss of head of the major humerus.

5. Throughout the period on appeal the Veteran's low back disability was not manifested by 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.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for left lower extremity sciatica, as secondary to degenerative arthritis of the thoracolumbar spine, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. The criteria for entitlement to service connection for right lower extremity sciatica, as secondary to degenerative arthritis of the thoracolumbar spine, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

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

4. The criteria for entitlement to an increased evaluation in excess of 20 percent for left shoulder acromioclavicular joint separation with degenerative arthritis, other than post-traumatic have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.14, 4.40-4.45, 4.59, 4.7, 4.71a, Diagnostic Codes 5003-5201.

5. The criteria for entitlement to an increased evaluation in excess of 10 percent for degenerative arthritis of the thoracolumbar spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.14, 4.40-4.45, 4.7, 4.71a, Diagnostic Code 5242.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from February 2014 through July 2022, to include Gulf War Era service.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from July 2024 and May 2025 rating decisions.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from February 2014 through July 2022, to include Gulf War Era service.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from July 2024 and May 2025 rating decisions.

In May 2025 the Veteran submitted a VA Form 10182, Decision Review Request: Board Appeal and selected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the July 2024 and May 2025 agency of original jurisdiction (AOJ) decisions on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decisions on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If evidence was submitted during the period after the AOJ issued the decisions on appeal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision addressing the claim, 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 claim for entitlement to service connection for pruritus, any evidence the Board could not consider will be considered by the AOJ in the adjudication of that claim. 38 C.F.R. § 3.103(c)(2)(ii).

As a preliminary matter, the Board acknowledges that the Veteran included the issues of service connection for bilateral carpal tunnel syndrome and right foot numbness, as well as an increased evaluation for right ankle tarsal tunnel syndrome on the May 2025 VA Form 10182 Decision Review Request: Board Appeal (Notice of Disagreement). As these issues were not addressed in the rating decisions on appeal, or any other rating decision one year prior to the submission of the May 2025 Notice of Disagreement, these issues are not on appeal before the Board and will not be addressed herein. See 38 C.F.R. § 20.203.

As an additional preliminary matter, the Board notes that the Veteran did not report for his VA medical examinations scheduled for February 10, 2025 with notification of these examinations sent to the Veteran's address of record on February 4, 2025. The Board acknowledges the Veteran changed his address of record, effective February 20, 2025, however there is no indication in the record, nor has the Veteran alleged, that he did not receive notification of these VA medical examinations.

Law and Analysis

Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Service connection may also be granted on a secondary basis for disability which is proximately due to or the result of a service-connected disease or injury. 38 U.S.C. § 1110 and 38 C.F.R. § 3.310(a); Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023) (holding that secondary service connection is warranted under the causation standard of 38 U.S.C. § 1110 where a nonservice-connected disability would have been less severe but for a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the nonservice-connected disability).

In addition, for veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C.
. Cir. 2023) (holding that secondary service connection is warranted under the causation standard of 38 U.S.C. § 1110 where a nonservice-connected disability would have been less severe but for a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the nonservice-connected disability).

For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

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. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. 38 C.F.R. § 4.7.

In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). While the regulations require review of the recorded history of a disability by the adjudicator to ensure a more accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings.

Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, where the question for consideration is the propriety of the initial rating assigned, evaluation of the evidence since the effective date of the grant of service connection is required. Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). Where VA's adjudication of the claim for increase is lengthy and factual findings show distinct time periods where the service-connected disability exhibits symptoms which would warrant different ratings, different or "staged" ratings may be assigned for such different periods of time. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007); Fenderson, 12 Vet. App. at 126-27.

Disability of the musculoskeletal system is primarily the inability, due to damage or infection in the parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portrays the anatomical damage and the functional loss with respect to all of these elements. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated innervation, or other pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be
are based adequately portrays the anatomical damage and the functional loss with respect to all of these elements. In evaluating disabilities of the musculoskeletal system, it is necessary to consider, along with the schedular criteria, functional loss due to flare-ups of pain, fatigability, incoordination, pain on movement, and weakness. DeLuca v. Brown, 8 Vet. App. 202 (1995). The functional loss may be due to absence of part, or all, of the necessary bones, joints and muscles, or associated innervation, or other pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. Pain on movement, swelling, deformity or atrophy of disuse as well as instability of station, disturbance of locomotion, interference with sitting, standing, and weight bearing are relevant considerations for determination of joint disabilities. 38 C.F.R. § 4.45. Painful, unstable, or misaligned joints, due to healed injury, are entitled to at least the minimal compensable rating for the joint. 38 C.F.R. § 4.59.

Even when the background factors listed in 38 C.F.R. §§ 4.40, 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which the motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the Veteran's disability, after which a rating is determined based on the § 4.71a criteria.").

Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits. VA shall consider all information and lay and medical evidence of record in a case and when there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (benefit-of-the-doubt rule not for application when evidence persuasively favors one side or the other).

As a preliminary matter, the Board notes that in the July 2024 rating decision, the AOJ made the favorable finding that the Veteran has sufficient service to meet the requirements for presumptive service connection. Additionally, in the May 2025 rating decision, the AOJ made the favorable finding that the claimed primary-disability is service-connected as the Veteran is service-connected for degenerative arthritis of the thoracolumbar spine. Findings identified as favorable in an AOJ decision are binding on subsequent adjudicators, including the Board. 38 U.S.C. § 5104(b)(4); 5104A; 38 C.F.R. § 20.801(a). Favorable findings can only be rebutted by evidence that identifies a clear and unmistakable error in the favorable finding. 38 C.F.R. § 20.801(a).

Entitlement to Service Connection for Bilateral Lower Extremity Sciatica

The Veteran contends he has bilateral lower extremity sciatica due to his service-connected degenerative arthritis of the thoracolumbar spine. See January 2025 VA Form 21-526EZ, Fully Developed Claim (Compensation).

The Veteran's service treatment records note a complaint of right leg numbness particularly around the right knee and foot in September 2015, which the Veteran reported he believed was due to his right ankle injury, as well as a complaint of back pain radiating down the right lower extremity, particularly around the patella, in September 2021. See September 2015 Baumholder Medical Record; see also September 2021 Schofield Barracks Medical Record.

There are no post-service medical records available for review except for a June 2023 VA thoracolumbar spine medical examination. In this examination, the Veteran reported back pain, which began in 2017 and had continued to worsen. Upon examination the Veteran had normal muscle strength testing, normal reflexes, and a normal sensory exam. There was no evidence of muscle atrophy or radiculopathy, to include of the sciatic nerve. See June 2023 VA Back (Thoracolumbar Spine) Conditions Disability Benefits Questionnaire.

The Board acknowledges that the
ella, in September 2021. See September 2015 Baumholder Medical Record; see also September 2021 Schofield Barracks Medical Record.

The Board acknowledges that the Veteran's service treatment records document complaints of right leg numbness in service. The requirement that a current disability be present is satisfied when a claimant has a disability at the time a claim for VA disability compensation is filed or during the pendency of that claim, even in cases where the disability resolves prior to the Secretary's adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321-323 (2007). However, in this case, the Veteran has not been shown to have a diagnosis of bilateral lower extremity sciatica at the time the claim was filed or during a period close in time to the claim, or during the pendency of the appeal. See Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013). Notably, the Veteran was not found to have radiculopathy of the sciatic nerve during his June 2023 VA medical examination.

The evidence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110, 1131; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). Evidence must show that the Veteran currently has the disability for which benefits are being claimed.

Based on the foregoing, the Board finds that the Veteran has not been shown to have a current diagnosis of bilateral lower extremity sciatica. Thus, the claim does not satisfy this element for service connection, and no discussion of the remaining elements is necessary. See Coburn v. Nicholson, 19 Vet. App. 427, 431 (2006) (the absence of any one element will result in a denial of service connection).

As the weight of the evidence is against the claim of entitlement to service connection for bilateral lower extremity sciatica, the benefit-of-the-doubt rule is not for application. 38 U.S.C. § 5107; Lynch, 21 F.4th at 776 (Fed. Cir. 2021). Therefore, the claims for entitlement to service connection for left lower extremity sciatica and right lower extremity sciatica are denied.

Entitlement to Service Connection for Neck Strain

The Veteran contends his neck strain was caused by an injury in service after rolling down a 20 foot hill with his full military kit in the middle of the night and knocking into trees. He also stated that he face-planted onto the ground in his full-kit after getting out of a truck. See January 2025 VA Form 21-526EZ, Fully Developed Claim (Compensation).

The Veteran's service treatment records document he was in a motor vehicle accident in service in December 2015, after which he reported head and neck pain. There were no further service treatment records documenting a neck condition or complaints of neck pain. See December 2015 Landstuhl RMC Treatment Record.

There are no post-service medical records containing complaints, diagnosis, or treatment of a neck condition.

There is not a VA medical examination of record to provide evidence of a diagnosis of a current neck disability. VA regulations provide that when a claimant fails to report for an examination scheduled in conjunction with an original compensation claim or a claim for an increase, the claim shall be rated based on the evidence of record. See 38 C.F.R. § 3.655; see also Turk v. Peake, 21 Vet. App. 565, 569-70 (2008). The Board notes the rating officer in a May 2025 rating decision stated the Veteran was a "no show" for his scheduled VA medical examination and that good cause was not shown. Examples of good cause include, but are not limited to, the illness or hospitalization of the claimant or the death of an immediate family member. See 38 C.F.R. § 3.655(a).

In this case, an examination was
an original compensation claim or a claim for an increase, the claim shall be rated based on the evidence of record. See 38 C.F.R. § 3.655; see also Turk v. Peake, 21 Vet. App. 565, 569-70 (2008). The Board notes the rating officer in a May 2025 rating decision stated the Veteran was a "no show" for his scheduled VA medical examination and that good cause was not shown. Examples of good cause include, but are not limited to, the illness or hospitalization of the claimant or the death of an immediate family member. See 38 C.F.R. § 3.655(a).

In this case, an examination was scheduled for February 10, 2025 however the Veteran did not show up for the examination and did not provide any explanation for his absence. The record indicates that the Veteran was notified of the date and time of the examination in a letter sent to his address of record on February 4, 2025. The Veteran has not provided any reasoning for failing to report to the February 2025 examination, nor has he argued that he was not properly notified of the examination. Accordingly, the Board finds that the Veteran has failed to demonstrate good cause for his failure to appear for the February 2025 examination, and therefore, the Veteran's claim for service connection for neck strain must be adjudicated based upon the current evidence of record. See 38 C.F.R. § 3.655(a). Additionally, as the Veteran did not attend the VA examination, no further assistance on VA's part is necessary. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (holding that the duty to assist is not a one-way street," and that, if he desires help with his claim, he must cooperate with VA's efforts to assist him).

As the evidence of record does not show the Veteran has a diagnosed neck condition for which benefits are being claimed, the claim does not satisfy the first element for service connection. 38 U.S.C. § 1110, 1131; see Degmetich, 104 F.3d at 1332 (1997). Accordingly, as the weight of the evidence is against the claim the benefit-of-the-doubt rule is not for application, and entitlement to service connection for a neck condition is denied. 38 U.S.C. § 5107; Lynch, 21 F.4th at 776 (Fed. Cir. 2021).

Entitlement to an Increased Evaluation for Left Shoulder Disability

The Veteran contends he is entitled to an increased evaluation for his service-connected left shoulder disability. See January 2025 VA Form 21-526EZ, Fully Developed Claim (Compensation).

The Veteran's left shoulder acromioclavicular joint separation with degenerative arthritis other than post-traumatic is currently assigned a 20 percent evaluation, pursuant to Diagnostic Codes 5003-5201, effective October 11, 2023. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the specific basis for the evaluation assigned. 38 C.F.R. § 4.27. The Board notes the appeal period begins January 22, 2025, the date VA received the Veteran's VA Form 526EZ Fully Developed Claim (Compensation) for an increased evaluation. The Board will also consider the one-year look-back period. 38 U.S.C. § 5110;?38 C.F.R. §3.400; Swain v. McDonald,?27?Vet. App.?219?(2015).

The rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended on February 7, 2021, including Diagnostic Codes 5003 and 5201. If a law or regulation changes during the adjudication of a claim or an appeal, the version more favorable to the Veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110. If the revised version of the regulation is more favorable, the implementation of the regulation under 38 U.S.C. § 5110 can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. As the Veteran's claim for an increased evaluation for his left shoulder disability was after February 7, 2021, only the revised regulations are applicable during the course of this appeal. See 65 Fed. Reg. 33,422 (2000); De
in question. 38 U.S.C. § 5110. If the revised version of the regulation is more favorable, the implementation of the regulation under 38 U.S.C. § 5110 can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110. As the Veteran's claim for an increased evaluation for his left shoulder disability was after February 7, 2021, only the revised regulations are applicable during the course of this appeal. See 65 Fed. Reg. 33,422 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997).

Handedness for the purpose of a dominant rating will be determined by the evidence of record, or by testing on VA examination. Only one hand shall be considered dominant. 38 C.F.R. § 4.69. In this case, the evidence shows that the Veteran is left hand dominant. The Veteran has not contended otherwise; therefore, the rating criteria for the major arm are applicable. See February 2024 VA Shoulder and Arm Conditions Disability Benefits Questionnaire.

Diagnostic Code 5003, degenerative arthritis other than post-traumatic, notes that degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, not added under Diagnostic Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion, in the absence of limitation of motion the following ratings apply: a ten percent evaluation with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups; and a 20 percent evaluation with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups with occasional incapacitating exacerbations. A 20 percent evaluation is the maximum evaluation under Diagnostic Code 5003. Note (1) provides that the 20 percent and 10 percent evaluations based on X-ray findings will not be combined with ratings based on limitation of motion. Note (2) provides that the 20 percent and 10 percent evaluations based on X-ray findings will not be utilized in rating conditions listed under Diagnostic Codes 5013 to 5024 inclusive.

Under Diagnostic Code 5201, a 20 percent evaluation is assigned for limitation of motion of the major arm at shoulder level (flexion and/or abduction limited to 90 degrees). A 30 percent evaluation is assigned for limitation of motion of the major arm midway between side and shoulder level (flexion and/or abduction limited to 45 degrees). A 40 percent evaluation is warranted when flexion and/or abduction of the major arm is limited to 25 degrees from the side.

For VA compensation purposes, normal range of motion for the shoulder is 180 degrees of forward flexion, 180 degrees of abduction, and 90 degrees of external and internal rotation. See 38 C.F.R. § 4.71, Plate I.

The Veteran underwent a VA medical examination in February 2024 which noted his diagnoses of acromioclavicular joint separation and degenerative arthritis, other than post-traumatic. He reported worsening shoulder pain with sleeping, prolonged driving, and lifting and that he used ibuprofen, ice, and rest for treatment. The Veteran stated he had daily flare-ups lasting 30 minutes to all day precipitated with repetitive movements of the shoulder or raising his arm over his head. He also reported functional loss with the inability to raise his arm above his head. On active range of motion testing for the left shoulder the Veteran had flexion to 170 degrees, abduction to 170 degrees, internal rotation to 80 degrees, and external rotation to 80 degrees with pain on flexion and abduction. Passive range of motion measurements were the same as active with pain on flexion and abduction. There was no evidence of crepitus but there was mild pain on palpation of the anterior shoulder. The Veteran was able to perform repetitive use testing with at least three repetitions with no additional loss of function or range of motion. The Veteran was not examined immediately after repeated use over time, however the examiner noted there would be pain causing functional loss with estimated range of motion measurements of flexion to 160 degrees, abduction to 160 degrees, internal rotation to 70 degrees, and external rotation to 70 degrees. The
to 170 degrees, internal rotation to 80 degrees, and external rotation to 80 degrees with pain on flexion and abduction. Passive range of motion measurements were the same as active with pain on flexion and abduction. There was no evidence of crepitus but there was mild pain on palpation of the anterior shoulder. The Veteran was able to perform repetitive use testing with at least three repetitions with no additional loss of function or range of motion. The Veteran was not examined immediately after repeated use over time, however the examiner noted there would be pain causing functional loss with estimated range of motion measurements of flexion to 160 degrees, abduction to 160 degrees, internal rotation to 70 degrees, and external rotation to 70 degrees. The Veteran was not examined during a flare-up however the examiner noted there would be pain and fatigability causing functional loss and estimated range of motion measurements were flexion to 150 degrees, abduction to 150 degrees, internal rotation to 60 degrees, and external rotation to 60 degrees. The Veteran was not found to have muscle atrophy, ankylosis, a humerus condition, or rotator cuff condition, but was noted to have mild widening of the left acromioclavicular joint in external rotation suggestive of instability. See February 2024 VA Shoulder and Arm Conditions Disability Benefits Questionnaire.

As noted above, the Veteran was scheduled for a VA medical examination in February 2025, however he did not report to this examination. The Board finds that the Veteran has failed to demonstrate good cause for his failure to appear for the February 2025 examination, and therefore, the Veteran's claim for an increased evaluation for his left shoulder disability must be adjudicated based upon the current evidence of record. See 38 C.F.R. § 3.655(a). In considering the evidence of record under the laws and regulations as set forth above, the Board concludes the Veteran is not entitled to an increased evaluation in excess of 20 percent for his service-connected left shoulder disability during the period on appeal, as the evidence does not show his motion was limited to midway between the side and shoulder level (flexion and/or abduction limited to 45 degrees from the side), or flexion and/or abduction limited to 25 degrees from the side. In this regard, the February 2024 VA medical examination revealed that at the Veteran's most limited, namely during a flare-up, estimated range of motion measurements were flexion and abduction to 150 degrees, which does not entitle him to an increased evaluation under Diagnostic Code 5201.

The Board notes that in Ingram v. Collins, 30 Vet. App. 130, 138-39 (2025) the Court held that when evaluating a disability under a diagnostic code that does not contemplate the ameliorative effects of medications, those effects must be disregarded. See also Jones v. Shinseki, 26 Vet. App. 56, 63 (2012). In the instant case, the Veteran's left shoulder disability is evaluated pursuant to Diagnostic Codes 5003-5201 which do not reference the ameliorative effects of medication. While the Veteran indicated he used ibuprofen at his February 2024 VA medical examination, there is no indication that he had taken such prior to the examination. Additionally, there is no indication the ameliorating effects of the Veteran's medication were not appropriately discounted by the examiner. In fact, in the repeated use over time and flare-up sections, the examiner is expressly directed to "provide the estimated range of motion based on a review of all procurable information-to include the Veteran's statement on examination, [and] case-specific evidence (to include medical treatment records when applicable and lay evidence)." The examination report also indicates separately that procured evidence, including statements from the Veteran, should be considered when determining whether pain, fatigability, weakness, lack of endurance, or incoordination significantly limits functional ability during flare-ups or after repeated use over time. These determinations necessarily involve factoring in the Veteran's reported medication use, which he described during the examination, and not considering such use when determining the worst functional impairment the Veteran would experience, such as during flare-ups and with repeated use over time. Accordingly, the evidence most nearly approximates the currently assigned 20 percent evaluation for the Veteran's left shoulder disability pain.

The Board has also considered whether an increased evaluation is warranted under other relevant diagnostic codes, including the diagnostic codes governing ankylosis of scapulohumeral articulation, other impairment of the humerus, and impairment of the clavicle or scapula. However, the Board finds that the criteria for higher or separate evaluations under these provisions are not met. See 38 C.F.R. § 4.71a, Diagnostic Codes 5200, 5202, 5203. In this regard, the February 2024 VA medical examiner specifically found the Veteran did not have ankylosis of the left shoulder, and the aforementioned range of motion findings do not show or suggest that his left shoulder is fixed or immobile. The Veteran has also not been shown to have impairment of the humerus. Indeed, the examiner found the Veteran did not have impairment of the humerus, to include loss of head (flail shoulder), nonunion (false flail shoulder), fibrous union of the humerus, and malunion of the humerus with moderate or marked deformity. Thus, the Board finds that the Veteran is not entitled to a higher or separate evaluation under Diagnostic Codes, 5200, 5202, or 5203.

The Board has also considered the provisions of 38 C.F.R. §§ 4.40, 4.45, 4.59 and the findings in DeLuca. However, an increased evaluation for the left shoulder disability is not warranted on the basis of functional loss due to pain or weakness in this case. The Veteran's left shoulder symptoms are supported by pathology consistent with the assigned 20 percent evaluation and no higher. In this regard, the Board observes that the Veteran has complained of pain and limited movement in his left shoulder. However, even with such symptoms, he has still maintained a range of motion greater than midway between his side and shoulder level and greater than 25 degrees from his side during all range of motion testing. Thus, even considering the Veteran's symptoms, the evidence does not show that he more nearly approximates the criteria for a higher evaluation. Pain itself does not constitute functional loss. See Mitchell v. Shinseki, 25 Vet. App. 32, 38-43 (2011).

As such, the Veteran's complaints do not, when viewed in conjunction with the medical evidence, tend to establish weakened movement, excess fatigability, or incoordination to a degree that would warrant an increased evaluation beyond the 20 percent evaluation already assigned. Accordingly, the Board concludes that increased or separate evaluations are not warranted for the Veteran's service-connected left shoulder disability under DeLuca.

Based on the foregoing, the Board finds that the weight of the evidence is against an increased evaluation in excess of 20 percent for the Veteran's service-connected left shoulder acromioclavicular joint separation with degenerative arthritis, other than post-traumatic. As such, the benefit-of-the-doubt rule is not for application, and the claim is denied. 38 U.S.C. § 5107; Lynch, 21 F.4th at 776 (Fed. Cir. 2021).

Entitlement to an Increased Evaluation for Thoracolumbar Spine Disability

The Veteran contends he is entitled to an increased evaluation for his service-connected degenerative arthritis of the thoracolumbar spine. See January 2025 VA Form 21-526EZ, Fully Developed Claim (Compensation).

The Veteran is currently assigned a 10 percent evaluation for degenerative arthritis of the thoracolumbar spine pursuant to Diagnostic Code 5242 effective July 29, 2022.

The Board notes the appeal period begins January 22, 2025, the date VA received the Veteran's VA Form 526EZ, Fully Developed Claim (Compensation). The Board will also consider the one-year look-back period. 38 U.S.C. § 5110;?38 C.F.R. §3.400; Swain,?27?Vet. App.?at 219?(2015).

As discussed above, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended on February 7, 2021, including Diagnostic Code 5242. As the Veteran's claim for an increased evaluation for his thoracolumbar spine disability was after February 7, 2021, only the revised regulations are applicable during the course of this appeal. See 65 Fed. Reg. 33,422 (2000); DeSousa, 10 Vet. App. at 467 (1997).

Diagnostic Code 524
38 C.F.R. §3.400; Swain,?27?Vet. App.?at 219?(2015).

Diagnostic Code 5242 Degenerative arthritis, degenerative disc disease other than intervertebral disc syndrome, is evaluated under the General Rating Formula for Diseases and Injuries of the Spine. Under this formula a 10 percent evaluation is assigned for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 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 evaluation 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 evaluation is warranted for forward flexion of the thoracolumbar spine 30 degrees or less; or favorable ankylosis of the entire thoracolumbar spine. A 50 percent evaluation is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A maximum 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine.

Note (2) provides that for VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. (See also Plate V.).

The Board finds there is no medical evidence of record within the appeal period to consider for his claim for an increased evaluation. Although the record contains a VA medical examination from June 2023, this evidence is outside the appeal period and thus not pertinent. As noted above, the Veteran was scheduled for a VA medical examination in February 2025, however he did not report to this examination. The Board finds that the Veteran has failed to demonstrate good cause for his failure to appear for the February 2025 examination, and therefore, the Veteran's claim for an increased evaluation for his thoracolumbar spine disability must be adjudicated based upon the current evidence of record. See 38 C.F.R. § 3.655(a). As there is no evidence of record to consider, the Board finds an increase in severity of the Veteran's thoracolumbar spine disability has not been shown. Accordingly, as the weight of the evidence is against the claim, the benefit-of-the-doubt rule is not for application, and entitlement to an increased evaluation in excess of 10 percent for degenerative arthritis of the thoracolumbar spine is denied. 38 U.S.C. § 5107; Lynch, 21 F.4th at 776 (Fed. Cir. 2021).

REASONS FOR REMAND

Service Connection for Pruritus

The Veteran contends he has pruritus from his military service due to going to training and being unable to wash his hair or Ach pad frequently, going to different places with insects, and dealing with different types of chemicals. See June 2024 VA Form 21-526EZ, Fully Developed Claim (Compensation).

Upon review, the Board finds that a remand is needed to correct a pre-decisional duty to assist error. The Veteran has not received a VA medical examination or medical opinion regarding his pruritus. 38 C.F.R. § 20.802(a).

VA must provide a
at 776 (Fed. Cir. 2021).

REASONS FOR REMAND

Service Connection for Pruritus

VA must provide a medical examination or opinion when there is (1) competent evidence of a current disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The third prong, which requires that the evidence of record "indicates" that the claimed disability or symptoms "may be" associated with the established event, is a low threshold. See McLendon, 20 Vet. App. at 83.

Although there is no formal diagnosis of pruritus, the Veteran is competent to report symptomatology of skin irritation. While lay testimony is not sufficient to render a diagnosis of a complex medical issue, it is competent to establish the presence of observable symptomatology, where the determination is not medical in nature and is capable of lay observation through the use of one's senses. See Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007); see also Layno v. Brown, 6 Vet. App. 465, 470 (1994). The Veteran's lay statement that he has pruritus from his military service due to going to training and being unable to wash his hair or Ach pad frequently, going to different places with insects, and dealing with different types of chemicals, provides some evidence of a current disability or signs and symptoms of a current disability and suggest the same may be related to service. However, the record contains insufficient information to decide the claim. Thus, remand for a VA medical examination and opinion is warranted.

In remanding this case, the Board takes the opportunity to advise the Veteran that the "duty to assist is not always a one-way street" and that he has an obligation to actively participate, to include attending scheduled VA medical examinations. He is expected to cooperate in the efforts to adjudicate the claim, and his failure to do so could subject him to the risk of an adverse adjudication based on an incomplete and underdeveloped record. See Wood, 1 Vet. App. at 193 (1991); Kowalski, 19 Vet. App. at 178 (2005).

The matters are REMANDED for the following action:

The AOJ should afford the Veteran a VA medical examination and opinion to determine the nature and etiology of the Veteran's claimed pruritus.

If the examiner does not find a diagnosis, this should be explained with a full rationale.

The examiner should review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and all assertions made by the Veteran, including his statement that he has pruritus from his military service due to going to training and being unable to wash his hair or Ach pad frequently, going to different places with insects, and dealing with different types of chemicals.

It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should state this with a fully reasoned explanation.

The examiner should specifically discuss and reconcile any contradictory evidence in the claims file.

If the examiner is unable to provide an opinion, the examiner must clarify whether the inability is due to a lack of personal knowledge or training; lack of knowledge in the medical community; or there is a deficiency in the record that requires additional factual development.

(Continued on the next page)

The examiner must provide a complete rationale for all opinions, including citations to relevant medical and scientific research relied upon and an explanation of how such research applies to the Veteran's specific medical history.

Ann

Analyze in VA Law Explorer