ANKLE IMPAIRMENT OF

Summary

The Veteran, an Army veteran who served from December 1986 to December 1989, appeals the denial of a compensable rating for pseudofolliculitis barbae (PFB) and seeks an increased rating for his service-connected right ankle condition. The Board reviewed evidence submitted up to 90 days after a February 2025 hearing, excluding later submissions. For the right ankle, the Veteran sought a rating higher than 10 percent, citing painful, limited motion, instability, swelling, and weakness. A March 2021 lay statement detailed these symptoms. The April 2021 VA examination measured plantar flexion to 25 degrees and dorsiflexion to 10 degrees, noting pain with motion, crepitus, and tenderness, but the examiner found functional ability was not significantly limited by repetitive use. The Veteran testified at the February 2025 hearing about pain, swelling, weakness, and instability, and difficulty with stairs and walking. The Board found that while range of motion findings were consistent with moderate limitation, the Veteran's testimony and records indicated significant impairment due to instability and pain, warranting a 20 percent rating, but not the next higher 30 percent rating which requires ankylosis. For PFB, the Veteran claimed recurring pustules and irritation after shaving. The April 2021 VA examination found the condition affected less than 5 percent of the body and was treated with topical therapy. The Veteran testified to limiting shaving and using topical treatments. The Board denied a compensable rating, finding the criteria for more than a non-compensable rating were not met, as the condition affected less than 5 percent of the body and only required topical therapy.

Rationale

Lay testimony and private treatment records show painful limited motion, instability, swelling, and weakness.; VA exam showed limited motion (dorsiflexion to 10 degrees, plantar flexion to 25 degrees) with pain, crepitus, and tenderness.; Board considered functional impairment beyond range of motion, including instability and pain, consistent with marked limitation under DC 5271.

Full Decision Text

Citation Nr: A26038342
Decision Date: 04/23/26	Archive Date: 04/23/26

DOCKET NO. 210511-160627
DATE: April 23, 2026

ORDER

Entitlement to a 20 percent rating, but no higher, for the Veteran's right ankle disability is granted. 

Entitlement to a compensable rating for pseudofolliculitis barbae (PFB) is denied. 

FINDINGS OF FACT

1. For the entire appeal period, the Veteran's right ankle has more nearly approximated marked limitation of motion. 

2. The Veteran's PFB affects less than 5 percent of the entire body or less than 5 percent of the exposed areas affected and requires no more than topical therapy. The Veteran's PFB is also not productive of deep acne affecting less than 40 percent of the face and neck, and did not exhibit a characteristic of disfigurement, or visible or palpable tissue loss with either gross distortion of assymetry of one feature. 

CONCLUSIONS OF LAW

1. The criteria for entitlement to a 20 percent rating, but no higher, for a right ankle disability have been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5271. 

2. The criteria for a compensable evaluation for PFB have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.159, 3.321, 4.1-4.14, 4.118, Diagnostic Code (DC) 7806. 

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from December 1986 to December 1989.

This matter comes before the Board of Veterans' Appeals (Board) from an April 2021 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran timely appealed this rating decision to the Board and requested a hearing with his appeal. The Veteran testified before the undersigned Veterans Law Judge on February 27, 2025. 

Under the AMA, the Board's review of evidence is limited to the evidence before the AOJ decision in April 2021and any evidence submitted within 90 days of the February 2025 hearing. 38 U.S.C. § 7113(b); 38 C.F.R. § 20.202(b)(2). If evidence was submitted either (1) after the April 2021 rating decision but before the February 2025 Board hearing, or (2) more than 90 days after the February 2025 Board hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302, 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, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Increased Rating

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (rating schedule), found in 38 C.F.R. Part 4. Disability ratings are intended to compensate impairment in earning capacity due to a service-connected disorder. 38 U.S.C. § 1155. Evaluation of a service-connected disorder requires a review of a veteran's entire medical history regarding that disorder. 38 C.F.R. §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). When a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. If there is a question as to which evaluation to apply, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

Entitlement to a rating higher than 10 percent for service-connected right ankle condition is granted.

The Veteran is seeking a rating higher than 10 percent
 §§ 4.1, 4.2; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). When a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the claimant. 38 C.F.R. § 4.3. If there is a question as to which evaluation to apply, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

Entitlement to a rating higher than 10 percent for service-connected right ankle condition is granted.

The Veteran is seeking a rating higher than 10 percent for his service-connected right ankle condition. As a preliminary matter, the Board notes that the Veteran underwent surgery for his ankle during the appeal period. During the convalescence periods, the Veteran was assigned a temporary total disability rating for his ankle. The Board will not disturb those ratings. Thus, the ensuing analysis will focus on the severity of the Veteran's right ankle during the appeal period, excluding the periods during which the Veteran's disability was rated 100 percent. 

Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance.  Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in 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.

With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes.  Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse.  38 C.F.R. § 4.45.

The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint.  38 C.F.R. § 4.59.

The Veteran's right ankle disability is currently rated 10 percent disabling pursuant to 38 C.F.R. § 4.71, Diagnostic Code (DC) 5271, which addresses limitation of motion of the ankle. Under DC 5271, a 10 percent rating is warranted for moderate limited motion of the ankle, defined as less than 15 degrees dorsiflexion or 30 degrees plantar flexion. A 20 percent rating is warranted for marked limitation of motion of the ankle, defined as motion less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion.

With regard to the criteria found at 38 C.F.R. § 4.71a, DC 5271, normal dorsiflexion of the ankle is from 0 degrees to 20 degrees. Normal plantar flexion is from 0 degrees to 45 degrees.  38 C.F.R. § 4.71, Plate II.

Turning to the facts, the Veteran filed the current increased rating claim in March 2021. In a contemporaneous lay statement, the Veteran described experiencing daily painful limited motion of the ankle along with occasional instability and locking. He stated that the weakness of the ankle prevented him from putting weight on it. He had swelling during periods of prolonged walking or standing. His treatment included rest and medication, which provided temporary relief.

In support of his claims, the Veteran submitted private treatment records, which document the limited motion and instability of the right ankle. See Private Treatment Records received April 14, 2021.

At the April 2021 VA examination, the Veteran continued experiencing daily pain in the ankle which impeded his ability to ambulate. He denied experiencing flare ups; however, functionally, he was unable to walk for prolonged periods without pain in the ankle. Range of motion testing revealed plantar flexion to 25 degrees and dorsiflexion to 10 degrees. He was able to perform repetitive use testing with at least three repetitions with no additional loss of function or range of motion. However, there was evidence of pain with motion, along with crepitus, and tenderness in the ankle. The examiner also found that symptoms of pain, weakness, and lack of endurance would significantly limit the Veteran's functional ability with repeated use over time.

At the February 2025 Board hearing, the Veteran testified as to the severity of his ankle condition. Specifically, he reported pain with motion, swelling, weakness
 however, functionally, he was unable to walk for prolonged periods without pain in the ankle. Range of motion testing revealed plantar flexion to 25 degrees and dorsiflexion to 10 degrees. He was able to perform repetitive use testing with at least three repetitions with no additional loss of function or range of motion. However, there was evidence of pain with motion, along with crepitus, and tenderness in the ankle. The examiner also found that symptoms of pain, weakness, and lack of endurance would significantly limit the Veteran's functional ability with repeated use over time.

At the February 2025 Board hearing, the Veteran testified as to the severity of his ankle condition. Specifically, he reported pain with motion, swelling, weakness, and instability. He stated that he was unable to exhibit full range of motion in the ankle. His symptoms flared up when the weather changed. Functionally, his ankle impairment caused difficulty with ambulating stairs and walking. He would use rest and medication to treat his ankle symptoms with temporary relief.

Based on the above, and resolving all reasonable doubt in the Veteran's favor, the Board finds that a rating of 20 percent, but no higher, is warranted for the right ankle condition. In so finding, the Board acknowledges the April 2021 VA examination, which measured right ankle motion loss as no worse than dorsiflexion to 10 degrees and plantar flexion to 25 degrees with pain. Thus, the Veteran demonstrates dorsiflexion which is 50 percent of normal and plantar flexion which is 55 percent of normal. This is consistent moderate motion loss as defined by the rating criteria.

However, the Veteran's range of motion findings do not account for other aspects of functional impairment. Specifically, the Board acknowledges specific facts in this case showing instability with ligament abnormality and quite significant impairment. VA does not have specific diagnostic codes for ligaments and tendons. Yet, the provisions of 38 C.F.R. §§ 4.40 and 4.45 fill in these gaps by specifically instructing that the evaluation of the extent of motion loss should take into consideration "damage" affecting normal excursion, strength, speed, coordination and endurance related to the absence, in whole or part, of bones, joints, muscles or associated structures, see 38 C.F.R. § 4.40, as well as more movement than normal due to relaxation of ligaments and weakened movement as specifically contemplated by 38 C.F.R. § 4.45(b) and (c). These are precisely the factors that the Board considered in the assignment of a 20 percent rating for the entire appeal period (despite normal range of motion findings prior to April 2023) and is a proper consideration in the broad and unlimited criteria for "marked" limitation of motion under DC 5271 or functional ankylosis. 

Although not precedential in nature, a Memorandum Decision by the Court of Appeals for Veterans Claims (the Court) in McKenzie v. McDonough, 2023 WL 6355543 (Sept. 29, 2023) held that a 20 percent rating under DC 5271 contemplated pain, stiffness, swelling, instability, and the need for assistive devices such as a cane, ankle braces and a motorized scooter. See Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (single judge memorandum decisions may be relied upon for any persuasiveness or reasoning they contain). Accordingly, a 20 percent rating, but no higher, is warranted.

The next higher 30 percent rating requires ankylosis. Ankylosis is a medical term meaning "immobility and consolidation of a joint due to disease, injury or surgical procedure" or "[s]tiffening or fixation of a joint as a result of a disease process, with fibrous or bony union across the joint." See Chavis v. McDonough, No. 18-2928 (U.S. Vet. App. Apr. 16, 2021) (citing STEADMAN'S MEDICAL DICTIONARY 95 (28th Ed. 2006) and CHURCHILL'S ILLUSTRATED MEDICAL DICTIONARY 91 (1989), respectively). On this record, the Veteran has consistently shown active motion in dorsiflexion and plantar flexion, albeit limited. Overall, the Board finds that the lay and medical evidence has not more nearly approximated ankylosis or functional ankylosis for any time during the appeal period. As such, the evidence is against a rating in excess of 20 percent for any time during the appeal period.

Entitlement to a compensable rating for PFB is denied.

The Veteran seeks a compensable rating for his pseudofolliculitis barbae (PFB)
 (28th Ed. 2006) and CHURCHILL'S ILLUSTRATED MEDICAL DICTIONARY 91 (1989), respectively). On this record, the Veteran has consistently shown active motion in dorsiflexion and plantar flexion, albeit limited. Overall, the Board finds that the lay and medical evidence has not more nearly approximated ankylosis or functional ankylosis for any time during the appeal period. As such, the evidence is against a rating in excess of 20 percent for any time during the appeal period.

Entitlement to a compensable rating for PFB is denied.

The Veteran seeks a compensable rating for his pseudofolliculitis barbae (PFB) under 38 C.F.R. § 4.118, DC 7806. Under 38 C.F.R. § 4.118, DC 7806, a noncompensable rating is assigned for no more than topical therapy required over the past 12-month period and at least one of the following: (1) characteristic lesions involving less than 5 percent of the entire body affected; or (2) characteristic lesions involving less than 5 percent of exposed areas affected. A 10 percent rating is assigned for at least one of the following: (1) characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or (2) at least 5 percent, but less than 20 percent, of exposed areas affected; or (3) intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12- month period. A 30 percent rating is assigned at least one of the following: (1) characteristic lesions involving more than 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or (2) systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. 38 C.F.R. § 4.118, General Rating for the Skin for DC 7806.

Effective August 31, 2018, VA regulations explicitly state that systemic therapy is treatment that is administered through any route other than the skin, and topical therapy is treatment that is administered through the skin. 38 C.F.R. § 4.118(a).

Turning to the facts of the case, the Veteran filed the current increased rating claim in March 2021. In a contemporaneous lay statement, the Veteran described experiencing reoccurring pustules and constant irritation of his skin after shaving. 

At the April 2021 VA examination, the Veteran reported experiencing shaving bumps and irritation on his chin after shaving. As a result, he limited shaving to once a month to avoid breakouts. He constantly used over-the-counter topical treatments to alleviate his symptoms. Upon evaluation, the examiner found that the Veteran's condition affected less than 5 percent of his exposed body area and total body area.

At the February 2025 Board hearing, the Veteran testified that he experienced irritation after shaving. He limited shaving to once a week or once every two weeks to alleviate his symptoms.

After reviewing the evidence of record, the Board finds that a compensable evaluation is not warranted for the Veteran's PFB for the period on appeal. The evidence does not show that more than 5 percent of the total and/or exposed body area was affected by the Veteran's PFB, and it has only been treated with topical therapy. Thus, a compensable rating under DC 7806 for dermatitis or eczema is not warranted.

The Board has considered other potentially applicable Diagnostic Codes but finds that a compensable rating is still not warranted. The Veteran has not endorsed disfigurement of the head, face, or neck nor was there evidence of visible or palpable tissue loss, gross distortion or asymmetry of one feature or paired set of features, acne, or hyperpigmentation. 

Accordingly, the Veteran has not met the criteria for a compensable evaluation for his PFB under the rating criteria under DC 7806 or any other diagnostic code. The claim is denied. 

 

 

T. MAINELLI

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	C. Orie, 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
, face, or neck nor was there evidence of visible or palpable tissue loss, gross distortion or asymmetry of one feature or paired set of features, acne, or hyperpigmentation. 

Accordingly, the Veteran has not met the criteria for a compensable evaluation for his PFB under the rating criteria under DC 7806 or any other diagnostic code. The claim is denied. 

 

 

T. MAINELLI

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	C. Orie, 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.