LUMBOSACRAL OR CERVICAL STRAIN

W. DAKNIS · 2026 · Case ID: A26038493

MIXED

Summary

The veteran, who served in the U.S. Army from June 2011 to April 2015, appeals a November 2024 rating decision. The veteran sought increased ratings for lumbosacral strain, right shoulder strain with rotator cuff tendonitis, and right lower extremity (RLE) radiculopathy (sciatic and femoral nerves), and an initial rating for bilateral knee conditions, hypertension, orchitis, and an eye disability. The Board granted an increased rating of 30 percent for the right shoulder strain with rotator cuff tendonitis, finding the evidence supported a 30 percent evaluation based on the private chiropractor's measurement of abduction limited to 40 degrees. The Board denied higher ratings for lumbosacral strain, noting the absence of unfavorable ankylosis and no evidence of incapacitating episodes under the IVDS Rating Formula. Similarly, higher ratings for RLE radiculopathy (sciatic and femoral nerves) were denied, as the evidence indicated only mild incomplete paralysis with intermittent symptoms and no objective neurological deficits. The Board remanded claims for bilateral knee tendonitis, hypertension, orchitis, and an eye disability, finding the VA medical opinions inadequate. For the knee claims, the VA examiner's opinion was insufficient for failing to address the Veteran's reports of chronicity and for relying on a lack of in-service treatment. The private opinion was also inadequate for relying on an inaccurate factual premise. For hypertension, the VA examiner's opinion was inadequate for failing to consider all in-service blood pressure readings and for lacking a rationale regarding the in-service groin pain complaint. For orchitis, the VA examiner's opinion was inadequate for failing to provide a rationale for relating the condition to service. For the eye disability, the VA examiner's opinion was inadequate for failing to consider the Veteran's reports of blurred vision and additional diagnoses.

Rationale

No unfavorable ankylosis of the entire thoracolumbar spine found.; No evidence of incapacitating episodes under IVDS Rating Formula.; Private chiropractor concurred with current 40% rating.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

5237

Docket No.

250710-563555

Full Decision Text

Citation Nr: A26038493
Decision Date: 04/24/26 Archive Date: 04/24/26

DOCKET NO. 250710-563555
DATE: April 24, 2026

ORDER

An initial rating in excess of 40 percent for lumbosacral strain is denied.

An initial rating of 30 percent for right shoulder strain with rotator cuff tendonitis is granted, subject to the laws and regulations governing the payment of monetary benefits.

An initial rating in excess of 10 percent for right lower extremity (RLE) radiculopathy, sciatic, is denied.

An initial rating in excess of 10 percent for RLE radiculopathy, femoral, is denied.

REMANDED

Entitlement to service connection for tendonitis of the right knee is remanded.

Entitlement to service connection for tendonitis of the left knee is remanded.

Entitlement to service connection for hypertension is remanded.

Entitlement to service connection for orchitis (inflammation of testicles) is remanded.

Entitlement to service connection for an eye disability is remanded.

FINDINGS OF FACT

1. For the entire review period, the Veteran's lumbosacral strain was not manifested by unfavorable ankylosis of the entire thoracolumbar spine.

2. The Veteran's right shoulder strain with rotator cuff tendonitis (dominant) is manifested by abduction limited to 40 degrees.

3. For the entire review period, the Veteran's RLE radiculopathy of the sciatic nerve resulted in no more than mild incomplete paralysis.

4. For the entire review period, the Veteran's RLE radiculopathy of the femoral nerve resulted in no more than mild incomplete paralysis.

CONCLUSIONS OF LAW

1. The criteria for an initial rating in excess of 40 percent for lumbosacral strain have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code (DC) 5237.

2. The criteria for an initial 30 percent rating for a right shoulder disability have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5201.

3. The criteria for an initial rating in excess of 10 percent for RLE radiculopathy, sciatic nerve, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 8520.

4. The criteria for an initial rating in excess of 10 percent for RLE radiculopathy, femoral nerve, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 8526.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from June 2011 to April 2015. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in November 2024 by a Department of Veterans Affairs (VA) Regional Office under the modernized appeals system known as the Appeals Modernization Act (AMA). In July 2025, the Veteran timely appealed such rating decision to the Board by submitting a Decision Review Request: Board Appeal (Notice of Disagreement) (VA Form 10182) in which he elected the evidence submission lane. Consequently, the Board's review is limited to the evidence of record at the time of the issuance of the rating decision on November 15, 2024 and any evidence submitted within 90 days of the receipt of his Notice of Disagreement on July 10, 2025. 38 C.F.R. § 20.303.

Increased Rating Claims

Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. §
appealed such rating decision to the Board by submitting a Decision Review Request: Board Appeal (Notice of Disagreement) (VA Form 10182) in which he elected the evidence submission lane. Consequently, the Board's review is limited to the evidence of record at the time of the issuance of the rating decision on November 15, 2024 and any evidence submitted within 90 days of the receipt of his Notice of Disagreement on July 10, 2025. 38 C.F.R. § 20.303.

Increased Rating Claims

Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7.

Separate ratings can be assigned for separate periods based on the facts found - a practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id.

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. In Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011), the United States Court of Appeals for Veterans Claims (Court) held that, although pain may cause a functional loss, "pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system." Rather, pain may result in functional loss, but only if it limits the ability "to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance." Id., quoting 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; DeLuca v. Brown, 8 Vet. App. 202 (1995).

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, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that "[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint." Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the DC under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016).

The review period before the Board begins on February
.59 requires that "[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint." Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the DC under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016).

The review period before the Board begins on February 12, 2024, the date of service-connection for the Veteran's back pain, right shoulder disability, and RLE radiculopathy of the sciatic and femoral nerves.

1. Entitlement to a rating in excess of 40 percent for lumbosacral strain.

For the entire review period, the Veteran's back disability is rated at 40 percent pursuant to DC 5237, pertinent to lumbosacral or cervical strain, which, in turn, is evaluated under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula) or the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Rating Formula), whichever method results in the higher evaluation when all disabilities are combined. 38 C.F.R. §§ 4.25, 4.71a.

Ratings under the General Rating Formula are made with or without symptoms such as pain (whether or not it radiates), stiffness, or aching in the area of the spine affected by residuals of injury or disease. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 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. Finally, a 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a.

Note (1): Any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, should be separately evaluated under an appropriate diagnostic code.

Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. 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 cervical spine is 340 degrees and 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.

Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted.

Note (4): Round each range of motion measurement to the nearest five degrees.

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

Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis
, 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.

Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability.

IVDS (preoperatively or postoperatively) may be evaluated either under the General Rating Formula or under the Formula for Rating IVDS Based on Incapacitating Episodes (IVDS Formula), whichever method results in the higher evaluation when all disabilities are combined. 38 C.F.R. § 4.25 (combined ratings table). The IVDS Formula provides that a 10 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least one week but less than 2 weeks during the past 12 months. A 20 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least 2 weeks but less than 4 weeks during the past 12 months. A 40 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. A 60 percent evaluation is warranted when there are incapacitating episodes having a total duration of at least 6 weeks during the past 12 months. Note (1) provides that 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.

At the November 2024 VA examination, the examiner reported that the Veteran did not have IVDS of the thoracolumbar spine. Furthermore, there is no clinical evidence showing incapacitating episodes during which the Veteran had a period of acute signs or symptoms due to IVDS that required bed rest prescribed by a physician and treatment by a physician. Therefore, an initial rating in excess of 40 percent for the Veteran's lumbosacral strain is not warranted under the IVDS Rating Formula.

Consequently, as noted above, a higher rating of 50 percent requires unfavorable ankylosis of the entire thoracolumbar spine.

However, none of the evidence shows findings consistent with this criteria. In this regard, VA treatment records reflect that the Veteran complains of back pain, but do not contain any range of motion findings or diagnosis of ankylosis.

The Veteran underwent a VA spine examination in October 2024. At such time, the examiner diagnosed lumbosacral strain. The Veteran reported that he had flare-ups of the thoracolumbar spine that occurred a few times a month and last a few days. The flare-ups were alleviated by time and medications. Range of motion testing reflected 60 degrees for forward flexion and 15 degrees for extension, right lateral flexion, left lateral flexion, right lateral rotation, and left lateral rotation. The Veteran exhibited pain on all planes, as well as with weight-bearing, nonweight-bearing, and active motion. The examiner noted that passive ROM testing could not be performed because it was contraindicated. Additionally, the Veteran was able to perform repetitive use testing with at least three repetitions, but there was no additional loss of function or ROM. The Veteran was not examined immediately after repeated use over time or during a flare-up, however, the examiner estimated that during these events, his ROM would be 30 degrees for forward flexion and 10 degrees for extension, right lateral flexion, left lateral flexion, right lateral rotation, and left lateral rotation. The Veteran did not have ankylosis of the spine including unfavorable ankylosis of the entire thoracolumbar spine.

In July 2025, the Veteran submitted a private examination report from Dr. M.T., a chiropractor. Dr. M.T. noted the Veteran had daily pain in varying degrees that has increased over time. She did note there was reduced segmental motion of segments T3-T8. However, she did not diagnose ankylosis and stated that she "concurs" with the Veteran's current service-connected 40 percent rating.

Based on the foregoing, the Board finds that an initial rating in excess of 40 percent for the Veteran's lumbosacral strain is not warranted. In this regard, VA treatment records and the VA examination conducted during
spine including unfavorable ankylosis of the entire thoracolumbar spine.

Based on the foregoing, the Board finds that an initial rating in excess of 40 percent for the Veteran's lumbosacral strain is not warranted. In this regard, VA treatment records and the VA examination conducted during the appeal period do not reflect unfavorable ankylosis of the entire thoracolumbar spine.

The Board has considered whether separate ratings for associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, are warranted pursuant to Note (1) of the General Rating Formula. However, the objective evidence, to include the October 2024 VA examination, fails to show that the Veteran's lumbosacral strain results in associated objective neurologic abnormalities aside from the RLE of the femoral and sciatic nerves, which is discussed further herein. Therefore, separate ratings for objective neurologic abnormalities associated with the Veteran's lumbosacral strain are not warranted.

2. Entitlement to a rating in excess of 20 percent for right shoulder strain with rotator cuff tendonitis.

For the entire review period, the Veteran's right shoulder disability has been rated as 20 percent disabling under DC 5201. As relevant, his right hand is his dominant hand.

DC 5201 provides that a 20 percent rating is warranted for a major or minor joint where motion is limited "at shoulder level," with flexion and/or abduction limited to 90 degrees or less. A 30 percent rating is warranted for a major joint, or 20 percent for a minor joint, where motion is limited to "midway between side and shoulder level," with flexion and/or abduction limited to 45 degrees or less. Finally, a 40 percent rating is warranted for a major joint, or 30 percent for a minor joint, where motion is limited "to 25 degrees from side" with flexion and/or abduction limited to 25 degrees from side.

Normal range of motion in the shoulder is from zero to 180 degrees of forward elevation (flexion) and zero to 180 degrees of shoulder abduction, and normal range of knee motion is 140 degrees of flexion and zero degrees of extension. 38 C.F.R. § 4.71a, Plate I, II.

Turning to the evidence of record, the Veteran underwent VA examination in October 2024. At that time, the Veteran was diagnosed with right shoulder strain with rotator cuff tendonitis. Initial ROM testing reflected abduction to 85 degrees and flexion to 70 degrees. He had internal and external rotation to 60 degrees. Pain was noted on examination for all ROM. The examiner estimated that ROM after repeated use over time would be abduction to 50 degrees, flexion to 50 degrees, and internal and external rotation to 30 degrees. The Veteran endorsed flare-ups, and the examiner estimated that additional loss of use would be abduction to 50 degrees, flexion to 50 degrees, and internal and external rotation to 30 degrees.

There was objective evidence of crepitus, but no ankylosis was noted on examination. Hawkins' Impingement Test, External Rotation/Infraspinatus Strength Test, and Empty-can Test were positive. There was no shoulder instability, dislocation, or labral pathology, history of recurrent dislocation, clavicle, scapula, acromioclavicular (AC) joint, or sternoclavicular joint conditions, or conditions or impairments of the humerus.

The examiner noted the Veteran's right shoulder disability impacted his ability to do repetitive movements of his right arm, carry heavy weight, and that he has difficulty with over the head movements.

In July 2025, the Veteran submitted a private examination report from Dr. M.T., who noted he suffers from daily right shoulder pain which varies in degrees and intensifies with reaching and overhead activity. The only ROM measurement provided was abduction to 40 degrees.

VA treatment records reflect reports of shoulder pain, but do not contain ROM findings.

Based on the foregoing, the Board finds that an initial 30 rating percent is warranted for the Veteran's right shoulder disability under DC 5201. In this regard, based on the private evaluation report, the Veteran's right shoulder abduction was limited to 40 degrees, which is commensurate with the 30 degree rating criteria. Therefore, the Veteran is entitled to an initial rating of 30 percent under DC
5, the Veteran submitted a private examination report from Dr. M.T., who noted he suffers from daily right shoulder pain which varies in degrees and intensifies with reaching and overhead activity. The only ROM measurement provided was abduction to 40 degrees.

VA treatment records reflect reports of shoulder pain, but do not contain ROM findings.

The Board also considered additional or higher ratings under applicable DCs. However, the evidence does not show, nor does the Veteran contend, that his right shoulder disability results in ankylosis of the scapulohumeral articulation, impairment of the humerus, or impairment of the clavicle or scapula. Consequently, higher or separate ratings are not warranted under DCs 5200, 5202, and 5203, respectively.

3. Entitlement to a rating in excess of 10 percent for RLE radiculopathy, sciatic.

4. Entitlement to a rating in excess of 10 percent for RLE radiculopathy, femoral.

For the entire review period, the Veteran has been in receipt of 10 percent ratings pursuant to DCs 8520 (sciatic) and 8526 (femoral) for RLE radiculopathy affecting the sciatic and femoral nerves.

DC 8520 pertains to the sciatic nerve and provides that mild incomplete paralysis is rated as 10 percent disabling, moderate incomplete paralysis is rated 20 percent disabling, moderately severe incomplete paralysis is rated as 40 percent disabling, and severe incomplete paralysis is rated 60 percent disabling. Complete paralysis, described as the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee wakened or (vary rarely) lost is rated 80 percent disabling.

DC 8526 provides for a 10 percent rating for mild incomplete paralysis of the femoral nerve; a 20 percent rating for moderate incomplete paralysis of the femoral nerve; and a 30 percent rating for severe incomplete paralysis of the femoral nerve. Further, a 40 percent rating is warranted where there is complete paralysis of the femoral nerve with paralysis of the femoral nerve with paralysis of quadriceps extensor muscles. 38 C.F.R. § 4.124a.

In this regard, in peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment and motor function, trophic changes, or sensory disturbances. 38 C.F.R. § 4.120. Under 38 C.F.R. § 4.124a, a disability from neurological disorders is rated from 10 to 100 percent in proportion to the impairment of motor, sensory, or mental function. With partial loss of use of one or more extremities from neurological lesions, rating is to be by comparison with mild, moderate, severe, or complete paralysis of the peripheral nerves. 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. Regulations specifically state that when the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.124a.

Descriptive words such as "slight," "moderate," "moderately severe," and "severe" as used in the various diagnostic codes are not defined in VA's Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence for "equitable and just decisions." 38 C.F.R. § 4.6. It should also be noted that use of terminology such as "severe" by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6.

Additionally, "VA's Adjudication Procedures Manual [M21-1] provides benchmarks for mild, moderate, moderately severe, and severe peripheral nerve conditions," and "[a]lthough the Board is not bound by the M21-1, the standards provided in the M21-1 are 'relevant guidance promulgated for the purpose of facilitating the efficient and proper resolution of claims,' which the Board
terminology such as "severe" by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6.

Additionally, "VA's Adjudication Procedures Manual [M21-1] provides benchmarks for mild, moderate, moderately severe, and severe peripheral nerve conditions," and "[a]lthough the Board is not bound by the M21-1, the standards provided in the M21-1 are 'relevant guidance promulgated for the purpose of facilitating the efficient and proper resolution of claims,' which the Board must consider and address as part of its duty to provide a reasoned explanation for its decision." Chavis v. McDonough, 34 Vet. App. 4, 17-18 (2021) (citing Healey v. McDonough, 33 Vet. App. 321 (2021) and Overton v. Wilkie, 30 Vet. App. 257, 264 (2018)).

In this regard, the M21-1 provides that, in cases where a peripheral nerve disability is only manifested by sensory impairment, 38 C.F.R. § 4.124a directs decision makers to assign the evaluation corresponding with the mild or at most the moderate degree of impairment. M21-1, V.iii.12.A.2.b. Such further provides that, to make a choice between mild and moderate, the adjudicator should consider the evidence of record and the following guidelines:

The mild level of evaluation would be more reasonably assigned when sensory symptoms are:

- recurrent but not continuous

- assigned a lower medical grade reflecting less impairment, and/or

- affecting a smaller area in the nerve distribution.

Reserve the moderate level of evaluation for the most significant and disabling cases of sensory-only involvement. These are cases where the sensory symptoms are:

- continuous

- assigned a higher medical grade reflecting greater impairment, and/or

- affecting a larger area in the nerve distribution.

The M21-1 also provides general guidelines for each level of incomplete paralysis of the upper and lower peripheral nerves. M21-1, V.iii.12.A.2.c. A "mild" degree of incomplete paralysis is characterized by disability limited to sensory deficits that are lower graded, less persistent, or affecting a small area. A very minimal reflex or motor abnormality potentially could also be consistent with mild incomplete paralysis.

"Moderate" is the maximum evaluation available for the most significant cases of sensory-only impairment and is characterized by symptoms described by the claimant and medically graded as significantly disabling and involving a larger area in the nerve distribution. Other sign or symptom combinations that may fall into the moderate category include combinations of significant sensory changes and reflex or motor changes of a lower degree, or motor and/or reflex impairment such as weakness or diminished or hyperactive reflexes (with or without sensory impairment) graded as medically moderate.

"Moderately severe" contemplates motor and/or reflex impairment (for example, weakness or diminished or hyperactive reflexes) at a grade reflecting a high level of limitation or disability. Additionally, atrophy may be present; however, for marked muscular atrophy, a rating contemplating severe incomplete paralysis is warranted.

"Severe" is characterized by 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 in severe long-standing neuropathy cases. For the sciatic nerve, marked muscular atrophy is expected. Although severe incomplete paralysis cases should show findings substantially less than those for complete impairment of the nerve, the disability picture for severe incomplete paralysis may contain signs or symptoms that resemble some of those expected in cases of complete paralysis of the nerve.

For the reasons set forth below, the Board finds that a rating in excess of 10 percent for RLE radiculopathy for the sciatic or femoral nerves is not warranted.

VA treatment records are silent for references to the Veteran's RLE radiculopathy of the sciatic or femoral nerves. In October 2024, the Veteran underwent a VA back examination. At that time, he was diagnosed with RLE radiculopathy of the sciatic and femoral nerves. His symptoms included no constant pain and moderate intermittent pain, paresthesias and/or dysesthesias, and numbness of the RLE. Upon examination, the Veteran's muscle strength, left side deep tendon reflexes (DTRs), and sensory examination were normal. He had hypoactive DTRs on his right side. A November 2024 VA knee examination noted the Veteran had no muscle atrophy.

The July 2025 private opinion from Dr
's RLE radiculopathy of the sciatic or femoral nerves. In October 2024, the Veteran underwent a VA back examination. At that time, he was diagnosed with RLE radiculopathy of the sciatic and femoral nerves. His symptoms included no constant pain and moderate intermittent pain, paresthesias and/or dysesthesias, and numbness of the RLE. Upon examination, the Veteran's muscle strength, left side deep tendon reflexes (DTRs), and sensory examination were normal. He had hypoactive DTRs on his right side. A November 2024 VA knee examination noted the Veteran had no muscle atrophy.

The July 2025 private opinion from Dr. M.T. did not provide any additional information regarding the Veteran's RLE radiculopathy except to state that she "concurs" with the Veteran's current service-connected 10 percent ratings.

Thus, as the Veteran's symptoms are intermittent (rather than continuous), result in no objective strength or sensory impairment, with non-absent DTRs, the Board finds that, for the entire appeal period his RLE radiculopathy affecting the sciatic and femoral nerves results in, at most, mild incomplete paralysis. Thus, a rating in excess of 10 percent for such disability is not warranted under DC 8520 or DC 8526.

Other Considerations

In reaching the foregoing determinations, the Board acknowledges the Veteran's sincerely held belief that the symptoms associated with his back and right shoulder disabilities, and RLE radiculopathy of the sciatic and femoral nerves are more severe than as reflected by the currently assigned ratings. In this regard, the Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to describe his symptomatology and resulting functional difficulties, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. See Woehlaert v. Nicholson, 21 Vet. App.456 (2007). Ultimately, the Board finds the medical evidence in which professionals with specialized expertise examined the Veteran, acknowledged his reported symptoms, and described the manifestations of such disabilities in light of the rating criteria to be more persuasive than his own reports regarding the severity of his disabilities.

The Board has also considered whether staged ratings under Fenderson, supra, or Hart, supra, are appropriate for the Veteran's back and right shoulder disabilities, and RLE radiculopathy of the sciatic and femoral nerves; however, the Board finds that his symptomatology has been stable throughout the appeal. Therefore, assigning staged ratings for such disabilities is not warranted. Further, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, in regard to the initial and increased rating claims adjudicated herein. Doucette v. Shulkin, 28Vet. App.366 (2017).

In reaching such decision, the Board has applied the benefit of the doubt doctrine and resolved all doubt in the Veteran's favor, which has resulted in the partial award of an increased rating of 30 percent for his right shoulder disability. However, insofar as the Board has denied higher or separate ratings for the Veteran's other claims, however, the evidence is firmly against the Veteran's claims for initial increased ratings for his service-connected disabilities. Therefore, the benefit of the doubt doctrine is not applicable in such regard and the Veteran's initial increased rating claims must otherwise be denied. 38U.S.C. §5107; 38 C.F.R. §§ 4.3, 4.7.

REASONS FOR REMAND

Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran's claim so that he is afforded every possible consideration. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159.

5. Entitlement to service connection for tendonitis of the right knee.

6. Entitlement to service connection for tendonitis of the left knee.

The Veteran claims his bilateral knee conditions were due to running in formation for long periods of time, and/or falling on the knees and continuing to run. In this regard, his service treatment records (STRs) are silent for complaints, treatment, or a diagnosis of a knee condition. However, April 2016 VA treatment records, dated within one year of the Veteran's military discharge reflect he was diagnosed with patellar tendinitis, right knee. VA treatment records also reflect complaints of bilateral knee pain, which the Veteran stated had been present for several years. See July 2016 and January 2019 records.

In November 2024, the Veteran underwent VA examination of his
itlement to service connection for tendonitis of the left knee.

In November 2024, the Veteran underwent VA examination of his knees. At that time, the Veteran was diagnosed with patellar tendinitis of the right knee only. No diagnosis was made for the Veteran's left knee. The examiner then stated that the Veteran's bilateral knee conditions were less likely than not due to his military service as there was a lack of evidence and no chronicity of care.

The Board finds these opinions to be inadequate to decide the claims. First, the Board notes that a VA examiner must offer a full rationale for all opinions given and should not rely solely on the absence of evidence of in-service treatment or injury in the Veteran's service treatment records as a basis for any given opinion. Here, the examiner simply noted a lack of chronicity of care.

Additionally, the July 2025 private opinion noted the Veteran has a diagnosis of left knee pain. Although Dr. M.T. opined that it was at least as likely as not that the Veteran's bilateral knee conditions were related to his military service, she did not offer an adequate rationale. Instead, she merely noted the "onset of this [bilateral knee] condition, which persists to the present, during active duty military service." However, as noted above, STRs are silent for references to knee complaints, and thus, such rationale is based on an inaccurate factual premise.

Thus, the Board finds that a remand is necessary to obtain adequate medical opinions addressing the nature and etiology of the Veteran's bilateral knee conditions.

7. Entitlement to service connection for hypertension.

The Veteran contends his hypertension had its onset in service. However, after a November 2024 records review, a VA examiner opined that it was less likely than not due to his military service. As rationale, she stated that "the submitted claims file is silent for any complaints, formal diagnosis or treatment for any hypertension condition. A nexus has not been established."

At his June 2010 entrance examination, the Veteran's blood pressure was 119/68. In October 2011, STRs reflect a reading of 125/83. However, STRs also reflect high blood pressure readings: 137/77 in July 2012, 134/72 in August 2012, 131/73 and 134/81 in December 2012, 143/82 in February 2013, 134/81 in September 2013, and 141/81 in January 2015. It does not appear that the November 2024 VA examiner considered the Veteran's STRs. Additionally, a private opinion submitted in July 2025 notes the Veteran has a diagnosis of hypertension with a blood pressure reading of 130/100 at the time of his examination.

However, the Veteran has not been afforded VA examination for his hypertension. Thus, the Board finds that a remand is necessary to afford the Veteran VA examination to determine the nature and etiology of such disorder.

8. Entitlement to service connection for orchitis (inflammation of testicles).

The Veteran contends that his orchitis was caused by strain on his body during service. In November 2024, the Veteran underwent VA examination. The examiner noted that STRs reflect a complaint of groin pain in service, and February 2017 VA treatment records reflect diagnoses of orchitis and tenderness of the right testicle. However, similar to above, she determined that the Veteran's orchitis was less likely than not due to his military service as there was a lack of evidence and no chronicity of care.

The Board finds the opinion inadequate to decide the claim. As noted above, the Board notes that a VA examiner must offer a full rationale for all opinions given and should not rely solely on the absence of evidence of in-service treatment or injury in the Veteran's service treatment records as a basis for any given opinion. Here, the examiner simply noted a lack of chronicity of care. Further, her statement that the Veteran's orchitis is not related to his in-service groin pain is conclusory and lacks any rationale.

Therefore, the Board finds that a remand is necessary to obtain adequate medical opinions addressing the nature and etiology of the Veteran's orchitis.

9. Entitlement to service connection
lack of evidence and no chronicity of care.

Therefore, the Board finds that a remand is necessary to obtain adequate medical opinions addressing the nature and etiology of the Veteran's orchitis.

9. Entitlement to service connection for an eye disability.

The Veteran contends he has an eye disability that began in service. In this regard, STRs are silent for any complaints, treatment or diagnoses of an eye complaint, except for a March 2014 notation of possible pink eye. However, it was noted at that time that he had no vision problems. In fact, STRs reflect the Veteran had no vision problems throughout his military service.

However, January 2020 VA treatment records reflect the Veteran was seen by ophthalmology for possible keratoconus and was given a provisional diagnosis of keratoconus, a distortion of the cornea. (See Dorland's Illustrated Medical Dictionary 968 (33rd Ed. 2020)). January 2021 records reflect additional diagnoses of myopia and astigmatism, and the Veteran was recommended to see a corneal specialist. VA treatment records reflect he stated he'd had blurred vision for many years.

In October 2024, the Veteran underwent VA examination. At that time, the examiner diagnosed him with bilateral keratoconus and bilateral generalized contraction of visual field. She offered a negative nexus opinion stating it was less likely than not the Veteran's keratoconus was due to his military service as he was diagnosed in January 2020. However, she did not comment on his reports of blurred vision for many years, or his additional diagnosis of myopia, astigmatism, or bilateral generalized contraction of visual field.

Additionally, the July 2025 private opinion noted the Veteran stated he was diagnosed with keratoconus during active duty. Although Dr. M.T. opined that it was at least as likely as not that the Veteran's eye condition was related to his military service, she did not offer an adequate rationale. Instead, she merely noted the "onset of this [eye] condition, which persists to the present, during active duty military service."

As the VA examiner did not consider the Veteran's reports of years of blurred vision or his additional diagnoses, the Board finds it necessary to obtain adequate medical opinions addressing the nature and etiology of the Veteran's eye disability.

The matters are REMANDED for the following action:

1. Forward the record, to include a copy of this remand, to an appropriate medical professional to obtain an addendum opinion addressing the etiology of the Veteran's bilateral knee conditions. The need for an additional examination of the Veteran is left to the discretion of the medical professional selected to write the addendum opinion. Following a review of the record, the examiner should offer an opinion as to whether it is at least as likely as not that his bilateral knee conditions are due to his military service, to include his reports of running in formation for long periods of time, and/or falling on the knees and continuing to run.

A rationale for any opinion offered should be provided.

2. Afford the Veteran an appropriate VA examination to determine the nature and etiology of his claimed hypertension.

Following a review of the record and any necessary testing, the examiner should offer an opinion as to whether it is at least as likely as not that the Veteran's hypertension had its onset in, or is related to, his military service. The examiner should consider his in-service blood pressure readings of 137/77 in July 2012, 134/72 in August 2012, 131/73 and 134/81 in December 2012, 143/82 in February 2013, 134/81 in September 2013, and 141/81 in January 2015.

A rationale for any opinion offered should be provided.

3. Forward the record, to include a copy of this remand, to an appropriate medical professional to obtain an addendum opinion addressing the etiology of the Veteran's orchitis. The need for an additional examination of the Veteran is left to the discretion of the medical professional selected to write the addendum opinion. Following a review of the record, the examiner should offer an opinion as to whether it is at least as likely as not that his orchitis is due to his military service, to include his contention of strain on his body.

A rationale for any opinion offered should
2013, 134/81 in September 2013, and 141/81 in January 2015.

A rationale for any opinion offered should be provided.

4. Forward the record, to include a copy of this remand, to an appropriate medical professional to obtain an addendum opinion addressing the etiology of the Veteran's eye disability, to include keratoconus, myopia, astigmatism, or bilateral generalized contraction of visual field. The need for an additional examination of the Veteran is left to the discretion of the medical professional selected to write the addendum opinion. Following a review of the record, the examiner should offer an opinion as to whether it at least as likely as not that his eye disability had its onset in, or is due to his military service, to include his report of years of blurred vision.

A rationale for any opinion offered should be provided.

W. Daknis

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board J.M. Kelly, 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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