DERMATITIS OR ECZEMA

CYNTHIA M. BRUCE · 2026 · Case ID: A26038602

MIXED

Summary

The veteran, who served in the U.S. Army from May 2004 to September 2025 with multiple service periods including deployments to Iraq and Afghanistan, appeals the denial of increased ratings for allergic rhinitis, right carpal tunnel syndrome, and GERD with chronic gastritis, as well as service connection for right upper extremity radiculopathy. The Board granted the restoration of a 10 percent rating for allergic rhinitis, finding the prior reduction improper because the evidence did not demonstrate sustained improvement under ordinary conditions of life and work, and the veteran was not afforded proper procedural notice. However, the Board denied entitlement to a rating higher than 10 percent for allergic rhinitis, right carpal tunnel syndrome, and GERD, as the evidence did not meet the criteria for higher evaluations. Service connection for right upper extremity radiculopathy was denied due to a lack of current diagnosis. The case was remanded for further development regarding the Veteran's left knee sprain, specifically to reconcile conflicting reports on symptom severity during flares and to obtain a clearer opinion on functional limitations. Additionally, the claim for left shoulder strain was remanded because the VA examiner's opinion inadequately addressed the Veteran's contention that the strain resulted from overcompensation for a service-connected right shoulder condition and failed to provide an aggravation opinion.

Rationale

Reduction of rating from 10% to 0% was improper.; Evidence did not demonstrate sustained improvement under ordinary conditions of life.; Veteran continues to have difficulties with blocked nasal passages.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

6522

Docket No.

210728-175807

Full Decision Text

Citation Nr: A26038602
Decision Date: 04/24/26 Archive Date: 04/24/26

DOCKET NO. 210728-175807
DATE: April 24, 2026

ORDER

1. As the reduction in the disability rating from 10 percent disabling to noncompensable for allergic rhinitis is not proper, restoration of the 10 percent rating is granted, effective October 1, 2020.

2. Entitlement to a disability rating in excess of 10 percent for allergic rhinitis is denied.

3. Entitlement to a disability rating in excess of 10 percent for right carpal tunnel syndrome is denied.

4. Entitlement to a disability rating in excess of 10 percent for gastroesophageal reflux disease (GERD), with chronic gastritis, is denied.

5. Entitlement to service connection for right upper extremity condition with radiculopathy is denied.

REMANDED

1. Entitlement to a disability rating in excess of 10 percent for left knee sprain is remanded.

2. Entitlement to service connection for left shoulder strain is remanded.

FINDINGS OF FACT

1. Prior to November 2022, a 10 percent rating for the Veteran's service-connected allergic rhinitis was in effect from March 17, 2017, to January 20, 2020, for a period less than 5 years.

2. In April 2021 rating decision, the Agency of Original Jurisdiction (AOJ) reduced the Veteran's allergic rhinitis rating from 10 percent to 0 percent, effective January 20, 2020.

3. November 2022, the Agency of Original Jurisdiction (AOJ) noted that a clear and unmistakable error was found in the effective date of March 17, 2017, granted for service connection for allergic rhinitis and proposed that the correct effective date should be March 1, 2018. The rating decision further noted a clear and unmistakable error in the effective date of January 20, 2020, assigned for the reduction for the evaluation from 10 to 0 percent. The AOJ proposed the correct effective date should be October 1, 2022.

4. In January 2023, service connection for allergic rhinitis was granted with a 10 percent evaluation effective March 1, 2018, and a 0 percent evaluation from October 1, 2022.

5. The Veteran did not appeal the November 2022 or the January 2023 rating decisions, and they are final. Thus, the Veteran's 10 percent rating was in effect for less than 5 years.

6. The AOJ's decision to reduce the Veteran's allergic rhinitis rating from 10 percent to 0 percent, effective October 1, 2022, was not proper. The evidence of record did not demonstrate improvement reasonably certain to continue under the ordinary conditions of life and work.

7. Throughout the appeal period, the Veteran is not shown to have nasal polyps.

8. The Veteran has mild incomplete paralysis of right upper extremity median nerve due to right carpal tunnel syndrome.

9. For the entire appeal period, the Veteran's GERD manifested the following symptoms: pyrosis, reflux, and substernal pain; but was not manifested by persistently recurrent epigastric distress, dysphagia, regurgitation, and symptoms productive of considerable impairment of health.

10. The evidence does not reflect that the Veteran has a current diagnosis of right upper extremity radiculopathy.

CONCLUSIONS OF LAW

1. As the AOJ's reduction of the rating for the Veteran's service-connected allergic rhinitis from 10 percent to 0 percent disabling, effective October 1, 2022, was not proper, the criteria for restoration of the 10 percent rating are met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.105(e), 3.344(a), (b), 4.1, 4.2, 4.10, 4.13, 4.25, 4.26, 4.40, 4.45, 4.59, 4.69, 4.71a, Diagnostic Code (DC) 6522.

2. The criteria for an evaluation in excess of 10 percent for allergic rhinitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.124a, DC 6522.

3. The criteria for an evaluation in excess of
(b), 4.1, 4.2, 4.10, 4.13, 4.25, 4.26, 4.40, 4.45, 4.59, 4.69, 4.71a, Diagnostic Code (DC) 6522.

2. The criteria for an evaluation in excess of 10 percent for allergic rhinitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.124a, DC 6522.

3. The criteria for an evaluation in excess of 10 percent for carpal tunnel syndrome of the right upper extremity median nerve have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.124a, DC 8515.

4. The criteria for entitlement to an initial rating in excess of 10 percent for GERD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.7, 4.10, 4.114, Diagnostic Code (DC) 7399-7346.

5. The criteria for service connection for right upper extremity radiculopathy have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty for the United States Army from May 2004 to April 2005, November 2006 to March 2008, September 2012 to September 2013, February 2017 to February 2018, May 2018 to January 2019, February 2019 to February 2020, and December 2022 to September 2025.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from July 2021 Higher-Level Review rating decision from a Department of Veterans Affairs (VA) Regional Office (RO).

On July 28, 2021, the Veteran disagreed with the abovementioned rating decision and filed a VA Form 10182 (Decision Review Request: Board Appeal (Notice of Disagreement)). The Veteran selected the Hearing Review Lane. However, on April 10, 2025, the Veteran withdrew his request for a Board hearing. Pursuant to 38 C.F.R. § 20.302(b), if a claimant commences an AMA appeal and initially selects the Hearing Lane but withdraws his/her hearing request before the hearing is held, the Board will adjudicate the claimant's challenges by issuing a decision based on a review of the evidence that is of record at the time of the underlying decision by the agency of original jurisdiction (AOJ), which is the April 2021 rating decision, as well as the evidence submitted within 90 days following receipt of the claimant's request for withdrawal.

2. Entitlement to a rating in excess of 10 percent for allergic rhinitis is denied.

The Veteran contends that the reduction of his service-connected allergic rhinitis from 10 percent to 0 percent was not proper. See July 2021 Notice of Disagreement (NOD).

The questions for the Board are whether the evidence supports a reduced rating based on an improvement in the Veteran's allergic rhinitis and whether the improvement actually reflects an improvement in the Veteran's ability to function in the ordinary conditions of life and work. For the reasons discussed below, the Board concludes the evidence does not support finding a reduction was proper.

The VA must comply with procedural and substantive provisions to sustain a rating reduction. The procedural requirements are set forth in 38 C.F.R. § 3.105(e) and (i); those provisions require the AOJ to issue a proposal of the rating reduction and advise the Veteran of his or her rights to have what is called a predetermination hearing. But those provisions only apply if the proposed rating reduction results in the reduction of the Veteran's total compensation amount. See VA Office of General Counsel Precedential Opinion (VAOPGCPREC) 71-91 at 3-4); Stelzel v. Mansfield, 508 F.3d 1345,
evidence does not support finding a reduction was proper.

The VA must comply with procedural and substantive provisions to sustain a rating reduction. The procedural requirements are set forth in 38 C.F.R. § 3.105(e) and (i); those provisions require the AOJ to issue a proposal of the rating reduction and advise the Veteran of his or her rights to have what is called a predetermination hearing. But those provisions only apply if the proposed rating reduction results in the reduction of the Veteran's total compensation amount. See VA Office of General Counsel Precedential Opinion (VAOPGCPREC) 71-91 at 3-4); Stelzel v. Mansfield, 508 F.3d 1345, 1347-49 (Fed. Cir. 2007) (holding that provisions of § 3.105(e) do not apply when there is no change in the overall disability rating).

The substantive requirements applicable to disability rating reductions are based on the number of years the relevant disability rating has been in effect; different standards apply if the disability rating has been in effect for less than five years, five years or more, or 20 years or more. Those durations are measured from the effective date of the rating to the effective date of the reduction. Brown v. Brown, 5 Vet. App. 413, 418-19 (1993). With regard to ratings in effect for less than five years, reduction is usually warranted if the evidence shows improvement of the condition. 38 C.F.R. § 3.951.

Also, in any reduction case, the VA needs to comply with several general VA regulations applicable to all rating-reduction cases, regardless of the rating level or how long that rating has been in effect; these regulations include 38 C.F.R. §§ 4.1, 4.2, 4.10, and 4.13. Under §§ 4.1 and 4.2, the VA is "required in any rating-reduction case to ascertain, based upon review of the entire recorded history of the condition, whether the evidence reflects an actual change in the disability and whether the examination report reflecting such change are based upon thorough examinations." Brown, 5 Vet. App at 421. And, under §§ 4.2 and 4.10, VA must not only "determine that an improvement in a disability has actually occurred but also that that improvement actually reflects an improvement in the veteran's ability to function under the ordinary conditions of life and work." Id.

It is the VA's burden to establish by the most probative evidence that the rating reduction is warranted. Id. If any of the factors listed in those provisions are not met, the rating reduction will be void ab initio, or void from the beginning, and the rating will be restored back to its previous level. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991).

Beginning with the initial grant of service-connection, in a September 2017 rating decision, the Veteran was granted service-connection for allergic rhinitis and assigned a 10 percent disability rating under DC 6522, effective March 17, 2017. The AOJ relied on the findings in an April 2017 VA disability examination when it assigned those ratings. Within the examination report, the Veteran denied any non-incapacitating or incapacitating episodes of sinusitis. The examiner observed that there was greater than 50 percent obstruction of the nasal passage on both sides due to rhinitis. No other pertinent physical findings were noted.

In January 2020, the Veteran submitted VA 21-526EZ, Fully Developed Claim, seeking, most pertinently, an increased rating for his service-connected allergic rhinitis. Resultingly, the Veteran underwent a VA examination for his allergic rhinitis in January 2021. The Veteran reported nasal congestion and runny nose which fairly improves with nasal spray. The examiner confirmed the diagnosis of allergic rhinitis and found permanent hypertrophy of the nasal turbinates, with no 50 percent or complete obstruction of either side of the nasal passages due to rhinitis. No other pertinent findings were noted.

In April 2021, the AOJ issued a decision that reduced the rating assigned to the Veteran's allergic rhinitis from 10 percent to noncompensable, effective January 20, 2020.

The Veteran requested higher-level review of this reduction in April 2021, and July 2021 higher-level review rating decision confirmed the 0 percent reduction from January 20, 2020. Subsequently, the November 2022 rating decision noted that a clear and unmistakable error was found in the effective date of March 17, 2017, granted for service connection for allergic rhinitis and proposed that the correct effective date should be March 1, 2018. The rating decision further noted a clear and unmistakable error in the effective date of January 20, 2020, assigned for the reduction for the evaluation from 10 to 0 percent. The AOJ proposed the correct effective date should be October 1, 2022. The Veteran did not initiate an appeal of this decision, and it is finale. Thereafter, in January 2023, service connection for allergic rhinitis was granted with a 10 percent evaluation, effective March 1, 2018, and a 0 percent evaluation from October 1, 2022. The Veteran did not initiate an appeal of this decision, and it is finale.

Because the record reflects the AOJ did not give the Veteran prior notice of proposed reduction or offer a predetermination hearing, the first issue is whether those procedural safeguards were required in this case. 38 C.F.R. § 105(e).

Given that the Veteran's total compensation did not decrease when the AOJ reduced his disability rating from 10 percent to 0 percent, the Board finds that the procedural safeguards were not required. The procedural safeguards, to include a notice of a proposed reduction, are not required if the rating reduction does not result in the reduction in the actual total compensation amount for the Veteran. See VAOPGCPREC 71-91 (Nov. 1991).

Given that the 10 percent rating assigned for the Veteran's allergic rhinitis condition was in effect for less than 5 years at the time of the reduction, a heightened duty to show sustained improvement is not required. However, although the Veteran is not afforded the more stringent substantive protections as ratings that have been in effect for more than five years, all rating reduction cases must show an actual improvement occurred and that the improvement reflects an improvement in the Veteran's ability to function under the ordinary conditions of life and work. Faust v. West, 13 Vet. App. 342, 349 (2000).

While January 2021 VA DBQ found improvement in the severity of the Veteran's allergic rhinitis, the evidence of record does not demonstrate sustained improvement in the Veteran's obstruction of either nasal passage under the ordinary conditions of life. Indeed, the Veteran reported during the examination that he has fair improvement of congestion and runny nose when he uses nasal spray. The Veteran did not state, nor did the examiner inquire, whether the nasal spray reduces nasal blockage in most instances. Moreover, in April 2021 rating decision the AOJ did not address whether the medical findings show improvement under the ordinary conditions of life and work.

Thus, notwithstanding the findings in January 2021 VA DBQ showing improvement in the condition, the evidence weighs against finding sustained medical improvement under the ordinary conditions of life and work. The evidence shows the Veteran continues to have difficulties with blocked nasal passages due to congestion. In light of the evidence, the Board affords the Veteran the benefit of the doubt on this issue and finds improvement under the ordinary conditions of life and work is not demonstrated. So, the Board finds that the reduction of the 10 percent disability rating was not proper. Accordingly, restoration of the 10 percent rating for service-connected allergic rhinitis is warranted, effective October 1, 2022. 38 C.F.R. §§ 4.2, 4.10; Brown, 5 Vet. App. at 421.

Moreover, the Board finds a rating in excess of 10 percent for allergic rhinitis is not warranted as the evidence fails to show polyps of the nasal passages. Accordingly, a rating in excess of 10 percent is denied.

3. Entitlement to a disability rating in excess of 10 percent for right carpal tunnel syndrome is denied.

The Veteran contends that he should be granted a higher rating for his right upper extremity carpal tunnel syndrome.

Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity caused by the given disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155
Vet. App. at 421.

3. Entitlement to a disability rating in excess of 10 percent for right carpal tunnel syndrome is denied.

The Veteran contends that he should be granted a higher rating for his right upper extremity carpal tunnel syndrome.

When a question arises as to which of two ratings applies under a particular Code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining, including degree of disability, is to be resolved in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104(a). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

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. Neither the Rating Schedule nor the regulations provide definitions for descriptive words such as "mild," "moderate," "moderately severe," and "severe." See Sellers v. Wilkie, 30 Vet. App. 157 (2018). Rather than applying a mechanical formula, the Board must instead evaluate all the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6.

Symptoms not "wholly sensory" could include weakness, imbalance, and reflex changes. There is no requirement that symptoms not wholly sensory be rated as "moderately severe" or worse. For example, a very minimal reflex or motor abnormality potentially could be consistent with "mild" incomplete paralysis. Rather, in assessing the "moderately severe" and "severe" criteria, the Board will look at how the frequency and severity of symptoms not "wholly sensory" impact the Veteran's ability to function under the ordinary conditions of life, including employment and self-support.

In rating diseases of the peripheral nerves, the term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration.

Under DC 8515 (for paralysis of the median nerve): a 10 percent rating is warranted for mild, incomplete paralysis (for either the dominant [major] or nondominant [minor] extremity); a 20 percent rating is warranted for moderate, incomplete paralysis of the nondominant (minor) extremity; a 30 percent rating is warranted for moderate, incomplete paralysis of the dominant (major) extremity; a 40 percent rating is warranted for severe, incomplete paralysis of the nondominant (minor) extremity; a 50 percent rating is warranted for severe, incomplete paralysis of the dominant (major) extremity; a 60 percent (maximum schedular for the nondominant [minor] extremity) rating is warranted for complete paralysis (the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand [ape hand]; pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx of thumb, defective opposition and abduction of the thumb, at right angles to palm; flexion of wrist weakened; pain with trophic disturbances); and a 70 percent (maximum schedular for the dominant [major] extremity) rating is warranted for complete paralysis (the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand [ape hand];
the plane of the hand [ape hand]; pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx of thumb, defective opposition and abduction of the thumb, at right angles to palm; flexion of wrist weakened; pain with trophic disturbances); and a 70 percent (maximum schedular for the dominant [major] extremity) rating is warranted for complete paralysis (the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand [ape hand]; pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx of thumb, defective opposition and abduction of the thumb, at right angles to palm; flexion of wrist weakened; pain with trophic disturbances). 38 C.F.R. § 4.124a, DC 8515. Further, 38 C.F.R. § 4.124a states that, when the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree.

The evidence of record reveals that the Veteran underwent a VA examination in April 2017. He declared the right hand to be his dominant hand. Hand grip muscle strength of the right hand was described as normal. No muscle atrophy or ankylosis of the right hand were observed. Noted symptoms attributable to right upper extremity carpal tunnel syndrome were mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness. Muscle strength testing of the right wrist and right grip were described as "active movement against some resistance." Reflexes were normal, with no trophic changes. Phalen and Tinel's sign tests were both positive, and the median nerve was noted to have mild, incomplete paralysis. No assistive devices were necessary for ambulation.

The Veteran underwent a follow-up VA examination in January 2021. He reported mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness. Muscle strength testing of the right wrist and right grip were described as normal. Reflexes were normal, with no ankylosis or trophic changes. Upon examination, there was decreased sensation of the right hand/fingers. Phalen and Tinel's sign tests were both positive, and the median nerve was noted to have mild, incomplete paralysis. No assistive devices were necessary for ambulation.

In light of the evidence above, the Veteran's right carpal tunnel syndrome is mild. The Veteran's reported symptoms primarily consist of numbness, intermittent pain, and paresthesias and/or dysesthesias. These symptoms are "wholly sensory." Therefore, at most, a "moderate" characterization could apply. Nonetheless, the evidence strongly supports that the correct characterization of the Veteran's symptoms is "mild." Indeed, the Veteran has not reported constant pain, no muscle atrophy, trophic changes, or ankylosis has ever been diagnosed, and muscle strength testing has been at worst described as "active movement against some resistance." A higher degree of impairment might involve symptoms perceptible upon objective testing such as constant pain, active movement against gravity, hypoactive or hyperactive reflexes, and the need for an assistive device for ambulation. In contrast, the Veteran's symptoms are mild.

Considering the foregoing, the Board finds that the persuasive weight of the evidence shows that the Veteran's right upper extremity carpal tunnel syndrome manifests as no worse than mild incomplete paralysis. As the evidence of record persuasively weighs against a rating in excess of 10 percent, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021). A rating in excess of 10 percent is denied.

4. Entitlement to a disability rating in excess of 10 percent for gastroesophageal reflux disease (GERD) with chronic gastritis is denied.

The Veteran generally contends that he is entitled to a rating in excess of 10 percent for his GERD condition.

4. Entitlement to a disability rating in excess of 10 percent for gastroesophageal reflux disease (GERD) with chronic gastritis is denied.

The Veteran generally contends that he is entitled to a rating in excess of 10 percent for his GERD condition.

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; the additional code is shown as a hyphen. 38 C.F.R. § 4.27. Unlisted disabilities requiring rating by analogy are coded with the first two numbers of the schedule provisions most closely related body part and 99. Here, the hyphenated diagnostic code indicates that the Veteran's GERD is currently rated as analogous to a disability of the digestive system under the hiatal hernia (DC 7346). 38 C.F.R. § 4114. The Board notes that VA amended the criteria for evaluating certain disabilities involving the digestive system, including hiatal hernia and GERD (which now has its own diagnostic code), effective May 19, 2024. See 89 Fed. Reg. 19375. However, under the AMA, the question in this case is whether the correct decision was made at the time of the July 2021 rating decision. Accordingly, the Board will only consider the Veteran's claim under the criteria that were in effect prior to May 19, 2024.

The Veteran's GERD is currently rated as 10 percent pursuant to DC 7346. 38 C.F.R. § 4.114. Under DC 7346, a 10 percent rating is given when two or more of the symptoms for the 30 percent evaluation of less severity are shown. A 30 percent evaluation is warranted when there is persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. A 60 percent rating contemplates pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health.

Following a review of the record, the Board concludes the criteria for a rating in excess of 10 percent for GERD have not been met at any point during the appeal. See 38 C.F.R. § 4.114, DC 7346.

The Veteran attended a VA examination in January 2021. The examiner declined to provide an intestinal condition diagnosis and the examination report was left empty. Another VA examination was associated with the claims file on January 20, 2021. The report notes the Veteran's complaint of epigastric pain, reflux, and heartburn. A GERD diagnosis was confirmed, with the use of over-the-counter medication for treatment. Reported symptoms were listed as pyrosis, reflux, and substernal pain. No esophageal structure, spasm, or diverticula were observed.

Private treatment records note complaints about abdominal pain. The esophagus, stomach, and duodenum were all described as normal.

Based on the evidence of record, the Board finds that a rating in excess of 10 percent is not warranted. The Veteran is competent to report his readily observable symptoms. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, the Veteran has not provided evidence, and the medical evidence of record does not show, that his GERD has resulted in persistently recurrent epigastric distress, dysphagia, regurgitation, and symptoms productive of considerable impairment of health, as required by the 30 percent criteria, or other symptom combinations productive of severe impairment of health as required by the 60 percent criteria.

The Board has considered whether any other Diagnostic Codes are relevant to the disability at issue. The selection of a particular diagnostic code "is a determination that is completely dependent upon the facts of a particular case." Butts v. Brown, 5 Vet. App. 532, 538 (1993) (en banc). There is no evidence of esophageal spasm, stricture, or diverticulum during the appeal period to warrant a rating under DC 7203 to 7205. The Board finds that the manifestations of the Veteran's disability are more appropriately rated under DC 7346.

Accordingly, the criteria for a rating in excess of 10 percent for GERD has not been met or nearly approximated. 38 C.F.R. § 4.114, DC 7346. Therefore, a rating in excess of 10 percent for
a determination that is completely dependent upon the facts of a particular case." Butts v. Brown, 5 Vet. App. 532, 538 (1993) (en banc). There is no evidence of esophageal spasm, stricture, or diverticulum during the appeal period to warrant a rating under DC 7203 to 7205. The Board finds that the manifestations of the Veteran's disability are more appropriately rated under DC 7346.

5. Entitlement to service connection for right upper extremity condition with radiculopathy is denied.

The Veteran contends that he has a right upper extremity radiculopathy condition which should be service-connected.

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§?1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004). 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).

In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

In August 2017, the Veteran underwent a VA examination for a back disability. The examiner found no signs or symptoms of radiculopathy. A January 2021 VA opinion opined that at the time of evaluation there was no subjective or objective evidence of radiculopathy of the right upper extremity. A January 2021 VA Examination for Neck Conditions noted that no report of radicular pain was provided and that no signs or symptoms due to radiculopathy were observed. Ultimately, the examiner opined that there was no subjective or objective evidence of cervical radiculopathy upon examination and available records provided. The March 2021 VA Examination for Neck Conditions again found no radicular pain or any other signs or symptoms due to radiculopathy.

July 2021 rating decision noted the favorable finding that the claimed primary disability of labral tear, including SLAP (Superior labral anterior-posterior lesion), of the right shoulder is service-connected.

The claims file does not contain any evidence, either VA or private, indicating that the Veteran has a current disability of right upper extremity radiculopathy. Therefore, the Board must find that the first element of service connection has not been met for the Veteran's claim. Accordingly, as the first element of service connection has not been met for the claim, it must be denied at this time. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992) (holding that a current diagnosis is the cornerstone of a claim for service connection).

REASONS FOR REMAND

1. Entitlement to a disability rating in excess of 10 percent for left knee sprain is remanded.

The Veteran contends that the symptoms of his left knee sprain are more severe than his currently assigned 10 percent rating.

Although the Board regrets causing delay by remanding this issue, the Board finds that remand is necessary. In this regard, the January 2021 examination report fails to account for the Veteran's report of severity during periods of flare. Specifically, the examination report notes the Veteran's complaint of difficulty performing squats and kneeling during periods of flare. However, when asked whether procured evidence suggests pain, fatigability, weakness, lack of endurance, or incoordination which significantly limits functional ability with flare ups, the examiner replied "no." The Board finds that there is a discrepancy between the Veteran's reports and the examiner's findings, which is stark enough to warrant an explanation of reconciliation of said information, or obtain another VA examination.

The AOJ's reliance on this inadequate examination and failure to obtain an opinion addressing the supposed inconsistency or conduct another examination entirely, constitutes a pre-decisional duty
report fails to account for the Veteran's report of severity during periods of flare. Specifically, the examination report notes the Veteran's complaint of difficulty performing squats and kneeling during periods of flare. However, when asked whether procured evidence suggests pain, fatigability, weakness, lack of endurance, or incoordination which significantly limits functional ability with flare ups, the examiner replied "no." The Board finds that there is a discrepancy between the Veteran's reports and the examiner's findings, which is stark enough to warrant an explanation of reconciliation of said information, or obtain another VA examination.

2. Entitlement to service connection for left shoulder strain is remanded.

The Veteran contends he has a left shoulder disability which was caused or aggravated by his service-connected right shoulder labral tear, including superior labrum anterior and posterior tear. Specifically, the Veteran avers that overcompensation for the service-connected right shoulder caused degeneration in the left shoulder. The Board finds remand is necessary as the evidence of record is insufficient to resolve his claim.

The Veteran was afforded a VA examination for his left shoulder in January 2021. A diagnosis of left shoulder strain was provided. The examiner opined that the left shoulder condition was less likely than not proximately due to or the result of the Veteran's service-connected right shoulder condition. The rationale states that "by definition right shoulder labral tear, including superior labrum anterior and posterior tear, and left shoulder strain have different anatomical sites with different pathophysiological process unrelated to each other." The Board finds this opinion inadequate as the examiner failed to clinically address the Veteran's contention that his left shoulder strain is due to overcompensating for his service-connected right shoulder condition. Moreover, no aggravation opinion was provided.

The reliance on an inadequate opinion constitutes a pre-decisional duty to assist error that requires remand.

The matters are REMANDED for the following action:

1. Obtain an addendum opinion from the same examiner who conducted the January 2021 examination if available, and if not available, a different examiner who is preferably an orthopedic specialist.

A new examination is not needed unless the examiner indicates otherwise. If the examiner determines that furnishing a fully informed opinion addressing all the requested Remand directives is not possible without a concurrent examination, the examiner must so state and the Veteran must be scheduled for a new examination.

The entire claims file must be made available to and reviewed by the examiner, to include a copy of this Remand, and the examiner must indicate that such review was completed.

After completing this review, the examiner must address the following items:

(a) During the January 2021 VA examination for the knee, the Veteran reported difficulty performing squats and kneeling during periods of flare. Please reconcile this report with the finding that no procured evidence suggests pain, fatigability, weakness, lack of endurance, or incoordination which significantly limits functional ability with flare ups. Upon reconsideration, if you opine that procured evidence does suggest pain, fatigability, weakness, lack of endurance, or incoordination which significantly limits functional ability with flare ups, please estimate range of motion in degrees for the joint during periods of flare based on information procured from relevant sources including the lay statements of the Veteran.

Please provide a robust rationale for all opinions. If unable to opine without resorting to speculation, the examiner must provide a basis for reaching this conclusion.

(b) If a new examination is warranted, schedule the Veteran for an additional VA examination to determine the severity of his left knee disability

The examiner must specifically provide range of motion figures for the Veteran's left knee in active and passive motion, and in weight-bearing and non-weight-bearing.

The examiner must also address the Veteran's reports of flare ups and any loss of function after repeated use over time.

2.Schedule the Veteran for a VA examination before an appropriate examiner to determine the nature and etiology of his left shoulder strain. The entire claims file and this remand should be made available to the examiner for review. The examiner should render an opinion, including rationale, addressing the following:

(a) whether the Veteran's left shoulder strain is at least as likely as not (an approximate balance of positive and negative evidence) proximately due to, or aggravated (worsened) by, service-connected right shoulder disability.

The opinion must explicitly address both causation and aggravation to be deemed adequate.

The examiner must specifically address the Veteran's contention that his left shoulder condition is due to overcompensation for the service-connected right shoulder condition.

The examiner must also be advised the Veteran is competent to
appropriate examiner to determine the nature and etiology of his left shoulder strain. The entire claims file and this remand should be made available to the examiner for review. The examiner should render an opinion, including rationale, addressing the following:

The opinion must explicitly address both causation and aggravation to be deemed adequate.

The examiner must specifically address the Veteran's contention that his left shoulder condition is due to overcompensation for the service-connected right shoulder condition.

The examiner must also be advised the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, he or she must provide a reason for doing so.

A complete rationale for the opinion must be provided.

Cynthia M. Bruce

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Russell, Tangela

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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