DEGENERATIVE ARTHRITIS

B. MULLINS · 2026 · Case ID: A26039046

MIXED

Summary

The Veteran, who served in the U.S. Navy from September 1962 to February 1966, appeals the denial of service connection for a lumbar spine disorder and a headache disorder, as well as an increased rating for anxiety and depressive disorders. The Board found that new and relevant evidence was submitted for the lumbar spine and headache claims, warranting readjudication and remand. The lumbar spine claim was remanded because the VA examiner's opinion was inadequate, relying on an inaccurate factual premise that the in-service injury was not well-documented and incorrectly assessing the timing of the Veteran's complaints. The headache claim was remanded because the private examiner's opinion was based on inaccurate factual premises regarding diagnoses in VA treatment records, and the VA examiner's opinion was inadequate for failing to consider the Veteran's assertions of ongoing symptoms since service and for not addressing the potential link to toxic exposures or the etiology of the tension headaches. The claim for an increased rating for anxiety and depressive disorders was denied, as the Board found the Veteran's symptoms, while present, did not rise to the level of occupational and social impairment with deficiencies in most areas required for a 70 percent rating, concluding the symptoms most nearly approximated a 50 percent rating. The claim for bilateral hearing loss was also denied as the audiometric testing did not meet the criteria for a compensable evaluation.

Rationale

New and relevant evidence submitted warrants readjudication.; Private examiner's opinion inadequate due to inaccurate factual premise.; VA examiner's opinion inadequate due to inaccurate assessment of record timeline and failure to consider Veteran's assertions.

Service Branch

NAVY

Special Benefit

TDIU

Docket No.

250923-590718

Full Decision Text

Citation Nr: A26039046
Decision Date: 04/27/26 Archive Date: 04/27/26

DOCKET NO. 250923-590718
DATE: April 27, 2026

ORDER

The Board, having determined that new and relevant evidence has been received, concludes that readjudication of the claim of entitlement to service connection for a lumbar spine disorder, is warranted.

The Board, having determined that new and relevant evidence has been received, concludes that readjudication of the claim of entitlement to service connection for a headache disorder, is warranted.

The appeal as to the claim of entitlement to an initial compensable evaluation for service-connected bilateral hearing is denied.

The appeal as to the claim of entitlement to an initial evaluation in excess of 50 percent for service-connected anxiety disorder and depressive disorder is denied.

REMANDED

The appeal as to the claim of entitlement to service connection for a lumbar spine disorder is remanded.

The appeal as to the claim of entitlement to service connection for a headache disorder is remanded.

The appeal as to the claim of entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded.

FINDINGS OF FACT

1. In a May 2022 rating decision, the RO denied of the Veteran's claim of entitlement to service connection for a lumbar spine disorder; the Veteran did not appeal the decision, and it is final.

2. Evidence has been received with the December 2023 Supplemental Claim (since May 2022 rating decision) that is new and relevant to the claim of entitlement to service connection for a lumbar spine disorder.

3. In a November 2017 rating decision, the RO denied the Veteran's claim of entitlement to service connection for a headache disorder; the Veteran did not appeal the decision, and it is final.

4. Evidence has been received with the December 2023 Supplemental Claim (since November 2017 rating decision) that is new and relevant to the claim of entitlement to service connection for a headache disorder.

5. Throughout the pendency of the appeal, the Veteran's hearing impairment has been no worse than Level I in the right and left ear.

6. Throughout the appeal period, the Veteran's anxiety and depressive disorder was manifested by occupational and social impairment with reduced reliability and productivity due to such symptoms as depressed mood; anxiety; and disturbances of motivation and mood; without more severe manifestations that more nearly approximate occupational and social impairment with deficiencies in most areas, or total occupational and social impairment.

CONCLUSIONS OF LAW

1. The criteria for readjudicating the claim of entitlement to service connection for a lumbar spine disorder have been met. 38 U.S.C. §§ 5103, 5108 (2012); 38 C.F.R. §§ 3.156 (d), 3.303 (2021).

2. The criteria for readjudicating the claim of entitlement to service connection for a headache disorder have been met. 38 U.S.C. §§ 5103, 5108 (2012); 38 C.F.R. §§ 3.156 (d), 3.303 (2021).

3. The criteria for establishing a compensable evaluation for service-connected bilateral hearing loss have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.85, Diagnostic Code 6100 (2021).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service in the United States Navy from September 1962 to February 1966. His service was under honorable conditions.

The matter is on appeal from April 2025, May 2025, and June 2025 rating decisions issued by a VA Regional Office (RO), which is the Agency of Original Jurisdiction (AOJ).

During the course of treatment, the Veteran raised an informal claim of entitlement to a TDIU due to his service-connected disabilities. The issue of whether entitlement to a TDIU is warranted as a result of that disability is part and parcel of the increased rating claim. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Thus, the issues are as noted on the title page.

In a September 23, 2025 VA Form 10182 (Notice of Disagreement), the Veteran timely appealed to the Board of Veterans' Appeals (Board) and elected the Hearing docket, indicating that he wanted a Board hearing and the opportunity to submit any additional evidence in support of the appeal within 90 days after the hearing. The Veteran was scheduled for a January 7, 2026, hearing; however, in December 2025 correspondence, the Veteran waived his right to a hearing and requested that the case move forward based on the evidence of record. Thereafter, in correspondence, the Board accepted the Veteran's appeal and placed it on the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the AOJ decisions on appeal, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. However, because the Board is remanding the claim of entitlement to service connection for a lumbar spine disorder and a headache disorder, any evidence the Board could not consider will be considered by the AOJ in the adjudication of the claim. 38 C.F.R. § 3.103(c)(2)(ii).

As a preliminary matter, the Board interprets the January 2026 Appellate Brief as reflecting an intent to have this matter reviewed in an expeditious manner, as the Veteran's representative waives RO review, and due to the advancement on the docket, the Board finds to be an implicit waiver of the Veteran's right to change Board dockets under Williams v. McDonough, 37 Vet. App. 305 (2024).

The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to the specific contentions regarding the case as raised directly by the Appellant and those reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016).

New and Relevant Evidence

VA will readjudicate a claim if new and relevant evidence is presented or secured. 38 C.F.R. § 3.156 (d). "Relevant evidence" is evidence that tends to prove or disprove a matter in issue. 38 C.F.R. § 3.2501 (a)(1). As the statutory definition of "relevant" does not require that the evidence relate to an unestablished fact necessary to substantiate the claim or raise a reasonable possibility of substantiating the claim; "new and relevant" evidence is a lower standard than the "new and material" evidence standard.

1. Whether new and relevant evidence has been received to readjudicate the claim of entitlement to service connection for a lumbar spine disorder.

In the present matter, the Veteran asserts that his current lumbar spine disorder is related to his active service. In this regard, the record demonstrates current diagnoses of lumbar spine degenerative arthritis and degenerative disc disease on VA examination in April 2025. Moreover, the Veteran asserts that his symptoms of lumbar spine pain and stiffness began in service and have progressively worsened to the present. In addition, a private examiner opined that the Veteran's current lumbar spine disorders are related to his active service.

Accordingly, as evidence has been submitted that is relevant to the matter at issue, the claim of entitlement to service connection for a lumbar spine disorder is reopened.

2. Whether new and relevant evidence has been received to readjudicate the claim of entitlement to service connection for a headache disorder.

In the present matter, the Veteran asserts that his current headache disorder is related to his active service. In this regard, the record demonstrates current a diagnosis of tension headaches on VA examination in April 2025. Moreover, the Veteran asserts that his symptoms of pain and dizziness began in service and have progressively worsened to the present. In addition, a private examiner opined that the Veteran's current headache disorder is related to his active service.

Accordingly, as evidence has been submitted that is relevant to the matter at issue, the claim of entitlement to service
bar spine disorder is reopened.

2. Whether new and relevant evidence has been received to readjudicate the claim of entitlement to service connection for a headache disorder.

Accordingly, as evidence has been submitted that is relevant to the matter at issue, the claim of entitlement to service connection for a headache disorder is reopened.

Increased Rating - Legal Criteria

Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4 (2021). The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.321 (a), 4.1 (2021).

Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2021).

In accordance with 38 C.F.R. §§ 4.1, 4.2 (2021) and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed all evidence of record pertaining to the history of the service-connected disabilities at issue. The Board has found nothing in the historical record which would lead to the conclusion that the current evidence of record is not adequate for rating purposes. Moreover, the Board is of the opinion that this case presents no evidentiary considerations which would warrant an exposition of remote clinical histories and findings pertaining to the disability.

In both initial rating claims and subsequent increased rating claims, the Board must discuss whether "staged ratings" are warranted, and if not, why not. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007).

The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10 (2021).

It is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified; findings sufficiently characteristic to identify the disease and the disability therefrom are sufficient; and above all, a coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21 (2021).

Except as otherwise provided by law, a claimant has the responsibility to present and support a claim for benefits under laws administered by the Secretary. The Secretary shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107 (2012); 38 C.F.R. §§ 3.102, 4.3 (2021); see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990).

3. Entitlement to an initial compensable evaluation for service-connected bilateral hearing.

The Veteran contends that his service-connected bilateral hearing loss disability is more severe than his current noncompensable rating.

Disability ratings for hearing loss disability are derived from mechanical application of the rating schedule to the numeric designations resulting from audiometric testing. See Lendenmann v. Principi, 3 Vet. App. 345 (1992).

The rating schedule establishes 11 auditory hearing acuity levels based upon average puretone thresholds and speech discrimination. 38 C.F.R. § 4.85.

An examination for hearing impairment for VA purposes must be conducted by a state-licensed audiologist and must include a controlled speech discrimination test (Maryland CNC) and a puretone audiometry test. Examinations will be conducted without the use of hearing aids. See Id.

Table VI,
able rating.

The rating schedule establishes 11 auditory hearing acuity levels based upon average puretone thresholds and speech discrimination. 38 C.F.R. § 4.85.

Table VI, "Numeric Designation of Hearing Impairment Based on Puretone Threshold Average and Speech Discrimination," is used to determine a Roman numeral designation (I through XI) for hearing impairment based on a combination of the percent of speech discrimination (horizontal rows) and the puretone threshold average (vertical columns). The Roman numeral designation is located at the point where the row and column intersect. 38 C.F.R. § 4.85(b).

Table VIa, "Numeric Designation of Hearing Impairment Based Only on Puretone Threshold Average," is used to determine a Roman numeral designation (I through XI) for hearing impairment based only on puretone threshold average. Table VIa is used when the examiner certifies that the use of the speech discrimination test is not appropriate due to language difficulties, inconsistent speech discrimination scores, etc., or when indicated under the provisions of § 4.86. 38 C.F.R. § 4.85(c).

"Puretone threshold average" as used in Tables VI and VIa is the sum of the puretone thresholds at 1000, 2000, 3000 and 4000 Hertz and divided by four. This average is used in all cases (including those of § 4.86) to determine a Roman numeral designation from Tables VI and VIa. 38 C.F.R. § 4.85(d).

Table VII, "Percentage Evaluations of Hearing Impairment," is used to determine the percentage evaluation by combining the Roman numeral designations for hearing impairment in each ear. The horizontal rows represent the ear having better hearing and the vertical columns represent the ear having the poorer hearing. The percentage evaluation is located at the point where the row and the column intersect. 38 C.F.R. § 4.85(e).

Provisions for evaluating exceptional patterns of hearing impairment are as follows:

(a) When the puretone thresholds at each of the four specified frequencies (1000, 2000, 3000 and 4000 Hertz) is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. Each ear will be evaluated separately.

(b) When the puretone thresholds are 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral; the numeral will then be elevated to the next higher Roman numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86.

The Veteran underwent a VA audiometric examination in June 2024. The Veteran's puretone thresholds were as follows:

HERTZ

1000 2000 3000 4000

RIGHT 20 20 30 95

LEFT 15 25 40 90

The puretone average for his right ear was 41. The puretone average for his left ear was 43. Speech recognition was 98 percent for his right ear and 96 percent for the left ear. The examiner diagnosed bilateral sensorineural hearing loss.

Applying the values above to Table VI results in a Level I Roman numeral designation for the right ear and a Level I Roman numeral designation for the left ear. Application of Level I and Level I designations to Table VII results in a noncompensable evaluation. Neither ear does not demonstrate an exceptional pattern of hearing impairment under the provisions of 38 C.F.R. §§ 4.86(a) or 4.86(b). The examiner noted that the Veteran's current bilateral hearing loss disability did impact ordinary conditions of daily life, to include difficulty hearing low pitched sounds, and hearing the television and radio.

Upon review of the evidence of record, it is evident that the criteria for a compensable evaluation for the Veteran's bilateral hearing loss under Diagnostic Code 6100 are
in a Level I Roman numeral designation for the right ear and a Level I Roman numeral designation for the left ear. Application of Level I and Level I designations to Table VII results in a noncompensable evaluation. Neither ear does not demonstrate an exceptional pattern of hearing impairment under the provisions of 38 C.F.R. §§ 4.86(a) or 4.86(b). The examiner noted that the Veteran's current bilateral hearing loss disability did impact ordinary conditions of daily life, to include difficulty hearing low pitched sounds, and hearing the television and radio.

Upon review of the evidence of record, it is evident that the criteria for a compensable evaluation for the Veteran's bilateral hearing loss under Diagnostic Code 6100 are not met. Although the aforementioned VA audiological evaluation clearly shows that the Veteran has bilateral hearing loss, it does not show sufficient hearing impairment to warrant a compensable evaluation during the appeal period.

The Court has held that, "in addition to dictating objective test results, a VA audiologist must fully describe the functional effects caused by a hearing disability in his or her final report." Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007). In this regard, the June 2024 VA examiner noted that the Veteran's bilateral hearing loss impacted ordinary conditions of daily life, to include his ability to hear low pitched sounds, and hearing the television and radio.

The Board acknowledges that a layperson is competent to testify regarding the onset and continuity of symptomatology. Heuer v. Brown, 7 Vet. App. 379, 384 (1995). However, the rating schedule for hearing loss is a reasonable exercise of the Secretary's rulemaking authority. Martinak, 21 Vet. App. 447. Whereas the Veteran's bilateral hearing loss has not been shown by medical or lay evidence to be worse than that measured during audiological evaluation.

Accordingly, an initial compensable evaluation for service-connected bilateral hearing loss is not warranted.

4. Entitlement to an initial evaluation in excess of 50 percent for service-connected anxiety disorder and depressive disorder.

The Veteran contends that he is entitled to an evaluation in excess of 50 percent for his service-connected anxiety and depressive disorders, under 38 C.F.R. § 4.130, Diagnostic Code 9434, which refers to the General Formula for Mental Disorders (General Formula). See 38 C.F.R. § 4.130.

Pursuant to the General Formula, a 50 percent rating is warranted when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more often than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130, Diagnostic Code 9411.

A 70 percent evaluation is warranted where there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. Id.

A 100 percent evaluation is assignable where there is total occupational and social impairment, due to such symptoms as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); and disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id.

Consideration is given to the frequency, severity, and duration of psychiatric symptoms, the length of remission, and the Veteran's capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner's assessment of the level of disability at the moment of the examination. See 38 C.F.R. § 4.126 (a). Furthermore, when evaluating the level of disability arising from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign an evaluation solely on
to time or place; memory loss for names of close relatives, own occupation, or own name. Id.

Consideration is given to the frequency, severity, and duration of psychiatric symptoms, the length of remission, and the Veteran's capacity for adjustment during periods of remission. The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner's assessment of the level of disability at the moment of the examination. See 38 C.F.R. § 4.126 (a). Furthermore, when evaluating the level of disability arising from a mental disorder, the rating agency will consider the extent of social impairment but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126 (b). It is necessary to evaluate a disability from the point of view of the Veteran working or seeking work. 38 C.F.R. § 4.2.

The Veteran underwent a VA psychiatric examination in April 2025. He reported that he has been married to his wife for the past 33 years. The Veteran has one son and four grandchildren, who live in Florida. The Veteran reported that he interacts with his nieces. He reported that he attends AA meetings every day. The Veteran denied experiencing social isolation. He reported that he enjoys riding his motorcycle for fun and relaxation. With respect to employment, the Veteran retired in 2020. For most of his career, he worked as a chemical dependency counselor. Regarding education, he completed his high school diploma. Regarding current symptoms, the Veteran reported symptoms of anxiety and depression, irritability, and occasional sadness. He denied a history of panic attacks, anger, and rage.

On examination, the Veteran was appropriately groomed and casually dressed. He was oriented to person, place, time, and situation; depressed mood; anxiety; chronic sleep impairment; disturbances of mood; difficulty in establishing and maintaining effective work and social relationships; difficulty adapting to stressful circumstances, including work or a work like setting; and denied any current suicidal and homicidal ideation or intention. The examiner assessed anxiety and depressive disorders. Overall, the examiner concluded that the Veteran's anxiety and depressive disorder symptoms resulted in occupational and social impairment with reduced reliability and productivity.

The Veteran underwent a VA psychiatric examination in March 2026. He reported that he has been married to his wife for the past 33 years. The Veteran has one son, who he maintains contact with. He reported that he attends AA meetings every day. With respect to employment, the Veteran retired in 2020. For most of his career, he worked as a chemical dependency counselor. Regarding education, he completed his high school diploma. Regarding current symptoms, the Veteran reported symptoms of struggling with memory, to including forgetting the names of people he previously met; feeling uncomfortable in crowds; and improved mood. The Veteran denied having panic attacks, episodes of anger, and suicidal and homicidal ideation. He reported that he takes medication for his anxiety and depression.

On examination, the Veteran was appropriately dressed. His hygiene and grooming were adequate. He was open and cooperative. He maintained adequate eye contact. He was oriented to person, place, time, and situation; depressed mood; anxiety; suspiciousness; chronic sleep impairment; thought processes were logical, linear, and goal directed; no indication of a formal thought disorder; mild memory loss such as forgetting names, directions or recent events; impairment of short and long term memory, for example, retention of only highly learned material, while forgetting to complete tasks, disturbances of mood and motivation; speech and affect were within normal limits; no psychomotor agitation or retardation; no evidence of suicidal or homicidal ideation; and insight and judgment were fair. The examiner assessed anxiety disorder, depressive disorder, and mild neurocognitive disorder of uncertain or unknown etiology. The examiner indicated that it was not possible to differentiate what symptoms are attributable to each diagnosis, as there is symptom overlap. Overall, the examiner concluded that the Veteran's anxiety and depressive disorder symptoms resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation.

Taking all factors into consideration with application of the approximating principles of 38 C.F.R. § 4.7, and the benefit-of-the-doubt doctrine, the Board finds that the Veteran's anxiety and depressive disorders most nearly approximated occupational and social impairment with reduced reliability and productivity throughout the appeal period. The above-cited evidence reflects that the Veteran's disorder was primarily manifested by depressed mood; anxiety; impairment of short- and long-term memory; and
. Overall, the examiner concluded that the Veteran's anxiety and depressive disorder symptoms resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation.

Taking all factors into consideration with application of the approximating principles of 38 C.F.R. § 4.7, and the benefit-of-the-doubt doctrine, the Board finds that the Veteran's anxiety and depressive disorders most nearly approximated occupational and social impairment with reduced reliability and productivity throughout the appeal period. The above-cited evidence reflects that the Veteran's disorder was primarily manifested by depressed mood; anxiety; impairment of short- and long-term memory; and disturbances of motivation and mood. Collectively, these symptoms are consistent with and similar to many of those contemplated by the currently assigned 50 percent rating, such as disturbances of motivation and mood. Thus, the Board finds that the functional impairment due to the above symptomatology during the appeal period, more nearly approximates the criteria for a 50 percent rating. See Mauerhan v. Principi, 16 Vet. App. 436 (2002) (symptoms recited in the rating schedule for mental disorders are to serve as examples of the type and degree of the symptoms and not an exhaustive list).

Nonetheless, the overall disability picture demonstrated by the evidence does not reflect that the Veteran's anxiety and depressive disorders manifested with more severe manifestations that more nearly approximate occupational and social impairment with deficiencies in most areas, or total occupational and social impairment.

As noted, a 70 percent evaluation is warranted where there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. Based on the severity of Veteran's symptoms, as well as their nature, frequency, and duration, the Board finds that the Veteran's anxiety and depressive disorders did not result in occupational and social impairment with deficiencies in most areas.

In this regard, the April 2025 VA examiner determined that the Veteran's anxiety and depressive disorder symptoms resulted in occupational and social impairment with reduced reliability and productivity. Further, the March 2026 VA examiner determined that the Veteran's anxiety and depressive disorder symptoms resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. The Board notes that such a level of impairment symptomatology does not support the assignment of a 70 percent rating under the General Rating Formula for Mental Disorders, which contemplates a significantly greater level of impairment.

With respect to the areas of impairment listed in the 70 percent criteria, the Board finds that the evidence does not demonstrate deficiency in work as contemplated by the applicable rating criteria. The Board notes that the criteria for a 50 percent rating expressly contemplate some level of occupational impairment, although no such impairment is shown by the evidence in this case, while the 70 percent rating contemplates difficulty in adapting to stressful circumstances, including work or a work like setting. This degree of occupational impairment due to anxiety and depressive disorder is not suggested by the evidence of record, which reflects that the Veteran is in fact very capable of adapting to stressful circumstances, as he spent many years working as a chemical dependency counselor. Moreover, there is no evidence of any performance or interpersonal problems at work.

Nor does the evidence demonstrate a deficiency in family relations as contemplated by the 70 percent criteria. As with occupational impairment, a degree of social impairment is contemplated by the 50 percent rating criteria. The 70 percent rating elaborates on the concept of deficiency in family relations in that it notes an inability, not merely a difficulty, in establishing and maintaining effective social relationships. In this case, the evidence shows that the Veteran was able to maintain social interactions with family members, including his wife of 33 years, adult son, four grandchildren, and his nieces. Thus, even if the Veteran had difficulty in maintaining relationships, it cannot be said that the Veteran was completely unable to establish and maintain effective relationships. Therefore, the Board finds that the evidence does not depict a deficiency in family relations for purposes of satisfying the 70 percent rating criteria.

The Board also finds that the evidence does not demonstrate deficiencies in judgment, thinking, and mood as contemplated by the 70 percent criteria. In this regard, there is no evidence of symptoms such as intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; or neglect of personal appearance and hygiene. In fact, the evidence of record shows that the Veteran was consistently noted as well-groomed with good hygiene and oriented to person,
the Board finds that the evidence does not depict a deficiency in family relations for purposes of satisfying the 70 percent rating criteria.

The Board also finds that the evidence does not demonstrate deficiencies in judgment, thinking, and mood as contemplated by the 70 percent criteria. In this regard, there is no evidence of symptoms such as intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; or neglect of personal appearance and hygiene. In fact, the evidence of record shows that the Veteran was consistently noted as well-groomed with good hygiene and oriented to person, time, and place. Similarly, his speech was within normal limits with regular rate and rhythm during the aforementioned VA examinations.

The Board also notes that the Veteran regularly endorsed depression, anxiety, and disturbances of motivation and mood; however, the evidence does not reflect that these symptoms were near-continuous, nor did they affect the Veteran's ability to function independently, appropriately and effectively. The record reveals more moderate anxiety and depression symptoms. This evidence indicates that although the Veteran experienced disturbances of motivation and mood, which are symptoms enumerated in the criteria for a 50 percent rating, he clearly does not exhibit an inability to function independently, appropriately and effectively, as contemplated by the criteria for a 70 percent rating.

The Board notes that it is not the type of symptoms, in this case, depression; anxiety; and disturbances of motivation and mood that is determinative of whether the criteria for the next higher rating have been met. It is the effect of the symptoms that is determinative. Stated in other way, the mere presence of depression, anxiety, and disturbances of motivation and mood in the record does not equate to the criteria for a 70 percent rating, rather it is the effect or degree of impairment in occupational and social functioning that needs to be determined. Here, the April 2025 VA examiner determined that the Veteran's disability resulted in occupational and social impairment with reduced reliability and productivity. Likewise, the March 2026 VA examiner determined that the Veteran's disability resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. Considering the overall effect of symptoms of depression, anxiety, and disturbances of motivation and mood on the Veteran's occupational and social impairment, the disability picture presented does not more nearly approximate or equate to occupational and social impairment with deficiencies in most areas, such as work, family relations, judgment, thinking, or mood.

The Board again notes that it is not the type of symptoms that is determinative of whether the criteria for the next higher rating have been met. It is the effect of the symptoms that is determinative. In other words, deficiencies in most areas must be "due to" the symptoms listed for that rating level, "or others of similar severity, frequency, and duration." Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013). That is, simply because this Veteran has some symptoms contemplated by the 70 percent rating criteria; it does not mean that disability rises to that level. The Board must instead look to the frequency, severity, and duration of the impairment. Id.

Here, the evidence of record does not support a finding that these symptoms caused social and occupational impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. Ultimately, the record reveals that the Veteran's thinking and judgment were good; he had no history of violence; he maintained relationships with family; and he maintained employment for many years prior to retiring, to include in a counseling position. Considering the overall effect of the Veteran's symptoms on his occupational and social impairment, the disability picture presented did not more nearly approximate or equate to occupational and social impairment with deficiencies in most areas, such as work, family relations, judgment, thinking, or mood. Taken together, the weight of the record evidence indicates that the Veteran's symptoms were, at worst, moderate during this period, which is consistent with a 50 percent rating.

The Board's finding that the Veteran's disability does not meet the criteria for a 70 percent rating entails a finding that he does not meet the criteria for a 100 percent rating during this period. The maximum schedular rating of 100 percent is not warranted because there is not total occupational and social impairment due to such symptoms as gross impairment in thought processes or communication; persistent delusions; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives,
indicates that the Veteran's symptoms were, at worst, moderate during this period, which is consistent with a 50 percent rating.

In this regard, there is no documentation of symptoms such as gross impairment in thought processes or communication; in fact, the Veteran was consistently able to actively communicate during the examinations. Similarly, his symptoms were not manifested by persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, intermittent inability to perform daily living activities, disorientation to time or place, or memory loss of names of close relatives, own occupation, or own name. In this regard, the record shows that the Veteran did not exhibit intermittently illogical, obscure, or irrelevant speech or spatial disorientation. In fact, the evidence of record shows that the Veteran was noted as oriented to person, time, place, and situation. His speech was within normal limits with regular rate and rhythm. His judgment and insight were noted as good. The Veteran's communication skills were good, and his understanding was intact. Additionally, the Veteran denied delusions or hallucinations; grossly inappropriate behavior has not been documented; there has not been persistent danger of hurting self or others noted; and memory loss for names of close relatives, own occupation, or own name or similar symptoms has not been shown.

Further, total occupational and social impairment has not been shown. As stated, the Veteran maintained social relationships with family throughout this appeal period, and maintained employment for many years prior to his retirement due to age in 2020.

The Board emphasizes that, in analyzing this claim, the symptoms identified in the Rating Formula have been considered not as an exhaustive list of symptoms, but as examples of the type and degree of the symptoms, or effects that would justify a particular rating. The Board has not required the presence of a specified quantity of symptoms in the rating schedule to warrant a higher rating. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). At times the Veteran's examination results indicate improved symptoms, which may, in fact, warrant lower ratings. However, giving the Veteran the benefit of the doubt, the Board concludes that the objective medical evidence and the Veteran's statements regarding his symptomatology show disability that most nearly approximates that which warrants the assignment of an initial 50 percent rating throughout the appeal period. See 38 C.F.R. § 4.7. All psychiatric symptoms have been considered in reaching the above conclusion. See Mittleider v. West, 11 Vet. App. 181, 182 (1998). The statements of the Veteran and others are considered competent, credible, and probative and were considered in reaching the above determinations.

Accordingly, the Board finds that an initial rating in excess of 50 percent for the Veteran's service-connected anxiety and depressive disorders is not warranted, to include as a "staged" rating(s) pursuant to Fenderson and Hart.

REASONS FOR REMAND

1. Entitlement to service connection for a lumbar spine disorder.

The Board finds that a remand is required to correct a duty to assist error that occurred prior to the Veteran's election to enter the RAMP program. Following a review of the evidence associated with the claims file prior to the Veteran electing to participate in the RAMP program, the Board finds that a VA opinion is warranted.

The Veteran contends that his current lumbar spine disorders had their onset during active service. He reported that as an aviation structural mechanic, he worked on the ejection seats of aircrafts, including the removal and installation of them and the oxygen and air condition system of the aircraft. He reported that he was required to use equipment and heavy tools, and carry ejection seats that resulted in ongoing wear and tear on his back. The Veteran stated that the ejection seats weighed a couple hundred pounds. He also indicated that there was one occurrence in 1965, when he injured his back while he was assisting in taking an ejection seat out of the aircraft. The Veteran explained that just as the ejection seat left its rails, the wind came up, causing it to spin and he
their onset during active service. He reported that as an aviation structural mechanic, he worked on the ejection seats of aircrafts, including the removal and installation of them and the oxygen and air condition system of the aircraft. He reported that he was required to use equipment and heavy tools, and carry ejection seats that resulted in ongoing wear and tear on his back. The Veteran stated that the ejection seats weighed a couple hundred pounds. He also indicated that there was one occurrence in 1965, when he injured his back while he was assisting in taking an ejection seat out of the aircraft. The Veteran explained that just as the ejection seat left its rails, the wind came up, causing it to spin and he lost his balance, wrenching his back. He indicated that he immediately experienced sharp pain in his lower back and had gone to sick bay/sick call but was just given ice packs and told to "buck up" and get back to work. He indicated that he continued to aggravate his injury by conducting his same duties, continually putting more wear and tear on his strained back.

Service personnel records confirm that the Veteran served as an aviation structural mechanic in 1965, and his duties included removal and installation of survival systems of aircrafts, maintenance of equipment, and assistance in preparation of aircrafts for drone operations.

Service treatment records are negative for complaints of, or a diagnosis of a lumbar spine disorder.

Post-service VA outpatient treatment records include a September 2017 record that notes the Veteran's report chronic low back pain that radiates to his right leg. The Veteran takes Gabapentin for his pain. An October 2017 VA record notes an assessment of lumbar radiculopathy. A December 2019 VA x-ray of the lumbar spine shows arthritis at L4-L5, and bone spurs.

Post-service records include a February 2025 private opinion. The examiner found that the Veteran's current lumbar spine disorder is related to his active service. The examiner, however, based the opinion on an inaccurate factual premise that the claimed low back injury in 1965 was "well documented." Thus, the Board finds the opinion inadequate to adjudicate the claim. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (An opinion based upon an inaccurate factual premise has no probative value). In this regard, the Veteran's service treatment records do not show any complaints with respect to the back.

The Veteran underwent a VA lumbar spine examination in April 2025, during which the examiner assessed degenerative arthritis and degenerative disc disease of the lumbar spine. Upon examination and review of the record, the examiner found that the Veteran's current lumbar spine disorders are not related to his active service. In providing the opinion, the examiner indicated that the Veteran's first mention of back pain is in 2019. The examiner concluded that it was difficult to attribute the Veteran's current lumbar spine diagnoses to a prior injury due to a lack of medical records revealing back pain.

The Board finds the April 2025 VA medical opinion inadequate to adjudicate the claim, as the examiner based his opinion on a lack of medical records documenting treatment. Moreover, the examiner based his opinion on an inaccurate assessment of the record, as he found that the Veteran did not complain of lumbar spine pain until 2019, when the record demonstrates that he complained in 2017. In addition, the examiner failed to consider the Veteran's assertions of ongoing lumbar spine pain since active service due to repeated activities related to his military occupational specialty as an aviation structural mechanic, including, the use of heavy equipment and tools, the carrying of ejection seats that resulted in wear and tear, as well as a lumbar spine injury, when he lifted an ejection seat and he lost his balance, and continued to reaggravate his back throughout service. Accordingly, the issue is remanded for an adequate VA medical opinion. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007).

2. Entitlement to service connection for a headache disorder.

The Veteran contends that his current headache disorder had its onset during his active service. He asserts that during active service, he was hit in the back of his head with a bayonet during a drill, and had received seven to eight stitches. The Veteran reports that he experienced headaches immediately following the injury, and has continued to have them periodically since service. The Veteran also claims that his current headache disorder is due to toxins that he was exposed to as an aviation mechanic, including oils, gases, solvents, and other engine chemicals.

Service treatment records include an October 1962 record that shows the Veteran sought treatment for a headache. A
311 (2007).

2. Entitlement to service connection for a headache disorder.

Service treatment records include an October 1962 record that shows the Veteran sought treatment for a headache. A subsequent October 1962 record notes an assessment of a headache. An October 1963 record notes the Veteran sought treatment for his head, and it was "dressed."

Post-service records include a February 2025 private opinion. The examiner found that the Veteran's current headache disorder is related to his active service. The examiner's rationale, however, was based on inaccurate factual premises. In this regard, the examiner referenced VA treatment records dated in 2017 and 2021, which noted the Veteran's complaints regarding headache symptomatology, and that such records allegedly diagnosed the Veteran with headache conditions. The aforementioned VA treatment records show that although the VA providers acknowledged the Veteran's reports of experiencing headache symptoms, none of the records indicate a formal diagnosis of a headache condition. The examiner also failed to address the Veteran's assertion regarding his intermittent symptomatology, that he had begun experiencing headaches again 10-15 years ago. At the time of the February 2025 opinion, the Veteran had been separated from active service for over five decades. Thus, Board finds the opinion inadequate, as it is based upon inaccurate factual premises and cannot serve as the basis of awarding entitlement to service connection for the claimed headache disorder. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993).

The Veteran underwent a VA headaches examination in April 2025, during which the examiner assessed tension headaches. Upon examination and review of the record, the examiner found that the Veteran's current headache disorder is not related to his active service. In providing the opinion, the examiner noted that the Veteran's service treatment records are "silent" for any complaints of headaches. The examiner further noted that the first mention of headaches is not until 2017, when the Veteran reported that his monthly headaches began 10-15 years ago. The examiner concluded that in the absence of a traumatic brain injury (TBI), the Veteran's current headaches are unlikely the result of the remote head injury that reportedly occurred during his service.

The Board finds the April 2025 VA medical opinion inadequate to adjudicate the claim, as the examiner based his opinion on a lack of service treatment records documenting treatment. In this regard, the Veteran's service treatment records demonstrate treatment for headaches in twice in October 1962, as well as treatment for his head in October 1963. In addition, the examiner failed to consider the Veteran's assertions of ongoing headaches since active service due. Accordingly, the issue is remanded for an adequate VA medical opinion. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Further, the examiner did not provide an opinion addressing whether the Veteran's current headache disorder is the result of his exposure to toxic risk exposure activities (TERA) due to his military occupational specialty as an aviation structural mechanic, including noxious fumes, fuel and petroleum distillates; lead inhalation and ingestion; industrial chemical splash, asbestos; dye and pain; and metallic fragments. Finally, the examiner failed to offer an opinion as to the etiology of the Veteran's current tension headache disorder. Thus, the issue is remanded for an adequate VA medical opinion. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007).

3. Entitlement to a TDIU due to service-connected disabilities.

As the aforementioned claim for entitlement to service connection for lumbar spine and headache disorders are being remanded for additional development by the AOJ, they are directly applicable to the question of employability, the issue of TDIU is also remanded as inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are "inextricably intertwined" when they are so closely ties together that a final Board decision cannot be rendered unless both are adjudicated).

The matters are REMANDED for the following actions:

1. LUMBAR SPINE DISORDER - This claim is advanced on the docket. All pertinent
service-connected disabilities.

The matters are REMANDED for the following actions:

1. LUMBAR SPINE DISORDER - This claim is advanced on the docket. All pertinent evidence of record must be made available to and reviewed by an appropriate VA physician who has not provided a prior opinion in this case. The Veteran need not appear for an examination unless deemed necessary by the physician assigned to offer an opinion.

Following a review of the record, the physician should state a medical opinion with respect to the lumbar spine disorders present during the period of the claim. The examiner must address the following:

Is it at least as likely as not (i.e., likelihood is at least approximately balanced or near equal, if not higher) that the Veteran's current degenerative arthritis and degenerative disc disease of the lumbar spine disorders manifested during, or as a result of, active military service, to include toxic risk exposure activities.

In providing the opinion, the examiner must consider the Veteran's assertions that he injured his lumbar spine repeatedly during service due to repeated activities related to his military occupational specialty, including, the use of heavy equipment and tools, the carrying of ejection seats that resulted in wear and tear, as well as a lumbar spine injury, when he lifted an ejection seat and he lost his balance. The Veteran reported that he immediately experienced sharp pain in his lower back and had gone to sick bay/sick call but was just given ice packs and told to "buck up" and get back to work. The Veteran also reported that he continued to reaggravate his back throughout service. The Veteran also asserts that he has experienced lumbar spine pain that has progressively worsened since active service.

For purposes of the opinion, the examiner should assume that the Veteran is a credible historian.

A complete rationale for all opinions offered must be provided. If the examiner is unable to provide any required opinion, the examiner should fully explain why this is the case. Likewise, if the examiner cannot provide an opinion without resorting to mere speculation, the examiner shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed.

2. HEADACHE DISORDER - All pertinent evidence of record must be made available to and reviewed by an appropriate VA physician who has not provided a prior opinion in this case. The Veteran need not appear for an examination unless deemed necessary by the physician assigned to offer an opinion.

Following a review of the record, the physician should state a medical opinion with respect to the headache disorder present during the period of the claim. The examiner must address the following:

Is it at least as likely as not (i.e., likelihood is at least approximately balanced or near equal, if not higher) that the Veteran's current tension headache disorder manifested during, or as a result of, active military service, to include toxic risk exposure activities.

In providing the opinion, the examiner must discuss the Veteran's service treatment records, to include:

" October 1962 record shows the Veteran sought treatment for a headache;

" October 1962 record notes an assessment of a headache; and

" October 1963 record notes the Veteran sought treatment for his head, and it was "dressed."

In providing the opinion, the examiner must discuss the Veteran's assertions that his exposure to TERA during service as an aviation structural mechanic, including noxious fumes, fuel and petroleum distillates; lead inhalation and ingestion; industrial chemical splash, asbestos; dye and pain; and metallic fragments, resulted in his current tension headache disorder.

In providing the opinion, the examiner must consider the Veteran's assertions that during service he was hit in the back of his head with a bayonet during a drill, and received seven to eight stitches. The Veteran reports that he experienced headaches immediately following the injury, and has continued to have them periodically since service.

(Continued on the next page)

For purposes of the opinion, the examiner should assume that the Veteran is a credible historian.

(Continued on the next page)

For purposes of the opinion, the examiner should assume that the Veteran is a credible historian.

B. MULLINS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Sara Schinnerer, 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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