PARALYSIS OF SCIATIC NERVE

Summary

The Veteran, an Army Veteran who served from September 2008 to February 2013, appeals the denial of increased disability ratings for his service-connected left lower extremity radiculopathy and degenerative arthritis of the spine with intervertebral disc syndrome, as well as the denial of a compensable rating for migraine headaches. The Board granted a 20 percent disability rating for left lower extremity radiculopathy, finding the Veteran's wholly sensory symptoms, including pain and numbness, more closely approximated moderate incomplete nerve paralysis. The Board noted that while the Veteran reported subjective weakness, the medical evidence did not document non-sensory symptoms like gait abnormality or muscle atrophy, limiting the rating to 20 percent. The claims for increased ratings for degenerative arthritis of the spine and for migraine headaches were remanded. For the back condition, the remand is to obtain an addendum VA opinion addressing the severity and range of motion, including during flareups, and to disregard the ameliorative effects of medication. For migraines, the remand is to obtain an addendum VA opinion on the frequency and severity of prostrating attacks, also disregarding medication effects, as the prior VA examination was unclear on these points. The Veteran testified at a Board hearing in July 2025, and evidence submitted after the AOJ decision but before the hearing was considered.

Rationale

Wholly sensory symptoms documented; Moderate severity described by one examiner; Consistent with moderate incomplete paralysis

Full Decision Text

Citation Nr: A26039527
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 210603-163978
DATE: April 28, 2026

ORDER

Entitlement to a disability rating of 20 percent, but no higher, for service-connected radiculopathy, left lower extremity, sciatic nerve is granted.

REMANDED

Entitlement to a compensable disability rating for service-connected migraine headaches is remanded.

Entitlement to a disability rating greater than 20 percent for service-connected degenerative arthritis of the spine with intervertebral disc syndrome is remanded.

FINDING OF FACT

The Veteran's service-connected left lower extremity radiculopathy disability is manifested by, at most, wholly sensory symptoms of constant pain; paresthesias and/or dysesthesias; and numbness, with a subjective sensation of left foot weakness, consistent with moderate nerve paralysis, but without evidence of non-sensory symptoms documented in the evidence of record. 

CONCLUSION OF LAW

The criteria for entitlement to a disability rating of 20 percent, but no higher, for service-connected radiculopathy, left lower extremity, sciatic nerve are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.120, 4.123, 4.124, 4.124a, Diagnostic Code (DC) 8520.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from September 2008 to February 2013.

These matters come before the Board of Veterans' Appeals (Board) on appeal from February 2021 and March 2021 rating decisions, issued by a Regional Office (RO) of the Department of Veterans Affairs (VA).

In the June 2021 Decision Review Request: Board Appeal (Notice of Disagreement), VA Form 10182, the Veteran elected the Hearing Docket. 

On July 8, 2025, the Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ), a transcript of the hearing is of record. 

Therefore, the Board may only consider the evidence of record at the time of the applicable February 2021 and/or March 2021 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran (or representative) at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the applicable decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. 

If the Veteran would like VA to consider any evidence that was submitted the Board could not consider, he may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

However, because the Board is remanding the claims of entitlement to a disability rating greater than 20 percent for service-connected back disability and entitlement to a compensable disability rating for service-connected migraine disability, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Entitlement to a disability rating of 20 percent, but no higher, for service-connected radiculopathy, left lower extremity, sciatic nerve is granted.

The Veteran contends his current 10 percent disability rating does not accurately reflect the severity of his service-connected left lower extremity radiculopathy.

Increased Ratings? 

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes (DCs). 38?U.S.C. § 1155; 38 C.F.R. § 4.1.? 

Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. §§ 4.3, 4
 percent disability rating does not accurately reflect the severity of his service-connected left lower extremity radiculopathy.

Increased Ratings? 

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes (DCs). 38?U.S.C. § 1155; 38 C.F.R. § 4.1.? 

Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. §§ 4.3, 4.7.? 

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be granted to the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 4.3.? 

"Staged" ratings are appropriate for any rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. Hart v. Mansfield, 21?Vet. App.?505 (2007); Fenderson v. West, 12?Vet. App.?119 (1999).? 

In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined?in accordance with?38?C.F.R. §?4.25. Pyramiding, the evaluation of the same disability or the same manifestation of a disability, under different diagnostic codes is to be avoided when rating a Veteran's service-connected disability. 38?C.F.R. §?4.14. A Veteran may have separate and distinct manifestations from the same injury which would?permit?rating under several diagnostic codes. The critical element in?permitting?the assignment of multiple ratings under various diagnostic codes is that none of the?symptomatology for any one condition is duplicative or overlapping with the symptomatology of another condition.?See Esteban v. Brown, 6?Vet. App.?259, 261-62 (1994).???? 

Paralysis of the sciatic nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8520. (Neuritis and neuralgia of that group are evaluated under Diagnostic Codes 8620 and 8720.). Under these criteria, mild incomplete paralysis is rated as 10 percent disabling. Moderate incomplete paralysis is rated as 20 percent disabling. Moderately severe incomplete paralysis is rated as 40 percent disabling. Severe incomplete paralysis, with marked muscular atrophy is rated as 60 percent disabling. Complete paralysis, with foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38?C.F.R. § 4.124a. 

The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based on the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. §?4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. 

The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28?Vet. App.?376 (2017).

For the following reasons, entitlement to an increased 20 percent disability rating, but no higher, is warranted for wholly sensory symptoms more nearly approximating moderate incomplete sciatic nerve paralysis. 

In November 2020, the Veteran underwent a VA back conditions examination. See November 2020 VA Examination. Regarding his left lower extremity radiculopathy
.124a, Note at "Diseases of the Peripheral Nerves." The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28?Vet. App.?376 (2017).

For the following reasons, entitlement to an increased 20 percent disability rating, but no higher, is warranted for wholly sensory symptoms more nearly approximating moderate incomplete sciatic nerve paralysis. 

In November 2020, the Veteran underwent a VA back conditions examination. See November 2020 VA Examination. Regarding his left lower extremity radiculopathy, the examiner noted symptoms of "mild" intermittent pain, paresthesias and/or dysesthesias, and numbness, with sciatic nerve involvement, which the examiner described as "mild" in severity. Id. On examination, the Veteran exhibited normal muscle strength and normal sensation. Id. He did not report the use of any assistive device. Id.

During a separate November 2020 VA peripheral nerve conditions examination, the Veteran reported that his left lower extremity radiculopathy disability had become progressively worse over time. See November 2020 VA Examination. The examiner noted symptoms of "mild" intermittent pain, paresthesias and/or dysesthesias, and numbness. Id. On examination, the Veteran exhibited full muscle strength, no muscle atrophy, normal reflexes, normal sensation, no trophic changes, and normal gait. Id. The examiner noted sciatic nerve involvement with "mild" incomplete paralysis. Id. The Veteran did not report the use of any assistive device. Id. The examiner indicated his left lower extremity radiculopathy then resulted in functional impairment of up to 1-week lost work time over the prior 12-month period, due to interference with prolonged standing, walking, and lifting. Id.

In March 2021 the Veteran underwent a further VA peripheral nerve conditions examination, the examiner diagnosed bilateral lower extremity radiculopathy. See March 2021 VA Examination. The Veteran is in receipt of a separate disability rating for his service-connected right lower extremity radiculopathy, sciatic nerve. 

Regarding the left lower extremity radiculopathy, the examiner noted symptoms of moderate intermittent pain, paresthesias and/or dysesthesias, and numbness. Id. The examiner noted bilateral involvement of the sciatic nerve, with "mild" incomplete paralysis. Id. 

On examination, the Veteran exhibited normal muscle strength; no muscle atrophy; normal reflexes; normal sensation; no trophic changes; normal gait; and negative Phalen's and Tinel's sign. Id. The Veteran did not report the use of any assistive device. Id. The examiner opined his bilateral lower extremity radiculopathy then resulted in functional impairment of up to 1-week lost work time based on the Veteran's reports of having to frequently change positions and take frequent small breaks while working due to pain, numbness, and tingling in his legs and feet. Id.

In sum, the VA examinations of record do not note any gait abnormality, impairment of motor function, trophic changes, loss of reflexes, and/or muscle atrophy, but do document wholly sensory symptoms of: (1) numbness and tingling in his leg and foot; and (2) intermittent leg pain. The November 2020 VA examiner described the sensory symptoms as "mild" while the March 2021 VA examiner described them as "moderate." Both examiners described the overall disability as consistent with "mild" incomplete paralysis of the sciatic nerve while in the November 2020 VA back examination, the examiner characterized the left lower extremity disability as "mild" in severity.

During his July 2025 Board hearing, the Veteran testified that his left lower extremity radiculopathy is exacerbated by engaging in any activities during which he is unable to keep his back straight (such as bending and/or twisting his back, including while sleeping). See July 2025 Board Hearing Transcript. He indicated other activities (picking things up with his left side; and/or lifting greater than 40 pounds) also exacerbate his left lower extremity symptoms. Id. Regarding his symptoms, while the VA examiners noted only intermittent pain during his VA examinations, he testified that his pain is constant and radiates from his lower back and down into his left buttock, thigh, and into the front of his shin. Id. He testified that the pain in his left lower extremity becomes greater with standing, requiring him to take 10-minute sitting breaks during which he must clench his core and suck in his stomach until the
 (such as bending and/or twisting his back, including while sleeping). See July 2025 Board Hearing Transcript. He indicated other activities (picking things up with his left side; and/or lifting greater than 40 pounds) also exacerbate his left lower extremity symptoms. Id. Regarding his symptoms, while the VA examiners noted only intermittent pain during his VA examinations, he testified that his pain is constant and radiates from his lower back and down into his left buttock, thigh, and into the front of his shin. Id. He testified that the pain in his left lower extremity becomes greater with standing, requiring him to take 10-minute sitting breaks during which he must clench his core and suck in his stomach until the pain subsides/becomes manageable enough to allow him to continue standing and/or walking. Id. He indicated he must take such sitting breaks whenever he is out, which allow him to go back inside and/or get to a place where he is able to sit continuously or relax. Id. Regarding his symptoms of numbness and tingling, he reported such symptoms go down into the toes of his left foot. Id. 

Finally, while the VA examiners indicated the Veteran exhibited full muscle strength and no muscle atrophy on examination, he testified to a subjective sensation of weakness in his left foot due to which he compensates by using his right leg to perform activities requiring more strength, such as standing or using stairs. Id. While the Veteran did not indicate whether he has experienced all the above symptoms since submitting his claim on appeal, he testified that those activities which exacerbate his left lower extremity symptoms also trigger flareups of his service-connected back disability that he has consistently experienced since prior to his November 2020 VA back examination. Id.

The only available treatment records within the applicable Hearing Docket evidence window are Durham VAMC treatment records dated from March 2013 through September 2020. See Durham VAMC Treatment Records, Received October 2020. While these treatment records do not document any treatment specifically for left lower extremity radiculopathy during the appeal period, they do document complaints consistent with the Veteran's Board hearing testimony. During an August 2013 physical therapy consult, the Veteran's VA treating provider noted complaints of pain radiating into his left lower extremity and noted he then exhibited "very focal weakness" in left ankle eversion, consistent with his July 2025 Board hearing testimony regarding his subjective left foot weakness. See August 2013 Physical Therapy Consult. However, no left lower extremity focal weakness in left ankle eversion is documented at any time after his August 2013 physical therapy consultation. 

While his symptoms of pain, paresthesias and/or dysesthesias, and numbness were noted to be "mild" in severity during his November 2020 VA examination, the examiner described them as "moderate" during his March 2021 VA examination, consistent with an increase in the severity of his overall disability. 

However, the Veteran's report of a subjective sensation of left foot weakness notwithstanding, the medical evidence of record does not document any relevant non-sensory symptoms. As indicated above, where symptoms are wholly sensory, the rating is for the mild (consistent with a 10 percent disability rating), or at most, the moderate (consistent with a 20 percent disability rating) degree.

Giving the Veteran the benefit of the doubt, and considering his Board hearing testimony that his left lower extremity pain is constant and he requires frequent sitting rest breaks of up to 10 minutes to perform exercises which allow his pain to subside enough that he is able to resume his daily activities, the evidence of record is consistent with wholly sensory left lower extremity symptoms that more nearly approximate "moderate" incomplete nerve paralysis, consistent with the 20 percent rating criteria.

Therefore, based on the foregoing, entitlement to a disability rating of 20 percent is warranted throughout the appeal period. 

However, the evidence of record does not demonstrate that a higher, 40 percent disability rating is warranted at any time throughout the appeal period because, as indicated above, notwithstanding the Veteran's reports of subjective weakness in his left foot, the medical evidence of record documents, at most, wholly sensory symptoms of disability without, for instance, any evidence of gait abnormality, trophic changes, loss of reflexes, loss of muscle strength, and/or muscle atrophy. 

The Board notes that caselaw requires the Board to consider and discount the beneficial effects of medication unless such effects are otherwise contemplated in a particular diagnostic code.?See Ingram v. Collins,?32?Vet. App.?130 (2025). Here, the relevant rating criteria do not contemplate the effects of medication use. 

In his November 2020 VA back conditions examination, the Veteran reported treating his back pain with 800 mg. ibuprofen. See November 202
 left foot, the medical evidence of record documents, at most, wholly sensory symptoms of disability without, for instance, any evidence of gait abnormality, trophic changes, loss of reflexes, loss of muscle strength, and/or muscle atrophy. 

The Board notes that caselaw requires the Board to consider and discount the beneficial effects of medication unless such effects are otherwise contemplated in a particular diagnostic code.?See Ingram v. Collins,?32?Vet. App.?130 (2025). Here, the relevant rating criteria do not contemplate the effects of medication use. 

In his November 2020 VA back conditions examination, the Veteran reported treating his back pain with 800 mg. ibuprofen. See November 2020 VA Examination. His November 2020 and March 2021 peripheral nerve conditions VA examinations do not address the use of medication. During his July 2025 Board hearing, the Veteran reported that during flareups of his back pain he also experiences aggravation of his left lower extremity radiculopathy pain. See July 2025 Board Hearing Transcript. He did not therein report taking any medication for his left lower extremity radiculopathy, nor is the topic addressed in his available VA treatment records. 

To the extent the Veteran takes ibuprofen to relieve both his back and left lower extremity pain, the ameliorative effect of such medication, if any, does not alter the Board's analysis because his pain is a sensory symptom and the medical evidence of record does not demonstrate that he experiences any non-sensory symptoms of disability. 

Therefore, based on the foregoing, entitlement to a disability rating greater than 20 percent is not warranted at any time throughout the appeal period. 

REASONS FOR REMAND

1. Entitlement to a compensable disability rating for service-connected migraine headaches is remanded.

The Veteran contends that his current noncompensable disability rating does not accurately reflect the severity of his service-connected headache disability.

Under the AMA, remands are limited to correction of: (1) duty to assist errors occurring prior to the date of the RO decision on appeal, and (2) RO errors in?satisfying a regulatory or statutory duty, if correction of such error would have a reasonable possibility of aiding in substantiating the Veteran's claim.?See?38 C.F.R. § 20.802(a).??? 

Remand is warranted to correct a pre-decisional duty to assist error. 38 C.F.R. §?20.802(a). Specifically, remand?is?warranted?to obtain an addendum VA medical opinion addressing the severity of the Veteran's migraine headache disability throughout the appeal period, from February 19, 2021, through present. See Barr v. Nicholson, 21?Vet. App.?303, 311 (2007) (once VA undertakes to provide an examination, such examination must be adequate).??? 

As indicated above, when addressing the severity of a service-connected disability, caselaw requires the Board to consider and discount the beneficial effects of medication, unless such effects are otherwise contemplated in a particular diagnostic code.?See Ingram v. Collins,?32?Vet. App.?130 (2025).  

The RO has rated the Veteran's migraine disability under the criteria of Diagnostic Code (DC) 8100 of 38 C.F.R. § 4.124a, for migraine.  

Under DC 8100, a noncompensable rating is warranted for migraines with less frequent attacks. A 10 percent rating is warranted for migraines with characteristic prostrating attacks averaging one in 2 months over the last several months. A 30 percent rating is warranted for migraines with characteristic prostrating attacks occurring on an average once a month over the last several months. A 50 percent rating is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. A 50 percent rating is the highest schedular rating under DC 8100. The relevant rating criteria do not contemplate the effects of medication. 

In March 2021, the Veteran underwent a VA examination. See March 2021 VA Examination. The Veteran reported his headaches had progressively worsened since approximately 2018, with headaches triggered by smells, sirens, and bright lights. Id. He indicated that he treated his migraine headaches with ibuprofen 800 mg. Id.

He reported symptoms of constant, pulsating or throbbing head pain on both sides of his head that worsens with physical activity and is accompanied by nausea, sensitivity to light and sound, and changes in vision (which the examiner did not therein describe in detail but which the Veteran testified during his July 2025 Board hearing consists of things becoming a little blurry). Id. He then indicated his headaches typically lasted less than 1 day. Id. The
 a VA examination. See March 2021 VA Examination. The Veteran reported his headaches had progressively worsened since approximately 2018, with headaches triggered by smells, sirens, and bright lights. Id. He indicated that he treated his migraine headaches with ibuprofen 800 mg. Id.

He reported symptoms of constant, pulsating or throbbing head pain on both sides of his head that worsens with physical activity and is accompanied by nausea, sensitivity to light and sound, and changes in vision (which the examiner did not therein describe in detail but which the Veteran testified during his July 2025 Board hearing consists of things becoming a little blurry). Id. He then indicated his headaches typically lasted less than 1 day. Id. The examiner indicated he did not report any characteristic prostrating attacks of migraine pain and/or very prostrating and prolonged attacks of migraine pain. Id. The examiner opined his headache disability did not then result in any functional impairment. Id.

It is unclear whether the March 2021 VA examiner disregarded the ameliorative effects, if any, of the Veteran's medication use when addressing the severity of his migraine headache disability, including whether he then experienced characteristic prostrating attacks and/or very prostrating and prolonged attacks of migraine pain. 

Based on the foregoing, remand is warranted to obtain an addendum VA medical opinion addressing the severity of the Veteran's service-connected migraine disability throughout the appeal period, from February 19, 2021, to present. 

2. Entitlement to a disability rating greater than 20 percent for service-connected degenerative arthritis of the spine with intervertebral disc syndrome is remanded.

The Veteran contends his current 20 percent disability rating does not accurately reflect the severity of his service-connected back disability.

Remand is warranted to correct a pre-decisional duty to?assist?error. 38 C.F.R. §?20.802(a). Specifically, remand?is?warranted?to obtain an addendum VA medical opinion addressing the severity of the Veteran's back disability throughout the appeal period, from October 25, 2020, through present. See Barr v. Nicholson, 21?Vet. App.?303, 311 (2007) (once VA undertakes to provide an examination, such examination must be adequate).??? 

Again, caselaw requires the Board to consider and discount the beneficial effects of medication unless such effects are otherwise contemplated in a particular diagnostic code.?See Ingram v. Collins,?32?Vet. App.?130 (2025) (holding the Board should discount the beneficial effects of medication in assessing musculoskeletal ratings as such effects are not contemplated?therein).  

In November 2020, the Veteran underwent a VA examination. See November 2020 VA Examination. During his VA examination, he reported using Motrin 800 mg. to treat his back pain. Id. It is unclear whether the examiner considered the ameliorative effects, if any, of the Veteran's medication use on the range of motion measurements and estimates provided in the November 2020 VA examination.

Based on the foregoing, remand is warranted to obtain an addendum VA medical opinion addressing the severity of the Veteran's service-connected back disability throughout the appeal period, from October 25, 2020, to present. 

Second, during his November 2020 VA examination, the Veteran reported that his back disability had grown progressively worse over time with current symptoms of constant lower back pain he rated as 2 to 3 out of 10 in severity, at baseline, and 7 to 8 out of 10 when aggravated. See November 2020 VA Examination. He also complained of current symptoms of muscle stiffness and muscle spasms, as well as symptoms resulting from his associated and separately service-connected left lower extremity radiculopathy disability. Id. 

Notwithstanding the Veteran's reports of worsened back pain during periods of aggravation, the examiner indicated he did not therein report experiencing any flareups and, as such, did not estimate his range of motion during flareups. Id. He reported experiencing functional loss of reduced range of motion of the lumbar spine; difficulty with prolonged sitting, standing, lifting, bending, and walking; and sleep disturbance. Id.

During his July 2025 Board hearing, the Veteran, through his representative, argued that the November 2020 VA examination was inadequate because while he did not therein specifically report experiencing flareups, he nonetheless reported symptoms and functional impairment consistent with flareups for which range of motion estimates should have been provided. See July 2025 Board Hearing Transcript.

The Veteran further testified during his Board hearing that he has experienced flareups of his back disability that he did not report as such during his November 2020 VA examination (which he then did not think to characterize as flareups rather than good and bad days and,
 motion of the lumbar spine; difficulty with prolonged sitting, standing, lifting, bending, and walking; and sleep disturbance. Id.

During his July 2025 Board hearing, the Veteran, through his representative, argued that the November 2020 VA examination was inadequate because while he did not therein specifically report experiencing flareups, he nonetheless reported symptoms and functional impairment consistent with flareups for which range of motion estimates should have been provided. See July 2025 Board Hearing Transcript.

The Veteran further testified during his Board hearing that he has experienced flareups of his back disability that he did not report as such during his November 2020 VA examination (which he then did not think to characterize as flareups rather than good and bad days and, therefore, did not report) consisting of worsened pain, and particularly worsened left lower extremity pain, triggered by any activity during which he is unable to keep his back straight, including while sleeping, bending, and/or twisting. Id. He reported his flareups are also triggered by picking things up with his left hand (using his left side) and by lifting greater than 40 pounds. Id. He indicated that his flareups occur approximately 3 times per month and persist for a period of approximately 4 days. Id. He testified that during his flareups he must be especially mindful to avoid engaging in the above-noted triggering activities. Id.

On remand, the VA examiner should also provide a medical opinion addressing the Veteran's flareups (to include periods of worsened back pain reported during his November 2020 VA examination and his descriptions of his flareups documented in his July 2025 Board hearing testimony). 

The matters are REMANDED for the following action:

1. In remanding these matters, the Board makes no credibility determination, express or implied at this juncture. 

2. Regarding the Veteran's service-connected back disability, forward the claims file to the November 2020 VA examiner or, if unavailable, to a qualified substitute clinician to obtain an addendum VA medical opinion addressing the severity of his service-connected degenerative arthritis of the spine with intervertebral disc syndrome throughout the appeal period, from October 25, 2020, through present. After reviewing the claims file, including this Remand, the clinician is requested to opine on the following:

(a.) Throughout the appeal period, from October 25, 2020, to present, and disregarding the ameliorative effects, if any, of the Veteran's medication use of ibuprofen 800 mg. reported during his November 2020 VA examination, please estimate the Veteran's range of motion of the thoracolumbar spine in forward flexion, extension, right and left lateral flexion, and right and left lateral rotation, to include during flareups (including periods of worsened back pain reported during his November 2020 VA examination and flareups reported during his July 2025 Board hearing testimony), after repeated use over time, while weightbearing, while non-weightbearing, and in active and in passive motion. 

Note: to the extent the clinician determines the Veteran's back disability has likely resulted in varying levels of severity at different times throughout the appeal period, the clinician is requested to provide, for each such time period, separate range of motion estimates of the thoracolumbar spine in forward flexion, extension, right and left lateral flexion, and right and left lateral rotation, including during flareups, after repeated use over time, while weightbearing, while non-weightbearing, and in active and passive motion, disregarding the ameliorative effects, if any, of the Veteran's medication use.

3. Regarding the Veteran's service-connected migraine headache disability, forward the claims file to the March 2021 VA examiner or, if unavailable, to a qualified substitute clinician to obtain an addendum VA medical opinion addressing the severity of the Veteran's service-connected migraine headaches throughout the appeal period, from February 19, 2021, to present. After reviewing the claims file, including this Remand, the clinician is requested to opine on the following:

(a.) Throughout the appeal period, from February 19, 2021, to present, and disregarding the ameliorative effects, if any, of the Veteran's medication use of ibuprofen 800 mg., have the Veteran's migraine headaches resulted in characteristic prostrating (i.e., characterized by extreme exhaustion, powerlessness, debilitation, or incapacitation, resulting in inability to engage in ordinary activities) headache attacks occurring, on average, at least once in 2 months?

(b.) Throughout the appeal period, from February 19, 2021, to present, and disregarding the ameliorative effects, if any, of the Veteran's medication use of ibuprofen 800 mg., have the Veteran's migraine headaches resulted in
 period, from February 19, 2021, to present, and disregarding the ameliorative effects, if any, of the Veteran's medication use of ibuprofen 800 mg., have the Veteran's migraine headaches resulted in characteristic prostrating (i.e., characterized by extreme exhaustion, powerlessness, debilitation, or incapacitation, resulting in inability to engage in ordinary activities) headache attacks occurring, on average, at least once in 2 months?

(b.) Throughout the appeal period, from February 19, 2021, to present, and disregarding the ameliorative effects, if any, of the Veteran's medication use of ibuprofen 800 mg., have the Veteran's migraine headaches resulted in characteristic prostrating (i.e., characterized by extreme exhaustion, powerlessness, debilitation, or incapacitation, resulting in inability to engage in ordinary activities) headache attacks occurring, on average, at least once a month?

(c.) Throughout the appeal period, from February 19, 2021, to present, and disregarding the ameliorative effects, if any, of the Veteran's medication use of ibuprofen 800 mg., have the Veteran's migraine headaches resulted in completely prostrating (i.e., characterized by extreme exhaustion, powerlessness, debilitation, or incapacitation which renders one entirely powerless, resulting in essentially total inability to engage in ordinary activities) and prolonged (i.e., extended in duration, drawn out, protracted) headache attacks occurring, on average, at least greater than once per month? 

Note: to the extent the clinician determines the Veteran's migraine headache disability has likely resulted in varying levels of severity at different times throughout the appeal period, the clinician is requested to provide, for each such time period, the applicable level of disability (i.e., characteristic prostrating headache attacks occurring  less often; characteristic prostrating headache attacks occurring, on average, one in 2 months; characteristic prostrating headache attacks occurring, on average, once a month; or completely prostrating and prolonged headache attacks occurring at least greater than once per month), disregarding the ameliorative effects, if any, of the Veteran's medication use. 

In providing answers to the above questions, the clinician is requested to consider relevant evidence of record to include: (1) the Veteran's available Durham VAMC treatment records throughout the appeal period; and (2) his July 2025 Board hearing testimony describing his symptoms and resulting functional impairment.

All findings must be reported in detail, and all opinions must be accompanied by a clear rationale.        

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If a clinician cannot provide an opinion as to one or more questions without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the clinician?shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to a given question.

 

 

G. A. WASIK

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Given, R. A.

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.