Case A26039659

MICHAEL J. SKALTSOUNIS · 2026 · Case ID: A26039659

MIXED

Summary

The veteran, who served in the Marine Corps and Army between October 1995 and October 2003, appeals a September 2020 rating decision. The appeal concerns the effective date for service connection of cervical strain, increased ratings for cervical strain and vertebral fracture/lumbar discectomy, an increased rating for PTSD, an initial rating for IBS, and service connection for erectile dysfunction secondary to PTSD. The Board granted an earlier effective date for service connection for cervical strain, finding the veteran's informal claim was raised by chiropractic records. Service connection for erectile dysfunction secondary to PTSD was also granted, based on a private medical opinion linking the condition to PTSD and its treatment. However, the Board denied increased ratings for cervical strain and vertebral fracture/lumbar discectomy, finding the veteran's symptoms did not meet the criteria for higher evaluations. For PTSD, the Board denied an increased rating beyond 70%, concluding the veteran's symptoms, while significant, did not rise to the level of total occupational and social impairment. The Board granted a 30% rating for IBS, finding the veteran's symptoms, particularly diarrhea and abdominal distress, met the criteria for severe irritable bowel syndrome, applying the benefit of the doubt. The Board considered both prior and revised rating criteria for IBS, applying the more favorable standard.

Rationale

Informal claim for cervical disability raised by private chiropractic records.; Symptoms did not meet criteria for 20% rating based on range of motion or muscle spasm.; Painful motion considered under 38 C.F.R. § 4.59, supporting the 10% rating.

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Docket No.

211019-193099

Full Decision Text

Citation Nr: A26039659
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 211019-193099
DATE: April 28, 2026

ORDER

Entitlement to an April 4, 2005, effective date for the grant of service connection for cervical strain is granted.

From April 26, 2016, entitlement to a rating higher than 10 percent for service-connected cervical strain is denied.

From April 26, 2016, entitlement to an initial rating higher than 20 percent for service-connected vertebral fracture and lumbar discectomy is denied.

From April 26, 2016, entitlement to an initial rating higher than 70 percent for service-connected posttraumatic stress disorder (PTSD) is denied.

From April 26, 2016, but not earlier, entitlement to an initial 30 percent rating for service-connected irritable bowel syndrome (IBS) is granted.

Service connection for erectile dysfunction, to include as secondary to service-connected PTSD, is granted.

FINDINGS OF FACT

1. The Veteran filed an informal claim for entitlement to service connection for a cervical disability on April 4, 2005, which consisted of his service connection claim and private treatment records associated with the claims file on April 15, 2005, pertaining to cervical spine symptoms, to include neck pain and related treatment.

2. The most probative and persuasive evidence shows that, from April 26, 2016, service-connected cervical strain has not manifested as more than functional loss due to painful motion.

3. The most probative and persuasive evidence shows that, from April 26, 2016, the Veteran's service-connected vertebral fracture and lumbar discectomy has not manifested as more than muscle spasm or guarding severe enough to result in an abnormal gait.

4. The most probative and persuasive evidence shows that, from April 26, 2016, the Veteran's PTSD has not manifested as more than occupational and social impairment, with deficiencies in most areas.

5. The most probative and persuasive evidence shows that, from April 26, 2016, the Veteran's service-connected IBS has manifested by symptoms that more closely approximate severe irritable colon syndrome, with diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress.

6. The most probative and persuasive evidence shows that it is as likely as not that the Veteran's erectile dysfunction is a result of the Veteran's service or service-connected disability.

CONCLUSIONS OF LAW

1. The criteria for entitlement to an April 4, 2005, effective date for the award of service connection for cervical strain have been met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.151, 3.155, 3.400.

2. From April 26, 2016, the criteria for entitlement to a rating higher than 10 percent for service-connected cervical strain (claimed as neck condition) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5237.

3. From April 26, 2016, the criteria for entitlement to an initial rating higher than 20 percent for service-connected vertebral fracture and lumbar discectomy have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5237.

4. From April 26, 2016, the criteria for entitlement to an initial rating higher 70 percent for service-connected PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 3.102, 4.126, 4.130, Diagnostic Code 9411.

5. From April 26, 2016, but not earlier, the criteria for entitlement to an initial rating of 30 percent for service-connected IBS have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.114., Diagnostic Code 7319.

6. The criteria for entitlement to service connection for erectile dysfunction, to include as secondary to service-connected PTSD, have
§§ 3.102, 4.1, 4.3, 4.7, 3.102, 4.126, 4.130, Diagnostic Code 9411.

6. The criteria for entitlement to service connection for erectile dysfunction, to include as secondary to service-connected PTSD, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310, 4.3.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service in the United States Marine Corps from October 1995 to October 1999 and in the United States Army from November 2002 to October 2003.

These matters are before the Board of Veterans' Appeals (Board) on appeal from a September 25, 2020, Appeals Modernization Act (AMA) rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) of the Veterans Benefits Administration (VBA), which is the Agency of Original Jurisdiction (AOJ). The September 25, 2020, rating decision was notified to the Veteran and his representative on October 19, 2020.

A September 24, 2020, Board decision, granted service connection for cervical strain, service connection for lumbar strain, service connection for posttraumatic stress disorder (PTSD), and service connection for irritable bowel syndrome.

Pursuant to the Board's September 24, 2020, decision, the AOJ issued the September 25, 2020, rating decision on appeal, which granted service connection for cervical strain with an initial noncompensable (0 percent) rating from April 26, 2016, service connection for status post back injuries with an initial noncompensable (0 percent) rating from April 26, 2016, service connection for posttraumatic stress disorder (PTSD, also claimed as social inadaptability and unable to maintain relationships) with an initial 50 percent rating from April 26, 2016, and service connection for irritable bowel syndrome (IBS, also claimed as inflammatory and digestive problems) with an initial noncompensable (0 percent) rating from April 26, 2016.

In a subsequent May 5, 2021, rating decision, pursuant to the September 24, 2020, Board decision, the AOJ, in pertinent part, granted an initial 10 percent rating for cervical strain from April 26, 2016, and granted an initial 10 percent rating for status post back injuries from April 26, 2016.

On October 19, 2021, the Veteran submitted a timely VA Form 10182 (Decision Review Request: Board Appeal (Notice of Disagreement) reflecting his decision to appeal several claims ruled upon in the September 25, 2020, rating decision. The Veteran requested the AMA direct review docket, which limits the Board's review to the evidence in the record through and until the date of the rating decision on appeal. See 38 U.S.C. §§ 5104C, 7105, 7113; 38 C.F.R. §§ 20.202(b), 20.301, 3.2500. The Board issued its docket letter on October 26, 2021.

Pursuant to the Veteran's appeal, in a November 1, 2024, decision, the Board, in pertinent part, denied entitlement to an effective date earlier than April 26, 2016, for the grant of service connection for cervical strain, denied entitlement to an initial rating higher than 10 percent for cervical strain, denied entitlement to an initial rating higher than 10 percent for vertebral fracture and lumbar discectomy, that is, for the status post back injuries, denied entitlement to an initial compensable rating for IBS, and granted an initial rating of 70 percent for PTSD.

The Veteran timely appealed the Board's November 1, 2024, decision to the United States Court of Appeals for Veterans Claims ("CAVC"). While the case was pending at the Court, the Veteran's attorney and the VA Office of the General Counsel filed a joint motion requesting that the Court vacate the Board's decision and issue a remand for readjudication as to the above-noted appealed claims. The parties agreed that a remand was necessary because the Board erred by failing to provide an adequate statement of reasons or bases when it denied the Veteran's claims. As such, remand was necessary for readjudication of the appealed claims. Particularly, the parties asserted that the Board discussed several 2021 VA examinations as evidence pertinent to the PTSD, vertebral fracture and lumbar discectomy, and IBS ratings on appeal, which were outside the stated evidentiary period of the September 25, 2020, rating decision on appeal. As such, the parties asserted that the Board erred by providing an inadequate statement of reasons or bases because it did not address all of the procedural history related to the Board's September 24, 2020, decision, to include the September 25, 2020, rating decision on appeal, and three additional rating decisions, dated May 5, 2021, September 23, 2021, and October 15, 2021, also issued pursuant to the Board's September 24, 2020, decision. As such, the Board's determination about the evidence considered on appeal was unclear. Thus, on remand, the Board would have to address the procedural history stated above as it related to the evidence considered on appeal. Also, the parties asserted that the Board did not address the 2014 rating criteria for IBS. Further, the parties asserted that the Board did not address the Veteran's argument for an earlier effective date for the grant of service connection for cervical strain. Finally, the parties asserted that the Board did not address in the first instance whether erectile dysfunction was on appeal based on an August 2019 private opinion. Accordingly, the parties moved the Court to vacate that part of the November 1, 2024, decision of the Board that denied entitlement to (1) an effective date earlier than April 26, 2016, for the grant of service connection for cervical strain; (2) an initial disability rating in excess of 70% PTSD; (3) an initial disability rating in excess of 10% for a vertebral fracture and lumbar discectomy; (4) an initial disability rating in excess of 10% for a cervical strain; (5) an initial compensable disability rating for IBS; and (6) failed to address whether erectile dysfunction was on appeal; and remand for readjudication. On November 10, 2025, the CAVC issued its Order remanding the appeal pursuant to the terms of the joint motion for remand.

The Veteran's appeal has been returned to the Board for further appellate consideration.

Preliminary note

The Board notes that, on September 9, 2025, the Board issued a decision in another appeal, pertaining to the September 23, 2021, rating decision, granting an initial 20 percent rating for status post back injuries. Consistently, the Board has modified the issues on appeal as to this claim to comport with the recently assigned initial higher rating. Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997); A.B. v. Brown, 6 Vet. App. 35 (1992).

As to the matters instructed upon as part of the CAVC's remand, the Board interprets them to be based on the premise that the Board erred by providing an inadequate statement of reasons or bases because it did not address all the relevant procedural history such that "its determination about the evidence considered on appeal is unclear." Accordingly, pursuant to the CAVC's remand, the Board will address and consider all the relevant evidence related to all the relevant procedural history in order to rule upon the claims on appeal.

Earlier effective date

In general, the effective date of an award of disability compensation, in conjunction with a grant of entitlement to service connection, shall be the day following separation from active service or the date entitlement arose if the claim is received within one year of separation from service;
AVC's remand, the Board interprets them to be based on the premise that the Board erred by providing an inadequate statement of reasons or bases because it did not address all the relevant procedural history such that "its determination about the evidence considered on appeal is unclear." Accordingly, pursuant to the CAVC's remand, the Board will address and consider all the relevant evidence related to all the relevant procedural history in order to rule upon the claims on appeal.

Earlier effective date

With regard to the date of entitlement, the term "date entitlement arose" is not defined in the current statute or regulation. However, it is the date when the veteran met the requirements for the benefits sought, which is determined on a "facts found" basis. 38 U.S.C. § 5110 (a); McGrath v. Gober, 14 Vet. App. 28, 35 (2000). An effective date generally can be no earlier than the "facts found." DeLisio v. Shinseki, 25 Vet. App. 45 (2011). These "facts found" include the date the disability first manifested and the date entitlement to benefits was authorized by law and regulation. For instance, if a veteran filed a claim for benefits for a disability before he actually had the disability, the effective date for benefits can be no earlier than the date the disability first manifested. Ellington v. Peake, 541 F.3d 1364, 1369-70 (Fed. Cir. 2008). A claim is a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1(p). Any communication or action indicating an intent to apply for VA benefits from a claimant or representative may be considered an informal claim. Such an informal claim must identify the benefit sought. 38 C.F.R. § 3.155(a). The essential elements for any claim, whether formal or informal, are "(1) an intent to apply for benefits, (2) an identification of the benefits sought, and (3) a communication in writing." Brokowski v. Shinseki, 23 Vet. App. 79, 84 (2009).

Prior to March 24, 2015, VA was required to construe any communication or action from a Veteran indicating intent to apply for one or more benefits as an informal claim. 38 U.S.C. § 5110(b)(3); 38 C.F.R. §§ 3.1(p), 3.155(a). VA is not required to anticipate any potential claim for a particular benefit where no intention to raise it was expressed. Brannon v. West, 12 Vet. App. 32, 35 (1998) (holding that before VA can adjudicate a claim for benefits, the claimant must submit a written document identifying the benefit and expressing some intent to seek it).

The Federal Circuit has emphasized that VA has a duty to fully and sympathetically develop a Veteran's claim to its optimum, which includes determining all potential claims raised by the evidence and applying all relevant laws and regulations. See Harris v. Shinseki, 704 F.3d 946, 948-49 (Fed. Cir. 2013); Szemraj v. Principi, 357 F.3d 1370, 1373 (Fed. Cir. 2004); Moody v. Principi, 360 F.3d 1306, 1310 (Fed. Cir. 2004); Roberson v. Principi, 251 F.3d 1378, 1383 (Fed. Cir. 2001). The Board is required to adjudicate all issues reasonably raised by a liberal reading of the appeal, including all documents and oral testimony in the record prior to the Board's decision. Brannon v. West, 12 Vet. App. 32, 34 (1998); Solomon v. Brown, 6 Vet. App. 396, 400 (1994). However, in determining whether an informal claim has been made, VA is not required to read the minds of the veteran or his
d 1306, 1310 (Fed. Cir. 2004); Roberson v. Principi, 251 F.3d 1378, 1383 (Fed. Cir. 2001). The Board is required to adjudicate all issues reasonably raised by a liberal reading of the appeal, including all documents and oral testimony in the record prior to the Board's decision. Brannon v. West, 12 Vet. App. 32, 34 (1998); Solomon v. Brown, 6 Vet. App. 396, 400 (1994). However, in determining whether an informal claim has been made, VA is not required to read the minds of the veteran or his representative. Cintron v. West, 13 Vet. App. 251, 259 (1999).

Increased rating

A disability rating is determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule). 38 C.F.R. Part 4. 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. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or the illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1.

VA has a duty to acknowledge and consider all regulations that are potentially applicable through the assertions and issues raised in the record and to explain the reasons and bases for its conclusions. Schafrath v. Derwinski, 1 Vet. App. 589, 592-593 (1991).

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. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3.

The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14. The critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994).

The Veteran's entire history is reviewed when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991).

Where the question for consideration is the propriety of the initial evaluation assigned, evaluation of the evidence since the grant of service connection is required. See Fenderson v. West, 12 Vet. App. 119, 126 (1999).

As pertains to noninitial increased rating claims, pursuant to the "look back" provisions of 38 C.F.R. § 3.400(o)(2), if it is factually ascertainable that an increase in disability occurred within the one-year period prior to the date of claim, the effective date can be the date the increase was shown. Gaston v. Shinseki, 605 F.3d 979, 980-981 (Fed. Cir. 2010).

The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings." Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505, 509 (2007).

In every instance where the schedule does not provide a zero percent evaluation for a diagnostic code, a zero percent evaluation shall be assigned when the requirements for a compensable rating are not met. 38 C.F.R. §4.31.

When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. § 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. § 4.45 requires consideration also be given to less movement than normal, more movement than is normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202, 204 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. § 4.71a; a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) (" [I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a criteria.").

Under 38 C.F.R. § 4.59, painful motion is a factor to be considered with any form of arthritis; however, 38 C.F.R. § 4.59 is not limited to disabilities involving arthritis. See Burton v. Shinseki, 25 Vet. App. 1, 5 (2011).

In the case of Correia v. McDonald, 28 Vet. App. 158, 168 (2016), the Court held that the final sentence of 38 C.F.R. § 4.59 requires that the examiner record the results of range of motion testing "for pain on both active and passive motion [and] in weightbearing and nonweight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint." The spine has no opposite joint.

In Sharp v. Shulkin, 29 Vet. App. 26, 31 (2017), the Court held that VA examiners must obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves, when a flare-up is not observable at the time of examination.

Service connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Service connection may also be granted for any disease diagnosed after discharge from service when all of the evidence, including lay evidence, establishes that the disability is due to disease or injury which was incurred in or aggravated by service. 38 C.F.R. § 3.303(d).

In order to establish service connection for a claimed disability, the following three elements must be satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship nexus) between the present disability and the disease or injury incurred or aggravated during service. Hickson v. West, 12 Vet. App. 246 (1999).

Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disability. See 38 C.F.R. § 3.310(a). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. See 38 C.F.R.§ 3.310 (a); Harder v. Brown, 5 Vet. App. 183, 187 (1993). The governing regulation has been interpreted to permit a grant of service connection not only for a disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995). In the case of Ward v. Wilkie,
.R. § 3.310(a). When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. See 38 C.F.R.§ 3.310 (a); Harder v. Brown, 5 Vet. App. 183, 187 (1993). The governing regulation has been interpreted to permit a grant of service connection not only for a disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995). In the case of Ward v. Wilkie, the United States Court of Appeals for Veterans Claims held that, for secondary service connection, "aggravation" need not be permanent in nature. 31 Vet. App. 233, 241-42 (2019).

In Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023), the United States Court of Appeals for the Federal Circuit held that secondary service connection under 38 U.S.C. § 1110 is warranted for any increase in a nonservice-connected disability that is due to a service-connected disability, including where a service-connected disability precludes treatment for a nonservice-connected disability. Id. at 1363-1365. That decision also found unlawful the VA regulation that required evidence establishing a pre-aggravation baseline before secondary service connection based on aggravation could be granted. Id. at 1366 ("We decide this case based on our interpretation of § 1110 alone. To the extent that the VA also applied 38 C.F.R. § 3.310(b) to reject Mr. Spicer's theory of compensation, that regulation is unlawful as inconsistent with 38 U.S.C. § 1110.").

In evaluating the evidence in an appeal, it is the responsibility of the Board to weigh the evidence and decide where to give credit and where to withhold the same and, in doing so, accept certain medical opinions over others. Schoolman v. West, 12 Vet. App. 307 (1999). In this regard, the Board has been charged with the duty to assess the credibility and weight given to the evidence. Jandreau v. Nicholson, 492 F.3d 1372 (2007).

Generally, the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider takes into account such factors as its thoroughness and degree of detail, and whether there was review of the claims file. See Prejean v. West, 13 Vet. App. 444, 448-449 (2000). Also significant is whether the examining medical provider had a sufficiently clear and well-reasoned rationale, and a basis in objective supporting clinical data. See Bloom v. West, 12 Vet. App. 185, 187 (1999); Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). In concluding that no relationship between a current disability and military service exists, the examiner may not rely solely on an absence of medical records and not consider any available competent and credible lay statements. Dalton v. Nicholson, 21 Vet. App. 23 (2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336-1336 (2006).

Competent lay evidence is any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). This may include some medical matters, such as describing symptoms or relating a contemporaneous medical diagnosis. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

In adjudicating a claim of service connection, the Board is required to evaluate evidence based on places, types, and circumstances of service, as shown by the veteran's military records and all pertinent medical and lay evidence. Hayes v. Brown, 5 Vet. App. 60, 66 (1993); see also 38 U.S.C. § 1154(a).

When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in approximate balance, with the veteran prevailing in either event. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

1. Entitlement to an April 4, 2005, effective date for the grant of service connection for cervical strain is granted.

The Veteran contends that he should be awarded an April 4, 1995, earlier effective date for the assignment of service connection for cervical strain because the Veteran filed an informal claim on such date.

The Board notes that, while the Veteran's April 4, 2005, VA Form 21-526 claim appears to be silent as to a cervical strain condition, a VA Form 21-4142 record release form submitted on that same date lists a private chiropractor as medical provider.

The treatment records from the private chiropractor were associated with the claims file on April 15, 2005. These records, received on April 15, 2005, discuss neck pain, cervical treatment, and restricted shoulder motion.

After careful consideration, the Board finds that the private chiropractic records can reasonably be construed as an informal claim for a cervical disability. That is, the Veteran's claim, together with its cross-referenced evidence of a cervical disability raised a potential claim that the Veteran had a cervical disability related to his in-service injury. Shea v. Wilkie, 926 F.3d 1362, 1369 (Fed. Cir.2019); Sellers v. Wilkie, 965 F.3d 1328, 1336 (Fed. Cir. 2020).

In sum, the Board finds that entitlement to an April 4, 2005, effective date for the grant of service connection for cervical strain is warranted.

2. From April 26, 2016, entitlement to a rating higher than 10 percent for service-connected cervical strain is denied.

3. From April 26, 2016, entitlement to an initial rating higher than 20 percent for service-connected vertebral fracture and lumbar discectomy is denied.

Under the General Rating Formula for Diseases and Injuries of the Spine, in pertinent part, a 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or the combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a.

Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1.

For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension
forward flexion of the thoracolumbar spine to 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine. A 100 percent rating is warranted for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a.

Any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Id. at Note 1.

For VA compensation purposes, normal forward flexion of the thoracolumbar spine is zero to 90 degrees, extension is zero to 30 degrees, left and right lateral flexion are zero to 30 degrees, and left and right lateral rotation are zero to 30 degrees.

The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion. Id. at Note 2; Plate V.

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

Each range of motion measurement must be rounded to the nearest five degrees. Id. at Note 4.

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

Disability of the thoracolumbar and cervical spine segments must be evaluated separately, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability. Id. at Note 6.

Ankylosis is defined as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." Dorland's Illustrated Medical Dictionary, 94 (32nd ed. 2012).

The Veteran claims entitlement to a rating higher than 10 percent from April 26, 2016, for service-connected cervical strain. This disability is currently rated at 10 percent from April 26, 2016, under 38 C.F.R. § 4.71a, Diagnostic Code 5237, under the Under the General Rating Formula for Diseases and Injuries of the Spine.

As to the cervical strain disability, June 2018 VA treatment records show the Veteran's complaints of headache and neck pain since October; rates pain 10/10, radiating pain from neck, aching character, pain scale 10. Neck pain was noted and an assessment of chronic cervicalgia was rendered.

In July 2018 VA treatment records, the Veteran reported having been involved in motor vehicle accident, hyperextended neck when rear-ended, had residual of pain in neck that radiated down left arm. This was treated by a procedure in the neck assumed to be an epidural steroid injection for pain management. That pain had improved but he had been left with axial neck pain. He described it as "sharp, cutting, at the midline of the spine. Going from the head to the level of C7. His gait was reasonable. There was tenderness to palpation along the cervical spine particularly along the paraspinal muscles. It was noted that the Veteran was scheduled to go to neurology for chronic back and neck pain which he related to the motor vehicle accident. He had been taking 200 mg over-the- counter strength ibuprofen with some relief and was using a heating pad. This morning his back pain and especially
in the neck assumed to be an epidural steroid injection for pain management. That pain had improved but he had been left with axial neck pain. He described it as "sharp, cutting, at the midline of the spine. Going from the head to the level of C7. His gait was reasonable. There was tenderness to palpation along the cervical spine particularly along the paraspinal muscles. It was noted that the Veteran was scheduled to go to neurology for chronic back and neck pain which he related to the motor vehicle accident. He had been taking 200 mg over-the- counter strength ibuprofen with some relief and was using a heating pad. This morning his back pain and especially his neck pain were flared-up. He had difficulty turning his neck to the right. The neck was noted as NECK: Other: decreased lateral rotation and flexion to R w/trapezius muscle spasm BACK: +paraspinous muscle tenderness, Negative SLR. Mid back muscle spasm.

In an August 2018 VA treatment note, the Veteran reported that he continued to have low energy and chronic neck pain. States that he will find out when he will have neck surgery later today. Veteran had no other complaints. Normal gait and posture upright were noted.

An August 2020 VA treatment note noted neck pain - complaint of neck pain that radiates to L upper extremity. Veteran stated he got a tingling sensation to his fingers that was worsened by left lateral flexion and was not relieved by rest. He has also noticed a decrease in grip strength of his left arm. This discomfort started a couple of days ago and he attributed it to a motor vehicle accident on 7/14. He had a history of cervicalgia and surgical placement of hardware to support cervical spine. Examination of neck revealed limited cervical motion, spasm; dx - cervicalgia.

The Veteran received a VA examination in July 2021 and the examiner noted a diagnosis of cervical strain, spinal stenosis, and status-post cervical spinal fusion. The Veteran reported that he experienced neck issues that seemed to cause headaches. No flare-ups were reported. Also, no functional loss or functional impairment was reported. Active ROM was reported; particularly, forward flexion was normal at 45 degrees, extension was normal at 45 degrees, right lateral flexion was normal at 45 degrees, left lateral flexion was normal at 45 degrees, right lateral rotation was limited to 70 degrees, and left lateral rotation was limited to 70 degrees. Passive ROM resulted in the same ROM measurements as active ROM. Pain was noted on examination on passive motion and did not result in or cause functional loss. There was no additional loss of ROM after repetitive use testing with at least three repetitions. Also, the Veteran was not examined immediately after repeated use over time but procured evidence did not suggest significantly limited ability with repeated use over time. The Veteran was not examined during a flare-up but procured evidence did not suggest significantly limited ability with flare-ups. Normal muscle strength, no muscle atrophy, normal reflexes, and normal sensory results were noted. No radiculopathy was noted. No intervertebral disc syndrome was noted. No use of assistive devices was noted. No functional impact was noted.

After careful consideration, the Board finds that from April 26, 2016, a rating higher than 10 percent for cervical strain is not warranted. Particularly, the Veteran's range of motion in flexion and combined range of motion did not reach the corresponding thresholds established by the diagnostic criteria for a 20 percent rating. Also, the Veteran does not have muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or any abnormal kyphosis, which would also entitle him to a 20 percent rating.

The Board also notes that, even though the corresponding cervical spine forward flexion ROM measurements have manifested as greater than 40 degrees, that is, as noncompensable under Diagnostic Code 5237, the Veteran has already been granted a 10 percent rating based on functional loss due to painful motion. The Board notes that 38 C.F.R. §4.59 allows consideration of functional loss due to painful motion to be rated to at least the minimum compensable rating for a particular joint. As such, the Board finds that the provisions of 38 C.F.R. § 4.40 and § 4.45 concerning functional loss due to pain, fatigue, weakness, or lack of endurance, incoordination, and flare-ups, as cited in DeLuca v. Brown, 8 Vet. App. 202, 204 (1995
is, as noncompensable under Diagnostic Code 5237, the Veteran has already been granted a 10 percent rating based on functional loss due to painful motion. The Board notes that 38 C.F.R. §4.59 allows consideration of functional loss due to painful motion to be rated to at least the minimum compensable rating for a particular joint. As such, the Board finds that the provisions of 38 C.F.R. § 4.40 and § 4.45 concerning functional loss due to pain, fatigue, weakness, or lack of endurance, incoordination, and flare-ups, as cited in DeLuca v. Brown, 8 Vet. App. 202, 204 (1995); and Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011) have been considered and applied under 38 C.F.R. § 4.59.

Accordingly, from April 26, 2016, entitlement to a rating higher than 10 percent for service-connected cervical strain is denied.

Also, the Veteran claims entitlement to an initial rating higher than 20 percent from April 26, 2016, for service-connected vertebral fracture and lumbar discectomy. This disability is currently rated at 20 percent from April 26, 2016, under 38 C.F.R. § 4.71a, Diagnostic Code 5237, under the General Rating Formula for Diseases and Injuries of the Spine.

As to the lumbar spine disability, the Board notes that VA treatment records show that in July 2018, the Veteran was scheduled to see neurology for chronic back and neck pain which he related to a motor vehicle accident last year. He has been taking over-the-counter ibuprofen with some relief and using a heating pad, but his back and neck pain had flared-up. Examination of the back revealed paraspinous muscle tenderness and mid back muscle spasm. There was no evidence of increased weakness in the lower extremities and his gait was "reasonable."

In August 2018 and November 2018, it was noted that the Veteran had a normal gait and an upright posture.

In January 2019, he reported low back pain at level 8/10 and examination revealed tenderness to palpation right paraspinal muscles of the lumbar area.

In January and April 2019, his gait was assessed as normal.

In November 2019, the Veteran reported a pain level of 8/10 and underwent a lumbar ESI (epidural steroid injection).

In December 2020, his gait was assessed as normal and steady.

In January 2021, an examination revealed acute and chronic right paralumbar spasm and sciatica and that he had an abnormal and antalgic gait.

VA treatment records further show that in March 2021, the Veteran reported constant low back pain and some weakness but denied any recent falls or loss of his bowel or bladder. He managed his pain with NSAIDS and muscle relaxers, which gave temporary relief.

In March 2021, he was treated for chronic low back pain, and examination revealed tenderness at the right lumbar paraspinal region. He underwent a right lumbar transforaminal epidural steroid injection and reported that the pain "eased off some" after the injections were done. Further, in March 2021, no gait disturbance was shown.

In April 2021, the Veteran reported that the shots only helped him for a few days before the pain came back and that he had seen a neurosurgeon who scheduled him for minimally invasive microscopic surgery.

In May 2021, he reported chronic low back pain at level 9/10. On examination, he exhibited full range of lumbosacral spine motion with slightly increased pain with flexion and extension. It was noted that the Veteran had a slight antalgic gait and used a cane for an ambulatory aid. No bony tenderness, crepitus, paraspinal tenderness, or spasms were noted.

In June 2021, the Veteran's gait was observed to be steady and he used a cane. A steady gait was also noted in September 2021.

In July 2021, the Veteran attended a VA examination for this issue. The Veteran reported experiencing low back pain which radiated to his right leg. No flare-ups were reported. Functional loss was noted, which resulted in difficulty bending and walking. Upon examination, the examiner reported active ROM measurements as flexion to 65 degrees, extension was normal at 30 degrees, right lateral flexion was normal at 30 degrees, left lateral flexion was normal at 30 degrees, right lateral rotation was considered normal at 30 degrees, and left lateral rotation was normal at 30 degrees, with pain noted on motion. The Veteran was unable to perform passive ROM and repetitive use testing with at least three repetitions. The VA examiner explained that the Veteran was less than 6 weeks s/p spine surgery and additional testing would impact healing and be unsafe. The Veteran was not examined immediately after repeated use over time, but procured evidence did not suggest significant limitation of functional ability with repeated use over time. The Veteran was not examined during a flare-up, but procured evidence did not suggest significant limitation of functional ability with flare-ups. Normal muscle strength was noted, and normal reflex and sensory results were noted. No radiculopathy was noted. No intervertebral disc syndrome was noted. The Veteran constantly used a cane as an assistive device. The Veteran was noted to be temporarily on disability due to a recent surgery.

In October 2021, the Veteran attended an additional examination for this issue. The Veteran reported experiencing current symptoms of mild back pain. Mild flare-ups were reported, lasting one to two hours, characterized by pinching pain above the right hip, precipitated by movement, and alleviated by rest and getting off his feet. The Veteran also reported experiencing functional loss due to an inability to stand for as long as he used to. Upon examination, the examiner initial ROM measurements as flexion was normal at 90 degrees, extension was normal at 30 degrees, right lateral flexion was normal at 30 degrees, left lateral flexion was normal at 30 degrees, right lateral rotation was normal at 30 degrees, and left lateral rotation was normal at 30 degrees, with pain noted on motion. Passive ROM measured was also the same as active ROM. The Veteran was able to perform repetitive use testing with three repetitions with no additional loss of function or range of motion. The Veteran was not examined immediately after repeated use over time, but procured evidence did not suggest significant limitation of functional ability with repeated use over time. The Veteran was not examined during flare-ups, but procured evidence did not suggest significant limitation of functional ability with flare-ups. Normal muscle strength, normal reflex, and normal sensory results were noted. No radiculopathy was noted. No intervertebral disc syndrome was noted. The Veteran occasionally used a cane as an assistive device. No functional impact was noted.

In an August 2022 letter, the Veteran's attorney noted that during the July 2021 VA examination, the Veteran was unable to attempt passive range of motion testing, repetitive-use testing, or straight-leg testing due to the surgery, which confirmed that he had postoperative residuals. The attorney also noted that a September 17, 2021, VA emergency department triage note indicated that the Veteran experienced continued severe postoperative residuals, to include the onset of muscle spasms. The attorney further noted that medical evidence confirmed that the Veteran has muscles spasms and an altered gait which supported a rating of at least 20% for the Veteran's lumbar disability.

After careful consideration, the Board finds that the Veteran's back symptoms have been of the duration and severity contemplated by the 20 percent rating criteria. In that regard, the Veteran has reported difficulty walking and bending, and while VA objective examinations have shown no muscle spasms or tenderness in the lumbar spine and a steady and normal gait, there has also been objective evidence of muscle spasms of the Veteran's lumbar spine and he has exhibited an antalgic gait on more than one occasion. As such, resolving all reasonable doubt in the Veteran's favor, the Board finds his symptoms to more nearly approximate muscle spasms severe enough to result in an abnormal gait. Thus, the 20 percent rating contemplates any episodes in which the Veteran's disability is so severe that muscle spasms cause an altered gait. The Board also finds that a higher 40 percent rating is not warranted as the evidence persuasively weighs against a finding that the Veteran experiences flexion limited to 30
tenderness in the lumbar spine and a steady and normal gait, there has also been objective evidence of muscle spasms of the Veteran's lumbar spine and he has exhibited an antalgic gait on more than one occasion. As such, resolving all reasonable doubt in the Veteran's favor, the Board finds his symptoms to more nearly approximate muscle spasms severe enough to result in an abnormal gait. Thus, the 20 percent rating contemplates any episodes in which the Veteran's disability is so severe that muscle spasms cause an altered gait. The Board also finds that a higher 40 percent rating is not warranted as the evidence persuasively weighs against a finding that the Veteran experiences flexion limited to 30 degrees or favorable ankylosis of the entire thoracolumbar spine. In that regard, objective examinations have shown flexion limited to 65 degrees at worst, and no findings of ankylosis. While the July 2021 VA examination showed that passive range of motion was medically contraindicated, the Veteran was able to perform active range of motion.

The Board has considered the impact of functional loss in the Veteran's lumbar spine due to flare-ups of pain to determine if his functional loss was equivalent to favorable ankylosis or flexion limited to 30 degrees. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 206-07 (1995). In this case, however, while the Veteran reported difficulties with standing, walking, and bending due to low back pain, the overall evidence does not show that this symptom results in additional and significant functional loss resulting in forward flexion limited to 30 degrees or less, or the equivalent of favorable ankylosis as the Veteran has maintained range of motion in his lumbar spine throughout the appeal period and the Veteran's spine is not fixated, in a neutral position or otherwise, and is not shown to result in an associated complication. Thus, the Veteran's condition does not result in the functional equivalent of favorable ankylosis. See Chavis v. McDonough, 34 Vet. App. 1 (2021). Moreover, the Veteran was generally found to exhibit full strength with no muscle atrophy. The Veteran's functional impairment is contemplated by the 20 percent rating, and the fact that the Veteran has full muscle strength with no atrophy is evidence against more than moderate weakness. The Board acknowledges that the Veteran has reported significant pain as a result of his lumbar disability, however, his pain has been contemplated by the 20 percent rating assigned. See 38 U.S.C. §§ 4.59.

Accordingly, from April 26, 2016, entitlement to an initial rating higher than 20 percent for service-connected vertebral fracture and lumbar discectomy is denied.

4. From April 26, 2016, entitlement to an initial rating higher than 70 percent for service-connected posttraumatic stress disorder (PTSD) is denied.

The Veteran claims entitlement to an initial rating higher than 70 percent for his service-connected PTSD.

The Veteran has a current initial rating of 70 percent for service-connected PTSD from April 26, 2016, under 38 C.F.R. § 4.130, Diagnostic Code 9411.

Under the Schedule of ratings - Mental disorders, in relevant part:

A 70 percent rating 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; speech intermittently illogical, obscure, or irrelevant; 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 worklike setting); inability to establish and maintain effective relationships. 38 C.F.R. §4.130, Diagnostic Code 9411.

A 100 percent rating is warranted 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); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id.

The United States Court of Appeals for the Federal Circuit held that an evaluation under 38 C.F.R. § 4.130 is "symptom-driven," meaning that "symptomatology should be
. 38 C.F.R. §4.130, Diagnostic Code 9411.

The United States Court of Appeals for the Federal Circuit held that an evaluation under 38 C.F.R. § 4.130 is "symptom-driven," meaning that "symptomatology should be the fact-finder's primary focus when deciding entitlement to a given disability rating." Vasquez-Claudio v. Shinseki, 713 F3d 112, 117 (Fed. Cir. 2013).

The symptoms listed are not exhaustive, but rather, "serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating." Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). In the context of determining whether a higher disability evaluation is warranted, the analysis requires considering "not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas. [a]lthough the veteran's symptomatology is the primary consideration, the regulation also requires an ultimate factual conclusion as to the veteran's level of impairment in 'most areas.'" Vasquez-Claudio, 713 F.3d at 117-118; 38 C.F.R. § 4.130.

Further, when evaluating a mental disorder, the Board must consider the "frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission." 38 C.F.R. § 4.126(a). The Board must also "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 examination." Id.

Turning to the evidence of record, a September 2016 treatment note evaluated the Veteran's PTSD. The Veteran reported that he denied symptoms of depression and anxiety. The Veteran also reported that he drove a truck a lot and had trouble with isolation due to his job. The Veteran acknowledged that he had some bouts of anxiety that lasted a few seconds. He also stated that he had been very defensive the past month and it was getting worse. The Veteran described being hypervigilant, having nightmares, and sporadic sleep. The Veteran endorsed feeling fatigued during the day.

An October 2016 treatment note evaluated the Veteran's PTSD. The Veteran reported that his PTSD was "getting to him." The Veteran added that he thought of his trauma several times a day. The Veteran reported that he had nightmares every night. The Veteran stated that he felt stress at this job, as a long distance trucker, including conflicts with coworkers and loneliness on the road for days at a time. The Veteran added that having time alone with his thoughts increased his anxiety and he endorsed hypervigilance while driving.

A November 2016 treatment note evaluated the Veteran's PTSD. The Veteran stated that since he started taking a new medication, he felt that his mood was better. The Veteran endorsed that his sleep was improved, but he continued to report nightmares that occurred approximately 3 days a week. The Veteran also reported that he was not as stressed when driving, though he continued to report some hypervigilance. He stated that he tended to be triggered when he was feeling trapped, or he was fatigued. The Veteran reported a history of passive suicidal ideation but stated that he would never hurt himself because he was afraid of the effect it would have on his young daughter, but he did find himself going over "pro and con" lists about his life.

A December 2016 treatment note evaluated the Veteran's PTSD. The Veteran reported that he'd had significant issues with anxiety since his last appointment, while he reported that he felt his mood was getting better, he felt more jittery and on edge. The Veteran reported that he slept about five to six hours a night. While the Veteran initially reported that his medication had helped his nightmares and that they were tolerable, he now reported that they were getting more severe. The Veteran also reported a history of passive suicidal ideation in prior appointments.

In January 2017, a treatment note evaluated the Veteran's PTSD. The Veteran reported that he had been free from suicidal ideation
"pro and con" lists about his life.

In January 2017, a treatment note evaluated the Veteran's PTSD. The Veteran reported that he had been free from suicidal ideation for the past month.

In March 2018, a treatment note evaluated the Veteran's PTSD. The Veteran's PTSD symptoms included depressed mood; diminished interest in activities; weight loss or gain; sleep disturbance; worthlessness/guilt; and clinically significant distress.

In May 2018, a treatment note evaluated the Veteran's PTSD. During the psychological evaluation, the Veteran reported having nihilistic thoughts, pondering the worth of his existence. He reported hopelessness related to his medical and mental health care and being unable to provide for his daughter.

The Veteran was provided a VA examination for his PTSD symptoms in June 2021. The VA examiner noted that the Veteran's PTSD resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of the inability to be able to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. The Veteran reported living alone, and that he had never been married, but had one daughter. The Veteran added that his own parents "disavowed" him, and that his ex-girlfriend turned his daughter against him. The Veteran also noted that he was employed at a pharmacy as a driver; and he had been in that job for a year. The Veteran stated that he was getting poor feedback from the supervisors about not knowing details of his job and being late on various jobs, and that he had a lot of write-ups and had walked off of jobs when frustrated. However, he stated that he had not been fired from any jobs. The VA examiner determined that the Veteran experienced intrusive symptoms associated with the in-service traumatic event include recurrent, involuntary, and intrusive distressing memories; recurrent distressing dreams; and marked physiological reactions to internal or external cues. The Veteran also experienced persistent avoidance of stimuli associated with the traumatic in-service event, avoidance of or efforts to avoid distressing memories, thoughts, or feelings; and avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings. The Veteran also experienced negative alterations in cognitions and mood associated with the traumatic in-service event including persistent and exaggerated negative beliefs or expectations about oneself, others, or the world; persistent, distorted cognitions; persistent negative emotional state; and feelings of detachment or estrangement from others. Additionally, the Veteran experienced marked alterations in arousal and reactivity associated with the traumatic in-service event including irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects; hypervigilance; exaggerated startle response; problems with concentration; and sleep disturbance. The VA examiner determined that the Veteran's PTSD symptoms included depressed mood; anxiety; suspiciousness; chronic sleep impairment; flattened affect; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; and difficulty in adapting to stressful circumstances, including work or a work like setting. The Veteran denied current intent or plan to harm himself or others.

In an August 2022 lay statement, the Veteran asserted that his symptoms had manifested with psychiatric impairments that include active and passive suicidal ideation; obsessive compulsive disorder; dissociative symptoms; hopelessness; impulsivity; social isolation; trust and safety issues; nihilistic thoughts; difficultly maintaining steady employment; and cognitive problems.

Subsequently, in a September 2024, VA mental health treatment note, the Veteran reported feeling "stressed" because of diagnosis related to bladder and kidneys with plans for second surgery followed by chemo. He was referred to a urologist. He reported that his sleep quality had been poor with a couple of nightmares after his procedure. His energy levels were decreased. He denied any significant changes to his appetite or concentration, denied thoughts of hurting himself or others, and denied symptoms consistent with psychosis or mania. He reported moving in with his parents as he no longer had his apartment. He planned to stay with his current employer.

Also, in a May 2025 mental health treatment note, the Veteran reported things had been "rough"
4, VA mental health treatment note, the Veteran reported feeling "stressed" because of diagnosis related to bladder and kidneys with plans for second surgery followed by chemo. He was referred to a urologist. He reported that his sleep quality had been poor with a couple of nightmares after his procedure. His energy levels were decreased. He denied any significant changes to his appetite or concentration, denied thoughts of hurting himself or others, and denied symptoms consistent with psychosis or mania. He reported moving in with his parents as he no longer had his apartment. He planned to stay with his current employer.

Also, in a May 2025 mental health treatment note, the Veteran reported things had been "rough" since his previous visit and attributed this to ongoing stressors related to his bladder cancer and work stress. He also had difficulty finding suitable housing. Regarding his cancer, he was referred to UVA. He had recent surgery and was scheduled for another surgery in June. He reported having housing contracts that fall through. He also reported increased stress at work. He did not have some positive support from his fiancée. He continued to use melatonin at bedtime to help with sleep. He reported last week his sleep was rough due to his surgery, but it was slowly improving. His energy and appetite had been manageable. He denied thoughts of hurting himself or others. He denied symptoms consistent with psychosis or mania/hypomania.

Finally, in a September 2025 mental health treatment note, the Veteran reported that things had been "okay" since his previous visit. He reported some significant stressors including having to pause his housing search and "breaking up" with his fiancée. He also reported needing to get at least 1-2 additional rounds of chemotherapy due to his bladder cancer. He remained busy at work, but that had been manageable. He did continue to take his melatonin at bedtime to help with sleep. His sleep quality had been somewhat rough due to anxiety levels with a counselor. His energy levels had been a little bit decreased. Some of this was attributable to his work stress. He denied issues with his appetite or concentration. He denied thoughts of hurting himself or others. He denied symptoms consistent with psychosis or mania. He expressed interest in going to flight school to become a pilot, but due to medical issues, he was not pursuing it. He planned on investing his time back to his hobby of playing the violin.

After careful consideration, the Board finds that throughout the period on appeal a rating higher than 70 percent for the Veteran's PTSD is not warranted. That is, the most probative and persuasive evidence shows that the Veteran's symptoms have manifested, at most, as occupational and social impairment, with deficiencies in most areas. Particularly, the Veteran has documented symptoms of depression, anxiety, hypervigilance, nightmares, impaired sleep, passive suicidal ideation, and conflict with coworkers. However, although the Veteran no longer has a home of his own, he continues to search for a new one, he was able to move in with his parents, which suggests that his relationship with them has somewhat improved, he has continued to work on a steady basis, has expressed interest in becoming a pilot and plans on investing some of time in his hobby of playing the violin. As such, throughout the period on appeal, the Veteran's symptoms have not manifested as total occupational and social impairment. Thus, a 100 percent rating is not warranted.

Accordingly, from April 26, 2016, entitlement to an initial rating higher than 70 percent for service-connected posttraumatic stress disorder (PTSD) is denied.

5. From April 26, 2016, but not earlier, entitlement to an initial 30 percent rating for service-connected irritable bowel syndrome (IBS) is granted.

The Veteran claims entitlement to an initial compensable rating for service-connected IBS.

The Veteran currently has an initial noncompensable (0 percent) rating for service-connected IBS from April 26, 2016, under 38 C.F.R. § 4.114, Diagnostic Code 7319.

Under Diagnostic Code 7319, mild irritable colon syndrome, with disturbances of bowel function with occasional episodes of abdominal distress, is noncompensable. Moderate irritable colon syndrome, with frequent episodes of bowel disturbance with abdominal distress, is rated 10 percent disabling. Severe irritable colon syndrome, with diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress, is rated 30 percent disabling.

Effective May 19, 2024, VA revised the criteria for evaluating disabilities of the digestive system. Schedule of Rating Disabilities: The Digestive System, 89 Fed. Reg. 19735
6, under 38 C.F.R. § 4.114, Diagnostic Code 7319.

Effective May 19, 2024, VA revised the criteria for evaluating disabilities of the digestive system. Schedule of Rating Disabilities: The Digestive System, 89 Fed. Reg. 19735, 19754 (Mar. 20, 2024).

Diagnostic Code 7319 is one of the diagnostic codes that was amended.

As of May 19, 2024, under the amended version of Diagnostic Code 7319, the criteria for irritable bowel syndrome are: abdominal pain related to defecation at least once during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension, is rated 10 percent disabling; abdominal pain related to defecation for at least three days per month during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension, is rated 20 percent disabling; and abdominal pain related to defecation is at least one day per week during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension, is rated 30 percent disabling.

When a law or regulation changes during the course of a claim, the version more favorable to the veteran will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g); see also Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). If the revised version of the regulation is more favorable, the implementation of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. If the former version is more favorable, VA can apply the earlier version of the regulation for the period prior to, and from, the effective date of the change. 38 U.S.C. § 5110; Kuzma, 341F. 3d 1327. Therefore, the Board will consider the Veteran's claim under both the old and new rating criteria, and the criteria that is more favorable to the Veteran will be applied. If the new criteria are more favorable, they will only be applied from when the regulations became effective.

VA treatment records between March and December 2016, August 2017 and March 2018 show, respectively, the Veteran's reporting of nausea and diarrhea in the past week, intermittent diarrhea, abdominal pain, diarrhea, mild crampy abdominal pain prior to diarrhea, diarrhea off and on, and continued "nausea, vomiting, diarrhea, gastrointestinal symptoms, to include diarrhea." In March 2018, a history of irritable bowel syndrome, including intermittent abdominal pain and changes in bowel movements was noted.

In a July 2021 VA examination report, the Veteran was diagnosed with IBS. He reported having "loud" bowel sounds, and feeling like his abdomen would swell after eating. The VA examiner reported that continuous medication was not required for the control of the Veteran's intestinal condition and that he had had no surgical treatment. The Veteran had signs and/or symptoms attributable to his non-surgical, non-infectious intestinal condition that consisted of diarrhea. He had no episodes of bowel disturbance with abdominal distress or exacerbations or attacks of his intestinal condition. The Veteran had no weight loss attributable to his IBS or malnutrition, serious complications, or other general health effects. He had no benign or malignant neoplasm or metastases related to his IBS. No functional impact was noted.

Subsequently, December 2022 VA treatment records show the Veteran's reporting of a history of intermittent diarrhea.

A December 2023 gastro
continuous medication was not required for the control of the Veteran's intestinal condition and that he had had no surgical treatment. The Veteran had signs and/or symptoms attributable to his non-surgical, non-infectious intestinal condition that consisted of diarrhea. He had no episodes of bowel disturbance with abdominal distress or exacerbations or attacks of his intestinal condition. The Veteran had no weight loss attributable to his IBS or malnutrition, serious complications, or other general health effects. He had no benign or malignant neoplasm or metastases related to his IBS. No functional impact was noted.

Subsequently, December 2022 VA treatment records show the Veteran's reporting of a history of intermittent diarrhea.

A December 2023 gastroenterology note indicated that the Veteran had reported diarrhea with urgency in September 2023 which on review of history was found to be longstanding with a diagnosis of diarrhea predominant irritable bowel syndrome. Diet was discussed particularly avoiding dairy. Primarily with dietary changes, his bowels had calmed down over the past 3 months. He would have a bowel movement about once in 3 days. He would have diarrhea if he ate greasy food or something else that upset his stomach. The Veteran's history of chronic diarrhea/irritable bowel syndrome, lactose intolerance was noted. Assessment was chronic diarrhea due to lactose intolerance and diarrhea predominant IBS, and iron deficiency anemia was noted.

In an April 2024, VA gastroenterology note, it was observed that at last visit the Veteran had complained of diarrhea and had a diagnosis of lactose intolerance and irritable bowel syndrome. At this time, he denied "abdominal pain, dysphagia, nausea, vomiting, chest pain, dyspnea, anorexia, palpitations, lightheadedness or unexplained weight loss." He denied fevers or shaking chills. Past medical history was noted, including chronic diarrhea/irritable bowel syndrome, lactose intolerance.

After careful consideration, the Board finds that, throughout the period on appeal, the most probative and persuasive evidence shows that the Veteran's service-connected IBS has manifested by symptoms that most closely approximate severe irritable colon syndrome, with diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress. As such, giving the Veteran the benefit of the doubt, the Board finds that an initial 30 percent rating for service-connected IBS is warranted.

Accordingly, From April 26, 2016, but not earlier, entitlement to an initial 30 percent rating for service-connected irritable bowel syndrome (IBS) is granted.

6. Service connection for erectile dysfunction, to include as secondary to service-connected PTSD, is granted.

The Veteran claims entitlement to service connection for erectile dysfunction, to include as secondary to service-connected PTSD.

At the outset, the Board notes that VA treatment records from August 2016 throughout November 2025 note a history of impotence of organic origin or erectile dysfunction.

The Veteran submitted an August 2019 private medical opinion in which the private examiner discussed the Veteran's medications taken to treat his psychiatric disability and opined that subsequent to using these medications, the Veteran developed erectile dysfunction. As such, the Board finds that, throughout the period on appeal, that is, from April 26, 2016, the Veteran's claim of service connection for erectile dysfunction has been reasonably raised by the record. See Bailey v. Wilkie, 33 Vet. App. 188, 203 (2021).

Also, the Board finds the August 2019 private medical opinion of high probative value in establishing that it is at least as likely as not that the Veteran's erectile dysfunction is a result of his service-connected PTSD.

Accordingly, giving the Veteran the benefit of the doubt, service connection for erectile dysfunction, to include as secondary to service-connected PTSD, is warranted.

Michael J. Skaltsounis

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Aquino Ramos, Carlos M.

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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