SHOULDER IMPAIRMENT OF

Summary

The veteran, who served from June 1975 to September 2000, appeals the denial of service connection for eight musculoskeletal conditions: right and left shoulder disorders, right and left elbow disorders, right and left hand disorders, and right and left ankle disorders. The veteran also appeals the denial of an increased rating for his neck disability. The veteran claimed these conditions were related to in-service physical activity, weightlifting, a 1983 TBI, or alternatively, were Gulf War illnesses. The Board found that the veteran had current diagnoses for all claimed conditions and that the second element of service connection (in-service incurrence) was met, citing treatment records for the affected joints and the 1983 TBI. However, the Board denied direct service connection for all eight joint claims, finding that the evidence persuasively weighed against a nexus to service. The Board gave significant weight to the July 2019 VA examiner's opinions, which concluded that the veteran's current conditions were less likely than not related to service due to a lack of continuity of symptomatology and the acute nature of in-service complaints. The Board found the private medical opinions and the veteran's lay testimony less persuasive. For the neck disability, the Board found the evidence supported the existing 20 percent rating, as the veteran's symptoms did not meet the criteria for a higher rating or ankylosis, and the veteran denied experiencing flare-ups.

Rationale

No credible nexus to service; VA examiner opined less likely than not related to service; Lack of continuity of symptomatology

Full Decision Text

Citation Nr: A26040006
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 200220-71007
DATE: April 29, 2026

ORDER

Entitlement to service connection for a right shoulder disorder is denied.

Entitlement to service connection for a left shoulder disorder is denied.

Entitlement to service connection for a right elbow disorder is denied.

Entitlement to service connection for a left elbow disorder is denied.

Entitlement to service connection for a right hand disorder is denied.

Entitlement to service connection for a left hand disorder is denied.

Entitlement to service connection for a right ankle disorder is denied.

Entitlement to service connection for a left ankle disorder is denied.

Entitlement to an initial rating in excess of 20 percent for a neck disability is denied.

FINDINGS OF FACT

1. The Veteran's right shoulder disorder is not related to his military service.

2. The Veteran's left shoulder disorder is not related to his military service.

3. The Veteran's right elbow disorder is not related to his military service.

4. The Veteran's left elbow disorder is not related to his military service.

5. The Veteran's right hand disorder was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disorder is not otherwise etiologically related to an in-service injury or disease.

6. The Veteran's left hand disorder was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established; and the disorder is not otherwise etiologically related to an in-service injury or disease.

7. The Veteran's right ankle disorder is not related to his military service.

8. The Veteran's left ankle disorder is not related to his military service

9. The Veteran's neck disability has most nearly approximated with painful forward flexion of the cervical spine greater than 15 degrees, but not greater than 30 degrees; the Veteran's neck disability has not been manifested by forward flexion of the cervical spine to 15 degrees or less; or ankylosis of any kind.

CONCLUSIONS OF LAW

1. The criteria for service connection for a right shoulder disorder have not been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for a left shoulder disorder have not been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for a right elbow disorder have not been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for service connection for a left elbow disorder have not been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for service connection for a right hand disorder have not been met.  38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

6. The criteria for service connection for a left hand disorder have not been met.  38 U.S.C. §§ 1110, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

7. The criteria for service connection for a right ankle disorder have not been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

8. The criteria for service connection for a left ankle disorder have not been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

9. The criteria for an initial rating in excess of 20 percent for a neck disability have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 
 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

8. The criteria for service connection for a left ankle disorder have not been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

9. The criteria for an initial rating in excess of 20 percent for a neck disability have not been met.  38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5237.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from June 1975 to September 2000.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2019 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).

In the February 20, 2020, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement (NOD)), the Veteran elected the Hearing docket. A Board hearing was held on July 18, 2024.  Therefore, the Board may only consider the evidence of record at the time of the August 2019 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran  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 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 that the Board could not consider, the Veteran 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 claims, considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a Supplemental Claim are included with this decision.

Notably, while the Veteran's former representative did not include the issue of entitlement to an increased initial rating for the cervical spine on the NOD, the Board docketed the issue and took testimony regarding such at the July 2024 hearing.  Thus, given 38 C.F.R. § 20.202(a)'s requirement to liberally interpret NODs and the fact that no harm will flow to the Veteran from the Board's adjudication of the issue, the Board has addressed such herein.

As a final introductory matter, the Board observes that the Veteran was last represented by a private attorney.  Thereafter, in May 2022 and August 2022 submissions, the Veteran's prior representative submitted letters to VA indicating that the firm was no longer representing the Veteran; a formal withdrawal was not submitted.  Thereafter, the Veteran appeared at the Board hearing without representation and expressed a desire to proceed on his own (i.e., pro se).  Accordingly, VA has removed his former representative from all databases and considers him unrepresented before VA.

Service Connection

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

Certain chronic diseases, including arthritis, will be presumed related to service if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease.  38 U.S.C. §§ 1101, 1112, 1137; 38 C
urrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury.  Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004).

Certain chronic diseases, including arthritis, will be presumed related to service if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease.  38 U.S.C. §§ 1101, 1112, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

Regulations provide that compensation may be paid to any Persian Gulf War veteran "suffering from a chronic disability resulting from an undiagnosed illness (or combination of undiagnosed illnesses)."  38 U.S.C. § 1117.  These may include, but are not limited to, muscle pain, joint pain, neurologic signs or symptoms, and symptoms involving the respiratory system.  See 38 C.F.R. § 3.317 (b).  Objective indications of a chronic disability include both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 8 C.F.R. § 3.317 (a)(3).

A qualifying chronic disability means a chronic disability resulting from any of the following, individually or in combination: (A) an undiagnosed illness; (B) the following medically unexplained chronic multisymptom illnesses that are defined by a cluster of signs or symptoms: (1) CFS; (2) fibromyalgia; (3) irritable bowel syndrome; or (4) any other illness that the Secretary determines meets the criteria in paragraph (a)(2)(ii) of this section for a medically unexplained chronic multisymptom illness; or (C) any diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C. § 1117 (d) warrants a presumption of service-connection. 38 C.F.R. § 3.317 (a)(2)(i).

1. Entitlement to service connection for a right shoulder disorder.

2. Entitlement to service connection for a left shoulder disorder.

3. Entitlement to service connection for a right elbow disorder.

4. Entitlement to service connection for a left elbow disorder.

5. Entitlement to service connection for a right hand disorder.

6. Entitlement to service connection for a left hand disorder.

7. Entitlement to service connection for a right ankle disorder.

8. Entitlement to service connection for a left ankle disorder.

The Veteran asserts that his shoulders, elbows, hands, and ankles were injured during his military service.  Specifically, he contends that such could be related to his physical activity during service (including sports played therein), lifting weights during service, and/or from a 1983 head injury that caused his service connected traumatic brain injury (TBI).  See July 2019 VA examination reports and July 2024 Board hearing transcript.  Alternatively, the Veteran contends that his disorders are considered "Gulf War" illnesses.  See May 2019 Application for Service Connection.

Turning to the first element of service connection, the July 2019 VA examination reports reveal diagnoses referrable to all of the claimed conditions.  While the RO did not acknowledge a right ankle diagnosis, the Veteran has credibly reported experiencing ankle pain and images obtained in July 2019 revealed bilateral minor achilles spurs involving the calcaneus.  As such, the Board finds that the first element of service connection has been established as to all eight issues, including the right ankle.  

Regarding the second element of service connection, the in service element, the Veteran's service treatment records (STRs) reveal shoulder treatment (1991, and 1997); elbow treatment (1983, 1988, and 1993); hand treatment (1978, 1983, 1987, 1992, 1997, and 1999); and ankle treatment (1979, 1980, and 1994).  Additionally, the STRs document the Veteran's 1983 TBI and VA has acknowledged his status as a Persian Gulf Veteran.  Thus, the second element of service connection has been established as to all eight issues. 

Turning to the final element, a nexus between the current diagnosis and an in service incident, such is not necessary
 element, the Veteran's service treatment records (STRs) reveal shoulder treatment (1991, and 1997); elbow treatment (1983, 1988, and 1993); hand treatment (1978, 1983, 1987, 1992, 1997, and 1999); and ankle treatment (1979, 1980, and 1994).  Additionally, the STRs document the Veteran's 1983 TBI and VA has acknowledged his status as a Persian Gulf Veteran.  Thus, the second element of service connection has been established as to all eight issues. 

Turning to the final element, a nexus between the current diagnosis and an in service incident, such is not necessary if the diagnosis is one that can be presumptively linked to service.  In this case, the Veteran's bilateral hand arthritis is capable of being presumptively linked to service, but the evidence does not support a finding that the Veteran was noted to have arthritis during his military service or for many years after.  Indeed, records indicate that arthritis was not diagnosed until at least a decade after the Veteran's separation from service.  While the Veteran was seen in service for hand pain, he only reported right hand cramping while playing golf during his May 2000 report of medical history; no symptoms were noted during a concurrent physical examination.  The foregoing refutes the concept of continuity of symptomology.  Thus, presumptive service-connection for right and left hand arthritis has not been established.

Similarly, the Gulf War presumptions are not for application in this case as the Veteran has been diagnosed with a disorder referrable to each of the eight claimed joints, none of which are presumably linked to service in the Persian Gulf.

Importantly, as the Veteran has been diagnosed with disorders referrable to his shoulders, elbows, hands, and ankles, service connection may be granted on a direct basis for all of these claims.  Nevertheless, the evidence is persuasively against finding that a medical nexus exists between the Veteran's shoulders, elbows, hands, ankles, and his service.  38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303.  

Specifically, in August 2019, after reviewing the relevant medical records, the service department records, interviewing the Veteran, and reviewing his lay statements, the July 2019 VA examiner found that it was less likely than not that the Veteran's bilateral shoulder, elbow, hand, and ankle disorders were related to his military service.  Initially, the clinician observed that the Veteran was treated during service for conditions referable to his shoulders, elbows, hands, and ankles.  Regarding his shoulders, the examiner noted a lack of report of symptoms after service until 2017 at which time a diagnosis was not even rendered, only a referral to occupational therapy.  Similarly, the Veteran was not seen after service for elbow symptoms until 2017 at which time he reported elbow pain during a sleep medicine consultation; no diagnosis was rendered, nor treatment prescribed.  Likewise, the Veteran did not report post-service hand or ankle pain until 2017.  Ultimately, given a lack of follow-up care following specific injury incidents during service and a lack of reported symptoms for many years after separation as to all eight issues, the clinician opined that the in service symptoms were acute in nature and unrelated to his current diagnoses.  

Significantly, there are no medical opinions of record that contradict the 2019 examiner's opinions.  The Board acknowledges that the 2019 examiner did not address whether the Veteran's disorders were related to his 1983 TBI or whether such were caused by his exposures to toxins during his military service.  Importantly, these theories of entitlement had not been raised at the time of the VA examinations and so there was no pre-decisional duty to assist in not discussing such.  Indeed, the Secretary of VA has determined that VA does not have an obligation to obtain an etiological opinion as to whether claims based on physical trauma were related to in service exposures.  Thus, the Board finds that the examiner's failure to address these theories does not reduce the probative value of such as the examiner had no duty to discuss them.  Otherwise, the opinions are based on a review of the record, a review of the Veteran's health history, examination of the Veteran, and are supported by sufficiently detailed rationales to support the conclusions reached.  Thus, the Board affords the etiological opinions great probative weight.

The Board acknowledges the Veteran's assertion that his shoulder, elbow, hand, and ankle disorders are related to his military service.  The Board finds, however, that he is not competent to
 obtain an etiological opinion as to whether claims based on physical trauma were related to in service exposures.  Thus, the Board finds that the examiner's failure to address these theories does not reduce the probative value of such as the examiner had no duty to discuss them.  Otherwise, the opinions are based on a review of the record, a review of the Veteran's health history, examination of the Veteran, and are supported by sufficiently detailed rationales to support the conclusions reached.  Thus, the Board affords the etiological opinions great probative weight.

The Board acknowledges the Veteran's assertion that his shoulder, elbow, hand, and ankle disorders are related to his military service.  The Board finds, however, that he is not competent to provide a nexus opinion in this case as the cause of musculoskeletal disorders is a matter not capable of lay observation and requires medical expertise to determine.  Indeed, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship.  See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007).  Opinions regarding the diagnosis and etiology of musculoskeletal disorders are complex and generally beyond the competency of a lay witness.  

Consequently, the Board gives more probative weight to the opinion of the 2019 examiner who has greater medical training than the Veteran and exercised medical expertise in rendering the opinions, which were supported with  reasoned rationales.

In sum, the most probative evidence is against a finding of service connection for bilateral hand arthritis pursuant to presumptive service connection under 38 C.F.R. § 3.309 as the most probative evidence indicates that the Veteran's disorders did not manifest to a compensable degree within one year of his separation from service and are not chronic in nature.  Further, service connection for a right shoulder disorder, left shoulder disorder, right elbow disorder, left elbow disorder, right hand disorder, left hand disorder, right ankle disorder, and left ankle disorder pursuant to direct service connection under 38 C.F.R. § 3.303 is not warranted as there is no competent evidence that the Veteran's disorders are directly related to service, to include his in service injuries.  Accordingly, the claims are denied.  In reaching the above conclusions, the Board has considered the applicability of the benefit-of-the-doubt doctrine, however, as the evidence is persuasively against the Veteran's claims, that doctrine is not applicable.  See 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

Increased Rating

9. Entitlement to an initial rating in excess of 20 percent for a neck disorder

Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule).  See 38 U.S.C. § 1155; 38 C.F.R. § 4.1.  Different ratings may be assigned for different periods of time for the same disorder if the facts show distinct time periods with different levels of disability.  Hart v. Mansfield, 21 Vet. App. 505 (2007).  If two ratings are potentially applicable, the higher rating will be assigned if the disability more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned.  See 38 C.F.R. § 4.7.  Any reasonable doubt regarding the degree of disability will be resolved in favor of the veteran.  See 38 C.F.R. § 4.3.

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 normal, weakened movement, excess fatigability, incoordination, and pain on movement.  See DeLuca v. Brown, 8 Vet. App. 202 (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 (musculoskeletal system) or § 4.73 (muscle injury); a separate or higher rating under
 less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement.  See DeLuca v. Brown, 8 Vet. App. 202 (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 (musculoskeletal system) or § 4.73 (muscle injury); 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 [or 4.73] criteria.").

In Correia v. McDonald, 28 Vet. App. 158 (2016), the United States Court of Appeals for Veterans Claims (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 weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint."

In Sharp v. Shulkin, 29 Vet. App. 26 (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.

As it relates to the Veteran's neck, the Board observes that the Veteran denied experiencing flare-ups of symptoms during his July 2019 VA examination.  Moreover, the spine does not have a paired joint.  

The Board acknowledges that the Veteran has reported the use of medication to treat his neck symptoms.  While 38 U.S.C. § 4.71a does not consider the ameliorative impact of medication, the Veteran has never alleged, nor does the record suggest, that but for the use of medication his symptoms would meet or more nearly approximate the relevant rating criteria for higher ratings. 

The Veteran's neck disability is rated under 38 C.F.R. § 4.71a (DC 5237).  Under the General Rating Formula for Diseases and Injuries of the Spine, a 20 percent rating is warranted for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or the combined range of motion of the cervical spine not greater than 170 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 30 percent rating is warranted for flexion to 15 degrees or less; or favorable ankylosis of the entire cervical spine.  A 40 percent rating is warranted for unfavorable ankylosis of the entire cervical spine.  A 100 percent evaluation is warranted for unfavorable ankylosis of the entire spine.  38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine.

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.  In this case, the most probative evidence of record (the July 2019 VA examination report) did not reveal any radicular signs or symptoms related to the Veteran's neck disability.  In fact, objective testing revealed full upper extremity strength, normal sensation to touch, and normal deep tendon reflexes.  Thus, given the absence of diagnosed neurological abnormalities associated with the cervical spine during the relevant appeal period, a further discussion of Note 1's application is not warranted in this case.  

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).  Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.  Id. at Note 5.

Notably, the regulations concerning spinal disabilities was revised during the period on appeal.   These revisions concern intervertebral disc syndrome (IVDS), for which
 normal deep tendon reflexes.  Thus, given the absence of diagnosed neurological abnormalities associated with the cervical spine during the relevant appeal period, a further discussion of Note 1's application is not warranted in this case.  

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).  Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.  Id. at Note 5.

Notably, the regulations concerning spinal disabilities was revised during the period on appeal.   These revisions concern intervertebral disc syndrome (IVDS), for which the Veteran is not in receipt of service connection.  Specifically, the July 2019 VA examiner found the Veteran does not suffer from IVDS and no other record suggests such.  Thus, the revisions have no impact on the outcome of this case and will not be discussed with relation to the Veteran's neck disability.

Turning to the merits of the claim, after review of all of the evidence of record, the Board finds that his symptoms most nearly approximate limitation of flexion of the cervical spine to more than 15 degrees, but less than 30 degrees, warranting the currently assigned 20 percent rating, but no higher.  

In terms of the evidence supporting the Board's decision, the Board finds the July 2019 VA examination is the most probative medical evidence of record regarding the Veteran's cervical spine function as the examiner conducted a physical examination of the Veteran pursuant to the requirements of the law and provided detailed reports on such.  At the examination, objective testing revealed cervical spine limitation of flexion to 30 degrees with a combined range of motion of 230 degrees, which is consistent with a 10 percent rating.  The examiner was unable to estimate any loss of range of motion with repeated use over time without resort to speculation, and, as noted above, the Veteran denied experiencing cervical flares.  The examiner specifically found that there was no evidence of any type of ankylosis of the cervical spine.

Given the foregoing, the Board finds that a higher 30 percent rating is not supported by the record as there is no evidence of ankylosis, nor symptoms equivalent thereto.  See July 2019 VA examination report, which documents the Veteran's reports and contains objective findings.  Additionally, VA treatments do not reveal any lay reports of the Veteran's neck feeling frozen, or stuck, nor medical findings of ankylosis.  Indeed, the Veteran reported working as a landscaper during the appeal, evincing that his spinal symptoms did not more nearly approximate ankylosis given his ability to engage in this type of employment involving bending and hinging at the neck, which would be precluded if ankylosis were present.

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?

Based on the foregoing, the evidence of record persuasively weighs against the Veteran's claim for a rating in excess of 20 percent for his neck disability.  Again, the Board acknowledges the Veteran's reports of symptoms and that there was functional loss due to pain; however, even considering these reports of symptoms and noted functional loss, the degree of additional limitation reflected would not result in symptoms more nearly approximating ankylosis.  Thus, a rating in excess of 20 percent is denied.

 

 

Nathaniel Doan

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	K. Sosna, Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.