PARALYSIS OF SCIATIC NERVE OR EXTERNAL POPLITEAL NERVE

J.P. NORMAN · 2026 · Case ID: A26040077

MIXED

Summary

The Veteran, an Army Veteran who served from August 1999 to July 2006, appeals several rating decisions. The Board addressed entitlement to increased ratings for left and right lower extremity radiculopathy, a 10 percent rating for sinusitis, denial of a compensable rating for rhinitis, and denial of service connection for chronic fatigue syndrome (CFS). The Board granted 30 percent ratings for both left and right lower extremity radiculopathy, finding the symptoms to be at least moderately severe and in approximate balance for the period on appeal, resolving doubt in the Veteran's favor. The Veteran's sinusitis was granted a 10 percent rating based on multiple non-incapacitating episodes annually, with headaches and purulent discharge, resolving doubt in his favor. However, the claim for rhinitis was denied, as the evidence did not support the objective criteria for a compensable rating, and the persuasive weight of the evidence was against the claim. The claim for CFS was also denied, as the evidence did not support a diagnosis of CFS as defined by VA, and the Veteran's symptoms were attributed to other service-connected conditions. The Board dismissed claims for sleep apnea and left knee ratings due to impermissible concurrent review elections and noted an untimely appeal for asthma. Claims for right knee arthritis, left elbow condition, and right elbow condition were remanded for further development, including obtaining missing VA treatment records and conducting new VA examinations.

Rationale

Symptoms of moderate severity; No muscle atrophy or need for assistive devices; Approximate balance of evidence

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

8520

Docket No.

250428-538018

Full Decision Text

Citation Nr: A26040077
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 250428-538018
DATE: April 29, 2026

ORDER

Entitlement to a 30 percent disability rating for left lower extremity (LLE) radiculopathy of the sciatic nerve from November 29, 2021, is granted.

Entitlement to a 30 percent disability rating for right lower extremity (RLE) radiculopathy of the sciatic nerve from November 29, 2021, is granted.

Entitlement to a 10 percent rating for sinusitis from August 10, 2022, is granted.

Entitlement to a compensable rating for rhinitis is denied.

Entitlement to service connection for chronic fatigue syndrome (CFS) is denied.

REMANDED

Entitlement to an increased disability rating for right knee arthritis is remanded.

Entitlement to service connection for a left elbow condition is remanded.

Entitlement to service connection for a right elbow condition is remanded.

FINDINGS OF FACT

1. Resolving reasonable doubt in the Veteran's favor, his LLE and RLE radiculopathies have manifested with moderately severe symptoms, including pain and numbness, for the entire period on appeal.

2. The Veteran's sinusitis has manifested with three to six non-incapacitating episodes annually for the entire period on appeal.

3. The record does not reflect nasal obstruction or polyps during the period on appeal.

4. The evidence of record persuasively weighs against finding that the Veteran has had CFS at any time during or approximate to the pendency of the claim.

CONCLUSIONS OF LAW

1. The criteria for a 30 percent disability rating for LLE radiculopathy have been met since November 29, 2021. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520.

2. The criteria for a 30 percent disability rating for RLE radiculopathy have been met since November 29, 2021. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8520.

3. The criteria for a 10 percent rating for sinusitis have been met since August 10, 2022. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.97, Diagnostic Code 6512.

4. The criteria for a compensable rhinitis rating have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.97, Diagnostic Code 6522.

5. The criteria for service connection for CFS have not been met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from August 1999 and July 2006.

In the April 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the March 2025 (regarding right knee claim), February 2025 (radiculopathy), and August 2024 (elbow, rhinitis, sinusitis, and fatigue claims) agency of original jurisdiction (AOJ) decisions on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

As a threshold matter, the VA Form 10182 included appeals requesting service connection for asthma and sleep apnea, and increased ratings for two left knee disabilities. His asthma claim was not adjudicated in either of the rating decisions on appeal. Prior to filing the April 2025 VA Form 10182, an asthma claim was most recently adjudicated by the AOJ
sinusitis, and fatigue claims) agency of original jurisdiction (AOJ) decisions on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

VA regulations unequivocally provide that, except in limited circumstances (which do not apply here), an appeal to the Board via VA Form 10182 must be submitted to the AOJ within one year of the rating decision being appealed. A Form 10182 must identify the specific decision and issues with which the claimant disagrees. The Board may dismiss any appeal which fails to identify the specific decision and issues therein. 38 C.F.R. § 20.202, 20.203. VA regulations also provide clear recourse in circumstances when a filing extension is required at 38 C.F.R. § 20.203 (c), allowing for an extension to be granted "for good cause" if a written request is submitted to the Board.

Here, the April 2025 Form 10182 was not timely filed with respect to the asthma claim last adjudicated in May 2023. Additionally, the Form 10182 did not indicate any request for extension to file a claim, and the Veteran has not filed a document that can be construed as a timely extension request. Indeed, the Veteran's representative filed a June 2025 brief stating the Veteran's contentions and intent to appeal rating decisions dated in March 2025, February 2025, and August 2024. The brief did not cite or mention an appeal regarding asthma. Good cause for the untimely appeal was not offered.

The record as a whole reflects no communications requesting an extension or that would have alerted VA or triggered a duty on VA to follow up with the Veteran. The Veteran also has not presented good cause for the untimely filing of the Form 10182. Thus, a claim regarding asthma is not before the Board.

The Board also concludes that claims for sleep apnea and increased left knee ratings are also not appropriately before the Board. The record shows an April 23, 2025, VA Form 20-0995 Supplemental Claim application, requesting readjudication of a May 2023 denial of service connection for sleep apnea, and a VA Form 20-0996 Request for Higher-Level Review, requesting higher left knee disability ratings for limited flexion and extension, identifying both February 2025 and March 2025 rating decisions as on appeal. Before either the Supplemental Claim or Request for Higher-Level Review were decided by the AOJ, he then filed the April 28, 2025, VA Form 10182 currently before the Board, appealing the same issues and citing the same rating decisions as those appealed in the pending Supplemental Claim and Request for Higher-Level Review.

Concurrent elections of review options, as here, are prohibited. Once a veteran has elected to pursue a supplemental claim, higher-level review, or appeal to the Board, he or she may not file another review with respect to the same claim, or same issues within the claim, until the first supplemental claim, higher-level review, or appeal to the Board is adjudicated or withdrawn. 38 U.S.C. § 5104C; 38 C.F.R. § 3.2500(b). By first filing April 2025 Supplemental and Higher-Level Review appeals, followed by the VA Form 10182 before the Board, an impermissible concurrent election has occurred in relation to these claims.

The Veteran's Supplemental Claim and Higher-Level Review were both developed by the AOJ, to include new VA examinations and additional medical records added to the claims file. His sleep apnea claim was most recently denied in a July 2025 rating decision. He filed additional claims regarding his left knee ratings, which were most recently addressed in a December 2025 rating decision. The Veteran is still within the one year period following each of these rating decisions to initiate an appeal, either at the AOJ or the Board. He has not withdrawn either the April 2025 Supplemental Claim or Request for Higher-Level Review.

The Board will accordingly dismiss these matters as impermissible concurrent review elections. 38 U.S.C. §
's Supplemental Claim and Higher-Level Review were both developed by the AOJ, to include new VA examinations and additional medical records added to the claims file. His sleep apnea claim was most recently denied in a July 2025 rating decision. He filed additional claims regarding his left knee ratings, which were most recently addressed in a December 2025 rating decision. The Veteran is still within the one year period following each of these rating decisions to initiate an appeal, either at the AOJ or the Board. He has not withdrawn either the April 2025 Supplemental Claim or Request for Higher-Level Review.

The Board will accordingly dismiss these matters as impermissible concurrent review elections. 38 U.S.C. § 5104C; 38 C.F.R. § 3.2500(b). Under 38 C.F.R. § 20.104(c), the Veteran is entitled to notice of a jurisdictional defect on which the Board intends to act and afforded 60 days to dispute such. No such notice was provided here, but the Veteran is not prejudiced because the AOJ has already developed the appeals referenced herein, and he may still appeal the July 2025 and December 2025 rating decisions regarding these claims. For these reasons, the Veteran's claims for service connection for sleep apnea and left knee ratings are accordingly DISMISSED. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.2500(b), 20.205. The Veteran is free to initiate an appeal, either at the AOJ or the Board, of the July 2025 or December 2025 rating decisions.

If the Veteran would like VA to consider evidence he submitted that the Board could not consider regarding granted or denied claims, 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. Regarding the remanded issues, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

1. Entitlement to a 30 percent disability rating for left lower extremity (LLE) radiculopathy of the sciatic nerve from November 29, 2021, is granted.

2. Entitlement to a 30 percent disability rating for right lower extremity (RLE) radiculopathy of the sciatic nerve from November 29, 2021, is granted.

The Veteran asserts that his bilateral lower extremity radiculopathy manifests with symptoms warranting higher ratings than currently assigned. He was awarded service connection for these disabilities in a March 2022 rating decision awarding bilateral 10 percent ratings from November 29, 2021, the date he filed a VA Form 21-526EZ requesting service connection for joint pain. He has since been awarded bilateral 20 percent ratings for LLE and RLE radiculopathy, effective October 20, 2025. See December 2025 rating decision.

In order to adjudicate the Veteran's claim, the Board must start by determining the period on appeal. As stated, the Veteran was awarded service connection in a March 2022 rating decision. He filed a VA Form 21-526EZ claim form within a month of that rating decision, requesting increased radiculopathy ratings, which was denied in a July 2022 rating decision. He then filed a January 2023 VA Form 21-526EZ claim, again requesting increased disability ratings, as again denied in a May 2023 rating decision. He filed the claim again in April 2024, was denied in August 2024, and refiled in February 2025. His claim was most recently denied in the February 2025 rating decision on appeal.

The modernized review system, also known as the Appeals Modernization Act (AMA), applies to all initial claims decided by the AOJ on or after February 19, 2019, as occurs here. Under AMA, an effective date may be pursued by continuously pursuing a claim. This is accomplished by filing an appropriate administrative review option to an AOJ decision as specified in 38 C.F.R. § 3.2500(c) within one year of the issuance of the decision (or within the time specified in § 3.2500(f), as applicable to simultaneously contested claims), provided that any appeal to the
2025. His claim was most recently denied in the February 2025 rating decision on appeal.

The modernized review system, also known as the Appeals Modernization Act (AMA), applies to all initial claims decided by the AOJ on or after February 19, 2019, as occurs here. Under AMA, an effective date may be pursued by continuously pursuing a claim. This is accomplished by filing an appropriate administrative review option to an AOJ decision as specified in 38 C.F.R. § 3.2500(c) within one year of the issuance of the decision (or within the time specified in § 3.2500(f), as applicable to simultaneously contested claims), provided that any appeal to the United States Court of Appeals for Veterans Claims (CAVC) must be accepted as timely by that court. 38 C.F.R. § 3.2500(h)(1).

The Board accordingly finds that the claim on appeal was filed on November 29, 2021, and has been continuously pursued since. Chisholm v. Collins, 38 Vet. App. 140 (2025). The period on appeal therefore stems from the effective date of the award of service connection. Fenderson v. West, 12 Vet. App. 119 (1999).

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule), which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes (DCs). 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability evaluations is the ability of the body as a whole or of the psyche or of a system or organ of the body to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10.

When evaluating the severity of a disability, it is essential the disability is considered in the context of the entire recorded history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where an appeal arises from the original assignment of a disability evaluation on an award of service connection, the severity of the disability is considered from the initial assignment of the disability rating to the present time. Fenderson, 12 Vet. App. at 125-26.

If the disability more closely approximates the criteria for the higher of two ratings, the higher rating will be assigned; otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. In general, it is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, this doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3.

The Veteran's LLE and RLE radiculopathies are evaluated under 38 C.F.R. § 4.124a, DC 8520, for sciatic nerve paralysis. Under these criteria, mild incomplete paralysis warrants a 10 percent rating. Moderate incomplete paralysis warrants a 20 percent rating. Moderately severe incomplete paralysis warrants a 40 percent rating. Severe incomplete paralysis, with marked muscular atrophy, warrants a 60 percent rating. Complete paralysis, with the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost is rated as 80 percent disabling. 38 C.F.R. § 4.124a.

The terms "mild," "moderate," and "severe" are not defined by regulation. For reference, mild is defined as "not severe," or "slight," which is further defied as "small in size, degree, or amount." See Webster's II New College Dictionary 694 (1995), at 1038. Moderate is defined as, "of average or medium quantity, quality, or extent." Id., at 704. Definitions for "severe" include "extremely intense." Id., at 1012. The Board accordingly considers moderately severe symptoms to be greater than average or medium quality, but not extremely intense or causing marked muscular atrophy.

"Incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or
slight," which is further defied as "small in size, degree, or amount." See Webster's II New College Dictionary 694 (1995), at 1038. Moderate is defined as, "of average or medium quantity, quality, or extent." Id., at 704. Definitions for "severe" include "extremely intense." Id., at 1012. The Board accordingly considers moderately severe symptoms to be greater than average or medium quality, but not extremely intense or causing marked muscular atrophy.

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

Ratings are assigned based on the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. When impaired function is wholly sensory, the rating is for the mild, or at most, the moderate degree. Miller, 28 Vet. App. 376.

Treatment records consistently reflect complaints of bilateral foot pain, tingling, and numbness prior to the appeal period. See, e.g., June 2009, June 2010 VA treatment records. The Veteran was afforded a VA spine examination at the outset of his appeal where he reported radiating low back pain down his bilateral legs. See December 2021 VA examination. He reported low back pain symptom flare ups that rendered him unable to stand or walk, but the record does not indicate if, or how, his radiculopathy symptoms played a role in those flare up situations. The VA examiner evaluated the Veteran's symptoms as moderate in severity. No muscle atrophy was seen on examination.

Medical notes for the following year reflect treatment for back pain, without concern for radicular symptoms or need for assistive devices walking. See, e.g., January 2022, April 2022 VA treatment records. An April 2022 VA peripheral nerve examination reflects bilateral sharp pain, numbness, and tingling reports, assessed by the examiner as moderate in severity. No atrophy or other physical impairment was indicated. Reflexes and sensory exams were within normal limits, which is consistent within all the Veteran's VA peripheral nerve examinations. The record does not show need for or use of assistive devices for mobility. A subsequent, March 2023 VA examination reflected worsening symptoms as reported by the Veteran, without physical findings, muscle atrophy, or the need for assistive devices for walking. His LLE and RLE incomplete paralysis symptoms were all identified as moderate in severity.

At a May 2024 VA examination, the Veteran observed that his radicular symptoms worsened early on but have remained stable for the last two to three years prior. He described radiating pain and numbness with occasional thigh spasms with low back pain flare ups. Again, the VA examiner observed moderate symptom severity without the need for assistive devices or resulting in muscle atrophy or other physical symptoms. Gait abnormality was observed.

The record accordingly reflects bilateral lower extremity radiculopathy symptoms that are at least moderate in severity, without resulting in muscle atrophy or requiring assistive devices for ambulation. That said, his LLE and RLE radiculopathy is associated with a service-connected lumbar disability that can result in periods of immobility during symptom flare ups. See December 2021 VA spine examination. He has also described thigh spasms and gait abnormality that were observed by VA examiners. As such, the record reflects bilateral radiculopathy symptoms that manifests with greater than sensory symptoms, without causing atrophy. This warrants bilateral 30 percent ratings under the provisions of 38 C.F.R. § 4.124a, DC 8520, for the entire period on appeal.

Those symptoms warranting a
in muscle atrophy or requiring assistive devices for ambulation. That said, his LLE and RLE radiculopathy is associated with a service-connected lumbar disability that can result in periods of immobility during symptom flare ups. See December 2021 VA spine examination. He has also described thigh spasms and gait abnormality that were observed by VA examiners. As such, the record reflects bilateral radiculopathy symptoms that manifests with greater than sensory symptoms, without causing atrophy. This warrants bilateral 30 percent ratings under the provisions of 38 C.F.R. § 4.124a, DC 8520, for the entire period on appeal.

Those symptoms warranting a higher rating for muscular atrophy or complete paralysis, including foot dangle and/or drop, without active movement possible below the knee, are not reflected on record. Likewise, the record does not reflect radiculopathy symptoms not contemplated by applicable diagnostic criteria. The Veteran's pain, numbness, and functional loss are contemplated by the rating criteria, without indicating complete nerve paralysis, hospitalization, or surgical intervention for the same. Thun v. Peake, 22 Vet. App. 111, 115-16 (2008). Extraschedular consideration is accordingly not for application.

The evidence is accordingly in approximate balance for versus against the claim. As such, the Veteran's service-connected LLE and RLE radiculopathies warrant 30 percent ratings for the entire period on appeal. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001). Entitlement to these ratings from November 29, 2021, is accordingly hereby GRANTED.

3. Entitlement to a 10 percent rating for sinusitis from August 10, 2022, is granted.

The Veteran additionally asserts that his sinusitis symptoms manifest with sufficient severity to warrant a compensable rating. He was awarded service connection for this disability in the May 2023 rating decision previously referenced. The Board finds that he has continued to pursue an increased rating since. Chisholm, 38 Vet. App. 140. The period on appeal stems from August 10, 2022, the effective date of the award of service connection as based on his award of service connection under the provisions of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act, Pub. L. No. 117-168 § 3373, 136 Stat. 1759 (2022). Fenderson, 12 Vet. App. 119. The general principles for increased ratings, identified above, also apply to this claim.

The Board is cognizant that the record reflects additional development of this claim outside of this specific appeal. First, the Veteran claimed entitlement to a compensable sinusitis rating in the April 2025 Request for Higher-Level Review previously addressed. In that filing, he appealed a February 2025 rating decision and additionally cited an August 2024 rating decision. However, in the April 2025 VA Form 10182 before the Board, he only appealed the August 2024 rating decision denying this claim. The Board accordingly concludes that a concurrent election is not present, as the April 2025 Request for Higher-Level Review and VA Form 10182 appeal different rating decisions, triggering two separate appeal streams.

Additionally, the record reflects that the Veteran filed an October 2025 claim for an increased sinusitis rating, resulting in a later award of a 10 percent rating for sinusitis. See December 2025 rating decision. The Board is limited in its review to evidence submitted prior to the August 2024 rating decision on appeal. 38 C.F.R. §§ 20.300, 20.301, 20.801. As such, evidence added to the record after that date cannot be considered by the Board.

The Veteran's sinusitis is rated pursuant to 38 CFR § 4.97, DC 6512 for frontal, chronic sinusitis. Under DC 6512, a noncompensable rating (0 percent) is warranted for sinusitis that is detected by X-ray only. A 10 percent rating is warranted for one or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 30 percent rating is warranted three or more incapacitating episodes per year of
the record after that date cannot be considered by the Board.

The Veteran's sinusitis is rated pursuant to 38 CFR § 4.97, DC 6512 for frontal, chronic sinusitis. Under DC 6512, a noncompensable rating (0 percent) is warranted for sinusitis that is detected by X-ray only. A 10 percent rating is warranted for one or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 30 percent rating is warranted three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting.

A maximum 50 percent rating is warranted following radical surgery with chronic osteomyelitis, or near constant sinusitis characterized by headaches, pain and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. Id.

The rating criteria of DC 6512 are considered successive, meaning that a claimant cannot fulfill the criteria of the higher rating without fulfilling those of the next lower rating. Johnson v. Wilkie, 30 Vet. App. 245, 252 (2018). An incapacitating episode of sinusitis is defined by regulation as "one that requires bed rest and treatment by a physician." See Note at 38 CFR § 4.97. The rating criteria for sinusitis under DC 6512 do not consider the ameliorative (beneficial) effects of medication. See Jones v. Shinseki, 26 Vet. App. 56, 63 (2012).

As such and in order to grant a compensable rating, the evidence must reflect at least one or two incapacitating episodes per year of sinusitis with four to six weeks antibiotic treatment, or three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. For the reasons that follow, the Board finds entitlement to a 10 percent rating, but no higher, warranted.

Treatment records during the appeal period consistently reflect reported seasonal allergies with congestion and watery eyes. See, e.g., June 2021, September 2022, September 2023 VA treatment records. The record does not indicate antibiotics prescribed for sinusitis or respiratory complaints, or sinus surgery.

A March 2023 VA sinusitis examination found allergic rhinitis and sinusitis. The Veteran reported symptoms twice weekly at onset during service, with current sneezing, congestion, runny nose, and swollen, itchy eyes. He also reported symptoms worsening since, with treatment from VA providers. He endorsed using apple cider vinegar for symptom control. The VA examiner found frontal and ethmoid sinuses effected, with headaches, sinus tenderness, and purulent discharge indicative of chronic symptoms. No incapacitating episodes, prolonged antibiotic use, or sinus surgery were found. A February 2023 sinus x-ray was referenced, finding no abnormalities. No functional impact was attributed to the claimed condition.

At a May 2024 VA sinusitis examination, the Veteran reported similar symptoms including sneezing, congestion, nasal drainage, headaches, and sinus pressure. The only treatment endorsed was use of apple cider vinegar. The examiner again found headaches, sinus pain, and discharge indicated, without incapacitating episodes, prolonged antibiotic use, or need for surgical intervention. No new x-rays or radiology reports were addressed.

A February 2025 VA sinusitis examination reiterated these findings, adding that the Veteran reported use of over the counter allergy medications for symptom control during multiple sinusitis episodes throughout the year. Headaches, sinus pain, and purulent discharge were again documented. Radiology performed for the examination was within normal limits, finding "no acute or chronic sinus disease." Again, the examiner did not find incapacitating episodes, prolonged antibiotic use, or surgical intervention for the claimed condition.

The record accordingly reflects that the Veteran experiences multiple, non-incapacitating, intermittent episodes of sinusitis symptoms annually, with headaches, sinus pain, and purulent discharge, without the need for antibiotics or surgical intervention. The majority of this evidence is provided by the Veteran's statements at his VA examinations, as the medical record does not reflect ongoing or repeated treatment for sinusitis. The Veteran's statements are competent to establish symptoms, their severity, and their recurrent nature. 38 C.F.R. § 3.159(a); Layno v. Brown, 6 Vet. App. 465,
Again, the examiner did not find incapacitating episodes, prolonged antibiotic use, or surgical intervention for the claimed condition.

The record accordingly reflects that the Veteran experiences multiple, non-incapacitating, intermittent episodes of sinusitis symptoms annually, with headaches, sinus pain, and purulent discharge, without the need for antibiotics or surgical intervention. The majority of this evidence is provided by the Veteran's statements at his VA examinations, as the medical record does not reflect ongoing or repeated treatment for sinusitis. The Veteran's statements are competent to establish symptoms, their severity, and their recurrent nature. 38 C.F.R. § 3.159(a); Layno v. Brown, 6 Vet. App. 465, 470 (1994) (providing that a Veteran is competent to report on that of which he or she has personal knowledge).

That said, there is little evidence of record to indicate how often the sinusitis episodes manifest. At the February 2025 VA sinusitis examination, the Veteran described his sinusitis episodes as "occasional." Occasional is defined as "encountered, occurring, appearing, or taken at irregular or infrequent intervals." See https:/merriam-webster.com/dictionary/occasional. The Veteran also stated that his sinusitis treatment was generally with VA providers. See March 2023 VA examination. However, VA records do not reflect repeated or ongoing treatment for sinusitis or seasonal allergies at any point during the appeal period. The record merely reflects that the Veteran had seasonal allergies with associated headaches and congestion.

Resolving reasonable doubt in the Veteran's favor, the Board accordingly finds sufficient evidence to establish three to six non-incapacitating episodes of sinusitis characterized by headaches, pain, and purulent discharge annually. This is sufficient to warrant a 10 percent rating for the entire period on appeal. 38 CFR § 4.97, DC 6512. That said, considering that the medical record does not reflect complaints or treatment regarding sinusitis symptoms, and the Veteran endorsed only "occasional" episodes, the Board does not find the evidence establishing episodes more than six times annually. The Veteran has not asserted, and the record does not reflect, incapacitating episodes, episodes requiring antibiotic treatment or surgical intervention, or sinusitis symptoms not contemplated by the rating criteria. A rating in excess of 10 percent is not for application.

Finally, the Board is obligated to consider whether a greater award, based on an earlier effective date of compensation, is applicable. The effective date of an evaluation and award of compensation is the day following separation from active duty service or the date entitlement arose if the claim is received within one year after separation from service; otherwise, it is the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a)-(b)(1); 38 C.F.R. § 3.400(b)(2). The Veteran filed his service connection claim for sinusitis in January 2023. However, he was awarded service connection effective August 10, 2022, consistent with the enactment of the PACT Act and entitlement to service connection for sinusitis on a presumptive basis. See May 2023 rating decision; 38 U.S.C. §§ 1116, 1119; 38 C.F.R. § 3.105, 3.114, 3.400.

A close review of the record shows no service connection claim for sinusitis, rhinitis, seasonal allergies, or another respiratory condition pending earlier than his January 2023 compensation claim. As such, the earliest date of service connection available is August 10, 2022, the enactment date of the PACT Act.

The record does not reflect hospitalization for, or treatment of sinusitis symptoms not contemplated by applicable diagnostic criteria. Extraschedular consideration is accordingly not for application. Thun, 22 Vet. App. at 115-16. That said, the evidence remains in approximate balance for versus against the claim. Entitlement to a 10 percent rating for sinusitis for the entire period on appeal is accordingly GRANTED. Lynch, 21 F.4th 776; Ortiz, 274 F.3d 1361.

4. Entitlement to a compensable rating for rhinitis is denied.

The Veteran asserts that his rhinitis disability manifests with symptoms warranting a compensable rating. He was awarded service connection for this disability in the May 2023 rating decision previously referenced. The Board finds that he has continued to pursue an increased rating since. Chisholm, 38 Vet. App. 140. The period on appeal stems from August
in approximate balance for versus against the claim. Entitlement to a 10 percent rating for sinusitis for the entire period on appeal is accordingly GRANTED. Lynch, 21 F.4th 776; Ortiz, 274 F.3d 1361.

4. Entitlement to a compensable rating for rhinitis is denied.

The Veteran asserts that his rhinitis disability manifests with symptoms warranting a compensable rating. He was awarded service connection for this disability in the May 2023 rating decision previously referenced. The Board finds that he has continued to pursue an increased rating since. Chisholm, 38 Vet. App. 140. The period on appeal stems from August 10, 2022, the effective date of the award of service connection as based on his award of service connection under the provisions of the PACT Act. Fenderson, 12 Vet. App. 119. The general principles for increased ratings, identified above, also apply to this claim.

The Veteran's disability is evaluated as allergic rhinitis and rated under 38 C.F.R. § 4.97, DC 6522. Under DC 6522, allergic rhinitis warrants a 10 percent rating when there are no nasal polyps but there is greater than 50 percent obstruction of nasal passages on both sides or complete obstruction on one side. A maximum rating of 30 percent is warranted when polyps are present. Id. In every case 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 evaluation are not met. 38 C.F.R. § 4.31.

The record reflects x-rays performed on the Veteran's nasal passages and sinuses in February 2023 and February 2025, neither of which showed any obstruction. VA examinations from March 2023, May 2024, and February 2025 likewise found no nasal obstruction or polyps present. These findings are unrefuted on record.

The rating criteria under DC 6522 are objective, requiring specific findings diagnosed by medical providers using medical equipment. The Board acknowledges the Veteran's statement that his disability warrants a higher rating, but while he is competent, as a layman, to report observable symptoms, he is not competent to assess the nature and degree of nasal obstruction as opposed to mere congestion, for instance. A degree of obstruction and the presence of nasal polyps present complex medical determinations that the record does not show he has the medical training and experience to offer. See Layno, 6 Vet. App. 465; Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The record does not reflect any rhinitis symptoms not contemplated by the rating schedule.

As the evidence is neither evenly balanced nor approximately so, the benefit of the doubt doctrine does not apply. Lynch, 21 F.4th 776. The persuasive weight of the evidence is against the Veteran's claim. Accordingly, the Veteran's claim for a compensable rating for rhinitis is hereby DENIED.

5. Entitlement to service connection for chronic fatigue syndrome (CFS) is denied.

The Veteran additionally asserts that he has CFS due to active service, including service in the Persian Gulf.

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. Generally, service connection requires (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).

In every case, however, establishing entitlement to service connection requires the evidence of the claimed disability. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The term "disability" for VA compensation purposes does not always require a clear clinical diagnosis or precisely identifiable pathology underlying the claimed manifestations, provided that such manifestations result in functional impairment in earning capacity. Saunders v. Wilkie, 886 F.3d 1356 (2018). In cases of Persian Gulf War veterans, service connection may be granted for certain illnesses that are undiagnosed or medically unexplained. See 38 C.F.R. § 3.317(a).

In the latter circumstances, however,
, however, establishing entitlement to service connection requires the evidence of the claimed disability. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The term "disability" for VA compensation purposes does not always require a clear clinical diagnosis or precisely identifiable pathology underlying the claimed manifestations, provided that such manifestations result in functional impairment in earning capacity. Saunders v. Wilkie, 886 F.3d 1356 (2018). In cases of Persian Gulf War veterans, service connection may be granted for certain illnesses that are undiagnosed or medically unexplained. See 38 C.F.R. § 3.317(a).

In the latter circumstances, however, service connection may be granted only for a "qualifying chronic disability," defined by a cluster of signs or symptoms, such as exists with CFS, lasting for at least six months and resulting from any of the undiagnosed illnesses or a medically unexplained chronic multi-symptom illness (MUCMI). See 38 C.F.R. § 3.317(a)(2)(B)(1)-(2).

As alluded, CFS requires a showing of signs and symptoms, and is not synonymous with experiencing persistent symptoms of fatigue. For VA purposes, a CFS diagnosis requires new onset of debilitating fatigue severe enough to reduce daily activity to less than 50 percent of the usual level for at least six months along with six or more of the following signs and symptoms: acute onset of the condition; low grade fever; nonexudative pharyngitis; palpable or tender cervical or axillary lymph nodes; generalized muscle aches or weakness; fatigue lasting 24 hours or longer after exercise; headaches; migratory joint pains; neuropsychologic symptoms; and/or sleep disturbance. 38 C.F.R. § 4.88a.

The Board finds that that evidence of record persuasively weighs against finding that the Veteran has a diagnosis of CFS, as defined by VA, at any time during or approximate to the pendency of the claim. The post-service medical record is generally absent complaints of generalized fatigue or prolonged fatigue after exercise, continued or repeated low grade fever, pharyngitis, or palpable or tender lymph nodes. There is no indication of acute onset complaints. To date, the treatment record does not reflect a diagnosis of, or medication to treat, CFS.

At a May 2024 VA CFS examination, the Veteran reported noticing increased fatigue, headaches, chronic lower extremity pain, back pain, and lymph node enlargement that remained for 2 to 3 years after onset in 2006. He reported current symptoms as bilateral lower extremity and back pain, headaches 4 to 5 times weekly, nasal congestion, sinus pressure, and daily mild fatigue. The VA examiner found these reports, and the medical record, did not support acute onset of symptoms, or debilitating fatigue reducing daily activity to 50 percent of pre-illness level. The examiner also found that the Veteran's reports did not support finding at least 6 signs or symptoms of CFS. No functional impairment of earning capacity was identified. As such, CFS was not diagnosed.

Notably, the Veteran's endorsed headaches, sleep disturbances, nasal congestion, and body pain are VA-compensated symptoms attributed to other service-connected conditions, including migraines, posttraumatic stress disorder (PTSD), sinusitis, lower extremity radiculopathies, and lumbosacral degenerative disc disease. See August 2024, July 2025, September 2025, December 2025 rating decisions. A veteran may not be compensated twice for the same symptomatology as "such a result would over compensate the claimant for the actual impairment of his earning capacity." Brady v. Brown, 4 Vet. App. 203, 206 (1993). This would result in pyramiding, contrary to the provisions of 38 C.F.R. § 4.14. See Esteban v. Brown, 6 Vet. App. 259 (1994); Fanning v. Brown, 4 Vet. App. 225 (1993). Further, those symptoms are accordingly attributed to diagnosed etiologies, rather than CFS or a MUCMI.

The VA examiner's findings are unrefuted on record. The Veteran has not provided nor identified any competent evidence, medical evidence, showing he has been assessed or diagnosed with CFS. Although the Veteran is competent to report symptoms of CFS, he is not competent to diagnose himself with this medically complex condition. Jandreau, 492 F.3d at 1377 n.4. The Board assigns significant probative value to the May 2024 VA CFS examination as it was made by a trained medical professional after in-person examination of the Veteran and review of his records and is consistent with the medical record. Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (the probative value of a medical opinion is the clinician's access to the claims file and the thoroughness and detail of the opinion). The Board is additionally cognizant that the medical record shows the Veteran's claimed symptoms do not present functional impairment sufficient to qualify as a compensable disability, regardless of an affirmative diagnosis. Saunders v. Wilkie, 886 F.3d 1356, 1367-69 (Fed. Cir. 2018).

Given the above, the first element of a claim for service connection has not been met. In the absence of proof of a present disability (and, if so, of a nexus between that disability and service), there can be no valid claim for service connection. See Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer, 3 Vet. App. at 225. As the evidence of record persuasively weighs against the claim, the benefit-of-the-doubt rule does not apply, and entitlement to service connection for CFS is DENIED. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Lynch, 21 F.4th 776.

REASONS FOR REMAND

1. Entitlement to an increased disability rating for right knee arthritis is remanded.

The Veteran additionally requests service connection for right knee arthritis. Unlike his left knee claim, the Veteran's April 2025 VA Form 10182 appealed a March 2025 rating decision not mentioned in the April 2025 Request for Higher-Level Review. As such, concurrent election is not present, and this claim remains before the Board. Regrettably, this matter must be remanded to correct a pre-decisional duty to assist error in failing to obtain Department of Veterans Affairs (VA) treatment records. 38 C.F.R. § 3.159(c)(3).

VA has a duty to obtain any VA treatment records, which are considered within VAs constructive possession and potentially relevant to the issue on appeal. Id. The available ratings for a knee disabilities include those for recurrent subluxation and meniscal injuries. VA treatment records show the Veteran was repeatedly referred for knee imaging in early 2024, indicating interior derangement, with a note entered in July 2024 that the imaging would be completed at a community care location. See also May 2024 VA treatment records. Subsequent, November 2024 VA records referred to scanned VISTA records consistent with the ordered MRIs. However, the MRIs themselves and related imaging reports are not of record.

At a March 2025 VA knee examination, the Veteran attested to ongoing recurrent subluxation. The examination report did not refer to new radiology or the MRIs taken in the year prior. Failure to obtain these records accordingly appears to have resulted in the VA examiner's failure to review them, which constitutes a pre-decisional duty to assist error requiring remand to remedy.

2. Entitlement to service connection for a left elbow condition is remanded.

3. Entitlement to service connection for a right elbow condition is remanded.

Finally, the Veteran asserts entitlement to bilateral elbow conditions. The Board finds a pre-decisional error in failing to afford the Veteran a VA examination for these claimed conditions. 38 C.F.R. § 3.159(c)(4).

2. Entitlement to service connection for a left elbow condition is remanded.

3. Entitlement to service connection for a right elbow condition is remanded.

A VA examination is required when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 U.S.C. § 5103A(d)(2), 38 C.F.R. § 3.159(c)(4)(i).

Although the Veteran's service treatment records do not reflect direct treatment for elbow pain, they refer to upper extremity numbness and tingling, associated with his service-connected upper extremity radiculopathy. Treatment records indicate chronic bilateral elbow pain, preexisting at least several years he sought treatment from VA providers in March 2017 VA. That treatment continued, with x-rays ordered by VA providers in November 2024. Resolving reasonable doubt in the Veteran's favor, the Board finds sufficient evidence of record to indicate current conditions that may be associated with service and therefore, an examination is warranted. McLendon, supra.

The matters are REMANDED for the following action(s):

1. Obtain the Veteran's VA treatment records for the period from May 2024 to January 2025, with particular attention to any and all VISTA documents, scanned images, or radiology reports generated in that time.

2. Schedule the Veteran for a VA examination for bilateral elbow conditions. The examiner must review the claims file.

If a diagnosis cannot be provided but the Veteran's symptoms manifest as to cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below.

The examiner is asked to provide a response to the following:

Is the left or right elbow condition at least as likely as not related to service, including the specific circumstances of the Veteran's service and military occupational specialty?

Is it at least as likely as not that the claimed conditions (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service?

Provide a rationale to support the opinion(s).

(This space intentionally left blank. VLJ signature on next page.)

J.P. Norman

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board W. Stearns, Counsel

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

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