NEURALGIA, CRANIAL OR PERIPHERAL

LEETRA J. HARRIS · 2026 · Case ID: A26040536

MIXED

Summary

The veteran served from January 1971 to October 1973 and January 1976 to December 1979. The veteran appeals the denial of an increased rating for left upper extremity radiculopathy and the dismissal of claims for osteoma, left hip, and tinnitus. The Board granted an initial 30 percent rating for right upper extremity radiculopathy, finding the criteria met based on moderate intermittent pain and mild sensory loss, identifying the median nerve, consistent with neuralgia under DC 8715. However, the Board denied an increased rating for left upper extremity radiculopathy, finding the evidence weighed against moderate or severe neuritis, paralysis, or higher ratings under DC 8715, and noted the AOJ's incorrect use of DC 8511. The Board dismissed the osteoma claim as already service-connected and the tinnitus claim as being appealed in a separate docket. The case was remanded for further development on Parkinson's disease, due to a conceded toxic exposure risk activity (TERA) related to herbicide exposure in Thailand and an unclear diagnosis, and for a psychiatric evaluation to address claimed conditions like Alzheimer's, depression, anxiety, and insomnia, as the prior VA exam was inadequate for failing to comment on anxiety and review service treatment records.

Rationale

Met criteria for 30 percent rating under DC 8715; Moderate intermittent pain, mild sensory loss, moderate paresthesias/dysesthesias; Neuralgia distribution identified median nerve

Special Benefit

NO SPECIAL BENEFIT

Docket No.

260330-641523

Full Decision Text

Citation Nr: A26040536
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 260330-641523
DATE: April 30, 2026

ORDER

Entitlement to an initial 30 percent rating for radiculopathy, right upper extremity, is granted.

Entitlement to an initial rating in excess of 20 percent for radiculopathy, left upper extremity, is denied.

Entitlement to service connection for osteoma, left hip, is dismissed.

Entitlement to service connection for tinnitus is dismissed.

REMANDED

Entitlement to service connection for Parkinson's disease is remanded.

Entitlement to service connection for an acquired psychiatric condition, to include Alzheimer's, depression, and insomnia, is remanded.

FINDINGS OF FACT

1. The Veteran's right upper extremity radiculopathy, dominant hand, manifested with symptoms of neuralgia characterized by moderate dull intermittent pain allowing for the identification of the median nerve.

2. The Veteran's left upper extremity radiculopathy, nondominant hand, manifested with symptoms of neuralgia characterized by moderate dull intermittent pain allowing for the identification of the median nerve.

3. The Veteran is already service-connected for osteoma, left hip, and thus, there remains no justiciable case or controversy over the issue.

4. The issue of service connection for tinnitus is already on appeal under docket 260127-628702.

CONCLUSIONS OF LAW

1. The criteria for an initial 30 percent rating for radiculopathy, right upper extremity, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8711.

2. The criteria for an initial rating in excess of 20 percent for radiculopathy, left upper extremity, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8711.

3. The criteria for dismissal of service connection for osteoma, left hip, have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.104.

4. The criteria for dismissal of service connection for tinnitus have been met. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.2500(b), 20.104.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from January 1971 to October 1973 and from January 1976 to December 1979.

The rating decisions on appeal were issued in January 2026 and February 2026 and they constitute initial decisions; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In the March 2026 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 January 2026 and February 2026 agency of original jurisdiction (AOJ) decisions on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decisions on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 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.

After reviewing the evidence of record, and in light of Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009), the Board has recharacterized the separate issues of service connection for insomnia, depression, and cognitive defect to encompass any acquired psychological disorder, to include Alzheimer's, depression, and insomnia.

In light of Williams v. McDonough, 37 Vet. App. 305 (2024), the Veteran has highlighted that he "will not submit any additional evidence" in his March 30, 2026, VA Form 10182. After receipt of the March 31, 2026, BVA Docketing Letter, the Veteran resubmitted his VA Form 10182 on April 6, 2026, without changing lanes and again highlighting that he "will not submit any additional evidence." As such, the Board finds this to be an adequate waiver of the Veteran's right to switch dockets.

This case has been advanced on the docket pursuant to 38 U.S.C. § 7107(b) and 38 C.F.R. § 20.902(c).

Increased Ratings

Disability evaluations are determined by the application of the facts presented to the VA's Schedule for Rating Disabilities (Rating Schedule) at 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 the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

Where an increase in the level of a disability is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55 (1994).

Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Reasonable doubt as to the degree of disability will be resolved in the Veteran's favor. 38 C.F.R. § 4.3.

Separate evaluations may be assigned for separate periods of time if such distinct periods are shown by the competent evidence of record during the appeal, a practice known as "staged" ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). VA's determination of the present level of a disability may result in a conclusion that the disability has undergone varying and distinct levels of severity throughout the entire time period the increased-rating claim has been pending. Hart v. Mansfield, supra.

1. Entitlement to an initial 30 percent rating for radiculopathy, right upper extremity, is granted.

2. Entitlement to an initial rating in excess of 20 percent for radiculopathy, left upper extremity, is denied.

The Veteran seeks an initial rating, in excess of 20 percent, for his right and left upper extremity radiculopathies. See March 2026 VA Form 10182.

The Veteran is currently rated at 20 percent separately for each right and left upper extremity radiculopathy under 38 C.F.R. § 4.124a, Diagnostic Code 8511. The appeal period begins on August 6, 2025, with the Veteran's VA Intent to File.

Paralysis of the median nerve is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, Diagnostic Code 8515. Neuritis and neuralgia of that group are evaluated under Diagnostic Codes DC 8615 and 8715. Under this criteria, mild incomplete paralysis is rated as 10 percent for both the major and minor extremity. Moderate incomplete paralysis is rated as 30 percent for the major extremity and 20 percent for the minor extremity. Severe incomplete paralysis is rated as 50 percent for the major extremity and 40 percent for the minor extremity. Complete paralysis is rated as 70 percent for major extremity and 60 percent for the minor extremity. 38 C.F.R § 4.124a.

The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based 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,
ity. Severe incomplete paralysis is rated as 50 percent for the major extremity and 40 percent for the minor extremity. Complete paralysis is rated as 70 percent for major extremity and 60 percent for the minor extremity. 38 C.F.R § 4.124a.

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

Neuralgia, cranial or peripheral, characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve, is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. Tic douloureux, or trifacial neuralgia, may be rated up to complete paralysis of the affected nerve. 38 C.F.R. § 4.124.

In a December 2025 VA examination, the examiner found mild constant pain, moderate intermittent pain, moderate paresthesias and or dysesthesias, and moderate numbness in the left and right upper extremities. Muscle strength was normal. Sensory exam showed decreased sensation in the left and right hands and fingers. There were no trophic changes. Median nerve testing revealed positive Phalen's sign and Tinel's sign with mild incomplete paralysis. The remaining nerves in the left and right arms were normal. The examiner noted that "occupational tasks which require the usage of bilateral hands picking up objects and performing repetitive motions with typing on a keyboard must be avoided to prevent a flare-up" in the Veteran. The Veteran is noted as right hand dominant.

Regarding pain, the evidence shows the presence of neuralgia as contemplated by 38 C.F.R. § 4.124. When there is neuralgia, usually characterized by dull and intermittent pain of a typical distribution so as to identify the nerve, it is to be rated on the same scale, with a maximum equal to moderate incomplete paralysis. See id. In the present case, the examiner found moderate intermittent or dull pain that was of a distribution to be able to identify the median nerve.

Regarding neuritis, under 38 C.F.R § 4.123, the examiner did not find loss of reflexes or muscle atrophy. The constant pain was noted as mild, and sensory loss was limited to the left and right hands and fingers. Therefore, a rating under neuralgia is more beneficial to the Veteran.

Based on the above, the Board finds that the disability manifested by peripheral neuralgia due to dull or intermittent pain with mild sensory loss, of a typical distribution to identify the median nerve. Moreover, the examiner noted moderate paresthesias and/or dysesthesias and numbness. Therefore, the Board finds that a 30 percent rating for the right upper extremity radiculopathy is warranted under DC 8715; however, an initial rating in excess of 20 percent for the left upper extremity radiculopathy is not warranted.

The Board also finds that the most probative evidence of record is against a finding that either disability manifested with moderate or severe neuritis, severe incomplete paralysis of the median nerve, or complete paralysis of the median nerve.

The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves that have not already been service-connected. Therefore, a separate or higher rating under a different Diagnostic Code is not warranted.

The Board notes that the AOJ has previously rated the Veteran's condition under DC 8511. This is not
8715; however, an initial rating in excess of 20 percent for the left upper extremity radiculopathy is not warranted.

The Board notes that the AOJ has previously rated the Veteran's condition under DC 8511. This is not an appropriate rating code as the evidence does not show any paralysis of the middle radicular group, but rather only the median nerve. See December 2025 VA examination. Thus, the Board cannot grant a higher rating using DC 8511.

The Board has considered the Veteran's statements regarding his upper radicular symptoms. The Veteran's statements are competent evidence as to his upper radicular symptoms because this comes to him through his senses and credible to the extent that they are consistent with the medical evidence of the record. However, his statements are not competent evidence as to a specific level of disability according to the appropriate diagnostic codes. See Robinson v. Shinseki, 557 F.3d 1355 (2009). Evidence concerning the nature and extent of the Veteran's upper radicular symptoms has been provided by the medical personnel who have examined him at various times during the current appeal and who have rendered pertinent opinions in conjunction with the physical evaluations. The medical findings as provided in the examination reports directly address the criteria under which this type of disability is evaluated. The Board, therefore, finds the medical findings to be of a greater probative value as to the current severity of the Veteran's upper radicular symptoms than his statements.

In conclusion, the Board finds that the evidence of record persuasively weighs in favor of a 30 percent disability rating for his right upper extremity radiculopathy, and a 20 percent for his left upper extremity radiculopathy under DC 8715, but against a higher rating for either. As the evidence of record is persuasive, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

3. Entitlement to service connection for osteoma, left hip, is dismissed.

The Veteran claims that his insomnia was caused by pain in his left hip, to include radiculopathy. See March 2026 VA Form 10182. Specifically, the Veteran's representative has asserted that the Veteran's left hip condition is due directly to his service. See April 1, 2026, Informal Hearing Presentation.

As a general matter, the grant of a service connection claim constitutes a full grant of benefits sought on appeal. See Seri v. Nicholson, 21 Vet. App. 441, 447 (2007); see also Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). In the present case, the November 2014 rating decision granted service connection for osteoma, left hip. Also, in the January 2026 rating decision, service connection was granted for sciatica, left lower extremity.

The Board may dismiss any appeal which fails to allege a specific error of fact or law in the determination being appealed. 38 U.S.C. § 7104; 38 C.F.R. § 20.104. Here, the November 2014 rating decision has already granted service connection for osteoma, left hip, and the January 2026 rating decision has granted service connection for sciatica, left lower extremity. There is no justiciable case or controversy regarding the issue of service connection for a left hip condition. Therefore, the Board lacks jurisdiction over the appealed issue, and dismissal is warranted. 38 U.S.C. §§ 7104, 7105; 38 C.F.R. §§ 20.103, 20.104.

4. Entitlement to service connection for tinnitus is dismissed.

The Veteran asserts that his tinnitus is due to service. See April 1, 2026, Informal Hearing Presentation.

Service connection for tinnitus is already on appeal, docket number 260127-628702, stemming from the Veteran's February 5, 2026, VA Form 10182.

Simply stated, the Veteran cannot appeal the same issue at the same time
connection for a left hip condition. Therefore, the Board lacks jurisdiction over the appealed issue, and dismissal is warranted. 38 U.S.C. §§ 7104, 7105; 38 C.F.R. §§ 20.103, 20.104.

4. Entitlement to service connection for tinnitus is dismissed.

The Veteran asserts that his tinnitus is due to service. See April 1, 2026, Informal Hearing Presentation.

Service connection for tinnitus is already on appeal, docket number 260127-628702, stemming from the Veteran's February 5, 2026, VA Form 10182.

Simply stated, the Veteran cannot appeal the same issue at the same time in two appeal streams.

Additionally, the Veteran has not changed dockets for the issue of service connection for tinnitus since submitting the February 5, 2026, VA Form 10182, or the February 26, 2026, VA Form 10182, .

Therefore, the Board will dismiss the issue here, as this appeal comes later in time; the issue is already pending in docket number 260127-627802; and no change to the review lane has been made by the Veteran. See 38 U.S.C. § 7105.

REASONS FOR REMAND

1. Entitlement to service connection for Parkinson's disease is remanded.

The Veteran contends that he has Parkinson's disease, or tremors, due to his service. See March 2026 VA Form 10182.

The Veteran is not currently diagnosed with Parkinson's disease, however an August 31, 2015, VA treatment record shows that the Veteran was diagnosed with Parkinsonism.

Service treatment records are silent for diagnosis or treatment of Parkinson's disease or tremors.

Service records show that the Veteran served in Thailand and participation in a toxic exposure risk activity (TERA) was conceded due to herbicide exposure in the February 2026 rating decision.

The low threshold for ordering an exam for a TERA opinion has been met because it is not clear whether the Veteran still has a current diagnosis of Parkinsonism, or if that condition has been subsumed under the Alzheimer's diagnosis. Since a VA examination for Parkinson's disease has not yet been obtained, a pre-decisional duty to assist error has occurred that must be corrected.

The Board recognizes the Veteran's difficult situation and has determined that if it is not possible for the Veteran to attend an in-person examination, an opinion is sufficient.

2. Entitlement to service connection for an acquired psychiatric condition, to include Alzheimer's, depression, and insomnia, is remanded.

The Veteran contends that he has a psychiatric condition, including depression and anxiety, due to service, Parkinson's disease, and/or caused or aggravated by pain, limitations, distractions. See January 2026 Supplemental Claim; see also March 2026 VA Form 10182. Additionally, he asserts that he has insomnia is secondary to his service-connected disabilities. See id.

In a February 23, 1973, service treatment record, the Veteran complained of being unable to sleep for the last few days. He was assessed as having anxiety.

In a March 9, 1973, service treatment record, the Veteran reported problems of being tense and was prescribed Valium. He reported not being able to sleep and a lack of interest in work.

In a February 2026 VA examination, the examiner opined that there was no diagnosis of depression or insomnia as these symptoms were subsumed under the Veteran's Alzheimer's disease diagnosis. The examiner failed to comment on the Veteran's claimed anxiety. Additionally, the examiner failed to review or comment on the Veteran's service treatment records showing that he was assessed as having anxiety in service and prescribed Valium. Therefore, the Board finds this examination and corresponding medical opinion inadequate. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007). As such, a pre-decisional duty to assist error has occurred.

The matters are REMANDED for the following action:

1. Obtain a VA TERA opinion concerning the Veteran's claimed Parkinson's disease.

(A) Confirm whether there is a current diagnosis to include Parkinson's disease, Parkinsonism, or tremors. If there is no current diagnosis, the examiner must explain whether the claimed diagnosis has been subsumed or combined with the current Alzheimer's diagnosis.

(B) Opine whether it is at least as likely as not that the Veteran's diagnosis is related to his toxic exposure risk activities, to include herbicide exposure in Thailand, chemicals, solvents, degreasers, and paint.

In answering this question,
). As such, a pre-decisional duty to assist error has occurred.

The matters are REMANDED for the following action:

1. Obtain a VA TERA opinion concerning the Veteran's claimed Parkinson's disease.

In answering this question, the clinician must consider the following: 1) the total potential exposure through all applicable deployments; and 2) the synergistic, combined effect of all toxic exposure risk activities of the Veteran.

2. Schedule a VA examination with an appropriate clinician to address the claimed acquired psychiatric condition, to include Alzheimer's, depression, anxiety, and insomnia. The examiner must address the following:

(A) Opine whether any of the Veteran's psychiatric disabilities are at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) related to his service, to include his anxiety and prescription for Valium in service.

(B) If the examiner finds that a mental health diagnosis existed prior to the Veteran's Alzheimer's disease, but the current symptoms can no longer be separated, the examiner should still attempt to opine whether that disability was related to service.

The examiner must provide a complete rationale for any opinion rendered. If the examiner cannot provide an opinion without resort to speculation, he or she should explain why an opinion cannot be provided (e.g., lack of sufficient information or evidence, the limits of medical knowledge, etc.).

Leetra J. Harris

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Hall, Michael J.

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.

Analyze in VA Law Explorer