MENTAL DISORDERS, UNSPECIFIED

JENNIFER WHITE · 2026 · Case ID: A26040959

MIXED

Summary

The Veteran, who served in the military from January 2012 to August 2019, appeals two rating decisions from the VA Regional Office (RO). The RO granted service connection for Polycystic Ovary Syndrome (PCOS) with a noncompensable rating but denied a higher rating. The RO also denied service connection for thrombocythemia and denied an increased rating for an acquired psychiatric disorder, initially granting it at 50%. The Veteran sought higher-level review, and the Board of Veterans' Appeals (Board) reviewed the evidence of record at the time of the RO decisions. The Board granted a 70% rating for the acquired psychiatric disorder, effective July 15, 2024, finding that the Veteran's symptoms met the criteria for that rating level, though not the 100% level due to continued full-time employment and stable marital status. The Board denied an increased rating for GERD, finding no evidence of recurrent or refractory esophageal stricture as required by regulation. The claim for a compensable initial rating for PCOS was also denied, as the evidence did not show symptoms requiring continuous treatment or symptoms not controlled by treatment during the appeal period. The case was remanded for thrombocythemia due to an inadequate TERA exposure analysis and for right and left upper extremity radiculopathy due to unclear consideration of medication's ameliorative effects.

Rationale

70% rating granted effective July 15, 2024; Maximum 100% rating not warranted due to full-time employment and stable marriage; No factually ascertainable worsening prior to July 15, 2024

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250528-548203

Full Decision Text

Citation Nr: A26040959
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 250528-548203
DATE: April 30, 2026

ORDER

Beginning July 15, 2024, but no earlier, entitlement to a 70 percent rating, but no higher, for an acquired psychiatric disorder is granted.

Entitlement to a rating in excess of 10 percent for gastroesophageal reflux disease (GERD) is denied.

Entitlement to a compensable initial rating for polycystic ovary syndrome (PCOS) is denied.

REMANDED

Entitlement to service connection for thrombocythemia is remanded.

Entitlement to an increased rating for right lower extremity radiculopathy (sciatic nerve) is remanded.

Entitlement to an increased rating for left upper extremity radiculopathy (middle radicular group) is remanded.

FINDINGS OF FACT

1. The Veteran filed a VA Form 21-526EZ requesting an increased rating for a psychiatric disability on September 14, 2024.

2. Beginning July 15, 2024, the evidence of record weighs persuasively against a finding that the Veteran's acquired psychiatric disorder is manifested by total occupational and social impairment.

3. Prior to July 15, 2024, there is not factually ascertainable worsening of the acquired psychiatric disorder.

4. The evidence of record weighs persuasively against a finding that the Veteran's GERD is manifested by a documented history of recurrent or refractory esophageal stricture(s).

5. The evidence of record weighs persuasively against a finding that the Veteran's PCOS is manifested by symptoms that require treatment or symptoms not controlled by continuous treatment.

CONCLUSIONS OF LAW

1. Beginning July 15, 2024, but no earlier, the criteria for the establishment of a 70 percent rating, but no higher, for an acquired psychiatric disorder have been met. 38 U.S.C. §§ 1155, 5107, 5110; 38 C.F.R. §§ 3.400, 4.1, 4.3, 4.130.

2. The criteria for the establishment of a rating in excess of 10 percent for GERD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.114, Diagnostic Code 7206.

3. The criteria for the establishment of a compensable initial rating for PCOS have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.116, Diagnostic Code 7615.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had confirmed service from January 2012 to August 2019.

This case comes before the Board of Veterans' Appeals (Board) on appeal from two separate May 2025 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO).

In a January 2025 rating decision, the Agency of Original Jurisdiction (AOJ) granted service connection for PCOS, assigning a noncompensable rating, effective September 14, 2024, and continued the assigned ratings for right lower extremity radiculopathy (sciatic nerve), left upper extremity radiculopathy (middle radicular group), and GERD. In a February 2025 rating decision, the AOJ denied service connection for thrombocythemia and increased the Veteran's rating for her acquired psychiatric disorder from 30 percent disabling to 50 percent disabling, effective September 14, 2024.

In February 2025, the Veteran submitted two separate VA Form 20-0996, Decision Review Requests: Higher-Level Review (HLR) and requested review of the January 2025 and February 2025 rating decisions. In May 2025, the AOJ issued two separate HLR decisions on appeal, which considered the evidence of record at the time of the initial rating decisions. Therefore, the Board may only consider the evidence of record at the time of the initial rating decisions (with respect to the issues decided in those decisions).

In the May 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the evidence review docket. Therefore, the Board may only consider the evidence of record at the time of the January 2025 and February 2025 AOJ decisions on appeal (with respect to the issues decided in those decisions), as well as any evidence submitted by the
. In May 2025, the AOJ issued two separate HLR decisions on appeal, which considered the evidence of record at the time of the initial rating decisions. Therefore, the Board may only consider the evidence of record at the time of the initial rating decisions (with respect to the issues decided in those decisions).

In the May 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the evidence review docket. Therefore, the Board may only consider the evidence of record at the time of the January 2025 and February 2025 AOJ decisions on appeal (with respect to the issues decided in those decisions), as well as any evidence submitted by the Veteran or her representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

The Board notes that the AOJ requested the Veteran submit any relevant private treatment records or submit information with which VA can assist the Veteran in obtaining private treatment records. Required notice and information were provided in the claim form which the Veteran signed, certifying to the fact that such notice was received and further that they have included or identified relevant evidence. VA requested records for which the Veteran submitted a proper release and/or adequately identified. The duty to assist is not a one-way street. If a Veteran desires help, she cannot passively wait for it in those circumstances where she may or should have information that is essential in obtaining evidence. Wood v. Derwinski, 1 Vet. App. 190 (1991). Thus, the Board finds that VA has satisfied the duty to assist. No further notice or assistance to the Veteran is required to fulfill VA's duty to assist in development. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); Quartuccio v. Principi, 16 Vet. App. 183 (2002).

The standard set forth in 38 C.F.R. § 3.103(c)(2)(iii) only permits constructive receipt of Veterans Health Administration (VHA) records that not only existed prior to the issuance of the AOJ decision on appeal, but also for which the claimant furnished sufficient information to make the Veterans Benefits Administration (VBA) aware of the existence of those records. Thus, the Board's consideration of VHA records is limited to the same. Here, the Board finds that VA treatment records were obtained and reviewed consistent with 38 C.F.R. § 3.103(c)(2)(iii) and the AMA framework.

Increased Rating Claims

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (Rating Schedule).? 38?C.F.R. Part 4.? The Rating Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service.? The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38?U.S.C. §?1155; 38?C.F.R. §?4.1.? Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned.? 38?C.F.R. §?4.7.? When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant.? 38?C.F.R. §?4.3.????

Acquired Psychiatric Disorder

On September 14, 2024, VA received a VA Form 21-526EZ, Fully Developed Claim, requesting an increased rating claim for an acquired psychiatric disorder. Thus, the Board?will consider whether a higher rating is warranted from September 14, 2024, the date of receipt of the claim, as well as whether there was factually ascertainable worsening during the year prior. See 38?C.F.R. § 3.400. If an increase in severity is
and assembled data, a reasonable doubt arises regarding the degree of disability such doubt will be resolved in favor of the claimant.? 38?C.F.R. §?4.3.????

Acquired Psychiatric Disorder

On September 14, 2024, VA received a VA Form 21-526EZ, Fully Developed Claim, requesting an increased rating claim for an acquired psychiatric disorder. Thus, the Board?will consider whether a higher rating is warranted from September 14, 2024, the date of receipt of the claim, as well as whether there was factually ascertainable worsening during the year prior. See 38?C.F.R. § 3.400. If an increase in severity is discernible during the one-year period prior to the filing date of the claim, the effective date is the date the increase in severity first became discernible. See Gaston?v. Shinseki, 605 F.3d 979, 984 (Fed. Cir. 2010).?

Acquired psychiatric disorders are rated under the Schedule of Ratings for Mental Disorders. 38 C.F.R. § 4.130. Under this diagnostic code, a 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. Id.

A 70 percent rating is warranted for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. Id.

The maximum 100 percent evaluation is warranted for total occupational and social impairment. Id. A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, or for the veteran's own occupation or name.

A private July 15, 2024, psychiatric treatment note reflects the Veteran experienced daily anxiety and had trouble focusing on tasks and irritability. She acknowledged suicidal thoughts almost daily and denied any plan or intent. She acknowledged a history of unstable friendships but reported a stable marriage.

Private mental health evaluations dated August 2024 and September 2024 reflect the Veteran reported thoughts of killing herself but stated she would not carry them out.

At an October 2024 examination, the Veteran reported depression, anxiety, chronic sleep impairment, irritability, concentration issues, panic attacks more than once a week, and daily suicidal ideations with no intent or plan. It was noted she was married and lived with her husband and step-son and that she worked full-time as an attorney.

A January 2025 addendum opinion indicates that the Veteran's panic attacks, chronic sleep impairment, and suicidal ideations are a progression of her service-connected mental health disorder.

Following review of the evidence of record, the Board finds that beginning July 15, 2024, a 70 percent rating, but no higher, is warranted for her acquired psychiatric disorder. The next higher and maximum 100 percent rating is not warranted as she is not totally occupationally and socially impaired; rather, the October 2024 examination reflects the Veteran worked full-time as an attorney and remained married to her husband.

Prior to July 15, 2024, there is not factually ascertainable worsening of the Veteran's acquired psychiatric disorder, and therefore, a higher rating during this time is not warranted. There are no medical records or lay statements beginning September 14, 2023, (the start of the one-year look-back period) and prior to July 15, 2024, which show any symptoms the Veteran experienced. Thus, as it is not discernable that the severity of the acquired psychiatric disorder increased prior to July 15, 2014, a higher rating prior to then is
and socially impaired; rather, the October 2024 examination reflects the Veteran worked full-time as an attorney and remained married to her husband.

Prior to July 15, 2024, there is not factually ascertainable worsening of the Veteran's acquired psychiatric disorder, and therefore, a higher rating during this time is not warranted. There are no medical records or lay statements beginning September 14, 2023, (the start of the one-year look-back period) and prior to July 15, 2024, which show any symptoms the Veteran experienced. Thus, as it is not discernable that the severity of the acquired psychiatric disorder increased prior to July 15, 2014, a higher rating prior to then is not warranted. See 38 C.F.R. § 3.400; see also Gaston, 605 F.3d at 984.?

Based on the foregoing, beginning July 15, 2024, but no earlier, a 70 percent rating, but no higher, is warranted for the Veteran's acquired psychiatric disorder, and to that extent only, the claim is granted.

GERD

On September 14, 2024, VA received an increased rating claim for GERD, and therefore, the Board?will consider whether a higher rating is warranted from September 14, 2024, the date of the claim, as well as whether there was factually ascertainable worsening during the year prior. See 38?C.F.R. § 3.400.? If an increase in severity is discernible during the one-year period prior to the filing date of the claim, the effective date is the date the increase in severity first became discernible. See Gaston, 605 F.3d at 984.?

The Veteran's GERD is currently rated as 10 percent disabling.

Diagnostic Code 7206 specifically contemplates GERD. 38 C.F.R. § 4.114. Under Diagnostic Code 7206, the next higher 30 percent rating is assigned for documented history of esophageal stricture(s) causing dysphagia which requires dilatation no more than two times per year. Id. A 50 percent rating is assigned for documented history of recurrent or refractory esophageal stricture(s) causing dysphagia which requires at least one of the following (1) dilatation 3 or more times per year, (2) dilatation using steroids at least one time per year, or (3) esophageal stent placement. Id. The maximum 80 percent rating is assigned for documented history of recurrent or refractory esophageal stricture(s) causing dysphagia with at least one of the symptoms present: (1) aspiration, (2) undernutrition, and/or (3) substantial weight loss as defined by § 4.112(a) and treatment with either surgical correction or percutaneous esophago-gastrointestinal (PEG) tube. Id. A note following the criteria instructs that findings must be documented by barium swallow, computerized tomography, or esophagogastroduodenoscopy. Id. at Note (1). Another note following the criteria states that non-gastrointestinal complications of procedures should be rated under the appropriate system. Id. at Note (2).

In a September 2024 statement from the Veteran's husband, he reports that the Veteran's GERD had increased over the past few years and that she took Nexium daily and often consumed Tums throughout the day. He states the Veteran is often sick to her stomach and complains of an acid taste in her throat along with burning, which prevents her from eating and keeping certain foods down. He reports that even on good days, the Veteran experiences nausea nad indigestion with chest pain and that sometimes it is so severe she goes a week without being able to keep food down.

At an October 2024 examination, the Veteran stated she experienced frequent burning in her throat along with nausea and vomiting not relieved with current medications. The examiner found the Veteran did not have a history of esophageal stricture (recurrent or refractory). The examiner noted the Veteran did not have dysphagia (difficulty swallowing), aspiration, undernutrition, or substantial weight loss. Her condition did not require dilation, esophageal stent placement, treatment with surgical correction, or treatment with a PEG tube. The examiner found no other symptoms of GERD not already documented.

At her May 2025 HLR informal conference, the Veteran states that she experiences severe indigestion every day, is sick a lot, and throws up multiple times a week; she indicated the examiner noted it had improved but she did not know how it improved and stated she avoided certain foods. In
Veteran did not have a history of esophageal stricture (recurrent or refractory). The examiner noted the Veteran did not have dysphagia (difficulty swallowing), aspiration, undernutrition, or substantial weight loss. Her condition did not require dilation, esophageal stent placement, treatment with surgical correction, or treatment with a PEG tube. The examiner found no other symptoms of GERD not already documented.

Following a review of the record, the Board finds a rating in excess of 10 percent is not warranted for GERD. In order to receive a higher rating under Diagnostic Code 7206, esophageal stricture (recurrent or refractory) must be present along with various other symptoms. See 38 C.F.R. § 4.114. At her October 2024 examination, the examiner found the Veteran's GERD was not manifested by a documented history of esophageal stricture (recurrent or refractory), and thus, a rating in excess of 10 percent is not warranted. See id. Further, other available medical records do not show any current or past history of esophageal stricture (recurrent or refractory) and the Veteran has not claimed she has experienced such. Even assuming the Veteran had esophageal stricture (which she has not) the evidence still weighs against a finding that she has required dilation two or more times a year, dilation with steroids once or more a year, esophageal stent placement, aspiration, undernutrition, or substantial weight loss defined by 38 C.F.R. § 4.112(a) and treatment with either surgical correction or a PEG tube. Any of these symptoms, in addition to esophageal stricture, are required in order to receive a rating in excess of 10 percent for GERD. See 38 C.F.R. § 4.114, Diagnostic Code 7206.

The Board acknowledges the Veteran's May 2025 claim that the examiner found her condition improved and notes that the October 2024 examination report does not say this. Rather, the examiner acknowledged that the Veteran's symptoms had worsened since she was previously examined. Despite the foregoing, absent evidence of esophageal stricture (recurrent or refractory), a higher rating is not allowed pursuant to VA regulation. See 38 C.F.R. § 4.114.

The Board has considered whether there is factually ascertainable worsening in the year prior to receipt of the claim and finds there is not; notably, there is no evidence showing esophageal stricture (recurrent or refractory), and therefore, a higher rating is not warranted during that time.

Based on the foregoing, a rating in excess of 10 percent for GERD is not warranted, and the claim is denied.

PCOS

In a January 2025 rating decision, the AOJ granted service connection for PCOS and assigned an initial noncompensable rating, effective September 14, 2024. The Veteran argues a compensable initial rating is warranted.

The Veteran's PCOS is rated under Diagnostic Code 7615, which contemplates ovary, disease, injury, or adhesions of. 38 C.F.R. § 4.116. Under this diagnostic code, a noncompensable rating is warranted when symptoms do not require continuous treatment. Id. A 10 percent rating is warranted for symptoms that require continuous treatment. Id. The maximum and 30 percent rating is warranted for symptoms not controlled by continuous treatment. Id.

Private records dated February 2024 reflect the Veteran had been trying to conceive since 2016 and also noted she was on, in pertinent part, Metformin.

At a January 2025 examination, the Veteran reported she began taking Metformin in 2023 and most of 2024 from a fertility specialist, but that she stopped taking it in September 2024. The examiner found the Veteran did not report any symptoms related to a gynecological condition, specifically noting she did not experience pain, pelvic pressure, irregular menstruation, dysmenorrhea associated with ovarian dysfunction, secondary amenorrhea associated with ovarian dysfunction, frequent or continuous menstrual disturbances, or other signs and/or symptoms.

In a February 2025 HLR request, the Veteran stated that medications did not manage her condition.

In May
2016 and also noted she was on, in pertinent part, Metformin.

In a February 2025 HLR request, the Veteran stated that medications did not manage her condition.

In May 2025, the Veteran argued she was on Metformin to assist with her PCOS.

Following a review of the evidence of record, the Board finds an initial compensable rating for PCOS is not warranted, and therefore, the claim must be denied. Here, the Veteran specifically indicated at her January 2025 examination that she stopped taking Metformin for her PCOS approximately four months prior, in September 2024. Private records submitted by the Veteran from February 2024 and prior reflect the Veteran took Metformin. There is no indication during the appeal period that Metformin was initially prescribed to manage any of the Veteran's PCOS symptoms. There is also no indication that the Veteran was taking any medication for her PCOS during the appeal period aside from, potentially, approximately two weeks in September (of note, she reported stopping taking it in September 2024 and service connection for PCOS is effective beginning September 14, 2024). In fact, there is no indication that during the appeal period the Veteran had any symptoms of PCOS; none were found at her January 2025 examination and there are no statements from the Veteran describing any specific symptoms during the appeal period. While she may have experienced PCOS symptoms in the past, the Board is looking at the instant period on appeal (which begins on September 14, 2024, and ends on the date of the notification of the January 2025 rating decision) and whether symptoms were present then.

Based on the foregoing, the Board finds that during the appeal period the evidence weighs persuasively against a finding that the Veteran had any PCOS symptoms requiring continuous treatment or any PCOS symptoms not controlled by continuous treatment, and therefore, a compensable initial rating is not warranted, and the claim is denied.

To the extent the Veteran is suggesting in her February 2025 HLR Request and May 2025 statement that her PCOS symptoms have worsened (i.e. that they now require mediation management and/or she is using medication which is not effective), these suggestions of worsening are made after the period on appeal and cannot form the basis for a remand herein. Moreover, there is no indication that these statements actually pertain to the period on appeal (which ended as of the date of notification of the January 2025 rating decision).

The Board recognizes that in February 2025 the Veteran argues that her PCOS is manifested by infertility. In that regard, in a February 2026 rating decision, the AOJ already granted entitlement to SMC due to loss of use of a creative organ based on the Veteran's infertility, effective February 16, 2026, and the Veteran has timely appealed that effective date. Thus, that issue is not currently before the Board.

In sum, a compensable initial rating for PCOS is not warranted, and the claim must be denied.

REASONS FOR REMAND

The matters are REMANDED for the following action:

BACKGROUND INFORMATION FOR REGIONAL OFFICE ADJUDICATOR:

Thrombocythemia: In her September 2024 VA Form 10182, the Veteran is claiming service connection for thrombocythemia. At a January 2025 examination, the examiner diagnosed thrombocythemia. The first January 2025 opinion does not consider the Veteran's conceded toxic exposure risk activity (TERA) participation. The second January 2025 opinion, while considering the Veteran's conceded TERA participation, is for thrombocytopenia (a disorder manifested by low platelet count), and not for the Veteran's diagnosed thrombocythemia (a disorder manifested by high platelet count). Thus, a remand is required to obtain an opinion regarding the Veteran's diagnosed thrombocythemia which considers her conceded TERA participation. This is a remand to correct a pre-decisional duty to assist error.

Right Lower Extremity Radiculopathy & Left Upper Extremity Radiculopathy: At an October 2024 peripheral nerves examination, the Veteran indicated she took Tylenol and Ibuprofen for her
The second January 2025 opinion, while considering the Veteran's conceded TERA participation, is for thrombocytopenia (a disorder manifested by low platelet count), and not for the Veteran's diagnosed thrombocythemia (a disorder manifested by high platelet count). Thus, a remand is required to obtain an opinion regarding the Veteran's diagnosed thrombocythemia which considers her conceded TERA participation. This is a remand to correct a pre-decisional duty to assist error.

Right Lower Extremity Radiculopathy & Left Upper Extremity Radiculopathy: At an October 2024 peripheral nerves examination, the Veteran indicated she took Tylenol and Ibuprofen for her right lower extremity radiculopathy and left upper extremity radiculopathy. It is unclear if this examination report considers the ameliorative effects of medication on these disabilities, and therefore, additional opinions are required.? This is a remand to correct a pre-decisional duty to assist error.?

THE REMAND DIRECTIVES FOLLOW.

1. Ensure the Veteran is scheduled for an examination in connection with her claim for thrombocythemia.

Following a review of the evidence and with consideration of the Veteran's statements, the examiner should provide the following:

Opine as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's thrombocythemia had its onset in, or is otherwise etiologically related to active service, to include as related to the total potential exposure through all applicable military deployments of the Veteran; and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. Why or why not?

The examiner must review the entire record in conjunction with rendering the requested opinions.? The examiner's attention is drawn, but not limited to, the following evidence:???

" The Veteran's platelet levels were tested during service in October 2012, July 2014, and June 2015.

" October 2019 laboratory tests revealed high platelet counts.

" Private records show thrombocythemia was diagnosed in February 2020.

" An April 2021 private treatment note reflects the Veteran was a new patient being seen for thrombocythemia; it indicates high plate counts were noted in October 2019 and that since then, multiple blood tests and platelet counts have remained consistently over 400K.

" A January 2025 TERA Memorandum reflects that the Veteran's MOS of a mine countermeasure mission specialist has possible exposure to cleaning and maintenance chemicals, lubricants, exhaust, sanding particles, paints, solvents, etc.

The Board notes that the claims folder must be provided to and reviewed by the examiner for all post-remand cases per AOJ policy. See VBA Manual M21-1, Part IV.i.2.A.8.b. Thus, the examiner must specifically note that the claims folder was received and reviewed in the body of the examination report.

The examiner is informed by the Board that chronicity is not required to find a nexus to service or for service connection to be granted.

The examiner is informed that a positive opinion indicating a nexus to service does not require certainty. Rather, if the weight of the evidence is in approximate balance for and against a nexus to service, the examiner should make a determination favorable to the Veteran.

All requested opinions must be supported with a rationale based on generally accepted medical principles and the examiner's medical training and expertise.

2. Obtain an opinion regarding the following from an appropriate examiner.

(a) Clearly indicate whether any medications (over the counter or prescription) the Veteran used affected the level of severity of her right lower extremity radiculopathy as of the October 2024 examination.

(b) If any such medication was productive of ameliorative effects, clearly identify such effects and opine as to the severity of the right lower extremity radiculopathy absent such medication as of the October 2024 examination.

(c) Clearly indicate whether any medications (over the counter or prescription) the Veteran used affected the level of severity of her left upper extremity radiculopathy as of the October 2024 examination.

(d) If any such medication was productive of ameliorative effects, clearly identify such effects and opine as to the severity of the left upper extremity radiculopathy absent such medication as of the October 2024 examination.

The examiner must review the entire record in conjunction with rendering the requested opinions.? The examiner's attention is drawn, but not limited to, the following evidence:???

" At an October 2024 peripheral nerves examination, the Veteran indicated she took Tylenol and Ibuprofen for her right lower extremity and left upper extremity rad
over the counter or prescription) the Veteran used affected the level of severity of her left upper extremity radiculopathy as of the October 2024 examination.

The examiner must review the entire record in conjunction with rendering the requested opinions.? The examiner's attention is drawn, but not limited to, the following evidence:???

" At an October 2024 peripheral nerves examination, the Veteran indicated she took Tylenol and Ibuprofen for her right lower extremity and left upper extremity radiculopathy.

3. Readjudicate.

Jennifer White

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board O'Connell, Jessica L. (BVA)

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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