CERVICAL SPINE LIMITATION OF MOTION

A. DEAN · 2026 · Case ID: A26040965

MIXED

Summary

The veteran, who served from December 2005 to December 2009, appeals the denial of service connection for several musculoskeletal conditions: neck, upper back, lower back, bilateral hips, bilateral ankles, and left shoulder. The Board denied these claims, finding no evidence of a current disability or functional impairment related to these conditions, nor any complaints documented in service treatment records. The Board noted that while the veteran claimed physical trauma from carrying heavy equipment during service, the absence of diagnosed disabilities meant a VA examination was not required. The Board also addressed the veteran's participation in toxic exposure risk activities (TERA) due to service in Southwest Asia and asbestos exposure, but determined that exceptions to obtaining TERA opinions applied because the claimed disabilities were attributed to physical trauma, not directly to toxic exposure. The Board also denied the left shoulder claim due to lack of diagnosed disability and no evidence of functional impairment, despite a VA examination noting right shoulder strain. The Board remanded claims for bilateral knee strain, right shoulder strain, and tension headaches. The knee and shoulder claims were remanded because the VA examiner's opinions were inadequate, relying solely on the lack of service treatment record notation and omitting discussion of the veteran's lay statements. The tension headache claim was remanded because the VA examiner's opinion was incomplete, failing to address direct service connection and potentially linking the headaches to an undiagnosed illness or MUCMI.

Rationale

No current diagnosis of neck disability; No evidence of functional impairment; No complaints or treatments in service records

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250515-544070

Full Decision Text

Citation Nr: A26040965
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 250515-544070
DATE: April 30, 2026

ORDER

Service connection for a neck disability is denied.

Service connection for an upper back disability is denied.

Service connection for a lower back disability is denied.

Service connection for a bilateral hip disability is denied.

Service connection for a bilateral ankle disability is denied.

Service connection for a foot disability is denied.

Service connection for a left shoulder disability is denied.

REMANDED

Entitlement to service connection for bilateral knee strain is remanded.

Entitlement to service connection for right shoulder strain is remanded.

Entitlement to service connection for tension headaches is remanded.

FINDINGS OF FACT

1. At no time during the pendency of his claim does the Veteran have a neck disability, and the record does not contain a recent diagnosis of disability prior to the Veteran's filing a claim.

2. At no time during the pendency of his claim does the Veteran have an upper back disability, and the record does not contain a recent diagnosis of disability prior to the Veteran's filing a claim.

3. At no time during the pendency of his claim does the Veteran have a lower back disability, and the record does not contain a recent diagnosis of disability prior to the Veteran's filing a claim.

4. At no time during the pendency of his claim does the Veteran have a bilateral hip disability, and the record does not contain a recent diagnosis of disability prior to the Veteran's filing a claim.

5. At no time during the pendency of his claim does the Veteran have a bilateral ankle disability, and the record does not contain a recent diagnosis of disability prior to the Veteran's filing a claim.

6. At no time during the pendency of his claim does the Veteran have a foot disability, and the record does not contain a recent diagnosis of disability prior to the Veteran's filing a claim.

7. At no time during the pendency of his claim does the Veteran have a left shoulder disability, and the record does not contain a recent diagnosis of disability prior to the Veteran's filing a claim.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for a neck disability have not been met. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317.

2. The criteria for entitlement to service connection for an upper back disability have not been met. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317.

3. The criteria for entitlement to service connection for a lower back disability have not been met. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317.

4. The criteria for entitlement to service connection for a bilateral hip disability have not been met. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317.

5. The criteria for entitlement to service connection for a bilateral ankle disability have not been met. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317.

6. The criteria for entitlement to service connection for a foot disability have not been met. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317.

7. The criteria for entitlement to service connection for a left shoulder disability have not been met. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from December 2005 to December 2009. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an April 2025 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO), which is also the agency of original jurisdiction (AOJ).

In the May 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 April 2025 AOJ decision 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,
of Veterans' Appeals (Board) on appeal from an April 2025 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO), which is also the agency of original jurisdiction (AOJ).

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 claim[s], considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. Generally, service connection requires three elements: (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). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

An award of service connection requires a finding of a current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Under applicable regulation, the term "disability" means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1; Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); Allen, 7 Vet. App. 439; Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (the term "disability" as used in 38 U.S.C. § 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability").

In McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), the United States Court of Appeals for Veterans Claims (Court) held that the requirement of the existence of a current disability is satisfied when a claimant has a disability at the time he files his claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a claimant filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency.

Compensation may be paid to a Persian Gulf War Veteran who exhibits objective indications of chronic disability due to undiagnosed illnesses or a combination of undiagnosed illnesses that became manifest either during active duty in the Southwest Asia theater of operations during the Persian Gulf War or to a degree of 10 percent or more. 38 U.S.C. § 1117(a)(1); 38 C.F.R. § 3.317(a).

A Persian Gulf Veteran is one who served in the Southwest Asia theater of operations during the Persian Gulf War. Id. The Southwest Asia theater of operations includes Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian
who exhibits objective indications of chronic disability due to undiagnosed illnesses or a combination of undiagnosed illnesses that became manifest either during active duty in the Southwest Asia theater of operations during the Persian Gulf War or to a degree of 10 percent or more. 38 U.S.C. § 1117(a)(1); 38 C.F.R. § 3.317(a).

For purposes of 38 C.F.R. § 3.317, there are three types of qualifying chronic disabilities: (1) an undiagnosed illness; (2) a medically unexplained chronic multi symptom illness (MUCMI) (such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome) that is defined by a cluster of signs or symptoms; and (3) a diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C. § 1117(d) warrants a presumption of service connection.

An undiagnosed illness is defined as a condition that by history, physical examination, and laboratory tests cannot be attributed to a known clinical diagnosis. 38 C.F.R. § 3.317(a)(1)(ii). In the case of claims based on undiagnosed illness under 38 U.S.C. § 1117, unlike other claims for "direct service connection," there is no requirement that there be competent evidence of a nexus between the claimed illness and service. Gutierrez v. Principi, 19 Vet. App. 1, 8-9 (2004).

A "medically unexplained chronic multi symptom illness" means a diagnosed illness without the conclusive pathophysiology or etiology, which is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multi symptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317(a)(2)(ii).

Objective indications of chronic disability include both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R.

§ 3.317(a)(3).

In deciding the Veteran's claim, the VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event; or whether the persuasive evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant.

1.-6. Service connection for a neck disability, an upper back disability, a lower back disability, a bilateral hip disability, a bilateral ankle disability, and a foot disability

In December 2024, the Veteran submitted a VA Form 526EZ claim form, where he explained that when he was in the military, he had to "low crawl, crawl, and climb over walls" with an excess of 150 pounds of equipment on his back.

As to the first element required for service connection, the Veteran must show that he has a disability. The Veteran's records do not document a medical diagnosis of any neck, upper back, lower back, bilateral hip, bilateral ankle, or foot disabilities. Medical records were reviewed and reveal no complaints, treatments, or diagnoses pertinent to the aforementioned conditions. In making this determination, the Board is cognizant of the holding in Saunders, where, to reiterate, the United States Court of Appeals for the Federal Circuit (Federal Circuit) found that the term "disability" as used in 38 U.S.C. § 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability."

However, in this case, the record does not contain evidence of any functional impairment of earning capacity due to pain in the neck, upper back, lower back, bilateral hips, bilateral ankles, or feet. Rather, the record is devoid of such complaints. Therefore, the record does
this determination, the Board is cognizant of the holding in Saunders, where, to reiterate, the United States Court of Appeals for the Federal Circuit (Federal Circuit) found that the term "disability" as used in 38 U.S.C. § 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability."

The Board acknowledges that the Veteran has not been afforded a VA examination with respect to these claims. However, here the Board finds an examination is not required. Under McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006), VA is obligated to provide an examination only when the record contains (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, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service, but (4) there is insufficient competent medical evidence on file to decide the claim. 38 U.S.C. § 5103A(d). Here, for examinations to be warranted, the record would need to include, at a minimum, competent evidence of a current disability, and as discussed, there is no evidence of such.

The Board further notes that the Veteran has participation in a toxic exposure risk activity (TERA) due to his service in Southwest Asia during the Persian Gulf War and due to asbestos exposure. See 38 U.S.C. § 1119. Although VA has an obligation to obtain medical opinions for any service connection claim which cannot be granted where there is evidence of a TERA and of a disability, VA has identified several exceptions to this general obligation where there is no indication of an association between the disability and the TERA. See 38 U.S.C. § 1168(b). Specifically, a TERA opinion is not required for disabilities resulting from physical trauma; mental disorders; disabilities that have not been shown to have any positive association with herbicide exposure; and disabilities that manifested during service or with a clear etiology that is not associated with toxic exposure. See VBA Letter 20-22-10 at 10-13, Processing Claims Involving the PACT Act, 87 Fed. Reg. 78,543 (Dec. 22, 2022).

In this case, there are no objective indications of chronic disability related to the Veteran's claimed disabilities, as required by the laws and regulations governing presumptive service connection for undiagnosed illnesses, MUCMIs, and other qualifying chronic disabilities, such are inapplicable to the instant appeals. Moreover, the Veteran has contended these claimed disabilities are the result of physical trauma from crawling and climbing while carrying heavy equipment during service. See December 2024 VA Form 526EZ. Therefore, an exception to the TERA opinion requirements applies, and remand for an examination is not warranted on this basis.

The Board acknowledges the Veteran's March 2026 statement in support of claim, where he explained that he "was a young man" during his service and that if he had reported "every little ache and pain, [he] would've been slayed, so [he] kept [his] mouth shut." While the Board sympathizes with the Veteran, it is bound by the laws and regulations currently in effect.

In the absence of proof of a present disorder, there can be no valid claim for service connection. See Brammer, 3 Vet. App. at 225. This principle has been repeatedly reaffirmed by the Federal Circuit, which has stated that "a Veteran seeking disability benefits must establish... the existence of a disability [and] a connection between the Veteran's service and the disability." Boyer v. West, 210 F.3d. 1351, 1353 (Fed. Cir. 2000).

Accordingly, the Board finds that the persuasive evidence is against the claims for service connection for neck, upper back, lower back, bilateral hip, bilateral ankle, and foot disabilities. As the evidence is not in relative equipoise, the benefit of the doubt rule does not apply. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

7. Service connection for a left shoulder disability

The Veteran contends he has a left shoulder disability due to military service, specifically
of a disability [and] a connection between the Veteran's service and the disability." Boyer v. West, 210 F.3d. 1351, 1353 (Fed. Cir. 2000).

7. Service connection for a left shoulder disability

The Veteran contends he has a left shoulder disability due to military service, specifically due to having to "low crawl, crawl, and climb over walls" with heavy equipment on his back. See December 2024 VA Form 526EZ.

In January 2025, the Veteran was afforded a VA medical examination to ascertain the nature and etiology of any shoulder disability. The examiner diagnosed the Veteran with right shoulder strain, but no diagnosis was made as to the left shoulder. On the examination report, the examiner noted that the Veteran denied left shoulder pain at the time of the examination.

Here, the Board affords great probative value to the aforementioned VA examination and associated opinion as such was completed by a trained medical professional who reviewed the record and performed an appropriate examination of the Veteran. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Moreover, the findings reported in the VA examination report and associated opinion are consistent with the contemporaneous medical evidence of record.

The Veteran's records do not document a medical diagnosis of any left shoulder disability. Medical records were reviewed and reveal no complaints, treatments, or diagnoses pertinent to the left shoulder. Notably, the record does not contain evidence of a functional impairment of earning capacity due to pain in his left shoulder such that would constitute a disability per Saunders. Rather, it is devoid of such complaints, and the Veteran expressly denied any left shoulder pain upon VA examination.

Consequently, the Board finds that at no time during the pendency of the claim does the Veteran have a left shoulder disability, and the record does not contain a diagnosis of such prior to the Veteran's filing of a claim. Furthermore, the record does not reflect that the Veteran's objective symptoms result in functional impairment of earning capacity.

While the Board acknowledges that the Veteran participated in a TERA, he does not have a diagnosed disability or objective indications of chronic disability related to the claimed left shoulder disability, as required by the laws and regulations governing presumptive service connection for undiagnosed illnesses, MUCMIs, and other qualifying chronic disabilities. Moreover, he contends a left shoulder disability is the result of physical trauma, so a TERA opinion is not required. See December 2024 VA Form 526EZ; see also 38 U.S.C. § 1168(b); VBA Letter 20-22-10 at 10-13, Processing Claims Involving the PACT Act, 87 Fed. Reg. 78,543 (Dec. 22, 2022).

Accordingly, service connection for a left shoulder disorder must be denied on the basis of no disability. In reaching such decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, the competent evidence persuasively weighs against the Veteran's claim. As such, that doctrine is not applicable in the instant appeal, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

REASONS FOR REMAND

1. Entitlement to service connection for bilateral knee strain is remanded.

2. Entitlement to service connection for right shoulder strain is remanded.

Issues 1-2:

The Veteran contends he has bilateral knee and right shoulder strains due to military service.

The April 2025 rating decision made a favorable finding that the Veteran has been diagnosed with disabilities, as a January 2025 VA medical examination shows diagnoses of bilateral knee strain and right shoulder strain.

The Veteran's service treatment records (STRs) do not contain any documentation regarding complaints or treatment of the Veteran's knees or right shoulder. However, in his December 2024 VA Form 526EZ claim form, the Veteran contended such disabilities were due to the fact that he had to "low crawl, crawl, and climb over walls" with an excess of 150 pounds of equipment on his back.

In January 2025, the Veteran was afforded a VA medical examination to ascertain the nature and etiology of his bilateral knee strain and right shoulder strain. The examiner provided a negative nexus medical opinion for both
diagnosed with disabilities, as a January 2025 VA medical examination shows diagnoses of bilateral knee strain and right shoulder strain.

In January 2025, the Veteran was afforded a VA medical examination to ascertain the nature and etiology of his bilateral knee strain and right shoulder strain. The examiner provided a negative nexus medical opinion for both claims as the Veteran's STRs are silent for complaints or diagnosis of a bilateral knee injury or a shoulder injury in service.

The Board finds the VA examiner's opinion inadequate because it relies solely on lack of notation in the STRs of bilateral knee or right shoulder complaints, and omitted discussion of the Veteran's lay statements. See Dalton v. Nicholson, 21 Vet. App. 23 (2007) (examination is inadequate where the examiner relied on lack of evidence in STRs to provide negative opinion). As such, a pre-decisional duty to assist error has occurred, which warrants a remand for correction of such.

3. Entitlement to service connection for tension headaches is remanded.

The Veteran contends his tension headaches are directly related to military service, and that they may be due to toxic exposure when he was deployed overseas.

The April 2025 rating decision on appeal made the favorable finding that the Veteran has been diagnosed with a disability, as a January 2025 VA medical examination shows a diagnosis of tension headaches.

The Veteran's participation in TERA has also been acknowledged, as his military personnel records show he served in Kuwait and Iraq at various times in 2007 through 2009. As such, he meets the definition of a Persian Gulf veteran per 38 U.S.C. § 1117.

In January 2025, the Veteran was afforded a VA medical examination to determine the nature and etiology of his tension headaches. The examiner opined that it is less likely than not caused by indicated TERA, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all TERA. The examiner explained that the current medical literature does not support toxic exposure activity as a primary cause of tension headaches, and that the etiology of tension headaches is thought to be multifactorial, but the precise mechanisms are uncertain. Environmental factors, such as stress and muscle tenderness appear to be the most impactful in the development of episodic headaches, while genetic factors appear to play a role in the development of chronic headaches. Thus, the examiner opined that his tension headaches are most likely due to these factors.

The Board finds the opinion rendered is incomplete, as no opinion was provided as to direct service connection. In this regard, the Board notes the Veteran reported on examination that he developed headaches upon deployment to Iraq. As well, the examiner noted the Veteran had a diagnosis of tension headaches but that the precise mechanisms of such are uncertain, therefore an addendum opinion is also warranted as to whether such may be a symptom of an undiagnosed illness or a medically unexplained chronic multisymptom illness such that compensation may be awarded under the provisions of 38 C.F.R. § 3.317. Consequently, this pre-decisional duty to assist error warrants a remand for correction of such.

The matters are REMANDED for the following action:

1. Obtain an addendum medical opinion regarding the Veteran's bilateral knee strain. The Veteran's claims file, including a copy of this remand, should be provided to and reviewed by the clinician. The clinician is asked to opine as to the following:

Whether it is at least as likely as not that the Veteran's bilateral knee strain is related to an in-service injury, event, or disease, including the Veteran's lay statement of his duties during military service, to include low crawl, crawl, and climbing over walls with an excess of 150 pounds of equipment on his back.

A complete rationale should be provided.

2. Obtain an addendum medical opinion regarding the Veteran's right shoulder strain. The Veteran's claims file, including a copy of this remand, should be provided to and reviewed by the clinician. The clinician is asked to opine as to the following:

Whether it is at least as likely as not that the Veteran's right shoulder strain is related to an in-service injury, event, or disease, including the Veteran's lay statement of his duties during military service, to include low crawl, crawl, and climbing over walls with an excess of 150 pounds of equipment on his back.

A complete rationale
crawl, and climbing over walls with an excess of 150 pounds of equipment on his back.

A complete rationale should be provided.

3. Obtain a medical addendum opinion as to the etiology of the Veteran's headache disability. The Veteran's claims file, including a copy of this remand, should be provided to and reviewed by the clinician. The clinician is asked to opine as to the following:

The clinician should state whether the Veteran's claimed headache disability is attributed to a known clinical disorder with a conclusive etiology and pathophysiology.

(a) For any known clinical diagnosis for headaches, is it at least as likely as not that such condition had its onset during service or is otherwise related to an in-service injury, disease, or event, to include the Veteran's acknowledged exposure to asbestos and to fine particulate matter as a Persian Gulf veteran?

In making this determination, the clinician must respond to the Veteran's report upon January 2025 VA examination that he developed his headaches in 2009 while deployed to Iraq and that they have continued since. The clinician is reminded that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology.

(b) If any of the Veteran's headache symptoms are not attributable to a known clinical diagnosis, then opine as to whether each symptom, including pain, had objective indications, as established by history, physical examination, and laboratory tests, of an undiagnosed illness or a medically unexplained chronic multisymptom illness, that existed for six months or more or exhibited intermittent episodes of improvement and worsening over a six-month period.

An undiagnosed illness is defined as a condition that by history, physical examination, and laboratory tests cannot be attributed to a known clinical diagnosis.

A "medically unexplained chronic multisymptom illness" is defined as a diagnosed illness without conclusive pathophysiology or etiology, that is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities.

A complete rationale should be provided.

A. Dean

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board R. Smith, Associate 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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