Citation Nr: A25035656 Decision Date: 04/17/25 Archive Date: 04/17/25 DOCKET NO. 240116-408261 DATE: April 17, 2025 ORDER Entitlement to service connection for right thigh pain is denied. Entitlement to service connection for left thigh pain is denied. Entitlement to service connection for right ankle pain is denied. Entitlement to service connection for left ankle pain is denied. Entitlement to an initial rating in excess of 10 percent for lumbosacral strain is denied. Entitlement to an initial rating in excess of 10 percent for right knee patellofemoral pain syndrome is denied. Entitlement to an initial rating in excess of 10 percent for left knee patellofemoral pain syndrome is denied. Entitlement to an initial rating in excess of 20 percent for lymphedema, right lower extremity, is denied. Entitlement to an initial rating in excess of 20 percent for lymphedema, left lower extremity, is denied. REMANDED Entitlement to service connection for right sciatica pain is remanded. FINDINGS OF FACT 1. There is no competent medical evidence that the Veteran has a right and/or left thigh and/or ankle disability. 2. The Veteran's lumbosacral strain was productive of forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour. 3. The Veteran's right and left knee patellofemoral pain syndrome are productive of painful motion. 4. The Veteran's right and left lower extremity lymphedema is productive of persistent edema, incompletely relieved by elevation of extremity, with or without beginning stasis pigmentation or eczema. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for right thigh pain have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137 (2018); 38 C.F.R. §§ 3.102, 3.303 (2024). 2. The criteria for entitlement to service connection for left thigh pain have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137 (2018); 38 C.F.R. §§ 3.102, 3.303 (2024). 3. The criteria for entitlement to service connection for right ankle pain have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137 (2018); 38 C.F.R. §§ 3.102, 3.303 (2024). 4. The criteria for entitlement to service connection for left ankle pain have not been met. 38 U.S.C. §§ 1110, 1112, 1131, 1137 (2018); 38 C.F.R. §§ 3.102, 3.303 (2024). 5. The criteria for an initial rating in excess of 10 percent for lumbosacral strain have not been met. 38 U.S.C. § 1155 (2018); 38 C.F.R. §§ 4.7, 4.71a, Diagnostic Code 5237 (2024). 6. The criteria for an initial rating in excess of 10 percent for right knee patellofemoral pain syndrome have not been met. 38 U.S.C. § 1155 (2018); 38 C.F.R. §§ 4.7, 4.71a, Diagnostic Code 5260 (2024). 7. The criteria for an initial rating in excess of 10 percent for left knee patellofemoral pain syndrome have not been met. 38 U.S.C. § 1155 (2018); 38 C.F.R. §§ 4.7, 4.71a, Diagnostic Code 5260 (2024). 8. The criteria for an initial rating in excess of 20 percent for lymphedema, right lower extremity, have not been met. 38 U.S.C. § 1155 (2018); 38 C.F.R. §§ 4.7, 4.104, Diagnostic Code 7199-7121 (2024). 9. The criteria for an initial rating in excess of 20 percent for lymphedema, left lower extremity, have not been met. 38 U.S.C. § 1155 (2018); 38 C.F.R. §§ 4.7, 4.104, Diagnostic Code 7199-7121 (2024). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active naval service from July 2017 to July 2023. These matters come before the Board of Veterans' Appeals (Board) on appeal from August 2023 and January 2024 rating decisions issued by the Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ). In the January 2024 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 respective August 2023 and January 2024 rating decisions on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the respective August 2023 and January 2024 rating decisions on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801 (2024). 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 (2024). 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. However, because the Board is remanding the claim of entitlement to service connection for right sciatica pain, any evidence the Board could not consider will be considered by the AOJ in the adjudication of that claim. 38 C.F.R. § 3.103(c)(2)(ii) (2024). 1. Service Connection - Right and Left Thigh and Ankle Pain The Veteran claims that she has right and left thigh and ankle pain which is related to her active service. Service treatment records (STRs) reveal that the Veteran complained of a history of bilateral leg swelling with associated foot pain from edema in as early as August 2018. Subsequently, she was diagnosed with lymphedema. She continued to report bilateral ankle and thigh pain accompanied by swelling and edema. In October 2022, a rheumatologist remarked that the Veteran continued to have pain in her legs due to lymphedema. In June 2023, the Veteran was afforded VA examinations. The examiner determined that the Veteran did not meet the diagnostic criteria for a thigh and/or ankle disability. While the Veteran is competent to report observable symptoms of a thigh and/or ankle disability, she is not competent to provide a diagnosis, as that requires medical expertise and is outside the realm of common knowledge of a layperson. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Hence, the Board gives more probative weight to the competent medical evidence showing that her thigh and ankle pain falls within the diagnostic criteria for lymphedema. The term "disability," used for VA purposes, refers to impairment of earning capacity resulting from diseases and injuries and their residual conditions. Allen v. Brown, 7 Vet. App. 439 (1995); Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991). See also Saunders v. Wilkie, No. 886 F.3d. 1356 (Fed. Cir. 2018) (indicating that the term "disability" refers to the functional impairment of earning capacity, rather than the underlying cause of the impairment, and pain alone may be a functional impairment). There is no evidence of record which suggests that the Veteran's thigh and ankle pain causes any impairment of earning capacity other than service-connected lymphedema. In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223 (1992); Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998). Accordingly, the Board finds that the benefit-of-the-doubt rule is not applicable as the evidence is not in approximate balance. Therefore, entitlement to service connection for right and left thigh and ankle pain is not warranted. 38 U.S.C. § 5107(b) (2018); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). 2. Increased Rating - Lumbosacral Strain The Veteran contends that her lumbosacral strain is worse than that accounted for by the currently assigned ratings. Her lumbosacral strain is rated 10 percent disabling pursuant to Diagnostic Code 5237. 38 C.F.R. § 4.71a. In June 2023, the Veteran was afforded a VA examination. She reported intermittent centralized and nagging low back pain. However, she denied any flare-ups or functional loss. On physical evaluation, she demonstrated forward flexion to 80 degrees, extension to 20 degrees, right and left lateral flexion to 25 degrees, and right and left lateral rotation to 25 degrees. Passive ROM was medical contraindicated. There was objective evidence of pain with extension which did not result in/cause functional loss. She had mild localized tenderness or pain on palpation. The Veteran's localized tenderness did not result in abnormal gait or spinal contour. After observed repetitive use, the Veteran did not have any additional loss of function or ROM. The examination was unremarkable for any other pertinent physical findings, complications, conditions, signs, or symptoms, to include ankylosis and intervertebral disc syndrome (IVDS). Based on the foregoing, the Board finds that the Veteran is not entitled to a higher rating for the entire period on appeal. In this regard, the Veteran demonstrated forward flexion greater than 60 degrees but not greater than 85 degrees; or combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour. The medical evidence of record does not show forward flexion greater than 30 degrees but not greater than 60 degrees; or combined range of motion not greater than 120 degrees; or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour. Therefore, a rating in excess of 10 percent for lumbosacral strain is not warranted. 38 C.F.R. § 4.71a, Diagnostic Code 5237. The Board acknowledges the Veteran's pain and functional limitations due to pain; however, there is no medical evidence of record that any pain, fatigability, incoordination, or weakness resulted in additional limitation of function to meet the criteria for a higher evaluation. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 24 Vet. App. 32 (2011). Moreover, the effect of pain is already contemplated by the assigned rating. As such, even with consideration of all pertinent disability factors, there remains no reasonable basis for assignment of a higher rating for the Veteran's lumbosacral strain. Consideration has been given to other appropriate diagnostic codes. However, the Board finds that the Veteran did not have IVDS. Therefore, the Veteran was appropriately rated based on pain and limitation of function, and a higher rating is not warranted under another diagnostic code. Id. at Diagnostic Code 5243. Consideration has been given to assigning separate ratings for neurological abnormalities or chronic neurologic manifestations. The issue of entitlement to a service connection for right sciatica pain has been remanded further development and adjudication below, and no other neurological abnormalities have been formally diagnosed. Id. at General Rating Formula, Note 1. Consideration has been given to assigning staged ratings. However, at no time during the period in question has the disability warranted a higher schedular rating than that assigned. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Accordingly, the Board finds that the benefit-of-the-doubt rule is not applicable as the evidence is not in approximate balance, and entitlement to an initial rating in excess of 10 percent for lumbosacral strain is not warranted. 38 U.S.C. § 5107(b); Lynch, 21 F.4th 776. 3. Increased Rating - Right and Left Knee Patellofemoral Pain Syndrome The Veteran asserts that her right and left knee patellofemoral pain syndrome is worse than that contemplated by the currently assigned ratings. Her right and left knee patellofemoral pain syndrome are currently rated 10 percent disabling pursuant to Diagnostic Code 5260. 38 C.F.R. § 4.71a. In June 2023, the Veteran was afforded a VA examination. She reported intermittent and achy patella pain in both knees. However, she denied any flare-ups or functional loss. On physical evaluation, she demonstrated normal active ROM, bilaterally. Passive ROM remained the same. There was no objective evidence of pain. There was objective evidence of localized tenderness or pain on palpation. After observed repetitive use, the Veteran did not have any additional loss of function or ROM. The examination was unremarkable for any additional pertinent procedures, physical findings, signs and/or symptoms, to include ankylosis. Based on the foregoing, the Board finds that the Veteran is not entitled to a higher rating for the entire appeal period. In this regard, the Veteran's right and left knee patellofemoral pain syndrome have been productive of painful motion. 38 C.F.R. § 4.71a. The ROM findings of record do not show right and/or left knee flexion limited to at least 45 degrees or extension limited to at least 10 degrees to warrant a higher rating. Id. at Diagnostic Codes 5260 or 5261. Consideration has been given to assignment of a higher or separate rating under another diagnostic code pertaining to the knee. However, there is no evidence of record showing that the Veteran has ankylosis, recurrent subluxation or instability, patellar instability, dislocated or removal of the semilunar cartilage, impairment of the tibia and fibula, or genu recurvatum. As such, higher or separate ratings for the Veteran's right and/or left knee is not warranted. Id. at Diagnostic Codes 5256, 5257, 5258, 5259, 5262, 5263. The Board has also considered the provisions of 38 C.F.R. §§ 4.40, 4.45, and 4.59. However, there is no medical evidence of record that any pain, fatigability, incoordination, or weakness resulted in additional limitation of function to meet the criteria for a higher evaluation. DeLuca, 8 Vet. App. 202 (1995). Furthermore, the effect of the pain on the Veteran's right and left knees is already contemplated by the assigned ratings. Mitchell, 24 Vet. App. 32, 33, 43. Consideration has been given to assigning staged ratings. However, at no time during the period in question has the disability warranted a higher schedular rating than that assigned. Fenderson, 12 Vet. App. 119; Hart, 21 Vet. App. 505. Accordingly, the Board finds that the benefit-of-the-doubt rule is not applicable as the evidence is not in approximate balance, and initial ratings in excess of 10 percent for right and left knee patellofemoral pain syndrome is not warranted. 38 U.S.C. § 5107(b); Lynch, 21 F.4th 776. 4. Increased Rating - Lymphedema The Veteran reports that her right and left lower extremity lymphedema is worse than that contemplated by the currently assigned ratings. Her right and left lower extremity lymphedema are currently rated 20 percent disabling pursuant to Diagnostic Code 7199-7121. 38 C.F.R. § 4.104. In June 2023, the Veteran was afforded VA examinations for hematologic and lymphatic conditions, artery and vein conditions, and skin diseases. She reported daily swelling of the legs, mainly in the ankles and feet, with more rare episodes of edema extending into the bilateral thigh. The examiner determined that the Veteran did not meet the diagnostic criteria for a skin disability. The examiner acknowledged the Veteran's prior treatment history for pityriasis rosea and hypoesthesia but found that those conditions had resolved. The examiner indicated that the Veteran's lymphedema impacted her ability to work due to a loss of productivity from prolonged standing/walking. In September and October 2023, the Veteran was provided additional VA examinations for artery and vein conditions. She reported continued swelling in both legs/ankles/feet, right leg worse than left. Her pregnancy was mildly contributing to her leg swelling. Additionally, she stated that her swelling worsened with frequent walking, standing, and moving around. Her symptoms were relieved by elevation of extremity or compression hosiery. She had persistent edema that was incompletely relieved by elevation of extremity. There was no evidence of stasis pigmentation, eczema, or ulceration. The examiner observed that the Veteran's ankles and feet were swollen, right more than left, with the presence of dipping edema. The examiner noted that such physical findings would travel up the Veteran's lower legs with frequent walking or standing. The examiner indicated that the Veteran's lymphedema impacted her ability to work with prolonged standing/walking. Based on the foregoing, the Board finds that the Veteran is not entitled to a higher rating. In this regard, the Veteran's lymphedema was productive of persistent edema, incompletely relieved by elevation of extremity, with or without beginning stasis pigmentation or eczema. There is no evidence that the Veteran had persistent edema and stasis pigmentation or eczema, with or without intermittent ulceration. 38 C.F.R. § 4.104, Diagnostic Code 7199-7121. Consideration has been given to assigning staged ratings. However, at no time during the appeal period has the disabilities warranted higher schedular ratings than that assigned. Fenderson, 12 Vet. App. 119; Hart, 21 Vet. App. 505. Accordingly, the Board finds that the benefit-of-the-doubt rule is not applicable as the evidence is not in approximate balance, and initial ratings in excess of 20 percent for right and left lower extremity lymphedema is not warranted. 38 U.S.C. § 5107(b); Lynch, 21 F.4th 776. REASONS FOR REMAND The Veteran claims that she has right sciatica pain which is related to her active service. Alternatively, the medical evidence of record raised the issue of entitlement to service connection for right sciatica pain as secondary to service-connected lumbosacral strain. STRs show that the Veteran reported occasional low back pain and sharp radiating pain in July 2021. In March 2022, she was diagnosed with right side sciatica. Additionally, she complained of radiation of back pain down the back of the right leg in January 2023. In June 2023, a VA back examiner determined that the Veteran did not meet the diagnostic criteria for lumbar radiculopathy. However, the Board finds that the VA examiner did not address the Veteran's STRs, to include diagnosis for right side sciatica. Therefore, a remand is required for corrective action. The matter is REMANDED for the following action: Schedule the Veteran for an examination to determine the nature and etiology of her claimed right sciatica pain. The claims file must be made available to and reviewed by the examiner. Any indicated studies should be performed. Based on the examination results and the review of the record, the examiner should provide an opinion 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 claimed right sciatica pain had its onset during her active service or is otherwise etiologically related to such service. Additionally, the examiner should determine 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 right sciatica pain was caused by, aggravated (chronically worsened) by, or would not have occurred but for service-connected lumbosacral strain. A complete and detailed rationale must be provided for all opinions expressed. Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Ware, 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.