Citation Nr: A26011237
Decision Date: 02/05/26	Archive Date: 02/05/26

DOCKET NO. 250828-581102
DATE: February 5, 2026

ORDER

Entitlement to reconsideration of the claim seeking an effective date prior to November 22, 2023, for the award of service connection for posttraumatic stress disorder (PTSD) with major depressive disorder is denied.

Entitlement to an effective date prior to November 22, 2023, for the award of service connection for PTSD with major depressive disorder is denied.

Entitlement to an effective date prior to November 22, 2023, for the award of service connection for cervical strain is denied.

Entitlement to an effective date prior to November 22, 2023, for the award of service connection for costochondritis is denied.

Entitlement to an effective date prior to November 22, 2023, for the award of service connection for right ankle lateral collateral ligament sprain is denied.

Entitlement to an effective date prior to November 22, 2023, for the award of service connection for left ankle lateral collateral ligament sprain is denied.

Entitlement to an initial rating in excess of 50 percent for PTSD with major depressive disorder is denied.

Entitlement to an initial rating in excess of 10 percent for cervical strain is denied.

Entitlement to an initial rating in excess of 10 percent for costochondritis is denied.

Entitlement to an initial rating in excess of 10 percent for right ankle lateral collateral ligament sprain is denied.

Entitlement to an initial rating in excess of 10 percent for left ankle lateral collateral ligament sprain is denied.

FINDINGS OF FACT

1. The Department of Veterans Affairs (VA) did not receive or associate with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim of service connection for PTSD with major depressive disorder on February 14, 2006.

2. PTSD with major depressive disorder, cervical strain, costochondritis, right ankle lateral collateral ligament sprain, and left ankle lateral collateral ligament sprain all originated during active service.

3. The Veteran separated from active service on July 23, 2004.

4. On September 5, 2023, VA received the Veteran's Intent to File a Claim for Compensation.

5. On November 15, 2023, VA received an intervening claim for compensation.

6. On November 22, 2023, VA received the Veteran's Supplemental Claim, VA Form 20-0995, seeking service connection for PTSD with major depressive disorder, cervical strain, costochondritis, right ankle lateral collateral ligament sprain, and left ankle lateral collateral ligament sprain.

7. From November 22, 2023, the Veteran's PTSD with major depressive disorder has been manifested by occupational and social impairment with reduced reliability and productivity due to such symptoms as depressed mood, anxiety, suspiciousness, chronic sleep impairment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances, including work or a work-like setting.

8. The Veteran's cervical strain manifested, at worst, as forward flexion to no less than 35 degrees, a combined range of motion limited to no less than 260 degrees, and no evidence of muscle spasm, guarding, favorable ankylosis of the entire cervical spine, or unfavorable ankylosis of the cervical spine.

9. The Veteran's costochondritis manifested, at worst, as painful motion; the Veteran did not have any ribs removed, nor have symptoms been productive of either severe or moderately severe disability of the associated muscles.

10. The Veteran's right ankle lateral collateral ligament sprain manifested by no more than moderate limited motion; dorsiflexion at 10 degrees and plantar flexion at 30 degrees.

11. The Veteran's left ankle lateral collateral ligament sprain manifested by no more than moderate limited motion; dorsiflexion at 10 degrees and plantar flexion at 35 degrees.

CONCLUSIONS OF LAW

1. The criteria for reconsideration of the claim seeking an effective date prior to November 22, 2023, for the award of service connection for PTSD with major depressive disorder are not met. 38 U.S.C. § 501(a); 38 C.F.R. § 3.156(c)(1).

2. The criteria for an effective prior to November 22, 2023, for the award of service connection for PTSD with major depressive disorder are not met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.400, 3.2500.

3. The criteria for an effective prior to November 22, 2023, for the award of service connection for cervical strain are not met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.400, 3.2500.

4. The criteria for an effective prior to November 22, 2023, for the award of service connection for costochondritis are not met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.400, 3.2500.

5. The criteria for an effective prior to November 22, 2023, for the award of service connection for right ankle lateral collateral ligament sprain are not met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.400, 3.2500.

6. The criteria for an effective prior to November 22, 2023, for the award of service connection for left ankle lateral collateral ligament sprain are not met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.400, 3.2500.

7. The criteria for an initial rating in excess of 50 percent rating for PTSD with major depressive disorder are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.71a, Diagnostic Code (DC) 9434-9411.

8. The criteria for an initial rating in excess of 10 percent for cervical strain are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.71a, DC 5237.

9. The criteria for an initial rating in excess of 10 percent for costochondritis are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.71a, DC 5299-5297, 4.73, DC 5321.

10. The criteria for an initial rating in excess of 10 percent for right ankle lateral collateral ligament sprain are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.71a, DC 5271.

11. The criteria for an initial rating in excess of 10 percent for left ankle lateral collateral ligament sprain are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.7, 4.71a, DC 5271.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from July 1998 to July 2004, to include service in both Kuwait and Iraq.

In June 2024, the Agency of Original Jurisdiction (AOJ) granted service connection for PTSD with major depressive disorder, cervical strain, costochondritis, right ankle lateral collateral ligament sprain, and left ankle lateral collateral ligament sprain; assigned a 50 percent rating for PTSD with major depressive disorder, 10 percent rating for cervical strain, 10 percent rating for costochondritis, 10 percent rating for right ankle lateral collateral ligament sprain, and a 10 percent rating for left ankle lateral collateral ligament sprain; and effectuated the awards as of November 22, 2023. In September 2024, the Veteran submitted a Decision Review Request: Higher-Level Review, VA Form 20-0996. In January 2025, the AOJ denied an effective date prior to November 22, 2023 for the award of service connection for PTSD with major depressive disorder, cervical strain, costochondritis, right ankle lateral collateral ligament sprain, and left ankle lateral collateral ligament sprain; denied a rating in excess of 50 percent for PTSD with major depressive disorder; and denied a rating in excess of 10 percent for cervical strain, costochondritis, right ankle lateral collateral ligament sprain, and left ankle lateral collateral ligament sprain.

In August 2025, the Veteran submitted a Decision Review Request: Board Appeal (Notice of Disagreement), VA Form 10182, and elected the Direct Review docket. Therefore, the Board of Veterans' Appeals (Board) may only consider the evidence of record at the time of the June 2024 AOJ decision, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the June 2024 decision, which was subsequently subject to higher-level review, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801. If the Veteran would like the 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. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. 38 C.F.R. § 3.2501. Specific instructions for filing a Supplemental Claim are included with this decision.

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Initial Matter - Boilerplate Argument from Attorney

The Board observes that the Veteran's attorney has submitted written argument that includes boilerplate language that is not in any way specific to this Veteran's appeal, including statements that "the Veteran disagrees with each and every denial, which expressly or impliedly made by the Secretary, on any and all claims pending at the time of the decision, whether informally or formally made by the Veteran" and headings such as "examination inadequate," "obesity as an intermediate step," "medications," and "scope of claims" with no reference to how these assertions relate to this specific Veteran's case.  See September 2024 Third Party Correspondence.  Such vague, unspecific assertions of general errors do not amount to a specific argument in this case and thus need not be addressed.           See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (the Board's obligation to read filings in a liberal manner does not require the Board or the CAVC to search the record and address procedural arguments when the claimant fails to raise them before the Board); see also Hanna v. McDonough, No. 22-7431, 2023 U.S. Vet. App. Claims LEXIS 1836 (Nov. 29, 2023) (finding that generic boilerplate language in Board appellate documents did not preserve issues for CAVC appeal).

1. Entitlement to reconsideration of the claim seeking an effective date prior to November 22, 2023, for the award of service connection for PTSD with major depressive disorder is denied.

The Veteran asserts that reconsideration under 38 C.F.R. § 3.156(c)(1) of the claim seeking an effective date prior to November 22, 2023, for the award of service connection for PTSD with major depressive disorder is warranted, as VA received on November 22, 2023, along with the Supplemental Claim, VA Form 20-0995, relevant official service department records that existed and had not been associated with the claims file when VA first denied the claim of service connection for "work related stress/mental health depression" in a February 2006 rating decision. See September 11, 2024 Third Party Correspondence; August 2025 VA Form 10182. Specifically, the Veteran's counsel stated that: "mainly for [the] work-related stress/mental health depression claims, as the new STRs reveal [the Veteran] was treated with Sertraline for his depression during service;" "this prescription would persuasively indicate that he experienced the onset of a chronic depression condition during service, as clearly identified in his service records, which qualifies for presumption under 38 C.F.R. § 3.303(b);" and "these records include post-deployment questionnaires and forms specifically identifying PTSD, depression, and various health concerns." See September 11, 2024 Third Party Correspondence; August 2025 VA Form 10182. For the reasons outlined below, the Board disagrees.

Notwithstanding any other section in this part, at any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, VA will reconsider the claim, notwithstanding paragraph (a) of this section. Such records include, but are not limited to: (i) service records that are related to a claimed in-service event, injury, or disease, regardless of whether such records mention the veteran by name, as long as the other requirements of paragraph (c) of this section are met; (ii) additional service records forwarded by the Department of Defense or the service department to VA any time after VA's original request for service records; and (iii) declassified records that could not have been obtained because the records were classified when VA decided the claim. 38 C.F.R. § 3.156(c)(1). Paragraph (c)(1) of this section does not apply to records that VA could not have obtained when it decided the claim because the records did not exist when VA decided the claim, or because the claimant failed to provide sufficient information for VA to identify and obtain the records from the respective service department or from any other official source. 38 C.F.R. § 3.156(c)(2). An award made based all or in part on the records identified by paragraph (c)(1) of this section is effective on the date entitlement arose or the date VA received the previously decided claim, whichever is later, or such other date as may be authorized by the provisions of this part applicable to the previously decided claim. 38 C.F.R. § 3.156(c)(3). A retroactive evaluation of disability resulting from disease or injury subsequently service connected on the basis of the new evidence from the service department must be supported adequately by medical evidence. Where such records clearly support the assignment of a specific rating over a part or the entire period of time involved, a retroactive evaluation will be assigned accordingly, except as it may be affected by the filing date of the original claim. 38 C.F.R. § 3.156(c)(4).

In Blubaugh v. McDonald, 773 F.3d 1310, 1313 (Fed. Cir. 2014), the Federal Circuit noted that paragraph (c)(1) "is a separate and distinct provision from subsection (c)(3)" and that "[t]he language and overall structure of § 3.156(c) strongly suggest that § 3.156(c)(1) requires ... VA to reconsider only the merits of a veteran's claim" whenever newly acquired relevant service records are associated with the claims file, and that "[o]nly if VA grants benefits resulting from reconsideration of the merits under § 3.156(c)(1) must it consider an earlier effective date under subsections (c)(3) and (c)(4)." Additionally, in Emerson v. McDonald, 28 Vet. App. 200, 208 (2016), the United States Court of Appeals for Veterans' Claims (Court) further emphasized the distinction between paragraphs (c)(1) and (c)(3), stating that the operative clause in § 3.156(c)(1) "mandates that 'VA will reconsider the claim'" at any time after it issues a decision on a claim if it receives relevant service department records not previously associated with the claims file. Further, "the context of § 3.156(c) makes clear that, in order to be 'relevant' for purposes of reconsideration, additional records must speak to the basis for the VA's prior decision." Kisor v. McDonough, 995 F.3d 1316, 1323 (Fed. Cir. 2021).

On February 18, 2004, VA received an Application for Compensation, VA Form 21-526, seeking, in pertinent part, service connection for "work related stress/mental health [and] depression." See February 18, 2004 VA Form 21-526. Also on February 18, 2004, VA associated with the claims file, six sets (see February 18, 2004 STR - Medical; STR - Dental; Military Personnel Record; STR - Medical; DD Form 214; and STR - Medical) of official service department records.  

Contrary to the attorney's contention that: "mainly for [the] work-related stress/mental health depression claims, as the new STRs reveal [the Veteran] was treated with Sertraline for his depression during service;" and "these records include post-deployment questionnaires and forms specifically identifying PTSD, depression, and various health concerns," the Board observes that the above-noted two out of the six sets of official service department records contained the referenced service records. In this regard, an undated "aeromedical evacuation patient record" states that the Veteran's "medications/treatments" included "also Sertraline" (see February 18, 2004 STR - Medical, p. 97) and a January 23, 2004 "post-deployment health assessment" states that the Veteran answered "some" to the question of how often he felt bothered by "feeling down, depressed, or hopeless" over the last two weeks (see February 18, 2004 STR - Medical, pp. 4-7). Notably, the post-deployment health assessment shows "today's date" of "23/01/2004" with a line inscribed across it and a date of "17/02/2004" inscribed next to it; and the "date of departure from theater" of "23/02/2004" with a line inscribed across it and a date of "11/02/2004" inscribed next to it (see February 17, 2004 STR - Medical p. 4).

The Board also observes that the Veteran was not afforded both a VA examination and medical opinion as to his claim of service connection for a psychiatric disability, and in February 2006, the AOJ denied service connection for "work related stress/mental health depression, " noting consideration of STRs dated from July 1988 to July 2004.  See February 14, 2006 Rating - Narrative. The Veteran was notified of this decision on February 16, 2006. See February 16, 2006 Notification Letter.

On November 22, 2023, VA received a Supplemental Claim, VA Form 20-0995, seeking, in pertinent part, readjudication of the claim of service connection for "work related stress/mental health depression" based on the receipt of new and relevant evidence. See November 22, 2023, VA Form 20-0995. Also on November 22, 2023, VA associated with the claims file, three sets (see November 22, 2023 STR - Medical; STR - Medical; and STR - Medical) of official service department records. 

The Board observes that the above-noted three sets of service department records are duplicates of the service department records that were associated with the claims file on February 18, 2004. Specifically in regard to the attorney's above-noted contention, two out of the three sets of official service department records contains the same undated "aeromedical evacuation patient record" that states that the Veteran's "medications/treatments" included "also Sertraline" (see November 22, 2023 STR - Medical, p. 43); the same January 23, 2004 "post-deployment health assessment" with the exact inscriptions (see November 22, 2023 STR - Medical, pp. 53-56); and the same January 23, 2004 "post-deployment health assessment" without the inscriptions (see November 22, 2023, STR - Medical, pp. 63-66).

The Board also observes that the Veteran was afforded a VA PTSD examination in April 2024 that resulted in a diagnosis of PTSD and major depressive disorder, recurrent, in remission and a positive opinion that related the Veteran's psychiatric disability to active service (see May 16, 2024 C&P Exam), and in June 2024, the AOJ granted service connection for PTSD with major depressive disorder; assigned a 50 percent rating for that disability; and effectuated the award as of November 22, 2023 (see June 25, 2024 Rating Decision - Narrative).

Here, VA did not receive or associate with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim of service connection for "work related stress/mental health depression" in February 2006, as the above-noted three sets of official service department records received by VA on November 11, 2023 were duplicates of the six sets of official service department records received by VA on February 18, 2004. Therefore, reconsideration under 38 C.F.R. § 3.156(c)(1) of the claim seeking an effective date prior to November 22, 2023, for the award of service connection for PTSD with major depressive disorder is denied.

2. Entitlement to an effective date prior to November 22, 2023, for the award of service connection for PTSD with major depressive disorder is denied.

3. Entitlement to an effective date prior to November 22, 2023, for the award of service connection for cervical strain is denied.

4. Entitlement to an effective date prior to November 22, 2023, for the award of service connection for costochondritis is denied.

5. Entitlement to an effective date prior to November 22, 2023, for the award of service connection for right ankle lateral collateral ligament sprain is denied.

6. Entitlement to an effective date prior to November 22, 2023, for the award of service connection for left ankle lateral collateral ligament sprain is denied.

The Veteran asserts that an effective date prior to November 22, 2023 is warranted for the award of service connection for PTSD with major depressive disorder, cervical strain, costochondritis, right ankle lateral collateral ligament sprain, and left ankle lateral collateral ligament sprain. For the reasons outlined below, the Board disagrees.

Except as otherwise provided, the effective date of an evaluation and award of pension, compensation, or dependency and indemnity compensation based on an initial claim or supplemental claim will be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400.

The effective date for an award of direct service connection, is the day after separation from active service or the date entitlement arose if the claim is received within one year after separation from service; otherwise, the effective date will be the date of receipt of the claim, or the date entitlement arose, whichever is later. Separation from service means separation under conditions other than dishonorable from continuous active service which extended from the date the disability was incurred or aggravated. 38 U.S.C. § 5110(b)(1); 38 C.F.R. § 3.400(b)(2)(i).

The term "date of receipt" means the date on which a claim, information or evidence was received in the VA, except as to specific provisions for claims or evidence received in the State Department (§ 3.108), or in the Social Security Administration (§§ 3.153, 3.201), or Department of Defense as to initial claims filed at or prior to separation. 38 C.F.R. § 3.1(r).

The term "date entitlement arose" is not defined in the current statute or regulation. However, the Court has interpreted it as the date when the claimant met the requirements for the benefits sought. This is determined on a "facts found" basis. See 38 U.S.C. § 5110(a); McGrath v. Gober, 14 Vet. App. 28, 35 (2000). An effective date generally can be no earlier than the "facts found." DeLisio v. Shinseki, 25 Vet. App. 45 (2011). These "facts found" include the date the disability first manifested and the date entitlement to benefits was authorized by law and regulation. See 38 C.F.R. § 3.400. For instance, if a claimant filed a claim for benefits for a disability before he actually had the disability, the effective date for benefits can be no earlier than the date the disability first manifested. Ellington v. Peake, 541 F.3d 1364, 1369-70 (Fed. Cir. 2008). However, the date entitlement arose is not the date that the AOJ receives the evidence, but the date to which that evidence refers. McGrath, 14 Vet. App. at 35. It is possible that a particular piece of evidence demonstrates that the Veteran suffered from the symptoms of a disability or rating level earlier than the date of the examination, opinion, or diagnosis. DeLisio, 25 Vet. App. at 56.

A claimant may continuously pursue a claim or an issue by timely and properly filing a supplemental claim, a request for a higher-level review, or appeal to the Board following notice of a decision on an initial claim or a supplemental claim and/or a supplemental claim or a notice of appeal to the United States Court of Appeals for Veterans Claims (Court) after notice of a Board decision. If a claimant continuously pursues an issue by filing one of these administrative review options within one year, the effective date will be the date of receipt of the initial claim or the date entitlement arose, whichever is later. If a supplemental claim is received more than one year after the date on which the AOJ or the Board issued notice of a decision, the effective date will not be earlier than the date of receipt of the supplemental claim. 38 C.F.R. § 3.2500.

If VA receives a complete application form prescribed by the Secretary, as defined in paragraph (a) of § 3.160, appropriate to the benefit sought within 1 year of receipt of the intent to file a claim, VA will consider the complete claim filed as of the date the intent to file a claim was received. 38 C.F.R. § 3.155(b). If VA receives a complete claim within 1 year of the filing of an intent to file a claim that meets the requirements of paragraph (b) of this section, it will be considered filed as of the date of receipt of the intent to file a claim. Only one complete claim for a benefit (e.g., compensation, pension) may be associated with each intent to file a claim for that benefit, though multiple issues may be contained within a complete claim. In the event that multiple complete claims for a benefit are filed within 1 year of an intent to file a claim for that benefit, only the first claim filed will be associated with the intent to file a claim. 38 C.F.R. § 3.155(d)(ii).

If a supplemental claim is received within one year of an intent to file, the date the intent to file was received is the date of claim for effective date purposes. See Military-Veterans Advocacy v. Sec'y of Veterans Affairs, 7 F.4th 1110 (Fed. Cir. July 2021) (invalidating 38 C.F.R. § 3.155 in part).

On February 18, 2004 - while the Veteran was on active service - VA received an Application for Compensation, VA Form 21-526, seeking service connection, in pertinent part, for "work related stress/mental health depression," "upper back pain," "chest (rib) pain," and "bilateral ankle pain." See February 18, 2004 VA Form 21-526. The Veteran separated from active service on July 23, 2004. See October 24, 2024 DPRIS Response, DD Form 214, p. 35.

In October 2004, the AOJ denied service connection for upper back pain, chest (rib) pain, right ankle pain, and left ankle pain; and deferred entitlement to service connection for work related stress/mental health depression. See October 5, 2004 Rating Decision - Narrative. The Veteran was notified of this decision on October 12, 2004. See October 12, 2004 Notification Letter. In February 2006, the AOJ denied service connection for work related stress/mental health depression. See February 14, 2006 Rating Decision - Narrative. The Veteran was notified of this decision on February 16, 2006. See February 16, 2006 Notification Letter.  The Veteran did not appeal the October 2004 or February 2006 rating decisions, and new and material evidence was not received within one year of notification of their issuance.  Thus, the October 2004 and February 2006 rating decisions are final. See 38 U.S.C. § 7105(c); Bond v. Shinseki, 659 F.3d 1362 (Fed. Cir. 2011); 38 C.F.R. §§ 3.104, 3.156(a)-(b), 20.302, 20.1103.  

On September 5, 2023, VA informed the Veteran that: "[w]e received your intent to file on September 5, 2023" and "you indicated you would like to file a claim for compensation." See September 5, 2023 Intent to File Letter.

On November 15, 2023, VA received an Application for Compensation, VA Form 21-526EZ, seeking service connection for "intestinal condition," "lower back condition," "tinnitus;" and a higher rating for both "shin splints right leg" and "shin splints left leg." See November 15, 2023 VA Form 21-526EZ.

On November 22, 2023, VA received a Supplemental Claim, VA Form 20-0995, seeking, in pertinent part, readjudication of the claims of service connection for work stress/mental health depression, upper back, chest (rib) pain, right ankle pain, and left ankle pain. See November 22, 2023 VA Form 20-0995.

In March 2024, the AOJ granted service connection for left ear hearing loss; assigned a noncompensable rating for that disability, effective as of September 5, 2023; and deferred, in pertinent part, entitlement to service connection for work related stress/mental health depression, upper back pain, chest (rib) pain, right ankle pain, and left ankle pain. See March 28, 2024 Rating Decision - Narrative. The Veteran was notified of this decision on April 3, 2024. See April 3, 2024 Notification Letter. On April 9, 2024, the AOJ granted service connection for degenerative disc disease with thoracic strain and degenerative arthritis and irritable bowel syndrome; assigned compensable ratings for those disabilities; and effectuated the awards as of September 5, 2023; and denied compensable ratings for both right lower leg shin splints and left lower leg shin splints. See April 9, 2024 Rating Decision - Narrative. The Veteran was notified of this decision on April 10, 2024. See April 10, 2024 Notification Letter.

In June 2024, the AOJ granted service connection for PTSD with major depressive disorder, cervical strain, costochondritis, right ankle lateral collateral ligament sprain, and left ankle lateral collateral ligament sprain all "as directly related to military service;" assigned a 50 percent rating for PTSD with major depressive disorder, 10 percent rating for cervical strain, 10 percent rating for costochondritis, 10 percent rating for right ankle lateral collateral ligament sprain, and a 10 percent rating for left ankle lateral collateral ligament sprain; and effectuated the awards as of November 22, 2023. See June 25, 2024 Rating Decision - Narrative. The Veteran was notified of this decision on June 27, 2024. See June 27, 2024 Notification Letter.

In September 2024, VA received a Higher-Level Review, VA Form 20-0996, as to the effective dates and ratings assigned in the June 2024 AOJ decision. See September 11, 2024 VA Form 20-0996. In January 2025, the AOJ denied an effective date prior to November 22, 2023 for the award of service connection for PTSD with major depressive disorder, cervical strain, costochondritis, right ankle lateral collateral ligament sprain, and left ankle lateral collateral ligament sprain; denied a rating in excess of 50 percent for PTSD with major depressive disorder; and denied a rating in excess of 10 percent for cervical strain, costochondritis, right ankle lateral collateral ligament sprain, and left ankle lateral collateral ligament sprain. See January 3, 2025 Rating Decision - Narrative. The Veteran was notified of this decision on January 6, 2025. See January 6, 2025 Notification Letter.

Here, the service-connected PTSD with major depressive disorder, cervical strain, costochondritis, right ankle lateral collateral ligament sprain, and left ankle lateral collateral ligament sprain has been shown to have originated during active service, which is the date entitlement arose. On February 18, 2004 - while the Veteran was on active service - VA received an initial claim of service connection for "work related stress/mental health depression," "upper back pain," "chest (rib) pain," and "bilateral ankle pain." The Veteran separated from active service on July 23, 2004. The AOJ denied service connection for upper back pain, chest (rib) pain, right ankle pain, and left ankle pain in October 2004; and denied service connection for work related stress/mental health depression in February 2006. On September 5, 2023, VA received an intent to file a claim for compensation. However, on November 15, 2023, VA received an Application for Compensation, VA Form 21-526EZ, seeking service connection for "intestinal condition," "lower back condition," "tinnitus;" and a higher rating for both "shin splints right leg" and "shin splints left leg," which was an intervening claim for compensation. On November 22, 2023, VA received a Supplemental Claim, VA Form 20-0995, seeking, in pertinent part, readjudication of the claims of service connection for work stress/mental health depression, upper back, chest (rib) pain, right ankle pain, and left ankle pain. Although the November 22, 2023 Supplemental Claim, VA Form 20-0995 was submitted within one year of the September 5, 2023 intent to file a claim for compensation, VA received an intervening claim for compensation on November 15, 2023 that attached to the September 5, 2023 intent to file a claim for compensation. 38 C.F.R. § 3.155(b).  The November 22, 2023 Supplemental claim was received by VA more than one year after the AOJ issued notice of the unappealed October 2004 decision that denied service connection for cervical strain, costochondritis, right ankle lateral collateral ligament sprain, and left ankle lateral collateral ligament sprain; and the unappealed February 2006 decision that denied service connection for PTSD with major depressive disorder. Therefore, the Board finds that the appropriate effective date for the award of service connection for PTSD with major depressive disorder, cervical strain, costochondritis, right ankle lateral collateral ligament sprain, and left ankle lateral collateral ligament sprain is November 22, 2023 - the receipt of the Supplemental Claim, VA Form 20-0995. Accordingly, an effective date prior to November 22, 2023, for the award of service connection for PTSD with major depressive disorder, cervical strain, costochondritis, right ankle lateral collateral ligament sprain, and left ankle lateral collateral ligament sprain is denied.

Ratings

Disability ratings are determined by comparing the Veteran's symptoms during the relevant period with the criteria set forth in the Schedule for Rating Disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When there is a question as to which of two disability ratings 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.

Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating, with the first code representing the underlying condition and the second code representing the residuals. 38 C.F.R. § 4.27.

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.

7. Entitlement to an initial rating in excess of 50 percent for PTSD with major depressive disorder is denied.

The Veteran asserts that a 70 percent rating for PTSD with major depressive disorder is warranted. See August 2025 VA Form 10182, p. 4. For the reasons outlined below, the Board disagrees.

The Board observes that the service-connected PTSD with major depressive disorder is rated 50 percent disabling, on and after November 22, 2023, under DC 9434-9411. See e.g., November 26, 2025 Rating Decision - Codesheet. 

PTSD and major depressive disorder are both evaluated under the General Rating Formula for Mental Disorders. A 50 percent rating is assigned 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. A 70 percent rating is warranted for PTSD with major depressive disorder where there is 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; intermittently illogical, obscure, or irrelevant speech; 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); and an inability to establish and maintain effective relationships. A 100 percent rating requires total occupational and social impairment due to symptoms such as gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, a persistent danger of hurting himself or others, an 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, own occupation, or own name. 38 C.F.R. § 4.130, DCs 9411, 9434.

Under the General Formula for Mental Disorders, the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant the rating, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). However, a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the symptoms associated with that percentage, or others of similar severity, frequency, and duration, and that such symptoms have resulted in the type of occupational and social impairment associated with that percentage. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117-18 (Fed. Cir. 2013).

A March 4, 2024 VA clinical record states that the Veteran was "going through stressful divorce" and he answered "several days" to the question of how often he felt feeling down, depressed, or hopeless over the past two weeks. See March 25, 2024 CAPRI, pp. 22, 27.

A March 26, 2024 VA clinical record states that the Veteran reported "symptoms of trauma, including intrusive memories [and] thoughts, avoidance of thoughts, feelings, reminders, negative mood, cognitions about self/others, irritability, and some arousal symptoms impacting sleep, concentration, [and] hypervigilance;" "doesn't pursue opportunities out of apprehension of the unknown;" "avoids people and unfamiliar routes;" "these [psychiatric] symptoms have impacted his relationship with his wife, and she started the divorce process in September;" "denied suicidal/homicidal ideation, plan, or intent;" and "denied past attempts or hospitalizations for mental health concerns." See May 14, 2024 CAPRI, pp. 1-3.

The report of an April 2024 VA PTSD examination states that the Veteran was diagnosed with both PTSD and major depressive disorder, recurrent, in remission. The examiner noted that it was not possible to different what symptoms were attributable to each diagnosis. The Veteran reported that "he got married in 2016 ... have one son, age six;" "his wife moved to California two years ago and took [his] son with her ... it's a struggle to see him and visit;" "he has an inability to communicate how I feel, which negatively impacted his relationship;" "his relationship with his son is going well;" "he has not had close friendships for many years;" "he stays in touch friends long distance and has one friend who lives nearby;" "enjoys working on projects, off roading, being out in the woods, riding his motorcycle, and target shooting;" "keeps a rifle in his closet and feels comforted by knowing where it's at;" "personality challenges arose [at his previous employment];" "[currently] working in quality assurance ... gets along with people at his current job and finds that there is less friction at work;" "hasn't been getting into fights or struggling with aggression for the last 10 or so years;" "his mood is currently good;" and "he continued struggling with depression off and on after discharge and most recently experienced depressed mood for a few months until [January 2024], when his mood improved." On mental status examination, the Veteran exhibited a depressed mood; anxiety; suspiciousness; chronic sleep impairment; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; and difficulty in adapting to stressful circumstances, including work or a work-like setting. The examiner stated that the Veteran "was well groomed and appropriately dressed;" "was alert and fully oriented to person, place, time, and situation;" "[exhibited] mood ... neutral with broad and appropriate affect;" "[exhibited] eye contact ... good;" "[exhibited] speech ... normal for volume, rate, and prosody;" "[exhibited] thought process ... clear, goal directed, and logical;" "denied current suicidal or homicidal ideation;" and "[exhibited] cognition ... within normal limits." The examiner concluded that the service-connected PTSD with major depressive disorder was productive of "occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication." See May 16, 2024 C&P Exam.

The April 2024 VA examiner concluded that the PTSD with major depressive disorder was productive of "occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by medication," which fits the criteria for a 10 percent rating under DC 9434-9411. However, the April 2024 VA examiner stated that the Veteran exhibited a depressed mood (30 percent rating); anxiety (30 percent rating); suspiciousness (30 percent rating); chronic sleep impairment (30 percent rating); disturbances of motivation and mood (50 percent rating); difficulty in establishing and maintaining effective work and social relationships (50 percent rating); and difficulty in adapting to stressful circumstances, including work or a work-like setting (70 percent rating).  Per this report, the Veteran exhibits only one of symptoms that correspond with the criteria for a 70 percent rating under DC 9434-9411, but two of the symptoms that correspond with the criteria for a 50 percent rating, and four symptoms that correspond with a 30 percent rating. In assigning a 50 percent rating, the AOJ afforded the Veteran the benefit of the doubt regarding his symptoms. 38 C.F.R. §§ 4.3, 4.7.

Occupationally, the  Veteran has been employed full-time over the full appeal period, noting to the VA examiner that he gets along with others at his current job and that there is "less friction" at work because of his understanding employer.  With regard to social impairment, while VA clinical records show that the Veteran's symptoms from his service-connected PTSD with major depressive disorder was a factor in the divorce from his wife, he reports that his relationship with his son is going well, that he stays in touch with friends long distance and has a close friend who lives near him.  Thus, while the Veteran has had some difficulty with relationships, he does not demonstrate an inability to establish and maintain effective relationships coincident with a 70 percent rating or higher.  He has denied suicidal ideation over the appeal period, his speech, orientation, and hygiene were normal, and he does not endorse more severe symptoms associated with a 100 percent rating such as persistent delusions or hallucinations, grossly inappropriate behavior, severe memory loss, or other symptoms of similar severity, frequency, or duration.

In short, the evidence of record persuasively weighs against finding that the severity, frequency, and duration of the Veteran's symptoms resulted in the level of impairment required for a 70 percent rating or 100 percent rating. The benefit-of-the-doubt rule does not apply, the criteria for a 70 percent or higher rating are not met, and the appeal must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

8. Entitlement to an initial rating in excess of 10 percent for cervical strain is denied.

The Veteran asserts that a rating in excess of 10 percent for cervical strain is warranted. See August 2025 VA Form 10182. The Board observes that the service-connected cervical strain is rated 10 percent disabling, on and after November 22, 2023, under DC 5237. See e.g., November 26, 2025 Rating Decision - Codesheet. For reasons outlined below, the Board disagrees.

Under DC 5237 for the General Rating Formula for Diseases and Injuries of the Spine, a 10 percent rating is assigned for forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees; or, combined range of the motion of the cervical spine greater than 170 degrees but not greater than 335 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or, vertebral body fracture with loss of 50 percent or more of the height. A 20 percent rating is assigned for forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees; or, the combined range of motion of the cervical spine not greater than 170 degrees; or, muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 30 percent rating is assigned for forward flexion of the cervical spine 15 degrees or less; or, favorable ankylosis of the entire cervical spine. A 40 percent rating is assigned for unfavorable ankylosis of the entire cervical spine. A 100 percent rating is assigned for unfavorable ankylosis of the entire spine. 38 C.F.R. § 4.71a, DC 5237.

There are also several relevant note provisions associated with DC 5237.

Note (1): Evaluate any associated objective neurologic abnormalities, including, but not limited to bowel or bladder impairment, separately, under an appropriate DC.

Note (2): (See also Plate V.) For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees, extension is zero to 45 degrees, left and right lateral flexion are zero to 45 degrees, and left and right lateral rotation are zero to 80 degrees. The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion.

Note (3): In exceptional cases, an examiner may state that because of age, body habitus, neurological disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in an individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted.

Note (4): Round each range of motion measure to the nearest five degrees.

Note (5): For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.

Note (6): Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability.

In Chavis v. McDonough, 34 Vet. App. 1 (2021), the Court held that when evaluating a disability under VA's General Rating Formula for Diseases and Injuries of the Spine, the criteria for a rating based on ankylosis may be met by evidence demonstrating the functional equivalent of ankylosis, i.e., functional loss consistent with that contemplated by ankylosis. 38 C.F.R. §§ 4.40, 4.45; Mitchell v. Shinseki, 25 Vet. App. 32 (2011); DeLuca v. Brown, 8 Vet. App. 202 (1995). The provisions of 38 C.F.R. §§ 4.40 and 4.45 are for application when evaluating joint disabilities and their manifestations, which may include ankylosis. These sections direct adjudicators to determine whether the joint demonstrates less movement than normal and ankylosis is specifically identified among the possible causes of less movement. Moreover, § 4.40 provides that "functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the claimant undertaking the motion." The Court in Chavis found that the application of §§ 4.40 and 4.45 permits consideration under the General Rating Formula of an evaluation based on ankylosis if a claimant's functional loss is consistent with that contemplated by ankylosis or if it is the functional equivalent of ankylosis.

The Board observes that the use of medications is not contemplated under DC 5237. The Board is required "to discount beneficial medication effects when relevant rating criteria do not specifically contemplate medication use." Ingram v. Collins, 38 Vet. App. 130 (2025); see also Jones v. Shinseki, 26 Vet. App. 56 (2012). In this regard, a March 2024 VA clinical record states "no medications found" under the section "Current Medication" (see May 14, 2024 CAPRI, p. 8) and the report of a May 2024 VA cervical spine examination does not reflect that the Veteran used medication for his cervical strain, instead, the examiner noted "chiropractor" as to whether the Veteran had any treatment, medications, or surgery as to his cervical strain (see May 20, 2024 C&P Exam). Therefore, the Board finds that Ingram is not applicable to this claim.

The report of a May 2024 VA cervical spine examination states that the Veteran reported "neck pain;" "stiffness;" "limited range of motion;" and "worse after repetitive movements or prolonged position of the head and neck." He was diagnosed with a cervical strain. The examiner noted "chiropractor" as to whether the Veteran had any treatment, medications, or surgery. The examiner noted that the Veteran did not report flare-ups of the cervical spine, but the Veteran reported functional loss of the cervical spine stated as "hurts to turn my head, I have to turn my body to look around." Active range of motion was forward flexion, extension, right lateral flexion, and left lateral flexion all at 40 degrees with painful motion; and right lateral rotation and left lateral rotation both at 70 degrees; at a combined range of motion of 300 degrees. The examiner noted that the range of motion itself did not contribute to functional loss. The examiner stated that passive range of motion testing was performed and that each range of motion was the "same as active range of motion" with only forward flexion and extension that exhibited painful motion. There was pain with weight-bearing; active motion; and passive motion that resulted in/caused functional loss stated as "limits repetitive movements and prolonged positioning of the head and neck." There was no evidence of crepitus, localized tenderness, or pain on palpation of the joint or associated soft tissue. The Veteran performed repetitive use testing without additional loss of function or range of motion; the Veteran was not examined immediately after repetitive use; the procured evidence suggested that both pain and fatigability significantly limited functional ability with repetitive use; and the examiner estimated range of motion immediately after repetitive use as forward flexion, extension, right lateral flexion, and left lateral flexion all at 35 degrees; and right lateral rotation and left lateral rotation both at 60 degrees; with a combined range of motion at 260 degrees based on information procured from the Veteran. The Veteran was not examined during a flare-up; the procured evidence did not suggest that any pain, fatigability, weakness, lack of endurance, or incoordination significantly limited functional ability with flare-ups; and the examiner did not estimate range of motion during flare-ups based on information procured from the Veteran. Muscle strength, reflex, and sensory testing was normal. There was no localized tenderness, muscle spasms, guarding, additional factors contributing to disability, muscle atrophy, radiculopathy, ankylosis, other neurologic abnormalities, intervertebral disc syndrome, other pertinent physical findings, or scars. The Veteran did not use assistive devices. The examiner stated that the cervical strain impacted the Veteran's ability to perform any type of occupational task, as "limits repetitive movements and prolonged positioning of the head and neck." See May 20, 2024 C&P Exam.

The May 2024 VA examination is probative. The Veteran was not examined immediately after repetitive use, but the examiner noted that the Veteran had both pain and fatigability that significantly limited functional ability with repetitive use; the examiner estimated range of motion immediately after repetitive use as forward flexion, extension, right lateral flexion, and left lateral flexion all at 35 degrees, and right lateral rotation and left lateral rotation both at 60 degrees with a combined range of motion at 260 degrees based on information procured from the Veteran; the Veteran did not report flare-ups; and the examiner tested for pain on active motion, passive motion, weight-bearing, and non-weight bearing. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995); Jones v. Shinseki, 23 Vet. App. 382, 391 (2010); Mitchell v. Shinseki, 25 Vet. App. 32 (2011); Correia v. McDonald, 28 Vet. App. 158 (2016); Sharp v. Shulkin, 29 Vet. App. 26, 36 (2017).

Here, the evidence of record at the time of the June 2024 AOJ decision shows that the orthopedic manifestations of the Veteran's cervical strain do not more nearly approximate that contemplated by a 20 percent rating or higher under DC 5237 at any time during the period on appeal. The May 2024 VA examination noted forward flexion to no less than 35 degrees, and a combined range of motion limited to 260 degrees, at worst, which fits squarely into the criteria for a 10 percent rating under DC 5237. There was no evidence of either muscle spasm or guarding on examination. Further, there was no evidence of radiculopathy, arthritis, ankylosis, or intervertebral disc syndrome throughout the period on appeal. Moreover, while the Veteran has competently indicated that "neck pain" and "stiffness" limits his functional ability, he denied flare-ups. Furthermore, such pain has not contributed to additional limitation of motion, including on passive range of motion and on weight-bearing, such that the symptoms would more nearly approximate forward flexion of the cervical spine greater than 15 degrees but not greater than 30 degrees or a combined range of motion of 170 degrees or less warranting a 20 percent rating under DC 5237. Accordingly, the Board finds that the evidence persuasively weighs against an initial rating in excess of 10 percent for the Veteran's cervical strain under the General Rating Formula for Diseases and Injuries of the Spine. 38 U.S.C. § 5107; 38 C.F.R. § 4.3.

9. Entitlement to an initial rating in excess of 10 percent for costochondritis is denied.

The Veteran asserts that a rating in excess of 10 percent for costochondritis is warranted. See August 2025 VA Form 10182. The Board observes that the service-connected costochondritis is rated 10 percent disabling, on and after November 22, 2023, under DC 5299-5297. See e.g., November 26, 2025 Rating Decision - Codesheet. For reasons outlined below, the Board disagrees.

The Board observes that costochondritis is not listed in the Rating Schedule. When a disability is not listed in the Rating Schedule, it may be rated by analogy to a closely related disease or injury in which not only the functions affected, but the anatomical location and symptomatology are closely analogous. 38 C.F.R. §§ 4.20, 4.27. The Veteran's costochondritis is rated under 38 C.F.R. § 4.71a, DC 5299-5297, by analogy. Specifically, the Veteran's costochondritis is rated under 38 C.F.R. § 4.59 for painful motion, which allows consideration of functional loss due to painful motion to be rated at least the minimum compensable rating for a particular joint, which is 10 percent under DC 5297. See June 25, 2024 Rating Decision - Narrative.

DC 5297 outlines the criteria for disability resulting from the removal of ribs. A 10 percent is assigned for removal of one rib or the resection of two or more ribs without regeneration. A 20 percent rating is assigned for the removal two ribs. A 30 percent rating is assigned for the removal of three or four ribs. A 40 percent rating is assigned for the removal of five or six ribs. A 50 percent rating is assigned for the removal of more than six ribs. 38 C.F.R. § 4.71a, DC 5297.

The Board has also considered whether evaluating the Veteran's costochondritis under another DC would result in a higher rating. Specifically, under DC 5321, disabilities resulting from injuries to the thoracic muscle group (Group XXI) are classified as slight, moderate, moderately severe, or severe. A noncompensable rating is warranted for slight muscle injury. A 10 percent rating is warranted for moderate muscle injury. A 20 percent rating is warranted for moderately severe or severe muscle injury. 38 C.F.R. § 4.73, DC 5321.

For VA rating purposes, the cardinal signs and symptoms of muscle disability are loss of power, weakness, lowered threshold of fatigue, fatigue-pain, impairment of coordination, and uncertainty of movement. 38 C.F.R. § 4.56(c). A slight disability of muscles comprises simple wound of muscle without debridement or infection. Objective findings include minimal scar; no evidence of fascial defect, atrophy, or impaired tonus; and no impairment of function or metallic fragments retained in muscle tissue. 38 C.F.R. § 4.56(d)(1). A moderate muscle disability comprises a through-and-through or deep penetrating wound of short track from a single bullet, small shell or shrapnel fragment, without explosive effect of high velocity missile, residuals of debridement, or prolonged infection. Objective findings should include entrance and (if present) exit scars; small or linear, indicating short track of missile through muscle tissue; some loss of deep fascia or muscle substance or impairment of muscle tonus; and loss of power or lowered threshold of fatigue when compared to the sound side. 38 C.F.R. § 4.56(d)(2).

A moderately severe muscle disability comprises a through-and-through or deep open penetrating wound by a small high-velocity missile or a large low-velocity missile, with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring. There should be a history of hospitalization for a prolonged period for treatment of the wound, with a record of consistent complaints of cardinal signs and symptoms of muscle disability, and, if present, evidence of inability to keep up with work requirements. Objective findings should include entrance and (if present) exit scars indicating track of missile through one or more muscle groups; and indications on palpation of loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with sound side. Tests of strength and endurance compared with sound side should demonstrate positive evidence of impairment. 38 C.F.R. § 4.56(d)(3). A severe muscle disability contemplates through-and-through or deep penetrating wounds due to high-velocity missile, or large or multiple low-velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, intermuscular binding and scarring. There should be a history of hospitalization for a prolonged period for treatment of the wound, with consistent complaints of cardinal signs and symptoms of muscle disability, worse than those shown for moderately severe muscle injuries, and, if present, evidence of inability to keep up with work requirements. Objective findings should include ragged, depressed and adherent scars indicating wide damage to muscle groups in missile track; palpable loss of deep fascia or muscle substance, or soft flabby muscles in wound area; and abnormal muscle swelling and hardening in contraction; tests of strength, endurance, or coordinated movements compared with the corresponding muscles of the uninjured side indicate severe impairment of function. 38 C.F.R. § 4.56(d)(4).

The report of a February 2024 VA bones and other skeletal conditions examination states the Veteran's report that "[he has] intermittent rib/sternal pain episodes" and "worse when taking deep breaths/on palpation." He was diagnosed with costochondritis. The examiner noted "ibuprofen PRN (as needed)" as current treatment/frequency. The examiner noted that the Veteran had not undergone either a rib removal or resection, or removal of the coccyx. There were no tumors, neoplasms, other pertinent physical findings, scars, and the Veteran did not use an assistive device. The examiner stated that the costochondritis impacted the Veteran's ability to work, as "during pain episodes, taking breaths worsens the pain" and "pain will wake him up at night sometimes." See February 20, 2024 C&P Exam.

The report of a May 2024 VA bones and other skeletal conditions examination states that the Veteran reported "right side sternum and rib pain." He was diagnosed with costochondritis. The examiner noted "PT" (physical therapy) as to whether the Veteran had any treatment, medications, or surgery. The examiner noted that the Veteran had not undergone either a rib removal or resection, or removal of the coccyx. There were no tumors, neoplasms, other pertinent physical findings, scars, and the Veteran did not use an assistive device. The examiner stated that the costochondritis did not impact the Veteran's ability to perform any type of occupational task. See May 20, 2024 C&P Exam.

Here, the evidence of record at the time of the June 2024 AOJ decision shows that the Veteran's costochondritis manifested as painful motion, at worst, which is closely analogous to the criteria for a 10 percent rating under DC 5297 based on painful motion under 38 C.F.R. § 4.59. The February 2024 VA examination and May 2024 VA examination both state that the Veteran had not undergone any rib removal, as a 20 percent rating under DC 5297 requires the removal of two ribs. Additionally, at no point during the appeal period does the evidence suggest that the Veteran's costochondritis produced symptoms that are more analogous to a moderately severe or severe impairment of Muscle Group XXI, to warrant the next higher rating of 20 percent under DC 5321. In this regard, the Veteran has no related muscular atrophy or objective evidence of diminished muscle strength, as reflected in both the February 2024 and May 2024 VA examinations. Although the Veteran reported painful motion that limits the extent of his physical activity, clinical testing during both the February 2024 and May 2024 VA examination revealed no objective loss of muscle strength or function, and he has no muscular atrophy or similar evidence of impaired muscle tone or loss of deep facia or muscle substance. Moreover, the Board observes that the use of medications is not contemplated under either DC 5297 or DC 5321, as the Board is required "to discount beneficial medication effects when relevant rating criteria do not specifically contemplate medication use." See Ingram v. Collins, 38 Vet. App. 130 (2025); Jones v. Shinseki, 26 Vet. App. 56 (2012). As noted, the February 2024 VA examiner noted "ibuprofen PRN (as needed)" as current treatment/frequency for the Veteran's rib/sternal pain episodes due to costochondritis. However, the ameliorative effects of medication are not shown to have any impact on functional impairment beyond reduction of pain, as the Veteran had not undergone any removal of his ribs, and both the February 2024 and May 2024 VA examination revealed no objective loss of muscle strength or function, and no muscular atrophy or similar evidence of impaired muscle tone or loss of deep facia or muscle substance. Accordingly, the Board finds that the evidence persuasively weights against an initial rating in excess of 10 percent for the Veteran's costochondritis under either DC 5297 or DC 5321. 38 U.S.C. § 5107; 38 C.F.R. § 4.3.

10. Entitlement to an initial rating in excess of 10 percent for right ankle lateral collateral ligament sprain is denied.

11. Entitlement to an initial rating in excess of 10 percent for left ankle lateral collateral ligament sprain is denied.

The Veteran asserts that a rating in excess of 10 percent for both right ankle lateral collateral ligament sprain and left ankle lateral collateral ligament sprain is warranted. See August 2025 VA Form 10182. The Board observes that the service-connected right ankle lateral collateral ligament sprain and left ankle lateral collateral ligament sprain are both rated 10 percent disabling, on and after November 22, 2023, under DC 5271. See e.g., November 26, 2025 Rating Decision - Codesheet. For reasons outlined below, the Board disagrees.

Under DC 5271, a 10 percent rating is assigned for moderate (less than 15 degrees dorsiflexion or less than 30 degrees plantar flexion) limited motion of the ankle. A 20 percent rating is assigned for marked (less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion) limited motion of the ankle. 38 C.F.R. § 4.71a, DC 5271.  

The report of a February 2024 VA ankle examination states that the Veteran reported "constant stiffness and pain" for both ankles and "worse in colder weather/seasonal changes." He was diagnosed with bilateral ankle tendonitis. The examiner noted "ibuprofen PRN (as needed)" as current treatment/frequency. The examiner noted the Veteran's report of flare-ups for both ankles stated as "very stiff, radiating pain;" "every day, especially after physical therapy;" "[lasting] hours;" "[precipitated by] physical activity;" "[alleviated by] stretching;" and "has a hard time moving his ankles from the stiffness and has to stretch and rotate them to warm them up." The examiner noted the Veteran's report of functional loss for both ankles stated as "worsening bilateral ankle pain with extended periods of sitting, walking, [and] standing." The Veteran reported "[a] history of his ankles rolling in service" and "this does not occur as often anymore after he stopped running." Active range of motion for the right ankle was plantar flexion at 35 degrees with painful motion and dorsiflexion at 20 degrees; and left ankle was plantar flexion at 45 degrees and dorsiflexion at 20. The examiner noted that the range of motion for the right ankle contributed to functional loss, but the range of motion for the left ankle did not contribute to functional loss. The examiner noted that passive range of motion was the "same as active range of motion." For the right ankle, there was pain with weight-bearing, non-weightbearing, active motion, passive motion, on rest/non-movement, and the pain caused functional loss stated as "pain with walking." For the left ankle, the examiner noted "no evidence of pain." For both ankles, there was no evidence of crepitus, but there was tenderness on palpation. For both ankles, the Veteran performed repetitive use testing without additional loss of function or range of motion; the Veteran was not examined immediately after repetitive use; the procured evidence suggested that pain significantly limited functional ability with repetitive use; and estimated range of motion for the right ankle was plantar flexion at 30 degrees and dorsiflexion at 20 degrees, and for the left ankle was plantar flexion at 45 degrees and dorsiflexion at 20 degrees. For both ankles, the examination was not conducted during a flare-up; the procured evidence suggested that pain significantly limited functional ability with flare-ups; and estimated range of motion for the right ankle was plantar flexion at 30 degrees and dorsiflexion at 20 degrees, and for the left ankle was plantar flexion at 40 degrees and dorsiflexion at 15 degrees. For the right ankle, additional factors contributing to disability were interference with standing, interference with sitting, disturbance of locomotion, swelling, and less movement than normal. For the left ankle, additional factors contributing to disability were interference with sitting, interference with standing, swelling, and disturbance of locomotion. For both ankles, there was no muscle atrophy, ankylosis, joint instability, other pertinent physical findings, or scars, and the Veteran did not use assistive devices. For both ankles, the examiner noted shin splints that were unresponsive to shoe orthotics or other conservative treatment, and that this condition did not affect the range of motion of either knee. The examiner stated that both ankle disabilities impacted the Veteran's ability to perform any type of occupational task stated as "his job requires him to walk around for quality inspection" and "walking for extended periods worsens his bilateral ankle pain."

The February 2024 VA examination is probative. The Veteran was not examined immediately after repetitive use, but the examiner noted that the Veteran had pain that significantly limited functional ability with repetitive use for both ankles; the examiner estimated range of motion immediately after repetitive use for the right ankle as plantar flexion at 30 degrees and dorsiflexion at 20 degrees, and for the left ankle as plantar flexion at 45 degrees and dorsiflexion at 20 degrees based on information procured from the Veteran; the examination was not conducted during a flare-up, but the examiner noted that pain significantly limited functional ability with flare-ups; the examiner estimated range of motion with flare-ups for the right ankle as plantar flexion at 30 degrees and dorsiflexion at 20 degrees, and for the left ankle as plantar flexion at 40 degrees and dorsiflexion at 15 degrees based on information procured from the Veteran; and the examiner tested for pain on weight-bearing, non-weightbearing, active motion, passive motion, and on rest/non-movement. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995); Jones v. Shinseki, 23 Vet. App. 382, 391 (2010); Mitchell v. Shinseki, 25 Vet. App. 32 (2011); Correia v. McDonald, 28 Vet. App. 158 (2016); Sharp v. Shulkin, 29 Vet. App. 26, 36 (2017).

The report of a May 2024 VA ankle examination states that the Veteran reported "bilateral ankle pain, stiffness, cracking, and limited range of motion. He was diagnosed with both right ankle lateral collateral ligament and left ankle lateral collateral ligament sprain. The examiner stated "none" as to whether had any treatment, medications, or surgery for both ankles. The examiner noted that the Veteran did not report flare-ups for either ankle, but the Veteran reported functional loss for both ankles stated as "trouble walking and standing for long periods of time." The examiner noted that the Veteran did not report or have a history of instability of either ankle. For both ankles, active range of motion was plantar flexion at 40 degrees and dorsiflexion at 15 degrees with painful motion for both ranges of motion; the range of motion itself did not contribute to functional loss; passive range of motion was the same as active range of motion; there was pain with weight-bearing, active motion, passive motion, and the pain caused functional loss stated as "limits prolonged walking [and] standing;" and there was crepitus, but no evidence of localized tenderness or pain on palpation. For both ankles, the Veteran performed repetitive use testing without additional loss of function or range of motion; the Veteran was not examined immediately after repetitive use; the procured evidence suggested that pain and fatigability significantly limited functional ability with repetitive use; and estimated range of motion was plantar flexion at 35 degrees and dorsiflexion at 10 degrees. For both ankles, the examination was not conducted during a flare-up and the procured evidence did not suggest that any pain, fatigability, weakness, lack of endurance, or incoordination significantly limited functional ability with flare-ups. For both ankles, there was no additional factors contributing to disability; no muscle atrophy; no ankylosis; no joint instability; no shin splints, stress fractures, achilles tendonitis, achilles tendon rupture, malunion of calcaneus or talus, or talectomy; no surgery; no other pertinent physical findings; no scars; and the Veteran did not use assistive devices. The examiner stated that both ankle disabilities impacted the Veteran's ability to perform any type of occupational task stated as "limits prolonged walking [and] standing." See May 20, 2024 C&P Exam.

The May 2024 VA examination is probative. The Veteran was not examined immediately after repetitive use, but the examiner noted that the Veteran had pain and fatigability that significantly limited functional ability with repetitive use for both ankles; the examiner estimated range of motion immediately after repetitive use for both ankles as plantar flexion at 35 degrees and dorsiflexion at 10 degrees based on information procured from the Veteran; the Veteran did not report flare-ups for both ankles; and the examiner tested for pain on weight-bearing, active motion, and passive motion. 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995); Jones v. Shinseki, 23 Vet. App. 382, 391 (2010); Mitchell v. Shinseki, 25 Vet. App. 32 (2011); Correia v. McDonald, 28 Vet. App. 158 (2016); Sharp v. Shulkin, 29 Vet. App. 26, 36 (2017).

Here, the evidence of record at the time of the June 2024 AOJ decision shows that, at worst, the Veteran's right ankle lateral collateral ligament sprain manifested as dorsiflexion at 10 degrees, plantar flexion at 30 degrees, and painful motion, which fits squarely into the criteria for a 10 percent rating under DC 5271 (less than 15 degrees dorsiflexion); and left ankle lateral collateral ligament sprain manifested as dorsiflexion at 10 degrees, plantar flexion at 35 degrees, and painful motion, which also fits squarely into the criteria for a 10 percent rating under DC 5271 (less than 15 degrees dorsiflexion). The Board acknowledges the Veteran's report of bilateral ankle symptoms and that there was functional loss due to pain, pain during flare-ups, and pain during repetitive use over time. However, even considering the Veteran's reports of symptoms and functional loss, the degree of additional limitation reflected by the statements that he had pain, limitation of motion, and flare-ups resulting in restriction in range of motion would not result in symptoms more nearly approximating marked limited motion of the ankle (e.g., less than 5 degrees dorsiflexion or less than 10 degrees plantar flexion). Further, the Board observes that the use of medications is not contemplated under DC 5271, and in this regard, the Veteran reported that he used "ibuprofen PRN (as needed)" for both ankles, but there is no indication in the record that range of motion would be further restricted without the use of medications. Therefore, the ameliorative effects of medications are not shown in this record to have any impact on functional impairment beyond reduction of pain. The Veteran's restrictions of motion do not more closely approximate the criteria for a 20 percent rating under DC 5271 for both ankles, with or without medication. Lastly, because the evidence is negative for ankylosis of the ankle, ankylosis of the subastragalar or tarsal joint, deformity of the os calcis or astragalus, or astragalectomy, no other DCs may be considered. See Copeland v. McDonald, 27 Vet. App. 333, 337 (2015) (when a condition is specifically listed in the rating schedule, it may not be rated by analogy and should be rated under the diagnostic code that specifically pertains to it). Accordingly, the Board finds that the evidence persuasively weights against an initial rating in excess of 10 percent for both the Veteran's right ankle lateral collateral ligament sprain and left ankle lateral collateral ligament sprain under DC 5271. 38 U.S.C. § 5107; 38 C.F.R. § 4.3.

 

 

S. BUSH

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	B. Cohen

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.