From November 1, 2010 to May 14, 2015, entitlement to an initial rating of 20 percent, but no higher, for intervertebral disc syndrome (IVDS) with degenerative disc disease/degenerative joint disease (DDD/DJD) of the…

Citation Nr: 26001404 Decision Date: 01/30/26 Archive Date: 01/30/26 DOCKET NO. 15-12 138A DATE: January 30, 2026 ORDER From November 1, 2010 to May 14, 2015, entitlement to an initial rating of 20 percent, but no higher, for intervertebral disc syndrome (IVDS) with degenerative disc disease/degenerative joint disease (DDD/DJD) of the cervical spine is granted. From May 15, 2015 to present, entitlement to an increased rating in excess of 20 percent, for IVDS with DDD/DJD of the cervical spine is denied. Entitlement to an initial disability rating of 50 percent, but no higher, for radiculopathy of the left upper extremity is granted. REMANDED Entitlement to service connection for headaches, to include as a neurological impairment associated with service-connected IVDS with DDD/DJD of the cervical spine is remanded. FINDINGS OF FACT 1. From November 1, 2010 to May 14, 2015, and after resolving reasonable doubt, the Veteran's IVDS with DDD/DJD of the cervical spine has been manifested by, at most, forward flexion limited to 20 degrees. 2. From May 15, 2015 to present, the Veteran's IVDS with DDD/DJD of the cervical spine has been manifested by, at most, forward flexion limited to 20 degrees. 3. The Veteran's radiculopathy of the left upper extremity is characterized by severe incomplete paralysis of the major extremity. CONCLUSIONS OF LAW 1. From November 1, 2010 to May 14, 2015, the criteria for an initial rating of 20 percent, but no higher, for Veteran's IVDS with DDD/DJD of the cervical spine have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DC) 5010-5243. 2. From May 15, 2015 to present, the criteria for an increased rating in excess of 20 percent for Veteran's IVDS with DDD/DJD of the cervical spine have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.10, 4.40, 4.45, 4.59, 4.71a, DC 5010-5243. 3. The criteria for an initial rating of 50 percent for radiculopathy of the left upper extremity have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8510. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active duty from July 1986 to September 1988, and from December 1992 to October 2010. This matter is before the Board of Veterans' Appeals (Board) on appeal from an April 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO), which, inter alia, granted service connection for the Veteran's cervical spine disability and assigned a 10 percent rating under DC 5243 effective November 1, 2010. In a March 2013 rating decision, the RO granted service connection for radiculopathy of the left upper extremity (LUE) and assigned a 20 percent evaluation effective August 12, 2013. The Veteran testified at a hearing before a Veterans Law Judge in January 2017. A transcript is of record. In a June 2021 letter, the Board sent the Veteran a letter which informed him that the Judge who conducted the January 2017 Board hearing was no longer employed at the Board, asked him to indicate whether he wanted to attend a new hearing, and indicated that if he did not respond within 30 days it would be assumed that a new hearing was not requested. The Veteran did not respond to the June 2021 letter and thus, the Board proceeded with adjudication of his appeal. The Board remanded the case for further development in August 2018. In March 2020, the RO increased the rating for the Veteran's LUE radiculopathy to 40 percent from August 12, 2013, and the Veteran's IVDS with DDD/DJD of the cervical spine to 20 percent effective September 25, 2019. As the increased benefits did not constitute a full grant of the benefits sought, the issues remained in appellate status. See A.B. v. Brown, 6 Vet. App. 35, 39 (1993). In August 2021, the Board denied an increased disability rating for DDD and DJD of the cervical spine prior to May 15, 2015, and granted an increased rating of 20 percent from May 15, 2015. The Veteran appealed the August 2021 Board decision to the United States Court of Appeals for Veterans Claims (Court). In August 2022, the Court approved a Joint Motion for Partial Remand (Joint Motion), vacated the Board's August 2021 decision, and remanded the case back to the Board. The Board has remanded the case in accordance with the Joint Motion in January 2023, August 2023, and October 2024. Increased Rating 1. Entitlement to an initial rating in excess of 10 percent, for IVDS with DDD/DJD of the cervical spine from November 1, 2010 to May 14, 2015. 2. Entitlement to an increased rating in excess of 20 percent, for IVDS with DDD/DJD of the cervical spine from May 15, 2015 to present. Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. The percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3. Where entitlement to compensation has already been established and an increase in disability rating is at issue, the present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Within that context, VA must assess the level of disability from the date of initial application for service connection and determine whether the level of disability warrants the assignment of different disability ratings at different times over the life of the claim, a practice known as a "staged rating." See Fenderson v. West, 12 Vet. App. 119 (1999). Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Generally, the Board has been directed to consider only those factors contained wholly in the rating criteria. See Massey v. Brown, 7 Vet. App. 204, 208 (1994); but see Mauerhan v. Principi, 16 Vet. App. 436 (2002) (finding it appropriate to consider factors outside the specific rating criteria in determining level of occupational and social impairment). The Veteran's cervical spine disability is evaluated at 10 percent prior to May 15, 2015 and 20 percent from that date under DC 5010-5243, which evaluates disabilities according to the General Rating Formula for Diseases and Injuries of the Spine (General Formula). 38 C.F.R. § 4.71a, DC 5235-5243. Under the General Formula, a 10 percent rating is assigned for forward flexion of the cervical spine greater than 30 degrees but not greater than 40 degrees, or for a combined range of motion greater than 170 degrees but not greater that 335 degrees. It may also be assigned for any muscle spasm, guarding or localized tenderness that does not result in an abnormal gait or abnormal spinal contour, or for a vertebral body fracture with the loss of 50 percent or more of the height. A 20 percent rating is assigned when forward flexion of the cervical spine is greater than 15 degrees but not greater than 30 degrees, or the combined range of motion is not greater than 170 degrees. It can also be assigned if there are muscle spasms or guarding severe enough to result in an abnormal gait or abnormal spinal contour. A 30 percent rating is warranted when there is forward flexion of the cervical spine that is 15 degrees or less, or for favorable ankylosis of the entire cervical spine. A 40 percent rating is assigned for unfavorable ankylosis of the entire cervical spine; and a 100 percent rating is warranted for unfavorable ankylosis of the entire spine. For VA compensation purposes, unfavorable ankylosis is a condition in which the cervical spine, the 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. Ankylosis is defined as "immobility and consolidation of a joint due to disease, injury, or surgical procedure." Dorland's Illustrated Medical Dictionary, 94 (32nd ed. 2012). The General Formula applies for rating purposes with or without symptoms such as pain, stiffness, or aching in the area of the spine affected by residuals of injury or disease. When rating according to the General Formula, any associated objective neurologic abnormalities are rated separately under their respective diagnostic codes. See 38 C.F.R. § 4.71a, General Formula, Note (1). For the purposes of rating disabilities of the cervical spine, normal forward flexion, extension, and left and right lateral flexion of the cervical spine are zero to 45 degrees. Left and right lateral rotation are zero to 80 degrees. Thus, the normal combined range of motion for the cervical spine is 340 degrees. See 38 C.F.R. § 4.71a, General Formula, Note (2). In determining the appropriate rating for musculoskeletal disabilities, particular attention is focused on functional loss of use of the affected body part. 38 C.F.R. § 4.40. Weakness is as important as limitation of motion; and, as such, a body part that becomes painful on use must be regarded as seriously disabled. Under 38 C.F.R. § 4.45, factors of joint disability include increased or limited motion, weakness, fatigability, painful movement, swelling, deformity or disuse atrophy. Under 38 C.F.R. § 4.59, painful motion is considered an important factor of joint disability, and actually painful joints are entitled to at least the minimum compensable rating for the joint. This regulation also requires that, whenever possible, the joints in question are tested for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with the range of the opposite undamaged joint. See Correia v. McDonald, 28 Vet. App. 158, 168 (2016). Where functional loss is alleged due to pain upon motion, the provisions of 38 C.F.R. § 4.40 and § 4.45 must be considered. DeLuca v. Brown, 8 Vet. App. 202, 207-08 (1995). Within this context, a finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the claimant. Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Pain itself does not rise to the level of functional loss as contemplated by § 4.40 and § 4.45, but it may result in functional loss if it limits the ability to perform the normal working movements of the body with normal excursion, strength, coordination or endurance. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). The Veteran's cervical spine disability can also be rated using the Formula for Rating IVDS Based on Incapacitating Episodes. See 38 C.F.R. § 4.71a, Diagnostic Code 5243. This formula allows for a rating of 10 percent if there have been incapacitating episodes having a total duration of at least one week but less than two weeks during the past 12 months; a 20 percent rating if there have been incapacitating episodes having a total duration of at least two weeks but less than four weeks during the past twelve months; a 40 percent rating was assigned for incapacitating episodes having a total duration of at least four weeks, but less than six weeks during the past twelve months; and a 60 percent rating is assigned for incapacitating episodes having a total duration of at least six weeks during the past 12 months. 38 C.F.R. § 4.71a, Diagnostic Code 5243, Incapacitating Episodes Formula. For the purposes of this formula, an incapacitating episode is a period of acute signs and symptoms due to IVDS that requires bed rest prescribed by a physician and treatment by a physician. Id. at Note (1). Analysis As an initial matter, the Veteran argued in August 2022 that records should have been requested from Hollowell Chiropractic despite the Veteran's failure to respond to a February 2016 request for authorization to release the records. The AOJ attempted to obtain these records by sending a September 2023 VA correspondence that requested authorization and advised the Veteran that he could obtain and submit the records himself. Again, the Veteran did not respond. As such, the Board concludes there is no remaining duty to assist with respect to these records, or any other potentially outstanding private treatment records. Turning to the relevant evidence of record, the Veteran has been afforded several VA examinations and opinions during the pendency of the appeal: January 2011, August 2013, February 2016, September 2019, January 2023, June 2023, January 2024, January 2025, June 2025, July 2025, and September 2025. The Board has made several attempts to obtain retrospective opinions regarding the severity of the Veteran's cervical spine disability, including consideration of the findings in the January 2011, August 2013, February 2016, and September 2019 VA examinations. See August 2022 Joint Motion. The June 2023 VA examiner explained he could not opine a specific degree in numbers due to the fact that the Veteran's condition waxes and wanes and could only opine the condition has progressively worsened. The January 2025 VA examiner merely recited previous VA examination findings. The June 2025 and July 2025 VA examiner stated an opinion could not be provided without resort to speculation and the Veteran should be reevaluated. As the June 2023, January 2025, June 2025 and July 2025 VA examiners could not provide a retrospective opinion due to speculation or need for an in-person examination, to include based on the January 2011, August 2013, February 2016, and September 2019 VA examinations, the Board will find that they lack probative weight with respect to the severity of the Veteran's disability particularly for the period prior to May 15, 2015. Additionally, as these examiners could not provide an opinion based on the data in the January 2011, August 2013, February 2016, and September 2019 examinations, the Board will resolve all reasonable doubt in the Veteran's favor and conclude that it cannot adequately rely on the January 2011, August 2013, February 2016, and September 2019 VA examinations to adjudicate the claim for the cervical spine particularly with respect to range of motion and IVDS incapacitating episodes. However, the Board finds the January 2023, January 2024 and September 2025 VA examinations and the September 2025 VA opinions are adequate and probative as they are based on an in-person examination and a review of the records. Additionally, the September 2025 VA examiner provided a retrospective opinion of estimated range of motion based on weight-bearing. As such, for rating purposes, the Board will consider the January 2023, January 2024 and September 2025 VA examinations and the September 2025 VA opinions, including the remaining evidence of record including the May 2015 disability benefits questionnaire (DBQ), VA and private treatment records, and lay statements. The Board acknowledges that pursuant to Ingram v. Collins, 38 Vet. App. 130, 138 (2025), caselaw requires the Board to take due consideration that the beneficial effects of medication are discounted unless such effects are otherwise contemplated in a particular diagnostic code. In this case, the January 2023, January 2024 and September 2025 VA examiners, in rendering range of motion findings, noted and considered the Veteran's lay statements describing functional limitations when his pain and functional impairment is at its worst (e.g., during flare ups, on repetitive motion, due to lack of endurance, lack of coordination, etc.). The examination report as a whole does not indicate whether the Veteran was on any pain medications at the time of the examination, but in any case, it is clear the examiner already provided an opinion estimating range of motion findings discounting any potential ameliorating effects of medication. Moreover, the January 2023, January 2024 and September 2025 examination findings are consistent with the findings in the May 2015 DBQ that was submitted by the Veteran. As such, the Board finds the report and the remainder of the evidentiary record adequate to base a decision, resolving all reasonable doubt in the Veteran's favor. The Board concludes the evidence persuasively weighs in favor of an initial rating of 20 percent, but no higher, for the period prior to May 15, 2015. The January 2023, January 2024 and September 2025 VA examinations determined after clinical evaluation and review of the record, that cervical spine forward flexion is limited to, at most, 20 degrees when considering weight-bearing, flare-ups, and pain. These findings are consistent with the remaining evidence of record. The May 2015 DBQ indicated a forward flexion endpoint of 25 degrees, with no change after repetitive testing. In sum, forward flexion of 20 degrees meets the rating criteria for a 20 percent rating under the General Rating Formula. September 2016 and August 2018 private physical therapy records noted cervical flexion of 25 degrees. For these reasons, an initial rating of 20 percent, but no higher, for the period prior to May 15, 2015 is warranted. However, a rating in excess of 20 percent is not warranted for the entire period on appeal. The evidence of record persuasively weighs against a rating in excess of 20 percent for the cervical spine disability based on the General Rating Formula. The Board acknowledges the Veteran's lay reports of symptoms and that there was functional loss due to pain, weakened movement, excess fatigability, repetitive use, pain during flare-ups, and pain during repetitive use over time. However, even considering the Veteran's lay reports of symptoms and noted functional loss, the degree of additional limitation reflected by the statements that flare-ups occur once a month lasting 3 days and are moderate in severity would not result in limitation of motion of forward flexion of the cervical spine to 15 degrees or less; or favorable ankylosis or the functional equivalent of favorable ankylosis of the entire cervical spine. Collectively, the January 2023, January 2024 and September 2025 VA examinations and the May 2015 DBQ revealed forward flexion of the cervical spine is limited to, at most, 20 degrees. This is consistent with the remaining evidence of record, including September 2016 and August 2018 private physical therapy records noting cervical flexion of 25 degrees. Additionally, the January 2023, January 2024 and September 2025 VA examinations and the May 2015 DBQ determined after clinical examination and consideration of the Veteran's statements that there was no indication of ankylosis or functional equivalent of favorable ankylosis. The January 2024 VA examiner opined that ankylosis is stiffness/abnormal immobility/fixation of a joint as a result of injury or disease, and is constant/permanent rather than intermittent. The January 2024 VA examiner concluded that the time-limited, intermittent episodes of the Veteran's inability to turn his neck on occasion due to neck pain does not constitute (functional) ankylosis. VA treatment records and private treatment records, to include records from B. Physical Therapy and Aria, do not include findings of ankylosis or functional ankylosis. To the extent that the Veteran's statements in April 2013 and January 2017 that severe pain can prevent him from moving his neck for a minimum of several minutes, the Board finds that the Veteran's statements are outweighed by the medical evidence of record. While the Veteran is competent to report having experienced symptoms he has observed, the Veteran is not competent to provide a medical determination that these episodes are ankylosis or approximate ankylosis or functional ankylosis. The issue is medically complex, as it requires knowledge of the interaction between multiple organ systems in the body, anatomical relationships, interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Therefore, it is outside the competence of the Veteran in this case because the record does not show that he has the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011). Consequently, the Board gives more probative weight to the January 2024 VA examination. Additionally, the Board finds that the evidence of record persuasively weighs against a rating in excess of 20 percent for cervical spine disability based on the Formula for Rating IVDS. The evidence of record is against a finding that the Veteran was ever prescribed bed rest by a physician for a duration that meets the criteria for a higher rating of 40 percent. Specifically, the collective medical evidence of record including the January 2023, January 2024 and September 2025 VA examinations, the May 2015 DBQ, VA treatment records, and private treatment records such as B. Physical Therapy and Aria records do not show incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. Regarding neurological impairment, the May 2015 DBQ indicated the Veteran had an objective neurologic abnormality and/or finding of headache. This is addressed in the remand subsection below. The Veteran has already been granted service connection for radiculopathy of the left upper extremity and the lay and medical evidence of record is against a finding that the Veteran has any other neurological abnormality associated with the spine disability. For the foregoing reasons, an initial disability rating of 20 percent is granted for the period from November 1, 2010 to May 14, 2015 for the cervical spine disability. However, the evidence of record persuasively weighs against the Veteran's claim for a rating in excess of 20 percent for a cervical spine disability for the entire period on appeal. As the evidence of record persuasively weighs against a rating in excess of 20 percent, the benefit-of-the-doubt rule does not apply, an increased rating in excess of 20 percent for the period from May 15, 2015 is denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (2021). 3. Entitlement to an initial disability rating in excess of 40 percent for radiculopathy of the left upper extremity. As an initial matter, the Board notes that distinct and separately evaluated neurological complications of an underlying spinal disability generally do not remain part and parcel of a claim for an underlying spine condition claim for appellate purposes. See De Hart v. McDonough, 37 Vet. App. 371 (2024) (explaining that an initial grant of service connection is a full grant and that the rating and effective date are downstream issues which must be separately appealed). However, as the Board appears to have assumed appellate control over the radiculopathy claim in the January 2023, August 2023, October 2024, and May 2025 Board decisions, the Board will proceed to adjudicate the claim regarding whether an increased rating is warranted for radiculopathy of the left upper extremity. See Chavis v. McDonough, 34 Vet. App. 1 (2021). Paralysis of the upper radicular nerve group is evaluated in accordance with the criteria set forth in 38 C.F.R. § 4.124a, DC 8510-8519. Under these criteria, mild incomplete paralysis is rated as 20 percent for both the major and minor extremity. Moderate incomplete paralysis is rated as 40 percent for the major extremity and 30 percent for the minor extremity. Severe incomplete paralysis is rated as 50 percent for the major extremity and 40 percent for the minor extremity. Complete paralysis, all shoulder and elbow movements lost or severely affected, hand and wrist movements not affected, is rated as 70 percent for the major extremity and 60 percent for the minor extremity. 38 C.F.R § 4.124a. The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based on the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." The Note to 38 C.F.R. § 4.124a establishes a maximum disability rating for conditions that are wholly sensory, as opposed to a minimum disability rating for conditions that are more than wholly sensory. See Miller v. Shulkin, 28 Vet. App. 376 (2017). The Veteran's left upper extremity is his major extremity. He has been afforded January 2023 and January 2024 VA peripheral nerve examinations and January 2011, August 2013, February 2016, September 2019, January 2023, January 2024, January 2025, and September 2025 VA cervical spine examinations. Collectively, the January 2023 and January 2024 VA peripheral nerve examinations and January 2011, August 2013, February 2016, September 2019, January 2023, January 2024, January 2025, and September 2025 VA cervical spine examinations, May 2015 DBQ, VA treatment records, and private treatment records such as B. Physical Therapy and Aria records show pain, muscle atrophy, impairment of motor functions, sensory disturbance, and loss of reflexes. The May 2015 DBQ revealed minor atrophy, moderate pain, and decreased muscle strength with left shoulder abduction and flexion. The January 2023 and January 2024 VA peripheral nerve examinations revealed moderate pain, moderate paresthesias/dysesthesias, moderate numbness, and decreased sensation of the hand/fingers. The September 2019, January 2023, January 2024 and September 2025 VA cervical spine examinations revealed decreased sensation to light touch, moderate pain, moderate paresthesias/dysesthesias, and moderate numbness. The February 2016 VA cervical spine examinations revealed hypoactive (1+) reflexes. The September 2025 VA examiner additionally provided a retrospective opinion indicating constant pain and worsening numbness and tingling in his left upper extremity. Based on the above, the Board concludes the Veteran's radiculopathy of the left upper extremity is primarily manifested by impairment of motor functions, sensory disturbance, loss of reflexes, pain, and muscle atrophy. Accordingly, the Board will resolve reasonable doubt in the Veteran's favor and find that the level of impairment is most analogous to severe incomplete paralysis. This meets the criteria for a higher 50 percent rating as it involves the major extremity. An initial rating higher than 50 percent is not warranted as the evidence persuasively weighs against complete paralysis with all shoulder and elbow movements lost or severely affected, hand and wrist movements not affected. The January 2023 and January 2024 VA peripheral nerve examinations and January 2011, August 2013, February 2016, September 2019, January 2023, January 2024, January 2025, and September 2025 VA cervical spine examinations, May 2015 DBQ, VA treatment records, and private treatment records such as B. Physical Therapy and Aria records do not show trophic changes or complete paralysis. The Board has considered all other potentially applicable Diagnostic Codes, but there is no evidence showing the Veteran has neurological impairment associated with any other peripheral nerves. Therefore, a separate or higher rating under a different Diagnostic Code is not warranted. In conclusion, the Board finds that the evidence of record persuasively weighs in favor of an initial rating of 50 percent, but no higher, for radiculopathy of the left upper extremity. REASONS FOR REMAND 1. Entitlement to service connection for headaches, to include as a neurological impairment associated with service-connected IVDS with DDD/DJD of the cervical spine. The May 2015 DBQ indicated the Veteran had an objective neurologic abnormality and/or finding of headache. Additionally, August 2018 B. Physical Therapy records noted the Veteran's statement that he has intermittent headaches associated with his neck pain. Though the January 2023, January 2024 and September 2025 VA examinations determined there was no additional objective abnormality, the Board finds an examination and opinion is warranted to address whether headaches are a neurological impairment associated with service-connected IVDS with DDD/DJD of the cervical spine. The matter is REMANDED for the following action: Schedule the Veteran for a VA examination for headaches. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: (a) Is any headache disability at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) due to service-connected IVDS with DDD/DJD of the cervical spine, to include as an associated neurological abnormality? (b) Is any headache disability at least as likely as not aggravated, i.e., made worse, by service-connected IVDS with DDD/DJD of the cervical spine, to include as an associated neurological abnormality? Attention is invited to the May 2015 DBQ indicating an objective neurologic abnormality and/or finding of headache and the August 2018 B. Physical Therapy record noting the Veteran's statement that he has intermittent headaches associated with neck pain. Any opinions offered should be accompanied by the underlying reasons for the conclusions. (continued on next page) TANYA SMITH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Vang, 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.