Entitlement to service connection for bilateral lower extremity radiculopathy, secondary to service-connected lumbosacral strain, on a causation basis, is granted.

Citation Nr: A26069998 Decision Date: 07/30/26 Archive Date: 07/30/26 DOCKET NO. 250820-576548 DATE: July 30, 2026 ORDER Entitlement to service connection for bilateral lower extremity radiculopathy, secondary to service-connected lumbosacral strain, on a causation basis, is granted. Entitlement to a 70 percent rating, but no higher, from September 23, 2024, for unspecified anxiety disorder, is granted, subject to the law and regulations governing the award of monetary benefits. Entitlement to a rating in excess of 10 percent, prior to December 3, 2024, for left knee strain, is denied. Entitlement to a 20 percent rating, but no higher, from December 3, 2024, for left knee strain, on the basis of limitation of flexion, is granted, subject to the law and regulations governing the award of monetary benefits. Entitlement to a separate 20 percent rating, but no higher, from December 3, 2024, but no earlier, for left knee strain, on the basis of limitation of extension, is granted, subject to the law and regulations governing the award of monetary benefits. Entitlement to a rating in excess of 10 percent, prior to December 3, 2024, for right knee strain, is denied. Entitlement to a 20 percent rating, but no higher, from December 3, 2024, for right knee strain, on the basis of limitation of flexion, is granted, subject to the law and regulations governing the award of monetary benefits. Entitlement to a separate 20 percent rating, but no higher, from December 3, 2024, but no earlier, for right knee strain, on the basis of limitation of extension, is granted, subject to the law and regulations governing the award of monetary benefits. Entitlement to a rating in excess of 20 percent for left shoulder strain is denied. Entitlement to a 30 percent rating, but no higher, from September 23, 2024, for right shoulder strain, is granted, subject to the law and regulations governing the award of monetary benefits. Entitlement to a rating in excess of 10 percent, prior to December 3, 2024, for lumbosacral strain, is denied. Entitlement to a 40 percent rating, but no higher, from December 3, 2024, for lumbosacral strain, is granted, subject to the law and regulations governing the award of monetary benefits. Entitlement to a 60 percent rating, but no higher, from September 23, 2024, for eczema on upper arms and dry skin on arms and legs, is granted, subject to the law and regulations governing the award of monetary benefits. Entitlement to a 10 percent rating, but no higher, from September 23, 2024, for bilateral tinea pedis, is granted, subject to the law and regulations governing the award of monetary benefits. REMANDED Entitlement to a rating in excess of 10 percent for right ankle high-grade sprain with either high-grade partial thickness tearing or full thickness tearing of both the anterior talofibular ligament and calcaneofibular ligaments is remanded. FINDINGS OF FACT 1. The Veteran's bilateral lower extremity radiculopathy is caused by his service-connected lumbosacral strain. 2. During the entire period on appeal from September 23, 2024, the Veteran's unspecified anxiety disorder has been manifested by occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgement, thinking, and mood; symptoms and impairment have not more nearly approximated total social and occupational impairment. 3. During the period on appeal prior to December 3, 2024, the Veteran's left knee strain was manifested by limitation of knee flexion to at most 130 degrees and knee extension to 0 degrees, with no significant or sustained additional loss of motion due to such factors as pain, weakness, lack of endurance, fatigability, incoordination, or flare ups; there was no actual or functional equivalent of left knee ankylosis. 4. During the period on appeal from December 3, 2024, the Veteran's left knee strain has been manifested by limitation of knee flexion to at most 30 degrees and limitation of knee extension to at most 15 degrees with repeated use over time and during flare ups; there is no actual or functional equivalent of left knee ankylosis. 5. During the period on appeal prior to December 3, 2024, the Veteran's right knee strain was manifested by limitation of knee flexion to at most 130 degrees and knee extension to 0 degrees, with no significant or sustained additional loss of motion due to such factors as pain, weakness, lack of endurance, fatigability, incoordination, or flare ups; there was no actual or functional equivalent of right knee ankylosis. 6. During the period on appeal from December 3, 2024, the Veteran's right knee strain has been manifested by limitation of knee flexion to at most 30 degrees and limitation of knee extension to 15 degrees with repeated use over time and during flare ups; there is no actual or functional equivalent of right knee ankylosis. 7. During the period on appeal, the Veteran's left shoulder strain has been manifested by limitation of flexion and abduction to at most 45 degrees with repeated use over time and during flare ups; there is no actual or functional equivalent of left shoulder ankylosis. 8. During the period on appeal, the Veteran's right shoulder strain has been manifested by limitation of flexion and abduction to at most 45 degrees with repeated use over time and during flare ups; there is no actual or functional equivalent of right shoulder ankylosis. 9. During the period on appeal prior to December 3, 2024, the Veteran's lumbosacral strain was manifested by limitation of motion of the thoracolumbar spine to at most 85 degrees of flexion, 20 degrees of extension, and 25 degrees of right and left lateral flexion and rotation with repeated use over time and during flare ups; there was no muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour and no actual or functional equivalent of spinal ankylosis. 10. During the period on appeal from December 3, 2024, the Veteran's lumbosacral strain has been manifested by limitation of spinal flexion and extension to at most 15 degrees and 10 degrees, respectively, with repeated use over time and during flare ups; there is no actual or functional equivalent of spinal ankylosis. 11. During the period on appeal from September 23, 2024, the Veteran's eczema on upper arms and dry skin on arms and legs has involved more than 40 percent of his entire body; there is no associated scarring or disfigurement of the head, face, or neck. 12. During the period on appeal from September 23, 2024, the Veteran's bilateral tinea pedis has involved 5 percent to less than 20 percent of his total body area and less than 5 percent of his exposed areas; he has not received any systemic therapy and there is no associated scarring or disfigurement of the head, face, or neck. CONCLUSIONS OF LAW 1. The criteria for service connection for bilateral lower extremity radiculopathy, secondary to service-connected lumbosacral strain, on a causation basis, are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310 (a). 2. The criteria for a 70 percent rating, but no higher, from September 23, 2024, for unspecified anxiety disorder, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.125, 4.126, 4.130, DC 9413. 3. The criteria for a rating in excess of 10 percent, prior to December 3, 2024, for left knee strain, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DC) 5256-5263. 4. The criteria for a 20 percent rating, but no higher, from December 3, 2024, for left knee strain, on the basis of limitation of flexion, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DC) 5256-5260, 5262-5263. 5. The criteria for a separate 20 percent rating, but no higher, from December 3, 2024, but no earlier, for left knee strain, on the basis of limitation of extension, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DC) 5256-5259, 5261-5263. 6. The criteria for a rating in excess of 10 percent, prior to December 3, 2024, for right knee strain, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DC) 5256-5263. 7. The criteria for a 20 percent rating, but no higher, from December 3, 2024, for right knee strain, on the basis of limitation of flexion, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DC) 5256-5260, 5262-5263. 8. The criteria for a separate 20 percent rating, but no higher, from December 3, 2024, but no earlier, for right knee strain, on the basis of limitation of extension, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DC) 5256-5259, 5261-5263. 9. The criteria for a rating in excess of 20 percent for left shoulder strain are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DC) 5200-5203. 10. The criteria for a 30 percent rating, but no higher, from September 23, 2024, for right shoulder strain are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes (DC) 5200-5203. 11. The criteria for a rating in excess of 10 percent, prior to December 3, 2024, for lumbosacral strain are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5237. 12. The criteria for a 40 percent rating, but no higher, from December 3, 2024, for lumbosacral strain are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code (DC) 5237. 13. The criteria for a 60 percent rating, but no higher, from September 23, 2024, for eczema on upper arms and dry skin on arms and legs are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.118, Diagnostic Code (DC) 7806. 14. The criteria for a 10 percent rating, but no higher, from September 23, 2024, for bilateral tinea pedis are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.20, 4.21, 4.118, Diagnostic Code (DC) 7813. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 2013 to August 2021, which includes service in the Southwest Asia theater of operations. His awards include the Army Commendation Medal. These matters come before the Board of Veterans' Appeals (Board) from May 2025 and August 2025 rating decisions. In the May 2025 decision, the agency of original jurisdiction (AOJ) made the following determinations: awarded an increased (50 percent) rating for unspecified anxiety disorder, from September 23, 2024; denied entitlement to ratings in excess of 20 percent for left and right shoulder strain; denied entitlement to ratings in excess of 10 percent for eczema on upper arms and dry skin on arms and legs, left and right knee strain, lumbosacral strain, and right ankle high-grade sprain with either high-grade partial thickness tearing or full thickness tearing of both the anterior talofibular ligament and calcaneofibular ligaments; and denied entitlement to an increased (compensable) rating for bilateral tinea pedis. Later in May 2025, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR) and requested review of the May 2025 decision, with respect to the ratings assigned for the service-connected left and right shoulder disabilities, eczema, tinea pedis, left and right knee disabilities, back disability, and right ankle disability. In August 2025, the AOJ issued the HLR decision on appeal, which considered the evidence of record at the time of the May 2025 decision and made the following determinations: denied entitlement to ratings in excess of 20 percent for left and right shoulder strain; denied entitlement to ratings in excess of 10 percent for eczema on upper arms and dry skin on arms and legs, left and right knee strain, lumbosacral strain, and right ankle high-grade sprain with either high-grade partial thickness tearing or full thickness tearing of both the anterior talofibular ligament and calcaneofibular ligaments; and denied entitlement to an increased (compensable) rating for bilateral tinea pedis. The Veteran timely appealed the May 2025 and August 2025 rating decisions to the Board on August 20, 2025 and requested direct review of the evidence considered by the AOJ. Subsequently, the Veteran submitted a request to switch to the Board's evidence submission docket on November 5, 2025. In a March 5, 2026 letter sent to the Veteran and his representative, the Board notified the Veteran that his appeal had been switched to the evidence submission docket. Therefore, the Board may only consider the evidence of record at the time of the May 2025 AOJ decision on appeal, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran or his representative with the November 5, 2025 notice of disagreement (NOD) and within 90 days following receipt of the Board's March 5, 2026 letter. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the May 2025 decision on appeal, which was subsequently subject to higher-level review, and prior to the Board's receipt the November 5, 2025 VA Form 10182, or (2) more than 90 days following the date of the Board's March 2026 letter, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. However, because the Board is remanding the claim for an increased rating for the service-connected right ankle disability, any evidence the Board could not consider will be considered by the AOJ in the adjudication of that claim. 38 C.F.R. § 3.103(c)(2)(ii). As for characterization of the issues on appeal, the evidence reflects that the Veteran has been diagnosed as having bilateral lower extremity radiculopathy, which is associated with his service-connected back disability. 38 C.F.R. § 3.155(d)(2) requires that, when entitlement to secondary service connection is raised, a formal claim for secondary service connection need not be filed, rather, VA must consider those "complications" in connection with the claim on appeal. Bailey v. Wilkie, 33 Vet. App. 188 (2021). The Board's duty to address a reasonably raised theory of service connection arises when the evidence triggers VA's duty to provide a medical opinion. Healey v. McDonough, 33 Vet. App. 312, 319 (2021). In this case, the evidence would trigger VA's duty to provide a medical opinion as to whether the Veteran's bilateral lower extremity radiculopathy is caused or aggravated by his service-connected back disability. Therefore, the Board has expanded the appeal to include the separate issue of entitlement to service connection for bilateral lower extremity radiculopathy, as secondary to service-connected lumbosacral strain. As a final preliminary matter, the Veteran submitted a statement in April 2025 (VA Form 21-4138) in which he requested that VA process his increased rating claims as a fully developed claim because he had submitted appropriate disability benefits questionnaires (DBQs) which were completed by private treatment providers. He requested that his claims be adjudicated based on the evidence in his claims file, without any scheduling of VA examinations. He subsequently contacted VA by telephone later in April 2025 and stated that he did not wish to attend any VA examinations and that he wanted his claims to be processed based on the evidence already in his claims file (see an April 2025 "Report of General Information" form (VA Form 27-0820)). A review of the claims file indicates that multiple VA examination requests were "cancelled at claimant's request" prior to the May 2025 rating decision. The Board notes that while VA has a duty to assist the Veteran in the development of his claim, the Veteran has a duty to cooperate with VA. Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). In the May 2025 and August 2025 rating decisions, the AOJ acknowledged the DBQs submitted by the Veteran, which indicated that they were completed based upon in-person examinations of the Veteran. The AOJ adjudicated the Veteran's claim for an increased rating for service-connected psychiatric disability based upon the evidence of record, which included a November 2024 mental disorders DBQ. With respect to the other increased rating claims, the AOJ questioned the validity of the submitted DBQs because the medical professional who conducted the examinations was located far from the Veteran's place of residence. Therefore, the AOJ adjudicated these claims based on the evidence of record, other than the submitted DBQs. In December 2025, statements were submitted from the Veteran, his wife, his mother, and the medical facility where the in-person examinations were conducted in order to complete the submitted DBQs. This evidence confirms that the Veteran was traveling to visit his mother at the time the examinations were conducted, and that he intentionally scheduled the examinations at the location where he was visiting in order to coincide with his time off from work. As explained above, under the Appeals Modernization Act (AMA), the statements received in December 2025 would not normally be considered within the evidence under consideration. However, the AMA evidence submission windows are claim-processing rules that may be waived. Bolds v. McDonough, 37 Vet. App. 359, 365-66 (2024) ("section 7113(b)'s and § 20.302(a)'s evidence submission limits are claims-processing rules subject to Secretarial waiver"). As the statements received in December 2025 provide relevant information which allows for the Board to adjudicate the Veteran's increased rating claims without the need to remand most of the issues on appeal for additional examinations, the Board will waive the claims processing rule violation as to the consideration of the above identified statements received in December 2025. The Board will proceed to adjudicate the claims for increased ratings for the service-connected psychiatric disability, knee disabilities, shoulder disabilities, back disability, and skin disabilities based on the current evidence of record, in accordance with the Veteran's wishes. I. Service Connection Entitlement to service connection for bilateral lower extremity radiculopathy, secondary to service-connected lumbosacral strain Service connection is warranted for disability that is caused by service-connected disease or injury. 38 C.F.R. § 3.310 (a). In this case, the Board finds, for the following reasons, that the Veteran has current bilateral lower extremity radiculopathy, and that this disability is caused by his service-connected lumbosacral strain. A December 2024 back conditions disability benefits questionnaire (DBQ) completed by physician J. Dygert, D.O. indicates that the Veteran has been diagnosed as having radiculopathy. Dr. Dygert noted that the Veteran had decreased lower extremity sensation bilaterally, that straight leg raise testing was positive bilaterally, and that the Veteran had signs or symptoms due to radiculopathy in terms of bilateral lower extremity constant pain, intermittent pain, paresthesias/dysesthesias, and numbness. Overall, there was involvement of the sciatic nerve bilaterally. Dr. Dygert concluded that the Veteran's bilateral lower extremity neurological symptoms were "indicative of lower extremity radiculopathy secondary to [the V]eteran's spine condition." In light of the symptoms and findings described above and the opinion of Dr. Dygert, the evidence supports a conclusion that the Veteran's current bilateral lower extremity radiculopathy is caused by his service-connected lumbosacral strain. There is no medical opinion contrary to this conclusion. Therefore, service connection for bilateral lower extremity radiculopathy, secondary to service-connected lumbosacral strain, on a causation basis, is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102, 3.310. II. Increased Ratings Disability ratings are determined by the application of rating criteria set forth in the VA Schedule for Rating Disabilities (38 C.F.R. Part 4) based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155. If two ratings are potentially applicable, 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. In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21. In evaluating a disability, the Board considers the current examination reports considering the whole recorded history to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The medical as well as industrial history is to be considered, and a full description of the effects of the disability upon ordinary activity is also required. 38 C.F.R. §§ 4.1, 4.2, 4.10. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). Staged ratings are, however, appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. The relevant focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. Hart v. Mansfield, 21 Vet. App. 505 (2007). Disabilities evaluated on the basis of limitation of motion require VA to apply the provisions of 38 C.F.R. § 4.40, 4.45, pertaining to functional impairment. The United States Court of Appeals for Veterans Claims (Court) has instructed that in applying these regulations VA should obtain examinations in which the examiner determines whether the disability is manifested by weakened movement, excess fatigability, incoordination, pain, or flare-ups. Such inquiry is not to be limited to muscles or nerves. These determinations are, if feasible, to be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, flare-ups, or pain. Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017). The examiner should also determine the point, if any, at which such factors cause functional impairment. Moreover, the joints involved should be 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. Correia v. McDonald, 28 Vet. App. 158 (2016); Mitchell v. Shinseki, 25 Vet. App. 32, 43-4 (2011); DeLuca v. Brown, 8 Vet. App. 202 (1995). 1. Entitlement to a rating in excess of 50 percent for unspecified anxiety disorder When evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission. The rating agency shall assign a rating based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. 38 C.F.R. § 4.126 (a). When evaluating the level of disability from a mental disorder, VA will also consider the extent of social impairment, but shall not assign a rating solely on the basis of social impairment. 38 C.F.R. § 4.126 (b). The schedular criteria for rating psychiatric disabilities incorporate the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). See 38 C.F.R. §§ 4.125, 4.130. The Veteran's unspecified anxiety disorder is rated under 38 C.F.R. § 4.130, DC 9413. This disability is rated according to the General Rating Formula for Mental Disorders (General Rating Formula). Under the General Rating Formula, a 50 percent rating is assigned when symptoms such 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; or difficulty in establishing and maintaining effective work and social relationships cause occupational and social impairment with reduced reliability and productivity. A 70 percent rating is assigned when symptoms such 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); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned when symptoms such as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation or own name cause total occupational and social impairment. Under the General Rating Formula, 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 Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013). 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. On the other hand, if the evidence shows that the Veteran suffers symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the diagnostic code, the appropriate equivalent rating will be assigned. Sellers v. Principi, 372 F.3d 1318, 1326 (Fed. Cir. 2004); Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). The criteria for a 70 percent rating are met if there are deficiencies in most of the areas of work, school, family relations, judgment, thinking, and mood. Bowling v. Principi, 15 Vet. App. 1, 11-14 (2001). Considering the pertinent evidence in light of the applicable rating criteria and considerations, the Board finds, for the following reasons, that the symptoms of the Veteran's unspecified anxiety disorder have resulted in deficiencies in most of the areas needed for a 70 percent rating, but no higher, under the General Rating Formula during the entire period on appeal. The Veteran's claim for an increased rating for unspecified anxiety disorder was received on September 23, 2024 (see a September 2024 letter acknowledging receipt of an Intent to File on September 23, 2024 and a December 2024 "Application for Disability Compensation and Related Compensation Benefits" form (VA Form 21-526EZ)). A November 2024 mental disorders DBQ completed by B. Aneke indicates that the Veteran was married. Despite no significant detriments towards familial bonds, he struggled to establish and maintain most friendships, had a decreased desire to welcome new individuals into his circle, and had difficulty maintaining existing friendships. As a result, he missed out on potentially meaningful and beneficial relationships due to inhibitions attributed to his psychiatric disability. With respect to employment, the severity of the Veteran's psychiatric disability caused occasional detriments to his ability to perform efficiently and to function in the workplace. He described varying effects and impediments depending on his assigned position, and noted a particular struggle with occupational tasks that require extensive socialization. Although workplace relationships were generally unaffected, the Veteran reported occasional tension whenever he experienced spikes in his psychiatric symptoms. He was pressured to reduce the amount of socialization, and this resulted in decreased productivity. Also, his psychiatric disability had forced him to leave work early on a few occasions. As for the symptoms of the Veteran's psychiatric disability, he experienced a depressed mood; anxiety; chronic sleep impairment; mild memory loss; impairment of short and long term memory; a flattened affect; circumstantial, circumlocutory, or stereotyped speech; impaired judgement; difficulty in establishing and maintaining effective work and social relationships; and neglect of personal appearance and hygiene. He struggled to maintain and establish meaningful interpersonal relationships, and noted a diminished desire to welcome new social bonds. He demonstrated impaired decision making and exhibited circumstantial, circumlocutory, and stereotyped speech, which caused him to become less engaged in most conversations and resulted in occasional arguments. Also, he had an absence of emotional expression, struggled to remember details over brief periods of time and recall information over prolonged periods, and occasionally failed to maintain personal appearance and hygiene due to diminished motivation. He did not have any other symptoms attributable to his psychiatric disability and was not an immediate threat or danger to himself or others. The Veteran was diagnosed as having unspecified anxiety disorder. B. Aneke concluded that the symptoms and impairment caused by the Veteran's psychiatric disability met the criteria for a 50 percent rating under the General Rating Formula (i.e., occupational and social impairment with reduced reliability and productivity). The above evidence reflects that the Veteran has experienced some problems at work due to his psychiatric disability in that he struggles with occupational tasks that require extensive socialization, he experiences tension during spikes of his psychiatric symptoms, his productivity is decreased because of his trouble with socialization, and he sometimes has to leave work early due to his psychiatric disability. He experiences impaired judgement and his symptoms of impaired memory, anxiety, and depression are reflective of deficiencies in the areas of thinking and mood. Also, he experiences neglect of personal appearance and hygiene. Given this evidence, the Board finds that the overall symptomatology described and demonstrated during the period on appeal most closely approximates occupational and social impairment with deficiencies in most areas during the entire period on appeal. Therefore, a 70 percent rating for unspecified anxiety disorder is warranted during the entire period on appeal from September 23, 2024. The Board also finds that a rating higher than 70 percent is not warranted at any time during the period on appeal. The November 2024 mental disorders DBQ suggests that although the Veteran had some occupational limitations due to his psychiatric disability, he was employed. The December 2025 statements from the Veteran, his wife, and his mother confirm that the Veteran has been employed during the period on appeal, as he was on approved leave from work when he attended examinations in December 2024 for the purpose of having DBQs completed. With respect to social impairment, the Veteran has reported that he experiences problems with socialization and struggles to establish and maintain most friendships. However, he has been married during the period on appeal and he reported that there were no significant detriments towards familial bonds due to his psychiatric disability. See Vasalka v. Collins, No. 25-0066, 2026 U.S. App. Vet. Claims LEXIS 403, *15 (Mar. 11, 2026) (mem dec) (Falvey, J.) ("familial communications support the Board's conclusion that he did not have total social impairment"); Id. at *8 ("if Mr. Vasalka maintained the ability to work or socialize, then he would not have the required level of impairment... This means that the functional impact of any one symptom (or at least the Board's obligation to significantly discuss that symptom) falls to the side if the Board has solid reasons to find that the veteran does not have the required level of occupational or social impairment") (citing Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013) (emphasis added); Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (single judge decisions may be relied upon for any persuasiveness or reasoning they contain). Overall, there have been neither symptoms nor impairment more nearly approximating both total occupational and social impairment due to the Veteran's psychiatric disability during the period on appeal. The Veteran reported some memory loss and neglect of personal appearance and hygiene during the period on appeal. However, there is no evidence that he has experienced impaired memory to such an extent or severity that there is memory loss for names of close relatives, own occupation, or name. Also, despite some neglect of personal appearance and hygiene, there is otherwise no evidence of an inability to perform activities of daily living due to his psychiatric disability. Moreover, the Veteran has not generally demonstrated gross impairment in thought processes or communication, he has not experienced any delusions or hallucinations, he has not exhibited any grossly inappropriate behavior, and he has not experienced any suicidal or homicidal ideation or otherwise exhibited any persistent danger of hurting himself or others. Also, there is no evidence of any disorientation to time or place during the period on appeal. There is no heightened requirement for a 100 percent rating under the general rating formula for mental disorders; the standard of 38 C.F.R. § 4.7, that the symptoms and impairment more nearly approximate the total occupational and social impairment for this rating, applies. See Del Valle v. Gober, No. 96-1116, 1997 U.S. Vet. App. LEXIS 960 (Oct. 1, 1997) (mem dec) (Holdaway, J.) (citing Giusti-Bravo v. United States Veterans Administration, 853 F. Supp. 34 (D.P.R. 1993) (discussing VA's San Juan Memorandum 82-3 which incorrectly advised rating board specialists to use heightened requirements for veterans seeking 100 percent disability ratings for psychiatric disorders). See also Bethea, 2 Vet. App. at 254. However, for the above reasons, the Veteran has not exhibited most of the symptoms listed in the criteria for the maximum, 100 percent rating under the General Rating Formula and the overall level of impairment has not more nearly approximated both total occupational and social impairment given that the Veteran has maintained employment and some social relationships. Rather, the Veteran's psychiatric symptoms and impairment have most closely approximated the criteria for a 70 percent rating under the General Rating Formula during the entire period on appeal. Therefore, a 70 percent rating, but no higher, for unspecified anxiety disorder is warranted during the entire period on appeal from September 23, 2024. 2. Entitlement to ratings in excess of 10 percent for left and right knee strain The Veteran's left and right knee strain are rated under 38 C.F.R. § 4.71a, DC 5260 on the basis of limitation of knee flexion. Limitation of knee flexion under DC 5260 is rated as follows: a 0 percent rating is warranted when it is limited to 60 degrees; a 10 percent rating is warranted when it is limited to 45 degrees; a 20 percent rating is warranted when it is limited to 30 degrees; and a 30 percent rating is warranted when it is limited to 15 degrees. 38 C.F.R. § 4.71a, DC 5260. VA's General Counsel has held that separate ratings can be provided for limitation of knee extension and flexion. VAOPGCPREC 9-2004; 69 Fed. Reg. 59,990 (2004). Limitation of knee extension is rated as follows: a 10 percent rating is warranted when it is limited to 10 degrees; a 20 percent rating is warranted when it is limited to 15 degrees; a 30 percent rating is warranted when it is limited to 20 degrees; a 40 percent rating is warranted when it is limited to 30 degrees; and a 50 percent rating is warranted when it is limited to 45 degrees. 38 C.F.R. § 4.71a, DC 5261. For rating purposes, normal range of motion in a knee joint is from 0 to 140 degrees. 38 C.F.R. § 4.71, Plate II. Considering the pertinent evidence in light of the applicable rating criteria and considerations, the Board finds, for the following reasons, that the Veteran's service-connected left and right knee disabilities have not met or more closely approximated the criteria for ratings in excess of 10 percent at any time during the period on appeal prior to December 3, 2024. As for the period on appeal since December 3, 2024, the knee disabilities have more closely approximated the criteria for separate 20 percent ratings, both on the basis of limitation of knee flexion and extension. The Veteran's claim for increased ratings for his service-connected knee disabilities was received on November 27, 2023 (see an Intent to File received on November 27, 2023 and a December 2023 VA Form 21-526EZ). He has continuously pursued this claim since that time (see a July 2024 rating decision, a December 2024 VA Form 21-526EZ, and a December 2024 knee and lower leg DBQ). See Chisholm v. Collins, 38 Vet. App. 140, 143 (2025) ("while a supplemental claim needs to be filed on a form prescribed by the Secretary, it doesn't need to be filed on a supplemental claim form"); 38 C.F.R. §§ 3.155, 3.156(d), 3.2501. A January 2024 VA knee examination report indicates that the Veteran experienced bilateral knee pain, soreness, and popping. He used pain medications to treat his symptoms. There were no flare ups of knee symptoms. There was functional loss/impairment in that the Veteran had to stop driving while experiencing knee pain because he was unable to hold the pedals. There was no history of any instability, recurrent subluxation, or frequent effusion of either knee. Examination revealed that active right and left knee flexion were to 135 degrees and 130 degrees, respectively, and that active knee extension was to 0 degrees bilaterally. The ranges of knee motion themselves contributed to a functional loss in that there was decreased range of motion. The passive ranges of knee motion were the same as the active ranges of motion bilaterally. There was no evidence of right or left knee pain. There was objective evidence of crepitus bilaterally, but no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of either knee. The Veteran was able to perform repetitive use testing with at least three repetitions and there was no additional loss of function or range of motion of either knee after three repetitions. He was not being examined immediately after repeated use over time and the procured evidence did not suggest that pain, fatigability, weakness, lack of endurance, or incoordination significantly limited functional ability of either knee with repeated use over time. There were no additional factors contributing to disability of either knee. Moreover, there was no muscle atrophy, ankylosis, subluxation, persistent instability, ligament tear (sprain), or patellar instability of either knee. The Veteran did not have any recurrent patellar dislocation, shin splints (medial tibial stress syndrome), stress fractures, or any other tibial or fibular impairment. He did not have any meniscus (semilunar cartilage) condition and had not undergone any knee surgery. There were no scars related to his knee disabilities and there were no other pertinent physical findings, complications, conditions, signs, or symptoms. The Veteran occasionally used knee braces, but there was no functional impairment of an extremity such that no effective function remained other than that which would have been equally well served by an amputation with prosthesis. He was diagnosed as having bilateral knee strain. This disability impacted his ability to perform occupational tasks in that he had to stop driving while experiencing knee pain because he was unable to use the pedals. A December 3, 2024 knee DBQ completed by Dr. Dygert indicates that the Veteran began to experience bilateral knee pain and swelling in service, and that his knee symptoms had progressed and increased in severity over time. Moderate flare ups of knee swelling, dull pain, and limited range of motion occurred on a monthly basis and lasted for 1 to 2 days at a time. The flare ups were triggered by random movements and the Veteran struggled to engage in any physical activities during flare ups. Knee pain was alleviated by stretching, taking over the counter medication, resting, and using ice packs. There was functional loss/impairment due to pain and limited range of knee motion in that the Veteran had to limit all activities of daily living and occupational tasks that required full range of motion and use of the knees. He experienced a moderate overall impact from his knee disabilities and tasks became more challenging (but still manageable) during and after flare ups. There was a history of frequent effusion of the knees, but no history of any instability or recurrent subluxation of either knee. Examination revealed that the active ranges of knee motion were flexion to 115 degrees and extension to 0 degrees bilaterally. The ranges of knee motion themselves contributed to a functional loss in that the Veteran's limited movement made walking difficult and painful, and prolonged standing or walking caused exacerbation of pain. There was pain with both active and passive knee flexion and extension bilaterally, and pain beginning at 90 degrees of flexion and 15 degrees of extension bilaterally contributed to limited range of motion. The passive ranges of knee motion were the same as the active ranges of motion bilaterally. Overall, there was evidence of pain with active motion, passive motion, weight-bearing, non weight-bearing, and on rest/non-movement, and the pain caused functional loss in that it limited movement to the point of functional loss of activity. There was objective evidence of crepitus bilaterally, but no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of either knee. The Veteran was able to perform repetitive use testing with at least three repetitions and there was no additional loss of function or range of motion of either knee after three repetitions. He was not being examined immediately after repeated use over time or during a flare up and the procured evidence suggested that pain, fatigability, weakness, and lack of endurance significantly limited functional ability of both knees with repeated use over time and during flare ups. Specifically, the ranges of knee motion with repeated use over time and during flare ups would be flexion to 30 degrees and extension to 15 degrees bilaterally. There were additional factors contributing to disability of both knees in terms of interference with standing, swelling, disturbance of locomotion, less movement than normal, and weakened movement. Moreover, there was no muscle atrophy, ankylosis, subluxation, persistent instability, ligament tear (sprain), or patellar instability of either knee. The Veteran did not have any recurrent patellar dislocation, shin splints (medial tibial stress syndrome), stress fractures, or any other tibial or fibular impairment. He did not have any meniscus (semilunar cartilage) condition and had not undergone any knee surgery. There were no scars related to his knee disabilities and there were no other pertinent physical findings, complications, conditions, signs, or symptoms. The Veteran occasionally used knee braces, but there was no functional impairment of an extremity such that no effective function remained other than that which would have been equally well served by an amputation with prosthesis. A diagnosis of bilateral knee strain was provided. This disability impacted his ability to perform occupational tasks in that he was unable to complete any occupational task that would require full range of motion in the knees. He was unable to walk or stand for extended periods and struggled to execute any movement that required extensive force using the knees. A. Limitation of knee motion prior to December 3, 2024 As a preliminary matter, the Board acknowledges that the Veteran has used medications to treat his knee symptoms during the period on appeal. The Court has held that 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, 131 (2025), motion for panel reconsideration denied on Apr. 29, 2025, motion for full Court review denied, 2025 U.S. App. Vet Claims LEXIS 661 (May 20, 2025), motion to stay precedential effect denied on Sept. 19, 2025, appeal dismissed, No. 2025-1972, 2026 U.S. App. Lexis 9106 (Fed. Cir. Mar. 30, 2026). In this case, the criteria for rating knee disabilities do not contemplate medication. Thus, the Board's analysis in this case discounts the beneficial effects of the Veteran's medications in assessing the severity of his service-connected knee disabilities and contemplates the nature, severity, and frequency of his knee symptoms and impairments without medication. The above evidence reflects that during the period on appeal prior to December 3, 2024, right and left knee flexion were to 135 degrees and 130 degrees, respectively, and knee extension was to 0 degrees bilaterally. These findings, by themselves and without consideration of potential functional impairment, are contemplated by no more than single 10 percent ratings for right and left knee pain. With respect to functional impairment, the Veteran did not report any flare ups of knee symptoms during the January 2024 VA knee examination. The ranges of knee motion remained the same following repetitive use testing and the examiner who conducted the January 2024 examination indicated that based upon the procured evidence, pain, fatigability, weakness, lack of endurance, and incoordination did not significantly limit functional ability of either knee with repeated use over time. The examiner also specified whether there was pain with active motion, passive motion, weight-bearing, and non weight-bearing. Therefore, the January 2024 knee examination is compliant with Correia, 28 Vet. App. at 158 and Sharp, 29 Vet. App. at 34-36. The Veteran is competent to report the symptoms associated with his service-connected right and left knee disabilities and the extent of his impairment following repetitive use, and the Board has no reason to challenge the credibility of his contentions. See Jandreau, 492 F.3d at 1377; Buchanan, 451 F.3d at 1337. Regardless of the competent and credible reports of pain and other functional impairments, the most persuasive evidence nonetheless supports the conclusion that the Veteran's right and left knee symptoms most closely approximated the criteria for at most single 10 percent ratings on the basis of knee pain during the entire period on appeal prior to December 3, 2024. Specifically, the above evidence reflects that the pain and other functional impairments were not so severe, frequent and/or prolonged to warrant the next higher percent ratings at any time during this period. The most persuasive evidence shows that even considering pain and other functional factors, the Veteran's right and left knee symptoms were not shown to be so disabling to actually or effectively result in limitation of knee flexion more nearly approximating 30 degrees (the requirement for a 20 percent rating for limitation of knee flexion under DC 5260) or limitation of knee extension more nearly approximating 10 degrees (the requirement for a compensable (10 percent) rating for limitation of knee extension under DC 5261) at any time during the period on appeal prior to December 3, 2024. This includes discounting the beneficial effects of the Veteran's medications, which as the above evidence shows were not indicated to be so significant, that in their absence there would have been more significant limitation of right or left knee motion so as to warrant ratings higher than 10 percent at any time during this period. B. Limitation of knee motion since December 3, 2024 The above evidence reflects that during the period on appeal since December 3, 2024, right and left knee flexion and extension are to 115 degrees and 0 degrees, respectively. These findings, by themselves and without consideration of potential functional impairment, are contemplated by no more than single 10 percent ratings for right and left knee pain. With respect to functional impairment, the Veteran reported flare ups of bilateral knee symptoms during the December 2024 knee examination. Dr. Dygert noted that pain, fatigability, weakness, and lack of endurance significantly limited functional ability of both knees with repeated use over time and during flare ups. He specified that right and left knee flexion and extension would be to 30 degrees and 15 degrees, respectively, with repeated use over time and during flare ups. These ranges of knee motion are contemplated by a 20 percent rating for limitation of knee flexion under DC 5260 and a separate 20 percent rating for limitation of knee extension under DC 5261. Therefore, 20 percent ratings for left and right knee strain on the basis of limitation of knee flexion and separate 20 percent ratings for left and right knee strain on the basis of limitation of knee extension are warranted during the period on appeal from December 3, 2024. This is the date of the December 2024 knee examination with Dr. Dygert, and it is the earliest that it is factually ascertainable that the Veteran's limitation of knee motion met or approximated the criteria for 20 percent ratings under DCs 5260 and 5261. The Board also finds that no higher ratings for the service-connected knee disabilities are warranted on the basis of limitation of motion at any time during the period on appeal since December 3, 2024. Specifically, as explained above, knee flexion and extension would be limited to at most 30 degrees and 15 degrees, respectively, with repeated use over time and during flare ups (as specified by Dr. Dygert's December 2024 examination report). The December 2024 examination report also specifies whether there was pain with active motion, passive motion, weight-bearing, and non weight-bearing. Therefore, the December 2024 knee examination is compliant with Correia, 28 Vet. App. at 158 and Sharp, 29 Vet. App. at 34-36. The Veteran is competent to report the symptoms associated with his service-connected knee disabilities and the extent of his impairment following repetitive use and during flare ups, and the Board has no reason to challenge the credibility of his contentions. See Jandreau, 492 F.3d at 1377; Buchanan, 451 F.3d at 1337. Regardless of the competent and credible reports of flare ups, pain, and other functional impairments, and discounting the beneficial effects of the Veteran's medications, the evidence persuasively weighs against a finding that the Veteran's right or left knee pain, flare ups, and other functional impairments have been so severe, frequent and/or prolonged so as to warrant the next higher percent ratings at any time during the period on appeal since December 3, 2024. The most persuasive evidence shows that even considering flare ups, pain, and other functional factors, the Veteran's knee symptoms are not shown to be so disabling to actually or effectively result in limitation of knee flexion more nearly approximating 15 degrees (the requirement for a 30 percent rating for limitation of knee flexion under DC 5260) or limitation of knee extension more nearly approximating 20 degrees (the requirement for a 30 percent rating for limitation of knee extension under DC 5261) at any time during this period. This includes discounting the ameliorative effects of the Veteran's medications, which as the above evidence shows are not indicated to be so significant, that in their absence there would be more significant limitation of knee motion so as to warrant ratings higher than 20 percent under DC 5260 or 5621 for either knee at any time during the period on appeal since December 3, 2024. Overall, in light of the above, 20 percent ratings (but no higher) for left and right knee strain on the basis of limitation of knee flexion under DC 5260 and separate 20 percent ratings (but no higher) for left and right knee strain on the basis of limitation of knee extension under DC 5261 are warranted during the entire period on appeal from December 3, 2024, but no earlier. C. Additional Knee Ratings There is no evidence of any left or right knee ankylosis at any time during the period on appeal. The January 2024 and December 2024 examination reports indicate that there was no actual left or right knee ankylosis. Also, the above evidence shows that, even considering knee flare ups, pain, and other functional factors, the Veteran has not experienced the functional equivalent of left or right knee ankylosis at any time during the period on appeal. The most persuasive evidence shows that even considering flare ups, pain, and other functional factors, the Veteran's left and right knee have continued to have significant ranges of motion and have not approximated being fixed in place such that the symptoms have actually or effectively resulted in immobility or fixation of either knee at any point in the ranges of knee motion. This includes discounting the beneficial effects of medications, which as the above evidence shows are not indicated to be so significant that in their absence the functional equivalent of knee ankylosis would result. Therefore, separate/higher ratings are not warranted on the basis of ankylosis/functional equivalent of ankylosis at any time during the period on appeal. See 38 C.F.R. § 4.71a, DC 5256. Cf. Chavis v. McDonough, 34 Vet. App. 1, 23-24 (2021) (a higher rating may be warranted if a veteran experiences the functional equivalent of ankylosis when considering the provisions of 38 C.F.R. §§ 4.40 and 4.45). Lastly, there is no evidence of any knee instability, subluxation, patellar instability involving the patellofemoral complex, ligament sprain, ligament tear, cartilage impairment, impairment of the tibia or fibula, medial tibial stress syndrome, or genu recurvatum at any time during the period on appeal. Therefore, separate/higher ratings are not warranted for either knee under DCs 5257, 5258, 5259, 5262, or 5263 at any time during the period on appeal. 3. Entitlement to ratings in excess of 20 percent for left and right shoulder strain The Veteran's left and right shoulder strain are rated under 38 C.F.R. § 4.71a, DC 5201 as limitation of shoulder motion. Under DC 5201, the following ratings apply: a 20 percent rating is warranted when arm motion of either the minor or major extremity is limited to shoulder level (defined as flexion and/or abduction limited to 90 degrees); a 20 percent rating for the minor extremity and a 30 percent rating for the major extremity is warranted when arm motion is limited to midway between the side and shoulder level (defined as flexion and/or abduction limited to 45 degrees); and a 30 percent rating for the minor extremity and a 40 percent rating for the major extremity is warranted when flexion and/or abduction is limited to 25 degrees from the side. 38 C.F.R. § 4.71a, DC 5201. The normal ranges of motion of the shoulder are 180 degrees of forward elevation (flexion) and abduction (90 degrees is shoulder level), and 90 degrees of internal and external rotation. 38 C.F.R. § 4.71, Plate I. Considering the pertinent evidence in light of the applicable rating criteria and considerations delineated above, the Board finds, for the following reasons, that the Veteran has manifested left shoulder symptoms of the type and extent, frequency, and/or severity, as appropriate, to warrant no more than a 20 percent rating during the entire period on appeal. He has manifested right shoulder symptoms of the type and extent, frequency, and/or severity, as appropriate, to warrant a 30 percent rating, but no higher, during the entire period on appeal. The Veteran's claim for increased ratings for left and right shoulder strain was received on September 23, 2024 (see the September 2024 letter acknowledging receipt of an Intent to File on September 23, 2024 and the December 2024 VA Form 21-526EZ). A December 2024 shoulder and arm conditions DBQ completed by Dr. Dygert indicates that the Veteran is right hand dominant. He experienced a popping sensation in his shoulders during service, and his symptoms had progressed and increased in severity over time. Severe flare ups of shoulder soreness, popping, pain, and limited range of motion occurred on a weekly basis for 1 to 2 days at a time, during which the Veteran was unable to lift and reach. The flare ups were triggered by working heavily and lifting using the shoulders, and they were alleviated by stretching and taking over the counter medications. There was functional loss/impairment in that the Veteran had to limit all activities of daily living and occupational tasks that require full range of motion and use of the shoulders due to pain and limited range of motion. He experienced little to no impact on daily activities, but most daily tasks became very challenging and sometimes impossible to complete during flare ups. Examination revealed that the active ranges of right shoulder motion were flexion to 170 degrees, abduction to 175 degrees, internal rotation to 85 degrees, and external rotation to 90 degrees. The active ranges of left shoulder motion were flexion and abduction both to 175 degrees, internal rotation to 85 degrees, and external rotation to 90 degrees. The ranges of motion themselves contributed to a functional loss in that the Veteran's limited movement made lifting items difficult and painful, and prolonged exertion of the arms caused pain. There was pain with all active and passive ranges of shoulder motion bilaterally, and pain beginning at 90 degrees of flexion and abduction bilaterally, at 50 degrees of internal rotation bilaterally, and at 55 degrees of external rotation bilaterally contributed to limited range of motion. Overall, there was evidence of pain with active motion, passive motion, weight-bearing, non weight-bearing, and on rest/non-movement bilaterally and the pain caused functional loss. There was objective evidence of crepitus bilaterally, but no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue of either shoulder. The Veteran was able to perform repetitive use testing with at least repetitions and there was no additional loss of function or range of motion of either shoulder after three repetitions. He was not being examined immediately after repeated use over time or during a flare up and the procured evidence suggested that pain and fatigability significantly limited functional ability of both shoulders with repeated use over time and during flare ups. Specifically, the ranges of right and left shoulder motions with repeated use over time and during flare ups would be flexion, abduction, and internal rotation all to 45 degrees bilaterally and external rotation to 35 degrees bilaterally. There were additional factors contributing to disability in terms of less movement than normal and swelling bilaterally. Moreover, there was no muscle atrophy, ankylosis, instability, dislocation, labral pathology, mechanical symptoms, or any residuals of recurrent dislocation (subluxation) of the glenohumeral (scapulohumeral) joint of either shoulder, and crank apprehension and relocation testing was negative bilaterally. There was no clavicle, scapula, acromioclavicular joint, or sternoclavicular joint condition or other impairment, the Veteran did not have loss of head (flail shoulder), nonunion (false flail shoulder), or fibrous union of either humerus, and there was no malunion of either humerus. He had not undergone any surgical procedures, there was no scarring related to his shoulder disabilities, and there were no other pertinent physical findings, complications, conditions, signs, or symptoms. The Veteran did not use any assistive devices and there was no functional impairment of an extremity such that no effective function remained other than that which would have been equally well served by an amputation with prosthesis. He was diagnosed as having bilateral shoulder strain. This disability impacted his ability to perform occupational tasks in that due to pain and limited range of motion, he was unable to complete any occupational task that required a full range of motion in the shoulders and he struggled to complete any activities that used force on the shoulders. As a preliminary matter, the Veteran has used medications to treat flare ups of his shoulder symptoms during the period on appeal. The criteria for rating shoulder disabilities do not contemplate medication. Thus, the Board's analysis in this case discounts the beneficial effects of the Veteran's medications in assessing the severity of his service-connected shoulder disabilities and contemplates the nature, severity, and frequency of his shoulder symptoms and impairments without medication. See Ingram, 38 Vet. App. at 131. The above evidence reflects that during the period on appeal, left and right shoulder flexion were to 175 degrees and 170 degrees, respectively. Also, left and right shoulder abduction were to 175 degrees bilaterally. These findings, by themselves and without consideration of potential functional impairment, are contemplated by no more than a 20 percent rating under DC 5201. With respect to functional impairment, the Veteran reported flare ups of shoulder symptoms. Dr. Dygert noted that pain and fatigability significantly limited functional ability of both shoulders with repeated use over time and during flare ups. He specified that left and right shoulder flexion and abduction would both be limited to 45 degrees bilaterally with repeated use over time and during flare ups. These ranges of shoulder motion are contemplated by a 30 percent rating for the major extremity under DC 5201. As the Veteran is right hand dominant, his right shoulder is the major extremity. Therefore, a 30 percent rating for right shoulder strain is warranted during the entire period on appeal. The Board also finds that a rating higher than 20 percent for left shoulder strain and a rating higher than 30 percent for right shoulder strain are not warranted at any time during the period on appeal. Specifically, as explained above, shoulder flexion and abduction would be limited to at most 45 degrees bilaterally with repeated use over time and during flare ups (as specified by Dr. Dygert's December 2024 examination report). The December 2024 examination report also specifies whether there was pain with active motion, passive motion, weight-bearing, and non weight-bearing. Therefore, the December 2024 shoulder examination is compliant with Correia, 28 Vet. App. at 158 and Sharp, 29 Vet. App. at 34-36. The Veteran is competent to report the symptoms associated with his service-connected shoulder disabilities and the extent of his impairment following repetitive use and during flare ups, and the Board has no reason to challenge the credibility of his contentions. See Jandreau, 492 F.3d at 1377; Buchanan, 451 F.3d at 1337. Regardless of the competent and credible reports of flare ups, pain, and other functional impairments, and discounting the beneficial effects of the Veteran's medications, the evidence persuasively weighs against a finding that the Veteran's left or right shoulder pain, flare ups, and other functional impairments have been so severe, frequent and/or prolonged so as to warrant the next higher percent ratings at any time during the period on appeal. The most persuasive evidence shows that even considering flare ups, pain, and other functional factors, the Veteran's shoulder symptoms are not shown to be so disabling to actually or effectively result in limitation of shoulder flexion or abduction more nearly approximating 25 degrees (the requirement for a 30 percent rating for the minor extremity (i.e., the Veteran's left shoulder) and a 40 percent rating for the major extremity (i.e., the Veteran's right shoulder) under DC 5201) at any time during the period on appeal. This includes discounting the ameliorative effects of the Veteran's medications, which as the above evidence shows are not indicated to be so significant, that in their absence there would be more significant limitation of shoulder motion so as to warrant a rating higher than 20 percent for the left shoulder or a rating higher than 30 percent for the right shoulder at any time during the period on appeal. Moreover, there is no evidence of any left or right shoulder ankylosis at any time during the period on appeal. The December 2024 examination indicates that there was no actual shoulder ankylosis. Also, the above evidence shows that, even considering shoulder flare ups, pain, and other functional factors, the Veteran has not experienced the functional equivalent of left or right shoulder ankylosis at any time during the period on appeal. The most persuasive evidence shows that even considering flare ups, pain, and other functional factors, the Veteran's shoulders have continued to have significant ranges of motion and have not approximated being fixed in place such that the symptoms actually or effectively result in immobility or fixation of either shoulder at any point in the ranges of shoulder motion. This includes discounting the beneficial effects of medications, which as the above evidence shows are not indicated to be so significant that in their absence the functional equivalent of shoulder ankylosis would result. Therefore, no separate/higher ratings are warranted on the basis of ankylosis/functional equivalent of ankylosis at any time during the period on appeal. See 38 C.F.R. § 4.71a, DC 5200. Cf. Chavis, 34 Vet. App. at 23-24. Lastly, there is no evidence of any impairment of either humerus, clavicle, or scapula. Therefore, no other separate/higher ratings under DCs 5202 or 5203 are warranted at any time during the period on appeal. Overall, in light of the above, a 30 percent rating (but no higher) for right shoulder strain is warranted during the entire period on appeal from September 23, 2024. A rating in excess of 20 percent for left shoulder strain is not warranted at any time during the period on appeal. 4. Entitlement to a rating in excess of 10 percent for lumbosacral strain The Veteran's lumbosacral strain is rated under 38 C.F.R. § 4.71a, DC 5237. Under DC 5237, a lumbosacral strain is rated under the General Rating Formula for Diseases and Injuries of the Spine (General Rating Formula). Under the General Rating Formula, with or without symptoms such as pain, stiffness or aching in the area of the spine affected by residuals of injury or disease, the following ratings apply: A 10 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or the combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or vertebral body fracture with loss of 50 percent or more of the height. Id. A 20 percent rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees, but not greater than 60 degrees; or combined range of motion of the thoracolumbar spine not greater than 120 degrees; or, if there is muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Id. A 40 percent rating is warranted for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. Id. A 50 percent rating is warranted for unfavorable ankylosis of the entire thoracolumbar spine and a 100 percent rating is warranted for ankylosis of the entire spine. Id. Note (2) provides that normal forward flexion of the thoracolumbar spine is to zero to 90 degrees and extension and left and right lateral flexion and rotation of the thoracolumbar spine are all zero to 30 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 thoracolumbar spine is 240 degrees. Each range of motion measurement is to be rounded to the nearest five degrees. The rating criteria provide that 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. 38 C.F.R. § 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Note (5). Considering the pertinent evidence in light of the applicable rating criteria and considerations, the Board finds, for the following reasons, that the Veteran's lumbosacral strain did not meet or more closely approximate the criteria for a rating in excess of 10 percent at any time during the period on appeal prior to December 3, 2024. As for the period on appeal since December 3, 2024, the back disability has more closely approximated the criteria for a 40 percent rating, but no higher. The Veteran's claim for an increased rating for his service-connected back disability was received on November 27, 2023 (see the Intent to File received on November 27, 2023 and the December 2023 VA Form 21-526EZ). He has continuously pursued this claim since that time (see a February 2024 rating decision, a December 2024 VA Form 21-526EZ, and a December 2024 back DBQ). See Chisholm, 38 Vet. App. at 143; 38 C.F.R. §§ 3.155, 3.156(d), 3.2501. A January 2024 VA back examination report indicates that the Veteran experienced back pain, soreness, and stiffness. He treated his symptoms with medications, and the symptoms impacted his ability to perform occupational functioning and ordinary activities because he was unable to drive during flare ups of symptoms. Severe flare ups of back symptoms occurred on a weekly basis, lasted for a couple of minutes at a time, were precipitated by bending over, and were alleviated by rest. Examination revealed that the ranges of active motion of the thoracolumbar spine were flexion to 90 degrees, extension to 25 degrees, and right and left lateral flexion and rotation all to 30 degrees. The ranges of motion themselves contributed to a functional loss in that there was decreased range of motion and pain with range of motion. There was pain with active and passive extension and right lateral rotation and the passive ranges of spinal motion were the same as the active ranges of motion. Overall, there was evidence of pain with active motion and passive motion, and the pain caused functional loss in that there was decreased range of motion and pain with range of motion. There was no objective evidence of crepitus or localized tenderness or pain on palpation of the joint or associated soft tissue. The Veteran was able to perform repetitive use testing with at least three repetitions and there was no additional loss of function or range of motion after three repetitions. He was not being examined immediately after repeated use over time or during a flare up and the procured evidence suggested that pain significantly limited functional ability with repeated use over time and during flare ups. Specifically, the ranges of spinal motion with repeated use over time would be flexion to 90 degrees, extension to 25 degrees, and right and left lateral flexion and rotation all to 30 degrees. The ranges of spinal motion during flare ups would be flexion to 85 degrees, extension to 20 degrees, and right and left lateral flexion and rotation all to 25 degrees. Moreover, there was no localized tenderness, guarding, or muscle spasm of the thoracolumbar spine and no additional factors contributing to disability. There was no muscle atrophy or ankylosis of the spine, the Veteran did not have intervertebral disc syndrome of the thoracolumbar spine, he did not use any assistive devices as a normal mode of locomotion, and there was no functional impairment of an extremity such that no effective function remained other than that which would have been equally well served by an amputation with prosthesis. There were no scars related to the Veteran's back disability and no other pertinent physical findings, complications, conditions, signs, or symptoms. The Veteran was diagnosed as having lumbosacral strain. This disability impacted his ability to work in that he was unable to drive during flare ups of the disability. A December 3, 2024 back DBQ completed by Dr. Dygert indicates that the Veteran began to experience a pinching sensation in his back after randomly transitioning from a hunched to an upright position during service, and that his symptoms continued to progress and increase in severity over time. Incapacitating flare ups of momentary paralysis and lingering soreness occurred on a monthly basis for less than one day at a time. The Veteran did not know what triggered flare ups, but he noticed that they frequently occurred after bending down. During flare ups, any movement became increasingly challenging. The Veteran's symptoms were alleviated by rest, over the counter medications, and occasional stretching. There was functional loss/impairment due to pain and limited range of motion in that the Veteran had to limit all activities of daily living and occupational activities that required the full use and range of motion of the back. There was a moderate impact on activities during and one to two days after the onset of a flare up. Examination revealed that the active ranges of motion of the thoracolumbar spine were flexion to 90 degrees and extension and right and left lateral flexion and rotation all to 30 degrees. The ranges of motion themselves contributed to a functional loss in that the limited movement in the Veteran's back made standing upright or walking difficult and painful. Also, prolonged sitting caused exacerbation of back pain. There was pain with all active ranges of spinal motion and limitation of motion was specifically attributable to pain at 60 degrees of flexion and 20 degrees of extension and right and left lateral flexion and rotation. The passive ranges of spinal motion were the same as the active ranges of motion and there was pain with all passive ranges of motion. Overall, there was evidence of pain with active motion, passive motion, weight-bearing, and non weight-bearing, and the pain caused functional loss of activity. There was objective evidence of crepitus, but no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The Veteran was able to perform repetitive use testing with at least three repetitions and there was no additional loss of function or range of motion after three repetitions. He was not being examined immediately after repeated use over time or during a flare up and the procured evidence suggested that pain and weakness significantly limited functional ability with repeated use over time and during flare ups. Specifically, the ranges of spinal motion with repeated use over time and during flare ups would be flexion to 15 degrees and extension and right and left lateral flexion and rotation all to 10 degrees. There was guarding, but it did not result in an abnormal gait or abnormal spinal contour. There was no localized tenderness or muscle spasm. There were additional factors contributing to disability in terms of interference with sitting and standing, swelling, disturbance of locomotion, less movement than normal, and weakened movement. The Veteran experienced difficulty sitting, standing, and walking for prolonged periods without frequent breaks. He also reported weakened movement, swelling, and less movement than normal affecting mobility. Moreover, there was no muscle atrophy or ankylosis of the spine and the Veteran did not have intervertebral disc syndrome of the thoracolumbar spine. He did not use any assistive devices as a normal mode of locomotion and there was no functional impairment of an extremity such that no effective function remained other than that which would have been equally well served by an amputation with prosthesis. There were no scars related to the Veteran's back disability and no other pertinent physical findings, complications, conditions, signs, or symptoms. A diagnosis of lumbosacral strain was provided. This disability impacted the Veteran's ability to perform occupational tasks in that he struggled with physical activities requiring the full use and range of motion of the back due to pain. Occupational tasks had become increasingly challenging (particularly after a flare up) because he felt more sore after the activity. During flare ups, he could not complete occupational tasks and had to remain completely stationary. This negatively impacted his ability to perform efficiently and to maintain gainful employment. A. Limitation of back motion prior to December 3, 2024 As a preliminary matter, the Veteran has used medications to treat his back symptoms during the period on appeal. The criteria for rating spinal disabilities do not contemplate medication. Thus, the Board's analysis in this case discounts the beneficial effects of the Veteran's medications in assessing the severity of his service-connected back disability and contemplates the nature, severity, and frequency of his back symptoms and impairments without medication. See Ingram, 38 Vet. App. at 131. The above evidence reflects that during the period on appeal prior to December 3, 2024, the ranges of motion of the thoracolumbar spine were limited to 90 degrees of flexion, 25 degrees of extension, and 30 degrees of left and right lateral flexion and rotation. Also, there was no guarding or muscle spasm of the thoracolumbar spine resulting in an abnormal gait or abnormal spinal contour. These findings, by themselves and without consideration of potential functional impairment, are contemplated by no more than a 10 percent rating under the General Rating Formula. As for functional impairment, the Veteran reported flare ups of back symptoms during the January 2024 VA back examination. The ranges of spinal motion remained the same following repetitive use testing and the examiner who conducted the January 2024 examination indicated that pain significantly limited functional ability of the thoracolumbar spine with repeated use over time and during flare ups. Specifically, the ranges of spinal motion with repeated use over time and during flare ups would be limited to at most 85 degrees of flexion, 20 degrees of extension, and 25 degrees of right and left lateral flexion and rotation. The examiner also specified whether there was pain with active motion, passive motion, weight-bearing, and non weight-bearing. Therefore, the January 2024 back examination is compliant with Correia, 28 Vet. App. at 158 and Sharp, 29 Vet. App. at 34-36. The Veteran is competent to report the symptoms associated with his service-connected back disability and the extent of his impairment following repetitive use and during flare ups, and the Board has no reason to challenge the credibility of his contentions. See Jandreau, 492 F.3d at 1377; Buchanan, 451 F.3d at 1337. Regardless of the competent and credible reports of flare ups, pain, and other functional impairments, the most persuasive evidence nonetheless supports the conclusion that the Veteran's back symptoms most closely approximated the criteria for at most a 10 percent rating under the General Rating Formula during the entire period on appeal prior to December 3, 2024. Specifically, the above evidence reflects that the flare ups, pain, and other functional impairments were not so severe, frequent and/or prolonged to warrant the next higher percent rating at any time during this period. The most persuasive evidence shows that even considering flare ups, pain, and other functional factors, the Veteran's back symptoms were not shown to be so disabling to actually or effectively result in limitation of motion of the thoracolumbar spine more nearly approximating forward flexion of the thoracolumbar spine to greater than 30 degrees, but not greater than 60 degrees, or limitation of the combined range of motion of the thoracolumbar spine to not greater than 120 degrees, or any muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour (the requirements for a 20 percent rating under the General Rating Formula) at any time during the period on appeal prior to December 3, 2024. This includes discounting the beneficial effects of the Veteran's medications, which as the above evidence shows were not indicated to be so significant, that in their absence there would have been more significant limitation of spinal motion or any muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour, so as to warrant a rating higher than 10 percent at any time during this period. Moreover, there is no evidence of any spinal ankylosis at any time during the period on appeal prior to December 3, 2024. Rather, the absence of actual spinal ankylosis was noted by the examiner who conducted the January 2024 examination. Also, despite the limited ranges of spinal motion during this period and the Veteran's reported flare ups of spinal symptoms and other functional impairments, the Board finds that the Veteran did not experience the functional equivalent of spinal ankylosis at any time during this period. Specifically, spinal flexion and extension were limited to at most 85 degrees and 20 degrees, respectively, with repeated use over time and during flare ups. Overall, regardless of the competent and credible reports of flare ups, pain, and other functional impairments, the evidence persuasively weighs against a finding that the Veteran's back symptoms were so disabling to actually or effectively result in fixation of the entire thoracolumbar spine in flexion or extension with any of the additional symptoms or limitations listed in Note (5) of the General Rating Formula, so as to find that he experienced the functional equivalent of spinal ankylosis at any time during the period on appeal prior to December 3, 2024. Specifically, the above evidence reflects that the flare ups and other functional impairments were not so severe, frequent and/or prolonged to warrant the next higher percent rating at any time during this period. This includes discounting the beneficial effects of medications, which as the above evidence shows were not indicated to be so significant that in their absence the functional equivalent of spinal ankylosis would have resulted. Therefore, a separate/higher rating is not warranted on the basis of ankylosis/functional equivalent of ankylosis at any time during the period on appeal prior to December 3, 2024. See 38 C.F.R. § 4.71a, DC 5237. Cf. Chavis, 34 Vet. App. at 23-24. Lastly, the Veteran did not experience any incapacitating episodes of intervertebral disc syndrome as defined in the applicable regulation at any time during the period on appeal prior to December 3, 2024. Therefore, a rating in excess of 10 percent for lumbosacral strain is not warranted on the basis of intervertebral disc syndrome at any time during this period. B. Limitation of back motion since December 3, 2024 The above evidence reflects that during the period on appeal since December 3, 2024, back flexion is limited to 90 degrees. The Veteran reported flare ups of back symptoms, and Dr. Dygert noted that pain and weakness significantly limited functional ability of the thoracolumbar spine with repeated use over time and during flare ups. He specified that spinal flexion would be limited to 15 degrees with repeated use over time and during flare ups. This finding is contemplated by a 40 percent rating under the General Rating Formula. Therefore, a 40 percent rating for lumbosacral strain is warranted during the period on appeal from December 3, 2024. This is the date of the December 2024 back examination with Dr. Dygert, and it is the earliest that it is factually ascertainable that the Veteran's limitation of spinal motion met or approximated the criteria for 40 percent rating under the General Rating Formula. The Board also finds that a rating higher than 40 percent for the service-connected back disability is not warranted at any time during the period on appeal since December 3, 2024. The Veteran has already been awarded the maximum schedular rating for thoracolumbar spine disability under the General Rating Formula for limitation of spinal motion in the absence of ankylosis during the entire period on appeal since December 3, 2024. With respect to ankylosis, the absence of actual spinal ankylosis was noted by Dr. Dygert in his December 2024 DBQ. Also, despite the limited ranges of spinal motion during this period and the Veteran's reported flare ups of spinal symptoms and other functional impairments, the Board finds that he has not experienced the functional equivalent of unfavorable spinal ankylosis at any time during this period. Specifically, spinal flexion and extension were limited to at most 15 degrees and 10 degrees, respectively, with repeated use over time and during flare ups. Overall, regardless of the competent and credible reports of flare ups, pain, and other functional impairments, the evidence persuasively weighs against a finding that the Veteran's back symptoms have been so disabling to actually or effectively result in fixation of the entire thoracolumbar spine in flexion or extension with any of the additional symptoms or limitations listed in Note (5) of the General Rating Formula, so as to find that he has experienced the functional equivalent of unfavorable spinal ankylosis at any time during the period on appeal since December 3, 2024. Specifically, the above evidence reflects that the flare ups and other functional impairments have not been so severe, frequent and/or prolonged to warrant the next higher percent rating at any time during this period. This includes discounting the beneficial effects of medications, which as the above evidence shows are not indicated to be so significant that in their absence the functional equivalent of spinal ankylosis would result. Therefore, a separate/higher rating is not warranted on the basis of ankylosis/functional equivalent of ankylosis at any time during the period on appeal since December 3, 2024. See 38 C.F.R. § 4.71a, DC 5237. Cf. Chavis, 34 Vet. App. at 23-24. Lastly, the Veteran has not experienced any incapacitating episodes of intervertebral disc syndrome as defined in the applicable regulation at any time during the period on appeal since December 3, 2024. Therefore, a rating in excess of 40 percent for lumbosacral strain is not warranted on the basis of intervertebral disc syndrome at any time during this period. 5. Entitlement to a rating in excess of 10 percent for eczema on upper arms and dry skin on arms and legs and entitlement to a compensable rating for bilateral tinea pedis. The Veteran's eczema on upper arms and dry skin on arms and legs is rated under 38 C.F.R. § 4.118, DC 7806. His bilateral tinea pedis is rated under 38 C.F.R. § 4.118, DC 7813. DC 7813 pertains to dermatophytosis, specifically including tinea pedis of the feet. Disabilities under DCs 7806 and 7813 are rated according to the General Rating Formula for the Skin (General Rating Formula). Under the General Rating Formula, a noncompensable (0 percent) rating is warranted if no more than topical therapy was required over the past 12-month period and at least one of the following was present: characteristic lesions involving less than 5 percent of the entire body affected; or characteristic lesions involving less than 5 percent of exposed areas affected. 38 C.F.R. § 4.118, DCs 7806, 7813. A 10 percent rating is warranted where at least one of the following is present: characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period. Id. A 30 percent rating is warranted where at least one of the following is present: Characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. Id. A maximum 60 percent rating is warranted for characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required over the past 12-month period. Id. A note preceding 38 C.F.R. § 4.118 provides that, for the purposes of this section, "systemic therapy is treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy is treatment that is administered through the skin." A. Background The Veteran's claim for increased ratings for eczema on upper arms and dry skin on arms and legs and bilateral tinea pedis was received on September 23, 2024 (see the September 2024 letter acknowledging receipt of an Intent to File on September 23, 2024 and the December 2024 VA Form 21-526EZ). A December 2024 skin DBQ completed by Dr. Dygert indicates that the Veteran experienced dry and cracked skin which would become irritated and bleed. There were red, itchy spots which he would scratch until they were bleeding. Frequent ingrown hairs added to his discomfort, and his symptoms had progressed and increased in severity over time. During the previous 12 months, the Veteran had used topical corticosteroids or other immunosuppressive medications (mupirocin ointment, 2 percent) on a constant/near-constant basis, but had not received any other treatments or procedures for his skin condition. Examination revealed that the Veteran had bilateral tinea pedis and eczema, with swelling, scarring, redness, bleeding, and flaky skin to his feet, wrists, hands, and legs. His eczema involved more than 40 percent of his entire body area and 20 to 40 percent of his exposed areas. His dermatophytosis (tinea pedis) involved 5 percent to less than 20 percent of his total body area and less than 5 percent of his exposed areas. There was no benign or malignant neoplasm or metastases related to his skin conditions, no scarring or disfigurement of his head, face, or neck, and no other pertinent physical findings, complications, conditions, signs, or symptoms. Diagnoses of eczema and bilateral tinea pedis were provided. These disabilities impacted the Veteran's ability to work in that flare ups could impact his work ability depending on severity and location. Severe cases with cracking and bleeding reduced his productivity due to pain and discomfort. B. Eczema on upper arms and dry skin on arms and legs The above evidence reflects that the Veteran's eczema involves more than 40 percent of his entire body. This is contemplated by a 60 percent rating under the General Rating Formula. There is no evidence of any scarring or disfigurement of the head, face, or neck associated with the Veteran's eczema that would warrant a rating in excess of 60 percent under the applicable diagnostic codes for scarring and disfigurement (DCs 7800-7805). Therefore, a 60 percent rating for eczema on upper arms and dry skin on arms and legs is warranted during the entire period on appeal from September 23, 2024. This is the maximum schedular rating under DC 7806. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.7, 4.118, DC 7806. C. Bilateral tinea pedis The above evidence reflects that the Veteran's bilateral tinea pedis involves 5 percent to less than 20 percent of his total body area. This is contemplated by a 10 percent rating under the General Rating Formula. Therefore, a 10 percent rating for bilateral tinea pedis is warranted during the entire period on appeal from September 23, 2024. The Board also finds that a rating in excess of 10 percent is not warranted for the Veteran's bilateral tinea pedis at any time during the period on appeal. Specifically, the December 2024 skin DBQ indicates that his tinea pedis involves 5 percent to less than 20 percent of his total body area and less than 5 percent of his exposed areas. Also, he has only used topical medication for his tinea pedis and has not received any systemic treatment for this disability at any time during the period on appeal. Moreover, there is no evidence of any scarring or disfigurement of the head, face, or neck associated with the Veteran's tinea pedis that would warrant a rating in excess of 10 percent under the applicable diagnostic codes for scarring and disfigurement (DCs 7800-7805). Therefore, the symptomatology and treatment described by the Veteran and observed during the period on appeal most closely approximates the criteria for a 10 percent rating, but no higher, for bilateral tinea pedis during the entire period on appeal. 6. Additional Considerations As a final point, in conjunction with the increased rating matters discussed above, neither the Veteran nor his representative have raised any other related issues, and no other such issues have been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND Entitlement to a rating in excess of 10 percent for right ankle high-grade sprain with either high-grade partial thickness tearing or full thickness tearing of both the anterior talofibular ligament and calcaneofibular ligaments is remanded. Under the AMA, the Board must remand a claim to correct an error by the AOJ to satisfy its duty to assist the claimant under 38 U.S.C. § 5103A, if the error occurred prior to the AOJ decision on appeal. 38 U.S.C. § 5103A (f)(2)(A); 38 C.F.R. § 20.802 (a). The Board may also remand a claim to correct any other AOJ error "in satisfying a regulatory or statutory duty, if correction of the error would have a reasonable possibility of aiding in substantiating" the claim. 38 C.F.R. § 20.802 (a). In this case, the Veteran submitted a December 2024 ankle DBQ completed by Dr. Dygert. This examination is inadequate because it does not comply with the requirements in Correia, 28 Vet. App. at 158. Specifically, the DBQ does not include the ranges of motion of the left ankle and does not otherwise indicate whether the left ankle was damaged or undamaged or explain why range of motion testing of the ankle could not be completed. The Veteran did not otherwise attend a VA ankle examination prior to the May 2025 rating decision. As this was either a pre-decisional duty to assist error or an error "in satisfying a regulatory or statutory duty," the correction of which could have a reasonable possibility of aiding in substantiating the claim, a remand is warranted to afford the Veteran an appropriate examination to ascertain the current severity and manifestations of his service-connected right ankle disability. The matter is REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected right ankle disability. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. In so doing, the examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing of both the right ankle and the left ankle. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups and with repeated use over time. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups and with repeated use over time based on the other evidence of record and the Veteran's statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The examiner may not rely solely upon his or her inability to personally observe the Veteran during a period of flare-up or following repeated use over time. (CONTINUED ON NEXT PAGE) The examiner must provide reasons for any opinion given. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Elwood, 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.