UNITED STAT ES COURT OF AP P EALS FOR VETERANS CLAIMS

N O
. 08-1193
G ER AR D C UL L EN , A PP EL L ANT ,

V
. E RI C K. S H I N SEKI , S EC RE T A RY O F V ET ER A N S A FF A I RS , A PPEL L EE
.

On Ap pe a l f ro m th e B oa

rd of Ve te ra ns ’ A pp e a ls (Argued June 10, 2010 Decide d Aug ust 13, 2010)

Landon Overby

, with Robert V. Chisholm , both of P rovidenc e, Rhode I sland, wer e on the br ie f f or the a pp e lla nt. Michae l Carr, with W

ill A. Gunn , G e ne ra l Co un se l; R. Ra nd all Cam pb e ll , Assistant Gener al Counsel; and Lesli e C. R og all , Deputy

Assistant Gener al Counsel, all of Washington, D.C., we re on the brief for the a ppellee.
Be fore HAGEL , MOORMAN, and D AVI S, Judges

. HAGEL , Judge : Ge rar d Cullen appea ls through c ounsel a F ebrua ry 27, 2008, Boa

rd of Veter ans' Appe als (B oard) decision deny ing e ntitlement to increase d disability rating s for (1) r esiduals of a

shrapne l wound to the rig ht shoulde r and rig ht side of bac k, and (2) deg ener ative joint dis ease of the thora cic spine, e ach curr ently rate d 20% disabling. The Court ha s jurisdiction pursuant to 38 U.S.C. §§ 7252(a) a nd 7266(a) to reviewthe Fe bruar y 2008 Boa

rd dec ision. This matter wa s ref

err ed to pane l to determine whe ther a claimant may be entitled to more than one disabili ty rating for the same condition under the same diagnostic code. We hold that he may not. Be cause , howeve r, the B oard f ailed t o p rovi de an a dequate statement of its rea sons or ba se s f or c on c lud ingthat Mr . Cu lle n w a s n ot e nti tle d to an in c re a se d d isa bil ity ra tin g fo r h is tho ra c ic spine condition due to additional limit ations du e t o pain, wea kness, or fatigue ; and bec ause the B oa rd ' s r e a so ns or

ba se s f or its de nia l of

e nti tle me nt t o a

n in c re a se d d isa

bil ity ratin g fo r t

he re sid ua ls of a shr apnel wound w ere also inadequate, the Court w ill vac ate the Fe bruar y 2008 Boa

rd dec isionFl ex i on i s "t h e a ct of ben di n g or c on di t i on of be i n g be n t

. " D OR L A ND ' S I L L US T R A T E D M E D I C A L D I CT I ON ARY 1 7 2 5 (31 st ed

. 20 0 7 ) [ herei naf t er D OR L A ND ' S ]

. E xt ens i on i s "t he mo vemen t t hat s t r ai gh t ens or i ncr eas es t he ang l e bet ween b o n e s o r p a rts o f t h e b o d y. I d. a t 670. Abdu ct i on me an s "t o dr aw a wa y f r om t h e medi an pl an e. " Id

. at 2. 2 and re mand the matte rs fo r f

ur the r d e ve lop me nt, if ne c e ssa ry , and re a dju dic a tio n c on sis te nt w iththi s decision.

I. F AC TS Mr. Cullen s erve d on active duty in the U.S. Army

from June 1966 to S eptember 1968, including se rvice in Vietnam. I n Marc h 2003, he soug ht increa sed disability rating s for re siduals of a rig ht shoulder shrapne l wou n d an d fo r deg ener ative joint disease of the thorac ic spine, ea ch of wh i ch h adb ee nra t ed1 0 % d i s ab l i n g. I n O c tob e r 2 00 4, Mr . Cu lle n und e rw e nt a V A mus c le s e xami natio n in c onne c tio n w ithbo th of his claims. Wit h respe ct to Mr. C ullen' s rig ht shoulder and r ight side of his back, the e x aminer repor ted: The ve tera

n has a limit ation of the flexion and e x tension of the rig ht shoulder to 60 deg ree s and 3 0 d egr ee s
. The a bduction is lim ited to 120 deg ree s on the rig ht shoulder

. I n te r

n a l r o tati o n5 5 d e g r e e s , e xte r n a l r o tati o nli mi te d

to 2 5 d e g r e e s
. The veter an ca n actively and passively

move the joint. The ve tera n cannot move the joint throug h g ravity . The joint func tion of the rig ht shoulde r is lim ited by pain, fatigue , weakness, and lac k of endur ance following repe titive use and also duringthe flare -up. Record ( R.) at 241. Reg ardingMr. Cullen' s thoracic spine condition, the examiner re ported: 1 Th e ve te ra

n h a s a los s o f l umb ar l or do sis , a nd the re is p ara

ve rt e br a l mu scl e sp a sm of the T4, T5, a

nd T6 area. Fo rw ar d fl exion i s restricte d to 70 deg ree s with pain. Ba ck wa rd ex tension he ca n do to only

20 deg ree s with pain. L eft late ral fle x ion produce s pain at 20 deg ree s. Right later al flexion produces pa in at 15 deg ree s. The ri g ht l a te ra l r otatio n to the ri g ht a nd the le ft is 2 0 d e g re es wi th pain . T he tho ra c ic spine is painful on motion, and there is a ddi t i onal limitation of the thoracic spine with pain, fa t i gu e, wea

kness, and lac k of endur ance following repe titive use and duri ngthe fl are-u p. Th e re is p a inf ul m oti on , s pa sm, and

te nd e rn e ss o f t

he tho ra c ic spine. Ther e is muscle spasm of t h e t h o racic spine. The n, there is gua rding of the thorac ic muscles and spine with abnormal spinal contour with a ky phosis of the thorac ic spine.Lo rdo si s i s " ab no rma l l y i ncreased co ncavi t y i n t he curvat ure of t he l um b ar s p i nal co l um n as vi ewed f rom t he 2
s i de. " D OR L A ND ' S at 1090. Par av er t ebr al me an s "be s i de t h e v er t ebr al c ol u mn
. " Id

. a t 1 4 0 3

. T 4 , T 5 , an d T 6 ind ic a te the 4 th, 5 th, a n d 6 th v e rte b ra e o f t h e tho ra c ic sp ina l co lu m n
. See h t t p: / / v i s u a l

. me r r i a m- w e bs t e r
. c om / im a g e s/h u m a n -b e ing /a n a to m y/sk e le to n /sp ina l-co lum n .jp g (la st visite d J u n e 1 1 , 2 0 1 0 ). K yp h o sis is " a b n o rm a lly i n cr ea s ed con v ex i t y i n t h e cu r v at u r e of t h e t h or ac i c s pi n al c ol u mn a s v i ew ed f r om t h e s i de. " D OR L A ND ' S at 1007.
A n k ylo sis is " im m o b ili ty an d c o n so lid a tio n o f a j o int d u e to d ise a se , i n ju ry, o r su r g ic a l p ro c e d u re ." 3 D OR L A ND ' S at 94. 3 R. at 243. 2 I n an Apr il 2005 rating decision, a V A re g ional office incre ased the disability rating s for e ach of Mr. Cul le n' s d isa

bil iti e s f ro m 10 % t o 2 0% . M r. Cul le n d isa g re e d w iththe ra tin g s a ssi g ne d v ia a Notice of Disag ree ment in May 2005, and ultimately

appea led to the B oard in Nove mber 2005. I n Fe bruar

y 2008, the B oard issued the decision on appe al deny ing e ntitlement to increase d dis a bil ity ratin g s. Re g ard ingMr . Cu lle n' s th or a c ic sp ine dis a bil ity , the B oa

rd dis c us se d th e c ri te ri a contained in 38 C.F .R. § 4.71a, and c oncluded that the med i cal evidence supported only a 20% rating . I n this reg ard, the Boa rd stated: Considering limit ation of motion, the competent medic al evidenc e of r ecor d shows that th e ve te ra

n c ur re ntl y ha s f or wa rd fl e xion o f t

he tho ra c olumba

r sp ine lim ite d to 70 deg ree s with pain and some additional limitation caus ed b y pain, fatigue , weakness and lac k of endurance following repe titive use. The B oard ha s considere d the applica

bility of De Luc a v . B ro wn , 8 Ve t. A

pp . 2 02 , in c lud ingwh e the r t he re is a basis for a ssigninga rating in excess of 20 pe rce nt due to additional li m itation of motion resulting from pain or functional loss. See 38 C.F.R. §§ 4.40 and 4.45. There i s n o qu e s t i o ni nt h i s c a s e t h a tp a i ni s a c o mp o n e n to f

t h e v e t e r an ' s d i s a

b i l i t y. Ne ve rt he le ss, the B oa

rd fi nd s th a t th e e ff

e c ts of pa in re a so na

bly sh ow n to be du e to the veter an' s service -conne cted de g ener ative joint disease of the thorac olumba

r s pine are contempl ated in the 20 perce nt rating curr ently assig ned. The competent evidenc e of r ecor d does not show that pain, fatigue, weakness and lac k of endur ance following repe titive use cau s es fo rw ard f lexi on of the thora columbar spine to be lim ite d to 30 de g re e s or le ss or to be e qu iva le nt to fa vo ra ble ank y lo si s. See

[3] 38 C. F.R

. § 4 .4 0; De

Luc a, su pra . Whil e re petitive motion reportedly added additional limit ation, the Board is of the opinion that even consider ing this additional lim itatio n a s r e po rt e d by

the VAe xami ne r t

he ve te ra n' s d isa bil ity pic tur e mor e ne arl y approximates the criter ia require d for the 20 perc ent rating ( forwa rd flexion lim ited to betwee n 30 and 60 degree s). See38 C.F.R. § 4.7 l a, DC 5242. As such, an evaluation in excess of 20 perc ent for deg ener ative joint disea se of the thorac ic spine based on limitation of motion is not warr anted. Se e id ., see also 38 C.F.R. § 4.7 la.S e c tio n 4 .7 1 a p ro v id e s a ge n e ra l ra ting fo rm u la fo r d ise a se s a n d in ju rie s o f t h e sp ine

. F o r a 2 0 % d isa b ili ty 4
r at i ng of t he t hor aci c s pi ne, t he r egu l at i on r equi r es "[f ] orwa r d f

l exi on of t he t hor acol umbar s pi ne gr eat er t han 30 d egr ees bu t n ot gr ea t er t h an 60 deg r ee s ; " f or a 40% di s abi l i t y ra t i n g of t h e t h or ac i c s pi n e, t h e r eg u l at i on r equ i r es "f or wa r d f l ex i on of t h e t h or a c ol u mb a r spi ne 30 de g r e e s or l e s s ; or , f a v or a bl e a n k y l os i s of

t h e e n t i r e t h or a c ol u mb a r s pi n e
. " 38 C. F. R. § 4. 71 a.
D i ag n os t i c Code 5201 pr ov i des f or a 30% di s abi l i t y r at i n g wh er e t h er e i s l i mi t at i on of mot i on of

t h e maj or 5
arm "[m ]i d way bet ween si d e and s ho ul d er l evel , " and f o r a 2 0 % d i sabil i t y rat i ng w here t he l i m i t at i o n of m o t i o n i s " [a]t s h ou l der l ev el

. " 38 C. F. R. § 4. 71a, D i ag n os t i c Code 5201. 4 R. at 19. Reg ardingMr. Cullen' s shoulder and ba ck disabili t y , the B oard discusse d the medica l evidenc e per

taining to the limitation of motion in hi s rig ht shoulder but ultimately co n cluded that the September

2004 VA examination supported only the cur rent 20% r ati n g. W i t h respe ct to the D eLuca fa c tor s, the B oa

rd ' s d isc us sio n w a s e sse nti a lly the same a s q

uo te d a bo ve fo r t he tho ra c ic

s p i n e d i s a b i l i t y. On a pp e a l, M r. Cul len fir st a

rgue s th a t th e B oa

rd e rr e d in its int e rp re tatio n o f 3 8 C. F .R. § 4 .71a. S peci fi c a lly , h e c on te nd s th a t a pr op e r r e a din g of

the re g ulatio n r e qu ir e d th e B oa rd to 4

awa rd him both a 20% disability ratingand a 40% disability ratingfor his thorac ic spine condition. He asserts t hat t his is so beca use (1) the criteria are wr itten in the disjunctive and are not duplicative

o r o v er l ap p i n g, an d t h ey t h er ef o re s erv e as i n d ep en d en tb as es o nwh i ch t o as s i gna d i s ab i l i t y ra t i n g,
an d (2 ) h e s u ff

er s fr o m s y

mp t o m s i n cl u d ed i nt h e c ri t er i a f o r b o t ha 2 0 % a n d

4 0 % d i s ab i l i t y

ra t i n g. Ap pe lla nt' s B ri e f ( B r. ) at 10- 15

. Mr . Culle n the n ar g ue s that th e B oa rd inc or re c tly a pp lie d 3 8 C. F .R. § 4 .7 1a , D ia g no sti c Cod e 52 01 , to de te rm ine that on ly a 20 % d isa

bil ity ratin g wa s w arr ante d f

or his rig ht shoulder and r ight side of back c ondition. I nstead, he co n t en d s , t h e September 2004 VA examination on which the Boa rd re lied in fac t supports a 30% disability ratingfor that c ondition. 5 Appellant' s Br . at 15-18. He reque sts that the Court r ever se the Boa rd' s decision and awa

rd a 20% dis a bil ity ratin g and

a 40 % di sab il it y

ratin g fo r h is tho ra c ic sp ine c on dit ion , a nd a 30 % d isa bil ity ratingfor his rig ht shoulder and ba ck condition, due to limited rang e of motion. I n response , the S ecr etar

y reje cts Mr. Cullen' s first argument as unsupported by regulations and existi ng case law. Howe ver, the Secre tary conce des that the Boa

rd' s discussion of the eff

ects of pain on Mr. Cullen's function is not supported by adequate re asons or ba ses. Ther efor e, the Sec reta ry
argue s, re mand , n ot r e ve rs a l, i s th e a pp ro pr iate re me dy

fo r e a c h o f M r. Cul le n' s c la ims

.5 II. AN AL YSI S A. Entitlement to Two Disability Ratings f or One Conditi on 1. VA's Interpretation of 38 C .F.R. § 4.71a A B oa rd de te rm inatio n o f t

he a pp ro pr iate de g re e of

dis a bil ity un der t he rat in g c od e is a fi nd ingof fa c t su bje c t to the " c le arl y

e rroneo us " sta

nd ard of re vie w. 38 U. S.C. § 7 26 1( a )( 4) ; see Sm all woo d v . B ro wn , 10 Vet.App. 93, 97 (1997). However , here , the Court is asked to deter mine whether the Secr etar

y ' s interp re t ation of 38 C.F.R. § 4.71a ( specific ally , the rating f ormula for diseases a nd injuries of the spine) as permitting the assig nment of only one disability

ratingis proper,

a le g a l qu e stion that

the Court

re vie ws de no vo . 3 8 U .S. C. § 72 61 (a )( 1) ; see Sm ith v. Gober , 14 Vet.App. 227, 230 ( 2000). The regulation at i ssue i n this matter is 38 C.F.R. § 4.71a, the rating schedule for disabilities of the musculoskeletal sy stem. Of particula r conce rn to Mr. Cullen is the

" Ge ne ra l Ratin g F or

mul a fo r D ise a se s and I nju

ri e s of the Spi ne ," wh ic h c or re sp on ds to D ia g no sti c C o d es 5 2 3 5 -5 2 4 3 an d

p ro v i d es t h e f

o l l o wi n g: Wit h or w i t hout sy

mptoms such as pain (whe ther or not it ra diates), stiffne ss, or a c hin g in t

he are a of the sp ine a ff

e c te d b y re sid ua ls o f i nju

ry or dis e a se Un fa v o rab l e a n kyl o s i s o f t h e e n t i re s p i n e.
. . . . . . . . . . . . . . . 1 0 0 [ % d i s ab i l i t y ra t i n g]
Unfavorable ankylosis of the entire thorac olumbar spine

. . . . . . . . . . . . . . . . . . . . 50
Unfavorable ankylosis of the entire c ervical spine; or, for war d flexion of the thorac olumbar spine 30 degree s or less; or, favorable ankylosis of the entire thorac olumbar spine .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
For war d flexion of the cer

vical spine 15 de g ree s or less; or, favorable anky losis of the entire cer

vical spine . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
For war d flexion of the thoracolumbar spine g reater than 30 de g ree s but not gre ater than 60 deg ree s; or, forwa rd flexion of the ce rvica l spine g reater than 15 de g ree s but not gr eate r t han 30 deg ree s; or, t he combined rang e of motion of the thora columbar spine not g reater than 120 de g ree s; or, the combined rang e of motion of the ce rvica l sp ine no t gr e a te r tha

n 170 de g re e s; or , mu sc le sp a sm o r gua rd ingse ve re e no ug h to result in an abnor

mal g ait or abnor

mal spinal contour such a s s co l i o s is, rever sed lordosis, or abnorma l ky

phosis . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
For war d flexion of the thoracolumbar spine g reater than 60 de g ree s but not gre ater than 85 degr ees; or, f

orwa rd flexion of the ce rvica l spine g reater than 30 de g ree s but6

not gr eate r than 40 de g ree s; or, combined ra ng e of motion of the thoracolumbar spine g reater than 120 de g ree s but not gre at er than 235 deg ree s; or, combined ra ng e of motion of the cer

vical spine g reater t h an 1 7 0 d egre es but not g reater than 335 de g re e s; o r, mus c le sp a sm , gu ard ing , o r l oc a lize d te nd e rn e ss n ot r e su lti ngin abnorma l ga it or abnorma l spinal contour; or, verte bral body fra cture with loss of 50 perc ent or more of the he ight . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 38 C.F.R. § 4.71a (2010)

. Mr . Cu lle n c on te nd s that be c a us e the c ri te ri a fo r e a c h sp ina l dis a bil ity ratin g are wr itt e n in the disjunctive, the cr iteria provide "inde pendent ba ses for e stablishing ei t h er a 20-per cent or

40- perc ent rating" for his th o ra ci c s p ine disability . Appellant' s Br . at 4. More pr ecise ly , Mr. Cullen

c on te nd s th a t, b e c a

us e he ha s sy

mpt oms that matc h on e of the c ri te ri a ne c e ssa ry fo r a 20 % d isa bil ity

rati ng(m us c le sp a sm o r gua

rd ingse ve re e no ug h to re su lt i n a n a bn or ma l sp ina l c on tou

r w ith ky phosis) and one of the cr iteria ne cessa ry for a 40% disability

rating(favorable ankylosis of the entire thora cic spine) , and bec ause those c riteria a re not "duplicative or overla pping," he is entitled to two disability

rating s for his thorac ic spine condition. Appellant 's Br

. at 5

. Moreove r, at ora l argument, Mr. Cullen a sserted that the Secre tary ' s interpre tation of this portion of § 4.71a–that he is e nti tle d to only on e dis a bil ity ratin g fo r his tho ra c ic sp ine c on dit ion –s ho uld be inv a lid a te d b e c a us e it is unreasonable

. VA re jects Mr. C ullen' s interpre tation of § 4.71a a nd argues that existi ng regulations and

case law m ak e it clea

r that a c laimant may

be aw arde d only

one disability

ratingfor a

particula r condition, absent express contra ry authorization in the reg ulation. At oral a rgument, the Secr etar

y noted that this question had never been raised prior to Mr

. Cullen's case , a fac t that a ccounts for the lack of VA Ge nera l Counsel Precede nt Opinions or other question-sp ecif ic interpre tation on the

m a t t e r
. H o w e v e r , p r i o r

t o o r a l ar g u m e n t , t h e S e c r e t ar y s u b m i t t e d a d d i t i o n a l r e l e v an ta

u t h o r i t y, specific ally , the notice of proposed rulemaking to a mend the portion of § 4.71a at issue in this case
. The Sec reta

ry argues that that docume nt provides insight into his inter pretation of the g ener al rating formula f or disease s and injuries of the spine prior to the litigation of this case. I n Cathedral Candl e Co. v. U.S. I nt'l Trade Commission , the Un ite d Stat e s Cour t of App e a ls fo r t he F e de ra l Cir c uit

(F e de ra l Cir c uit ) d e sc ri be d th e su bs tant ia l le ve l of

de fe re nc e g e ne ra lly aff orded to a

n ag ency ' s interpre tation of its own regulation, noting that the interpre tation i s "'ofT he not e pr ovi des an ex cept i on wh er e t her e i s "un f avor abl e a nk y l osi s of

bot h s egmen t s , " i n w hi ch cas e t hey 6
ar e t o be r at ed as a s i n g l e di s abi l i t y
. 38 C. F. R. § 4. 71a, D i ag n os t i c Codes 5234- 5243, n ot e 6. 7 controlling weig ht unless it is plainly err oneous or inconsistent w ith the regulation.'" 400 F.3d 1352, 1 3 6 4 (F ed

. C i r. 2 0 0 5 ) ( qu o t i n g Bowles v. Sem inole Rock & Sand Co. , 325 U.S. 41 0 , 4 1 4 (1 9 45)). Such g ener ous defe renc e is due even when the age ncy ' s interpre tation is prese nted i n a brie f during the litigation stag e, as longas there is " ' no rea son to suspe ct that the interpre tation doe s not refle ct th e agency 's fai r and cons id ered ju dgmen t on th e ma tt er i n ques ti on .'" Id. (q u o t i n g Auer v. R obbins , 519 U.S. 452, 461-62 (1997) ( noting that de fer ence must be aff orded to an age ncy ' s interpre tation of a regulation even whe re that interpretation is first advance d in a leg al brief if that position articulates a we ll established ag ency prac tice))

. The Court conc ludes that Mr. Cullen' s argument, althoug h cre ative, is not persua sive. The langua g e of

the re g ulatio n, re a d a s a who le, make s c le ar t hat th e re g ulatio n p ro hib its mul tip le disability rating s for a

single spinal disability , except in c erta in c ircumstance s. I n note 1, the rating specia list i s specific ally

direc ted to evaluate par

ticular sy mptoms, specifically , "a ssociated objec tive

ne ur olo g ic a

bn or ma lit ie s, " un de r t

he " a pp ro pr iate dia g no sti c c od e ." 38 C.F .R. § 4 .7 1a , D ia g no sti c Codes 5234-5243, note 1. This statement indicates that there are some circ umstances unde r which an additional disability

ratingfor sy

mptoms related to a spinal disability is warr anted. Mr. Cullen does not sug g est that either of his claimed sy

mptoms ar e n eu ro l og ic abnor malities warr anting an additional disability rating

. Simi larly , note 6 states that whe n a cla imant has disabilities of both the

c e rv ic a l and thorac olumbar spine, the r esulting disabilities ar e t o be rated sepa rate ly , i.e., may

be

a ssi g ne d s e pa

rate dis a bil ity ratin g s und e r t

he g e ne ra l r a tin g fo rm

ula

. Th e imp lic a tio n o f t his 6 state me nt i s th a t w he re a

c la ima nt' s d isa bil ity inv olv e s only t h e t h o ra co l u mb ar s p i n e, as M r. C u l l en 's does, he is entitled to only one disability

ratingfor that c ondition. Turn ingto V A' s n oti c e of pr op osed ru le makin g , p ub lis he d in the F e de ra l Re g ist e r i n September 2002 ( pri o r t o t h e fina l rule' s enac tment in November 2003) , the Court finds simil ar support for the Sec reta

ry ' s position. VA proposed to a mend VA' s "Sche dule for Rating Disa biliti es by revisingth at porti on of the Musculoskele tal Sy stem that addre sses disabilities of the spine." 67 Fe d. Reg . 56,506 (Sept. 4, 2002). VA stated that it intended to "r evise the e valuation cr iteria for ratingdisabiliti es of the spine by establishing a

g ener al rating formula that will a pply to all diseasesT he gen er al r at i ng f ormul a f or t he s pi ne s t at es t hat t he f ormul a wi l l be appl i ed "wi t h or wi t hout s y mp t om s s uch 7
a s p a in ( w h e the r o r n o t i t ra d ia te s) , sti ff n e ss, o r a c h ing in the a re a o f th e s p ine a ff e c te d b y re sid u a ls o f i n

ju ry o r d ise a se ." 3 8 C .F .R . § 4 .7 1 a , D ia g n o stic C o d e s 5 2 3 5 -5 2 4 3 ; s ee 6 8 Fed

. R eg. 51 , 4 5 4 (Aug. 2 7 , 20 0 3 ). 8 and injuries of the spine." 67 Fe d

. R eg. at 5 6 ,510. VA explained its proposal to include note 1, dis c us se d a

bo ve , s tatin g tha

t su c h d ir e c tio n to oth e r d ia g no sti c c od e s f or e va luatio n of n e ur olo g ic abnorma lities was nece ssary beca use the varie ty

of neur ologic abnorma lities that mi g ht stem from diseases a nd injuries of the spine made it impra ctical to include them in the proposed r ating schedule , wh i ch co n ce rn edo n l y

o rt h o p ed i c l i m i t at i o n s
. T h i s s t at em en ti mp l i es t h at s ep ar at e d i s ab i l i t y ra t i n gs
wo uld be ava ila ble fo r s ome kin ds of

dis a bil iti e s th a t ste m f

ro m sp ina l di sa

bil iti e s ( i.e ., ne ur olo g ic disabiliti es), but that one disability ratingwould be assig ned under the g ener al rating f

ormula for

any orthopedic limitations that arose. VAa lso pr op os e d to "d e le te the se ve n d ia g no sti c c od e s .
. . that in vo lve fi nd ing s o f a nk y los is

o r l i m i t at i o no f m o t i o no f t h e s p i n e b ec au s e, ra t h er t h an re p re s en t i n g conditions or diagnoses , they

are fi nd ing s that are c omm on to a va ri e ty of sp ina l c on dit io ns ." Id. (empha sis added). Th is statement direc tly

supports the Secre tary ' s argument that disability rating s are assig ned base d on a "c ondition," rather than on any sy mptoms of a particula

r condition, which is essentially what Mr. C u l l en 's ar gu m en tb o i l s d o wn t o
. I nfa ct , an kyl o s i s o f t h e t h o ra ci c s p i n e i s t h e ba s i s fo r M r. C u l l en 's

asser ted entitlement to a sepa

rate 4 0 % d i s ab i l i ty

ratingin this case. I t is clear, how ever , that VA int e nd e d to do awa

y wi th se pa

rate dis a bil ity ratin g s f or ank ylos is a nd ins te a d r a te sp ina l conditions (i.e., disabilities) that include a nkylosis as a symptom

. Additionally , VA propose d to eliminate the diag nostic code f or lumbosacr al strain "ba sed

on pa in, mus c le sp a sm, lim itatio n o f m oti on , li sti ngof the sp in e, lo ss o f l a te ra l mo tio n w ith osteoarthr itic chang es, etc ." 67 F ed. Reg . at 56,5 1 2

. VA stated that it would move lumbosacra l strain to Diag nostic Code 5237 (that is, within the ge nera l formula for ratingdisabiliti es or injuries of t he s pi ne), "whi ch wou ld in clu de cri ter ia adeq uat e for it s ev alu ati on ." Id. Ag ain, the fa ct that VA eliminated a se parate diag nostic code that could be based o n m u s cl e spasms (among othe r sy mptoms ) and instea d included muscle spa sms as o n e o f t he cr iteria include d in severa l of the

7 d i s ab i l i t y ra t i n gs fo r t h e s p i n e d em o n s t ra t es VA 's i n t en tt o el i m i n at e t h e p o s s i b i l i t y o f as s i gn i n g a9

s e p ar a t e d i s a

b i l i t y fo r t ha t s

ymptom in addition to a disabilit y ratingfor the ove rar chingspinal condition . V A' s f

ina l r ule , p ub lis he d in

Au g us t 20 03 , c on fi rm s th is: Pain alone ca

nnot be eva l u at ed without being a ssociated with an unde rlying patholog ic abnor

mality . I n the case of spine disabiliti es, i t would be ra re f or pain not to be pr e se nt. Pa in is of

te n the pr ima

ry fa c tor lim iti ngmot ion , f

or e xamp le , a

nd is a lmo st a lw ay s p re se nt whe n th e re is mus c le sp a sm. Th e re fo re the e va luatio n c ri te ri a provided a

re me ant to en co m p as s and take into account the pr esenc e of pa in, stiffness, or a ching , which ar e g ener ally prese nt wh en there is a disability of the spine.
68 F e d. Re g
. a t 51 ,4 54 -5 5. F ur the r: " [W]e d e ve lop e d e va luatio n c ri te ri a that are me ant t o ta

ke pa in and other sy mptoms i nto acc ount. There fore an eva luation based on pa i n al o n e would not be appropr iate, unless ther e is specif ic ner ve root pain, for example, that c ould be evaluated under the neurolog ic sec tions of the ratingschedule ." 68 F ed. Reg . at 51,455. These statements by VA, made long before the questi on arose befor e the Court, make clea r wh e n a se pa rate dis a bil ity ratin g is w arr ante d– fo r e xamp le in the c a se of ne ur olo g ic a bn or ma lit ie s, or whe n a cla imant has both thoracic and ce rvica l spine disabiliti es
. T h es e stateme nts also make

c le ar VA ' s posi tio n that sep arate dis a bil ity ratin g s are no t to be a ssi g ne d f or dif fe re nt sy mp tom s of an under ly ing spina l condition, suc h as pain, ankylosis, or muscle spasms. The Court concludes that VA' s position i s consistent both with the reg ulation itself and with VA' s demonstrated inter pretation of the re g ulation and is theref ore due substantial de fer ence from the Court. See A uer , 519 U.S. at 46 1- 62 ; Cathedral Candl e Co. , 400 F.3d at 1364. Mr. Cullen has not car ried his burde n of demonstrating t h at t he Secr etar y ' s interpre tation or position is unrea sonable. See R eizenstein v. Shinseki , 583 F.3d 1331, 1336 (F ed. C ir. 2009) ("In order to defe at t he VA's claim to defer ence , [t he

a pp e lla nt] mus t g ive us a

' re a so n to su sp e c t th a t th e int e rp re tatio n d oe s n ot r e fl e c t th e a g e nc y ' s f a ir

an d co n s i d er edj u d gm en t o n t h e m at t er i nqu es t i o n
. '" ( qu o t i n g Cathedral Candl e Co. , 400 F.3d at 1364)). 2. Applicability of Other Regulations Mr. Cullen' s argumen t t hat he is entitled to two disability rating s for his thorac ic spine

c on dit ion is a lso no t su

pp or te d b y oth e r r e g ulatio ns . U nd e r 3 8 C.F.R

. § 4. 7, " Whe re the re is a qu e sti on a s to wh ic h of tw o e va luatio ns sh a ll be a pp lie d, the highe r e va luatio n wi ll be a ssi g ned if the disability

picture more near ly

approximates the criter ia re quired for that rating . Otherw ise, theT he C our t not es t hat , f or r at i ng pur po s es , § 4. 71 a c om bi nes t he t horac i c and l umbar s pi nes an d provi des 8
c rite ria fo r ra ting d isa b ili ties o f t h e " tho ra c o lum b a r sp ine ." 10 lower r ating will be assig ned." This regulation clea rly indicates that only

one disability

ratingper diag nostic code may be assigned and t hat i t will be base d on the over all disability picture. Mor eover , the Fe dera l Circuit has held that a ve tera n simply "c annot be c ompensated more than once for the

sam e di sab il it y ." Boggs v. Pe ake , 520 F .3 d 1 33 0, 13 37 (F e d. Cir . 2 00 8) ; see 38 C.F.R. § 4.14 (2010) (" The e valuation of the sa me disability

under va rious diag noses is to be avoided." ). Mr. Cullen is corr ect that 38 C.F.R. § 4.25(b) entitles veter ans to have "the dis ab ili tie s arising fr om a sin g le dis e a se e nti ty

. . . rate d se pa ra te ly " (e mph a sis a dd e d) and the indi vi du al d is a bil ity

ratin g s c ombin e d. Ho we ve r, he a sk s th e Cou rt to i nte rp re t th a t r e g ulatio n a s p e rm itt ingse pa rate dis a bil ity ratin g s to be ba se d o n in div idu a l sy mp tom s of a dis a bil ity , r a the r than on se pa rate dis a biliti es . For e xamp le , M r. Cul le n w ou ld h a ve the Cou rt fi nd that hi s in div idu a l symptoms (f avo ra ble ank ylos is o f the ent ire tho ra c ic sp ine and mus c le sp a sm o r gua

rd ingse ve re e no ug h to

re su lt i n a n a bn or ma l sp ina l c on tou

r w ithky ph os is) a re su ff ic ie nt t o a ssi g n tw o s e pa

rate dis a bil ity rating s for the effe cts of one disabling conditi on (deg ener ative joint disea se of the thorac ic spine). That is not permitted. See B oggs , 5 20 F .3 d at 13 37 ; cf. Bradley v. Peak e , 22 Vet.App. 280, 290- 91 (20 08 ) (st atin g tha

t § 4 .2 5 r e qu ir e s th a t " a ll dis ab ili tie s ar e to b e r a te d

s e p ar a te ly " an d

n o ti n g f ew exceptions to that rule (empha sis added))

. Mr. Cullen' s sugg estion at oral a rgument that the cr iteria of § 4.71a relating to the spine would have be en wr itten in the con junctive i f separate disability rating s wer e not permitted for spinal disabiliti es ig nores the f

act that the spine is made u p of three distinct parts–the ce rvica l spine, the thorac i c s pine, and the lumbar spine–and that the disputed por tion of § 4.71a is a " g ener al" rating fo rm u l a f o r d i s ea s es an d i n

j u ri es o f t h e s p i n e. Ac co rd i n gl y , b o t ht h e 2 0 % a n d 4 0 % d i s ab i l i t y

ra t i n gs provide c riteria a

pplicable to e ith e r the ce rvica l spine or the thorac ic spine. See 38 C.F.R. § 4.71a. 8 I f the c riteria w ere written in the conjunctive, a claimant would have to show disabilities of both the thorac ic and c ervic al spines to establish entitlement to compensation. The C o urt is theref ore not pe rs ua de d b y

thi s argume nt.11

3. Appellant's Reliance on Caselaw and VA General Counsel Prec edent Opinion 9-2004 I n sever al of the cases on which Mr. Cullen relies, discussed below, the Court found t hat the Boa rd er red in re quiring a cla imant to show eac h of the va rious sy mp t oms list ed in the rating schedule for a particular disabi lity rating fo r t he c la ima nt' s a lle g e d c on dit ion , w he n th os e c ri te ri a
wer e wr itten in the disjunctive form. In Dr os ky v . B ro wn , for instanc e, the a ppellant was se eking a 30% disability

ratingfor r

heumatic he art disea se, and the criter ia for that rating wer e inactive r heumatic he art disea se " [f] rom the termination of a n established ser

vice ep i s o d e o f rh eu m at i c f

ever , or i t s s ub se qu e nt r e c ur re nc e , w ithc ard ia c manif

e statio ns , during the episode or

rec urre nce, f

or 3 y ear s, or dia sto lic mur mur wi th c ha

ra c te ri sti c EKG manife stations or definitely enlar g ed hea

rt."
10 Ve t.A pp . 2 51 , 2 54 (1 99 7) (q

uo tin g 38 C.F .R. § 4 .1 04 , D ia g no sti c Cod e 70 00 (1 99 6) ) ( e mph a sis added) . There , the Secre tary conce ded, and the Court a g ree d, that the Boa rd had e rre d by

requiring that the veter an have both a dia sto lic mur

mur wi th E KGmanif

e statio ns and a def

initely enlar g ed h e art to qu a li f

y f o r a 3 0 % d is a

b il it y r a ti n g
. Id. at 255. Simil arly , in J oh ns on v . B ro wn , the Court found that the B oard ha d err ed i n requiring a claimant to satisfy

all of the disjunctively

written criter ia i n 38 C.F.R. § 4.132 (1994) f or a 100% disability rati ng for post-tra umatic stress disorder

. 7 V e t.A pp . 9 5, 99 (1 99 4) (" [U]po n r e mand the B oa rd sh a ll d e te rm ine wh e the r t he a pp e lla nt' s [po sttr a umatic str e ss d iso rd e r] d isa bil ity me e ts any one of the thre e indepe ndent criteria require d for a 100% [pos t- tr a

umatic str e ss dis or de r] ratin g . I f the B oa rd de te rm ine s that one of the c ri te ri a is m e t, it shall award a

100% rating." (empha sis added) ). These c ases e stablish that disj unctive cr iteria for a particular disabi lity rating are ind e pe nd e nt b a se s o n w hic h to a ssi g n a sing le pa rt ic ula r d isa bil ity rating . Neither

case supports the interpre tation of the assig nment of disability rating s that Mr. Cullen puts forth. Mr. Cullen' s relianc e on Es te ba n v . B ro wn , 6 Vet.App. 259 ( 1994), is simil arly misplaced. The Court' s holding in Esteban , that the "critica l element" of whe ther sepa rate disability

rating s are permitted is whether the s y mptomatology of each rating is " distinct and separ ate," 6 Vet.App. at 262, cannot be divorce d from the c ontext of that ca se. In Esteban , the appe llant had four sc ars on his fa ce
as a re s u l t of a ve hicle ac cident in servic e and ha d been a ssigne d a 10% disability ratingunder 38 C.F.R. § 4.118, Diag nostic Code 7800 (1993) (disfigur ing scars)

. The Boar d deter mined that the

a pp e lla nt' s sc ars mig ht a lso have be e n p ro pe rl y e va luate d und e r t

wo a dd it iona l di a g no sti c c od e s,12

7804 (pai n ful scar s) or 5325 (f acia l muscle injury

), but deter

mined that the appe llant was entitled to only one 10% disability

rating , not three se parate 10% disability rating s (to be combined unde r § 4.25), bec ause " ' the evidenc e of recor d shows that the residual of an injury to the rig ht side of the veter an' s fac e is compatible with, but does not meet[,] any of the sche dular c riteria f

or a r ating highe r than 10 per cent.' " 6 V et.App. at 260. The Court, however , found: Th e con di tion e mbo die d in a ratin g un de r [D ia g no sti c Cod e ] 780 0 is e nti re ly c os me tic in n a tur e . Su c h r a tin g do e s n ot c on ta in a ny c omp on e nt o f p a in o r m

us c le dama g e . T he c ri tic a l e le me nt i s th a t none of the sy mpt omatol og y

fo r a ny on e of the se thr e e c on dit ion s is duplicative of or overlapping with the sy mptomatology

of the oth e r t wo c on dit ion s. Ap pe lla

nt' s sy mpt omatol og y is dis tin c t and se pa rate

. . . . Thus , as a matter of law, appellant is entitled to combine his 10% rating f or disfig ureme nt under [ Diag nostic Code] 7800 with an additional 10% rating f or tende r and pa inful scar s under [ Diag nostic Code 7804] and a third 10% rating f or fa cial muscle injury interfe ring with mastication under [Diag nostic Code] 5325.
Id. at 261-62. Esteban , a case involving thre e sepa rate "c onditions" or disabilities–as emphasized by the a ssi g nme nt o f t

hr e e se pa rate dis a bil ity ra tin g s und e r t

hr e e se pa ra te dia g no sti c c od e s– is e a sil y distinguishable f

rom Mr. Cullen' s case , in which he seeks two se parate disability rating s for the same condition or disability

–deg ener ative joi nt disease of the t horac ic spine–under one diag nostic code. Th e Court

is n ot p e rs ua de d th a t Esteban c an b e fa ir ly re a d to su

pp or t Mr . Cu lle n' s a

rgume nt. Simi la r ly , th e Co u rt a ls o f

in d s M r
. Cu ll e n ' s r e li an c e o nV A G e n e r a l C o u n s e l P r e cede nt Op ini on 9- 20 04 mis pla c e d. Th a t op ini on a dd re sse d wh e the r a ve te ra

n c an re c e ive se pa

rate dis a bil ity

ra t i n gs u n d er

3 8 C

. F. R

. § 4

. 7 1 a, Di agn o s t i c C o d es 5 2 6 0 (l eg, l i m i t at i o n o f fl ex i o n ) an d 5 2 6 1 (l eg, lim itatio n o f e xten sio n) fo r t he same joi nt. VAGe ne ra l Co un se l de te rm ine d th a t, i n s ome circ umstances, se parate disability rating s could be a ssign ed (a n d combined under § 4.25) without

c on sti tut ingpy

ra mid ing , w hic h is pr oh ibi te d b y § 4 .1 4. Th e Ge ne ra l Co un se l st a te d: [T ]h e k e y

c o n s id e r a ti o nin

d e te r mi n in g w h e th e r

r a ti n g u n d e r more than one diagnostic code is in order is whethe r the ratings unde r different diagnostic codes would be based on the same manifestation of disability or whether no n e o f t he sy mptomatology

upon which the se parat e ra t i n g s would be base d is duplicative or o v er l ap p i n g. VA Ge n. Coun. Prec. 9-2004 ( Sep. 17, 2004) (e mphasis added) . As in Esteban , the key differ ence betwee n the questi o n t he Ge nera l Counsel was asked to r esolve a nd Mr. Cullen' s case is that theIf M r. C ul l en b el i eves t hat t he current dis ab i l i t y rat i ng ass i gned d o es no t ad eq uat el y co m p ensat e hi m f o r t he 9 p ra c tica l e ff

e c ts o f h is d isa b ili ty, the p ro p e r re c o u rs e is t o se e k e x tra sc h e d u la r c o n sid e ra tio n
. See 38 C. F. R. § 3. 321( b) ( 1) (20 1 0 ). 13 Gene ral Counsel wa s asked to dete rmine whe n separ ate disability rating s under two pa rti cular, dif fe re nt d iag no sti c c od

es is proper, no t whether separ ate disability rating s can be as s i gn ed under the same diagnostic code . Acc ording ly , the Court reje cts Mr. Cullen' s argument on this iss ue. 9 4. Su mm ar

y We hold that, within a particula r diag nostic code, a

claimant is not entitled to more than one disability ratingfor a single disabili ty unless the re g ulation expressly provides otherwise. To find oth e rw ise wo uld

pe rm it a bs ur d r e su lts –c omp e ns a tio n tw ic e fo r the same c on dit ion –a nd no t on ly

in the ca se of disea ses and injuries of t h e spi ne. F or example, under 38 C.F .R. § 4.97, the rating schedule for disabiliti es o f the re spiratory sy stem, Diag nostic Code 6846 (sar coidosis) contains dis jun c tiv e c ri te ri a

tha t are no t " du

pli c a tiv e or

ov e rl a pp ing ," su c h th a t a c lai man t w ho ha d b oth pulmonary

and ca rdiac involvement would be entitled to both a 60% a nd a 100% disability

rating for the same condition unde r Mr. Cullen' s interpre tation. Sim ilarly , under 38 C.F .R. § 4.119 (2010), the rating sc hedule f

or disabilities of the endoc rine sy stem, a 10% disability rating can be awa rded under num er o u s d i ag nostic codes whe n continuous medication is require d for c ontrol, but that require ment does not appe ar in the criteria for any of t he higher disability rating s. Acc ording to Mr. Cullen's log ic, a claimant who suffe red from, for e x ample, hy perthy roidism and require d continuous medicati o nto c o n tr o l t

h a t c o n d it io nb u t wh o a ls o e xp e r ie n c e d ta c h y c ar d ia , tr e mo r , an d

in c r e a s ed p u ls e o r b lo o d p r e s s u r e r e late d to o r c a u s e d b y th a t c o n d it io n w o u ld b e e ntitled to b o th a 10% disability ratingbased on the need f or medication and a 30% disab i l ity ratingfor the othe r sy mptoms. See 38 C.F.R. § 4.119, Diag nostic Code 7900. As discussed above, this is simply not contemplated by

the rating sc hedule. B. Rea sons or Ba ses I n his br ief, and at oral argument, the Secre tary conce ded that the Boa rd' s rea sons or bases fo r d e nyingMr . Cu lle n' s c la ims we re ina de qu a te

. I n re nd e ri ng its de c isi on , the B oa rd is r e qu ir e d to provide a written st atement of the reasons or base s for its "f indings a nd conclusions[] on all materia l issues of fa ct and law

prese nted on the re cord." 38 U.S

. C

. § 7 1 0 4(d)( 1). The statement must be14

a de qu a te to e na

ble a c la ima

nt t o und e rs tand

the pr e c ise ba sis fo r t

he B oa rd ' s d e c isi on , a s w e ll a s to fac ilitate reviewin this C ourt. See G ilbert v. Derwinski , 1 Vet.App. 49, 57 ( 1990). I n De Luc a v . B ro wn , the Court h el d that 38 C.F.R § 4.40 require s that the disabling e ffe ct of painful motion be conside red when rating joint disabiliti es. 8 Ve t.App. 202, 205-06 (1995)

. Pursuan t to § 4 .4 0, a

" [d]isa bil ity of the mus c ulo sk e le ta l sy ste m is pr ima ri ly the ina bil ity , d ue to damag e or infe ction in pa rts of the sy stem, to pe rfor m the normal workingmovements of the body with normal excursion, streng th, speed, c oordination and e nduranc e." Fur ther, under § 4.40, fu nc tio na l lo ss " may be du e to pa in, su pp or te d by a de qu a te patho logy and e vid e nc e d by the vis ibl e behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion,

and a pa rt wh ic h b e c ome s p a inf

ul o n u se mus t be re g ard e d a s se ri ou sly dis a ble d. " Withre g ard

to the joints, 38 C.F.R. § 4.45 provides that "the fac tors of disability reside in reduc tions of their normal excursion of movements in differ ent pl anes." When rating disabiliti es of joints, including the spine, the B oard must discuss any additional limit ations a claimant experience s due to pain, weakness, or fatigue. DeLuca , 8 Vet.App. at 205-06. 1. Thoracic Spine Her e, the B oard' s discussion of the ef fe cts of pain, we akness, or fatigue is conc lusory

and without supporting rationale: T h e r e i s n o qu e s t i o n i n t h i s c a s e t h a t p a i n i s a c o mp o n e n t o f t h e v e t e r an ' s d i s a b i l i t y. Ne ve rt he le ss, the B oa

rd fi nd s that the e ff

e c ts o f p a in r e a so na

bly sh ow n to be du e to the veter an' s service -conne cted de g ener ative joint disease of the thorac olumbar s p ine are contemplated in the 20 per cent r ating curr ently assig ned. The competent evidenc e of r ecor d does not show that pain, fatigue, weakness and lac k of endur ance follo w in g r e p e ti ti v e u s e c a u s e s f o r w ar d f le xio n o f th e th o r a c o lumb ar s p in e to be lim ite d to 30 de g re e s o r l e ss o r t o b e e qu iva le nt t o f a vo ra ble ank ylos is. Whil e repe titive moti on repor

tedly added additional limit ation, the B oard is of the opinion that even considering this additional li mitation as reporte d by the VA e x aminer the veter an' s disability picture more near ly approximates the criter ia re quired for the 20 perc ent rating ( forwa

rd flexion lim ited to betwee n 30 and 60 degree s). R. at 19 (citations o m i t t ed ). This explanation tacitly acknow ledg es that the Septembe r 2004 VA

e xami n e r d e te r mi n e d th a t M r
. Cu ll e n ' s " th o r a c ic s p in e [w a ]s p a in f u l on mo ti o n , an d

th e r e [w a ]s ad d it io n a l l im it a ti o no f

th e th o r a c ic s p in e w it

hp a in , f a ti g u e , w e a kn e s s , an d

la c k o f e n duranc e following repe titive use and duringthe flar e- u p
. " R. at 243. The Court, howeve r, per ceive s two15

pr ob le ms w i t h t h e p h y s i c i an ' s s t a t e m e n t : F i r s t , t h a t s t a t e m e n t i s l e s s t h an h e l p f u l t o t h e B o a rd

in

rea chinga conc lusion on thi s issue beca use it l ac k s an y s p ecif

ics reg ardingthe ef

fec ts of the ad d i t i o n al l imitation of mot ion of the spine. Second, de spite this shortcoming, not only did the Boa rd opt to rely

on such a conclusory statement, but a lso the Boa rd failed to e x plain its conclusion any more thoroughly than di d the VA e x aminer. See 38 U.S.C. § 7104(d)( 1); 38 C.F.R. § 4.2 (2010) (stating that if an e x amination repor t does not contain suffic ient detail, " it i s i n cu mbent upon the

ratin g bo ard to re tur

n th e re po rt

a s in a de qu a te fo r e va luatio n p ur po se s" ); see also Bowling v. Principi , 15 Vet.App. 1, 12 (2001) (e mphasizi ng Boa rd' s duty to return inade quate e x amination repor t). Acc ording ly , t h e C o u rt ' s ability to reviewthe B oard' s decision on this claim has bee n frustrat ed , an d vactur

and re mand is nece ssary
. Se e Tuc k e r v . W est , 11 Vet.App. 369, 374 ( 1998) (holding that rema

nd is warr anted wher e the B oard' s rea sons or bases a re ina dequate ). On re mand, the B oard should see k clar ification and a more specific descr iption from the VA examiner re g arding the extent of the additional limit ations Mr. Cullen experience s due to pain, we akness, a nd fatig ue–or pr ov ide a ne w, tho ro ug h me dic a l e xami natio n– and re a dju dic a te Mr . Cu lle n' s c la im. To the extent that Mr. Cullen conten d s that the B oard e rre d in not assigninga sing le 40% dis a bil ity ratin g fo r h is tho ra c ic sp ine c on dit ion, the Cou rt ne e d n ot a dd

re ss t hat argume nt a

t th is time. B e c a

u s e th e Co u rt h a s d e te r

mi n e d th a t v a c a tu

r an d r e ma n d is w ar r an te d f o r th is c la im , the Boa rd will be re quired to re adjudicate Mr. Cullen' s claim and provide a new stat em ent of reasons

or ba se s f or its de c isi on , w hic h w ill ne c e ssa ri ly inc lud e a dis c us sio n of whe the r a

40 % d isa

bil ity ratingis warr anted. See B est v. Principi , 15 Vet.App. 18, 20 (2001) (per curiam order) ("Anarr ow decision pre serve s for the a ppellant an opportunity to argue those c laimed er rors be fore the B oard

a t th e re a djud icatio n, and , o f c ours e , b e fo re thi s Co ur t in an a pp e a l, s ho uld

the B oa rd ru le a g a ins t him."). 2. Residuals of Shrapnel W ound Her e, the B oard' s discussion of the additional limit ations due to pain, we akness, or fatig ue is v e ry sim ila r t o th a t c on ta ine d in

its dis c us sio n o f M r. Cul len's cla im fo r b e ne fi ts f or a tho ra c ic spine condition. The B oard wrote: T h e r e i s n o qu e s t i o n i n t h i s c a s e t h a t p a i n i s a c o mp o n e n t o f t h e v e t e r an ' s d i s a b i l i t y. Ne ve rt he le ss, the B oa

rd fi nd s th a t th e e ff

e c ts o f p a in r e a so na

bly sh ow n to be du e to the veter an' s service -conne cted r esiduals of shra pnel wound to the rig ht shoulde r and16

ri g ht s ide of

ba c k a re c onte mpl a te d in

the 20 pe rc e nt r a tin g c ur

re ntl y a ssi g ne d. Whil e the September

2004 VA examiner re ported that pain, fatigue , weakness, and lac k of endura nce f ollowing r epetitive use r esulted in inability to lift objects with the rig ht sh ou lde r, takin g thi s in to c on sid e ratio n, the B oa rd is s til l of the op ini on

the ov e ra ll dis a bil ity pic tur e mor e ne arl y

a pp ro xima te s mo de rate ly se ve re dis a bil ity of mus c le g roup XX, as opposed to sever e. The additional limit ation resulting from pain a nd functional loss also still m ore ne arly approximates limi tation of the arm to shoulder le ve l, a s o pp os e d to mid

wa y be tw e e n s ide and

sh ou lde r l e ve l. R. at 12-13 (c itations omi tted). The Court per ceive s two problems with this ex planation as we ll: First, the Boa rd' s statement that the a dd iti on a l fun c tio na l limitatio n mor e ne arl y a pp ro xima te s a mode ra

te ly se ve re dis a

bil ity is conclusory

and unsupported by

any further explanation. Second, as t he Secr etar y conce des, the Board did not addre ss the fac t that the September 2004 V A examination found that Mr. Cull en 's fl ex i o no f th e ri gh t arm / s h o u l d er wa s l i m i t edt o 6 0 d egr ee s , wh i ch ap p ea rs t o s u p p o rt M r. C u l l en 's

asser tion that his disability limit s the rang e of motion of his rig ht arm to midway betwee n his side and his s h o u l d er an d there fore entitles him to a 30% disability rating

. See R. at 24 1; 3 8 C. F .R. § 4.71a, Diagnostic Code 5201 ; S ecr etar y ' s Br . at 10-11. The Court theref ore c oncludes that the Boa rd' s rea sons or bases for denying entitlement to an incre ased disability ratingfor this condition

are ina de qu a te , a

nd va c a tur and re mand is req uir e d s o th a t th e B oa

rd c an a de qu a te ly

e xpla in i ts

c on c lus ion s o r c on du c t f

ur the r d e ve lop me nt t o o bta in t he inf or matio n a nd e vid e nc e ne c e ssa

ry to adjudicate Mr. Cullen' s claims. See Tuck er , 11 Vet.App. at 374. On re mand , Mr

. Cul le n is fr e e to su bmi t a dd iti on a l e vid e nc e and argume nt w ithre sp e c t to both of hi s claims, in acc ordanc e with Kut sc he ro us k yv . W est , 12 Vet.App. 369, 372- 73 (1999) ( per curiam order)

. See Kay

v. Principi , 16 Vet.App. 529, 534 (2002). The Court r eminds the Boa rd that "[ a] rem andis mea ntto ent ail a cri ti cal ex ami nat io n o f t he j us ti fi cat io n fo r t he d eci si on ." Fletche r v. De rwinski , 1 Ve t.A

pp . 3 94 , 3 97 (1 99 1) . In a dd iti on , th e B oa rd sh a ll p ro c e e d e xpe dit iou sly , in

acc ordanc e with 38 U.S.C. § 7112 (expedited treatment of r emande d claims).

III . C ON CL USI ON Upon consider ation of the for eg oing, the Fe bruar y 27, 2008, Boa

rd dec ision is VACATED and the matter s are REMANDED f or re adjudication consistent with this decision.