You may need to address pain without a diagnosis using one or more functional impact statements. As discussed earlier in this course, the Federal Circuit, in Saunders v. Wilkie, held that pain alone, even in the absence of a specific diagnosis or otherwise identified disease or injury, can constitute a disability for which service connection may be granted under 38 USC 1110. The Veteran's pain must result in functional impairment of earning capacity to constitute a disability. The court determined that the term disability refers to the functional impairment of earning capacity, not the underlying cause of the disability.

The Federal Circuit also made clear that a Veteran cannot "demonstrate service connection simply by asserting subjective pain—to establish a disability, the veteran's pain must amount to a functional impairment. To establish the presence of a disability, a veteran will need to show that their pain reaches the level of a functional impairment of earning capacity."

Functional impairment of earning capacity refers to the limited ability to perform occupational tasks to the extent that work performance, i.e., earning capacity, is impaired. Examples include, but aren't limited to

  • the inability to perform certain movements or tasks due to pain,
  • time lost from work due to pain, or
  • pain resulting in increased fatigability or incoordination affecting job performance.

Documentation protocols prompt you for this kind of information in the Functional Impact section by asking whether a condition limits the Veteran's ability to perform occupational tasks. You must complete the Functional Impact section even if only pain is found.

Note

If there is no pathological process for the Veteran's reported pain, you must explain why a diagnosis cannot be provided.