ERECTILE DYSFUNCTION

MICHAEL LANE · 2025 · Case ID: A25100362

MIXED

Summary

The veteran, who served in the U.S. Army from March 1990 to June 1996, appealed the denial of service connection for erectile dysfunction, GERD, hypertension, non-allergic rhinitis, sinus headaches, dermatitis, and IBS, as well as seeking an increased rating for dermatitis and an earlier effective date for several conditions. The Board granted service connection for erectile dysfunction, finding it secondary to the veteran's service-connected PTSD, major depressive disorder, and alcohol use disorder, as supported by a VA examiner's opinion. Service connection for GERD was also granted, found to be caused by the veteran's alcohol use disorder, as per a VA examiner's opinion. The claim for hypertension was denied, as the Board found the evidence persuasively weighed against a diagnosis, relying on a VA examiner's conclusion that the veteran did not have hypertension and that his symptoms were not related to service or toxic exposure. Earlier effective dates for rhinitis, headaches, and dermatitis were denied due to lack of timely claims or evidence, and the earlier effective date for IBS was denied because the diagnosis of IBS was not confirmed until after the relevant period. The Board granted a 10 percent rating for sinus headaches, finding the evidence supported characteristic prostrating attacks occurring on average once every two months, but denied a higher rating due to insufficient evidence of frequency and severity. For dermatitis, the Board found the evidence persuasively weighed against a rating higher than 10 percent, as the treatment received was topical, not systemic, and the affected body area did not meet the criteria for higher ratings.

Rationale

Granted as secondary to service-connected PTSD, MDD, and alcohol use disorder; VA examiner opined BPH, obesity, and alcohol use disorder caused ED; Obesity and alcohol abuse identified as major risk factors for ED

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

241210-503505

Full Decision Text

Citation Nr: A25100362
Decision Date: 11/19/25 Archive Date: 11/19/25

DOCKET NO. 241210-503505
DATE: November 19, 2025

ORDER

Entitlement to service connection for erectile dysfunction is granted.

Entitlement to service connection for gastroesophageal reflux disease (GERD) is granted.

Entitlement to service connection for high blood pressure / hypertension is denied.

Entitlement to an effective date prior to September 13, 2021, for the grant of service connection for non-allergic rhinitis is denied.

Entitlement to an effective date prior to September 13, 2021, for the grant of service connection for sinus headaches is denied.

Entitlement to an effective date prior to September 13, 2021, for the grant of service connection for dermatitis is denied.

Entitlement to an effective date prior to August 10, 2022, for the grant of service connection for irritable bowel syndrome (IBS) is denied.

Entitlement to a 10 percent rating for sinus headaches is granted, subject to the laws and regulations governing the payment of monetary benefits.

Entitlement to a disability rating in excess of 10 percent for dermatitis (claimed as skin condition, neck and arms) is denied.

FINDINGS OF FACT

1. The Veteran's erectile dysfunction was due to his service-connected posttraumatic stress disorder (PTSD) with major depressive disorder and alcohol use disorder.

2. The Veteran's GERD was due to his service-connected PTSD with major depressive disorder and alcohol use disorder.

3. The evidence of record persuasively weighs against finding that the Veteran has had a hypertension disability at any time during or approximate to the pendency of the claim.

4. The Veteran submitted an intent to file that was received by VA on September 13, 2021, and filed a formal claim for service connection for rhinitis, headaches, and a skin condition on October 4, 2021, and prior to the date of the intent to file there were no outstanding claims for service connection for rhinitis, headaches, a skin condition, or residuals thereof.

5. The above October 4, 2021, submission also included a claim for a digestive condition, which was diagnosed as constipation in a June 2022 VA examination and the evidence does not support a conclusion that the service-connected IBS disability was diagnosed prior to August 10, 2022.

6. For the entire appellate time period, the Veteran's sinus headaches were manifested by characteristic prostrating attacks averaging one in 2 months over the last several months.

7. For the entire appellate time period, the Veteran's dermatitis required intermittent systemic therapy.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for erectile dysfunction have been met. 38 U.S.C. §§ 1110, 1117, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.310.

2. The criteria for entitlement to service connection for GERD have been met. 38 U.S.C. §§ 1110, 1117, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.310.

3. The criteria for entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1117, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.317.

4. The criteria for entitlement to an effective date prior to September 13, 2021, for the grant of entitlement to service connection for non-allergic rhinitis have not been met. 38 U.S.C. § 5110(a)(2); 38 C.F.R. §§ 3.1, 3.103, 3.104, 3.2500.

5. The criteria for entitlement to an effective date prior to September 13, 2021, for the grant of entitlement to service connection for sinus headaches have not been met. 38 U.S.C. § 5110(a)(2); 38 C.F.R. §§ 3.1, 3.103, 3.104, 3.2500.

6. The criteria for entitlement to an effective date prior to September 13, 2021, for the grant of entitlement to service connection for
U.S.C. § 5110(a)(2); 38 C.F.R. §§ 3.1, 3.103, 3.104, 3.2500.

6. The criteria for entitlement to an effective date prior to September 13, 2021, for the grant of entitlement to service connection for dermatitis have not been met. 38 U.S.C. § 5110(a)(2); 38 C.F.R. §§ 3.1, 3.103, 3.104, 3.2500.

7. The criteria for entitlement to an effective date prior to August 10, 2022, for the grant of entitlement to service connection for IBS have not been met. 38 U.S.C. § 5110(a)(2); 38 C.F.R. §§ 3.1, 3.103, 3.104, 3.2500.

8. The criteria for a 10 percent disability rating for sinus headaches have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code (DC) 8100.

9. The criteria for a rating in excess of 10 percent for dermatitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, DC 7806.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service in the United States Army from March 1990 to June 1996.

In July 2024, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of October 2023 and November 2023 decisions. In October 2024, the agency of original jurisdiction (AOJ) issued the HLR decision on appeal, which considered the evidence of record at the time of the prior October 2023 (erectile dysfunction, GERD, dermatitis, migraines, IBS, and allergic rhinitis) or November 2023 (hypertension / high blood pressure) decisions. Therefore, the Board may only consider the evidence of record at the time of the prior decisions.

In the December 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the October 2023 and November 2023 agency of original jurisdiction (AOJ) decisions, which was subsequently subject to higher-level review. 38 C.F.R. § 20.301. If evidence was submitted during the period after the AOJ issued the decision, which was subsequently subject to higher-level review the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like 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.

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303.

The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Service connection may be granted for a disability that is due to
Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303.

Service connection may be granted for a disability that is due to, or aggravated by, service-connected disease or injury. 38 C.F.R. § 3.310.

Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

In the present case, the Veteran has contended that she suffers from multiple disabilities due to her active service in Southwest Asia and/or symptoms that are manifestations of one or more undiagnosed illnesses resulting from her service in the Southwest Asia theater of operations during the Persian Gulf War.

In order to obtain a grant of service connection pursuant to 38 U.S.C. § 1117 and 38 C.F.R. § 3.317, a Veteran needs to present some evidence (1) that he or she is a Persian Gulf Veteran; (2) who exhibits objective indications of chronic disability resulting from an illness or combination of illnesses manifested by one or more signs or symptoms such as those listed in paragraph (b) of 38 C.F.R. § 3.317; (3) which became manifest either during active military, naval or air service in the Southwest Asia theater of operations during the Persian Gulf War, or to a degree of 10 percent or more not later than December 31, 2026; and (4) that such symptomatology by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 C.F.R. § 3.317(a); see Neumann v. West, 14 Vet. App. 12, 22 (2000), vacated on other grounds, 14 Vet. App. 304 (2001) (per curiam order); Gutierrez v. Principi, 19 Vet. App. 1 (2004).

For purposes of 38 C.F.R. § 3.317, there are three types of qualifying chronic disabilities: (1) an undiagnosed illness; (2) a medically unexplained chronic multisymptom illness; and (3) a diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C. § 1117(d) warrants a presumption of service-connection.

An undiagnosed illness is defined as a condition that by history, physical examination and laboratory tests cannot be attributed to a known clinical diagnosis. In the case of claims based on undiagnosed illness under 38 U.S.C. § 1117; 38 C.F.R. § 3.117, unlike those for "direct service connection," there is no requirement that there be competent evidence of a nexus between the claimed illness and service. Gutierrez v. Principi, 19 Vet. App. 1, 8-9 (2004). Further, lay persons are competent to report objective signs of illness. Id.

Medically unexplained chronic multisymptom illnesses are defined by a cluster of signs or symptoms, and are currently limited to chronic fatigue syndrome, fibromyalgia, and functional gastrointestinal disorders (excluding structural gastrointestinal diseases), as the Secretary has not determined that any other conditions meet the criteria for a medically unexplained chronic multi symptom illness. Chronic multisymptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317(a)(2); 75 Fed. Reg. 61995-97 (Oct. 7, 2010) (adding diabetes and multiple sclerosis as examples of chronic multi-symptom illnesses of partially understood etiology
. Id.

38 C.F.R. § 3.317 also allows for service connection on a presumptive basis for certain enumerated infectious diseases. See 75 Fed. Reg. 59968-72 (Sept. 29, 2010) (amending 38 C.F.R. § 3.317(c) to allow for presumptive service connection for nine infectious diseases.) As none of the enumerated diseases are at issue in this case, the Board has omitted listing the diseases or discussing them.

Section 3.317 explicitly acknowledges that a claimant's "signs or symptoms" need not be shown by medical evidence; however, the regulation does specifically require some "objective indications" of disability. See 38 C.F.R. § 3.317(a). "Objective indications of chronic disability" include both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3). Signs or symptoms that may be manifestations of undiagnosed illness include, but are not limited to, the following: (1) fatigue; (2) signs or symptoms involving skin; (3) headache; (4) muscle pain; (5) joint pain; (6) neurologic signs or symptoms; (7) neuropsychological signs or symptoms; (8) signs or symptoms involving the respiratory system (upper or lower); (9) sleep disturbances; (10) gastrointestinal signs or symptoms; (11) cardiovascular signs or symptoms; (12) abnormal weight loss; and (13) menstrual disorders. 38 C.F.R. § 3.317(b).

For purposes of section 3.317, disabilities that have existed for six months or more and disabilities that exhibit intermittent episodes of improvement and worsening over a six-month period will be considered chronic. The six-month period of chronicity will be measured from the earliest date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. 38 C.F.R. § 3.317(a)(4).

Lastly, compensation shall not be paid under section 3.317 if there is affirmative evidence that an undiagnosed illness was not incurred during active military service in the Southwest Asia theater of operations during the Persian Gulf War; if there is affirmative evidence that an undiagnosed illness was caused by a supervening condition or event that occurred between the Veteran's most recent departure from active duty in the Southwest Asia theater of operations during the Persian Gulf War and the onset of the illness; or if there is affirmative evidence that the illness is the result of the Veteran's own willful misconduct or the abuse of alcohol or drugs. 38 C.F.R. § 3.317(c).

A Persian Gulf Veteran is a Veteran who served on active military, naval, or air service in the Southwest Asia Theater of operations during the Persian Gulf War. 38 C.F.R. § 3.317(d); 75 Fed. Reg. 59968-72 (Sept. 29, 2010) (reordering this part of the regulation to 38 C.F.R. § 3.317(e)). The Veteran's military records document that she served in Southwest Asia during the pertinent time period. Therefore, the above-described provisions possibly apply to this case.

In cases where a Veteran applies for service connection under 38 C.F.R. § 3.317, but is found to have a disability attributable to a known diagnosis, further consideration under the direct service connection provisions of 38 U.S.C. § 1110 is warranted. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994) (specifically addressing claims based on ionizing radiation exposure). Thus, the presumption is not the sole method for showing causation. However, as noted above, where the issue involves a question of medical diagnosis or causation, as presented here, a claimant must establish
provisions possibly apply to this case.

Effective from August 10, 2022, the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act), Section 303 implemented 38 U.S.C. § 1168. The PACT Act requires a disability examination and medical opinion be requested for certain non-presumptive conditions involving toxic exposure risk activity (TERA). For such claims, VA is required to provide a disability examination and medical opinion when the Veteran submits a claim for compensation, has evidence of a disability, had evidence of participation in a TERA, and such evidence is not sufficient to establish service connection for the disability. A Veteran can claim participation in a TERA explicitly or implicitly through service in a location presumed associated with toxic exposure, or records showing participation in a TERA; or, if VA has conceded exposure in a prior claim, or the file has a claim attributable to toxic exposure. Other ways to claim or establish participation in a TERA include, when a Veteran's military occupational specialty (MOS) is associated with toxic exposure; when medical records suggest exposure to a toxic substance, chemical, or airborne hazard such as VHA exposure screening; or, with any other relevant evidence of record to include garrison exposures.

A March 2023 VA memorandum verified that the Veteran had presumed toxic exposure from his service in Southwest Asia. As such, the Veteran participated in a TERA.

The sub-regulatory guidance defines four exceptions to the requirement to obtain a TERA examination and medical opinion: physical trauma, mental disorders, disabilities that have not been shown to have any positive association with herbicide agent exposure, and disabilities that manifested during service or with a clear etiology that is not associated with toxic exposure (to include due to post-service events). VBA Letter 20-22-10, 10-13, Processing Claims Involving the PACT Act, 87 Fed. Reg. 78,543 (Dec. 22, 2022).

In this case and as will be discussed in greater detail below, the Veteran does not have a diagnosis associated with the claimed hypertension / high blood pressure disability and medical opinions have concluded that the GERD and erectile dysfunction are unrelated to the Veteran's toxic exposure during service.

1. Entitlement to service connection for erectile dysfunction

The Veteran asserts that his currently diagnosed erectile dysfunction was caused by service or service-connected disability.

The Veteran's service treatment records include no complaints, treatment, or diagnosis of erectile dysfunction or symptoms medically associated thereto. The Veteran does not allege otherwise.

The Veteran underwent a VA examination in April 2023. The examiner noted a diagnosis of erectile dysfunction from 2020, when the Veteran began experiencing problems achieving an erection. The condition had worsened / progressed since that time. Currently, the Veteran had a decreased libido, difficulty achieving an erection, and difficulty maintaining an erection. The Veteran took Viagra as needed. After examination, the examiner concluded that the "Veteran developed erectile dysfunction symptoms in 2020, at 50 years of age. Veteran's BMI is over 40. Erectile dysfunction is common in men 50 years and older with increasing rates with BMI over 30. Given Veteran's comorbid conditions, his erectile dysfunction is a disease with a clear and specific etiology and diagnosis." Following examination, the examiner concluded that it was less likely than not that the erectile dysfunction was caused by the indicated toxic exposure risk activities, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. The rationale was that the Veteran was diagnosed with erectile dysfunction from 2020. "He is also diagnosed with BPH, obesity, and alcohol abuse disorder, with all diagnoses preceding the diagnosis of erectile dysfunction by 20 years. Obesity and alcohol abuse are well known to be two of the biggest risk factors for the development of erectile dysfunction. Review of current medical literature shows that of individuals that are diagnosed with BPH
iology and diagnosis." Following examination, the examiner concluded that it was less likely than not that the erectile dysfunction was caused by the indicated toxic exposure risk activities, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. The rationale was that the Veteran was diagnosed with erectile dysfunction from 2020. "He is also diagnosed with BPH, obesity, and alcohol abuse disorder, with all diagnoses preceding the diagnosis of erectile dysfunction by 20 years. Obesity and alcohol abuse are well known to be two of the biggest risk factors for the development of erectile dysfunction. Review of current medical literature shows that of individuals that are diagnosed with BPH causing urinary and prostate symptoms, more than 50% are also diagnosed with erection and ejaculation difficulties, regardless of age. Given that Veteran has been diagnosed with BPH, obesity, and alcohol abuse disorder well before his diagnosis of erectile dysfunction a combination of these diagnoses of erectile dysfunction is less likely than not caused by the indicated toxic exposure risk activities, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran."

Thus, the April 2023 VA examiner concluded that a combination of the Veteran's BPH, obesity, and alcohol abuse disorder combined to cause the erectile dysfunction and that obesity and alcohol abuse were two of the biggest risk factors for the development of erectile dysfunction. The Veteran is service connected for PTSD with major depressive disorder and alcohol use disorder. As the sole medical opinion of record found that the Veteran's alcohol use disorder caused in whole or in part his erectile dysfunction, the Board concludes that entitlement to service connection for erectile dysfunction is warranted.

2. Entitlement to service connection for GERD

The Veteran asserts that his currently diagnosed GERD was incurred in or otherwise caused by service or service-connected disability.

The Veteran's service treatment records include no complaints, treatment, or diagnosis of GERD or symptoms medically associated thereto. The Veteran does not allege otherwise.

The Veteran's VA treatment records include an assessment of GERD.

The Veteran underwent a VA GERD examination in June 2022. The examiner diagnosed GERD. The Veteran reported symptom onset in 1994, when the Veteran started having problems with a burning pain in the upper abdomen and vomit coming back into the throat when sleeping. The Veteran sought treatment and was told he had a little acid reflux and was told to drink more water. Currently, the Veteran experienced symptoms twice per week, for which he used Zantac. Following examination, the examiner concluded that it was less likely than not that the Veteran's GERD was incurred in or caused by service. The rationale was that the Veteran's GERD was a disease with a clear and specific etiology and diagnosis. It was less likely than not that the GERD was related to in-service exposure in Southwest Asia. The claims file was silent for complaints of gastrointestinal symptoms and the Veteran treated himself with over-the-counter medication that relieved the symptoms. As there was no documentation that the GERD problems began during service a nexus could not be established. In addition, the Veteran had a larger abdomen, which was known to cause additional pressure in the abdomen that led to reflux.

The Veteran was afforded a VA examination in April 2023. The examiner concluded that the Veteran had a diagnosis of GERD from 2022. The Veteran reported onset in 1998, with burning in the chest, particularly with spicy food. Symptoms started after increasing alcohol intake. Current symptoms included daily acid reflux symptoms with burning in the chest, nightly regurgitation, and nausea. The Veteran avoided spicy food because it made his symptoms worse. The Veteran used Zantac twice daily. In the medical opinion section the examiner stated that the Veteran currently was diagnosed with GERD and had classic GERD symptoms controlled with diet and Zantac. The Veteran did not have GERD symptoms until several years of heavy alcohol use. The Veteran began drinking heavily in 1994 and GERD symptoms developed in 1998. "Excessive alcohol use is one of the biggest risk factors for the development of GERD. Given Veteran's alcohol use corresponding to the development of symptoms and Veteran's typical GERD symptoms that are controlled with diet and Zantac, Veteran's excessive alcohol use is more likely than not the main contributor to the Veteran developing GERD. Therefore, Veteran's current diagnosis of GERD is less likely than not caused by the indicated toxic exposure risk activities, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran."

Thus, the April 2023 VA examiner concluded that the Veteran's alcohol use disorder caused his
symptoms developed in 1998. "Excessive alcohol use is one of the biggest risk factors for the development of GERD. Given Veteran's alcohol use corresponding to the development of symptoms and Veteran's typical GERD symptoms that are controlled with diet and Zantac, Veteran's excessive alcohol use is more likely than not the main contributor to the Veteran developing GERD. Therefore, Veteran's current diagnosis of GERD is less likely than not caused by the indicated toxic exposure risk activities, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran."

Thus, the April 2023 VA examiner concluded that the Veteran's alcohol use disorder caused his GERD. The Veteran is service connected for PTSD with major depressive disorder and alcohol use disorder. The June 2022 VA examination report did not provide any opinion as to the cause of the GERD, other than that it was not due to in-service toxic exposure. As the sole medical opinion of record found that the Veteran's alcohol use disorder caused his GERD, the Board concludes that entitlement to service connection for GERD is warranted.

3. Entitlement to service connection for high blood pressure / hypertension

The Veteran contends that he has hypertension / high blood pressure due to his active service.

The Veteran's service treatment records include no complaints, treatment, or diagnosis of high blood pressure / hypertension or symptoms medically associated thereto. The Veteran does not allege otherwise.

VA treatment records document various blood pressure readings, including 115/75 (January 2018), 126/68 (November 2019), 158/81 (September 2021), 138/83 (December 2021), 124/73 (September 2022), and 122/71 (August 2023).

The Veteran was afforded a VA hypertension examination in November 2023. The examiner discussed the Veteran's documented blood pressure readings from 2018 and concluded that the Veteran did not have a diagnosis of hypertension or isolated systolic hypertension based on the criteria diastolic blood pressure predominantly 90mm or greater and systolic blood pressure predominantly 160mm or greater with a diastolic blood pressure of less than 90mm. The Veteran reported that since he was about 27 or 28 years old he had been told at medical appointments that his blood pressure was high. That said, the Veteran acknowledged his blood pressure had not consistently been high and had never taken medication for his blood pressure. At the examination, the Veteran had noted blood pressure readings of 155/85, 145/78, and 146/90. In addition, prior to the start of the examination the Veteran had blood pressure readings of 167/91, 176/83, and 162/89. The examiner discussed how since 2018 her maximum documented systolic blood pressure was 158mm and his maximum diastolic pressure of 84mm. The examiner encouraged the Veteran to schedule a blood pressure check with his primary care provider.

A subsequent nursing blood pressure check included readings of 132/82 and 143/80. The Veteran was not taking any medication. Hypertension education was not provided.

The Board concludes that the Veteran does not have hypertension and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). The November 2023 VA examiner specifically considered the Veteran's contentions and after reviewing the claims file and conducting a physical examination concluded that the Veteran did not have a hypertension disability. The Board finds this examination report the most probative evidence of record. The treatment records do not otherwise document or support a diagnosis of hypertension.

The Board recognizes that under 38 C.F.R. § 3.317 signs or symptoms of undiagnosed illness includes cardiovascular signs or symptoms. In this case, the Veteran's blood pressure does not meet the criteria for a 10 percent rating or higher for VA compensation purposes under 38 C.F.R. § 4.104, DC 7101. Moreover, the Veteran's asserted blood pressure issues do not exhibit objective indications of chronic disability resulting from an illness or combination of illnesses. As such, the provisions of 38 C.F.R. § 3.317 are not for application.

The sole evidence in support of the Veteran's claim are his lay contentions. While the Veteran is competent to report physically observed symptoms, he is not shown to have the education, training, and experience necessary to diagnose hypertension or attribute such disabilities to his active service, to include
In this case, the Veteran's blood pressure does not meet the criteria for a 10 percent rating or higher for VA compensation purposes under 38 C.F.R. § 4.104, DC 7101. Moreover, the Veteran's asserted blood pressure issues do not exhibit objective indications of chronic disability resulting from an illness or combination of illnesses. As such, the provisions of 38 C.F.R. § 3.317 are not for application.

Therefore, the Board concludes that the evidence is persuasively against the claims. The benefit-of-the-doubt rule does not apply, and the claim must be denied. See generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F.3d 1361 (Fed Cir. 2001).

Earlier Effective Dates

1. Entitlement to an effective date prior to September 13, 2021, for the grant of service connection for non-allergic rhinitis

2. Entitlement to an effective date prior to September 13, 2021, for the grant of service connection for sinus headaches

3. Entitlement to an effective date prior to September 13, 2021, for the grant of service connection for dermatitis

4. Entitlement to an effective date prior to August 10, 2022, for the grant of service connection for IBS

For appeals governed by the AMA, 38 C.F.R. § 3.2500(h) controls the assignment of effective dates. Under that provision, the effective date will be the date VA received a veteran's initial claim or the date entitlement arose, whichever is later, if a veteran continuously pursues an issue by timely filing in succession any of the available review options as specified in § 3.2500(c) within one year of the issuance of the decision. 38 C.F.R. § 3.2500(h).

Applicable laws and regulations define an initial claim as any complete claim, other than a supplemental claim, for a benefit on a form prescribed by the Secretary. 38 C.F.R. § 3.1(p)(1). A first initial claim for one or more benefits received by VA is further defined as an original claim. 38 C.F.R. § 3.160(b). Continuously pursued issues include situations where following notice of a decision on an initial claim or a supplemental claim, the claimant files a supplemental claim, request for a higher-level review, or an appeal to the Board. 38 C.F.R. § 3.2500(c)(1).

The Veteran contends that an earlier effective date for service connection for non-allergic rhinitis, sinus headaches, dermatitis, and IBS is warranted. The current effective date is September 13, 2021, for the headaches, rhinitis, and dermatitis and August 10, 2022, for the IBS disability.

In February 2014, the Veteran filed claims for service connection for a right leg stress fracture, a pulled back and back pain in the lower back, and difficulty breathing and these issues were denied in a December 2014 rating decision.

On July 14, 2017, VA received an Intent to File a Claim for Compensation and/or Pension. The form was dated that same day and signed by the Veteran.

In a subsequent July 18, 2017, letter, VA acknowledged receipt of the July 14, 2017, intent to file and notified the Veteran that he had one year from the date that the intent to file was received by VA in order to preserve that effective date for any granted compensation benefits.

In November 2017, the Veteran filed a claim for service connection for right and left knee and lumbar spine disabilities. Those issues were denied in a January 2018 rating decision.

On September 13, 2021, VA received an Intent to File a Claim for Compensation and/or Pension. The form was dated September 10, 2021, and signed by the Veteran.

A September 14, 2021, letter from VA acknowledged receipt of the Veteran's intent to file that was received on September 13, 2021.

On October 4, 2021, the Veteran's attorney representative submitted a letter entitled, "Submission of Initial Claim
to preserve that effective date for any granted compensation benefits.

In November 2017, the Veteran filed a claim for service connection for right and left knee and lumbar spine disabilities. Those issues were denied in a January 2018 rating decision.

On September 13, 2021, VA received an Intent to File a Claim for Compensation and/or Pension. The form was dated September 10, 2021, and signed by the Veteran.

A September 14, 2021, letter from VA acknowledged receipt of the Veteran's intent to file that was received on September 13, 2021.

On October 4, 2021, the Veteran's attorney representative submitted a letter entitled, "Submission of Initial Claim" that accompanied a VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, which listed issues that included allergic rhinitis / sinusitis; skin condition, neck and arms; digestive condition; GERD; and headaches.

During September 2021 and December 2021 VA treatment visits, the Veteran denied nausea, vomiting, abdominal pain, or rectal bleeding.

A June 2022 VA intestinal conditions examination report concluded that the Veteran did not have IBS, but did diagnose constipation. The Veteran reported symptom onset in 1991, when he started noticing that he was not having as many bowel movements as he should, but did not seek medical attention until recently. The treatment providers planned on setting up an EGD and colonoscopy next month. The Veteran was using metamucil every day and laxatives once per month. The treatment had increased bowel frequency, but not to the extent that the Veteran believed it should. The Veteran denied issues with diarrhea, alternating diarrhea and constipation, anemia, nausea, or vomiting. He also denied episodes of bowel disturbance with abdominal distress or exacerbations or attacks of the intestinal condition.

A July 2022 rating decision granted entitlement to service connection for dermatitis and assigned a 0 percent rating, effective September 13, 2021. In addition, the rating decision denied service connection for rhinitis and sinusitis. That rating decision also denied entitlement to service connection for constipation (claimed as digestive condition).

An April 2023 VA intestinal conditions examination report noted a diagnosis of IBS from 2022. The Veteran reported progressively worsening symptoms that currently included chronic constipation, with typical bowel movements every 3 days. If the Veteran did not have a bowel movement for more than 5 days he experienced pain and rectal bleeding with a bowel movement. The Veteran also had loose and watery stools between episodes of constipation that typically lasted for 2 to 3 days.

An October 2023 rating decision granted entitlement to service connection for IBS, non-allergic rhinitis, and sinus headaches. For each issue, the AOJ granted the disability pursuant to the PACT Act and assigned an effective date of August 10, 2022, the effective date of the PACT Act.

The October 2024 rating decision on appeal assigned earlier effective dates of September 13, 2021, for the grants of service connection for non-allergic rhinitis and sinus headaches, but denied an earlier effective date for IBS. The rationale in the rating decision for denying the IBS claim was that while the Veteran had continuously prosecuted his claim since September 13, 2021, "the evidence did not show a confirmed diagnosis as indicated by your VA examination completed on June 17, 2022."

As to the Veteran's rhinitis, headache, and dermatitis claims, prior to September 13, 2021, the Veteran had no pending claims for service connection for any of these disabilities. The Veteran's attorney representative acknowledged such in the October 2021 statement entitled "Submission of Initial Claim" along with the formal claim following the September 13, 2021, intent to file submission. The Veteran has not fully articulated why he believes an earlier effective date is warranted for any of these claims. The Board recognizes that the Veteran previously submitted an intent to file in July 2017, but he did not submit a claim for rhinitis, headaches, or a skin condition within one year of that intent to file. Similarly, while the Veteran's September 2021 intent to file form was dated September 10, 2021, it was not received by VA until September 13, 2021, and the date of receipt by VA is the earliest effective date possible. As such, the claims for earlier effective dates for the rhinitis, headache, and dermatitis disabilities are denied.

As to the Veteran's IBS claim, while the Veteran did bring a claim for a "digestive condition" in October 2021, within one year of the September
intent to file in July 2017, but he did not submit a claim for rhinitis, headaches, or a skin condition within one year of that intent to file. Similarly, while the Veteran's September 2021 intent to file form was dated September 10, 2021, it was not received by VA until September 13, 2021, and the date of receipt by VA is the earliest effective date possible. As such, the claims for earlier effective dates for the rhinitis, headache, and dermatitis disabilities are denied.

As to the Veteran's IBS claim, while the Veteran did bring a claim for a "digestive condition" in October 2021, within one year of the September 13, 2021, intent to file, the subsequent June 2022 VA examination did not find that the Veteran had IBS and, instead, diagnosed constipation. Such a finding is supported by the Veteran's September 2021 and December 2021 VA treatment visits, where he denied nausea, vomiting, abdominal pain, or rectal bleeding (as he did during the June 2022 VA examination). It was not until the April 2023 VA examination that the Veteran reported worsening gastrointestinal symptoms, including abdominal pain and rectal bleeding without a bowel movement for more than 5 days, as well as intermittent loose and watery stools alternating with constipation. Such symptoms were not reported during VA treatment visits prior to August 10, 2022, or during the June 2022 VA examination. The Board recognizes that the symptoms documented during the April 2023 VA examination likely did not start at that time, but there is no clear indication that they started prior to August 10, 2022. As such, the earliest date available for service connection is the date entitlement arose (i.e. the date of diagnosis of the claimed disability) and not the date of claim that pre-dated the manifestation of symptoms that ultimately led to the diagnosis of IBS. Thus, an effective date prior to August 10, 2022, is not warranted for the grant of service connection for IBS.

Increased Ratings

Disability evaluations are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate DCs identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3.

The Veteran's entire history is reviewed when making a disability determination. See 38 C.F.R. § 4.1. VA must consider whether the Veteran is entitled to "staged" ratings to compensate when his or her disability may have been more severe than at other times during the course of his or her appeal.

The evaluation of the same disability under various diagnoses, known as pyramiding, is generally to be avoided. 38 C.F.R. § 4.14. The critical element in permitting the assignment of several ratings under various DCs is that none of the symptomatology for any one of the disabilities is duplicative or overlapping with the symptomatology of the other disability. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994).

1. Entitlement to a compensable rating for sinus headaches

The Veteran contends that a compensable rating is warranted for his headache disability because the current rating does not accurately reflect the severity of his disability.

Under DC 8100, migraines are evaluated as follows: a 50 percent rating is assigned with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. A 30 percent rating is assigned with characteristic prostrating attacks occurring on an average once a month over last several months. A 10 percent rating is warranted with characteristic prostrating attacks averaging one in 2 months over the last several months.

In Johnson v.
. App. 259, 261-62 (1994).

1. Entitlement to a compensable rating for sinus headaches

The Veteran contends that a compensable rating is warranted for his headache disability because the current rating does not accurately reflect the severity of his disability.

In Johnson v. Wilkie, 30 Vet. App. 245, 247 (2018), the Court held that the rating criteria under DC 8100 are successive, meaning that a claimant cannot fulfill the criteria of the higher rating without fulfilling those of the next lower rating. In that decision, the Court also found that the phrase "characteristic prostrating attacks" plainly describes migraine attacks that typically produce powerlessness or a lack of vitality. Id. at 252.

"Prostrating" means "lacking in vitality or will: powerless to rise: laid low." Id (citing Webster's Third New International Dictionary of the English Language Unabridged 1822 (1966)). Thus, "Because DC 8100 specifically governs migraine headaches, the phrase 'characteristic prostrating attacks' plainly describes migraine attacks that typically produce powerlessness or a lack of vitality." Id. at 252. The modifier "completely," as used before "prostrating" in the 50 percent criteria, means that the Veteran must be rendered entirely powerless and that "productive of severe economic inadaptability" means either producing or capable of producing severe economic inadaptability." Id. at 253.

The rating criteria for a 50 percent rating contain several undefined phrases. The descriptive phrase "very frequent" connotes a frequency at least greater than once a month, as is required by the rating criteria corresponding to a lesser 30 percent rating. Id. The phrase "completely prostrating" generally means that the migraines attack must render the veteran entirely powerless. Id. The completely prostrating attacks must also be "prolonged," which is defined as "to lengthen in time: extend duration: draw out: continue, protract." Id. (internal citation omitted). Lastly, the 50 percent rating criteria requires that the very frequent completely prostrating and prolonged attacks be "productive of severe economic inadaptability." Productive can be read as having either the meaning of "producing" or "capable of producing," and, regarding severe economic inadaptability, nothing in DC 8100 requires that the claimant be completely unable to work in order to qualify for a 50 percent rating. Pierce v. Principi, 18 Vet. App. 440, 445-46 (2004).

A June 2022 VA examination report included the Veteran's reports of 2 to 3 headaches per week, with no associated nausea, vomiting, sensitivity to light or sound, or other non-headache symptoms. The typical headaches lasted for less than 1 day. The Veteran had no characteristic prostrating attacks of migraine / non-migraine headache pain. The headaches impacted the Veteran's ability to work in that he was limited in activities that required focus and concentration during migraine episodes, such as using a computer or reading. Occasionally, the Veteran had to go home.

In a March 2023 statement, the Veteran reported headaches that worsened with light, noise, strong smells, nausea, and dizziness. The headaches prevented him from driving, operating heavy machinery, eating, or attending any function where there was food or noise. The Veteran's headaches prevented him from working or doing things around the house. The headaches were worsening and had increased in frequency.

The Veteran underwent a VA examination in April 2023. Current symptoms included pounding headaches behind the left eye that occurred 2 to 3 times per week. The headaches were associated with sinus congestion, photophobia, and nausea. With more severe headaches, the Veteran needed to be in a dark room for about 1 hour. The Veteran treated the headaches with ibuprofen and Tylenol as needed. Non-headache symptoms associated with the disability were nausea and sensitivity to light and sound. The typical headaches lasted for less than 1 day. The Veteran had no characteristic prostrating attacks of migraine / non-migraine headache pain. The headaches impacted the Veteran's ability to work as strenuous physical exercise exacerbated the Veteran's headaches.

In
2023. Current symptoms included pounding headaches behind the left eye that occurred 2 to 3 times per week. The headaches were associated with sinus congestion, photophobia, and nausea. With more severe headaches, the Veteran needed to be in a dark room for about 1 hour. The Veteran treated the headaches with ibuprofen and Tylenol as needed. Non-headache symptoms associated with the disability were nausea and sensitivity to light and sound. The typical headaches lasted for less than 1 day. The Veteran had no characteristic prostrating attacks of migraine / non-migraine headache pain. The headaches impacted the Veteran's ability to work as strenuous physical exercise exacerbated the Veteran's headaches.

In September 2022 and August 2023, the Veteran denied problems with headaches.

In light of the foregoing evidence, the Board concludes that a 10 percent rating under DC 8100 is warranted for the entire period on appeal. In that regard, the Veteran reported during his June 2022 VA examination that occasionally his headaches caused him to have to go home. The Board recognizes that the foregoing demonstrates unclear evidence of incapacitation, as even when leaving work the Veteran presumably drove himself home. Such an activity does not clearly demonstrate incapacitation. Read in context with the report during the April 2023 VA examination that with more severe headaches he needed to be in a dark room for about 1 hour, however, the Board will afford the Veteran the benefit of the doubt that his symptoms on occasion were incapacitating in nature.

As to granting a rating greater than 10 percent, the Board finds insufficient evidence of characteristic prostrating attacks occurring on an average once a month over last several months to warrant a rating greater than 10 percent. The VA examination reports of record concluded that the Veteran had no characteristic prostrating attacks. The Veteran reported during the June 2022 examination that he occasionally had to go home due to the migraines. The Board finds as a fact in this case that such reports do not support characteristic prostrating attacks occurring on an average once a month. In March 2023, the Veteran reported increased frequency and severity of headaches, but those reports and his statements do not indicate the frequency of the debilitating headaches. Given the foregoing and the absence of contemporaneous evidence supportive of characteristic prostrating attacks occurring on an average once a month over last several months as defined above, the Board does not find that the rating criteria for 30 percent under DC 8100 are met or approximated.

In conclusion, the Board finds that the evidence of record supports a 10 percent rating for the Veteran's headaches during the entire appellate time period, but does not support a rating greater than 30 percent for any period on appeal. For the reasons discussed above, the Board finds that a staged rating is not warranted. As the evidence of record persuasively weighs against further higher ratings, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7.

2. Entitlement to a disability rating in excess of 10 percent for dermatitis (claimed as skin condition, neck and arms)

The Veteran contends that he warrants a higher rating for his dermatitis disability because the current rating does not accurately reflect the severity of the disability.

The Veteran's service-connected folliculitis is evaluated under 38 C.F.R. § 4.118, DC 7806. Disabilities rated under DC 7806 are to be evaluated under the General Rating Formula for the Skin. A noncompensable rating is assigned when non more than topical therapy required over the past 12-month period and at least one of the following: characteristic lesions involving less than 5 percent of the entire body affected; or characteristic lesions involving less than 5 percent of exposed areas affected. A 10 percent rating is assigned when the record demonstrates at least one of the following: 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. A 30 percent rating is assigned when the record demonstrates at least one of the following: 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, bi
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. A 30 percent rating is assigned when the record demonstrates at least one of the following: 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. A 60 percent rating is assigned when the record demonstrates at least one of the following: 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, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period. See 38 C.F.R. § 4.118, DC 7806.

A disability under DC 7806 may also be rated as disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801, 7802, 7804, or 7805), depending on the predominant disability. See 38 C.F.R. § 4.118.

DC 7800 applies to burn scar(s) of the head, face, or neck; scar(s) of the head, face, or neck due to other causes; or other disfigurement of the head, face, or neck. A 10 percent disability rating is warranted with one characteristic of disfigurement, which are: scar 5 or more inches (13 or more centimeters (cm.)) in length; scar at least one-quarter inch (0.6 cm.) wife at widest part; surface contour of scar elevated or depressed on palpation; scar adherent to underlying tissue; skin hypo-or hyper-pigmented in an area exceeding six square inches (39 square (sq.) cm.); skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 sq. cm.); underlying soft tissue missing in an area exceeding six square inches (39 sq. cm.); or skin indurated and inflexible in an area exceeding six square inches (39 sq. cm.).

DC 7801 applies to burn scar(s) or other scar(s) due to other causes, not of the head, face or neck, that are associated with underlying soft tissue damage. A 10 percent disability rating is warranted if the area or areas covered is at least 6 square inches (39 sq. cm.), but less than 12 square inches (77 sq. cm.). A 20 percent disability rating is warranted if the area or areas covered is at least 12 square inches (77 sq. cm.), but less than 72 square inches (465 sq. cm.). A 30 percent disability rating is warranted if the area or areas covered is at least 72 square inches (465 sq. cm.) but less than 144 square inches (929 sq. cm.). A 40 percent disability rating is warranted if the area or areas covered is at least 144 square inches (929 sq. cm.) or greater.

DC 7802 applies to burns scar(s) or scar(s) due to other causes, not of the head, face or neck, that are not associated with underlying soft tissue damage. A 10 percent disability rating is warranted if the area or areas covered is at least 144 square inches (929 sq. cm) or greater.

DC 7804 applies to unstable or painful scars. A 10 percent disability rating is warranted if there are one or two scars that are unstable or painful. A 20 percent disability rating is warranted if there are three or four scars that are unstable or painful. A 30 percent disability rating is warranted if there are five or more scars that are unstable or painful.

DC 7805 applies to other scars and other effects of scars evaluated under DCs 7800, 7801, 7802, or 7804, which notes that any disabling effect(s) not considered in a rating provided under DCs 7800-04 under an appropriate
least 144 square inches (929 sq. cm) or greater.

Under the General Rating Formula for the Skin, "systemic therapy" is defined as "treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin," and "topical therapy" is defined as "treatment that is administered through the skin." See 38 C.F.R. § 4.118(a).

During an October 2021 VA skin examination, the Veteran reported a dark, circular, scaly, and flat skin lesion on the nape of the neck. He also had a dark, circular, and flat skin lesion on the left upper arm on the inner medial area. In addition, the Veteran had a dark, circular, and raised skin at the midline area of the back of the neck. Finally, the Veteran had a dark, circular, and flat skin lesion to the right of the midline on the scalp. The Veteran treated the symptoms with a urea hydrating cream and Gold Bond cream. The Veteran had no other treatment for the skin in the past 12 months. The dermatitis covered 5 percent to less than 20 percent of the total body and exposed body.

A June 2022 VA skin examination report noted problems on the inside left upper arm and the base of the neck that involved discolored, itchy, and painful skin. The skin problems were treated with topical corticosteroid cream mixed with urea cream and applied as needed. The dermatitis affected less than 5 percent of the total body area and no exposed areas. On examination, the Veteran had 2 dark pruritic macular lesions on the left inner bicep (2cm by 2cm) and the top of the back of the base of the neck measuring 1.5cm by 3cm.

The Veteran was afforded a VA skin examination in April 2023. The examiner noted a diagnosis of contact dermatitis since 1995. Current symptoms included scaly papules and patches on the posterior neck, arms, back, and chest that would come and go. Areas were pruritic when present and would become lichenified and hyperpigmented. The Veteran treated the symptoms with topical creams. The Veteran's skin disability had been treated in the last 12 months with corticosteroids or other immunosuppressive medications, specifically Triamcinolone ointment. The treatment was topical and had been for 6 weeks or more, but not constant. On examination, the dermatitis involved no exposed area on the body and between 5 percent and less than 20 percent of the total body area.

In September 2022 and August 2023, the Veteran's skin examination was negative for rashes, sores, pruritus, or edema.

Based on the evidence of record, the Board finds as a fact in this case that the evidence is persuasively against assigning a rating greater than 10 percent under DC 7806 for any period on appeal. A 30 percent rating or higher would require at least one of the following: 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. The April 2023 VA examination report documented the use of topical corticosteroids for 6 weeks or more, but not constant. As discussed above, however, "systemic therapy" is defined as "treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin," and "topical therapy" is defined as "treatment that is administered through the skin.". As such, while the Veteran had treatment for 6 weeks or more, but not constantly over
ologics, 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. The April 2023 VA examination report documented the use of topical corticosteroids for 6 weeks or more, but not constant. As discussed above, however, "systemic therapy" is defined as "treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin," and "topical therapy" is defined as "treatment that is administered through the skin.". As such, while the Veteran had treatment for 6 weeks or more, but not constantly over the past 12 months, because the treatment was topical treatment through the skin that does not constitute systemic therapy. The Veteran does not otherwise meet the criteria for a rating greater than 10 percent under DC 7806.

The Board has considered whether the application of any other DCs would provide for a higher disability rating. However, the evidence does not reflect that a higher rating is warranted under any other DC, as the evidence does not demonstrate that the Veteran's disability was manifested by scars involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected or other characteristics of disfigurements.

In conclusion, the Board finds as a fact in this case that the evidence of record persuasively weighs against assigning a rating in excess of 10 percent for the dermatitis for any period on appeal. As the evidence of record persuasively weighs against a higher rating, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7.

MICHAEL LANE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board C. J. Houbeck, 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.

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