CYSTS OF SKIN

W. DAKNIS · 2026 · Case ID: 26004217

MIXED

Summary

The Veteran served in the United States Army from June 1968 to March 1971. The Veteran appeals the denial of service connection for a pilonidal cyst and venereal warts, and seeks increased ratings for hemorrhoids and impairment of sphincter control. The Board denied service connection for the pilonidal cyst and venereal warts, finding no current disability for these conditions, despite evidence of in-service treatment for the cysts and STIs. The Veteran's hemorrhoid claim was granted a 20 percent rating for the period prior to December 8, 2025, and continued at 20 percent thereafter, based on persistent bleeding and frequent recurrences, approximating the criteria for the maximum rating. For impairment of sphincter control, the Board granted a 100 percent rating effective December 8, 2025, under the amended criteria, finding the Veteran experienced incontinence two or more times per day requiring pad changes, which was more favorable than the prior rating. The case was remanded for Hailey-Hailey disease due to an inadequate VA medical opinion that failed to fully address aggravation by conceded herbicide exposure and the potential link between in-service pilonidal cysts and the current condition.

Rationale

No current disability found; In-service treatment noted but condition resolved

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

20-16 020

Full Decision Text

Citation Nr: 26004217
Decision Date: 04/06/26 Archive Date: 04/06/26

DOCKET NO. 20-16 020
DATE: April 6, 2026

ORDER

Entitlement to service connection for a pilonidal cyst is denied.

Entitlement to service connection for venereal warts is denied.

Entitlement to a rating of 20 percent for hemorrhoids for the period prior to December 8, 2025, is granted.

Entitlement to a rating in excess of 20 percent for hemorrhoids for the period from December 8, 2025, is denied.

Entitlement to a rating in excess of 10 percent for impairment of sphincter control for the period prior to May 19, 2024, is denied.

Entitlement to a 100 percent rating for impairment of sphincter control for the period from May 19, 2024, to December 7, 2025, is granted.

REMANDED

Entitlement to service connection for Hailey-Hailey disease is remanded.

FINDINGS OF FACT

1. The Veteran does not currently suffer from a pilonidal cyst condition.

2. The Veteran does not currently suffer from venereal warts.

3. For the period prior to December 8, 2025, the Veteran's hemorrhoids are characterized as external with very frequent and persistent bleeding.

4. For the period from December 8, 2025, the Veteran's hemorrhoids are characterized as external with persistent bleeding.

5. For the period prior to May 19, 2024, the Veteran's impairment of sphincter control was characterized as involving constant, slight leakage.

6. For the period from May 19, 2024, to December 7, 2025, the Veteran's impairment of sphincter control involved incontinence two or more times per day, which required changing a pad two or more times per day.

CONCLUSIONS OF LAW

1. The criteria for service connection for a pilonidal cyst are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for venereal warts are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for a rating of 20 percent for hemorrhoids for the period prior to December 8, 2025, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.7, 4.114, Diagnostic Code (DC) 7336.

4. The criteria for a rating in excess of 20 percent for hemorrhoids for the period from December 8, 2025, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.7, 4.114, DC 7336.

5. The criteria for a rating in excess of 10 percent for impairment of sphincter control for the period prior to May 19, 2024, are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.7, 4.114, DC 7332.

6. The criteria for a 100 percent for impairment of sphincter control for the period from May 19, 2024, to December 7, 2025, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.7, 4.114, DC 7332.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from June 1968 to March 1971. These matters return to the Board of Veterans' Appeals (Board) most recently after an October 2025 remand.

The Board's remand directed the Agency of Original Jurisdiction (AOJ) to provide the Veteran with VA examinations for each of these disabilities on appeal. Following those examinations, in a January 2026 rating decision, the rating for the Veteran's hemorrhoids was increased to 20 percent effective December 8, 2025; and his rating for impairment of sphincter control was increased to 100 percent effective December 8, 2025. Service connection for squamous cell carcinoma was granted. These matters (with the exception of
in the United States Army from June 1968 to March 1971. These matters return to the Board of Veterans' Appeals (Board) most recently after an October 2025 remand.

The Board's remand directed the Agency of Original Jurisdiction (AOJ) to provide the Veteran with VA examinations for each of these disabilities on appeal. Following those examinations, in a January 2026 rating decision, the rating for the Veteran's hemorrhoids was increased to 20 percent effective December 8, 2025; and his rating for impairment of sphincter control was increased to 100 percent effective December 8, 2025. Service connection for squamous cell carcinoma was granted. These matters (with the exception of service connection for squamous cell carcinoma granted on appeal) now return to the Board.

Service Connection

Service connection is warranted if the evidence demonstrates that a current disability resulted from an injury or disease that was incurred or aggravated during active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). In general, service connection requires: (1) evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of an in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). When a disability is initially diagnosed after separation from service and not within any applicable presumptive period, service connection may be granted if all the evidence establishes that it was incurred in or related to service. 38 C.F.R. § 3.303(d).

In rendering a decision on appeal, the Board must analyze the credibility and probative value of all medical and lay evidence of record, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the veteran. 38 U.S.C. § 1154(a); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Board must resolve reasonable doubt in favor of the veteran. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. 49. To deny a claim on its merits, the evidence must weigh persuasively against the claim. Lynch v. McDonough, 21 F.4th 776, 781-82 (2021).

Entitlement to service connection for a pilonidal cyst

Entitlement to service connection for venereal warts

The Veteran asserts that he suffers from a pilonidal cyst and venereal warts that are related to service. The Veteran reported that he was treated for genital warts and other sexually spread infections while serving on active duty and that he "had a lot of skin issues with cysts." The evidence fails to show that the Veteran currently suffers from these conditions.

At his December 2025 VA examination for the skin, the examiner found no evidence of current pilonidal cysts or any other cysts on the body, nor did he identify any venereal warts. He recognized that there is evidence of treatment for recurrent pilonidal cysts during service and after; however, the condition appears to have "resolved." The examiner took note of evidence that the Veteran was treated during service for sexually transmitted infections; but there was no evidence that the Veteran currently suffered from any related disease.

The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 104 F.3d 1328, 1333 (1997). Indeed, in the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3?Vet. App.?223, 225 (1992); see also Rabideau v. Derwinski, 2?Vet. App.?141, 143-44 (1992); McClain v. Nicholson, 21?Vet. App.?319 (2007) (recognizing that a disability could arise at any time during a claim).

As the evidence fails to show that the Veteran currently suffers from a pilonidal cyst or venereal warts, there are no disabilities for which service connection can be granted, and the Board must deny the Veteran's claims.

The Board notes that if the Veteran's pilonidal cyst returns
valid claim. Brammer v. Derwinski, 3?Vet. App.?223, 225 (1992); see also Rabideau v. Derwinski, 2?Vet. App.?141, 143-44 (1992); McClain v. Nicholson, 21?Vet. App.?319 (2007) (recognizing that a disability could arise at any time during a claim).

The Board notes that if the Veteran's pilonidal cyst returns, he is welcome to apply for service connection once again.

Increased Ratings

Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10.

In evaluating a disability, the Board considers current examination reports in light of the entire record to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. §§ 4.1, 4.2, 4.10.

When there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Reasonable doubt regarding the degree of disability will be resolved in the veteran's favor. 38 C.F.R. § 4.3.

Relevant here, while this appeal was pending, VA amended the rating criteria for the digestive system effective May 19, 2024. See Schedule for Rating Disabilities: The Digestive System, 89 Fed. Reg. 19,735 (March 20, 2024) (codified at 38 C.F.R. § 4.114). That means the Board must consider the Veteran's claim under both the old and new rating criteria for the period from May 19, 2024, and apply the criteria more favorable to the Veteran. 38 U.S.C. § 5110(g); Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003).

Entitlement to a rating in excess of 10 percent for hemorrhoids for the period prior to December 8, 2025, and to a rating in excess of 20 percent for the period thereafter

The Veteran filed a formal claim for an increased rating for his hemorrhoids on August 1, 2018; and in the January 2019 rating decision that followed, his 10 percent rating was continued. At that time, he was also granted service connection for impairment of sphincter control with a 10 percent rating.

In February 2019, the Veteran filed a Notice of Disagreement; and in December 2023, the Board remanded these matters for a new VA examination. These matters were remanded again in October 2024 because the Veteran failed to attend his scheduled examination, and the Board provided him with an additional opportunity to do so. The Veteran attended his examination in December 2025. The period on appeal for both the Veteran's hemorrhoids and impairment of sphincter control is, therefore, from August 1, 2018.

The Veteran's hemorrhoids are rated at 10 percent for the period prior to December 8, 2025, the date of his VA examination that was conducted on remand. They are rated at 20 percent for the period thereafter. Both periods on appeal are rated under DC 7336 that governs internal and external hemorrhoids.

Under the criteria in effect prior to May 19, 2024, DC 7336 provides a noncompensable rating for mild or moderate external or internal hemorrhoids. A 10 percent rating is warranted for large or thrombotic, irreducible internal or external hemorrhoids with excessive redundant tissue evidencing frequent recurrences. A maximum 20 percent rating is warranted for internal or external hemorrhoids with persistent bleeding and with secondary anemia or with fissures.

Post-amendment, DC 7336 provides a 10 percent rating for prolapsed internal hemorrhoids with two or less episodes per year of thromb
percent for the period thereafter. Both periods on appeal are rated under DC 7336 that governs internal and external hemorrhoids.

Post-amendment, DC 7336 provides a 10 percent rating for prolapsed internal hemorrhoids with two or less episodes per year of thrombosis; or for external hemorrhoids with three or more episodes per year of thrombosis. A maximum 20 percent rating is warranted for internal or external hemorrhoids with persistent bleeding and anemia; or continuously prolapsed internal hemorrhoids with three or more episodes per year of thrombosis.

At his December 2018 VA examination, the examiner noted that the Veteran's hemorrhoids continue to bleed intermittently or occasionally. The examiner identified the Veteran's condition as "moderate external hemorrhoids at 5 and 7 o'clock" with persistent bleeding. No functional impact was noted.

An April 2020 medical opinion indicates that the Veteran's hemorrhoid condition may have been worse than the December 2018 VA examination suggested. The opinion remarks that the Veteran's condition "made his work as a truck driver tortuous [sic.] with the blisters and infections caused by the hemorrhoids breaking." The Veteran's daily life was deeply affected, "since any perspiration or activity as simple as walking aggravate[d] the condition." The opinion noted also that the Veteran was often embarrassed by the smell from discharge and this caused him to isolate himself from other people.

At his December 2025 VA examination, the Veteran reported pain with sitting and bowel movements, and bleeding as well as anal leakage which required him to change incontinence pads. The examiner identified external hemorrhoids with persistent bleeding, but no anorectal or perianal fistula, and no rectal or anal stricture. Functional impact included the inability to sit for prolonged periods of time due to intermittent pain.

Based on the foregoing, the Board finds that for the period prior to December 8, 2025, a 20 percent rating is appropriate under the old criteria because the Veteran's hemorrhoids involved "frequent recurrences" while "persistent bleeding" is specifically noted. The examiner in April 2020 identified "blisters and infections caused by hemorrhoids breaking." This, taken with the examiner's statement that perspiration or even walking can aggravate the Veteran's hemorrhoids speaks to the prevalence of the Veteran's persistent bleeding. Indeed, the Veteran's report in December 2025 that he frequently must change incontinence pads due to anal leakage speaks to the severity of this condition.

Although anemia is noted as a requirement for this rating, the Board finds that the Veteran's condition nevertheless most closely approximates a 20 percent rating because the 10 percent rating accounts for only excessive redundant tissue evidencing frequent occurrences, which represents a significantly less severe condition than the Veteran's actual condition. Indeed, the most prevalent symptom of the Veteran's hemorrhoid condition is his persistent bleeding that significantly affects his daily life. As this symptom is only accounted for under the 20 percent rating, the Board finds that a 20 percent rating is most appropriate.

As for the period from December 8, 2025, a 20 percent rating continues to be appropriate for the same reasons explained above.

For both periods on appeal, a higher rating is not warranted because the 20 percent rating that is assigned is the maximum rating available.

Entitlement to a rating in excess of 10 percent for impairment of sphincter control

The Veteran was service-connected for impairment of sphincter control in a January 2019 rating decision and assigned a 10 percent rating effective August 1, 2018. As noted above, he has continuously pursued a higher rating since then. The Veteran was granted a 100 percent rating effective December 8, 2025, the date of his most recent VA examination. This is the highest rating available, and the Board will not disturb this rating. The period on appeal, therefore, is from August 1, 2018, to December 7, 2025.

The Veteran's impairment of sphincter control is rated at 10 percent under DC 7332 which governs impairment of sphincter control of the rectum and anus.

Prior to May 19, 2024, DC 7332 provided a noncompensable rating for a healed or slight condition without leakage. A 10 percent rating was provided for constant slight leakage or occasional
The Veteran was granted a 100 percent rating effective December 8, 2025, the date of his most recent VA examination. This is the highest rating available, and the Board will not disturb this rating. The period on appeal, therefore, is from August 1, 2018, to December 7, 2025.

The Veteran's impairment of sphincter control is rated at 10 percent under DC 7332 which governs impairment of sphincter control of the rectum and anus.

Prior to May 19, 2024, DC 7332 provided a noncompensable rating for a healed or slight condition without leakage. A 10 percent rating was provided for constant slight leakage or occasional moderate leakage. A 30 percent rating was provided for occasional involuntary bowel movements necessitating the wearing of a pad. A 60 percent rating was provided for extensive leakage and fairly frequent involuntary bowel movements. Finally, a 100 percent rating was provided for complete loss of sphincter control.

The amended diagnostic code provides a noncompensable rating for a history of loss of sphincter control that is currently asymptomatic. A 10 percent rating is available for complete or partial loss of sphincter control characterized by incontinence or retention that is fully responsive to a physician-prescribed bowel program and requires medication or special diet, or for incontinence to solids and/or liquids at least once every six months, which requires wearing a pad at least once every six months.

A 30 percent rating is available for complete or partial loss of sphincter control characterized by incontinence or retention that is fully responsive to a physician-prescribed bowel program and requires digital stimulation, medication (beyond laxative use), and special diet, or for incontinence to solids and/or liquids two or more times per month, which requires wearing a pad two or more times per month.

A 60 percent rating is available for complete or partial loss of sphincter control characterized by incontinence or retention that is partially responsive to a physician-prescribed bowel program and requires either surgery or digital stimulation, medication (beyond laxative use), and special diet; or incontinence to solids and/or liquids two or more times per week, which requires wearing a pad two or more times per week.

Finally, a 100 percent rating is available for complete loss of sphincter control characterized by incontinence or retention that is not responsive to a physician-prescribed bowel program and requires either surgery or digital stimulation, medication (beyond laxative use), and special diet; or incontinence to solids and/or liquids two or more times per day, which requires changing a pad two or more times per day.

At the December 2018 VA examination, the examiner noted that the Veteran developed chronic bowel incontinence with daily leakage. The examiner characterized the Veteran's condition as "slight constant leakage with normal rectal sphincter tone." No functional impact was noted, and the Veteran was not noted to take any medication for this condition. The examiner stated, "the Veteran now has bowel incontinence with daily leakage of small amounts of fluid discharge."

As explained above, however, the April 2020 medical opinion indicates that the Veteran's condition was worse than the December 2018 VA examination suggested. Specifically, the Veteran was often embarrassed by the smell of discharge due to his condition, and it caused him to isolate from other people. He felt "deep shame and embarrassment" due to smelling so much.

At his December 2025 VA examination, the Veteran reported leakage of stool and blood. He did not report taking prescribed medications for his condition. The examiner noted "partial loss of sphincter control" and incontinence to solids and/or liquids two or more times per day, requiring changing a pad two or more times per day. The Veteran did not have a physician-prescribed bowel program, special diet, or rectal prolapse. The examiner remarked that the Veteran required "frequent breaks" for changing his incontinent materials for which he requires assistance.

Based on the foregoing, the Board finds that for the period prior to May 19, 2024, under the old criteria, a 10 percent rating continues to be appropriate because the Veteran's condition was noted as involving "constant slight leakage" which is specifically accounted for in the 10 percent rating criteria. A 30 percent rating is not appropriate because this requires occasional involuntary bowel movements which are not at all noted in the 2018 VA examination or in the April 2020 medical opinion.

As for the period from May 19, 2024, to December 7, 2025, the Board finds that the amended criteria are more favorable to the Veteran and, resolving all doubt in the Veteran's favor, a 100 percent rating is warranted. Indeed, a 100 percent rating accounts for the Veteran's loss
2024, under the old criteria, a 10 percent rating continues to be appropriate because the Veteran's condition was noted as involving "constant slight leakage" which is specifically accounted for in the 10 percent rating criteria. A 30 percent rating is not appropriate because this requires occasional involuntary bowel movements which are not at all noted in the 2018 VA examination or in the April 2020 medical opinion.

In concluding so, the Board recognizes that the Veteran is not specifically noted to have "complete" loss of sphincter control in his most recent VA examination, as required by a 100 percent rating. However, the examination report is clear that the Veteran is incontinent "two or more times per day, which requires changing a pad two or more times per day." Thus, even though the examiner happened to select "partial" loss of sphincter control, the effect of the Veteran's disability is, in fact, the most severe level of incontinence noted on the VA examination.

Although this level of incontinence was not made specifically apparent until the Veteran's December 2025 VA examination, the Board finds that, in light of the substantial progression of the Veteran's condition from his 2018 VA examination to the April 2020 medial opinion, and then the Veteran's significant decline to incontinence by December 2025, it is more than likely that the Veteran's incontinence developed to a severe degree by May 2024 when the amended criteria became available to the Veteran.

In sum, the Board finds that for the period prior to May 19, 2024, a 10 percent rating continues to be appropriate for the Veteran's condition. However, for the period thereafter, resolving all doubt in the Veteran's favor, a 100 percent rating is warranted.

REASONS FOR REMAND

Entitlement to service connection for Hailey-Hailey Disease

Although the Board sincerely regrets the additional delay, this matter must be remanded to correct a pre-decisional duty-to-assist error. Specifically, an addendum medical opinion is required.

At a December 2025 VA examination, the Veteran's Hailey-Hailey disease diagnosis was confirmed. The examiner noted scattered scabbed erythematic lesions on the full posterior back and truck, as well as the full anterior chest and abdomen.

Unfortunately, the examiner determined that this condition is not related to the Veteran's service. He took note of the Veteran's pilonidal cysts during service and consulted medical literature to determine whether this could have been indicative of undiagnosed Hailey-Hailey disease. To the contrary, the examiner discovered that Hailey-Hailey disease is a genetic acantholytic disorder and not a cyst-forming disease. It results from ATP2C1 mutations causing defective keratinocyte adhesion and recurrent erosive plaques in intertriginous areas. The pathology is epidermal acantholysis, and not follicular occlusion or sinus-tract formation. Pilonidal disease, conversely, is a follicular occlusion problem and pilonidal cysts arise from hair penetration, friction, and inflammation in the natal cleft. Medical literature does not indicate that pilonidal cysts, inclusion cysts and other deep cysts are related, caused, or presented as deep cysts but rather superficial lesions. Accordingly, the examiner opined that pilonidal cysts the Veteran experienced in service are unrelated to his current Hailey-Hailey disease and there is no other indication that Hailey-Hailey disease is related to service. Rather, the examiner concluded that Hailey-Hailey disease is more likely an inherited skin condition.

The examiner also considered whether the Veteran's Hailey-Hailey disease was caused by the Veteran's confirmed herbicide agent exposure during service. Indeed, the record contains a Toxic Exposure Risk Activity Memorandum confirming that the Veteran was exposed to herbicide agents while stationed in Okinawa, Japan.

The examiner explained that while the literature shows clear associations of dioxin-like exposures with chloracne and, at times, porphyria cutanea tarda, it does not indicate an association with the Veteran's condition. The examiner explained, as noted above, that Hailey-Hailey disease is primarily a genetic genodermatosis (hereditary skin disease). It is classically caused by pathogenic variants in the
inherited skin condition.

However, in concluding so, examiner remarked that "while environmental triggers can aggravate flares, the root etiology is genetic rather than toxicant-driven in the literature." Indeed, he appears to concede that exposure to herbicide agents can worsen Hailey-Hailey disease, yet he did not discuss whether it more likely than not did so in the Veteran's case.

In this regard, the Board takes note of a March 2020 letter from one of the Veteran's healthcare providers surmising that the Veteran's skin irritation noted in service was "downplayed" as "jock itch" by his then-treatment provider and was later "correctly identified as Hailey-Hailey Disease." Indeed, the December 2025 VA examiner discounted the presence of jock itch during service as a single episode and not indicative of a chronic condition. However, he based this only on an absence of records without any further explanation.

The examiner's failure to address whether the Veteran's Hailey-Hailey disease was aggravated by his active-duty service renders his medical opinion inadequate to decide the claim and a remand is warranted to correct it.

The matter is REMANDED for the following action:

Obtain an addendum opinion from an appropriate clinician regarding the Veteran's Hailey-Hailey disease.

The clinician is asked to address the contention that the Veteran's jock itch in service was a sign or symptom of Hailey-Hailey disease. The clinician is reminded that the opinion cannot rely solely on an absence of records in forming the opinion.

Further, the clinician is asked to opine as to whether the Veteran's disease was aggravated by the Veteran's conceded exposure to herbicide agents.

A thorough rational must be provided for each opinion.

W. Daknis

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Freda J. F. Smith, 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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