Case A25111101

WENDY DAKNIS · 2025 · Case ID: A25111101

MIXED

Summary

The Veteran, who served in the U.S. Air Force from May 2017 to May 2020, appeals decisions denying service connection for multiple conditions and seeking remand for others. The Veteran's claims include left wrist condition (dismissed), bilateral flat foot (pes planus), hearing loss, neck strain secondary to low back condition, dermatitis due to environmental exposures, migraines due to environmental exposures, low fertility due to environmental exposures, left knee condition, right knee condition, low back condition secondary to left knee condition, sleep apnea, and fatigue secondary to sleep apnea. The Board dismissed the left wrist claim due to procedural issues and denied the claims for bilateral flat foot, hearing loss, neck strain, and dermatitis, finding the criteria for service connection or a compensable rating were not met. The Board remanded claims for PTSD, sinusitis, migraines, low fertility, left knee, right knee, low back, sleep apnea, and fatigue. For PTSD, the Board found a duty to assist error in not providing a VA examination, noting the Veteran's claim of panic attacks and anxiety in service following a sexual assault accusation, which was corroborated by personnel records. A remand was ordered for an opinion on the etiology of PTSD. For sinusitis, the Board noted STRs reflecting sinus pain but found the VA examiner's negative nexus opinion insufficient, as it incorrectly linked the claim to toxic exposures when the Veteran claimed environmental exposures. The Board remanded sinusitis, migraines, low fertility, knee conditions, low back condition, sleep apnea, and fatigue for further development and opinions.

Rationale

Criteria for dismissal met under 38 U.S.C. § 7105 and 38 C.F.R. § 20.104.; Veteran filed for Higher-Level Review of a prior denial, then filed a Board appeal.; VA erroneously accepted the Board appeal as to the left wrist condition.

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250406-535131

Full Decision Text

Citation Nr: A25111101
Decision Date: 12/30/25 Archive Date: 12/30/25

DOCKET NO. 250406-535131
DATE: December 30, 2025

ORDER

Entitlement to service connection for a left wrist condition left is dismissed.

An initial compensable rating for bilateral flat foot (pes planus) is denied.

Service connection for hearing loss is denied.

Service connection for neck strain, to include as secondary to a low back condition, is denied.

Service connection for dermatitis, (skin condition) as due to environmental exposures, is denied.

REMANDED

Entitlement to service connection for posttraumatic stress disorder and memory loss (PTSD) is remanded.

Entitlement to service connection for sinusitis, to include as due to environmental exposures, is remanded.

Entitlement to service connection for migraines, as due to environmental exposures, is remanded.

Entitlement to service connection for low fertility, as due to environmental exposures, is remanded.

Entitlement to service connection for a left knee condition is remanded.

Entitlement to service connection for a right knee condition is remanded.

Entitlement to service connection for a low back condition, to include as secondary to a left knee condition, is remanded.

Entitlement to service connection for sleep apnea is remanded.

Entitlement to service connection for fatigue, to include as secondary to sleep apnea, is remanded.

FINDINGS OF FACT

1. A July 12, 2024 request for a Higher-Level Review of the July 2024 rating decision which denied entitlement to service connection for a left wrist condition remained pending when the Veteran filed a Board appeal of the July 2024 rating decision, which constitutes concurrent election.

2. The Veteran's bilateral pes planus does not manifest as moderate bilateral or unilateral flatfoot, with weight-bearing line over or medial to great toe, inward bowing of the tendo Achillis, and pain on manipulation and use of the feet.

3. At no time during the pendency of the claim does the Veteran have a current disability of bilateral hearing loss as defined by VA regulations, and the record does not contain a recent diagnosis of such disability prior to the Veteran's filing of a claim.

4. At no time during the pendency of the claim does the Veteran have a current disability of a neck condition, and the record does not contain a recent diagnosis of disability prior to the Veteran's filing of a claim.

5. At no time during the pendency of the claim does the Veteran have a current disability of dermatitis, and the record does not contain a recent diagnosis of disability prior to the Veteran's filing of a claim.

CONCLUSIONS OF LAW

1. The criteria for dismissal of service connection for a left wrist condition have been met. 38 U.S.C. § 7104; 38 C.F.R. § 3.2500 (b).

2. The criteria for a compensable rating for bilateral pes planus have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.7, 4.71a, 4.73, Diagnostic Code (DC) 5276.

3. The criteria for service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385.

4. The criteria for entitlement to service connection for a neck condition have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for entitlement to service connection for dermatitis have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Air Force from May 2017 to May 2020. This matter comes before the Board of Veterans' Appeals (Board) on appeal from July 2024 and October 2024 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). In April 2025, the Veteran submitted a Decision Review Request: Board Appeal (Notice of Disagreement) (VA Form 10182) under the Veterans Appeals Improvement and Modernization Act, Pub. L. No. 115-55, also known as the Appeals Modernization Act (AMA). In such election, the Veteran requested Direct Review of the evidence considered by the Agency of Original Jurisdiction (AOJ). Consequently, the Board's review is limited to the evidence of record at the time of the issuance of the rating decisions issued on July 11, 2024 (all claims but low fertility) and October 17, 2024 (low fertility claim). 38 C.F.R. § 20.301.

The Board notes that evidence was added to the claims file during a period of time when new evidence was not allowed and may not be considered in this decision. 38 C.F.R. § 20.300. However, as the Board is remanding the claims of entitlement to service connection for PTSD, sinusitis, migraines, low fertility, left knee, right knee, and low back conditions, sleep apnea, and fatigue, this additional evidence will be considered by the RO in the adjudication of those claims.

Dismissal of Claim

1. Entitlement to service connection for a left wrist condition.

Under 38 U.S.C. § 7105, the Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. See e.g., 38 C.F.R. § 20.104. In essence, a "case or controversy" involving a pending adverse determination to which the appellant has taken exception no longer exists. See Shoen v. Brown, 6 Vet. App. 456, 457 (1994).

In the instant case, on July 12, 2024, within one year of the rating decision, the Veteran filed a VA Form 20-0996 requesting Higher-Level Review of the July 2024 rating decision which, as relevant, denied service connection for a left wrist condition. In a rating decision issued November 26, 2024, the AOJ identified a duty to assist error and referred the claim for further development.

Thereafter, in April 2025, VA received the Veteran's VA Form 10182 disagreeing with the denial of service connection in the July 2024 rating decision. In response, VA sent a letter erroneously accepting the VA Form 10182 as to the issue of entitlement to service connection for a left wrist condition and placed his appeal on the Direct Review Docket.

In this regard, under the AMA, a claimant who has filed for review under one of the options available under paragraph (a) of §3.2500 may not, while that review is pending final adjudication, choose another lane of review with respect to the same claim or same issue contained within the claim until the higher-level review, supplemental claim, or notice of disagreement is adjudicated; or the request for higher-level review, supplemental claim, or notice of disagreement is withdrawn. 38 C.F.R. § 3.2500 (b).

Consequently, as a Higher-Level Review was pending at the time VA received the Veteran's April 2025 VA Form 10182, and the Veteran did not withdraw his Higher-Level Review request as to the issue of entitlement to service connection for a left wrist condition, his Board appeal constitutes a concurrent election and must be dismissed as a matter of law. 38 C.F.R. § 3.2500 (b). Accordingly, the appeal is prohibited due to the rule against concurrent election and is dismissed.

Increased Rating Claim

2. Entitlement to an initial compensable rating for bilateral pes planus.

Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7.

Separate ratings can be assigned for separate periods based on the facts found - a practice known as "staged" ratings. Fenderson, supra; Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id.

The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10.

Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011), the Court held that, although pain may cause a functional loss, "pain itself does not rise to the level of functional loss as contemplated by VA regulations applicable to the musculoskeletal system." Rather, pain may result in functional loss, but only if it limits the ability "to perform the normal working movements of the body with normal excursion, strength, speed, coordination, or endurance." Id., quoting 38 C.F.R. § 4.40.

With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995).

The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint, even in the absence of arthritis. 38 C.F.R. § 4.59; Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). In this regard, 38 C.F.R. § 4.59 requires that "[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint." Correia v. McDonald, 28 Vet. App. 158 (2016). Further, 38 C.F.R. § 4.59 is applicable to the evaluation of musculoskeletal disabilities involving actually painful, unstable or malaligned joints or periarticular regions, regardless of whether the Diagnostic Code under which the disability is evaluated is predicated on range of motion measurements. Southall-Norman v. McDonald, 28 Vet. App. 346 (2016).

For the review period stemming from October 24, 2023, the date of service connection, the Veteran's bilateral pes planus has been evaluated as noncompensably disabling pursuant to DC 5276. In this regard, under DC 5276, a noncompensable rating is assigned for mild flatfoot with symptoms relieved by built-up shoe or arch support. A 10 percent rating is warranted where there is moderate bilateral or unilateral flatfoot, with weight-bearing line over or medial to great toe, inward bowing of the tendo achillis, and pain on manipulation and use of the feet. A 30 percent rating is assigned for severe bilateral flatfoot with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, and characteristic callosities. For pronounced bilateral flatfoot with marked pronation, extreme tenderness of plantar surfaces of the feet, and marked inward displacement and severe spasm of the tendo achillis on manipulation, not improved by orthopedic shoes or appliance, a 50 percent rating is assigned. 38 C.F.R. § 4.71a, DC 5276.

When terms such as "mild," "moderate," and "severe" are not defined by the rating schedule; rather than applying a mechanical formula, VA must evaluate all the evidence to the end that its decisions are "equitable and just." 38 C.F.R. § 4.6. According to Merriam Webster's Collegiate Dictionary 999 (11th Ed. 2007), "mild" means not very severe. "Moderate" means limited in scope or effect, also defined as tending toward the mean or average. "Severe" means very painful or harmful or of a great degree. The Board also notes that the criteria under DC 5276 are conjunctive, and therefore, all of the listed requirements included in the criteria must be met in order for the respective rating to be assigned. See Melson v. Derwinski, 1 Vet. App. 334 (1991).

Turning to the evidence of record, on VA examination in February 2024, the Veteran did not have pain on use of both feet, pain on manipulation of the feet, or swelling on use. He had no characteristic calluses or extreme tenderness of plantar surface of either foot. While the Veteran had decreased longitudinal arch height on weight-bearing of both feet, he did not have objective evidence of marked deformity of either foot or marked pronation of either foot, nor did the weight-bearing line of either foot fall over or medial to the great toe. He did not have inward bowing of the Achilles' tendon on either foot or marked inward displacement and severe spasms of the Achilles' tendon.

VA treatment records within the evidence window did not contain any reference to the Veteran's bilateral pes planus.

Upon review, the Board finds that VA examination and VA treatments records show that the Veteran is not entitled to an initial compensable rating under DC 5276. Specifically, the Veteran exhibited no symptoms, to include pain, and the VA examiner found he had no functional impairment as a result of his bilateral pes planus. Therefore, entitlement to an initial compensable rating for bilateral pes planus is denied. See 38 C.F.R. § 4.71a. The Board has also considered whether rating of the Veteran's disability under any alternative DC would provide a basis for higher rating. 38 C.F.R. § 4.71a, DC 5269, 5276-5284. The Veteran has not been diagnosed with plantar fasciitis, weak foot, claw foot, metatarsalgia, hallux valgus, hallux rigidus, hammer toe, or malunion of the tarsal or metatarsal bones. Therefore, DCs 5269, 5277, 5278, 5279, 5280, 5281, 5282, and 5283 are not applicable.

Service Connection Claims

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service
us, hallux rigidus, hammer toe, or malunion of the tarsal or metatarsal bones. Therefore, DCs 5269, 5277, 5278, 5279, 5280, 5281, 5282, and 5283 are not applicable.

Service Connection Claims

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Service connection may also be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996).

Where a veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases, such as organic diseases of the nervous system, to include arthritis and hearing loss, to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. In an October 4, 1995, opinion, VA's Under Secretary for Health determined that high frequency sensorineural hearing loss is considered an organic disease of the nervous system and therefore a presumptive disability. Alternatively, when a disease at 38 C.F.R. § 3.309 (a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. 38 C.F.R. § 3.303 (b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. § 3.309 (a) and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Pertinent to a claim for service connection, such a determination requires a finding of a current disability that is related to an injury or disease in service. Watson v. Brown, 4 Vet. App. 309 (1993); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992). Under applicable regulation, the term "disability" means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1; Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); Allen v. Brown, 7 Vet. App. 439 (1995); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (the term "disability" as used in 38 U.S.C. § 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability").

In McClain v. Nicholson, 21 Vet. App. 319, 321 (2007), the United States Court of Appeals for Veterans Claims (Court) held that the requirement of the existence of a current disability is satisfied when a claimant has a disability at the time he files his claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a claimant filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency.

3. Entitlement to service connection for bilateral
Veterans Claims (Court) held that the requirement of the existence of a current disability is satisfied when a claimant has a disability at the time he files his claim for service connection or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. However, in Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that when the record contains a recent diagnosis of disability prior to a claimant filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency.

3. Entitlement to service connection for bilateral hearing loss.

The Veteran contends he currently has bilateral hearing loss as a result of his military service. In this regard, the Veteran's hazardous noise exposure is conceded as his military occupational specialty (MOS) was aircraft armament systems journeyman, which has a high probability of noise exposure. See November 2023 VA Toxic Exposure Risk Activity (TERA) Memorandum and July 2024 Rating Decision.

For bilateral hearing loss, for the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385.

An examination for hearing impairment for VA purposes must be conducted by a state-licensed audiologist and must include a controlled speech discrimination test (Maryland CNC) and a puretone audiometry test. Examinations will be conducted without the use of hearing aids. 38 C.F.R. § 4.85(a).

As to a current diagnosis of hearing loss, the Board notes that the Veteran was afforded VA examination in December 2023. However, at no point during the appeal period does the Veteran have a current diagnosis of hearing loss for VA purposes.

In this regard, the evidence does not demonstrate that his auditory thresholds are at least 40 decibels for any frequency, or at least 26 decibels for three frequencies, or his speech recognition scores using the Maryland CNC Test are less than 94 percent in either ear. Specifically, at the December 2023 VA examination, the Veteran's auditory thresholds at 500 HZ, 1000Hz, 2000 Hz, 3000 Hz, and 4000 Hz, were 10, 15, 10, 10, and 15 decibels in the right ear, and 5, 10, 5, 10, and 10 decibels in the left ear, respectively. Speech recognition scores were 100 percent bilaterally.

While the Veteran believes he has bilateral hearing loss, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007); Woehlaert v. Nicholson, 21 Vet. App. 456 (2007). Consequently, the Board gives more probative weight to the competent medical evidence.

Therefore, the Board finds that at no time during the pendency of the claim does the Veteran have a current diagnosis of hearing loss as defined by VA regulations, and the record does not contain recent diagnoses of such disabilities prior to the Veteran's filing of a claim. See McClain, supra; Romanowsky, supra. Thus, where, as here, there is no probative evidence indicating that the Veteran has the disability for which service connection is sought, there can be no valid claim for service connection. See Brammer, supra. Consequently, service connection for bilateral hearing loss is not warranted.

In reaching such decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the evidence of record persuasively weighs against the Veteran's claims for service connection for bilateral hearing loss, such doctrine is not applicable in the instant appeal and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

4. Entitlement to service connection for neck strain, to include as secondary to a low back condition.

The Veteran contends his neck condition is due to his in-service duties of lifting, constantly standing for long periods of time, and excessive force while
See Brammer, supra. Consequently, service connection for bilateral hearing loss is not warranted.

4. Entitlement to service connection for neck strain, to include as secondary to a low back condition.

The Veteran contends his neck condition is due to his in-service duties of lifting, constantly standing for long periods of time, and excessive force while doing physical activities. See October 2023 VA 21-526EZ Claim Form.

Service treatment records (STRs) are silent for any complaints, diagnoses, or treatment for a neck condition and STRs dated March 2018, August 2018, April 2019, September 2019, and February 2020 note he has no neck pain and/or a normal neck.

The Board notes that the Veteran was not afforded VA examination for his claimed neck condition during the appeal period. The Secretary is required to provide an examination or medical opinion when such service "is necessary to make a decision on the claim." 38 U.S.C. § 5103(d). A medical examination or opinion is necessary only if (1) the evidence contains competent evidence of a current diagnosed disability or persistent or recurrent symptoms of disease; (2) the evidence establishes that the veteran suffered an in-service event, injury or disease; (3) the evidence indicates that the claimed disability or symptoms may be associated with the established in-service event, injury or disease or with another service-connected disability; and (4) the information and evidence of record does not contain sufficient competent medical evidence to decide the claim. Id.; McLendon v. Nicholson, 20 Vet. App. 79, 85-86 (2006).

Here, however, an examination is not warranted as the duty to assist has not been triggered. See Id.; 38 C.F.R. § 3.159 (c)(4). Although McLendon sets a low bar, that bar has not been met as there is no evidence indicating the presence of a current diagnosis.

Upon review of the evidence, the Board finds that, as he does not have a current disability of a neck condition at any time proximate to his claim, service connection for such condition is not warranted. See McClain, supra; Romanowsky, supra. See Brammer, supra. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the probative evidence is against the Veteran's claim of entitlement to service connection for a neck condition, that doctrine is not applicable in the instant appeal and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

5. Entitlement to service connection for dermatitis, as due to environmental exposures.

The Veteran contends he had dermatitis on his legs in-service after exposure to heavy fumes and toxic chemicals. In this regard, a November 2023 VA TERA Memorandum acknowledged the Veteran was exposed to dust and compounds due to his MOS in service. STRs dated March 2018 reflect he had multiple skin lesions, papules, and scabs. July 2018 STRs reflect that the Veteran reported a rash on both legs. In August 2018 and September 2018, he reported taking an over the counter steroid cream for a rash after putting up a fence in a yard, and that friends who had helped with the fence had the same rash. At that time, the diagnosis was "No skin disorder; No urticaria; No anaphylaxis." A different August 2018 STR noted a diagnosis of atopic dermatitis, unspecified and described papules and small scabs on the Veteran's ankles and feet.

However, the Veteran's April 2020 separation examination noted that his skin was normal and the Veteran checked "no" to skin diseases.

During the review period, the Veteran underwent VA examination for his claimed skin condition in February 2024. At that time, the examiner determined the Veteran did not have a current diagnosis of a skin condition and stated that there was "no objective evidence for dermatitis or other skin diagnosis," and that the skin condition has resolved. VA treatment records do not contain any references to a rash or skin condition, and in fact, April 2024 records reflect the Veteran denied having a skin rash.

Therefore, upon review of the evidence, the Board finds that, as he does not have a current disability of dermatitis at any time proximate to his claim, service connection
that his skin was normal and the Veteran checked "no" to skin diseases.

Therefore, upon review of the evidence, the Board finds that, as he does not have a current disability of dermatitis at any time proximate to his claim, service connection for such condition is not warranted. See McClain, supra; Romanowsky, supra. See Brammer, supra. In reaching this decision, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the weight of the probative evidence is against the Veteran's claim of entitlement to service connection for dermatitis, that doctrine is not applicable in the instant appeal and his claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

REASONS FOR REMAND

Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the Veteran's claim so that he is afforded every possible consideration. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159.

6. Entitlement to service connection for PTSD.

The Veteran contends he has PTSD after being falsely accused of sexual assault while in service. (See October 2023 Statement). In this regard, an April 2020 Notification Memorandum describes the reported incident happening on or about December 30, 2019.

The Veteran's claim for PTSD was denied in the July 2024 rating decision, which stated there was no evidence of a current disability. Additionally, the rating decision noted that PTSD is a mental disorder and it has not been established that PTSD, memory loss is caused by environmental exposures. However, environmental exposures were not the basis of the Veteran's claim.

The Veteran was not afforded VA examination during the appeal period. The rating decision noted that the Veteran was not afforded a TERA examination because PTSD is a mental disorder and it has not been established that PTSD, memory loss is caused by environmental exposures. However, environmental exposures were not the basis of the Veteran's claim.

Applying the McLendon criteria, the Board finds that not providing an examination was a duty to assist error. In his October 2023 VA Form 21-0781, Statement in Support of Claim for Service Connection for PTSD, the Veteran contended that he developed panic attacks, anxiety, and stress in service that have impacted his daily life after separation, which is sufficient evidence of persistent or recurrent symptoms of disease. Further, the Veteran alleges that these symptoms began in service following accusations that he sexually assaulted someone, which stressor is corroborated by the Veteran's personnel records. Given that the evidence indicates that the claimed disability or symptoms may be associated with the established in-service event, and the record does not contain sufficient competent medical evidence to decide the claim, the Board finds a remand is warranted in order to obtain an opinion as to the etiology of the Veteran's claimed PTSD.

7. Entitlement to service connection for sinusitis, to include as due to environmental exposures.

The Veteran claims his currently diagnosed chronic sinusitis began in service. (See October 2023 VA 21-526EZ claim form.) In this regard, STRs reflect sinus pain in September 2018.

The Veteran underwent VA examination in February 2024, at which time he was diagnosed with chronic sinusitis. However, the examiner offered a negative nexus opinion stating that his sinus condition was less likely than not related to his toxic exposures because "there are no records to support the sinusitis condition is due to toxic exposures."

In this regard, the Occupational and Environmental Health Exposure Data notices in the Veteran's STRs state that toluene, cadmium, chromium VI, rosin core solder, pyrolysis products, and xylene target the respiratory system. Therefore the Board finds the examiner's opinion to be based on an inaccurate factual premise, and finds a remand is warranted in order to obtain an adequate opinion as to the etiology of his currently diagnosed chronic sinusitis.

8. Entitlement to service connection for migraines, as due to environmental exposures.

Similar to above, the Veteran claims his migraines are due to his exposure to exposure to toxic chemicals and heavy fumes. See October 2023 VA 21-526EZ claim form.

During the appeal period, the Veteran underwent VA examination for
Data notices in the Veteran's STRs state that toluene, cadmium, chromium VI, rosin core solder, pyrolysis products, and xylene target the respiratory system. Therefore the Board finds the examiner's opinion to be based on an inaccurate factual premise, and finds a remand is warranted in order to obtain an adequate opinion as to the etiology of his currently diagnosed chronic sinusitis.

8. Entitlement to service connection for migraines, as due to environmental exposures.

Similar to above, the Veteran claims his migraines are due to his exposure to exposure to toxic chemicals and heavy fumes. See October 2023 VA 21-526EZ claim form.

During the appeal period, the Veteran underwent VA examination for his claimed migraines in February 2024. At that time, the examiner determined the Veteran had a diagnosis of migraines, including migraine variants, but that such were not related to his in-service headaches, which were due to sinus infections.

The TERA opinion stated that the Veteran's migraine condition was less likely than not caused by the indicated toxic exposure risk activities because medical literature does not associate "dust and noise" with migraines. However, the Veteran's exposure to petroleum distillates, chromium, methyl ethyl ketone, lead, kerosene, dipropylene glycol monomethyl ether, and cadmium is conceded, and the examiner offered no opinion as to whether such exposure could cause migraines. Therefore, the Board finds a remand is warranted in order to obtain an adequate opinion as to the etiology of his currently diagnosed migraines.

9. Entitlement to service connection for low fertility, as due to environmental exposures.

Similar to above, the Veteran claims his low fertility is due to his exposure to exposure to toxic chemicals and metals and radioactive materials. See July 2024 VA 21-526EZ claim form.

In August 2024, the Veteran underwent examination for his claimed low fertility. The examiner determined the Veteran did not have a current diagnosis and did not render an etiological opinion.

Specifically, the examiner stated the Veteran's testosterone level of 46.5 was "within the normal limits" of 46 to 224 pg/ml. However, an August 2024 Quest Diagnostics report reflects the Veteran underwent a testosterone test and the results were "out of range." Further, an April 2024 VA treatment record reflects a provisional diagnosis of male infertility, unspecified, and the examiner did not comment on the provisional diagnosis.

As the Veteran had a provisional diagnosis of male infertility, unspecified, and the record suggests his testosterone may be "out of range," the Board finds a remand is warranted in order to obtain an opinion as to the etiology of his claimed low fertility.

10. Entitlement to service connection for a left knee condition.

The Veteran contends he has a left knee condition due to his in-service duties of lifting, constantly standing for long periods of time, and excessive force while doing physical activities.

In this regard, STRs reflect numerous reports of left knee pain, left knee buckling, and a January 2019 diagnosis of disorder of patellofemoral joint. In August 2017, he was placed on a temporary duty restriction for two days due to his left knee and in January 2019, the Veteran was placed on a no running profile for an upcoming PT test. On his April 2020 discharge examination, he noted yes to knee trouble.

However, at his February 2024 VA examination, the examiner determined the Veteran did not have a current diagnosis of a left knee condition and that his left knee issues had resolved and did not render an etiological opinion. The examiner did not discuss the Veteran's extensive knee complaints in service, his previous in-service diagnosis, or VA treatment records documenting left knee pain. Therefore, the Board finds this opinion inadequate to decide the claim and a remand is warranted in order to obtain an opinion as to the etiology of his claimed left knee condition.

11. Entitlement to service connection for a right knee condition.

12. Entitlement to service connection for a low back condition, to include as secondary to his left knee condition.

The Veteran contends his right knee and low back conditions are due to his in-service duties of lifting, constantly standing for long periods of time, and excessive force while doing physical activities. Additionally, he contends his low back condition is secondary to his claimed left knee condition. See October 2023 VA 21-526EZ Claim Form.

In a September 2019 memorandum to his commander, the Veteran described bilateral knee pain that had occurred over the past couple of years. Additionally, the Veteran's April 2020 separation examination reflects he checked "yes" to painful joints and knee trouble. However, he checked "no" to back pain or any back problem.

During the appeal period, the Veteran underwent VA examination for his claimed back and right knee
The Veteran contends his right knee and low back conditions are due to his in-service duties of lifting, constantly standing for long periods of time, and excessive force while doing physical activities. Additionally, he contends his low back condition is secondary to his claimed left knee condition. See October 2023 VA 21-526EZ Claim Form.

During the appeal period, the Veteran underwent VA examination for his claimed back and right knee conditions in February 2024. At that time, the examiner determined the Veteran did not have current diagnoses of a back or right knee condition. She noted that the Veteran had strained his back lifting in service and had strained his knee from walking and physical training exercises, but such conditions had resolved. His back and right knee had full range of motion without evidence of pain. The examiner noted normal examinations with no objective findings and offered a negative nexus opinion stating that the Veteran did not have a diagnosis of a right knee and low back condition.

However, VA treatment records dated April 2024 reflect complaints of bilateral knee pain and chronic lower back pain. Thus, as the examiner did not discuss his extensive knee complaints in service, his previous in-service diagnosis, or VA treatment records documenting right knee and chronic low back pain, the Board finds the opinions inadequate to decide the claims and a remand is warranted in order to obtain opinions as to the etiology of his claimed right knee and low back conditions.

13. Entitlement to service connection for sleep apnea.

The Veteran contends his sleep apnea began in service as he was told he snored excessively, he woke up a lot in the middle of the night, and he was tired and fatigued even after 7 or 8 hours of sleep. See October 2023 VA 21-526EZ claim form.

In this regard, October 2017 STRs reflect complaints of difficulty sleeping and feeling tired.

In December 2023, the Veteran underwent a home sleep test. At that time, it was determined he was negative for obstructive sleep apnea (OSA). Therefore, based on the results of the home sleep test, and without VA examination, in February 2024, the VA examiner opined that the Veteran did not have a current diagnosis of sleep apnea and did not render an etiological opinion.

However, the results of the home sleep test also noted that home sleep testing does not definitively rule out OSA and that patients should consider in-lab polysomnography to reassess for the presence of OSA.

Given the Veteran's in-service complaints of difficulty sleeping and the examiner's determination the Veteran did not have a diagnosis based on a home test only, the Board finds a remand is warranted in order to schedule an appropriate VA examination and obtain an opinion as to the etiology of the Veteran's claimed sleep apnea.

14. Entitlement to service connection for fatigue, secondary to sleep apnea.

The Veteran has advanced the narrow theory of entitlement to service connection for fatigue as secondary to his claimed sleep apnea. Robinson v. Shinseki, 557 F.3d 1355, 1361 (2008). See October 2023 VA 21-526EZ claim form.

In this regard, STRs reflect complaints of generalized fatigue in October 2017 and May 2019, but reports of not feeling tired (fatigue) in May 2017, March 2018, July 2018, August 2018, and August 2019.

The Veteran underwent a VA chronic fatigue syndrome examination in February 2024. At that time, the examiner noted he did not have a current diagnosis of fatigue, nor had he ever had such a diagnosis despite his in-service complaints.

Nonetheless, given the Veteran's claim that his fatigue is caused by his sleep apnea, and the Board's determination that the RO's denial of that issue was based on an inadequate opinion, the Board finds that denying the claim based on such inadequate opinion constituted a duty-to-assist error that needs to be cured in order to adjudicate the claim on appeal. 38 U.S.C. § 5103A; 38 C.F.R. § 20.802.

Further, as the Veteran contends his fatigue is due to his sleep apnea, the matter of entitlement to service connection for fatigue is, therefore, inextricably intertwined with the sleep apnea claim remanded herein, a remand of this matter is also required. Harris v. Derwinski, 1 Vet. App. 180 (1991); Tyrues v. Shinseki
denial of that issue was based on an inadequate opinion, the Board finds that denying the claim based on such inadequate opinion constituted a duty-to-assist error that needs to be cured in order to adjudicate the claim on appeal. 38 U.S.C. § 5103A; 38 C.F.R. § 20.802.

Further, as the Veteran contends his fatigue is due to his sleep apnea, the matter of entitlement to service connection for fatigue is, therefore, inextricably intertwined with the sleep apnea claim remanded herein, a remand of this matter is also required. Harris v. Derwinski, 1 Vet. App. 180 (1991); Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc) (claims are inextricably intertwined where the adjudication of one claim could have a significant impact on the adjudication of another claim).

The matters are REMANDED for the following action:

1. Schedule the Veteran for an appropriate VA examination to determine the nature and etiology of his claimed PTSD. The record and a copy of this Remand must be made available to the examiner, and all indicated tests should be completed.

Following a review of the record, the examiner should offer an opinion as to whether it is at least as likely as not that his claimed PTSD is related to his military service, to include an accusation of sexual assault as documented in his military personnel records.