LEFT TOES DISABILITY

MICHAEL LANE · 2026 · Case ID: A26005377

MIXED

Summary

The veteran, who served in the United States Marine Corps from June 1990 to June 1994, including service in the Persian Gulf region, appeals the denial of increased ratings for left toes and left ankle disabilities, and the denial of service connection for hypertension, left knee disability, hemorrhoids, an acquired psychiatric disorder, and an alcohol-related disorder. The Board granted a 30 percent disability rating for stress fractures of the left second and third metatarsals, effective November 9, 2022, finding the evidence equipoised and resolving doubt in the veteran's favor. However, the Board denied a higher rating for the left ankle disability, finding the evidence weighed against ankylosis or its functional equivalent. For hypertension, left knee disability, hemorrhoids, and psychiatric/alcohol-related disorders, the Board denied claims due to the veteran's failure to report for scheduled VA examinations without good cause, which were deemed necessary to establish the claims. The Board found the evidence persuasively weighed against a nexus to service or service-connected conditions for these denied claims. The claim for erectile dysfunction was remanded due to a duty-to-assist error regarding examination scheduling.

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250217-518356

Full Decision Text

Citation Nr: A26005377
Decision Date: 01/21/26 Archive Date: 01/21/26

DOCKET NO. 250217-518356
DATE: January 21, 2026

ORDER

A 30 percent, but not higher, disability rating for stress fractures of the left second and third metatarsals since November 9, 2022, is granted.

Entitlement to a disability rating in excess of 20 percent for left ankle sprain status post arthrotomy is denied.

Entitlement to service connection for hypertension, to include as secondary to in-service exposure to burn pits and other environmental toxins and as secondary to the service-connected left ankle disability, is denied.

Entitlement to service connection for a left knee disability, to include as secondary to in-service exposure to burn pits and other environmental toxins and as secondary to the service-connected left ankle disability, is denied.

Entitlement to service connection for hemorrhoids, to include as secondary to in-service exposure to burn pits and other environmental toxins and as secondary to hypertension, is denied.

Entitlement to service connection for an acquired psychiatric disorder other than an alcohol-related disorder, to include as secondary to in-service exposure to burn pits and other environmental toxins and as secondary to the service-connected left ankle disability, is denied.

Entitlement to service connection for an alcohol-related disorder, to include as secondary to in-service exposure to burn pits and other environmental toxins and as secondary to the service-connected left ankle disability, is denied.

REMANDED

Entitlement to service connection for erectile dysfunction, to include as secondary to in-service exposure to burn pits and other environmental toxins and as secondary to hypertension, is remanded.

FINDINGS OF FACT

1. The evidence is equipoise as to whether the stress fractures of the left second and third metatarsals have been manifested by severe symptomatology since November 9, 2023.

2. The evidence is in equipoise as to whether there was an increase in disability in the left toes disability during the one-year period prior to the date of claim, November 9, 2023.

3. The evidence is in equipoise as to whether from November 9, 2022, to November 8, 2023, the fractures of the left second and third metatarsals were manifested by severe symptomatology.

4. The evidence persuasively weighs against a finding that the left ankle disability has been manifested by actual ankylosis of the left ankle or the functional equivalent of ankylosis in plantar flexion between 30 and 40 degrees or in dorsiflexion between zero and 10 degrees.

5. The evidence persuasively shows that entitlement to service connection for hypertension cannot be established without a current Department of Veterans Affairs (VA) examination.

6. The evidence persuasively weighs against a finding that there was good cause for the Veteran's failure to report for the VA examinations in October 2024 and November 2024 scheduled in conjunction with his claim for entitlement to service connection for hypertension.

7. The evidence persuasively weighs against a finding that hypertension has an inconclusive pathophysiology or etiology and is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities

8. The evidence persuasively weighs against a finding that the hypertension was demonstrated in service or was compensably manifested within a year of separation from active service; that hypertension is related to active service, including in-service elevated blood pressure readings, in-service stress, and in-service exposure to burn pits, fine particulate matter, and other environmental toxins; or that hypertension was caused or aggravated by the service-connected left ankle disability, to include use of medications to treat that disability.

9. The evidence persuasively shows that entitlement to service connection for a left knee disability cannot be established without a current VA examination.

10. The evidence persuasively weighs against a finding that there was good cause for the Veteran's failure to report for the VA examination in November 2024 scheduled in conjunction with his claim for entitlement to service connection for a left knee disability.

11. The evidence persuasively weighs against a finding that the disability resulting in arthroscopic surgery of the left knee has an inconclusive pathophysiology or etiology and is characterized by overlapping symptoms and signs and have features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities.

12. The evidence persuasively weighs against a finding that the left knee disability is related to active service, to include in-service locking and in-service exposure to burn pits, fine particulate matter, and other environmental toxins, or was caused or aggravated by the service-connected left ankle disability.

13. The evidence persuasively weighs against a finding that the Veteran has or has had hemorrhoids during the appeal period.

14. The evidence persuasively weighs against a finding that the Veteran has or has had an acquired psychiatric disorder other than an alcohol-related disorder during the appeal period.

15. The evidence persuasively weighs against a finding that the Veteran's alcohol-related disorder was in the line of duty.

16. The evidence persuasively weights against a finding that the alcohol-related disorder was caused or aggravated by the service-connected left ankle disability.

CONCLUSIONS OF LAW

1. Resolving all reasonable doubt in the Veteran's favor, the criteria for a 30 percent disability rating for stress fractures of the left second and third metatarsals since November 9, 2022, have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5283, 5284 (2026).

2. The criteria for a disability rating in excess of 20 percent for left ankle sprain status post arthrotomy have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 4.3, 4.7, 4.40, 4.45, 4.59, 4.71a, Diagnostic Codes 5270, 5271 (2026).

3. The criteria for entitlement to service connection for hypertension, to include as secondary to in-service exposure to burn pits and other environmental toxins and as secondary to the service-connected left ankle disability, have not been met. 38 U.S.C. §§ 1110, 1112, 1117, 1118, 1119, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309, 3.310, 3.317, 3.326, 3.655, 4.104, Diagnostic Code 7101 (2026).

4. The criteria for entitlement to service connection for a left knee disability, to include as secondary to in-service exposure to burn pits and other environmental toxins and as secondary to the service-connected left ankle disability, have not been met. 38 U.S.C. §§ 1110, 1117, 1118, 1119, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310, 3.317, 3.326, 3.655.

5. The criteria for entitlement to service connection for hemorrhoids, to include as secondary to in-service exposure to burn pits and other environmental toxins and as secondary to hypertension, have not been met. 38 U.S.C. §§ 1110, 1117, 1118, 1119, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310, 3.317, 3.326, 3.655.

6. The criteria for entitlement to service connection for an acquired psychiatric disorder other than an alcohol-related disorder, to include as secondary to in-service exposure to burn pits and other environmental toxins and as secondary to the service-connected left ankle disability, have not been met. 38 U.S.C. §§ 1110, 1117, 1118, 1119, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310, 3.317
, 3.159, 3.303, 3.310, 3.317, 3.326, 3.655.

7. The criteria for entitlement to service connection for an alcohol-related disorder, to include as secondary to in-service exposure to burn pits and other environmental toxins and as secondary to the service-connected left ankle disability, have not been met. 38 U.S.C. §§ 105, 1103, 1110, 1117, 1118, 1119, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.1(n), 3.102, 3.159, 3.300, 3.301, 3.303, 3.310, 3.317, 3.326, 3.655 (2026).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from June 1990 to June 1994 in the United States Marine Corps, to include service in the Persian Gulf region.

These matters come before the Board of Veterans' Appeals (Board) on appeal from October 2024 (denying increased ratings) and November 2024 (denying service connection) rating decisions of a VA regional office (RO).

In the February 2025 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 2024 and November 2024 agency of original jurisdiction (AOJ) decisions on appeal. 38 C.F.R. § 20.301 (2026). Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801 (2026).

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 (2026). 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.

In the February 2025 VA Form 10182, the Veteran indicated that he was appealing the denials of increased ratings for the left toes and left ankle disabilities in an October 2004 rating decision. The Board notes that there is no rating decision issued in October 2004. While the RO denied increased ratings for the left toes and left ankle disabilities in an April 2004 rating decision, that rating decision cannot be a subject of an appeal under the modernized review system pursuant to the Appeals Management Act (AMA) because the decision became final in 2005, well before the enactment of the AMA. 38 C.F.R. § 3.2400 (2026).

In the February 2025 VA Form 10182, the Veteran indicated that he was appealing the deferred adjudication of service connection for anxiety in a November 7, 2024, rating decision. The November 7, 2024, rating decision is not an adjudication of the claim of entitlement to service connection for anxiety. In other words, the November 7, 2024, rating decision is not a decision on the claim of entitlement to service connection for anxiety. The appeal of the deferral of the claim of entitlement to service connection for anxiety is not eligible for consideration under the modernized review system pursuant to the AMA. In any event, the Veteran filed an appeal on the denial of service connection for anxiety in the November 26, 2024, rating decision.

In the November 26, 2024, rating decision, the RO denied service connection for anxiety. In addition to the claimed anxiety disorder, an August 2023 VA treatment record revealed an assessment of excessive
ication of the claim of entitlement to service connection for anxiety. In other words, the November 7, 2024, rating decision is not a decision on the claim of entitlement to service connection for anxiety. The appeal of the deferral of the claim of entitlement to service connection for anxiety is not eligible for consideration under the modernized review system pursuant to the AMA. In any event, the Veteran filed an appeal on the denial of service connection for anxiety in the November 26, 2024, rating decision.

In the November 26, 2024, rating decision, the RO denied service connection for anxiety. In addition to the claimed anxiety disorder, an August 2023 VA treatment record revealed an assessment of excessive alcohol use. Pursuant to Clemons v. Shinseki, 23 Vet. App. 1 (2009), the issues on appeal includes not only the claimed anxiety disorder but also an alcohol-related disorder.

In a December 2025 written brief presentation, the Veteran's representative suggested that hypertension is secondary to use of non-steroidal anti-inflammatory drugs for his service-connected left ankle disability. The Veteran's representative also asserted that the hypertension may be related to in-service exposure to 2,4-D, Picloram, and cacodylic acid. Nevertheless, the Board cannot undertake any evidentiary development regarding these contentions as they were not raised prior to the November 26, 2024, rating decision on appeal.

The November 2024 rating decision reflects that the RO considered whether the Veteran's hypertension is related to a toxic exposure risk activity, specifically exposure to toxins from service in the Persian Gulf region. Pursuant to Schroeder v. West, 212 F.3d 1265 (Fed. Cir. 2000), the Board will consider whether all disabilities are related to exposure to toxins from service in the Persian Gulf region.

Duties to Assist and Notify

Governing law and regulations

VA's duties to notify and assist claimants in substantiating a claim for VA benefits are found at 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5107, 5126 and 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a).

When entitlement to a benefit cannot be established without a current examination and a claimant without good cause fails to report for such an examination, 38 C.F.R. § 3.655(b) applies. 38 C.F.R. § 3.655(a). When a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. When the examination was scheduled in conjunction with any other original claim, a reopened claim for a benefit which was previously disallowed, or a claim for increase, the claim shall be denied. 38 C.F.R. § 3.655(b). Examples of "good cause" include, but are not limited to, the illness or hospitalization of the claimant, death of an immediate family member, etc. See 38 C.F.R. § 3.655(a); see also Engelke v. Gober, 10 Vet. App. 396, 399 (1997); Ashley v. Derwinski, 2 Vet. App. 307, 311 (1992).

The Veteran and his representative have not raised any issues with the duty to notify or duty to assist as to the claims. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that "the Board's obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board."); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to duty to assist argument).

Analysis

The Veteran was scheduled for VA examinations to be conducted in October 2024 and November 2024 regarding his claims of service connection for hypertension. The Veteran was scheduled for VA examinations to be conducted in November 2024 regarding his claims of service connection for a left knee disability, hemorrhoids, and an anxiety disorder. Though the Veteran reported for other VA examinations in June 2024, he failed to report for the VA examinations scheduled in October 2024 and November 2024.

The Veteran has not presented any reason for his failure to report for the scheduled examinations in October 2024 and November 2024. In an April 2025 written brief presentation, the representative noted that the Veteran
argument).

Analysis

It is plain from the record before the Board that the Veteran has been advised of what was required of him to adjudicate these claims, but he has failed to comply. See Wood v. Derwinski, 1 Vet. App. 190, 192-93 (1991) (the duty to assist includes a duty to be "helpful and clear in explaining to a veteran what evidence [the veteran] needs together with help and advice in obtaining it"). There is no correspondence or report of contact from the Veteran that would explain his failure to report for the examinations scheduled to be conducted in October 2024 and November 2024.

The Board is mindful of 38 C.F.R. § 3.655, which provides that when entitlement to a benefit cannot be established without a current VA examination or reexamination, it is the responsibility of VA adjudicators, based upon their administrative experience and expertise in reviewing many claims of this nature, to determine at what point the record is sufficiently developed to support a reasonably informed decision. See 38 C.F.R. §§ 3.159, 3.326; see also Shoffner v. Principi, 16 Vet. App. 208, 213 (2002) (holding that VA has discretion to decide when additional development is necessary). As provided in 38 C.F.R. § 3.159(c)(4), VA will provide a medical examination or obtain a medical opinion based upon a review of the evidence of record if VA determines it is necessary to decide the claim. To support this objective, the regulations provide that "[i]ndividuals for whom an examination has been scheduled are required to report for the examination." 38 C.F.R. § 3.326(a) (emphasis added). Thus, the regulations clearly indicate it is the duty of VA to determine the adequacy of evidentiary development, and the duty of a veteran to cooperate with VA in these efforts.

The Veteran asserts that hypertension is related to active service and his service-connected left ankle disability. As explained below, a VA examination was necessary to determine whether the Veteran's current hypertension is related to active service or his service-connected left ankle disability. 38 C.F.R. §§ 3.159, 3.303. The evidence persuasively shows that entitlement to service connection for hypertension cannot be established without a current VA examination. The evidence persuasively weighs against a finding that there was good cause for the Veteran's failure to report for the VA examinations in October 2024 and November 2024 scheduled in conjunction with his claim for entitlement to service connection for hypertension. Thus, the Veteran failed, without good cause, to report for VA examinations in October 2024 and November 2024 scheduled in conjunction with his claim for entitlement to service connection for hypertension.

The Veteran asserts that his left knee disability is related to his service-connected left ankle disability. As explained below, a VA examination was necessary to determine whether the Veteran's current left knee disability is related to his service-connected left ankle disability. 38 C.F.R. §§ 3.159, 3.310. The evidence persuasively shows that entitlement to service connection for a left knee disability cannot be established without a current VA examination. The evidence persuasively weighs against a finding that there was good cause for the Veteran's failure to report for the VA examination in November 2024 scheduled in conjunction with his claim for entitlement to service connection for a left knee disability. Therefore, the Veteran failed, without good cause, to report for a VA examination in November 2024 scheduled in conjunction with his claim for entitlement to service connection for a left knee disability.

The Veteran asserts that he has hemorrhoids are related to hypertension. As explained below, a VA examination was necessary to determine whether the Veteran has hemorrhoids and whether any hemorrhoids are related to in-service exposure to toxins. 38 C.F.R. §§ 3.159, 3.303. The evidence persuasively shows that entitlement to
there was good cause for the Veteran's failure to report for the VA examination in November 2024 scheduled in conjunction with his claim for entitlement to service connection for a left knee disability. Therefore, the Veteran failed, without good cause, to report for a VA examination in November 2024 scheduled in conjunction with his claim for entitlement to service connection for a left knee disability.

The Veteran asserts that he has hemorrhoids are related to hypertension. As explained below, a VA examination was necessary to determine whether the Veteran has hemorrhoids and whether any hemorrhoids are related to in-service exposure to toxins. 38 C.F.R. §§ 3.159, 3.303. The evidence persuasively shows that entitlement to service connection for hemorrhoids cannot be established without a current VA examination. The evidence persuasively weighs against a finding that there was good cause for the Veteran's failure to report for the VA examination in November 2024 scheduled in conjunction with his claim for entitlement to service connection for hemorrhoids. As such, the Veteran failed, without good cause, to report for a VA examination in November 2024 scheduled in conjunction with his claim for entitlement to service connection for hemorrhoids.

The Veteran asserts that he has an anxiety disorder related to his service-connected left ankle disability. As explained below, a VA examination was necessary to determine whether the Veteran has an anxiety disorder and whether any anxiety disorder or the alcohol-related disorder is related to the service-connected left ankle disability. 38 C.F.R. §§ 3.159, 3.310. The evidence persuasively shows that entitlement to service connection for an acquired psychiatric disorder other than an alcohol-related disorder and for an alcohol-related disorder cannot be established without a current VA examination. The evidence persuasively weighs against a finding that there was good cause for the Veteran's failure to report for the VA examination in November 2024 scheduled in conjunction with his claims for entitlement to service connection for an acquired psychiatric disorder other than an alcohol-related disorder and for an alcohol-related disorder. Hence, the Veteran failed, without good cause, to report for a VA examination in November 2024 scheduled in conjunction with his claims for entitlement to service connection for an acquired psychiatric disorder other than an alcohol-related disorder and for an alcohol-related disorder.

Increased Rating

1. Entitlement to a disability rating in excess of 10 percent for stress fractures of the left second and third metatarsals since November 9, 2022

Governing law and regulations

Twenty and 30 percent disability ratings are warranted for moderately severe and severe foot injuries, respectively. With actual loss of use of the foot, the disability should be rated 40 percent disabling. 38 C.F.R. § 4.71a, Diagnostic Code 5284.

Twenty and 30 percent disability ratings are warranted for moderately severe and severe malunion of or nonunion of tarsal or metatarsal bones, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5283.

Pursuant to Hart v. Mansfield, 21 Vet. App. 505 (2007), the Board must consider the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim.

Analysis

In a June 1994 rating decision, a RO granted service connection for stress fractures of the left second and third metatarsals and assigned a zero percent disability rating under Diagnostic Code 5283. In an August 2019 rating decision, a RO assigned a 10 percent disability rating for the left foot disability effective May 20, 2009, under Diagnostic Code 5283. In the October 2024 rating decision, the RO denied a disability rating in excess of 10 percent but now rated the disability under Diagnostic Code 5284 effective November 9, 2023. A RO received the Veteran's intent to file a claim on November 9, 2023. In May 2024, a RO received the Veteran's formal claim for an increased rating for his left toes disability. Pursuant to Hart, the Board will consider whether a disability rating in excess of 10 percent for the left toes disability since November 9, 2022, is warranted.

An August 2024 foot examination report reflects that the Veteran reported that he continued to have sharp pain in the left foot with cramping and numbness. He stated that he has flare-ups of left foot symptomatology daily. The examiner noted that the flare-ups of the left foot symptomatology are moderate to severe in severity. The examiner stated that the severity of the left foot injury was moderate in severity. The contributing factors of disability are less movement than normal, disturbance of locomotion, interference with standing, and pain. The nurse practitioner
. Pursuant to Hart, the Board will consider whether a disability rating in excess of 10 percent for the left toes disability since November 9, 2022, is warranted.

An August 2024 foot examination report reflects that the Veteran reported that he continued to have sharp pain in the left foot with cramping and numbness. He stated that he has flare-ups of left foot symptomatology daily. The examiner noted that the flare-ups of the left foot symptomatology are moderate to severe in severity. The examiner stated that the severity of the left foot injury was moderate in severity. The contributing factors of disability are less movement than normal, disturbance of locomotion, interference with standing, and pain. The nurse practitioner noted that there is evidence of pain on passive motion, active motion, weight-bearing, non-weight-bearing, and on rest and non-movement. The clinician added that the fractures interfere with his ability to stand and walk for long periods of time.

The Board places great weight on the findings from the August 2024 VA foot examination regarding flare-ups, contributing factors of disability, the extent of pain, and functional impact. The evidence is equipoise as to whether the stress fractures of the left second and third metatarsals have been manifested by severe symptomatology since November 9, 2023. A 30 percent disability rating under Diagnostic Code 5283 is warranted.

There is no higher rating under Diagnostic Code 5283. As for whether a higher rating is warranted under Diagnostic Code 5284, the August 2024 VA examiner stated that there was not any functional impairment of the left lower extremity such that no effective functions remain other than that which would be equally well served by an amputation with prosthesis. The Board places great weight on this finding. The evidence persuasively weighs against a finding that since November 9, 2023, the left toes disability has been manifested by actual loss of the left foot. Thus, a higher rating under Diagnostic Code 5284 is not warranted. A 30 percent, but not higher, rating for the left toes disability is granted effective November 9, 2023.

As for the one-year period prior to the date of claim, the Veteran stated at the August 2024 VA examination that over the years, he continued to have a sharp pain in the left foot. The Veteran is competent to report this symptomatology, and the Board finds him credible. Based on the Veteran's reporting, the evidence is in equipoise as to whether there was an increase in disability in the left toes disability during the one-year period prior to the date of claim, November 9, 2023. Based on the findings from the August 2024 VA foot examination, the evidence is in equipoise as to whether from November 9, 2022, to November 8, 2023, the fractures of the left second and third metatarsals were manifested by severe symptomatology. As for whether a rating in excess of 30 percent is warranted from November 9, 2022, to November 8, 2023, the Board again places much weight on the finding from the August 2024 VA examination that was not any functional impairment of the left lower extremity such that no effective functions remain other than that which would be equally well served by an amputation with prosthesis. The evidence persuasively weighs against a finding that from November 9, 2022, to November 8, 2023, the left toes disability has been manifested by actual loss of the left foot. As such, a higher rating under Diagnostic Code 5284 is not warranted. A 30 percent, but not higher, rating for the left toes disability is granted effective November 9, 2022, to November 8, 2023.

2. Entitlement to a disability rating in excess of 20 percent for the left ankle disability

Governing law and regulations

Diagnostic Code 5271 still provides that 10 and 20 percent disability ratings are warranted for moderate and marked limitation of motions, respectively. Moderate is defined as less than 15 degrees of dorsiflexion or less than 30 degrees of plantar flexion. Marked is denied as less than five degrees of dorsiflexion or less than 10 degrees of plantar flexion.

Under 38 C.F.R. § 4.71, Plate II (2026), normal range of motion for the ankle is 20 degrees of dorsiflexion and 45 degrees of plantar flexion.

The United States Court of Appeals for Veterans Claims (the Court) has noted that when evaluating a disability under VA's General Rating Formula, the criteria for a rating based on ankylosis may be met by evidence demonstrating the functional
motions, respectively. Moderate is defined as less than 15 degrees of dorsiflexion or less than 30 degrees of plantar flexion. Marked is denied as less than five degrees of dorsiflexion or less than 10 degrees of plantar flexion.

Under 38 C.F.R. § 4.71, Plate II (2026), normal range of motion for the ankle is 20 degrees of dorsiflexion and 45 degrees of plantar flexion.

The United States Court of Appeals for Veterans Claims (the Court) has noted that when evaluating a disability under VA's General Rating Formula, the criteria for a rating based on ankylosis may be met by evidence demonstrating the functional equivalent of ankylosis. Chavis v. McDonough, 34 Vet. App. 1 (2021). Therefore, ankylosis can be shown via functional loss consistent with that contemplated by ankylosis. See 38 C.F.R. §§ 4.40, 4.45; Mitchell v. Shinseki, 25 Vet. App. 32 (2011); DeLuca v. Brown, 8 Vet. App. 202 (1995).

Under Diagnostic Code 5270, a 20 percent rating is warranted for ankylosis of the ankle in plantar flexion at less than 30 degrees. A 30 percent rating is warranted for ankylosis of the ankle in plantar flexion between 30 degrees and 40 degrees, or in dorsiflexion between zero degrees and 10 degrees. A maximum 40 percent rating is warranted for ankylosis of the ankle in plantar flexion at more than 40 degrees, or in dorsiflexion at more than 10 degrees or with abduction, adduction, inversion, or eversion deformity. 38 C.F.R. § 4.71a, Diagnostic Code 5270 (2026).

Analysis

In the June 1994 rating decision, a RO granted service connection for left ankle sprain with arthrotomy and assigned a 10 percent disability rating under Diagnostic Code 5271. In an October 1996 rating decision, a RO assigned a 20 percent disability rating for the left ankle disability effective June 11, 1994, under Diagnostic Code 5271. A RO received the Veteran's intent to file a claim on November 9, 2023. In May 2024, a RO received the Veteran's formal claim for an increased rating for his left ankle disability. Pursuant to Hart, the Board will consider whether a disability rating in excess of 20 percent for the left ankle disability since November 9, 2022, is warranted.

As for whether there is actual ankylosis of the left ankle, there is no evidence of ankylosis during the appeal period. A June 2024 VA ankle examiner noted that there is no ankylosis. The medical evidence shows that the Veteran has some range of motion in his left ankle during the appeal period. The June 2024 VA ankle examination report reflects that the active range of motion for the left ankle is plantar flexion to 40 degrees and that dorsiflexion to 15 degrees. The evidence persuasively weighs against a finding that the left ankle disability has been manifested by actual ankylosis in plantar flexion or in dorsiflexion.

The Board will consider whether a 30 percent disability rating is warranted pursuant to Chavis based on the left ankle disability being manifested by the functional equivalent of ankylosis in plantar flexion between 30 and 40 degrees or in dorsiflexion between zero and 10 degrees during flare-ups or repeated use over time. The Board places great weight on the August 2024 disability benefits questionnaire report revealing that there was no additional loss of range of motion after three repetitions, that the estimated range of motion during a flare-up was still 35 degrees of plantar flexion and 10 degrees of dorsiflexion, and that the estimated range of motion during repeated use over time was still 30 degrees of plantar flexion and five degrees of dorsiflexion.

The evidence persuasively weighs against a finding that the left ankle disability has been manifested by the functional equivalent of ankylosis in plantar flexion between 30 and 40 degrees or in dorsiflexion between zero and 10 degrees during flare-ups or repeated use over time. Therefore, a higher rating based on the functional equivalent of ankylosis in plantar flexion between 30 and 40 degrees or in dorsiflexion between zero and 10 degrees is not warranted. A disability rating in excess of 20 percent is
iflexion, and that the estimated range of motion during repeated use over time was still 30 degrees of plantar flexion and five degrees of dorsiflexion.

Service connection

3. Entitlement to service connection for hypertension, to include as secondary to in-service exposure to burn pits and other environmental toxins and as secondary to the service-connected left ankle disability

Governing law and regulations

In general, service connection may be granted for disability or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110.

Direct service connection

Notwithstanding the above, service connection may be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred or aggravated in service. 38 C.F.R. § 3.303(a).

To establish service connection for a claimed disorder, there must be (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of 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. See Hickson v. West, 12 Vet. App. 247, 253 (1999).

Where a veteran served ninety days or more of active service, and certain chronic diseases become manifest to a degree of 10 percent or more within one year after the date of separation from such service, such disease shall be presumed to have been incurred 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(a). Among the chronic disorders listed under 38 C.F.R. § 3.309 (a) is cardiovascular-renal disease, including hypertension. Where chronicity of a disease is not shown in service, service connection may yet be established by showing continuity of symptomatology between the currently claimed disability and a condition noted in service. 38 C.F.R. § 3.303(b). Continuity of symptomatology may be established if a claimant can demonstrate (1) that a condition was "noted" during service; (2) evidence of post-service continuity of the same symptomatology; and (3) medical or, in certain circumstances, lay evidence of a nexus between the present disability and the post-service symptomatology. Savage v. Gober, 10 Vet. App. 488, 495-96 (1997).

A 10 percent disability rating is warranted for hypertension manifested by diastolic pressure predominantly 100 or more, systolic pressure 160 or more, or a history of diastolic pressure predominantly 100 or more that requires continuous medication for control. 38 C.F.R. § 4.104, Diagnostic Code 7101 (2024).

Hypertension must be confirmed by readings taken two or more times on at least three different days. For purposes of this section, the term hypertension means that the diastolic blood pressure is predominantly 90 mm or greater. The isolated systolic hypertension means that the systolic blood pressure is predominantly 160 mm or greater with a diastolic blood pressure of less than 90 mm. Id. at Note (1).

The mere fact of an in-service injury is not enough; there must be evidence of a chronic disability resulting from that injury. In order to show a chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support a veteran's claim. See 38 C.F.R. § 3.303(b).

The chronicity provision of 38 C.F.R. § 3.303(b) applies when evidence, regardless of its date, establishes that a veteran had a chronic condition in service and still has that condition. There must be competent medical evidence unless the evidence relates to
In order to show a chronic disease in service there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time, as distinguished from merely isolated findings or a diagnosis including the word "chronic." When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support a veteran's claim. See 38 C.F.R. § 3.303(b).

For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. 38 C.F.R. § 3.303(b). An alternative to showing chronicity in service is a showing of continuity of symptoms after discharge. The United States Court of Appeals for the Federal Circuit (Federal Circuit), however, clarified that this notion of continuity of symptomatology since service under 38 C.F.R. § 3.303(b), which is an alternative means of establishing the required nexus or linkage between current disability and service, only applies to disabilities identified as chronic under 38 C.F.R. § 3.309(a). Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

Service connection may also be established for a chronic disability resulting from an undiagnosed illness that became manifest either during active service in the Southwest Asia theater of operations during the Persian Gulf War or not later than December 31, 2021. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317.

The term "Persian Gulf veteran" means 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)(1). The Southwest Asia Theater of operations includes Iraq, Kuwait, Saudi Arabia, the neutral zone between Iraq and Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, the Gulf of Aden, the Gulf of Oman, the Persian Gulf, the Arabian Sea, the Red Sea, and the airspace above these locations. 38 C.F.R. § 3.317(d)(2).

A 'qualifying chronic disability' means a chronic disability resulting from any of the following (or any combination of any of the following): an undiagnosed illness; a medically unexplained chronic multi-symptom illness (such as chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome) that is defined by a cluster of signs or symptoms; and any diagnosed illness that the Secretary determines. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(1)(i).

The term medically unexplained illness means a diagnosed illness without conclusive pathophysiology or etiology that is characterized by overlapping symptoms and signs and have features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. Chronic multisymptom illnesses of partially understood etiology and pathophysiology, such as diabetes and multiple sclerosis, will not be considered medically unexplained. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(1)(ii).

Objective indications of a 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. 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. A chronic disability resulting from an undiagnosed illness referred to in this section shall be rated using evaluation criteria from the VA's Schedule for Rating Disabilities for a disease or injury in which the functions affected, anatomical localization, or symptomatology are similar. A disability referred to in this section shall be considered service-connected for the purposes of all laws in the United States. 38 C.F.R. § 3.317(a) (2-5).

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
date on which the pertinent evidence establishes that the signs or symptoms of the disability first became manifest. A chronic disability resulting from an undiagnosed illness referred to in this section shall be rated using evaluation criteria from the VA's Schedule for Rating Disabilities for a disease or injury in which the functions affected, anatomical localization, or symptomatology are similar. A disability referred to in this section shall be considered service-connected for the purposes of all laws in the United States. 38 C.F.R. § 3.317(a) (2-5).

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 nevertheless warranted. See Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994).

Secondary service connection

A disability that is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary disorder, the secondary disorder shall be considered a part of the original condition. 38 C.F.R. § 3.310(a).

To establish service connection for a claimed disability on a secondary basis, there must be (1) medical evidence of a current disability; (2) a service-connected disability; and (3) medical evidence of a nexus between the service-connected disease or injury and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

Analysis

Turning first to Hickson and Wallin element (1), current disability, VA treatment records reveal that in August 2023 the assessment was hypertension. Hence, Hickson and Wallin element (1), current disability, is established.

As to Hickson element (2) with regard to in-service disease, in a December 2025 written brief presentation, the representative argued that the first hypertensive blood pressure readings are in the Veteran's service treatment records. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The Board notes that although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issues in this case, the existence of hypertension fall outside the realm of common knowledge of a lay person. See Jandreau, 492 F.3d at 1733 n. 4 (lay persons not competent to diagnose cancer). As for the Veteran's representative's assertion that the service treatment records show hypertensive blood pressure readings, this assertions is not the reporting of a contemporaneous diagnosis of hypertension. The service treatment records do not contain a diagnosis of hypertension.

The service treatment records show that the Veteran's blood pressure was taken multiple times. The diastolic blood pressure was only 90 mm or higher twice. More specifically, in December 1991, his blood pressure was 110/90. At a June 1994 separation examination, his blood pressure was 156/90. The heart and vascular system were normal on exam, and the examiner did not diagnose hypertension. The systolic blood pressure was never 160 mm or higher. The evidence persuasively weighs against a finding that the hypertension was demonstrated in service.

In the October 2024 claim, the Veteran attributed his hypertension to the in-service stress. The Veteran is competent to report his in-service stress, and the Board finds him credible. A November 2024 VA memorandum and the Veteran's service personnel records show that the Veteran had Persian Gulf War service with service in Iraq. Given the evidence of in-service elevated blood pressure readings, in-service stress, and in-service exposure to environmental toxins, Hickson element (2), in-service disease or injury, is met.

With regard to Wallin element (2), service-connected disability, service connection is in effect for a left ankle disability. Thus, Wallin element (2) is shown.

As for Hickson element (3), medical nexus, there is no competent medical evidence showing a diagnosis of hypertension within one year of separation from active service. VA treatment records from the first year after service do not reveal a diagnosis of hypertension. While the Veteran's blood pressure was
's service personnel records show that the Veteran had Persian Gulf War service with service in Iraq. Given the evidence of in-service elevated blood pressure readings, in-service stress, and in-service exposure to environmental toxins, Hickson element (2), in-service disease or injury, is met.

With regard to Wallin element (2), service-connected disability, service connection is in effect for a left ankle disability. Thus, Wallin element (2) is shown.

As for Hickson element (3), medical nexus, there is no competent medical evidence showing a diagnosis of hypertension within one year of separation from active service. VA treatment records from the first year after service do not reveal a diagnosis of hypertension. While the Veteran's blood pressure was 166/96 in January 1995, his blood pressure was only 128/72 in March 1995. The evidence persuasively weighs against a finding that the hypertension was compensably manifested within a year of separation from active service.

Regarding whether hypertension is a medically unexplained chronic multisymptom illness, there is no competent medical evidence that hypertension has an inconclusive pathophysiology or etiology and is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. VA treatment records do not contain a medical opinion indicating that hypertension is a medically unexplained chronic multisymptom illness. The Veteran failed to report for VA examinations that would have addressed whether hypertension is a medically unexplained chronic multisymptom illness. The evidence persuasively weighs against a finding that hypertension has an inconclusive pathophysiology or etiology and is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities

As for in-service elevated blood pressure readings, in-service stress, and in-service exposure to environmental toxins, there is no competent medical evidence that the Veteran's hypertension is related to in-service elevated blood pressure readings, in-service stress and in-service exposure to environmental toxins. VA treatment records do not contain a medical opinion indicating that hypertension is related to in-service elevated blood pressure readings, in-service stress and in-service exposure to environmental toxins. The Veteran failed to report for VA examinations that would have addressed whether hypertension is related to in-service elevated blood pressure readings, in-service stress, and in-service exposure to environmental toxins.

In the July 2024 claim, the Veteran attributed his hypertension to in-service stress. In the December 2025 written brief presentation, the Veteran's representative asserted that the hypertension may be related to in-service exposure to 2,4-D, Picloram, and cacodylic acid. The Board notes that although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issues in this case, the etiology of hypertension falls outside the realm of common knowledge of a lay person. See Jandreau, 492 F.3d at 1733 n. 4 (lay persons not competent to diagnose cancer).

As for the Veteran's claimed continuity of symptomatology of stress, the Veteran is competent to report this symptomatology and the Board finds him credible. Relating to hypertension to stress falls outside the realm of common knowledge of a lay person. Id. There is, however, no competent medical evidence of a nexus between the current diagnosis of hypertension to the continuity of symptomatology of stress. VA treatment records do not reveal that hypertension is due to stress. The Veteran failed to report for VA examinations that would have addressed whether hypertension is related continuity of symptomatology of stress.

The evidence persuasively weighs against a finding that hypertension is related to active service, including in-service elevated blood pressure readings, in-service stress, and in-service exposure to burn pits, fine particulate matter, and other environmental toxins. As such, Hickson element (3), medical nexus, is not established.

In regard to Wallin element (3), medical nexus, there is no competent medical evidence indicating that hypertension was caused or aggravated by the service-connected left ankle disability. VA treatment records do not reveal that hypertension was caused or aggravated by the service-connected left ankle disability. The Veteran failed to report for VA examinations that would have addressed whether hypertension was caused or aggravated by the service-connected left ankle disability.

In the December 2025 written brief presentation, the representative cited medical treatise evidence that the causal factors of primary or essential hypertension include sedentary lifestyle and that the main causes of secondary hypertension include non-steroidal anti-inflammatory drugs. The Court has held that "[g]enerally, an attempt to establish a medical nexus to a disease or injury solely by generic information in a medical journal or treat
no competent medical evidence indicating that hypertension was caused or aggravated by the service-connected left ankle disability. VA treatment records do not reveal that hypertension was caused or aggravated by the service-connected left ankle disability. The Veteran failed to report for VA examinations that would have addressed whether hypertension was caused or aggravated by the service-connected left ankle disability.

In the December 2025 written brief presentation, the representative cited medical treatise evidence that the causal factors of primary or essential hypertension include sedentary lifestyle and that the main causes of secondary hypertension include non-steroidal anti-inflammatory drugs. The Court has held that "[g]enerally, an attempt to establish a medical nexus to a disease or injury solely by generic information in a medical journal or treatise is too general and inconclusive." Mattern v. West, 12 Vet. App. 222, 228 (1999) (citing Sacks v. West, 11 Vet. App. 314, 317 (1998)). The Court has, however, also held that medical treatise evidence "standing alone, discusses generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least plausible causality based upon objective facts rather than on an unsubstantiated lay medical opinion." Wallin v. West, 11 Vet. App. 509, 514 (1998) (citing Sacks, 11 Vet. App. at 317 ).

While there is medical evidence of functional impairment from the left ankle disability, this medical treatise evidence standing alone does not discusses generic relationships with a degree of certainty such that, under the facts of this case, there is at least plausible causality based upon objective facts between the Veteran's hypertension and any sedentary lifestyle due to the service-connected left ankle disability. There is no medical evidence showing that the Veteran takes non-steroidal anti-inflammatory drugs. This medical treatise evidence standing alone does not discuss generic relationships with a degree of certainty such that, under the facts of this case, there is at least plausible causality based upon objective facts between the Veteran's hypertension and any side effects from use of non-steroidal anti-inflammatory drugs for the service-connected left ankle disability.

The Veteran claims that his hypertension is due to the left ankle disability. The Board again notes that the etiology of hypertension falls outside the realm of common knowledge of a lay person. See Jandreau, 492 F.3d at 1733 n. 4 (lay persons not competent to diagnose cancer).

The evidence persuasively weighs against a finding that hypertension was caused or aggravated by the service-connected left ankle disability, to include use of medications to treat that disability or sedentary lifestyle caused by that disability. Thus, Wallin element (3), medical nexus, is not established. The claim is denied.

4. Entitlement to service connection for a left knee disability, to include as secondary to in-service exposure to burn pits and other environmental toxins and as secondary to the service-connected left ankle disability

Analysis

Turning first to Hickson and Wallin element (1), current disability, VA treatment records reveal that in August 2023 a clinician noted a history of arthroscopic surgery of the left knee. Hence, Hickson and Wallin element (1), current disability, is established.

As to Hickson element (2) with regard to in-service disease or injury, service treatment records show that in May 1990 the Veteran reported recurring locking of both knees. X-rays were normal. A November 2024 VA memorandum and the Veteran's service personnel records show that the Veteran had Persian Gulf War service with service in Iraq. Given the evidence of in-service locking and in-service exposure to environmental toxins, Hickson element (2), in-service disease or injury, is met.

With regard to Wallin element (2), service-connected disability, service connection is in effect for a left ankle disability. Thus, Wallin element (2) is shown.

As for Hickson element (3), medical nexus, regarding whether the disability resulting in arthroscopic surgery of the left knee is a medically unexplained chronic multisymptom illness, there is no competent medical evidence that the disability resulting in arthroscopic surgery of the left knee has an inconclusive pathophysiology or etiology and is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. VA treatment records do not contain a medical opinion indicating that the disability resulting in arthroscopic surgery of the left knee is a medically unexplained chronic multisymptom illness. The Veteran failed to report for a VA examination that would have addressed whether the disability resulting in arthroscopic surgery of the left knee is a medically unexplained chronic multisymptom illness. The
the left knee is a medically unexplained chronic multisymptom illness, there is no competent medical evidence that the disability resulting in arthroscopic surgery of the left knee has an inconclusive pathophysiology or etiology and is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities. VA treatment records do not contain a medical opinion indicating that the disability resulting in arthroscopic surgery of the left knee is a medically unexplained chronic multisymptom illness. The Veteran failed to report for a VA examination that would have addressed whether the disability resulting in arthroscopic surgery of the left knee is a medically unexplained chronic multisymptom illness. The evidence persuasively weighs against a finding that the disability resulting in arthroscopic surgery of the left knee has an inconclusive pathophysiology or etiology and is characterized by overlapping symptoms and signs and has features such as fatigue, pain, disability out of proportion to physical findings, and inconsistent demonstration of laboratory abnormalities

As for in-service locking and in-service exposure to environmental toxins, there is no competent medical evidence that the Veteran's residuals of an arthroscopic surgery are related to in-service locking and in-service exposure to environmental toxins. VA treatment records do not contain a medical opinion indicating that residuals of an arthroscopic surgery are related to in-service locking and in-service exposure to environmental toxins. The Veteran failed to report for VA examinations that would have addressed whether residuals of an arthroscopic surgery are related to in-service locking and in-service exposure to environmental toxins. The evidence persuasively weighs against a finding that the left knee disability is related to active service, to include in-service locking and in-service exposure to burn pits, fine particulate matter, and other environmental toxins. As such, Hickson element (3), medical nexus, is not established.

In regard to Wallin element (3), medical nexus, there is no competent medical evidence indicating that the left knee disability was caused or aggravated by the service-connected left ankle disability. VA treatment records do not reveal that the left knee disability was caused or aggravated by the service-connected left ankle disability. The Veteran failed to report for VA examinations that would have addressed whether the left knee disability was caused or aggravated by the service-connected left ankle disability.

The Veteran claims that his left knee disability is due to the left ankle disability. The Board notes that the etiology of a knee disability requiring arthroscopic surgery falls outside the realm of common knowledge of a lay person. See Jandreau, 492 F.3d at 1733 n. 4 (lay persons not competent to diagnose cancer).

The evidence persuasively weighs against a finding that the left knee disability was caused or aggravated by the service-connected left ankle disability. Thus, Wallin element (3), medical nexus, is not established. The claim is denied.

5. Entitlement to service connection for hemorrhoids, to include as secondary to in-service exposure to burn pits and other environmental toxins and as secondary to hypertension

Governing law and regulations

The existence of a current disability is the cornerstone of a claim for VA disability compensation. Degmetich v. Brown, 104 F. 3d 1328 (1997). To be present as a current disability, the claimed condition must be present at the time of the claim for benefits, as opposed to sometime in the distant past. Gilpin v. West, 155 F. 3d 1353 (Fed. Cir. 1998). The Gilpin requirement that there be a current disability is satisfied when the disability is shown at the time of the claim or during the pendency of the claim, even though the disability subsequently resolves. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

Analysis

Turning to Hickson and Wallin element (1), current disability, the Veteran filed his claims for service connection for hemorrhoids in October 2024. His service treatment records from the Marine Corps do not reveal complaints of hemorrhoids or a diagnosis of hemorrhoids. At a July 1993 periodic exam, the Veteran denied any history of piles or rectal disease. The Veteran did not identify any treatment for hemorrhoids. VA treatment records do not show any diagnosis of hemorrhoids or complaints of rectal bleeding and pain. The Veteran failed to report for a VA examination in November 2024 that would have determined whether he currently has hemorrhoids.

The Veteran asserts that he currently has hemorrhoids. The Board notes that as to the specific issues in this case, the existence of hemorrhoids fall outside the realm of common knowledge of a lay person. See Jandreau, 492 F.3d at 1733 n. 4 (lay persons not
of hemorrhoids. At a July 1993 periodic exam, the Veteran denied any history of piles or rectal disease. The Veteran did not identify any treatment for hemorrhoids. VA treatment records do not show any diagnosis of hemorrhoids or complaints of rectal bleeding and pain. The Veteran failed to report for a VA examination in November 2024 that would have determined whether he currently has hemorrhoids.

The evidence persuasively weighs against a finding that the Veteran has or has had hemorrhoids during the appeal period. In short, the Board finds that Hickson and Wallin element (1), current disability, is not satisfied as to the claim of entitlement to service connection for hemorrhoids. The benefit sought on appeal is accordingly denied.

6. Entitlement to service connection for an acquired psychiatric disorder other than an alcohol-related disorder, to include as secondary to in-service exposure to burn pits and other environmental toxins and as secondary to the service-connected left ankle disability

Analysis

Turning to Hickson and Wallin element (1), current disability, the Veteran filed his claim for service connection for an anxiety disorder in October 2024. His service treatment records from the Marine Corps do not reveal complaints of anxiety or a diagnosis of anxiety disorder or other psychiatric disorder. At a July 1993 periodic exam, the Veteran denied any history of psychiatric symptomatology. The Veteran did not identify any treatment for an anxiety disorder . VA treatment records do not show any diagnosis of anxiety disorder. In August 2023, the depression and posttraumatic stress disorder (PTSD) screenings were negative. While the Veteran was informed in August 2023 that alcohol use can increase the risk of depression and anxiety, the clinician did not diagnose an anxiety or depressive disorder.. The Veteran failed to report for a VA examination in November 2024 that would have determined whether he currently has an acquired psychiatric disorder other than an alcohol-related disorder.

The Veteran asserts that he currently has an anxiety disorder. The Board notes that as to the specific issues in this case, the existence of an anxiety disorder falls outside the realm of common knowledge of a lay person. See Jandreau, 492 F.3d at 1733 n. 4 (lay persons not competent to diagnose cancer). As for the Veteran's reporting of an anxiety disorder, this assertion is not the reporting of a contemporaneous or later diagnosis of an anxiety disorder.

The evidence persuasively weighs against a finding that the Veteran has or has had an acquired psychiatric disorder other than an alcohol-related disorder during the appeal period. In short, the Board finds that Hickson and Wallin element (1), current disability, is not satisfied as to the claim of entitlement to service connection for an acquired psychiatric disorder other than an alcohol-related disorder. The benefit sought on appeal is accordingly denied.

7. Entitlement to service connection for an alcohol-related disorder, to include as secondary to in-service exposure to burn pits and other environmental toxins and as secondary to the service-connected left ankle disability

Governing law and regulations

No compensation shall be paid if the disability resulting from injury or disease in service is a result of the veteran's own willful misconduct or abuse of alcohol or drugs. 38 U.S.C. §§ 105, 1311. Direct service connection may be granted only when a disability was incurred or aggravated in line of duty, and not the result of the veteran's own willful misconduct or, for claims filed after October 31, 1990, the result of his abuse of alcohol or drugs. 38 C.F.R. § 3.301.

The simple drinking of alcoholic beverage is not of itself willful misconduct. However, the deliberate drinking of a known poisonous substance or under conditions which would raise a presumption to that effect will be considered willful misconduct. If, in the drinking of a beverage to enjoy its intoxicating effects, intoxication results proximately and immediately in disability or death, the disability or death will be considered the result of the person's willful misconduct. Organic diseases and disabilities which are a secondary result of the chronic use of alcohol as a beverage, whether out of compulsion or otherwise, will not be considered of willful misconduct origin. 38 C.F.R. § 3.301(c)(2).

An injury or disease incurred during active military, naval,
of alcoholic beverage is not of itself willful misconduct. However, the deliberate drinking of a known poisonous substance or under conditions which would raise a presumption to that effect will be considered willful misconduct. If, in the drinking of a beverage to enjoy its intoxicating effects, intoxication results proximately and immediately in disability or death, the disability or death will be considered the result of the person's willful misconduct. Organic diseases and disabilities which are a secondary result of the chronic use of alcohol as a beverage, whether out of compulsion or otherwise, will not be considered of willful misconduct origin. 38 C.F.R. § 3.301(c)(2).

An injury or disease incurred during active military, naval, or air service shall not be deemed to have been incurred in line of duty if such injury or disease was a result of the abuse of alcohol or drugs by the person on whose service benefits are claimed. For the purpose of this paragraph, alcohol abuse means the use of alcoholic beverages over time, or such excessive use at any one time, sufficient to cause disability of the user; drug abuse means the use of illegal drugs (including prescription drugs that are illegally or illicitly obtained), the intentional use of prescription or non-prescription drugs for a purpose other than the medically intended use, or the use of substances other than alcohol to enjoy their intoxicating effects. 38 C.F.R. § 3.301(d).

Analysis

The August 2023 VA treatment record revealed an assessment of excessive alcohol use. An alcohol-related disorder nonetheless is not a disability for which service connection can be granted. 38 U.S.C. §§ 105, 1110; 38 C.F.R. § 3.301.

Under the circumstances here presented, there is no legal basis upon which the Veteran can establish entitlement to service connection for alcohol-related disorder on direct basis. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994).

Turning to secondary service connection, based on the August 2024 VA treatment record showing an assessment of excessive alcohol use, Wallin element (1), current disability, is established. With regard to Wallin element (2), service-connected disability, service connection is in effect for a left ankle disability. Thus, Wallin element (2) is shown.

In regard to Wallin element (3), medical nexus, there is no competent medical evidence indicating that the alcohol-related disorder was caused or aggravated by the service-connected left ankle disability. VA treatment records do not reveal that the alcohol-related disorder was caused or aggravated by the service-connected left ankle disability. The Veteran failed to report for a VA examination in November 2024 that would have addressed whether the alcohol-related disorder was caused or aggravated by the service-connected left ankle disability. The evidence persuasively weighs against a finding that the alcohol-related disorder was caused or aggravated by the service-connected left ankle disability. Thus, Wallin element (3), medical nexus, is not established.

The benefit sought on appeal is accordingly denied.

REASONS FOR REMAND

The issue of entitlement to service connection for erectile dysfunction is being remanded to correct a duty-to-assist error that occurred prior to the November 26, 2024 rating decision. In the November 6, 2024, rating decision, the issue of entitlement to service connection for erectile dysfunction was deferred for a VA examination and medical opinion. In the November 26, 2024, the RO noted that the Veteran failed to report for the examination scheduled in conjunction with the claim of service connection for erectile dysfunction. The November 6, 2024, exam scheduling request, nonetheless, does not show that the Veteran was scheduled for an examination scheduled in conjunction with the claim of service connection for erectile dysfunction. The RO should have scheduled the Veteran for that examination.

The matter is REMANDED for the following action:

1. Schedule the Veteran for an examination to determine the nature and etiology of any erectile dysfunction. The examiner must opine on whether it is at least as likely as not it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any erectile dysfunction the Veteran has or had has an inconclusive etiology or pathophysiology. In rendering the opinion, the clinician must comment on whether the erectile dysfunction that the Veteran has or has had results from a partially understood or known etiology or pathophysiology. This determination must be based on the Veteran's specific case and cannot be based on the etiology of the disease or disability population as a whole.

The examiner must opine on whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any erectile dysfunction the Veteran has or had has is related to
least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any erectile dysfunction the Veteran has or had has an inconclusive etiology or pathophysiology. In rendering the opinion, the clinician must comment on whether the erectile dysfunction that the Veteran has or has had results from a partially understood or known etiology or pathophysiology. This determination must be based on the Veteran's specific case and cannot be based on the etiology of the disease or disability population as a whole.

The examiner must opine on whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any erectile dysfunction the Veteran has or had has is related to an in-service injury, event, or disease, including exposure to environmental hazards during service in the Persian Gulf region such as burn pits, fine particulate matter, smoke from Gulf War oil well fires, ethyl benzene, vanadium, P-xylene, and other toxins. The examiner is advised the VA has conceded exposure to a toxic exposure risk activity during his active military service. A November 2024 VA Memorandum confirmed the Veteran served in Iraq in 1990 and 1991 and that constituted toxic exposure per 38 U.S.C. §§ 1117 and 1119. When providing this opinion, the examiner must consider: 1) the total potential exposure through all applicable deployments; and 2) the synergistic, combined effect of all toxic exposure risk activities of the Veteran. The clinician should be advised that simply stating that erectile dysfunction is not a presumptive disorder under the statute for exposure to burn pits and other toxins or a presumptive disorder for exposure to fine particulate matter is not a medical rationale and that the clinician must give a rationale on whether erectile dysfunction is related to in-service exposure to burn pits and other toxins and in-service exposure to fine particulate matter.

MICHAEL LANE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Cherry, David T.

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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