HEARING LOSS

MELANIE J. MANN · 2026 · Case ID: A26011853

MIXED

Summary

The Veteran served in the U.S. Army from February 1985 to February 2005, including service in Southwest Asia from March 2003 to March 2004. The Veteran appeals the denial of service connection for multiple conditions, including bilateral hearing loss, hemorrhoids, migraine headaches, PTSD, persistent depressive disorder, generalized anxiety disorder, somatic symptom disorder, irritable bowel syndrome, dyspnea, chronic fatigue syndrome, fibromyalgia, abdominal pain syndrome, and bilateral hand tremors. The Board granted a 20% rating for recurring Bell's Palsy, finding the criteria met for severe incomplete paralysis of the facial cranial nerve. For all other claimed conditions, the Board denied service connection or an increased rating, finding the criteria were not met or that a current disability was not established. The Board found the Veteran's PTSD, PDD, GAD, and SSD to be subsumed by the service-connected PTSD. The case is remanded for a skin disorder, claimed as dermatosis of the arms, due to an inadequate VA examination and an insufficient private medical opinion from a chiropractor regarding the diagnosis. The VA examiner focused on pityriasis alba, potentially ignoring the Veteran's reported red patchy skin, and opined it was less likely than not related to TERA due to its unknown cause and potential link to eczema. The Board found the chiropractor not competent to diagnose skin conditions.

Rationale

No compensable rating criteria met; Hearing acuity within normal limits

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250701-560763

Full Decision Text

Citation Nr: A26011853
Decision Date: 02/09/26 Archive Date: 02/09/26

DOCKET NO. 250701-560763
DATE: February 9, 2026

ORDER

Entitlement to a compensable rating for bilateral hearing loss is denied.

Entitlement to a compensable rating for hemorrhoids is denied.

Entitlement to a 20 percent rating, but no higher, for recurring Bell's Palsy is granted.

Entitlement to a rating in excess of 30 percent for migraine headaches is denied.

Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is denied.

Entitlement to service connection for persistent depressive disorder (PDD) is denied.

Entitlement to service connection for somatic symptom disorder (SSD) is denied.

Entitlement to service connection for generalized anxiety disorder (GAD) is denied.

Entitlement to service connection for irritable bowel syndrome is denied.

Entitlement to service connection for dyspnea is denied.

Entitlement to service connection for chronic fatigue syndrome is denied.

Entitlement to service connection for fibromyalgia is denied.

Entitlement to service connection for abdominal pain syndrome is denied.

Entitlement to service connection for left hand tremors is denied.

Entitlement to service connection for right hand tremors is denied.

REMANDED

Entitlement to service connection for a skin disorder (claimed as dermatosis of the arms) is remanded.

FINDINGS OF FACT

1. The Veteran had no worse than Level I hearing acuity in each ear.

2. The Veteran did not have hemorrhoids that presented with persistent bleeding, anemia, or episodes of thrombosis.

3. The Veteran's recurring Bell's Palsy resulted in severe incomplete paralysis of the facial cranial nerve.

4. The Veteran's migraine headaches do not result in very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability.

5. The Veteran's PTSD has been manifested by symptomatology resulting in occupational and social impairment with reduced reliability and productivity.

6. The Veteran's PDD, GAD, and SSD are considered subsumed by the Veteran's service-connected PTSD.

7. The Veteran does not have a current irritable bowel disability.

8. The Veteran does not have a current dyspnea disability.

9. The Veteran does not have a current diagnosis of chronic fatigue syndrome.

10. The Veteran does not have a current diagnosis of fibromyalgia.

11. The Veteran does not have a current abdominal pain disorder.

12. The medical evidence of record shows that the Veteran does not have left hand tremors.

13. The medical evidence of record shows that the Veteran does not have right hand tremors.

CONCLUSIONS OF LAW

1. The criteria for entitlement to a compensable rating for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6100.

2. The criteria for entitlement to a compensable rating for hemorrhoids have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.114, Diagnostic Code 7336.

3. The criteria for entitlement to a 20 percent rating, but no higher, for recurring Bell's Palsy have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.59, 4.7, 4.124a, Diagnostic Code 8207.

4. The criteria for entitlement to a rating in excess of 30 percent for migraine headaches have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.124a, Diagnostic Code 8100.

5. The criteria for entitlement to a rating in excess of 50 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9440.

6. The criteria for entitlement to service connection for PDD have not been met. 38 U.S.C. §§ 1110,
; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.124a, Diagnostic Code 8100.

5. The criteria for entitlement to a rating in excess of 50 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9440.

6. The criteria for entitlement to service connection for PDD have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.14.

7. The criteria for entitlement to service connection for SSD have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.14.

8. The criteria for entitlement to service connection for GAD have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 4.14.

9. The criteria for entitlement to service connection for irritable bowel syndrome have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

10. The criteria for entitlement to service connection for dyspnea have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

11. The criteria for entitlement to service connection for chronic fatigue syndrome have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

12. The criteria for entitlement to service connection for fibromyalgia have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

13. The criteria for entitlement to service connection for abdominal pain syndrome have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

14. The criteria for entitlement to service connection for left hand tremors have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

15. The criteria for entitlement to service connection for right hand tremors have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from February 1985 to February 2005, to include service in Southwest Asia.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in May 2025 by a Department of Veterans Affairs (VA) Regional Office under the modernized appeals system known as the Appeals Modernization Act.

The Veteran submitted a July 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) and elected the evidence docket. Therefore, the Board may only consider the evidence of record at the time of the May 2025 rating decision, as well as any evidence submitted by the Veteran and his representative with, and within 90 days of the Board's receipt of, the VA Form 10182. 38 C.F.R. § 20.303(b). If evidence was submitted during a period of time when additional evidence was not allowed, the Board has not considered it in its decision. 38 C.F.R. § 20.300.

However, because the Board is remanding the claim of entitlement to service connection for a skin disability, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred
within 90 days of the Board's receipt of, the VA Form 10182. 38 C.F.R. § 20.303(b). If evidence was submitted during a period of time when additional evidence was not allowed, the Board has not considered it in its decision. 38 C.F.R. § 20.300.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 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).

Service connection may also be granted to a veteran who served in the Southwest Asia Theater of operations during the Persian Gulf War who exhibits objective indications of a qualifying chronic disability provided that such disability became manifest during either active service in the Southwest Asia theater of operations during the Persian Gulf War era or to a degree of 10 percent or more, under the appropriate diagnostic code of 38 C.F.R. Part 4, not later than December 31, 2026, and by history, physical examination, and laboratory tests, the disability cannot be attributed to any known clinical diagnosis. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(1).

In this case, the record reflects that the Veteran served in the Southwest Asia theater of operations from March 30, 2003, to March 10, 2004, and, therefore, such laws and regulations are applicable to his claims.

For purposes of these laws and regulations, a qualifying chronic disability means a chronic disability resulting from (A) An undiagnosed illness; (B) A medically unexplained chronic multisymptom illness (MUCMI) that is defined by a cluster of signs or symptoms such as: (1) chronic fatigue syndrome; (2) fibromyalgia; (3) irritable bowel syndrome; or (C) any diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C. § 1117(c) warrants a presumption of service connection. 38 U.S.C. § 1117(a).

For purposes of these regulations, the term MUCMI means a diagnosed illness without conclusive pathophysiology or etiology, that 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. Chronic multisymptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. 38 C.F.R. § 3.317 (a)(2)(ii).

"[O]bjective indications of chronic disability" include both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. 38 C.F.R. § 3.317(a)(3).

Signs or symptoms which may be manifestations of undiagnosed illness or medically unexplained chronic multi-symptom illness include, but are not limited to: (1) fatigue, (2) unexplained rashes or other dermatological signs or symptoms, (3) headache, (4) muscle pain, (5) joint pain, (6) neurological signs and symptoms, (7) neuropsychological signs or symptoms, (8) signs or symptoms involving the upper or lower respiratory system, (9) sleep disturbances, (10) gastrointestinal signs or symptoms, (11) cardiovascular signs or symptoms, (12) abnormal weight loss, and (13) menstrual disorders. 38 C.F.R. § 3.317 (b).

Additionally, a qualifying chronic disability shall be rated using evaluation criteria from Part 4 of Chapter 38 of the Code of Federal Regulations for a disease or injury in which the functions affected, anatomical localization, or symptomatology are similar.
symptoms, (3) headache, (4) muscle pain, (5) joint pain, (6) neurological signs and symptoms, (7) neuropsychological signs or symptoms, (8) signs or symptoms involving the upper or lower respiratory system, (9) sleep disturbances, (10) gastrointestinal signs or symptoms, (11) cardiovascular signs or symptoms, (12) abnormal weight loss, and (13) menstrual disorders. 38 C.F.R. § 3.317 (b).

In the case of claims based on a qualifying chronic disability under 38 U.S.C. § 1117 and 38 C.F.R. § 3.317, unlike those for direct service connection, there is no requirement of a nexus or association between the claimed disability and in-service incurrence or aggravation. Gutierrez v. Principi, 19 Vet. App. 1, 8-9 (2004).

The Board notes that a claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021). If "the positive and negative evidence is in approximate balance (which includes but is not limited to equipoise) the claimant receives the benefit of the doubt." Id.

Increased Ratings

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 v. West, 12 Vet. App. 119 (1999); 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.

1. Entitlement to a compensable rating for bilateral hearing loss.

The Veteran contends that the severity of his bilateral hearing loss warrants a higher rating than that currently assigned.

The appeal period before the Board begins on December 18, 2023, the date of the Veteran's intent to file a claim for an increased rating for bilateral hearing loss, plus the one-year look-back period. See Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010).

For the entire appeal period, the Veteran's bilateral hearing loss disability has been assigned a noncompensable rating under 38 C.F.R. § 4.85, Diagnostic Code 6100.

Ratings of hearing loss range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of speech discrimination tests combined with the average hearing threshold levels as measured by pure tone audiometry tests in the frequencies 1000, 2000, 3000, and 4000 cycles per second. To rate the degree of disability for service-connected hearing loss, the Rating Schedule has established eleven auditory acuity levels, designated from Level I, for essentially normal acuity, through Level XI, for profound deafness. 38 C.F.R. § 4.85(h), Table VI. In order to establish entitlement to a compensable rating for hearing loss, it must be shown that certain minimum levels of the combination of the percentage of speech discrimination loss and average pure tone decibel loss are met. The assignment of disability ratings for hearing impairment is derived by a mechanical application of the Rating Schedule to the numeric designations assigned after audiometric evaluations are rendered. Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992).

The criteria for rating hearing impairment use controlled speech discrimination tests (Maryland CNC) together with the results of pure tone audiometry tests. These results are then charted on Table VI, or Table VIA in exceptional cases as described in 38 C.F.R. § 4.86, and Table VII, as set out in the Rating Schedule. 38 C.F.R. § 4.85. An exceptional pattern of hearing loss occurs when the pure tone threshold at 1000, 2000, 3000, and 4000 Hertz is 55 decibels or more, or when the pure tone threshold is 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz. 38 C.F.R. § 4.86.

During a November 2024 private examination, a licensed chiropractor evaluated the Veteran's hearing and noted that "[t]oday his hearing is tested in a very quiet room, then again in a room wherein normal day to day noise (air conditioner, computer, and soft background music) is introduced to test functional hearing under normal day to day conditions. 256 cps, 512 cps stimuli are employed along with spoken words, and whispered words at a distance of 5 feet." The chiropractor reported that "[t]esting reveals that [the Veteran] has a bilateral hearing loss under normal conditions of approximately 40% of the right ear and 50% of the left ear." The chiropractor did not perform audiometric testing.

At the January 2025 VA examination, audiometric testing revealed the following pure tone thresholds in decibels at 1000, 2000, 3000, and 4000 Hertz, respectively: 20, 30, 65, 60 in the right ear, and 20, 50, 60, 65 in the left ear. No exceptional pattern of hearing loss was shown. The examiner noted that the pure tone threshold average was 43.75 decibels in the right ear and 48.75 decibels in the left ear. Speech discrimination scores were 96 percent in both ears. These audiometry test results equate to Level I hearing acuity in each ear pursuant to Table VI. Applying the percentage ratings for hearing impairment found in Table VII, such impairment results in a noncompensable rating.

The Board acknowledges the November 2024 private medical examination completed by a chiropractor, however the Board finds that the chiropractor is not competent to evaluate hearing loss. At the bottom of the November 2024 examination and medical opinion, the chiropractor included a "disclosure" in relation to all evaluated disabilities. She cites "chapter 460 of the Florida statutes" that provides chiropractic physicians "full diagnostic authority under said statute." See November 2024 Private Treatment Record. She quotes the statute as saying: "any chiropractic physician who has complied with the provisions of this chapter may examine, and diagnose the human living body and diseases . . . [based on any method] taught in any school of chiropractic." Id.

The Board is not bound by Florida statutes. The Board must assess the qualifications of examiners on an individual basis, based on all evidence of record. Regardless of whether Florida permits a chiropractor to diagnose and examine a person, the foundation for her examination is assessed by the Board based on her qualifications, not Florida statute. The chiropractor is a doctor of chiropractic medicine. Assessment of bilateral hearing loss is a particular field of
See November 2024 Private Treatment Record. She quotes the statute as saying: "any chiropractic physician who has complied with the provisions of this chapter may examine, and diagnose the human living body and diseases . . . [based on any method] taught in any school of chiropractic." Id.

The Board is not bound by Florida statutes. The Board must assess the qualifications of examiners on an individual basis, based on all evidence of record. Regardless of whether Florida permits a chiropractor to diagnose and examine a person, the foundation for her examination is assessed by the Board based on her qualifications, not Florida statute. The chiropractor is a doctor of chiropractic medicine. Assessment of bilateral hearing loss is a particular field of medicine, which the Board finds is outside the normal scope of a chiropractic doctor.

In light of the above, the Board does not find the chiropractor competent to evaluate the severity of the Veteran's bilateral hearing loss. Moreover, the chiropractor did not provide audiometric testing results necessary to evaluate the Veteran's bilateral hearing loss.

The Board acknowledges the Veteran's reports of difficulties associated with his bilateral hearing loss. However, even after considering such contentions as to the effects of the disability on his daily life, the Board finds that the criteria for a compensable evaluation are not met. See Lendenmann, supra. In this regard, in Doucette v. Shulkin, 28 Vet. App. 366, 369 (2017), the United States Court of Appeals for Veterans Claims (Court) held that the rating criteria for hearing loss contemplate the functional effects of decreased hearing and difficulty understanding speech in an everyday work environment as these are the effects that VA's audiometric tests are designed to measure. The Veteran has not otherwise described functional effects that are considered exceptional or that are not otherwise contemplated by the assigned evaluation. Id. Thus, his complete disability picture is compensated under the rating schedule.

The Board has also considered whether staged ratings under Hart, supra, are appropriate for the Veteran's service-connected bilateral hearing loss; however, the Board finds that his symptomatology has been stable throughout the appeal period. Therefore, assigning staged ratings for such disability is not warranted. Further, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, in regard to the increased rating claim decided herein. Doucette, 28 Vet. App. at 369.

The Board is grateful for the Veteran's honorable service, and this decision in no way is meant to detract from that service. However, given the record before it, an increased rating for bilateral hearing loss is not warranted at this time.

Accordingly, the Board finds a compensable rating for bilateral hearing loss is not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, the competent, probative evidence persuasively weighs against the Veteran's claim. Therefore, the benefit of the doubt doctrine is not applicable in the instant appeal, and his increased rating claim must be denied. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7.

2. Entitlement to a compensable rating for hemorrhoids

The Veteran contends that the severity of his hemorrhoids warrants a higher rating than that currently assigned.

The appeal period before the Board begins on December 18, 2023, the date of the Veteran's intent to file a claim for an increased rating for hemorrhoids, plus the one-year look-back period. See Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010).

For the entire appeal period, the Veteran's hemorrhoids have been assigned a noncompensable rating under Diagnostic Code 7336. See 38 C.F.R. § 4.114. Under Diagnostic Code 7336 a 10 percent rating is warranted for prolapsed internal hemorrhoids with two or less episodes per year of thrombosis; or external hemorrhoids with three or more episodes per year of thrombosis. A 20 percent rating is warranted for internal or external hemorrhoids with persistent bleeding and anemia; or continuously prolapsed internal hemorrhoids with three or more episodes per year of thrombosis.

During a November 2024 private examination by a chiropractor, the Veteran reported experiencing flare-ups of hemorrhoids "several times per year" with "pain, itching, and burning sensations" as well as occasional bleeding.

During the January 2025 VA examination, the Veteran reported that his symptoms had worsened and that he now experiences painful hemorrhoid episodes two to three times per year. The examiner noted that on examination the Veteran has solely external hemorrhoids
or external hemorrhoids with three or more episodes per year of thrombosis. A 20 percent rating is warranted for internal or external hemorrhoids with persistent bleeding and anemia; or continuously prolapsed internal hemorrhoids with three or more episodes per year of thrombosis.

Upon review, the Board finds that a compensable rating is not warranted for the Veteran's hemorrhoids. Specifically, the Board notes that the medical and lay evidence of record does not document persistent bleeding, anemia, or episodes of thrombosis.

The Board has considered whether staged ratings under Fenderson, supra, are appropriate for the Veteran's service-connected disabilities on appeal; however, the Board finds that his symptomatology has been stable throughout the appeal period. Therefore, assigning staged ratings is not warranted. Furthermore, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the increased rating claim adjudicated herein. See Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

Accordingly, the Board finds a compensable rating for hemorrhoids is not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, the competent, probative evidence persuasively weighs against the Veteran's claim. Therefore, the benefit of the doubt doctrine is not applicable in the instant appeal, and his claim must be denied. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7.

3. Entitlement to a 20 percent rating, but no higher, for recurring Bell's Palsy.

The Veteran contends that the severity of his recurring Bell's palsy warrants a higher rating than that currently assigned.

The appeal period before the Board begins on December 18, 2023, the date of the Veteran's intent to file a claim for an increased rating for recurring Bell's Palsy, plus the one-year look-back period. See Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010).

The Veteran's recurrent Bell's Palsy is currently rated under Diagnostic Code 8299-8207. 38 C.F.R. § 4.124a. Diagnostic Code 8299 refers to an unlisted neurological disability. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the evaluation assigned. The additional code is shown after the hyphen; unlisted disabilities requiring rating by analogy will be coded first the numbers of the most closely related body part and "99." In this case, the hyphenated diagnostic code may be read to indicate that a neurological disability is the service-connected disability, and it is rated as paralysis of the facial cranial nerve under Diagnostic Code 8207. Id.

Under Diagnostic Code 8207, a 10 percent rating is warranted for moderate incomplete paralysis of the facial cranial nerve. A 20 percent rating is warranted for severe incomplete paralysis of the facial cranial nerve. And a 30 percent rating is warranted for complete paralysis of the facial cranial nerve.

The terms "moderate" and "severe" are not defined in the rating schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to arrive at a just and equitable decision. Additionally, the use of such terminology by VA examiners and others, although an element to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6.

The term "incomplete paralysis" with peripheral nerve injuries indicates a degree of loss or impaired function substantially less than the type pictured
rating is warranted for complete paralysis of the facial cranial nerve.

The term "incomplete paralysis" with peripheral nerve injuries indicates a degree of loss or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to the varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be for mild, or at most, the moderate degree. See note at "Diseases of the Peripheral Nerves" in 38 C.F.R. § 4.124 (a). Thus, the terms "mild" and "moderate" each contemplate incomplete paralysis that is wholly sensory.

Neuritis, cranial or peripheral, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated at a maximum equal to severe, incomplete, paralysis. 38 C.F.R. § 4.123. Thus, the term "severe" indicates incomplete paralysis characterized by loss of reflexes, muscle atrophy, sensory disturbances, or constant, at times excruciating pain. The maximum rating which may be assigned for neuritis not characterized by the organic changes referred to above will be that for "moderate," or with sciatic nerve involvement, for "moderately severe," incomplete paralysis. Id. Thus, the term "moderate" indicates incomplete paralysis with no organic changes, or with sciatic nerve involvement, "moderately severe," incomplete paralysis.

In a November 2024 private examination by a chiropractor, the Veteran reported symptoms including "residual drooping of the left side of his face" and "paresthesia along the left mandibular region near the lip."

During the January 2025 VA examination, the Veteran reported twitching, numbness, and muscle weakness on the left side of his face. The examiner documented mild numbness, loss of muscle strength, and decreased light touch sensation on the left side of his face. The examiner indicated that the Veteran has incomplete moderate paralysis of the facial cranial nerve.

Upon review, the Board finds that the Veteran presents with severe symptomatology associated with his recurrent Bell's palsy. Specifically, the Board notes that during the January 2025 VA examination, the Veteran presented with sensory symptoms including numbness and twitching as well as loss of muscle strength and sensory disturbances including decreased light touch sensation indicating severe incomplete paralysis. However, as there is no evidence of complete paralysis of the Veteran's facial cranial nerve, a rating in excess of 20 percent is not warranted.

The Board has considered whether staged ratings under Fenderson, supra, are appropriate for the Veteran's service-connected disabilities on appeal; however, the Board finds that his symptomatology has been stable throughout the appeal period. Therefore, assigning staged ratings is not warranted. Furthermore, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record, with regard to the increased rating claim adjudicated herein. See Doucette, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

Accordingly, the Board finds that the Veteran's recurring Bell's palsy presented with severe incomplete paralysis of the facial cranial nerve. Thus, entitlement to a 20 percent rating, but no higher, for recurring Bell's palsy is warranted. See 38 C.F.R. § 4.124a, Diagnostic Code 8207.

4. Entitlement to a rating in excess of 30 percent for migraine headaches.

The Veteran contends that the severity of his migraine headaches warrants a higher rating than that currently assigned.

The appeal period before the Board begins on December 18, 2023, the date of the Veteran's intent to file a claim for an increased rating for migraine headaches, plus the one-year look-back period. See Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010).

The Veteran's migraine headache disability is currently rated under Diagnostic Code 8100. See 38 C.F.R. §
. § 4.124a, Diagnostic Code 8207.

4. Entitlement to a rating in excess of 30 percent for migraine headaches.

The Veteran contends that the severity of his migraine headaches warrants a higher rating than that currently assigned.

The Veteran's migraine headache disability is currently rated under Diagnostic Code 8100. See 38 C.F.R. § 4.124a. Under Diagnostic Code 8100, a 30 percent rating is warranted with characteristic prostrating attacks occurring on average once a month over the last several months. A 50 percent rating is warranted with very frequent completely prostrating headaches and prolonged attacks productive of severe economic inadaptability. In Johnson v. Wilkie, 30 Vet. App. 245, 247 (2018), the Court held that the rating criteria under DC 8100 are successive, meaning that a claimant cannot fulfill the criteria of the higher rating without fulfilling those of the next lower rating.

In November 2024, during a private examination by a chiropractor, the Veteran reported experiencing headaches approximately once per week and migraine symptoms one to two times per month. He noted that his migraine symptoms included light and sound sensitivity as well as visual disturbances. The chiropractor then opined that the Veteran's migraine headaches "last 24 -36 hours, are prostrating, and require he lay down in a dark and quiet room" and that he "will often have to miss work as result."

During the January 2025 VA examination, the Veteran reported constant headache pain that "impedes on his ability to work as a high school teacher" along with nauseam and sensitivity to light and sound. The examiner noted that the Veteran has characteristic prostrating attacks greater than once per month, but no completely prostrating attacks. The examiner noted that the functional impact of the Veteran's migraine headaches include difficulty focusing, which results in him "leav[ing] work early to go home to rest."

Upon review, the Board finds that the Veteran's migraine headaches do not present with very frequent completely prostrating and prolonged attacks. Specifically, the Board notes that the competent medical evidence of record shows that the Veteran has characteristic prostrating attacks but that his migraines do not present with completely prostrating attacks. See January 2025 VA medical examination.

The Board acknowledges the November 2024 private medical examination completed by a chiropractor, however the Board finds that the chiropractor is not competent to evaluate the severity of migraine headaches. At the bottom of the November 2024 examination and medical opinion, the chiropractor included a "disclosure" in relation to all evaluated disabilities. She cites "chapter 460 of the Florida statutes" that provides chiropractic physicians "full diagnostic authority under said statute." See November 2024 Private Treatment Record. She quotes the statute as saying: "any chiropractic physician who has complied with the provisions of this chapter may examine, and diagnose the human living body and diseases . . . [based on any method] taught in any school of chiropractic." Id.

The Board is not bound by Florida statutes. The Board must assess the qualifications of examiners on an individual basis, based on all evidence of record. Regardless of whether Florida permits a chiropractor to diagnose and examine a person, the foundation for her examination is assessed by the Board based on her qualifications, not Florida statute. The chiropractor is a doctor of chiropractic medicine. Assessment of neurological disabilities, including migraine headaches, is a particular field of medicine, which the Board finds is outside the normal scope of a chiropractic doctor. In light of the above, the Board does not find the chiropractor competent to evaluate the severity of the Veteran's migraine headaches.

In sum, the Board finds a rating in excess of 30 percent for migraine headaches is not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, the competent, probative evidence persuasively weighs against the Veteran's claim. Therefore, the benefit of the doubt doctrine is not applicable in the instant appeal, and his claim must be denied. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7.

5. Entitlement to a rating in excess of 50 percent for PTSD.

The Veteran contends that the severity of his PTSD warrants a higher rating than that currently assigned.

The appeal period before the Board begins on December 18, 2023, the date of the Veteran's intent to file a claim for an increased rating for PTSD, plus the one-year look-back period. See Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010).

The Veteran's PTSD is rated under Diagnostic Code 9440, which provides that such disability is evaluated pursuant to the General Rating Formula for Mental Disorders (General Rating Formula). 38?C.F.R. §?4.130. In pertinent part, the General Rating Formula provides a 50 percent rating is warranted when there is occupational and social impairment with reduced reliability and productivity, due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships.

A 70 percent rating is warranted when there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or work-like setting); and inability to establish and maintain effective relationships.

A 100 percent rating is warranted when there is total occupational and social impairment due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of closest relatives, own occupation, or own name.

The United States Court of Appeals for the Federal Circuit has held that the evaluation under 38?C.F.R. §?4.130 is "symptom-driven," meaning that "symptomatology should be the fact-finder's primary focus when deciding entitlement to a given disability rating" under that regulation. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-117 (Fed. Cir. 2013). The symptoms listed are not exhaustive, but rather "serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating." Mauerhan v. Principi, 16?Vet. App.?436, 442 (2002). In the context of determining whether a higher disability evaluation is warranted, the analysis requires considering "not only the presence of certain symptoms, but also that those symptoms have caused occupational and social impairment in most of the referenced areas" - i.e., "the regulation... requires an ultimate factual conclusion as to the Veteran's level of impairment in most areas." Vazquez-Claudio, 713 F.
117 (Fed. Cir. 2013). The symptoms listed are not exhaustive, but rather "serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating." Mauerhan v. Principi, 16?Vet. App.?436, 442 (2002). In the context of determining whether a higher disability evaluation is warranted, the analysis requires considering "not only the presence of certain symptoms, but also that those symptoms have caused occupational and social impairment in most of the referenced areas" - i.e., "the regulation... requires an ultimate factual conclusion as to the Veteran's level of impairment in most areas." Vazquez-Claudio, 713 F.3d at 117-118; 38?C.F.R. §?4.130, Diagnostic Code 9411.

Further, when evaluating a mental disorder, the Board must consider the "frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission," and must also "assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination." 38?C.F.R. §?4.126(a).

The Veteran's service-connected PTSD is rated as 50 percent disabling for the period on appeal. Therefore, to warrant a higher rating, the evidence must demonstrate manifestations that more nearly approximate occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and mood.

Upon review, the Board finds a rating in excess of 50 percent is not warranted at any time during the appeal period.

In a November 2024 private examination, the Veteran reported difficulty expressing emotions, detachment from others, hypervigilance, and loss of interest in activities. He reported that he is currently employed as a JROTC Instructor and works approximately 50 hours per week. The private psychologist documented symptoms of avoidance, persistent negative emotional state, markedly diminished interest in significant activities, detachment/estrangement from others, persistent inability to experience positive emotions, irritable behavior and angry outbursts with little to no provocation, exaggerated startle response, concentration problems, depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss, flattened affect, circumstantial speech, disturbances of motivation and mood, difficulty establishing or maintaining effective relationships, difficulty adapting to stressful circumstances, including work, obsessional rituals that interfere with routine activities, and impaired impulse control. The psychologist then opined that the Veteran's PTSD manifests with occupational and social impairment with reduced reliability and productivity.

During the January 2025 VA examination, the Veteran reported experiencing anxiety and irritability. He noted he has a good relationship with his partner and children, and maintains contact with friends. He noted that he prefers to remain at home and does not like interacting with people. The Veteran reported that his symptoms impact his job as a JROTC Instructor because he sometimes has difficulty at work, gets short tempered when anxious, and leaves work early. The examiner documenting symptoms including avoidance, persistent exaggerated negative beliefs, persistent negative emotional state, markedly diminished interest or participation in significant activities, feelings of detachment or estrangement from others, persistent inability to experience positive emotions, irritable behavior and angry outbursts, problems with concentration, sleep disturbances, depressed mood, anxiety, suspiciousness, disturbances of motivation and mood, difficulty in establishing and maintaining effective relationships, and difficulty in adapting to stressful circumstances including work. The examiner then opined that the Veteran's PTSD manifests with occupational and social impairment with reduced reliability and productivity.

During the January 2025 VA examination, the examiner observed that the Veteran was alert and oriented to person, place, time and situation, and was polite and cooperative throughout the examination. The examiner noted that the Veteran exhibited appropriate grooming and dress, and logical thinking. He reported there was "[n]o evidence of perceptual disturbances, paranoia, or delusional ideation" and the Veteran denied suicidal or homicidal ideation.

Notably, the evidence does not reflect suicidal ideation, speech intermittently illogical, obscure, or irrelevant, near-continuous panic or depression affecting the ability to function independently, appropriately and effectively, spatial disorientation, neglect of personal appearance and hygiene, or an inability to establish and maintain effective relationships, each of which fall within the rating criteria considered by the assignment of a 70 percent rating.

Although the Veteran did exhibit some symptoms contemplated by a 70 percent rating, including obsessional rituals, impaired impulse control, and difficulty in adapting to stressful circumstances, as recognized by the Court in Bankhead v. Shulkin, 29 Vet. App. 10 (2017), VA must engage in a holistic analysis in assessing the severity, frequency, and duration of the signs and symptoms of a veteran's service-connected psychiatric disability and their resulting social and occupational impairment.

In this respect, the medical evidence demonstrates the severity of the Veteran's behavioral symptoms were consistent with occupational and social impairment as contemplated by a 50 percent rating. Specifically, throughout the appeal period private physicians and VA examiners noted that the Veteran's symptoms did not cause deficiencies in most areas including work, school, family relations, judgment, thinking, and mood. See November 2024 private medical examination and January 2025 VA examination. Further, although the Veteran reported that he occasionally has to leave work due to his PTSD, he also reported an ability to maintain a schedule of working 50 hours per week as a JROTC instructor. Additionally, the medical and lay evidence of record shows that the Veteran has some social impairment, as indicated by his difficulty in establishing and maintaining effective work and social relationships, he did not report familial difficulties and in fact stated that he had good relationships with his family. Additionally, the Veteran's thinking was noted to be logical and appropriate to the situation.

In sum, the Board finds a rating in excess of 50 percent for PTSD is not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine. However, the competent, probative evidence persuasively weighs against the Veteran's claim. Therefore, the benefit of the doubt doctrine is not applicable in the instant appeal, and his claim must be denied. See 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7.

6. Entitlement to service connection for persistent depressive disorder (PDD)

7. Entitlement to service connection for somatic symptom disorder (SSD)

8. Entitlement to service connection for generalized anxiety disorder (GAD)

The Veteran contends that service connection is warranted for PDD, SSD, and GAD, in addition to his already service-connected PTSD.

The Board notes that the Veteran is currently service-connected for PTSD. See May 2025 rating decision and codesheet. Under 38 C.F.R. § 4.14, the "evaluation of the same disability under various diagnoses is to be avoided" as impermissible pyramiding.

In the November 2024 private psychologist's examination, the psychologist diagnosed the Veteran with PTSD, PDD, GAD, and SSD. The psychologist additionally noted that it is not possible to differentiate which symptoms belong to each diagnosis because "[s]ymptoms overlap within conditions."

In the January 2025 VA examination, the examiner noted the Veteran has only PTSD, without PDD, GAD, and SSD.

Upon review, the Board finds that the Veteran's currently service-connected PTSD includes his diagnosed PDD, GAD, and SSD. Specifically, the Board notes that although the November 2024 private psychologist noted that the Veteran has additional diagnoses, the Veteran's symptoms were indistinguishable. As the Veteran's symptoms are already being compensated under his rating for PTSD, the Board finds the Veteran's PDD, GAD, and SSD are subsumed under his current rating for PTSD. Further, any compensation for the same symptoms would constitute impermissible pyramiding. See 38

In the January 2025 VA examination, the examiner noted the Veteran has only PTSD, without PDD, GAD, and SSD.

Accordingly, entitlement to service connection independent of PTSD for PDD, GAD, and SSD are not warranted.

9. Entitlement to service connection for irritable bowel syndrome.

10. Entitlement to service connection for dyspnea.

11. Entitlement to service connection for chronic fatigue syndrome.

12. Entitlement to service connection for fibromyalgia.

13. Entitlement to service connection for abdominal pain syndrome.

14. Entitlement to service connection for left hand tremors.

15. Entitlement to service connection for right hand tremors.

The Veteran contends that service connection is warranted for irritable bowel syndrome, dyspnea, chronic fatigue syndrome, fibromyalgia, abdominal pain syndrome, and bilateral hand tremors.

July 2023 VA treatment records show that the Veteran denied experiencing hand tremors.

July 2024 VA treatment records document that the Veteran denied experiencing fatigue, shortness of breath, and diarrhea.

In September 2024 VA treatment records, the Veteran denied experiencing diarrhea, constipation, and abdominal pain.

In a November 2024 private examination, a chiropractor diagnosed the Veteran with chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, functional abdominal pain syndrome, and dyspnea based on the Veteran's reported symptoms.

In January 2025 VA examiners noted that the Veteran does not have currently diagnosed intestinal disabilities, to include irritable bowel syndrome or functional abdominal pain syndrome, chronic fatigue syndrome, fibromyalgia, bilateral hand tremors, or respiratory disabilities including dyspnea. X-ray evidence obtained in February 2025 confirm that the Veteran's respiratory system is normal.

Upon review, the Board finds that there is no medical or lay evidence of record documenting that the Veteran has a current diagnosis of irritable bowel syndrome, dyspnea, chronic fatigue syndrome, fibromyalgia, abdominal pain syndrome, or bilateral hand tremors. Specifically, the Board notes that the Veteran's treatment records show that he affirmatively denied experiencing the claimed symptoms. See July 2023, July 2024, and September 2024 VA treatment records. Further, VA examinations from January 2025 confirm that the Veteran does not have a current diagnosis of irritable bowel syndrome, dyspnea, chronic fatigue syndrome, fibromyalgia, abdominal pain syndrome, or bilateral hand tremors.

The Board acknowledges that the Veteran alternatively claimed that his symptoms are manifestations of an undiagnosed illness associated with his conceded toxic exposure risk activities (TERA) coincident with service Southwest Asia during the Persian Gulf War. However, to be considered manifestations of an undiagnosed illness, the evidence of record must show "objective indications of a qualifying chronic disability." 38 C.F.R. § 3.317(a)(1). Put another way, the medical evidence of record must show that the Veteran has the symptoms indicative of a undiagnosed illness. Here, the Veteran affirmatively denied having any symptoms associated with the claimed conditions, including fatigue, shortness of breath, diarrhea, constipation, and abdominal pain. See July 2023, July 2024, and September 2024 VA treatment records. The Board finds these records especially probative considering the fact that they were elicited while the Veteran sought treatment, rather than in connection with a claim for service connection.

The Board acknowledges the November 2024 private medical examination completed by a chiropractor, however the Board finds that the chiropractor is not competent to diagnose non-orthopedic disabilities. At the bottom of the November 2024 examination and medical opinion, the chiropractor included a "disclosure" in relation to all evaluated disabilities. She cites "chapter 460 of the Florida statutes" that provides chiropractic physicians "full diagnostic authority under said statute." See November 2024 Private Treatment Record. She quotes the statute as saying: "any chiropractic physician who has complied with the provisions of this chapter may examine, and diagnose the human living body and diseases . . . [based on any method] taught in any
connection.

The Board is not bound by Florida statutes. The Board must assess the qualifications of examiners on an individual basis, based on all evidence of record. Regardless of whether Florida permits a chiropractor to diagnose and examine a person, the foundation for her examination is assessed by the Board based on her qualifications, not Florida statute. The chiropractor is a doctor of chiropractic medicine. The claimed conditions are evaluated leveraging particular fields of medicine specific to each disability, which the Board finds are outside the normal scope of a chiropractic doctor.

In light of the above, the Board does not find the chiropractor competent to diagnose the Veteran with irritable bowel syndrome, dyspnea, chronic fatigue syndrome, fibromyalgia, abdominal pain syndrome, or bilateral hand tremors.

The fundamental requirement to a claim for service connection, based on any recognized theory of entitlement, is first establishing that the Veteran has the claimed disability, meaning either presently or at least at some point since or contemporaneous to the filing of the claim for the disability. See McClain v. Nicholson, 21 Vet. App. 319 (2007). This requires competent and credible (i.e., probative) evidence that a disability exists. In the absence of proof of present disability, there can be no valid claim because, for all intents and purposes, the inquiry ends if there is no current disability to attempt to relate or attribute to the Veteran's service. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

Accordingly, because the Veteran does not have a current diagnosis or adequate lay or medical evidence demonstrating irritable bowel syndrome, dyspnea, chronic fatigue syndrome, fibromyalgia, abdominal pain syndrome, or bilateral hand tremors, the claims must be denied.

The Board is grateful for the Veteran's honorable service, and this decision in no way is meant to detract from that service. However, given the record before it, service connection for irritable bowel syndrome, dyspnea, chronic fatigue syndrome, fibromyalgia, abdominal pain syndrome, or bilateral hand tremors is not warranted at this time.

REASONS FOR REMAND

16. Entitlement to service connection for a skin disorder (claimed as dermatosis of the arms) is remanded.

The Veteran contends that service connection is warranted for a skin disorder.

In November 2024 private medical examination a chiropractor diagnosed the Veteran with dermatosis and opined it is as likely as not that the Veteran's dermatosis is directly and causally related to the Veteran's TERA coincident with Southwest Asia service.

During the January 2025 VA examination, the Veteran reported that he "started noticing skin color change on his . . . arms back in the military" and that it has continued to recur since that time. He described his current symptoms as small red patches on his skin. The examiner diagnosed the Veteran with pityriasis alba characterized by small white spots on his bilateral arms. The examiner then opined that the Veteran's diagnosed pityriasis alba is less likely than not caused by the Veteran's TERA coincident with Southwest Asia service because "[t]he exact cause of pityriasis alba is unknown, but it is thought to be related to an overactive immune system or a mild form of eczema" and "is an over use condition and does not relate to a qualifying specific exposure event."

Upon review, the Board finds that the medical evidence is insufficient for the purposes of determining whether the Veteran has a current skin disability related to his TERA. Specifically, the Board finds the January 2025 VA examination inadequate because the examiner focused solely on a skin condition characterized by white spots, and appeared to ignore the Veteran's reports of red patchy skin. It is unclear from the examination if the Veteran did not present with these symptoms, or if the examiner did not report an additional rash. Further, during the medical opinion, the examiner noted that the diagnosed pityriasis alba can be related to other skin disabilities, such as ecz
"is an over use condition and does not relate to a qualifying specific exposure event."

The Board acknowledges the November 2024 private medical examination completed by a chiropractor, however the Board finds that the chiropractor is not competent to diagnose skin disabilities.

At the bottom of the November 2024 examination and medical opinion, the chiropractor included a "disclosure" in relation to all evaluated disabilities. She cites "chapter 460 of the Florida statutes" that provides chiropractic physicians "full diagnostic authority under said statute." See November 2024 Private Treatment Record. She quotes the statute as saying: "any chiropractic physician who has complied with the provisions of this chapter may examine, and diagnose the human living body and diseases... [based on any method] taught in any school of chiropractic." Id.

The Board is not bound by Florida statutes. The Board must assess the qualifications of examiners on an individual basis, based on all evidence of record. Regardless of whether Florida permits a chiropractor to diagnose and examine a person, the foundation for her examination is assessed by the Board based on her qualifications, not Florida statute. The chiropractor is a doctor of chiropractic medicine. Assessment of skin disabilities is a particular field of medicine, which the Board finds is outside the normal scope of a chiropractic doctor. In light of the above, the Board does not find the chiropractor competent to diagnose or assess skin disabilities.

The Board finds the aforementioned inadequacy of the November 2024 private medical examination and the January 2025 VA examination constitutes a pre-decisional duty to assist error and, as such, a remand for a new examination and medical opinion is warranted to correct such.

The matters are REMANDED for the following action:

Schedule the Veteran for an appropriate examination to determine the etiology of any current skin disorder.

A copy of the claims file, to include this Remand, must be made available to and reviewed by the examiner. All necessary testing should be conducted. Following a review of the record, the examiner is asked to provide the following:

A) Identify all skin disorders diagnosed during the pendency of the appeal.

B) Identify the date of onset of any diagnosed skin disorders.

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C) Offer an opinion as to whether it is at least as likely as not any current skin disorder had its onset in, or is otherwise related to, the Veteran's military service, to include as related to TERA coincident with Southwest Asia service.

The examiner is advised that the absence of evidence of continuous treatment of a skin disorder in the Veteran's treatment records cannot serve as the sole basis for a negative opinion. In this regard, if the examiner rejects the lay statements of record as to onset and/or a continuity of symptoms, to include the Veteran's description of red patchy skin during and following service, he or she should provide a reason for doing so beyond the mere lack of corroborating records.

Melanie J. Mann

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Webster, Rebecca

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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