BONE NEOPLASM BENIGN

Summary

The veteran, who served from October 1993 to October 2013, appeals the denial of service connection for a pubic bone disability. The Board noted that the veteran was presumed sound upon enlistment as no pubic bone injury was noted at that time. The veteran reported an in-service injury in June 2004 during combat training, initially diagnosed as a severe groin strain, which he believes caused his current pubic bone deformity. A September 2015 x-ray showed evidence of an old fracture of the left pubic symphysis bone related to this incident. The Board found the August 2020 VA examination inadequate because it failed to address the presumption of soundness and incorrectly focused on a pre-service accident. The veteran's testimony at the August 2024 hearing reiterated the in-service injury and denied pre-service injury. A private medical opinion in August 2024 linked the pubic bone deformity and osteoarthritis to the in-service fracture. The Board found the evidence nearly equal regarding the onset of the disability in service and resolved the doubt in the veteran's favor, granting service connection. The Board found the September 2015 x-ray and the August 2024 private opinion sufficiently linked the current disability to the in-service incident.

Rationale

Presumption of soundness applies due to no noted pre-service injury.; In-service injury (groin strain) linked to current pubic bone deformity via x-ray and private medical opinion.; Doubt resolved in veteran's favor due to nearly equal evidence.

Full Decision Text

Citation Nr: A26016613
Decision Date: 02/24/26	Archive Date: 02/24/26

DOCKET NO. 201018-117906
DATE: February 24, 2026

ORDER

Entitlement to service connection for a pubic bone disability is granted.

FINDING OF FACT

Resolving all doubt in the Veteran's favor, his pubic bone disability is related to service.

CONCLUSION OF LAW

The criteria for entitlement to service connection for a pubic bone disability have been met. 38 U.S.C. §§ 1101, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309. 

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from October 1993 to October 2013.

This matter comes to the Board of Veterans' Appeals (Board) on appeal from a September 2020 Department of Veterans Affairs (VA) regional office (RO) rating decision.

In the October 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held in August 2024.

Therefore, the Board may only consider the evidence of record at the time of the September 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.  To that end and based on these limitations, the Board is unable to review the evidence submitted contemporaneous to the October 2020 VA Form 10182.  The Federal Circuit's decision in Cash v. Collins, No. 2024-1811 (Fed. Cir. Feb. 5, 2026) does not apply as that case is limited to 38 U.S.C. § 7113(c)(2) (or cases without request for a hearing and with a request for additional evidence) and not 38 U.S.C. § 7113(b) (cases with request for a hearing).

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Service Connection

Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).  Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. § 3.303(d).

Under ordinary circumstances for veterans of active military wartime service or peacetime service on or after January 1, 1947, for purposes of 38 U.S.C. §§ 1110, 1131, and 1137, every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1132. 

The presumption of soundness may only be rebutted by clear and unmistakable evidence that the Veteran's disability was both preexisting and not aggravated by service.  Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004); 
, 1131, and 1137, every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service. 38 U.S.C. § 1132. 

The presumption of soundness may only be rebutted by clear and unmistakable evidence that the Veteran's disability was both preexisting and not aggravated by service.  Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004); 38 C.F.R. § 3.304(b). This statutory provision is referred to as the "presumption of soundness." Horn v. Shinseki, 25 Vet. App. 231, 234 (2012). In VAOGCPREC 3-2003, VA's General Counsel reinforced that the presumption of soundness is rebutted only where clear and unmistakable evidence shows both that the disorder existed prior to service and that it was not aggravated by service. The General Counsel concluded that 38 U.S.C. § 1111 requires VA to bear the burden of showing the absence of aggravation in order to rebut the presumption of sound condition. See Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004). 

This presumption is only rebutted where the evidence clearly and unmistakably shows that the Veteran's disability both existed before acceptance and enrollment into service and was not aggravated by service. See Wagner, 370 F.3d at 1096; Bagby v. Derwinski, 1 Vet. App. 225 (1991). The two parts of this rebuttal standard are referred to as the "preexistence prong" and the "aggravation prong." Horn, 25 Vet. App. at 234. 

Entitlement to service connection for a pubic bone disability

The Veteran contends that his pubic bone disability is related to service.  Of note, the September 2020 rating decision favorably found that new and relevant evidence was submitted to reconsider the claim, that he was diagnosed with a current disability (left pubic bone deformity), and was diagnosed in-service (June 2004) with a left inguinal strain.  The Board is bound by these findings.  38 U.S.C. § 5104A.  Therefore, the last remaining determination is whether there is a nexus between the current disability and in-service treatment.

Also preliminarily, the October 1993 enlistment examination failed to note any pubic bone injury upon entry into service.  As such, the Veteran is presumed sound and this case proceeds under regular service connection criteria.  See 38 C.F.R. § 3.304(b) (stating that "only conditions as are recorded in examination reports are to be considered as noted.").

The Veteran is currently diagnosed with left pubic bone deformity and was seen for what was then identified as a left inguinal strain in June 2004.  The September 30, 2015, x-ray showed "evidence of old fracture of left pubic symphysis bone...He recalls he was doing combat training as federal agent more than 2 years ago and someone landed on top of him during mat training exercises and how he had left sided hip pain after that particular session." 

An August 2020 VA examiner opined that it was less likely than not that the Veteran's pubic bone disability was related to service as the "Pubic bone is a very stable structure, fractures are typically seen with traumatic accidents such as a fall or car accident. Review of records did not show evidence of pubic bone fracture or circumstances to create a pubic bone deformity while in service...Veteran was involved in a car accident in 1992, prior to service."  The Board finds this examination inadequate in light of the Board's above determination that the Veteran is presumed sound upon enlistment into service.  Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004).

At the August 2024 hearing, the Veteran reiterated the circumstances of his injury, relayed that it was to the same area that is currently painful, and that while he was involved in a 1992 accident, he was not injured during such.

In an August 2024 private medical opinion, the examiner stated that the Veteran was "injured during combat defensive tactics in 2004 where he was initially diagnosed with a severe groin strain."  After review of the medical records, the examiner opined that the "deformity of the pubic bone sym
 the Veteran is presumed sound upon enlistment into service.  Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004).

At the August 2024 hearing, the Veteran reiterated the circumstances of his injury, relayed that it was to the same area that is currently painful, and that while he was involved in a 1992 accident, he was not injured during such.

In an August 2024 private medical opinion, the examiner stated that the Veteran was "injured during combat defensive tactics in 2004 where he was initially diagnosed with a severe groin strain."  After review of the medical records, the examiner opined that the "deformity of the pubic bone symphysis and osteoarthritis in his pelvic region [are] directly related to the fracture sustained during training."

Based on the above, the Board finds that service connection is warranted.  The eligible evidence supports a conclusion that the in-service June 2004 injury was "initially diagnosed [as] a severe groin strain," but a September 30, 2025, x-ray actually revealed, "evidence of old fracture of left pubic symphysis bone" due to that incident.  In sum, the September 30, 2015, x-ray and August 2024 private opinion sufficiently link the current disability to in-service incident.  38 C.F.R. § 3.303(d).   

After reviewing the above, the Board finds that the evidence is "nearly equal" as to whether his pubic bone disability onset in service.  Lynch v. McDonough, 999 F.3d 1391 (Fed. Cir. 2021).  While the Board could obtain another VA examination, remand is unnecessary at this juncture as the evidence is nearly equal.  Mariano v. Principi, 17 Vet. App. 305 (2003) (holding that the Board is prohibited from developing additional evidence for the purpose of obtaining evidence against a claimant's case).  The claim is granted. 

 

M. C. WILSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Finelli, Christopher

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.