FINGER IMPAIRMENT OF

EMILY TAMLYN · 2026 · Case ID: A26024723

MIXED

Summary

The veteran, who served in the U.S. Army from August 1995 to September 1997, with subsequent service in the California Army National Guard and U.S. Army Reserves, appeals the denial of service connection for several conditions. The primary issues on appeal were entitlement to service connection for a right fifth finger disorder (including tendonitis), a perianal abscess, a skin disorder, a lumbar spine disorder, a headache disorder (including migraines), fatigue, and painful joints. The Board granted service connection for the right fifth finger disorder, perianal abscess, and skin disorder, finding the evidence in approximate balance and resolving reasonable doubt in the veteran's favor, particularly given the inadequacy of the VA medical opinions. The Board denied service connection for the lumbar spine disorder, headache disorder, fatigue, and painful joints, finding the evidence persuasively weighed against these claims, noting inconsistencies in the veteran's reports and lack of corroborating evidence. The case was remanded for further development and readjudication of entitlement to service connection for a pelvic disorder (including UTIs) and GERD, as the prior VA examinations were deemed inadequate for failing to fully develop the veteran's claims and reports.

Rationale

Approximate balance of evidence; Resolved reasonable doubt in veteran's favor; Inadequate VA medical opinions; Consistent lay evidence

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

201008-114960

Full Decision Text

Citation Nr: A26024723
Decision Date: 03/19/26 Archive Date: 03/19/26

DOCKET NO. 201008-114960
DATE: March 19, 2026

ORDER

Entitlement to service connection for a right fifth finger disorder, to include tendonitis, is granted.

Entitlement to service connection for a perianal abscess is granted.

Entitlement to service connection for a skin disorder is granted.

Entitlement to service connection for a lumbar spine disorder is denied.

Entitlement to service connection for a headache disorder, to include migraines, is denied.

Entitlement to service connection for fatigue is denied.

Entitlement to service connection for painful joints is denied.

REMANDED

Entitlement to service connection for a pelvic disorder, to include recurrent urinary tract infections (UTI), is remanded.

Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded.

FINDINGS OF FACT

1. There is an approximate balance of evidence showing that the Veteran's right fifth finger disorder, to include tendonitis, is related to her active military service.

2. There is an approximate balance of evidence showing that a perianal abscess is related to her active military service.

3. There is an approximate balance of evidence showing that the Veteran's skin disorder is related to her active military service.

4. The evidence of record persuasively weighs against finding that a lumbar spine disorder began during active service or is otherwise related to an in-service injury or disease.

5. The evidence of record persuasively weighs against finding that a headache disorder, to include migraines, began during active service or is otherwise related to an in-service injury or disease.

6. The evidence of record persuasively weighs against finding that the Veteran has had a diagnosis of fatigue at any time during or approximate to the pendency of the claim.

7. The evidence of record persuasively weighs against finding that the Veteran has had a diagnosis of painful joints at any time during or approximate to the pendency of the claim.

CONCLUSIONS OF LAW

1. The criteria for service connection for a right fifth finger disorder, to include tendonitis, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for a perianal abscess are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for a skin disorder are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for service connection for a lumbar spine disorder are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

5. The criteria for service connection for a headache disorder, to include migraines, are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for service connection for fatigue are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

7. The criteria for service connection for painful joints are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the U.S. Army from August 1995 to September 1997. She also had service in the California Army National Guard and the U.S. Army Reserves.

The rating decision on appeal was issued in September 2020 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In August 2020, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of entitlement to service connection for a lumbar spine disorder, bacterial vaginosis, fatigue, GERD, migraines, painful joints, perianal abscess, skin disorder, and a right fifth finger disorder most recently addressed in a
August 1995 to September 1997. She also had service in the California Army National Guard and the U.S. Army Reserves.

The rating decision on appeal was issued in September 2020 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In August 2020, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of entitlement to service connection for a lumbar spine disorder, bacterial vaginosis, fatigue, GERD, migraines, painful joints, perianal abscess, skin disorder, and a right fifth finger disorder most recently addressed in a July 2020 rating decision. In September 2020, the agency of original jurisdiction (AOJ) issued the supplemental claim decision on appeal, which found that new and relevant evidence had been received and denied the claims based on the evidence of record at the time of that decision.

In the September 2020 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held in July 2024; a copy of the transcript is of record.

Therefore, the Board may only consider the evidence of record at the time of the September 2020 AOJ decision on appeal, as well as any evidence submitted by the Veteran, or representative, 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.

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 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.

However, because the Board is remanding the claims of entitlement to service connection for a pelvic disorder, to include UTIs, and GERD, 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).

As a point of clarification, the Board notes that there were several rating decisions issued prior to the Veteran's filing of the October 2020 Notice of Disagreement. At the July 2024 Board hearing, it was clarified on the record that the Veteran is appealing the September 2020 rating decision, as noted above.

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. §§ 1110, 1131. Establishing service connection generally requires competent evidence of three elements: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. 38 C.F.R. § 3.303 (a). Service connection may be granted for any disease diagnosed after separation when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d).

Certain chronic diseases, including arthritis, may be service connected on a presumptive basis if manifested to a compensable degree in a specified period of time post-service. 38 U.S.C. §§ 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. That period of time is usually one year. 38 C.F.R. § 3.307 (a)(3). 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).

Under 38 C.F.R. § 3.303 (b), an alternative method of establishing an in-service disease or injury and a nexus for chronic diseases is through a demonstration of continuity of symptomatology. Barr v. Nicholson, 21 Vet. App. 303 (2007); see Savage v. Gober,
. §§ 3.307, 3.309. That period of time is usually one year. 38 C.F.R. § 3.307 (a)(3). 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).

Under 38 C.F.R. § 3.303 (b), an alternative method of establishing an in-service disease or injury and a nexus for chronic diseases is through a demonstration of continuity of symptomatology. Barr v. Nicholson, 21 Vet. App. 303 (2007); see Savage v. Gober, 10 Vet. App. 488, 495-97 (1997); see also Clyburn v. West, 12 Vet. App. 296, 302 (1999). 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, 10 Vet. App. at 495-96; 38 C.F.R. § 3.303 (b).

Lay assertions may serve to support a claim for service connection by establishing the occurrence of observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C. § 1154 (a); 38 C.F.R. § 3.303 (a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). Lay evidence can be competent and sufficient to establish a diagnosis or etiology when (1) a lay person is competent to identify a medical condition; (2) the lay person is reporting a contemporaneous medical diagnosis or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

Duty to Notify and Assist

VA has a duty to notify and assist claimants in substantiating a claim for VA benefits. See 38 U.S.C. §§ 5103(a), 5103A; 38 C.F.R. § 3.159. The Board emphasizes that the Veteran has not raised a specific concern with respect to any notification or additional assistance with respect to this appeal.

Here, the AOJ requested service treatment records (STRs). See March 2019 VA 21-3101 Request for Information. AMEDD Records Processing Center responded in July 2019 that a thorough review of all Department of Defense (DOD) systems had been accomplished. It was noted that the bulk of the STRs are electronic and there is minimal paper in the file. Further, it was noted that dental records were missing and that no other STRs were available. See July 2019 DD 2963 Service Treatment Record Transfer or Certification.

The AOJ sent the Veteran a July 2019 letter notifying her that the STRs were unavailable. It advised her about alternative records that may substitute for STRs and how to submit such records. See July 2019 Correspondence.

Given these search actions, it appears that further STR search efforts would be futile. The Board finds that VA has made the required efforts to obtain the missing STRs. See 38 C.F.R. § 3.159(c)(2). In these circumstances, the duty to assist does not require additional action on the part of VA. There has been no contention to the contrary.

1. Entitlement to service connection for a right fifth finger disorder, to include tendonitis

2. Entitlement to service connection for residuals of a perianal abscess

The Veteran seeks service connection for a right fifth finger disorder, to include tendonitis, and for residuals of a perianal abscess. The Veteran contends that she incurred these disorders during active military service.

In the September 2020 rating decision on appeal, the AOJ made the favorable findings that the Veteran has a current diagnosis of right fifth finger tendonitis and that a November 1996 service treatment record shows a qualifying event, injury, or disease had its onset during service. Further, the AOJ made the favorable findings that a diagnosis of perianal abscess was rendered during service, and that a December
, to include tendonitis

2. Entitlement to service connection for residuals of a perianal abscess

Turning to the record, the Veteran's service treatment records reveal a February 1995 Report of Medical Examination at the time of enlistment that showed normal clinical evaluations of the anus and rectum and other musculoskeletal systems. In December 1995, the Veteran was seen and treated for a painful lesion on the left buttock, for which the Veteran was referred to surgery clinic. In November 1996, the Veteran reported that she injured the fifth digit on the right hand after she tripped and the weapon fell on it. She was assessed with a sprain in her right fifth finger. In a June 1997 Report of Medical Examination at the time of separation, a clinical evaluation of the anus and rectum was deferred and a normal clinical evaluation for other musculoskeletal was noted.

In February 2019, the Veteran was afforded a VA examination for her hand. A Diagnosis of tendonitis for the right fifth finger was rendered. The Veteran reported that she fell in-service and injured her finger and that it was treated with a splint. The examiner opined that the Veeran's right fifth finger tendonitis was not the result of the Veteran's military service. Rather, the examiner indicated that there was no evidence of ongoing finger pain at the time of separation, therefore, the Veteran's finger pain is not due to service.

Likewise, a February 2019 VA examination found that the Veteran did not have any diagnosis of a muscle injury. The Veteran reported that she had a perianal abscess during service that was drained, and that she continued to have pain in her buttocks. In February 2019 VA opinion, the examiner opined that the Veteran's perianal abscess was not due to service. The examiner noted that the Veteran claimed persistent pain in the buttocks and recurrent bleeding and raining from the site. However, there was no report of recurrence at the time of separation, and the current examination did not show any evidence of abscess/cyst or skin breakdown.

In July 2024, the Veteran testified at a Board hearing. She explained that the perianal abscess began during basic training. She further testified that the perianal abscess did not heal properly and that she continues to experience tears in the area. The Veteran also described that during service she injured the fifth finger on her right hand after tripping. She testified that she experiences pain in this digit, especially during the winter.

When assessing the probative value of a medical opinion, the access to claims files and the thoroughness and detail of the opinion must be considered. The opinion is considered probative if it is definitive and supported by detailed rationale. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000). The Court has held that claims file review, as it pertains to obtaining an overview of a claimant's medical history, is not a requirement for private medical opinions. A medical opinion that contains only data and conclusions is not entitled to any weight. Further, a review of the claims file cannot compensate for lack of the reasoned analysis required in a medical opinion, which is where most of the probative value of a medical opinion comes from. "It is the factually accurate, fully articulated, sound reasoning for the conclusion, not the mere fact that the claims file was reviewed, that contributes probative value to a medical opinion." Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2009).

The Board finds the February 2019 VA medical opinions are of less persuasive value. In this regard, the VA examiners rendered negative etiological based solely on the absence of treatment records without considering the Veteran's reports of continued impairment from the right fifth finger injury and from the perianal abscess.

Nevertheless, in adjudicating this claim, the Board must assess the competence and credibility of the Veteran and probative value of the
the factually accurate, fully articulated, sound reasoning for the conclusion, not the mere fact that the claims file was reviewed, that contributes probative value to a medical opinion." Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2009).

Nevertheless, in adjudicating this claim, the Board must assess the competence and credibility of the Veteran and probative value of the evidence of record in its whole. See Washington v. Nicholson, 19 Vet. App. 362 (2005), 38 C.F.R. § 3.159(a)(2) (Lay evidence is competent if it is provided by a person who has knowledge of the facts or circumstances and conveys matters that can be observed and described by a lay person). In determining whether documents submitted by a veteran are credible, the Board may consider internal consistency, facial plausibility, and consistency with other evidence submitted on behalf of the claimant. Caluza v. Brown, 7 Vet. App. 498 (1995). In this case the Veteran is competent to report her diagnoses of right fifth finger tendonitis and perianal abscess in-service, with residuals post-service. As shown above and by the evidence of record, the Veteran's reports have been consistent. Also, the Board finds the objective evidence indicates that the Veteran has diagnoses pertaining to her right fifth finger and her perianal abscess. Therefore, the Board assigns these statements asserting current diagnoses and how she experiences them significant weight.

Based on the evidence as discussed above, the evidence is in approximate balance as to whether the Veteran's right fifth finger disorder, to include tendonitis, and perianal abscess are caused by the Veteran's active military service. See 38 C.F.R. § 3.102. The AOJ rendered the favorable findings that the Veteran has diagnoses of right fifth finger tendinitis and perianal abscess, and that there were qualifying in-service events with respect to each of these claims. Moreover, the VA medical opinions in the record are inadequate, and there are no contrary opinions in the record. Therefore, resolving reasonable doubt in the Veteran's favor, separate grants of entitlement to service connection for a right fifth finger disorder, to include tendonitis, and entitlement to service connection for a perianal abscess are warranted.

3. Entitlement to service connection for a skin disorder

The Veteran contends that she has a skin disorder that began during service and she seeks service connection.

Turning to the record, the Veteran's service treatment records reveal an August 1996 encounter that shows the Veteran was assessed with folliculitis behind the thighs. A Report of Medical Examination from June 1997 reveals a normal clinical evaluation of the skin.

Private treatment records from June 2015 reveal that the Veteran was diagnosed with contact dermatitis.

In July 2024, the Veteran testified at a Board hearing. The Veteran described that she started getting rashes during service due to unsanitary conditions. She further explained that she continues to get rashes that she treats with steroid cream.

In September 2024, the Veteran submitted an August 2024 private clinician report that revealed a diagnosis of macular amyloidosis. The clinician explained that macular amyloidosis is due to prolonged periods of friction or rubbing of the back, which results in chronic mild to severe pruritus. The clinician opined that the Veteran's current skin disorder was incurred in or caused by her military service.

The Board finds this medical opinion is fully adequate. Here, the opinion writer fully addressed the nexus question. The opinion reflects that the writer reviewed the file and provided an informed opinion fully responsive to the question at issue. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). This opinion is valuable and is afforded great weight.

In light of the evidence as discussed above, the Board finds that the evidence is at least in approximate balance as to whether the Veteran's skin disorder began in service and the symptoms of her skin disorder have continued since service to the present. The evidence documents that the Veteran's complaint of skin irritation while in service and post-service treatment records confirm that the Veteran has macular amyloidosis. Moreover, there are no contrary opinions in the record. Therefore, resolving reasonable doubt in the Veteran's favor, entitlement to service connection for a skin disorder is warranted.

4. Entitlement to service connection for a lumbar spine
ake, 22 Vet. App. 295 (2008). This opinion is valuable and is afforded great weight.

4. Entitlement to service connection for a lumbar spine disorder

5. Entitlement to service connection for a headache disorder, to include migraines

The Veteran seeks service connection for a lumbar spine disorder and a headache disorder, to include migraines, which she asserts are attributable to her active military service.

In the September 2020 rating decision, the AOJ made the favorable findings that the Veteran has diagnoses of lower back sprain and migraine. The AOJ also made the favorable finding that the Veteran reported a complaint of acute low back pain and a complaint of headache. The Board is bound by these favorable findings.

Turning to the record, the Veteran's service treatment record reveal a May 1996 encounter in which the Veteran complained of headaches and was assessed with an upper respiratory infection. In October 1995, the Veteran complained of upper and lower back pain and was assessed with overuse. In May 1997, the Veteran complained of headaches and was assessed with an upper respiratory infection. A June 1997 Report of Medical History at the time of separation reveals that the Veteran denied frequent or severe headache and recurrent back pain. A June 1997 Report of Medical Examination at the time of separation reveals a normal clinical evaluation of the spine.

In February 2019, the Veteran was afforded a VA examination with respect to her claim for a headache disorder. A diagnosis of migraine was rendered and an onset in 1999 was noted. The examiner opined that the Veteran's headache disorder was not incurred in or caused by service. The examiner explained that the Veteran reported that she was not diagnosed with migraines until 1999, which is post-service. Further, the examiner noted that at the time of separation the Veteran denied frequent or severe headaches.

In July 2020, the Veteran was afforded a VA examination with respect ot her claim for a lumbar spine disorder. A diagnosis of degenerative arthritis of the spine was rendered and an onset of July 2020 was noted. The examiner opined that the Veteran's lumbar spine disorder was not incurred in or caused by active military service. The examiner noted that service treatment records show evidence of a back complaint in 1995, however, there is no evidence of chronic back complaints or treatments since service. Rather, the back complaint during service was acute only.

In July 2020, the Veteran submitted a statement from her spouse in support of her claims. The Veteran's spouse described that the Veteran began experiencing back pain during service due to wearing heavy gear and her job in a warehouse. He further related that she experienced constant headaches from the being out in the heat during service.

In August 2020, the Veteran submitted private physical therapy records. However, these records pertain to physical therapy of the neck and shoulder and do not give any indication as to the etiology of the Veteran's claimed lumbar spine disorder.

In July 2024, the Veteran testified at a Board hearing that she injured her back during basic training due to the significant weight from required gear during marches. She explained that there was not one particular incident or situation that happened during service, rather it was a wear-and-tear type of injury from overuse. The Veteran testified that she began lumbar spine treatments around 2001 and that she continues to get shots in her back as treatment. Further, the Veteran testified that the stressful circumstances of her service caused her headaches during service.

The Board finds the February 2019 and July 2020 medical opinions are fully adequate. Here, the opinion writers fully addressed the nexus question. The opinions reflect that the writer reviewed the file and provided informed opinions fully responsive to the questions at issue. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). These opinions are valuable and are afforded great weight.

The Board finds that service connection for a lumbar spine disorder and a headache disorder is not warranted. Specifically, the Veteran's service treatment records reflect one instance of a complaint of low back pain which was assessed as overuse at the time of the encounter. Moreover, at the time of separation the Veteran denied recurrent back pain. Although the Veteran testified that she continued to experience back pain since service, the July 2020 VA examiner determined that the symptoms experienced during service were acute only.

Likewise, the Veteran's service treatment records reflect two instances of complaints of headache symptoms, both of which were attributed to upper respiratory infections. Further, at the time of separation, the Veteran denied experiencing frequent or severe headaches. Moreover, the July 2020 VA medical opinion explained that the Veteran's headache disorder is not the result of her service, but rather was an acute occurrence and is not chronic.

The Veteran is competent to describe observable symptoms of low back pain and headaches. However, based on the cited information above, the Board finds that the there is inconsistencies in the record to the extent that there is the assertion that there has been continuity of symptomatology since service. For example, a lack of reporting or clinical findings about these issues at separation. Other issues, such as pregnancy, were reported at separation. As a result, the lay evidence is assigned less weight.

Thus, for the reasons discussed, the evidence for the claims versus the evidence against is not in approximate balance; instead, the most probative and, therefore, most persuasive evidence is against the claims. See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Service connection for a lumbar spine disorder and a headache disorder is denied.

6. Entitlement to service connection for fatigue

7. Entitlement to service connection for painful joints

The Veteran seeks service connection for fatigue and painful joints, which she asserts are attributable to her active military service.

Turning to the record, the Veteran's service treatment records (STRs) are silent as to any diagnosis or treatment for fatigue or joint pain during active service. A June 1997 report of medical history from the time of separation reveals that the Veteran denied painful shoulder and locked knee. A June 1997 Report of Medical Examination reveals a normal clinical evaluation of the upper and lower extremities and a normal clinical evaluation of the spine, other musculoskeletal.

In July 2020, the Veteran submitted a statement from her spouse in support of her claims. He described that the Veteran was constantly fatigued during service due to work hours.

In July 2024, the Veteran testified at a Board hearing. She described that she experiences fatigue due to her lumbar spine and her GERD symptoms. The Veteran explained that her symptoms impact her ability to sleep, so she experiences fatigue. Additionally, the Veteran testified that she has pain in her joints and throughout her nerves from the marches she did during service.

The Board notes that the Veteran has not been afforded VA examinations to determine the etiology of the fatigue and painful joints claims but finds as a fact in this case that VA examinations are not necessary. The VA must provide a medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service or with another service related disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also, 38 C.F.R. § 3.159 (c)(4)(i).

The Board finds in this case that the evidence of record fails to establish that the Veteran suffered an in-service event, injury, or disease, that the claimed fatigue and painful joints had their onset during service or may be associated with an in-service event, injury, or disease, or with another service-connected disability, or manifested to a compensable degree within the applicable presumptive period. See McLendon, 20 Vet. App. at 83. To the extent that the Veteran alleged that her fatigue is attributable to her lumbar spine disorder and GERD, the Board notes that the Veteran is not service-connected for either disorder. Moreover, although the issue of entitlement to service connection for GERD is remanded below, the Veteran did not allege the theory of secondary service connection until the time of the hearing and not prior to the adjudication of the rating decision on appeal. Thus, the VA's duty to assist by affording the Veteran VA examinations was not required in this case, and no pre-decisional duty to assist error occurred.

As noted above, there were no in-service complaints, treatment, or diagnoses of any fatigue and/or painful joints. Rather, the Veteran has asserted experiencing fatigue and painful joints many years after her separation from service. Although a lack of contemporaneous medical evidence does not automatically constitute substantive negative evidence, the Board may weigh the absence of contemporaneous records when assessing the credibility and weight to be given lay evidence. See Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006); Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011). The record reflects that the record contains entry and exit examinations during the Veteran's single period of active duty. The Board emphasizes that the Veteran's credibility is not being discounted solely because of a lack of contemporaneous evidence. The Board finds the Veteran to be competent and credible in her reporting; however, the Board assigns minimal probative value to her lay assertions as they are not supported by the competent and credible evidence of record, specifically her statements at the Board hearing that fatigue and painful joints are only generally attributable to her time in-service and/or due to other disorders. See Caluza, 7 Vet. App. at 511, aff'd per curium, 78 F.3d 604 (Fed. Cir. 1996) (when determining whether lay evidence is satisfactory, the Board may properly consider internal consistency, facial plausibility, consistency with other evidence, and demeanor of witnesses (if hearing held)).

In conclusion, the Board finds that the relevant evidence of record persuasively weighs against the Veteran's claims of service connection for fatigue and painful joints. As the evidence of record persuasively weighs against service connection, the benefit-of-the-doubt rule does not apply, and service connection for fatigue and painful joints is not warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Lynch, 21 F.4th at 781-82. Accordingly, these claims are denied.

REASONS FOR REMAND

1. Entitlement to service connection for a pelvic disorder, to include recurrent UTIs is remanded.

The Veteran has contended that she has a pelvic disorder related to active military service, and she seeks service connection.

To afford the Veteran the broadest possible scope for his claim, the issue has been recharacterized accordingly to that of entitlement to service connection for a pelvic disorder, to include recurrent UTIs. Clemons v. Shinseki, 23 Vet. App. 1,6 (2009).

Turning to the record, the Veteran's service treatment records reveal that the Veteran was assessed with UTI in July 1996 and September 1996. A June 1997 Report of Medical Examination reveals that a pelvic examination was deferred. It also revealed a normal clinical evaluation of the genitourinary system.

In March 2019, the Veteran was afforded a VA examination for gynecological conditions. A diagnosis of bacterial vaginosis was rendered. At the time of the examination, the Veteran reported that during service she had recurrent vaginal discharge and dysuria diagnosed as UTI. The examiner opined that the Veteran's bacterial vaginosis was not incurred in or caused by service. In support of this conclusion, the examiner noted that there is no documentation of treatment for vaginal infection and there was no complaint of a vaginal condition at the time of separation.

The Board finds that the March
of Medical Examination reveals that a pelvic examination was deferred. It also revealed a normal clinical evaluation of the genitourinary system.

The Board finds that the March 2019 VA examination is inadequate for purposes of determining service connection because the examination did not develop the Veteran's reports of UTI. Rather, the examination focused solely on gynecological disorders without considering the UTIs during service. Given this deficiency, another VA examination is required with respect to the Veteran's service connection claim. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); see also Bowling v. Principi, 15 Vet. App. 1, 12 (2001) (emphasizing the Board's duty to return an inadequate examination report "if further evidence or clarification of the evidence... is essential for a proper appellate decision").

Therefore, the Board finds that pre-decisional duty to assist error was committed because the March 2019 VA examination is inadequate. When the Board identifies a pre-decisional duty to assist error, under 38 U.S.C. § 5103A; 38 C.F.R. §§ 3.159(c), 20.802(a), the Board must remand the appeal back to the AOJ with instructions to correct the error.

In ordering remand in the instant case, the Board is not making a preliminary formal finding as to the credibility of the Veteran's lay reports. Rather, the Board is merely requesting that the clinician on remand consider the Veteran's own descriptions of the history of her pelvic disorder, to include recurrent UTIs. See Smith v. Wilkie, 32 Vet. App. 332, 338-39 (2020).

2. Entitlement to service connection for GERD

The Veteran seeks service connection for GERD, which she attributes to her active military service.

Turning to the record, the Veteran's service treatment records reveal that in February 1997 the Veteran reported complaints of nausea and weight loss. In March 1997 she complained of abdominal pain. A Report of Medical History from June 1997 at the time of separation reveals that the Veteran denied frequent indigestion.

In February 2019, the Veteran was afforded a VA examination for Stomach and Duodenal Conditions (Not Including GERD or Esophageal Disorders). The examiner determined that the Veteran did not have a diagnosis of a stomach disorder. At the time of the examination the Veteran reported that she had a diagnosis of GERD. The examiner opined that any currently diagnosed GERD was not incurred in or caused by service. In support of this conclusion, the examiner explained that there are no medical records to support this diagnosis or claim.

The Board finds that the February 2019 VA examination is inadequate for purposes of determining service connection. Specifically, the VA examination conducted to not confirm or refute the Veteran's claimed GERD diagnosis because it is noted to be an examination for disorders other than GERD. Moreover, the negative etiological opinion relies solely on the absence of evidence. Given these deficiencies, another VA examination is required with respect to the Veteran's service connection claim. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); see also Bowling v. Principi, 15 Vet. App. 1, 12 (2001) (emphasizing the Board's duty to return an inadequate examination report "if further evidence or clarification of the evidence... is essential for a proper appellate decision").

In ordering remand in the instant case, the Board is not making a preliminary formal finding as to the credibility of the Veteran's lay reports. Rather, the Board is merely requesting that the clinician on remand consider the Veteran's own descriptions of the history of GERD. See Smith v. Wilkie, 32 Vet. App. 332, 338-39 (2020).

The matters are REMANDED for the following action:

1. Schedule the Veteran with the appropriate VA examiner to determine the nature and etiology of the Veteran's claimed pelvic disorder, to include UTIs, and claimed GERD. The entire electronic claims file must be reviewed, and such review must be documented in the report. The report should include discussion of the
remand in the instant case, the Board is not making a preliminary formal finding as to the credibility of the Veteran's lay reports. Rather, the Board is merely requesting that the clinician on remand consider the Veteran's own descriptions of the history of GERD. See Smith v. Wilkie, 32 Vet. App. 332, 338-39 (2020).

The matters are REMANDED for the following action:

1. Schedule the Veteran with the appropriate VA examiner to determine the nature and etiology of the Veteran's claimed pelvic disorder, to include UTIs, and claimed GERD. The entire electronic claims file must be reviewed, and such review must be documented in the report. The report should include discussion of the Veteran's documented medical history and assertions. All indicated tests should be accomplished and all clinical findings should be reported in detail and any earlier reports should be reconciled, if necessary.

The examiner should opine as to whether the Veteran's pelvic disorder, to include UTIs, and claimed GERD is related to service. In rendering this opinion, the examiner must consider the Veteran's statements regarding the onset of his condition and continuity of symptomatology.

In offering any opinion, the examiner must consider the full record, to include the Veteran's lay statements of continuity of symptoms since service and may not disregard those statements merely because there was no treatment.

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The rationale for all opinions expressed must be provided and the examiner must clearly articulate the reasons for his or her conclusions. If an opinion cannot be provided without resort to speculation, it must be noted in the opinion report, and a rationale should be provided for that conclusion.

2. Readjudicate the claims.

Emily Tamlyn

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board K. Scanlan, Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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