SCARS OF THE SKIN

B.T. KNOPE · 2026 · Case ID: A26024834

MIXED

Summary

The veteran, who served from January 1984 to January 1987, appeals the denial of service connection for several conditions, including skin cancer, scars on the nose and cheek, hyperthyroidism, left adrenal gland adenoma, polymorphic lymphocytes, major depressive disorder, anxiety disorder, erectile dysfunction, prostate cancer, and tinnitus. The Board denied claims for skin cancer and scars, finding that the veteran's cancer was in remission and the scars lacked characteristics of disfigurement, thus not warranting a compensable rating. For adrenal gland adenoma, prostate cancer, and erectile dysfunction, the Board found no evidence of in-service onset or continuity of symptoms, and while a VA examination addressed nexus to service-connected varicocele, it opined the conditions were less likely than not related. The Board also denied claims for hyperthyroidism and tinnitus due to lack of current diagnosis and for polymorphic lymphocytes, stating it was not a disability. Service connection for major depressive disorder and anxiety disorder was denied due to lack of continuity of symptoms and an unfavorable VA opinion, though the veteran was invited to file a supplemental claim for secondary service connection. Service connection for prostate cancer was granted.

Rationale

No compensable symptoms during period on appeal; Cancer in remission, symptoms resolved; No characteristic lesions or treatment needed

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

7800

Docket No.

250211-520391

Full Decision Text

Citation Nr: A26024834
Decision Date: 03/19/26 Archive Date: 03/19/26

DOCKET NO. 250211-520391
DATE: March 19, 2026

ORDER

Entitlement to a compensable rating for skin cancer is denied.

Entitlement to a compensable rating for scars on nose and cheek is denied.

Entitlement to service connection for hyperthyroidism is denied.

Entitlement to service connection for left adrenal gland adenoma is denied.

Entitlement to service connection for polymorphic lymphocytes is denied.

Entitlement to service connection for an acquired psychiatric disorder, diagnosed as major depressive disorder single episode unspecified and anxiety disorder unspecified, is denied.

Entitlement to service connection for erectile dysfunction is denied.

Entitlement to service connection for prostate cancer is granted.

Entitlement to service connection for tinnitus is denied.

FINDINGS OF FACT

1. The Veteran's skin cancer has not been manifested by characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent of the exposed areas affected; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period.

2. The Veteran's scars on the nose and cheek have not been manifested by characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent of the exposed areas affected; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period.

3. The evidence does not show a current diagnosis of hyperthyroidism at any time during the period on appeal.

4. The Veteran's adrenal gland adenoma is not etiologically related to service.

5. The Veteran's polymorphic lymphocytes are not a disability for VA purposes.

6. The Veteran's major depressive disorder single episode unspecified and anxiety disorder unspecified are not etiologically related to service.

7. The Veteran's erectile dysfunction is not etiologically related to service.

8. The Veteran's prostate cancer is not etiologically related to service.

9. The evidence does not show a current tinnitus diagnosis at any time during the period on appeal.

CONCLUSIONS OF LAW

1. The criteria for entitlement to a compensable rating for skin cancer have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.71a Diagnostic Code 7818.

2. The criteria for entitlement to a compensable rating for scars on nose and cheek have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.71a Diagnostic Code 7800.

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

4. The criteria for entitlement to service connection for left adrenal gland adenoma have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

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

6. The criteria for entitlement to service connection for an acquired psychiatric disorder, diagnosed as major depressive disorder single episode unspecified and anxiety disorder unspecified, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

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

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

8. The criteria for entitlement to service connection for prostate cancer have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

9. The criteria for entitlement to service connection for tinnitus 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 from January 1984 to January 1987. This matter comes before the Board of Veterans' Appeals (Board) on appeal from December 2024 January 2025 rating decisions.

In the February 2025 VA Form 10182, Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the December 2024 and January 2025 agency of original jurisdiction (AOJ) decisions on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

Increased Ratings

Disability ratings are determined by the application of a schedule of ratings, which is based on the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The Veteran's entire history is reviewed when making disability evaluations. See generally, Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. § 4.1. Where the question for consideration is the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection is required. See Fenderson v. West, 12 Vet. App. 199, 125-26 (1999). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Further, "[w]here there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned." 38 C.F.R. § 4.7.

1. Entitlement to a compensable rating for skin cancer.

2. Entitlement to a compensable rating for scars on nose and cheek.

The Veteran seeks higher ratings for his skin cancer and associated scars. After a review of the evidence, the Board finds that a compensable rating not warranted for either condition.

The Veteran's skin cancer is rated under the General Formula for the Skin. 38 C.F.R. § 4.118, Diagnostic Code 7818. Under the General Rating Formula for the Skin, a noncompensable rating is assigned when no more than topical therapy is required over the prior 12-month period and at least one of the following: characteristic lesions involving less than 5 percent of the entire body affected; or characteristic lesions involving less than 5 percent of the exposed areas affected.

A 10 percent rating is assigned for at least one of the following: characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent of the exposed areas affected; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of
therapy is required over the prior 12-month period and at least one of the following: characteristic lesions involving less than 5 percent of the entire body affected; or characteristic lesions involving less than 5 percent of the exposed areas affected.

A 30 percent rating is assigned for at least one of the following: characteristic lesions involving 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or Systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period.

Finally, a maximum 60 percent rating is assigned for characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period.

The Veteran's scars are rated under Diagnostic Code 7800, which compensates for scars of the head, neck, or face. The level of evaluation is based on characteristics of disfigurement. C.F.R. § 4.118. The following ratings are available:

" 10 percent - one characteristic of disfigurement;

" 30 percent - With visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with two or three characteristics of disfigurement;

" 50 percent - With visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with four or five characteristics of disfigurement;

" 80 percent - With visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with six or more characteristics of disfigurement.

Note (1) delineates the 8 characteristics of disfigurement, for purposes of evaluation under § 4.118:

" Scar 5 or more inches (13 or more cm.) in length.

" Scar at least one-quarter inch (0.6 cm.) wide at widest part.

" Surface contour of scar elevated or depressed on palpation.

" Scar adherent to underlying tissue.

" Skin hypo-or hyper-pigmented in an area exceeding six square inches (39 sq. cm.).

" Skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 sq. cm.).

" Underlying soft tissue missing in an area exceeding six square inches (39 sq. cm.).

" Skin indurated and inflexible in an area exceeding six square inches (39 sq. cm.).

Turning to the evidence, the Board was afforded VA examinations for his skin cancer and scarring in January 2025. The examiner noted that the Veteran had three basil cell carcinomas removed in January 202. At the time of the examination, the Veteran was in remission and the condition had resolved; the Veteran had not been treated for a skin condition within the previous 12 months and there were no visibly characteristic lesions. Removal of the basil cell carcinomas resulted in two scars, one on the nasal root and the other on the left cheek. The scars measured 2.2 cm x .3 cm and 3 cm x .3 cm respectively. There was no elevation, depression, adherence to underlying tissue, or missing underlying soft tissue.

Based on the foregoing medical evidence, the Board finds that compensable ratings are not warranted for the Veteran's skin cancer and associated scars. The Veteran's skin cancer
in January 202. At the time of the examination, the Veteran was in remission and the condition had resolved; the Veteran had not been treated for a skin condition within the previous 12 months and there were no visibly characteristic lesions. Removal of the basil cell carcinomas resulted in two scars, one on the nasal root and the other on the left cheek. The scars measured 2.2 cm x .3 cm and 3 cm x .3 cm respectively. There was no elevation, depression, adherence to underlying tissue, or missing underlying soft tissue.

Based on the foregoing medical evidence, the Board finds that compensable ratings are not warranted for the Veteran's skin cancer and associated scars. The Veteran's skin cancer is currently in remission and his symptoms have resolved. In addition, his residual scars did not show any characteristics of disfigurement. If a recurrence of symptoms were to occur, the Veteran would certainly be invited to file a Supplemental Claim. However, as it stands, the evidence does not show compensable symptoms during the period on appeal. Accordingly, the claims are denied.

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, 1131; 5107 (b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. §§ 3.303 (a), 3.304, 3.307, 3.309, 3.310. 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); Caluza v. Brown, 7 Vet. App. 498, 505 (1995).

A disability may also be found service connected on a secondary basis by demonstrating that the disability is either (1) proximately due to or the result of an already service-connected disease or injury or (2) aggravated by an already service-connected disease or injury. See Allen v. Brown, 7 Vet. App. 439, 448 (1995); 38 C.F.R. § 3.310.

3. Entitlement to service connection for left adrenal gland adenoma.

4. Entitlement to service connection for prostate cancer.

5. Entitlement to service connection for erectile dysfunction.

The Veteran contends that his adrenal gland adenoma, prostate cancer, and erectile dysfunction are related to service. He specifically asserts that his prostate cancer and erectile dysfunction are related his service-connected varicocele. After a review of the evidence, the Board finds that service connection is not warranted for these conditions.

As an initial matter, the Board notes that service treatment records do not show diagnosis or treatment for adrenal gland or prostate conditions, or complaints of erectile dysfunction, but was rather treated extensively in service for varicocele. He reported a hernia and hemorrhoids at separation but denied any other medical problems. He was diagnosed with prostate cancer in February 2023, erectile dysfunction in April 2023, and left adrenocortical adenoma in August 2024.

While the clinical evidence does not show treatment for prostate or adrenal gland cancer prior to diagnosis, erectile dysfunction is shown as early as 2010. In any event, the record does not show symptoms of these claimed condition within 20 years of active service. Indeed, the Veteran has never asserted that any of these claimed conditions began during or shortly after separation from service. Thus, based on the medical and lay evidence, or lack thereof, a continuity of symptoms since service has not been established.

Despite a lack of continuous symptoms, service connection may still be warranted if the evidence otherwise indicates a relationship between the Veteran's claimed conditions and active duty service. In this regard, the Veteran submitted a March 2025 statement arguing that his conditions are related to chemical exposure during service. However, this theory of entitlement was not asserted prior to issuance of the rating decision on appeal. In this regard, the Veteran is invited to file a Supplemental Claim so that it may be addressed in the first instance by the RO.

As to nexus, the Board observes that the Veteran has not been afforded a VA examination specifically to address service connection for the claimed conditions on a direct basis. However, given the lack of any in-service incident, illness, or injury to which the disabilities may be linked
still be warranted if the evidence otherwise indicates a relationship between the Veteran's claimed conditions and active duty service. In this regard, the Veteran submitted a March 2025 statement arguing that his conditions are related to chemical exposure during service. However, this theory of entitlement was not asserted prior to issuance of the rating decision on appeal. In this regard, the Veteran is invited to file a Supplemental Claim so that it may be addressed in the first instance by the RO.

As to nexus, the Board observes that the Veteran has not been afforded a VA examination specifically to address service connection for the claimed conditions on a direct basis. However, given the lack of any in-service incident, illness, or injury to which the disabilities may be linked combined with the absence of evidence of symptoms for many years after separation from active service, the duty to assist did not require such development prior to issuance of the rating decisions on appeal. 38 C.F.R. § 3.159(c)(4)(i); McLendon v. Nicholson, 20 Vet. App. 79 (2006). Here, the evidence does not show the onset of the Veteran's adrenal gland carcinoma, prostate cancer or erectile dysfunction until many years after separation from active service. As such, based on the evidence of record, the Board finds that a nexus has not been established for these conditions on a direct basis.

The Veteran was afforded a VA examination in January 2025 to determine whether his prostate cancer or erectile dysfunction were related to his service connected bilateral varicoceles. The examiner opined that the conditions were less likely than not related. The examiner reasoned that there is no documented medical evidence indicating that prostate cancer or erectile dysfunction can be caused by testicle pain, urinary tract infection, or varicocele.

The Board affords significant probative weight to the opinion rendered by the January 2025 VA examiner. The opinion was provided by a qualified medical professional after review of the claims file and application of the facts to current medical knowledge. Accordingly, a nexus has not been established.

In conclusion, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for adrenal gland carcinoma, prostate cancer, and erectile dysfunction is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

6. Entitlement to service connection for major depressive disorder single episode unspecified and anxiety disorder unspecified.

The Veteran seeks entitlement to service connection for depression and anxiety. After a review of the evidence, the Board finds that service connection is not warranted.

Here, the Veteran did check the box corresponding to depression or excess worry at his separation physical. He explained that he difficulties and worries due to family problems while stationed in Germany. However, the problems had since resolved. He was diagnosed with major depressive disorder single episode unspecified and anxiety disorder unspecified in January 2025.

Here, the Veteran has never asserted that his depression or anxiety began during or shortly after separation from service. In his March 2025 statement, he attributed his psychiatric symptoms to the manifold physical conditions he has developed in recent years. Indeed, he reported that he first sought mental health treatment in 2020. Hence, a continuity of symptoms since service has not been established.

As to nexus, the Veteran was afforded a VA examination January 2025. The examiner opined that the Veteran's depression and anxiety were less likely than not related to service. The examiner reasoned that there was insufficient evidence to form a nexus between his conditions and the complaint of trouble sleeping and worrying in service. His current symptoms are of the type that can be part of work and life situations. In addition, there is no evidence of follow up or treatment during service or one year after service. The Veteran anxiety and depression are more likely due to his current medical conditions.

The Board acknowledges that the Veteran reported in his March 2025 statement that his depression and anxiety were related to his service-connected disabilities. Unfortunately, this theory of entitlement was not raised prior to issuance of the January rating decision on appeal. The Veteran is invited to file a Supplemental Claim to pursue this theory of entitlement so the Regional Office (RO) may address the issue in the first instance.

In conclusion, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service
review of the claims file and application of the facts to current medical knowledge. Accordingly, a nexus has not been established on a direct basis.

In conclusion, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for major depressive disorder and anxiety disorder is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

7. Entitlement to service connection for tinnitus.

8. Entitlement to service connection for hyperthyroidism.

9. Entitlement to service connection for polymorphic lymphocytes.

The Veteran seeks entitlement to service connection for hyperthyroidism, polymorphic lymphocytes, and tinnitus. After a review of the evidence, the Board finds that service connection is not warranted for any of the claimed conditions.

First, the Board notes that the term "disability" means impairment in earning capacity resulting from diseases and injuries and their residual conditions. 38 C.F.R. § 4.1; see also Hunt v. Derwinski, 1 Vet. App. 292, 296 (1991); Allen v. Brown, 7 Vet. App. 439 (1995). A symptom, without a diagnosed or identifiable underlying malady or condition, does not, in and of itself, constitute a "disability" for which service connection may be granted. See Sanchez-Benitez v. West, 13 Vet. App. 282 (1999); dismissed in part and vacated in part on other grounds, Sanchez-Benitez v. Principi, 239 F.3d 1356 (Fed. Cir. 2001). Notably, VA has in its rulemaking capacity has determined that "laboratory test results...are not, in and of themselves, disabilities". 61 Fed. Reg. 20440, 20445 (May 7, 1996)

In this regard, polymorphic is defined as, "occurring in several or many forms; appearing in different forms at different stages of development". Dorland's Illustrated Medical Dictionary 1467 (33rd ed. 2020). Lymphocyte is defined as, "any of the mononuclear nonphagocytic leukocytes, found in the blood, lymph, and lymphoid tissue that are the body's immunologically competent cells and their precursors". Id at 1070. Thus, the term polymorphic lymphocytes, as found in the record in this case, was simply a reference to the various forms of lymphocytes found during treatment. This finding in and of itself does not constitute a disability.

Next, a thorough review of the evidence does not show a diagnosis of hypothyroidism or tinnitus at any time during or after service. Indeed, the Veteran specifically denied experiencing tinnitus at his April 2023 VA examination. To the extent that the Veteran asserts that he has hypothyroidism, the Board observes that he may attest to factual matters of which he has first-hand knowledge and that his assertions in that regard are entitled to some probative weight. See Layno v. Brown, 6 Vet. App. 465 (1994). Yet, he is not competent to render an opinion as to whether there is a currently existing thyroid condition, because he does not have the requisite medical knowledge or training, and because such matters are beyond the ability of a lay person to observe. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

Consequently, when a claimed condition is not shown, there may be no grant of service connection. 38 U.S.C. § 1110, 1131; Rabideau v. Derwinski, 2 Vet. App. 141 (1992) (Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

In summation, there is no valid claim for service connection as there is no competent evidence of a current hearing disability upon which to predicate a such a grant. Id.
claimed condition is not shown, there may be no grant of service connection. 38 U.S.C. § 1110, 1131; Rabideau v. Derwinski, 2 Vet. App. 141 (1992) (Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

In summation, there is no valid claim for service connection as there is no competent evidence of a current hearing disability upon which to predicate a such a grant. Id. Based on the foregoing, the benefit-of-the-doubt doctrine is not applicable and service connection for tinnitus, hypothyroidism, and polymorphic lymphocytes is not warranted. 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.

B.T. KNOPE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Ballinger, Daniel

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