UNDIAGNOSED ILLNESSES

ANTHONY C. SCIRÉ, JR · 2026 · Case ID: A26025759

MIXED

Summary

The veteran, who served in the U.S. Army from June 2019 to March 2024, appeals several denials and seeks an increased rating for ulcerative colitis. The Board denied service connection for chronic fatigue syndrome (CFS), left heel pain, right heel pain, and right shoulder pain. For CFS, the Board found no current diagnosis in the record, which is a prerequisite for service connection, particularly under the PACT Act's provisions for undiagnosed illnesses. For the heel and shoulder pain claims, the Board found no evidence of a present disability, as neither VA nor private treatment records documented these conditions, nor did they indicate any impact on the veteran's occupational functioning. Consequently, these claims were denied. The Board granted an increased rating for ulcerative colitis from 30% to 60%, applying amended criteria effective May 2024. The Board found the evidence evenly balanced regarding whether the veteran's symptoms met the criteria for a 60% rating, noting the use of Humira and multiple daily episodes of diarrhea. However, a 100% rating was not warranted as the condition was not unresponsive to treatment and did not require hospitalization. Deferred claims for Meniere's syndrome, back pain, carpal tunnel, knee pain, neck pain, left shoulder strain, and unexplained weight loss were dismissed for lack of appellate jurisdiction, as they were not final AOJ decisions. Service connection for a skin disability, including dermatitis and cellulitis of the face, was remanded for a new VA examination and etiology opinion due to a pre-decisional duty to assist error.

Rationale

No current diagnosis of CFS; Lack of objective indications of qualifying chronic disability; Service treatment records and VA/private post-service records do not show CFS diagnosis

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250125-512418

Full Decision Text

Citation Nr: A26025759
Decision Date: 03/23/26 Archive Date: 03/23/26

DOCKET NO. 250125-512418
DATE: March 23, 2026

ORDER

Entitlement to service connection for chronic fatigue syndrome (CFS) is denied.

Entitlement to service connection for left heel pain is denied.

Entitlement to service connection for right heel pain is denied.

Entitlement to service connection for right shoulder pain is denied.

Entitlement to an increased rating of 60 percent for ulcerative colitis (claimed as painful rectal bleeding, bloody diarrhea, malabsorption) is granted.

The deferred claims for Meniere's syndrome, back pain, carpal tunnel, knee pain, neck pain and cervicalgia, left shoulder strain, and unexplained weight loss are dismissed.

REMANDED

Entitlement to service connection for a skin disability, to include dermatitis and cellulitis of the face, is remanded.

FINDINGS OF FACT

1. The record does not show that the Veteran has a diagnosis of CFS.

2. The record does not show that the Veteran has a diagnosis of bilateral heel pain or right shoulder pain disability.

3. The November 2024 rating decision that deferred the claims for Meniere's syndrome, back pain, carpal tunnel, knee pain, neck pain and cervicalgia, left shoulder strain, and unexplained weight loss, does not constitute adjudicative determinations from which a Notice of Disagreement may be filed with respect to those claims.

CONCLUSIONS OF LAW

1. The criteria to establish service connection for CFS have not been met. 38 U.S.C. §§ 1110, 1131, 1117; 38 C.F.R. §§ 3.303(d), 3.317.

2. The criteria to establish service connection for left heel pain have not been met. 38 U.S.C. §§ 1110, 1131, 1117; 38 C.F.R. §§ 3.303(d), 3.317.

3. The criteria to establish service connection for right heel pain have not been met. 38 U.S.C. §§ 1110, 1131, 1117; 38 C.F.R. §§ 3.303(d), 3.317.

4. The criteria to establish service connection for right shoulder pain disability have not been met. 38 U.S.C. §§ 1110, 1131, 1117; 38 C.F.R. §§ 3.303(d), 3.317.

5. The criteria for dismissals of entitlement of the deferred issues to compensation for Meniere's syndrome, back pain, carpal tunnel, knee pain, neck pain and cervicalgia, left shoulder strain, and unexplained weight loss have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served in the United States Army from June 2019 to March 2024.

In the January 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the November 2024 agency of original jurisdiction (AOJ) decision 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.

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 skin disability claim, any evidence the Board could not consider will be considered by the AOJ in the adjudication of the claim. 38 C.F.R. § 3.103(c)(2)(ii).

Service Connection

Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in
considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a link between the claimed in-service disease or injury and the present disability. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013).

1. Entitlement to service connection for CFS is denied.

The Board concludes that the Veteran does not have a current diagnosis of CFS and has not had one at any time during the pendency of the claims. Romanowsky, 26 Vet. App. at 294; McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

VA will pay compensation to a Persian Gulf veteran who exhibits objective indications of a qualifying chronic disability, provided that such disability: (i) became manifest either during active military, naval, or air service in the Southwest Asia theater of operations, or to a degree of 10 percent or more not later than December 31, 2026, and (ii) by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 C.F.R. § 3.317(a)(1).

However, the PACT Act eliminated the manifestation period and the degree to which a qualifying chronic disability must manifest. See Pub. L. No. 117-168 (August 10, 2022). Therefore, an undiagnosed illness or medically unexplained chronic multi-symptom illness (MUCMI) may now manifest at any time to any degree, including noncompensable. 38 U.S.C. § 1117.

A qualifying chronic disability is either an undiagnosed illness or a MUCMI that is defined by a cluster of signs and symptoms, such as fibromyalgia, chronic fatigue syndrome, or functional gastrointestinal disorders (excluding structural gastrointestinal diseases). 38 C.F.R. § 3.317(a)(2)(i). A MUCMI is defined as 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. 38 C.F.R. § 3.317(a)(2)(ii).

The issue as to whether the Veteran served in Southwest Asia during the presumptive period is not questioned. Rather, the crux of the appeal centers on whether the Veteran has a diagnosis of CFS.

Because the Board finds that the Veteran has not been diagnosed with CFS at any point during the appeal period (or recent to the filing of his claim), the claim will be denied.

Here, service treatment records do not show references to any complaints, symptoms, treatment, and/or diagnosis pertaining to CFS. A diagnosis of CFS is not found in the VA and private post-service treatment records. Moreover, the Veteran's October 2024 VA CFS examination confirmed no diagnosis of CFS and, instead, noted that the Veteran's condition has not been ruled out to be related to thyroid, sleep apnea, and/or anemia conditions.

As such, the lack of a current diagnosis or present disability for CFS precludes service connection for CFS. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Consequently, service connection is not warranted.

2. Entitlement to service connection for left heel pain is denied.

3. Entitlement to service connection for right heel pain is denied.

4. Entitlement to service connection for right shoulder pain is denied.

As to the first element of service connection regarding the bilateral heel pain and right shoulder pain disability service connection claims, the Board finds that the evidence of record does not demonstrate a present disability. Specifically, there are no private or VA medical records that show a diagnosis of any of these conditions. See October 2024 VA Shoulder examination; October 2024 VA Foot Conditions examination. There is also no indication that any of these claimed conditions impact the Veteran's ability to perform any type of occupational task. See October 202
connection is not warranted.

2. Entitlement to service connection for left heel pain is denied.

3. Entitlement to service connection for right heel pain is denied.

4. Entitlement to service connection for right shoulder pain is denied.

Without a current disability, the Veteran's claims must be denied as a matter of law. Brammer, 3 Vet. App. at 225.

Accordingly, the appeal seeking service connection for the bilateral heel pain and right shoulder pain disability must be denied.

Increased Rating

Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10.

If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. The Veteran's entire history is to be considered when making disability evaluations. See 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995).

5. Entitlement to an increased rating of 60 percent for ulcerative colitis (claimed as painful rectal bleeding, bloody diarrhea, malabsorption) is granted.

The Veteran filed a claim in July 2024 seeking an increased rating for his ulcerative colitis. The Veteran is currently assigned a 30 percent rating under Diagnostic Code 7323. Effective May 19, 2024, VA amended the criteria for rating digestive system disabilities. As the increased rating claim was received after the effective date of the amended criteria, the Board will apply the amended rating criteria.

The amended Diagnostic Code 7323 instructs to rate ulcerative colitis under Diagnostic Code 7326. Under Diagnostic Code 7326, a 30 percent rating is warranted when mild to moderate inflammatory bowel disease that is managed with oral and topical agents (other than immunosuppressants or other biologic agents); and is characterized by recurrent abdominal pain with three or less daily episodes of diarrhea and minimal signs of toxicity such as fever, tachycardia, or anemia.

A 60 percent rating is warranted when moderate inflammatory bowel disease that is managed on an outpatient basis with immunosuppressants or other biologic agents; and is characterized by recurrent abdominal pain, four to five daily episodes of diarrhea; and intermittent signs of toxicity such as fever, tachycardia, or anemia.

A 100 percent rating is warranted when severe inflammatory bowel disease that is unresponsive to treatment; and requires hospitalization at least once per year; and results in either an inability to work or is characterized by recurrent abdominal pain associated with at least two of the following: (1) six or more episodes per day of diarrhea, (2) six or more episodes per day of rectal bleeding, (3) recurrent episodes of rectal incontinence, or (4) recurrent abdominal distension.

The United States Court of Appeals for Veterans Claims (Court) has held, "the Board may not deny entitlement to a higher rating on the basis of relief provided by medication when those effects are not specifically contemplated by the rating criteria." Jones v. Shinseki, 26 Vet. App. 56, 63 (2012).

Diagnostic Code 7323 does not contemplate the effects of relief provided by medication, thus entitlement to a higher rating based on such relief may not be denied in this instance.

Here, the Board finds that the evidence is at least evenly balanced as to whether his symptoms more nearly approximate the criteria for a 60 percent rating under Diagnostic Code 7323. There is competent evidence of the Veteran's disability being managed on an outpatient basis and that he is prescribed a biologic agent, Humira, for medical treatment. See, e.g., May 9, 2024 VA medical treatment record ("placed patient on Humira to help control sxs.") The medical treatment records also establish that the Veteran has symptoms of recurrent abdominal pain, and multiple episodes of diarrhea. See, e.g., October 2024 VA Rectum and Anus Conditions examination (progressed/worsened symptoms of rectal bleeding with blood diarrhea); April 11, 2023, service treatment record ("continues to have blood diarrhea and abdominal cramping and diarrhea has been ongoing x 2 months.").

However, a 100 percent rating is not warranted here. There is no evidence that the Veteran's disability is unresponsive to treatment. The May 9, 2024, VA medical treatment record specifically indicates that the biologic agent Humira works to keep the Veteran's symptoms under control. See May 9, 2024, VA medical treatment record ("placed patient on Humira to help control sxs."). Moreover, there is nothing in the record to indicate hospitalization at least once per year. In addition, the VA examination reports of record within the appeal period state that the Veteran's symptoms do not result in an inability to work, and the Veteran has not asserted that either. See October 2024 VA Eating disorders examination; October 2024 VA General Medical examination; October 2024 VA Intestinal examination; October 2024 VA Rectum and Anus Conditions examination; October 2024 VA Nutritional Deficiencies examination.

While the Board acknowledges the Veteran is competent to report observable symptoms, see Layno v. Brown, 6 Vet. App. 765 (1994), the competent medical evidence offering detailed, specific, and specialized determinations pertinent to the rating criteria are the most persuasive evidence with regard to evaluating the Veteran's symptoms. In any event, the medical evidence as described above is largely consistent with the Veteran's descriptions of his symptoms.

Furthermore, Diagnostic Code 7301 (adhesions of peritoneum) does not apply to the Veteran here because there is no evidence of adhesions causing definite partial obstruction. While the Board acknowledges the Veteran's weight loss as a symptom, he cannot be awarded under Diagnostic Code 7203 (stricture of esophagus) because there is no evidence of a documented history of recurrent or refractory esophageal stricture. He cannot be awarded under Diagnostic 7345 (chronic liver disease without cirrhosis) because he does not have a history of liver disease.

Having considered the application of other Diagnostic Codes pertaining to the gastric system, see Mittleider v. West, 11 Vet. App. 181, 182 (1998) (stating when the effects of a service-connected disability have not been clinically disassociated from those of a non-service-connected disorder, all relevant signs and symptoms must be attributed to the service-connected disability), the Board finds higher ratings under any of the other potentially applicable Diagnostic Codes are not warranted in this case.

For the foregoing reasons, and resolving reasonable doubt in the Veteran's favor, an increased rating of 60 percent is warranted for the Veteran's disability under Diagnostic Code 7323. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

6. The deferred claims for Meniere's syndrome, back pain, carpal tunnel, knee pain, neck pain and cervicalgia, left shoulder strain, and unexplained weight loss are dismissed.

The December 2024 rating decision deferred adjudication of the claims for Meniere's syndrome, back pain, carpal tunnel, knee pain, neck pain and cervicalgia, left shoulder strain, and unexplained weight loss. In January 2025, the Veteran filed a VA Form 10182, seeking to appeal the issues.

Here, the Board finds that the December 2024 rating decision that deferred the claims for Meniere's syndrome, back pain, carpal tunnel, knee pain, neck pain and cervicalgia, left shoulder strain, and unexplained weight loss, do not constitute adjudicative determinations from which a Notice of Disagreement may be filed with respect to those issues. As such, the Board does not have jurisdiction to review these claims, and the appeals must be dismissed for lack of appellate jurisdiction. 38 U.S.C. § 7104(c); 38 C.F.R. §§ 20.104(a), 20.105, 20.201; Shipley v. Shinseki, 24 Vet. App. 458 (2011) (concluding that a deferred rating decision does not constitute an appealable adjudicative action). Accordingly, the appeals are dismissed.

REASONS FOR REMAND

Entitlement to service connection for a skin disability, to include dermatitis and cellulitis of the face, is remanded.

Under the Veterans Appeals Improvement Modernization Act of 2017 (AMA), the Board must remand appeals to the AOJ to correct pre-decisional duty to assist errors. See 38 C.F.R. § 20.802 (a). Here, the Board's review of the record reveals a duty to assist error that was evident prior to the rating decision on appeal.

Pertinent to a claim for service connection, such a determination requires a finding of current disability that is related to an injury or disease in service. See Brammer v. Derwinski, 3 Vet. App. 223 (1992). The requirement of a current disability is satisfied when the Veteran has a disability at the time he files his service connection claim or during the pendency of that claim, even if the disability resolves prior to the adjudication of the claim.

Here, service treatment records show the Veteran had dermatitis that spread from his trunk to his extremities. However, the October 2024 VA Skin examination did not list dermatitis as a condition that the Veteran had that later resolved. In addition, while the October 2024 VA Skin examination lists cellulitis as a condition that resolved, it does not indicate the time period of when it resolved, which would be pertinent to the Veteran's appeal.

Therefore, remand is warranted for a new VA examination and etiology opinion. See 38 U.S.C. § 5103A(d); see also 38 C.F.R. § 20.802(a).

The matters are REMANDED for the following action:

Schedule the Veteran for a VA Skin examination to determine the nature and etiology of any skin condition diagnosis, to include dermatitis and cellulitis.

A current disability is satisfied when the Veteran has a disability at the time he files his service connection claim or during the pendency of that claim, even if the disability resolves prior to the adjudication of the claim.

The claims file must be made available to the examiner for review of the case. All examination findings, along with the complete rationale for all opinions expressed, should be set forth in the examination report. All tests and studies deemed necessary should be conducted.

After reviewing the claims folder and examining the Veteran, the examiner is specifically instructed to provide the following information:

Is it "at least as likely as not" that the Veteran's skin condition diagnosis, to specifically include dermatitis and cellulitis, BEGAN IN or is otherwise related to his time in the service, including his conceded toxic exposure risk activity (TERA) during service, yes, or no?

In forming the opinion, the examiner must consider: (a) total potential exposure through all applicable military deployments; and (b) synergistic, combined effect of all TERAs.

The examination opinion must reflect consideration of the Veteran's lay statements of record. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinions.

A complete rationale for all opinions is requested. Any opinion expressed must "contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two." See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008).

If the requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state
and (b) synergistic, combined effect of all TERAs.

If the requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed knowledge or training. Jones v. Shinseki, 23 Vet. App. 382, 389 (2010) (The Agency of Original Jurisdiction should ensure that any additional evidentiary development suggested by the examiner be undertaken so that a definite opinion can be obtained.)

ANTHONY C. SCIRÉ, JR

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board C.J. Cho

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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