MALIG. NEOPLASMS OF THE DIGESTIVE SYSTEM

Summary

The Veteran served from May 1968 to April 1970. The Veteran appeals the denial of service connection for multiple conditions, including liver, kidney, temporomandibular disorder, right hip, left hip, left shoulder, prostate condition (BPH), skin condition (tinea capitis), and erectile dysfunction. The Board found that the evidence persuasively weighed against service connection for all these conditions. The Veteran's claims for liver, kidney, temporomandibular disorder, right hip, left hip, left shoulder, prostate condition, skin condition, and erectile dysfunction were denied because the evidence did not establish the necessary elements for service connection, such as in-service incurrence or a causal link to service. The Board noted that the evidence preponderated against a finding of service connection for these conditions. However, the case is remanded for further development concerning the claim for gastroesophageal reflux disease (GERD). The Board found the prior VA medical opinion inadequate because it relied on Gulf War exposures, which are not relevant to the Veteran's Vietnam-era service. The examiner must obtain a new opinion to determine the etiology of the GERD, considering the Veteran's actual service period and presumed toxic exposures.

Rationale

Evidence persuasively weighs against finding of liver disability during or proximate to service.; Criteria for service connection for liver disability not met.

Full Decision Text

Citation Nr: A26025951
Decision Date: 03/24/26	Archive Date: 03/24/26

DOCKET NO. 250808-573195
DATE: March 24, 2026

ORDER

Entitlement to service connection for a liver disability is denied.

Entitlement to service connection for a kidney disability is denied.

Entitlement to service connection for a temporomandibular disorder is denied.

Entitlement to service connection for a right hip disability, to include degenerative arthritis, is denied.

Entitlement to service connection for a left hip disability, to include degenerative arthritis, is denied.

Entitlement to service connection for a left shoulder disability, to include degenerative arthritis, is denied.

Entitlement to service connection for a prostate condition, to include benign prostatic hyperplasia (BPH), is denied.

Entitlement to service connection for a skin disability, to include tinea capitis, is denied.

Entitlement to service connection for erectile dysfunction is denied.

REMANDED

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

FINDINGS OF FACT

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

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

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

4. The evidence of record persuasively weighs against a finding that the Veteran has a right hip disability, to include degenerative arthritis, that had onset during active service or within one year of service discharge, or that it is otherwise related to active service.

5. The evidence of record persuasively weighs against a finding that the Veteran has a left hip disability, to include degenerative arthritis, that had onset during active service or within one year of service discharge, or that it is otherwise related to active service.

6. The evidence of record persuasively weighs against a finding that the Veteran has a left shoulder disability, to include degenerative arthritis, that had onset during active service or within one year of service discharge, or that it is otherwise related to active service.

7. The evidence of record persuasively weighs against a finding that the Veteran has a prostate condition, to include BPH, that had onset during active service, to include exposure to toxic agents.

8. The evidence of record persuasively weighs against a finding that the Veteran has a skin disability, to include tinea capitis, that had onset during active service, to include exposure to toxic agents.

9. The evidence of record persuasively weighs against a finding that the Veteran's erectile dysfunction had onset during active service or is caused or aggravated by service-connected PTSD.

CONCLUSIONS OF LAW

1. The criteria for service connection for a liver disability have not been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303.

2. The criteria for service connection for a kidney disability have not been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303.

3. The criteria for service connection for a temporomandibular disorder have not been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.303.

4. The criteria for service connection for a right hip disability, to include degenerative arthritis, have not been met.  38 U.S.C. §§ 1101, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

5. The criteria for service connection for a left hip disability, to include degenerative arthritis, have not been met.  38 U.S.C. §§ 1101, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

6. The criteria for service connection for a left shoulder disability, to include degenerative arthritis, have not been met.  38 U.S.C. §§ 1101, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

7. The criteria for
 to include degenerative arthritis, have not been met.  38 U.S.C. §§ 1101, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

6. The criteria for service connection for a left shoulder disability, to include degenerative arthritis, have not been met.  38 U.S.C. §§ 1101, 1112, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

7. The criteria for service connection for a prostate condition, to include BPH, have not been met.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303.

8. The criteria for service connection for a skin disability, to include tinea capitis, have not been met.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303.

9. The criteria for service connection for erectile dysfunction, to include as secondary to service-connected PTSD, have not been met.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from May 1968 to April 1970.

This matter comes before the Board of Veterans' Appeals (Board) from an August 2024 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO).

By way of history, in June 2022, the agency of original jurisdiction (AOJ) denied the service connection claims on appeal.  Thereafter, in May 2023, the Veteran submitted VA Form 20-0996 Request for Higher-Level Review.  In a September 2023 rating decision, duty to assist errors were identified.  Following development, an August 2024 rating decision continued denial of the claims on appeal.

In August 2025, the Veteran filed a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement).  Although the Veteran selected the hearing lane, he withdrew his hearing request on November 21, 2025.

Pursuant to 38 C.F.R. § 20.302(b), if a claimant commences an AMA appeal and initially selects the Hearing Lane but withdraws his/her hearing request before the hearing is held, the Board adjudicates the claimant's challenges by issuing a decision based on a review of the evidence that is of record at the time of the underlying decision by the AOJ, as well as the evidence submitted within 90 days following receipt of the claimant's request for withdrawal.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred or aggravated by active service.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).  Service connection may also 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).

Generally, to prevail on the issue of service connection, 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.  Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)).

Service connection under 38 U.S.C. § 1110 may be awarded on a secondary basis if a claimant suffers a disability that is "proximately due to or the result of a service-connected disease or injury."  See 38 C.F.R. § 3.310(a); but see Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023).  For "aggravation of nonservice-connected disabilities" it is enough to show that a nonservice-connected disability would have been less severe but-for a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the nonservice-connected disability. 
 § 1110 may be awarded on a secondary basis if a claimant suffers a disability that is "proximately due to or the result of a service-connected disease or injury."  See 38 C.F.R. § 3.310(a); but see Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023).  For "aggravation of nonservice-connected disabilities" it is enough to show that a nonservice-connected disability would have been less severe but-for a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the nonservice-connected disability.  Id.

Additionally, for Veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including arthritis, are presumed to have been incurred in service, if manifested to a compensable degree within one year of discharge from service.  38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309.  These enumerated chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease.  38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309.  Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

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.  McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).  However, when the record contains a recent diagnosis of disability prior to the Veteran's filing of a claim for benefits based on that disability, the report of the diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time of the claim was filed or during its pendency.  Romanowsky v. Shinseki, 26 Vet. App. 289 (2013).  Under applicable regulation, 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. 49 (1990); Saunders v. Wilkie, 886 F.3d 1356, 1364-65 (Fed. Cir. 2018).

In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant.  See Daye v. Nicholson, 20 Vet. App. 512, 526 (2006).  The Board has the responsibility of determining the degree of probative value which may be attributed to a medical opinion issued by a VA or private treatment provider.  See Prejean v. West, 13 Vet. App. 444, 448-49 (2000).

When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant.  38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

Entitlement to service connection for a liver disability is denied.

Entitlement to service connection for a kidney disability is denied.

Entitlement to service connection for a temporomandibular disorder is denied.

The Veteran asserts service connection for a liver disability, a kidney disability, and a temporomandibular disorder.

The August 2024 rating decision favorably found the evidence shows that participation in a toxic exposure
 benefit of the doubt in resolving each such issue shall be given to the claimant.  38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

Entitlement to service connection for a liver disability is denied.

Entitlement to service connection for a kidney disability is denied.

Entitlement to service connection for a temporomandibular disorder is denied.

The Veteran asserts service connection for a liver disability, a kidney disability, and a temporomandibular disorder.

The August 2024 rating decision favorably found the evidence shows that participation in a toxic exposure risk activity (TERA) is conceded as the Veteran's service records confirm exposure to herbicides during active duty service.  Also, the evidence shows that a qualifying event, injury, or disease had its onset during service as service treatment records (STRs) from June 1968 note complaints of weak kidneys.  Favorable findings made by the AOJ are binding on all AOJ adjudicators as well as on the Board.  38 U.S.C. § 5104A; 38 C.F.R. § 20.801(a).

However, the Board notes that the threshold consideration is whether the Veteran has a disability for service connection purposes during the period on appeal.  As outlined below, the Board does not find probative evidence of a liver disability, a kidney disability, and a temporomandibular disorder or symptomatology resulting in functional impairment that impacts earning capacity.

In connection with his claims, the Veteran underwent a March 2022 and February 2024 VA Kidney Conditions examination, a February 2024 VA Hepatitis, Cirrhosis, and Other Liver Conditions examination, and a February 2024 VA Temporomandibular Disorders examination.

During the March 2022 VA Kidney Conditions examination, the Veteran reported that he did not have any symptoms and did not know he had kidney problems.  He stated that he urinated often and sometimes felt like he had to force it to come out.  Following interview and examination of the Veteran as well as review of the claims file, the examiner remarked that for the Veteran's claimed kidney condition, there was no diagnosis because there were no findings, signs and or symptoms to support a diagnosis.

At the February 2024 VA Kidney Conditions examinations, the examiner noted the Veteran was unsure of the exact condition that he had, had not been given a diagnosis for his condition, and had not been referred to any specialist.  He stated that he had back pain in the area of his kidneys.  He believed it was due to taking medication over time.  The Veteran stated "he was told around, unsure of exactly when, that he had a kidney condition, but was never treated for it or told exactly what was wrong."  The examiner was unable to find any evidence of a kidney condition found in the Veteran's claims file.  Following interview and examination of the Veteran as well as review of the claims file, the examiner determined there was no pathology to render a current diagnosis.

During the February 2024 VA Hepatitis, Cirrhosis, and Other Liver Conditions examination, the Veteran reported having no current symptoms.  He also stated that since his provider brought it to his attention that he had a liver condition, he had not been treated or told anything else about it since.  He stated that he was not being treated for any liver condition that he knew of.  The examiner was unable to find any evidence of a liver condition or treatment within the Veteran's claims file.  Following interview and examination of the Veteran as well as review of the claims file, the examiner found there was no current objective diagnosis warranted as there was no pathology.

At the February 2024 VA Temporomandibular Disorders examination, the Veteran stated that he had dealt with bilateral jaw pain since his time in the military.  He believed that it was due to stress related circumstances.  He reported that he had been grinding his teeth for years due to stress.  The Veteran also reported that his jaw popped.  The examiner was unable to find any evidence of a temporomandibular disorder, treatment, or plan within Veteran's claims file.  Following interview and examination of the Veteran as well as review of the claims file, the examiner did not observe symptoms of a temporomandibular disorder.  The examiner determined there was no current objective diagnosis warranted as there was no pathology.

In considering the evidence of record and the applicable laws and regulations, the Board concludes that the Veteran is not entitled to service connection for a liver disability, a kidney disability, and a temporomandibular disorder.

While the Veteran believes he has a current diagnosis of a liver disability, a kidney disability, and a temporomandib
 reported that his jaw popped.  The examiner was unable to find any evidence of a temporomandibular disorder, treatment, or plan within Veteran's claims file.  Following interview and examination of the Veteran as well as review of the claims file, the examiner did not observe symptoms of a temporomandibular disorder.  The examiner determined there was no current objective diagnosis warranted as there was no pathology.

In considering the evidence of record and the applicable laws and regulations, the Board concludes that the Veteran is not entitled to service connection for a liver disability, a kidney disability, and a temporomandibular disorder.

While the Veteran believes he has a current diagnosis of a liver disability, a kidney disability, and a temporomandibular disorder, he has not been shown to be competent to provide a diagnosis in this case.  Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007).  Consequently, the Board gives more probative weight to the competent medical evidence.

As the evidence does not show diagnosis of, or disability related to a liver disability, a kidney disability, and a temporomandibular disorder, service connection is denied.  See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); see also McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013); Saunders v. Wilkie, 886 F.3d 1356, 1364-65 (Fed. Cir. 2018).

To the extent that the Veteran complains that he has a liver disability, a kidney disability, and a temporomandibular disorder, there is no indication that any subjective complaints result in functional impairment of earning capacity.  See Hunt, supra; Saunders, supra.  Consequently, the Board finds that, at no time during the pendency of the claim does the Veteran have a current diagnosis of a liver disability, a kidney disability, and a temporomandibular disorder and the record does not contain a recent diagnosis of disability prior to the Veteran's filing of a claim.  Therefore, service connection for a liver disability, a kidney disability, and a temporomandibular disorder is not warranted.

Entitlement to service connection for a right hip disability is denied.

Entitlement to service connection for a left hip disability is denied.

Entitlement to service connection for a left shoulder disability is denied.

The Veteran asserts service connection for a bilateral hip disability and a left shoulder disability.

The August 2024 rating decision favorably found the evidence shows that participation in a toxic exposure risk activity is conceded as the Veteran's service records confirm exposure to herbicides during active duty service.  Also, February 2024 VA examinations diagnosed the Veteran with degenerative arthritis of the hips and left shoulder degenerative arthritis.  Favorable findings made by the AOJ are binding on all AOJ adjudicators as well as on the Board.  38 U.S.C. § 5104A; 38 C.F.R. § 20.801(a).

STRs are silent as to complaints of or treatment for any symptoms related to the Veteran's claimed conditions.  The Veteran has not asserted that he experienced bilateral hip or left shoulder symptoms in or since service.

Post-service, a November 2011 VA treatment record reflects the Veteran presented for treatment with comes with complaints of left shoulder pains after falling two days ago.  A March 2016 VA treatment record shows the Veteran complained of shooting pain into the left shoulder.  A December 2017 VA treatment record shows a diagnostic impression of bilateral hip pain.

In connection with his claims, the Veteran underwent a February 2024 VA Hip and Thigh Conditions examination and a Shoulder and Arms Conditions examination.

At the February 2024 VA Hip and Thigh Conditions examination, the Veteran reported that he was unsure of when he started to have hip pain.  He stated that he believed the pain started due to activity over time.  Additionally, he stated that the pain gradually worsened over time.  The examiner noted that the Veteran was seen for bilateral hip pain in 2017 by his provider.  Following interview and examination of the Veteran as well as review of the claims file, the examiner opined the claimed conditions were less likely than not incurred in or caused by the claimed in-service injury, event, or illness.  As rationale, the examiner stated,

"Veteran has claimed left hip condition as being directly related to military service.  Based on review of the available evidence, it is less likely than not that the claimed condition is due to service as there is a lack of substantiating evidence supporting a nexus between the current diagnosis of
 due to activity over time.  Additionally, he stated that the pain gradually worsened over time.  The examiner noted that the Veteran was seen for bilateral hip pain in 2017 by his provider.  Following interview and examination of the Veteran as well as review of the claims file, the examiner opined the claimed conditions were less likely than not incurred in or caused by the claimed in-service injury, event, or illness.  As rationale, the examiner stated,

"Veteran has claimed left hip condition as being directly related to military service.  Based on review of the available evidence, it is less likely than not that the claimed condition is due to service as there is a lack of substantiating evidence supporting a nexus between the current diagnosis of degenerative arthritis other than post traumatic of the left hip and military service.  Without chronicity during service or after service, a post-service event, illness, or injury is considered to be a more likely etiology.  Veteran has claimed right hip condition as being directly related to military service.  Based on review of the available evidence, it is less likely than not that the claimed condition is due to service as there is a lack of substantiating evidence supporting a nexus between the current diagnosis of degenerative arthritis of the right hip other than post traumatic and military service.  Without chronicity during service or after service, a post-service event, illness, or injury is considered to be a more likely etiology.  There is no objective evidence found of a left hip condition during service.  Patient also has no recent history of a left hip condition within [claims file].  Degenerative arthritis found on recent x-ray during examination.  Degenerative arthritis is osteoarthritis is a degenerative joint disease, in which the tissues in the joint break down over time."

During the February 2024 VA Shoulder and Arms Conditions examination, the Veteran reported he was unsure when he started to have shoulder pain, but out of nowhere he just started to have pain.  He stated that the pain gradually worsened over time.  The examiner noted that in 2011, the Veteran reported left shoulder pain after a fall and was not seen again for left shoulder pain until 2016.  Additionally, the examiner stated that in 2016, the Veteran reported shooting pain into left shoulder, but there was no objective evidence showing that the Veteran had been treated since for his left shoulder pain or diagnosed with anything following.  Following interview and examination of the Veteran as well as review of the claims file, the examiner opined the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness.  As rationale, the examiner stated,

"Veteran has claimed left shoulder condition as being directly related to military service.  Based on review of the available evidence, it is less likely than not that the claimed condition is due to service as there is a lack of substantiating evidence supporting a nexus between the current diagnosis of shoulder degenerative arthritis, other than post-traumatic and military service.  Without chronicity during service or after service, a post-service event, illness, or injury is considered to be a more likely etiology.  There is no objective evidence found of a left shoulder condition during service.  Patient also has no recent history of a left shoulder condition within [claims file].  Degenerative arthritis found on recent x-ray during examination.  Degenerative arthritis is osteoarthritis is a degenerative joint disease, in which the tissues in the joint break down over time.  No nexus has been established."

The Board finds the February 2024 VA opinions are probative evidence, which weigh against a finding of a nexus between the Veteran's current bilateral hip and left shoulder disabilities and his active service.  The VA examiners' opinions were based upon a review of service treatment records, post-service records, and the Veteran's lay and medical history, and the examiners found that there was a lack of ongoing bilateral hip and left shoulder symptoms to warrant a nexus between the Veteran's current bilateral hip and left shoulder disabilities and active service.  Additionally, the February 2024 VA examiners noted that in 2011, the Veteran reported left shoulder pain after a fall and was not seen again for left shoulder pain until 2016.  Furthermore, the Veteran admittedly was unsure as to when either of his claimed disabilities began.  The February 2024 VA examiners concluded that a post-service event, illness, or injury was considered to be a more likely etiology.

There is also no probative evidence that degenerative arthritis of the bilateral hips and left shoulder first manifested during active service or within one year of service discharge, and as such, presumptive service connection for arthritis as a chronic disease is not warranted.

The Board acknowledges the lay statements of the Veteran regarding his right hip, left hip, and left shoulder, which are probative insofar as they report observable
 Veteran reported left shoulder pain after a fall and was not seen again for left shoulder pain until 2016.  Furthermore, the Veteran admittedly was unsure as to when either of his claimed disabilities began.  The February 2024 VA examiners concluded that a post-service event, illness, or injury was considered to be a more likely etiology.

There is also no probative evidence that degenerative arthritis of the bilateral hips and left shoulder first manifested during active service or within one year of service discharge, and as such, presumptive service connection for arthritis as a chronic disease is not warranted.

The Board acknowledges the lay statements of the Veteran regarding his right hip, left hip, and left shoulder, which are probative insofar as they report observable symptomatology.  However, to the extent that the Veteran asserts that his current right hip, left hip, and left shoulder disabilities had onset during active service, manifested as arthritis during or within one year of service discharge, or that a current right hip, left hip, and left shoulder disabilities are otherwise related to active service, the Board finds that the Veteran is not competent as a layperson to provide a nexus opinion regarding a complex and internal condition involving arthritic changes of the bilateral hip and left shoulder, which is beyond the immediate observation and competence of a layperson.  See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).  Additionally, to the extent that the Veteran asserts that his bilateral hip and left shoulder pain had onset during service and has continued to the present time, the Board finds such statements to be inconsistent with subsequent evidence, including STRs that document normal clinical findings of the bilateral hips and left shoulder as well as the Veteran's own lay Report of Medical History denying any hip or left shoulder symptoms, and his post-service treatment records documenting left shoulder injuries many years after service discharge.  Even more significantly, the Veteran has reported being unsure as to when his claimed disabilities began.  For the above reasons, the Board finds that the lay evidence of record is of less probative value than the additional objective evidence of record, including service treatment records and post-service treatment records, and the probative medical opinions evidence of record discussed above.

For the above reasons, the Board finds that the evidence persuasively weighs against the Veteran's claim for service connection for a right and left hip disability as well as a left shoulder disability, to include degenerative arthritis.  The benefit of the doubt doctrine, see 38 U.S.C. § 5107(b), is therefore not for application, and the claim is denied.  Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side, or another, is the benefit of the doubt doctrine not for application).

Entitlement to service connection for a prostate condition, to include BPH, is denied.

Entitlement to service connection for a skin disability, to include tinea capitis, is denied.

The Veteran asserts service connection for a prostate condition and a skin disability.

The August 2024 rating decision favorably found the evidence shows that participation in a toxic exposure risk activity is conceded as the Veteran's service records confirm exposure to herbicides during active duty service.  Also, October 2023 VA examinations diagnosed the Veteran with benign prostatic hypertrophy and tinea capitis.  Favorable findings made by the AOJ are binding on all AOJ adjudicators as well as on the Board.  38 U.S.C. § 5104A; 38 C.F.R. § 20.801(a).

Service treatment records are silent as to complaints of or treatment for any symptoms related to the Veteran's claimed conditions.  The Veteran has not asserted that he experienced a prostate condition or skin symptoms in or since service.

As noted, the RO has favorably found the Veteran participated in a TERA.  An October 2023 VA Memorandum indicates that the Veteran was exposed to herbicides in service.  Accordingly, the RO ordered VA opinions to determine whether the Veteran's claimed prostate and skin conditions were related to his in-service TERA exposure.

In connection with his claimed prostate condition, the Veteran underwent an October 2023 VA Male Reproductive Organ Conditions examination.  He reported a gradual onset within the last 15 years.  Following interview and examination of the Veteran as well as review of the claims file, the examiner opined the claimed condition was less likely than not caused by the indicated toxic exposure risk activity(ies), after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.  As rationale, the examiner stated,

"The veteran is currently diagnosed with BPH.  Benign Prostatic Hypertrophy (B
 prostate and skin conditions were related to his in-service TERA exposure.

In connection with his claimed prostate condition, the Veteran underwent an October 2023 VA Male Reproductive Organ Conditions examination.  He reported a gradual onset within the last 15 years.  Following interview and examination of the Veteran as well as review of the claims file, the examiner opined the claimed condition was less likely than not caused by the indicated toxic exposure risk activity(ies), after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.  As rationale, the examiner stated,

"The veteran is currently diagnosed with BPH.  Benign Prostatic Hypertrophy (BPH) arises as a result of the loss of homeostasis between cellular proliferation and cell death, resulting in an imbalance favoring cellular proliferation.  This results in increased numbers of epithelial and stromal cells in the periurethral area and is not caused by the indicated toxic exposure risk activities."

The Veteran also underwent an October 2023 Urinary Tract Conditions examination.  During the examination, the examiner noted, "After several attempts and asking in more ways than one if the Veteran had any urinary or prostate symptoms to which he repeatedly states that he did not; eventually, he stated that 'last time I went to the VA they told me I had a prostate problem" and that when he urinates it is slow.  He denied any incontinence."  The examiner concluded, "Urinary urgency is not diagnosed here as it is a symptom not a disease entity, which in this case is likely due to BPH which is addressed in the Male DBQ."

In connection with his claimed skin disability, the Veteran underwent an October 2023 VA Skin Diseases examination.  He reported a gradual of 10 years ago with no history of specific events.  Following interview and examination of the Veteran as well as review of the claims file, the examiner opined the claimed condition was less likely than not caused by the indicated toxic exposure risk activity(ies), after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran.  As rationale, the examiner stated, 

"Tinea capitis is due to fungal infection and is not caused by the indicated toxic exposure risk activities."

The Board acknowledges that the Veteran believes he has a prostate condition and skin disability related to service.  However, he is not competent to link his prostate condition and skin disability to in-service injury, to include exposure to toxic agents.  The etiologies are a complex medical matter not susceptible to lay observation and require medical knowledge and training of the disease processes of the prostate, skin, and their causes.  Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

Consequently, the Board assigns greater probative value to the October 2023 VA examinations and medical opinions, which are more probative than the Veteran's unsubstantiated medical opinion because they were prepared by a trained medical professional with consideration of the Veteran's medical history, current findings, and relevant medical literature.  Further, they are supported by a complete rationale.  See Prejean v. West, 13 Vet. App. 444, 448-49 (2000) (noting that factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion.); Nieves Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).  The Veteran has not provided a favorable medical opinion supported by a rationale to weigh in these matters.

In sum, for the reasons and bases expressed above the Board finds that the most persuasive evidence is against the Veteran's claim of entitlement to service connection for a prostate condition and skin disability.  The benefit-of-the-doubt rule does not apply, and the claims must be denied.  38 U.S.C. § 5107(b).

Entitlement to service connection for erectile dysfunction is denied.

The Veteran asserts service connection for erectile dysfunction.

The August 2024 rating decision favorably found the evidence shows that participation in a toxic exposure risk activity is conceded as the Veteran's service records confirm exposure to herbicides during active duty service.  Also, an October 2023 VA examination diagnosed the Veteran with erectile dysfunction.  Favorable findings made by the AOJ are binding on all AOJ adjudicators as well as on the Board.  38 U.S.C. § 5104A; 38 C.F.R. § 20.801(a).

STRs are silent as to complaints of or treatment for any symptoms related to the Veteran's claimed condition.  The Veteran has not asserted that he experienced erectile dysfunction in or since service.

In connection with
 for erectile dysfunction.

The August 2024 rating decision favorably found the evidence shows that participation in a toxic exposure risk activity is conceded as the Veteran's service records confirm exposure to herbicides during active duty service.  Also, an October 2023 VA examination diagnosed the Veteran with erectile dysfunction.  Favorable findings made by the AOJ are binding on all AOJ adjudicators as well as on the Board.  38 U.S.C. § 5104A; 38 C.F.R. § 20.801(a).

STRs are silent as to complaints of or treatment for any symptoms related to the Veteran's claimed condition.  The Veteran has not asserted that he experienced erectile dysfunction in or since service.

In connection with his claimed prostate condition, the RO sought an opinion regarding whether the Veteran's erectile dysfunction was secondary to his service-connected PTSD.  Accordingly, the Veteran underwent an October 2023 VA Male Reproductive Organ Conditions examination.  He reported a gradual onset within the last 15 years.  Following interview and examination of the Veteran as well as review of the claims file, the examiner opined the Veteran's claimed erectile dysfunction was less likely than not proximately due to or the result of the Veteran's service-connected PTSD.  As rationale, the examiner stated,

"The veteran reports that his [erectile dysfunction] began in his 60s.  The veteran was diagnosed with PTSD due to his service in Vietnam as a medic.  The veteran contends that his [erectile dysfunction ] is due to his PTSD.  The veteran was married for quite some time after returning from the service in Vietnam and has one child from his first marriage.  He did not have any problems with [erectile dysfunction] until his 60s.  If the veteran's [erectile dysfunction]is due to PTSD, it would have manifested much earlier.  The veteran's [erectile dysfunction] is more likely than not an aging process and [it is] not due to PTSD."

The examiner further opined,

"The veteran's claimed erectile dysfunction was not aggravated beyond its natural progression by the veteran's service-connected post-traumatic stress disorder.  In veteran's testimony he did not have any problem with [erectile dysfunction] until his 60s, at which time the condition started gradually, which is commensurate with the veteran's age and which is also seen in the general public."

Initially, the Board finds that as to an in-service disease or injury, the evidence does not support a finding of a disease or injury in service indicative of erectile dysfunction.  The STRs show that the Veteran was found to have a clinically normal evaluation of his genito-urinary system in a Report of Medical Examination from April 1970 at separation from service.  In a Report of Medical History from April 1970, the Veteran did not report a history of symptoms indicative of erectile dysfunction.  Additionally, as noted, the Veteran has not alleged experiencing erectile dysfunction symptoms in service or that there was in-service incident that resulted in his developing erectile dysfunction.

To that end, the Board acknowledges that a VA medical opinion regarding direct service connection has not been obtained but finds a VA opinion is not warranted in this case.  The evidence of record fails to suggest or support by any actual medical indication of a connection that the Veteran has erectile dysfunction that may be related to his service.  See Waters v. Shinseki, 601 F.3d 1274, 1278 (2010) (a mere conclusory generalized lay statement that service caused the claimant's current condition is insufficient to require the Secretary to provide an examination).  Thus, the low standard of McLendon has not been met and a VA opinion is not warranted.  See McLendon v. Nicholson, 20 Vet. App. 79 (2006).

The Board acknowledges that the Veteran believes he has an erectile dysfunction condition related to service.  However, he is not competent to link his erectile dysfunction to in-service injury.  The etiology is a complex medical matter not susceptible to lay observation and requires medical knowledge and training of the disease processes of the male reproductive system and its causes.  Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

Consequently, the Board assigns greater probative value to the October 2023 VA examination and medical opinion, which is more probative than the Veteran's unsubstantiated medical opinion because it was prepared by a trained medical professional with consideration of the Veteran's medical history, current findings, and relevant medical literature.  Further, they are supported by a complete rationale.  See Prejean v. West, 13 Vet. App. 444, 448-49 (2000) (noting that factors for assessing the probative value of a medical opinion include the thoroughness and detail
 and its causes.  Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

Consequently, the Board assigns greater probative value to the October 2023 VA examination and medical opinion, which is more probative than the Veteran's unsubstantiated medical opinion because it was prepared by a trained medical professional with consideration of the Veteran's medical history, current findings, and relevant medical literature.  Further, they are supported by a complete rationale.  See Prejean v. West, 13 Vet. App. 444, 448-49 (2000) (noting that factors for assessing the probative value of a medical opinion include the thoroughness and detail of the opinion.); Nieves Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).  The Veteran has not provided a favorable medical opinion supported by a rationale to weigh in this matter.

In sum, for the reasons and bases expressed above the Board finds that the most persuasive evidence is against the Veteran's claim of entitlement to service connection for erectile dysfunction.  The benefit-of-the-doubt rule does not apply, and the claim must be denied.  38 U.S.C. § 5107(b).

REASONS FOR REMAND

Entitlement to service connection for GERD is remanded.

The Veteran asserts service connection for GERD.

The August 2024 rating decision favorably found the evidence shows that participation in a toxic exposure risk activity is conceded as the Veteran's service records confirm exposure to herbicides during active duty service and a February 2024 VA examination diagnosed the Veteran with GERD.  Favorable findings made by the AOJ are binding on all AOJ adjudicators as well as on the Board.  38 U.S.C. § 5104A; 38 C.F.R. § 20.801(a).

At a February 2024 VA Esophageal Conditions examination, the Veteran reported an onset of 2009.  Following interview and examination of the Veteran as well as review of the claims file, the examiner opined the claimed condition was less likely than not caused by the indicated toxic exposure risk activity(ies), after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran..  As rationale, the examiner stated,

"Gulf War Veterans have been exposed to toxic chemicals such as chemical warfare, pesticides, and prophylactic drugs, which could contribute to higher incidence of chronic illnesses such as GI and respiratory diseases.  In one study, specific gastrointestinal diseases include more than 500,000 ambulatory care visits annually in the United States, which included peptic ulcer disease, gastroesophageal reflux disease, diverticular disease, ulcerative colitis, Crohn's disease, irritable bowel syndrome, and functional dyspepsia, as well as the symptoms of constipation and nausea/vomiting.  Findings revealed that gastrointestinal disease prevalence among Veterans varied according to their period of service."

On review, the Board finds that the VA medical opinion is not adequate because the opinion focuses on Gulf War exposures, which are not relevant to the Veteran's case.  The Veteran had service during the Vietnam era.  Thus, the examiner has relied upon an inaccurate factual premise.  See Reonal v. Brown, 5 Vet. App. 458, 461 (1993).  ("An opinion based upon an inaccurate factual premise has no probative value.").  Therefore, a remand is necessary to correct this pre-decisional duty to assist error and allow the RO an opportunity to acquire an adequate opinion.

The matters are REMANDED for the following action:

1. Obtain a VA medical opinion from an appropriate examiner to determine the etiology of the claimed GERD disability.  The claims folder (including a copy of this remand) must be provided to and reviewed by the VA examiner.

Based on a review of the record, the examiner should:

a) Provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that such GERD disability arose during service or is otherwise related to any incident of service including the Veteran's presumed toxic exposure in service.

The examiner must address the synergistic, combined effect of all of the Veteran's TERAs, and any potential toxic exposures from his MOS duties generally.

The Board emphasizes that the Veteran is not a Gulf War veteran.  Rather, he had service during the Vietnam era.

All opinions expressed by the examiner must be accompanied by a complete rationale.

Adequate reasons and bases for any opinion rendered must be provided.  All studies deemed appropriate in the medical opinion of the examiner should be performed, and all the findings should be set forth in detail.  The claims file
 approximately balanced or nearly equal, if not higher) that such GERD disability arose during service or is otherwise related to any incident of service including the Veteran's presumed toxic exposure in service.

The examiner must address the synergistic, combined effect of all of the Veteran's TERAs, and any potential toxic exposures from his MOS duties generally.

The Board emphasizes that the Veteran is not a Gulf War veteran.  Rather, he had service during the Vietnam era.

All opinions expressed by the examiner must be accompanied by a complete rationale.

Adequate reasons and bases for any opinion rendered must be provided.  All studies deemed appropriate in the medical opinion of the examiner should be performed, and all the findings should be set forth in detail.  The claims file should be made available to the examiner, who should review the entire claims folder in conjunction with this examination.  

 

 

R. Bisignani

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Griffith, S.

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.