DERMATITIS OR ECZEMA

Summary

The Veteran served in the United States Air Force from March 1985 to February 1990. The Veteran appeals the denial of service connection for several conditions, including dermatitis, latex allergy, nickel allergy, major depressive disorder, chronic fatigue disorder, excessive daytime sleepiness, generalized anxiety disorder, allergic rhinitis, hypertrophy of the nasal turbinates, bruxism (teeth grinding), uterine disorder, ovarian disorder, and acne. The Board granted service connection for latex allergy and nickel allergy. However, the Board denied service connection for dermatitis, major depressive disorder, chronic fatigue disorder, excessive daytime sleepiness, generalized anxiety disorder, allergic rhinitis, hypertrophy of the nasal turbinates, bruxism, uterine disorder, ovarian disorder, and acne, finding the evidence weighed against a service connection for these conditions. The Board remanded claims for neck disorder (cervical spine degenerative disease), back disorder (lumbar spine degenerative disc and joint disease), bilateral lower extremity disorder (sciatica/radiculopathy), bilateral mycotic nails/onychomycosis, headache disorder (migraine), bilateral hearing loss, tinnitus, and bilateral toe scars. The remand was necessary to obtain VA medical opinions on the nature and etiology of these conditions, as the Veteran asserted they were secondary to her service-connected bilateral foot disabilities. The Board noted that the Veteran's service treatment records documented current disabilities for latex and nickel allergies, supporting the grant of service connection.

Rationale

Evidence weighs against current dermatitis; No in-service event, injury, or illness linked

Full Decision Text

Citation Nr: A26026035
Decision Date: 03/24/26	Archive Date: 03/24/26

DOCKET NO. 200421-83256
DATE: March 24, 2026

ORDER

Entitlement to service connection for dermatitis is denied.

Entitlement to service connection for latex allergy is granted.

Entitlement to service connection for nickel allergy is granted.

Entitlement to service connection for major depressive disorder is denied.

Entitlement to service connection for chronic fatigue disorder is denied.

Entitlement to service connection for excessive daytime sleepiness is denied.

Entitlement to service connection for generalized anxiety disorder is denied.

Entitlement to service connection for allergic rhinitis is denied.

Entitlement to service connection for hypertrophy of the nasal turbinates is denied.

Entitlement to service connection for teeth grinding (bruxism) to include as secondary to service-connected disability is denied.

Entitlement to service connection for uterine disorder to include heterogeneous uterine with fibroids and adenomyosis is denied.

Entitlement to ovarian disorder to include ovarian hemorrhagic complex cysts and follicles is denied.

Entitlement to an initial compensable disability rating for service-connected acne is denied.

REMANDED

Entitlement to service connection for neck disorder to include cervical spine multilevel degenerative disease, to include as secondary to service-connected disability is remanded.

Entitlement to service connection for back disorder to include degenerative disc and joint disease, to include as secondary to service-connected disability is remanded.

Entitlement to service connection for bilateral lower extremity disorder to include sciatica (radiculopathy), to include as secondary to service-connected disability is remanded.

Entitlement to service connection for bilateral mycotic nails/onychomycosis to include as secondary to service-connected disability is remanded.

Entitlement to service connection for headache disorder to include migraine headaches is remanded.

Entitlement to service connection for bilateral hearing loss is remanded.

Entitlement to service connection for tinnitus is remanded.

Entitlement to an initial, compensable disability rating for service-connected right toe scar is remanded.

Entitlement to an initial, compensable disability rating for left service-connected left toe scar is remanded.

FINDINGS OF FACT

1. The evidence of record clearly weighs against finding the Veteran has a current dermatitis disorder that was incurred in or is otherwise related to an in-service event, injury, or illness. 

2. The evidence of record demonstrates the Veteran developed a latex allergy during service which has persisted to date. 

3. The evidence of record demonstrates the Veteran developed a nickel allergy during service which has persisted to date.

4. The evidence of record clearly weighs against finding the Veteran's diagnosed major depressive disorder was incurred in or is otherwise related to an in-service event, injury, or illness. 

5. The evidence of record clearly weighs against finding the Veteran has a current chronic fatigue disorder that was incurred in or is otherwise related to an in-service event, injury, or illness. 

6. The evidence of record clearly weighs against finding the Veteran has a current excessive daytime sleepiness disorder that was incurred in or is otherwise related to an in-service event, injury, or illness. 

7. The evidence of record clearly weighs against finding the Veteran has a current generalized anxiety disorder that was incurred in or is otherwise related to an in-service event, injury, or illness. 

8. The evidence of record clearly weighs against finding the Veteran's diagnosed allergic rhinitis was incurred in or is otherwise related to an in-service event, injury, or illness. 

9. The evidence of record clearly weighs against finding the Veteran's diagnosed hypertrophy of nasal turbinates was incurred in or is otherwise related to an in-service event, injury, or illness.

10. The evidence of record clearly weighs against finding the Veteran's diagnosed teeth grinding (bruxism) was incurred in or is otherwise related to an in-service event, injury, or illness.

11. The evidence of record clearly weighs against finding the Veteran's diagnosed uterine fibroids were incurred in or are otherwise related to an in-service event, injury, or illness. 

12. The evidence of record clearly weighs against finding the Veteran has a current ovarian disorder that was incurred in or is otherwise related to an in-service event, injury, or illness. 

13. The Veteran's service-connected acne is manifested by, at most, superficial acne without more severe symptoms to include deep acne; disfigurement of the head, face, or neck; and/or scarring. 

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for dermatitis are not met. 38?U.S.C. §§?1131, 5107; 38?C.F.R. §§?3.102, 3.303.?

2. The criteria for entitlement to service connection for latex allergy are
. The evidence of record clearly weighs against finding the Veteran has a current ovarian disorder that was incurred in or is otherwise related to an in-service event, injury, or illness. 

13. The Veteran's service-connected acne is manifested by, at most, superficial acne without more severe symptoms to include deep acne; disfigurement of the head, face, or neck; and/or scarring. 

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for dermatitis are not met. 38?U.S.C. §§?1131, 5107; 38?C.F.R. §§?3.102, 3.303.?

2. The criteria for entitlement to service connection for latex allergy are met. 38?U.S.C. §§?1131, 5107; 38?C.F.R. §§?3.102, 3.303.?

3. The criteria for entitlement to service connection for nickel allergy are met. 38?U.S.C. §§?1131, 5107; 38?C.F.R. §§?3.102, 3.303.?

4. The criteria for entitlement to service connection for major depressive disorder are not met. 38?U.S.C. §§?1131, 5107; 38?C.F.R. §§?3.102, 3.303.

5. The criteria for entitlement to service connection for chronic fatigue disorder are not met. 38?U.S.C. §§?1131, 5107; 38?C.F.R. §§?3.102, 3.303.

6. The criteria for entitlement to service connection for excessive daytime sleepiness disorder are not met. 38?U.S.C. §§?1131, 5107; 38?C.F.R. §§?3.102, 3.303.

7. The criteria for entitlement to service connection for generalized anxiety disorder are not met. 38?U.S.C. §§?1131, 5107; 38?C.F.R. §§?3.102, 3.303.

8. The criteria for entitlement to service connection for allergic rhinitis are not met. 38?U.S.C. §§?1131, 5107; 38?C.F.R. §§?3.102, 3.303.?

9. The criteria for entitlement to service connection for hypertrophy of nasal turbinates are not met. 38?U.S.C. §§?1131, 5107; 38?C.F.R. §§?3.102, 3.303.?

10. The criteria for entitlement to service connection for teeth grinding (bruxism), to include as secondary to service-connected disability are not met. 38?U.S.C. §§?1131, 5107; 38?C.F.R. §§?3.102, 3.303, 3.310.?

11. The criteria for entitlement to service connection for uterine disorder to include heterogeneous uterine with fibroids and adenomyosis are not met. 38?U.S.C. §§?1110, 5107; 38?C.F.R. §§?3.102, 3.303.?

12. The criteria for entitlement to service connection for ovarian disorder to include ovarian hemorrhagic complex cysts and follicles are not met. 38?U.S.C. §§?1110, 5107; 38?C.F.R. §§?3.102, 3.303.?

13. The criteria for entitlement to an initial compensable disability rating for service-connected acne are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.118, Diagnostic Code 7828.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Air Force from March 1985 to February 1990.

These matters come before the Board of Veterans' Appeals (Board) on appeal from an April 2020 decision, issued by a Regional Office (RO) of the Department of Veterans Affairs (VA). 

In the April 2020 Decision Review Request: Board Appeal (Notice of Disagreement), VA Form 10182, the Veteran elected the Hearing Docket. 

On May 8, 2024, the Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ), a transcript of the hearing is of record. 

Therefore, the Board may only consider the evidence of record at the time of the April 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran (or representative) at the hearing or within 90 days
 appeal from an April 2020 decision, issued by a Regional Office (RO) of the Department of Veterans Affairs (VA). 

In the April 2020 Decision Review Request: Board Appeal (Notice of Disagreement), VA Form 10182, the Veteran elected the Hearing Docket. 

On May 8, 2024, the Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ), a transcript of the hearing is of record. 

Therefore, the Board may only consider the evidence of record at the time of the April 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran (or representative) at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. 

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

However, because the Board is remanding the claims of entitlement to service connection for neck, back, bilateral lower extremity, bilateral mycotic nails/onychomycosis, headache, bilateral hearing loss, and tinnitus disorders and entitlement to initial compensable disability ratings for service-connected bilateral toe scar disabilities, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

 

Service Connection 

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38?U.S.C. §?1131; 38?C.F.R. §?3.303.???????  

To establish a right to compensation for a present disability, a claimant 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 active service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).???????  

For veterans who served 90 days or more of active duty during a war period or after December 31, 1946, certain chronic disorders are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38?U.S.C. §§?1131, 1112, 1113; 38?C.F.R. §§?3.307(a), 3.309(a). For the showing of chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38?C.F.R. §?3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (the theory of continuity of symptomatology can be used only in cases involving those disabilities specified as chronic under 38?C.F.R. §?3.309(a)).?????  

Service connection may be granted for a disability diagnosed after service if the evidence establishes the disability is due to disease or injury that was incurred or aggravated in service. 38?C.F.R. §?3.303.????  

Service connection may be established on a secondary basis for a disability which is due to or the result of service-connected disease or injury. 38?C.F.R. §?3.310(a). Establishing service connection on a secondary basis requires evidence showing (1) a current disability exists and (2) the current disability was either (a) caused, or (b) aggravated by service-connected disability. Allen v. Brown, 7?Vet. App.?439, 448 (1995) (en banc).?????  

In the absence of evidence of a current disability, there can be no grant of service connection under the law
 aggravated in service. 38?C.F.R. §?3.303.????  

Service connection may be established on a secondary basis for a disability which is due to or the result of service-connected disease or injury. 38?C.F.R. §?3.310(a). Establishing service connection on a secondary basis requires evidence showing (1) a current disability exists and (2) the current disability was either (a) caused, or (b) aggravated by service-connected disability. Allen v. Brown, 7?Vet. App.?439, 448 (1995) (en banc).?????  

In the absence of evidence of a current disability, there can be no grant of service connection under the law. See Brammer v. Derwinski, 3?Vet. App.?223, 225 (1992).  

Where there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt will be granted to the claimant. 38?U.S.C. §?5107; 38?C.F.R. §?3.102; Gilbert v. Derwinski, 1?Vet. App.?49, 53 (1990). To deny a claim, the evidence must clearly weigh against the claim. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). 

1. Entitlement to service connection for dermatitis is denied.

2. Entitlement to service connection for latex allergy is granted.

3. Entitlement to service connection for nickel allergy is granted.

The Veteran contends she was treated for dermatitis/skin rashes during service which have persisted to date. 

The AOJ has conceded that the Veteran's service treatment records document treatment for complaints of contact dermatitis during service. See April 2020 Statement of the Case. 

The Veteran's service treatment records document in-service treatment for: (1) a rash on her left leg, assessed as tinea corporis (ring worm, a fungal infection) in August 1985; (2) a facial rash persisting 1 week affecting both ear lobes, assessed as contact dermatitis in January 1986; (3) an infected ear lobe in April 1989; (4) a rash on her left hand assessed as contact dermatitis in July 1989; (5) a follow up for the above noted contact dermatitis in October 1989; and (6) allergy patch testing at Louisiana State University School of Medicine which noted reactions to specific allergens in November 1989. See Treatment Records, Received August 2015; July 2024. 

The Veteran did not report a medical history of allergies and/or skin condition(s) upon entering service and no allergies and/or skin issues were noted on her enlistment examination. Id. 

There is no separation history and/or medical examination of record. 

In June 2016, the Veteran underwent a VA examination. See June 2016 VA Examination. The examiner noted a medical history of contact dermatitis during service which the examiner indicated had resolved. Id. The examiner did not diagnose a current contact dermatitis disorder. Id. The Veteran reported that while on active duty her military occupational specialty was changed from surgical service specialist to a different occupation because she developed contact dermatitis after interacting with gloves and Hibiclens (a cleanser). Id.

On examination, the examiner did not observe any current contact dermatitis, nor did the medical evidence then of record document any post-service treatment for contact dermatitis. Id. The examiner did not offer a medical opinion, having found no pathology to warrant a diagnosis. Id.

VA treatment records dated from April 2003 through March 2020 do not document any complaints, treatment, and/or diagnosis of a skin condition, to include dermatitis, other than acne. The Veteran is already in receipt of service connection for her acne with onset during service. However, VA treatment records during this period indicate she is allergic to latex gloves. See e.g., September 2018 Nursing Emergency Department Note.

During her May 2024 Board hearing, the Veteran testified that during service she developed a rash after using gloves while performing her military occupational specialty of surgical technician and subsequently learned she was allergic to latex, following the above noted skin patch testing. See May 2024 Board Hearing Transcript. She indicated she is allergic to various things to include cosmetics, and certain jewelry. Id.  

In an August 2024 written statement, the Veteran's daughter, G.J., indicated her mother had developed skin rashes due to an allergy to synthetic fibers. See August 2024 Written Statement, G.J.

In an August 2024 written statement, the Veteran reported she was then receiving treatment from a dermatologist, to include for surgical removal of: (1) a
 2024 Board hearing, the Veteran testified that during service she developed a rash after using gloves while performing her military occupational specialty of surgical technician and subsequently learned she was allergic to latex, following the above noted skin patch testing. See May 2024 Board Hearing Transcript. She indicated she is allergic to various things to include cosmetics, and certain jewelry. Id.  

In an August 2024 written statement, the Veteran's daughter, G.J., indicated her mother had developed skin rashes due to an allergy to synthetic fibers. See August 2024 Written Statement, G.J.

In an August 2024 written statement, the Veteran reported she was then receiving treatment from a dermatologist, to include for surgical removal of: (1) a cyst on the left side of her neck; (2) a mole under her right eye; and (3) cysts on her groin/buttock/hip area. See August 2024 Written Statement. The Veteran's service treatment records do not document any complaints, treatment, or diagnosis of any moles or cysts requiring removal during service. She further reported that during service she had allergic reactions to nickel earrings and latex gloves. Id.

More recent VA treatment records submitted by the Veteran document treatment for allergic contact dermatitis after wearing synthetic hair in July 2023. See July 2023 Dermatology Note, Received July 2024. A January 2024 VA dermatology note indicates her allergic contact dermatitis had since resolved. See January 2024 Dermatology Note. A May 2024 VA dermatology note again documents treatment for contact dermatitis due to synthetic hair. See May 2024 Dermatology Note. 

In a June 2024 letter, the Veteran's dermatologist, D.S., M.D., reported having treated the Veteran for contact dermatitis and noted the Veteran had also been treated for contact dermatitis during service. See June 2024 Letter, D.S., M.D., Received July 2024. Her dermatologist did not opine that her allergic contact dermatitis treated beginning in 2023 was related to her contact dermatitis documented in service treatment records 

In sum, the evidence of record demonstrates the Veteran was treated for contact dermatitis in service resulting from allergic reactions to nickel earrings and latex gloves and documents post-service treatment for contact dermatitis resulting from an allergic reaction to synthetic hair in 2023, more than 30 years after her separation from service. However, the evidence of record does not document a current diagnosis of a chronic dermatitis disorder with onset during service which has persisted to date. There is no competent medical evidence of record documenting a diagnosed, chronic dermatitis disorder and/or linking the Veteran's allergic contact dermatitis treated from 2023 to her documented treatment for contact dermatitis during service.

While the Veteran may genuinely believe that her allergic contact dermatitis treated from 2023 is related to service, the evidence of record does not show that she has the medical training, experience, or expertise needed to competently provide a medical etiology opinion. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Thus, her unsubstantiated lay assertions do not outweigh the probative medical evidence of record. 

Therefore, based on the foregoing, as the competent medical evidence of record clearly weighs against finding the Veteran has a currently diagnosed chronic dermatitis disorder, entitlement to service-connection is not warranted. See Brammer v. Derwinski, 3?Vet. App.?223, 225 (1992) (Congress specifically limited entitlement to service-connected benefits to cases where there is a current disability).?? 

As the evidence of record clearly weighs against the Veteran's claim, the benefit-of-the-doubt doctrine does not apply, and the claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.??? 

However, notwithstanding the foregoing, the Veteran's contention that she developed allergies to nickel and latex during service which have persisted to date are consistent with the evidence of record to include: (1) her military occupational specialty of surgical technician; (2) her documented in-service treatment for a rash on her left hand assessed as contact dermatitis in July 1989; (3) her documented in-service treatment for a facial rash persisting 1 week affecting both ear lobes assessed as contact dermatitis in January 1986; (4) her subsequent allergy patch testing at Louisiana State University School of Medicine which noted reactions to specific allergens to include nickel in November 1989; (5) VA treatment records documenting an ongoing allergy to latex gloves; and (6) lay statements of record describing a persistent allergy to jewelry containing nickel. 

Based on the foregoing and giving the Veteran the benefit of the doubt, the evidence of record demonstrates she developed nickel and
 specialty of surgical technician; (2) her documented in-service treatment for a rash on her left hand assessed as contact dermatitis in July 1989; (3) her documented in-service treatment for a facial rash persisting 1 week affecting both ear lobes assessed as contact dermatitis in January 1986; (4) her subsequent allergy patch testing at Louisiana State University School of Medicine which noted reactions to specific allergens to include nickel in November 1989; (5) VA treatment records documenting an ongoing allergy to latex gloves; and (6) lay statements of record describing a persistent allergy to jewelry containing nickel. 

Based on the foregoing and giving the Veteran the benefit of the doubt, the evidence of record demonstrates she developed nickel and latex allergies during service which have persisted to date. Therefore, entitlement to service connection for nickel and latex allergies is warranted. 

4. Entitlement to service connection for major depressive disorder is denied.

5. Entitlement to service connection for chronic fatigue disorder is denied.

6. Entitlement to service connection for excessive daytime sleepiness is denied.

7. Entitlement to service connection for generalized anxiety disorder is denied.

The Veteran contends she developed psychiatric symptoms during service which have persisted to date including depression, chronic fatigue, excessive daytime sleepiness, sleep disturbance, and anxiety. See May 2024 Board Hearing Transcript. 

During her Board hearing, the Veteran testified that she became depressed early into her active-duty military career due to occupational issues which persisted across multiple occupational specialties. See May 2024 Board Hearing Transcript. She testified that when she was recruited as a freshman out of a 4-year college at the age of 18, she reluctantly joined with a military occupational specialty (MOS) she did not prefer (aircraft maintenance technician) because her recruiter told her that she would be precluded from enlistment unless she accepted that occupation. Id. She indicated that after beginning her career as an aircraft maintenance technician she underwent several occupational changes, in administration, as a supply specialist, and as a surgical technician. Id.

She testified her psychiatric symptoms began during her first assignment, at which time she was stationed in England and was required to: (1) wear heavy, steel-toed combat boots; (2) work on the flight line; and (3) work in a cold warehouse, all of which made her feel undervalued and envious of her peers who she perceived as occupying more valued and comfortable occupations. Id. She indicated she then began to experience symptoms of depression and anxiety which persisted throughout her active-duty service and across multiple occupational changes, without relief. Id. 

She testified that while she consistently performed her work to the best of her ability, she remained unhappy in each of her subsequent occupations; continued to feel envious of others who she perceived as having better jobs; and continued to experience persistent feelings of inadequacy which alienated her from others. Id. She indicated that after her separation from service she continued to experience depression and anxiety symptoms and continued to struggle with occupational dissatisfaction in her post-service occupations. Id.

She testified she did not seek treatment for her persistent psychiatric symptoms during service due to the stigma associated with mental health disorders and because she feared that disclosing such symptoms to seek treatment would result in her being dishonorably discharged. Id.  

In a July 2024 written statement, the Veteran again reported the in-service onset of psychiatric symptoms including depression, anxiety, worthlessness, distrust of others, frustration, dislike of her duties, and envy of others which she indicated have persisted to date. See July 2024 Written Statement. She indicated that while she did not seek treatment for such symptoms during service, she: (1) took vitamins to combat her resulting fatigue, pointing to a March 1988 service treatment record; and (2) reported her fatigue to a service treating provider, pointing to a May 1987 service treatment record. Id; see also March 1988 Chronological Record of Medical Care (walk-in requesting refill of vitamins); May 1987 Chronological Record of Medical Care (reports she is feeling tired all the time, prefers not to address the fatigue issue today).

The Veteran's service treatment records (STRs) are silent for complaints, treatment, and/or diagnosis of a mental health disorder during service. As indicated above, she did report feeling tired/fatigued, however STRs do not document any reported psychiatric symptoms. Her service personnel records document her various military occupations. See e.g. December 1985 Service Personnel Note (Veteran found unable to perform her duties as an Aircraft Crew Chief Specialist due to being unable to lift 70 lbs., retraining due to physical profile); DD214 (administrative, material storage and distribution, and surgical service specialist occupations). Available service performance evaluations are consistently positive and full of praise, containing recommendations for promotion. See Military Personnel Record, Received March 2016. 

Private treatment records dated from 2009,
 silent for complaints, treatment, and/or diagnosis of a mental health disorder during service. As indicated above, she did report feeling tired/fatigued, however STRs do not document any reported psychiatric symptoms. Her service personnel records document her various military occupations. See e.g. December 1985 Service Personnel Note (Veteran found unable to perform her duties as an Aircraft Crew Chief Specialist due to being unable to lift 70 lbs., retraining due to physical profile); DD214 (administrative, material storage and distribution, and surgical service specialist occupations). Available service performance evaluations are consistently positive and full of praise, containing recommendations for promotion. See Military Personnel Record, Received March 2016. 

Private treatment records dated from 2009, some 19 years after her separation from service, are the earliest available evidence of record documenting treatment for psychiatric symptoms. See Treatment Records, Received July 2024 (anger, depressed mood, anxiety, agitation, daytime fatigue, diagnosis of adjustment disorder with depressed mood). She then reported she was experiencing family and job-related psychosocial stressors, to include perceived retaliation after filing an equal opportunity complaint against her employer. Id.

However, in VA treatment records dated from 2003 and prior to 2009, the Veteran denied experiencing significant psychiatric symptoms on several occasions. See e.g., April 2003 Nursing Note (negative depression screen, negative posttraumatic stress disorder (PTSD) screen, negative suicide screen); June 2003 Primary Care Initial Evaluation Note (denies depression, anxiety, unusual stress); August 2003 Surgery Health and Physical Note (denies anxiety and depression); July 2008 Emergency Department Note (denies history of psychiatric illness). 

Conversely, VA treatment records from December 2014 document ongoing treatment for diagnosed major depressive disorder presenting with symptoms consistent with those documented in the above-noted private treatment records including depression, anxiety, sleep impairment, daytime fatigue, and ongoing workplace dissatisfaction and difficulties. See e.g., Mental Health Notes Dated December 2014; February 2015; April 2015; January 2016; August 2016; January 2017; September 2017; March 2018; October 2018; March 2020. 

Significantly, while the Veteran therein reported the onset of her symptoms early during her military service, the record does not document any reported symptoms prior to 2009, some 19 years after her separation from service.

In July 2016 the Veteran underwent a VA examination. See July 2016 VA Examination. The examiner diagnosed unspecified depressive disorder, manifested by symptoms of depressed mood, anxiety, chronic sleep impairment, and disturbances of mood and motivation. Id. The examiner opined the chronic sleep impairment (and resulting daytime fatigue) were symptoms of the diagnosed depressive disorder but did not warrant a separate insomnia and/or other sleep disorder diagnosis consistent with DSM-5 diagnostic criteria. Id. 

The examiner further opined that the diagnosed depressive disorder was not due to or the result of the service-connected bilateral foot disabilities, pointing to various psychosocial stressors documented in treatment records including the Veteran's equal opportunity complaint against her employer, job difficulties, financial problems, divorce, and her relationship with her daughter. Id. The examiner did not offer a medical opinion regarding whether it is at least as likely as not the diagnosed depressive disorder was incurred in or otherwise directly related to an in-service event, injury, or illness. 

In a July 2024 written statement, C.E. (a retired Chief Master Sergeant, and former coworker and current friend of the Veteran) indicated that after they began working together in 2014, the Veteran told him stories about her time on active duty, to include her occupational and work environment problems and resulting feelings of depression and anxiety. See July 2024 Written Statement, C.E. He indicated that throughout their acquaintance she has struggled with depression, anxiety, relationship problems, and trust and anger issues. Id. Finally, he expressed his belief that her current psychiatric symptoms are related to her time in the military, specifically to her numerous career changes; her (undocumented but subsequently reported) in-service depression and anxiety due to occupational and work environment problems; and her reported in-service reluctance to seek treatment out of fear of reprisal. Id.

In an August 2024 written statement, the Veteran's daughter, G.J., described the Veteran's ongoing struggles with depression. See August 2024 Written Statement, G.J. She indicated the Veteran isolates at home, does not date, does not have many friends, does not trust others, and is always sad, frustrated and anxious. Id.

In a May 2024 medical opinion, the Veteran's VA treating psychiatrist, R.M., M.D. (who has treated the Veteran since December 2014) opined her diagnosed major depressive disorder is likely related to her reported depression with onset during active service
 occupational and work environment problems; and her reported in-service reluctance to seek treatment out of fear of reprisal. Id.

In an August 2024 written statement, the Veteran's daughter, G.J., described the Veteran's ongoing struggles with depression. See August 2024 Written Statement, G.J. She indicated the Veteran isolates at home, does not date, does not have many friends, does not trust others, and is always sad, frustrated and anxious. Id.

In a May 2024 medical opinion, the Veteran's VA treating psychiatrist, R.M., M.D. (who has treated the Veteran since December 2014) opined her diagnosed major depressive disorder is likely related to her reported depression with onset during active service. See May 2024 Medical Opinion, R.M., M.D., Received July 2024. 

As a rationale, he pointed to her reports of: (1) in-service occupational dissatisfaction beginning early in her military career, resulting in psychiatric symptoms to include depression, sleep impairment, and feelings of anger, envy, and regret; and (2) ongoing depression and occupational struggles following her separation from service which have persisted to date. Id. 

Regarding her post-service occupational history, he indicated that after the Veteran's separation from service she remained distrustful of others, and since compensates for her work-related frustration, sadness, and depressive symptoms by avoiding teamwork and working overtime to prove herself. Id. He indicated that despite 10 years of consistent mental health treatment with adherence to medications and appointments, she persists in a chronic dysthymic and depressive state and is persistently unable to find joy in her work. Id. Based on the foregoing, he indicated he had "no doubt" in his clinical assessment that her current depressive state is related to her military experiences. Id.

While the Veteran's VA treating provider's May 2024 medical opinion is the sole competent medical evidence of record addressing whether the diagnosed major depressive disorder was incurred in or is otherwise directly related to an in-service event, injury, or illness, its rationale relies entirely upon the Veteran's reports of the onset of psychiatric symptoms during service which have persisted to date, including significant occupational dissatisfaction. 

When deciding a claim, the Board must consider all the evidence of record, to include lay statements. 38 U.S.C. §§ 5107(b), 7104(a); 38 C.F.R. § 3.303(a). The Board must assess not only competency of any lay statements, but also their credibility. See Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). In weighing credibility, VA may consider internal inconsistency, facial plausibility, and consistency with other evidence of record. Caluza v. Brown, 7?Vet. App.?498, 511 (1995). The Board does not find the Veteran's statements regarding the onset of her psychiatric symptoms and occupational dissatisfaction during service, with persistence to date, to be credible for the following reasons. 

First, as noted above, the evidence of record does not document any reports of psychiatric symptoms during the Veteran's service or at any time prior to 2009, some 19 years after her separation from service, at which time she was noted to be undergoing significant post-service psychosocial stressors including perceived retaliation after filing an equal opportunity complaint against her employer. Indeed, in available VA treatment records dated from 2003 and prior to 2009, the Veteran affirmatively denied experiencing psychiatric symptoms and/or having a history of psychiatric illness. 

Second, the Veteran's service records do not document any occupational dissatisfaction and/or behavioral issues during service. While they do indicate that she was unable to continue her original military occupational specialty of aircraft maintenance due to being unable to lift 70 lbs., in a narrative clinical summary she was then observed to be "well motivated and desirous of cross training" notwithstanding her inability to physically perform Aircraft Crew Chief duties. See Service Treatment Records, Received July 2024. As indicated above, her subsequent performance evaluations do not document any occupational dissatisfaction. Rather, they are uniformly positive. 

A performance evaluation for the period from March 1985 to April 1986 describes the Veteran's performance as "outstanding" and her behavior as "without flaw," she was further noted to be engaged in the following base activities: Chapel programs, Chapel travelling choir, and young adult bible classes. See April 1986 Service Performance Evaluation. Her reviewer "highly" recommended her for retention and early promotion. Id. A performance evaluation for the period from April 1986 to December 1986 is similarly positive and she is therein described as being professional, courteous, considerate, and friendly with a unique ability to work with others harmoniously, again her reviewer recommended her for promotion. See December 1986 Service Performance Evaluation. Performance evaluations for the periods from December 198
 March 1985 to April 1986 describes the Veteran's performance as "outstanding" and her behavior as "without flaw," she was further noted to be engaged in the following base activities: Chapel programs, Chapel travelling choir, and young adult bible classes. See April 1986 Service Performance Evaluation. Her reviewer "highly" recommended her for retention and early promotion. Id. A performance evaluation for the period from April 1986 to December 1986 is similarly positive and she is therein described as being professional, courteous, considerate, and friendly with a unique ability to work with others harmoniously, again her reviewer recommended her for promotion. See December 1986 Service Performance Evaluation. Performance evaluations for the periods from December 1986 to September 1987, from October 1987 to September 1988, and from October 1988 to November 1989 are similarly positive, each with evaluators recommending promotion. See Military Personnel Record, Received March 2016. In sum, while her service records document multiple occupational changes throughout her active service, they do not document any psychiatric symptoms, behavioral issues, and/or decline in work performance throughout such changes. 

Based on the foregoing, the Board finds the Veteran's contention that she developed persistent psychiatric symptoms and significant occupational dissatisfaction during service are inconsistent with the above-noted documentary evidence of record, to include her own denials of experiencing psychiatric symptoms and/or having a history of psychiatric illness recorded in VA treatment records dated prior to 2009. Caluza, 7 Vet. App. at 511.  The Board places greater probative value on the contemporaneous evidence over the Veteran's allegations advanced many years after the fact and in pursuit of compensation.   Curry v. Brown, 7 Vet. App. 59 (1994). 

The Board finds the lay statements of record to also not be credible.  They are all based on a self-reported history by the Veteran which, as set out above, has been found to not be credible.  

Therefore, entitlement to service connection for major depressive disorder is denied.  

Finally, the evidence of record does not demonstrate the Veteran has current diagnoses of sleep, fatigue, and/or anxiety disorders (separate and distinct from her diagnosed depressive disorder) that were incurred in or are otherwise related to an in-service event, injury, or illness. Therefore, entitlement to service connection for chronic fatigue, excessive daytime sleepiness, sleep disturbance, and/or generalized anxiety disorders is not warranted. 

8. Entitlement to service connection for allergic rhinitis is denied.

9. Entitlement to service connection for hypertrophy of the nasal turbinates is denied.

For the following reasons, entitlement to service connection for allergic rhinitis and/or hypertrophy of nasal turbinates is not warranted.

The AOJ has conceded the Veteran's VA treatment records document treatment for hypertrophy of nasal turbinates and allergic rhinitis. See April 2020 Statement of the Case. 

Her service treatment records do not contain any complaints, treatment, and/or diagnosis of allergic rhinitis, hay fever, or relevant symptoms/conditions either prior to or during service. There are no separation reports of medical examination and/or history of record. 

During her May 2024 Board hearing, the Veteran did not testify that she either experienced or was treated for any nasal and/or allergy symptoms/conditions during service. Rather, she testified that she developed headaches during service which are exacerbated/made worse by sinus symptoms that she attributes to her allergic rhinitis and/or hypertrophy of nasal turbinates. See May 2024 Board Hearing Transcript.

In an August 2024 written statement, the Veteran's daughter, G.J., indicated the Veteran currently uses daily Flonase and over the counter allergy medication for her allergic rhinitis; is sensitive to the smell of tobacco smoke and perfume; and experiences facial swelling around her sinuses, accompanied by headaches. See August 2024 Written Statement, G.J. 

In an August 2024 written statement, the Veteran reported she: (1) takes daily Flonase for inflamed nostrils; (2) was treated in the VA emergency department in June 2016 for allergic rhinitis; (3) experiences various allergy-related symptoms (headache, runny nose, swollen face, mucous drainage, hoarse voice, sneezing, congestion, itchy nose, watery eyes, clogged ears); and (4) experiences allergies that are triggered by tobacco smoke, automobile exhaust, and dust. See August 2024 Written Statement. 

VA treatment records dated from 2003 do not document any treatment for complaints of allergy/nasal symptoms prior to July 2014. In July 2014, more than 20 years after her separation from service, the Veteran was treated for complaints of nasal congestion with yellow discharge and tightness around the eyes for which she had
 June 2016 for allergic rhinitis; (3) experiences various allergy-related symptoms (headache, runny nose, swollen face, mucous drainage, hoarse voice, sneezing, congestion, itchy nose, watery eyes, clogged ears); and (4) experiences allergies that are triggered by tobacco smoke, automobile exhaust, and dust. See August 2024 Written Statement. 

VA treatment records dated from 2003 do not document any treatment for complaints of allergy/nasal symptoms prior to July 2014. In July 2014, more than 20 years after her separation from service, the Veteran was treated for complaints of nasal congestion with yellow discharge and tightness around the eyes for which she had reportedly used Flonase in the past. See July 2014 Otolaryngology Consult. Her provider prescribed Flonase and noted possible eustachian tube dysfunction due to nasal congestion, based on her then reported ear pain. Id. In October 2014, she again reported nasal obstruction, on examination her provider noted bilateral inferior turbinate hypertrophy without septal deviation and prescribed a second nasal spray medication. See October 2014 Otolaryngology Note. 

In June 2016, the Veteran was treated in the emergency department for complaints of recurrent nasal congestion associated with headache and tinnitus over the prior 2 months, assessed as allergic rhinitis. See June 2016 Emergency Department Note. In July 2016, she was treated for reported post-nasal drip and associated frontal head pain/pressure, assessed as possible chronic sinusitis. See July 2016 Otolaryngology Note. An August 2016 CT of the Veteran's sinuses documented multiple mucous retention cysts/polyps in the maxillary sinuses bilaterally, without evidence of acute sinusitis. See August 2016 Radiology Report. VA treatment records submitted by the Veteran in July 2024 document emergency treatment for a sinus pressure headache persisting for 3 days in October 2023 and for headache, sinus congestion, sore throat, productive cough, and intermittent fever and chills, assessed as viral syndrome, in January 2024. See October 2023 Emergency Department Note; January 2024 Emergency Department Note. 

In sum, there is no medical evidence of record documenting complaints, treatment, and/or diagnosis of hypertrophy of nasal turbinates and/or allergic rhinitis during or within one year following the Veteran's separation from service. She does not contend she developed sinus, allergy, and/or nasal symptoms during or within one year following her separation from service. There is no medical evidence of record documenting treatment for allergy/nasal symptoms prior to June 2014, more than 20 years after her separation from service. Finally, there is no medical evidence of record which indicates her allergic rhinitis and/or hypertrophy of nasal turbinates was incurred in or is otherwise related to an in-service event, injury, or illness. 

To the extent the Veteran contends her allergy/sinus symptoms exacerbate her claimed headaches, remanded herein, she does not contend her headaches either caused or aggravated her allergic rhinitis and/or hypertrophy of nasal turbinates.

Therefore, based on the foregoing, the evidence of record clearly weighs against finding the Veteran's allergic rhinitis and/or hypertrophy of the nasal turbinates was incurred in or is otherwise related to an in-service event, injury, or illness. 

As the evidence of record clearly weighs against the Veteran's claims, the benefit-of-the doubt doctrine does not apply, and the claims must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

10. Entitlement to service connection for teeth grinding (bruxism) to include as secondary to service-connected disability is denied.

The Veteran does not contend that her teeth grinding (diagnosed bruxism) was incurred in or is otherwise directly related to an in-service event, injury, or illness. Rather, during her May 2024 Board hearing she expressed her belief that her teeth grinding is caused by anxiety/stress she attributes to her (herein service-connected) psychiatric disability. See May 2024 Board Hearing Transcript. 

For the following reasons, entitlement to service connection for bruxism, to include as secondary to her service-connected psychiatric disability is not warranted.

The AOJ has conceded the Veteran's diagnosis of bruxism. See April 2020 Statement of the Case. The Veteran's service treatment records do not document any complaints, treatment, and/or diagnosis of teeth grinding and/or bruxism either prior to or during service. There are no separation reports of medical history and/or examination of record. 

The earliest dated evidence of record documenting a diagnosis of bruxism is an April 2015 VA treatment record, dated some 
/stress she attributes to her (herein service-connected) psychiatric disability. See May 2024 Board Hearing Transcript. 

For the following reasons, entitlement to service connection for bruxism, to include as secondary to her service-connected psychiatric disability is not warranted.

The AOJ has conceded the Veteran's diagnosis of bruxism. See April 2020 Statement of the Case. The Veteran's service treatment records do not document any complaints, treatment, and/or diagnosis of teeth grinding and/or bruxism either prior to or during service. There are no separation reports of medical history and/or examination of record. 

The earliest dated evidence of record documenting a diagnosis of bruxism is an April 2015 VA treatment record, dated some 25 years after her separation from service, in which she reported her dentist had made her a nightguard for bruxism, which she therein attributed to stress. See April 2015 Mental Health Note. 

In a June 2024 letter, the Veteran's private treating dentist, Dr. L.B., indicated she is prescribed a nightguard for "severe teeth grinding at night" and exhibits clinical signs of bruxism and occlusal wear. See June 2024 Letter, Dr. L.B., Received July 2024. 

In sum, the evidence of record does not document complaints, treatment, and/or diagnosis of bruxism prior to April 2015, some 25 years after her separation from service, notwithstanding her reports of anxiety symptoms with onset during service which have persisted to date. There is no medical evidence of record linking the Veteran's bruxism to service and/or to her now service-connected psychiatric disability. Indeed, the sole evidence of record linking the Veteran's bruxism to her service-connected psychiatric disability is her belief, unsupported by any competent medical evidence of record, that her bruxism is due to stress. 

While the Veteran is competent to report on her observable symptoms, to include teeth grinding and stress, she does not contend and the evidence of record does not demonstrate that her teeth grinding had its onset during service, nor does the evidence of record demonstrate that she has the medical training, experience, or expertise needed to competently provide a medical etiology opinion. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). 

Thus, the Veteran's sincerely held belief notwithstanding, the competent evidence of record clearly weighs against finding her bruxism was incurred in or is otherwise related to an in-service event, injury, or illness, to include as secondary to her service-connected psychiatric disability. 

As the competent evidence of record clearly weighs against the claim, the benefit-of-the doubt doctrine does not apply, and the claim must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

11. Entitlement to service connection for uterine disorder to include heterogeneous uterine with fibroids and adenomyosis is denied.

12. Entitlement to ovarian disorder to include ovarian hemorrhagic complex cysts and follicles is denied. 

The Veteran contends she has uterine fibroids and ovarian cysts that were incurred in or are otherwise related to an in-service event, injury, or illness. Specifically, she points to her service treatment records which document treatment for complaints of menstrual cramps/pain during service. 

For the following reasons, entitlement to service connection for uterine and/or ovarian disorders is not warranted. 

The Veteran's service treatment records do not document any complaints, treatment, and/or diagnosis of an ovarian and/or uterine disorder either prior to or during service. There are no separation reports of medical history and/or examination of record. 

In July 1985, the Veteran was treated for complaints of abdominal pain and cramps, with noted onset of menses that morning. See July 1985 Service Treatment Note. In February 1989, she was again treated for complaints of menstrual cramps. See February 1989 Chronological Record of Medical Care. 

Her service treatment records do not document any gynecologic complaints other than the above noted report of menstrual cramps in July 1985 and in February 1989. Nor does the Veteran contend she experienced any gynecologic symptoms, other than the pelvic pain and menstrual cramps for which she sought treatment during service. 

VA treatment records dated from 2003 do not document any complaints, treatment, and/or diagnosis of any ovarian and/or uterine condition at any time prior to September 2014. In September 2014, more than 20 years after her separation from service, she reported that an MRI of her lower back completed through a private doctor incidentally showed a hemorrhagic cyst or endometrioma of the right ovary. See September 2014 Primary Care Note. 


 other than the above noted report of menstrual cramps in July 1985 and in February 1989. Nor does the Veteran contend she experienced any gynecologic symptoms, other than the pelvic pain and menstrual cramps for which she sought treatment during service. 

VA treatment records dated from 2003 do not document any complaints, treatment, and/or diagnosis of any ovarian and/or uterine condition at any time prior to September 2014. In September 2014, more than 20 years after her separation from service, she reported that an MRI of her lower back completed through a private doctor incidentally showed a hemorrhagic cyst or endometrioma of the right ovary. See September 2014 Primary Care Note. 

A September 2014 pelvic ultrasound documented: (1) a heterogeneous uterus, may represent adenomyosis; (2) uterine fibroid; (3) right ovarian complex cyst; and (4) left ovarian follicles. See September 2014 Radiology Report; October 2014 Primary Care Letter. A July 2016 ultrasound documented: (1) multi fibroid uterus; and (2) cystic structure in right ovary, may represent a hemorrhagic cyst versus endometrioma. See June 2016 Radiology Report; July 2016 Primary Care Letter. In August 2016, the Veteran's primary care provider referred her to a gynecologist. See August 2016 Primary Care Note. However, an August 2018 primary care note indicates the Veteran did not follow up with the gynecologist. See August 2018 Primary Care Note. 

In an August 2024 written statement, the Veteran's daughter, G.J., indicated her mother has told her that she experienced painful menstrual cycles during service and that she now has fibroids. See August 2024 Written Statement, G.J. 

In an August 2024 written statement, the Veteran expressed her belief that her uterine fibroid is connected to the painful menstrual cramps for which she sought treatment during service. See August 2024 Written Statement.

Notwithstanding the Veteran's documented reports of menstrual cramps during service, several service gynecological examinations of record do not reveal any relevant abnormalities. See e.g., August 1985 Gynecological Cytology (pelvic organs within normal limits); August 1986 Chronological Record of Medical Care (does not report any spotting/bleeding between periods, examination within normal limits); August 1987 Chronological Record of Medical Care (normal gynecological examination); August 1988 Gynecologic Cytology (physical examination within normal limits).

A June 2024 VA letter indicates imaging then showed normal ovaries, with no evidence of ovarian cyst, and a small uterine fibroid. See June 2024 VA Letter, Received July 2024. 

In sum, while the evidence of record documents a current diagnosis of uterine fibroid, it does not demonstrate that the Veteran has a current ovarian disorder. See Brammer v. Derwinski, 3?Vet. App.?223, 225 (1992) (Congress specifically limited entitlement to service-connected benefits to cases where there is a current disability).  

Moreover, the sole evidence of record linking the Veteran's currently diagnosed uterine fibroid and/or past documented uterine and ovarian disorders to service is her belief, unsupported by medical evidence of record, that they are in some way related to her menstrual pain treated in service. Significantly, no abnormalities of the uterus and/or ovaries were documented across multiple in-service physical gynecological examinations. 

While the Veteran is competent to report on her observable symptoms, such as menstrual and pelvic pain, the evidence of record does not demonstrate that she has the medical training, experience, or expertise needed to competently provide a medical etiology opinion. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). 

Thus, the Veteran's sincerely held belief notwithstanding, the competent evidence of record clearly weighs against finding her currently diagnosed uterine fibroid and/or past documented uterine and ovarian disorders were incurred in or are otherwise related to an in-service event, injury, or illness. 

As the competent evidence of record clearly weighs against the claims, the benefit-of-the doubt doctrine does not apply, and the claims must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

As indicated above, if the Veteran would like VA to consider any evidence the Board could not consider, she may file a supplemental claim and submit or identify this evidence. If the evidence is new and relevant, VA will issue another decision on the claim(s), considering the new evidence in addition to the evidence previously considered. 

Increased
ine fibroid and/or past documented uterine and ovarian disorders were incurred in or are otherwise related to an in-service event, injury, or illness. 

As the competent evidence of record clearly weighs against the claims, the benefit-of-the doubt doctrine does not apply, and the claims must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

As indicated above, if the Veteran would like VA to consider any evidence the Board could not consider, she may file a supplemental claim and submit or identify this evidence. If the evidence is new and relevant, VA will issue another decision on the claim(s), considering the new evidence in addition to the evidence previously considered. 

Increased Ratings

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38?U.S.C. §?1155; 38?C.F.R. §?4.1.???? 

Where 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 for that rating. Otherwise, the lower rating will be assigned. 38?C.F.R. §?4.7.???? 

"Staged" ratings are appropriate for any rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21?Vet. App.?505 (2007); Fenderson v. West, 12?Vet. App.?119 (1999).???? 

The applicable law and regulations concerning effective dates state in relevant part that, except as otherwise provided, the effective date of a disability rating will be the date of receipt of claim or the date entitlement arose, whichever is the later. 38?U.S.C. § 5110; 38 C.F.R. § 3.400.? 

An exception to this rule provides the effective date of an award of increased disability compensation shall be the earliest date as of which it is factually ascertainable an increase in disability has occurred, if the claim is received within one year from such date; otherwise, it is the date of receipt of the claim. 38 U.S.C. § 5110 (b)(2); 38 C.F.R. § 3.400 (o)(2); see also Hazan v. Gober, 10?Vet. App.?511 (1997) (When considering the appropriate effective date for an increased rating, VA must consider the evidence of disability during the period one year prior to the application). In other words, the effective date of an award of increased compensation can be the earliest date on which it was ascertainable an increase in disability occurred, if the application is received within one year from such date.?

13. Entitlement to an initial compensable disability rating for service-connected acne is denied.

The Veteran contends her initial, noncompensable disability rating does not accurately reflect the severity of her service-connected disability. 

Specifically, she contends that she receives ongoing dermatology treatment for acne, to include breakouts, for which she is prescribed medications. 

The AOJ has rated the Veteran's acne pursuant to Diagnostic Code (DC) 7828, for acne, under 38 C.F.R. § 4.118. During the pendency of the appeal, the criteria for evaluating certain disabilities of the skin were revised, effective August 13, 2018. See 38 C.F.R. § 4.118, (Diagnostic Codes 7801, 7802, 7805, and 7806). However, DC 7828 was unaffected by the revisions, and DC 7828 is the only applicable DC to address the disability at issue.  As such, the revisions do not affect the Veteran's claim for a higher rating.

Under DC 7828, a noncompensable disability rating is warranted for superficial acne (comedones, papules, pustules, superficial cysts) of any extent. A 10 percent disability rating is warranted for deep acne (deep inflamed nodules and pus-filled cysts) affecting less than 40 percent of the face and neck, or; deep acne other than on the face and neck. The maximum 30 percent disability rating is warranted for deep acne (deep inflamed nodules and pus-filled cysts) affecting 40 percent or more of the face and neck. Or acne may be rated as disfigurement of the head, face or neck (DC 7800) or scars (DCs 7801, 7802, 7803, 7804, 7805), depending upon the predominant disability.

Private treatment records dated from
, superficial cysts) of any extent. A 10 percent disability rating is warranted for deep acne (deep inflamed nodules and pus-filled cysts) affecting less than 40 percent of the face and neck, or; deep acne other than on the face and neck. The maximum 30 percent disability rating is warranted for deep acne (deep inflamed nodules and pus-filled cysts) affecting 40 percent or more of the face and neck. Or acne may be rated as disfigurement of the head, face or neck (DC 7800) or scars (DCs 7801, 7802, 7803, 7804, 7805), depending upon the predominant disability.

Private treatment records dated from 2012 document a diagnosis of adult acne and treatment for facial sebaceous gland hyperplasia, consistent with the below-noted VA examination. See February 2012 Treatment Record, D.S., M.D.; February 2015 Treatment Record, D.S., M.D., Received July 2024.

In June 2016 the Veteran underwent a VA examination. The examiner diagnosed acne. See June 2016 VA Examination. The examiner noted review of treatment records documenting facial sebaceous gland hyperplasia; a nodule on the bilateral angle of the mandible face; and acne affecting the chest and back for which the Veteran was prescribed topical acne medications. Id. 

The Veteran reported having missed 12 days of work over the prior 12-month period due to reported symptoms of painful swelling affecting her face, nose, and neck area. Id. The examiner noted the use of topical acne medications for a duration of less than 6 weeks over the prior 12-month period. Id. On examination, the Veteran did not exhibit any scarring or disfigurement of the head, face, or neck; however, the examiner noted superficial acne (comedones, papules, pustules, superficial cysts) affecting body areas other than the face and neck. Id. 

In a June 2016 addendum, the examiner indicated the Veteran did not exhibit any facial and/or chest acne during her June 2016 VA examination but did exhibit back acne affecting less than 5 percent of her total back area and none of the exposed area of her back. See June 2016 Addendum. 

VA treatment records dated from April 2003 through March 2020 document prescriptions for topical acne medications. See September 2014 Emergency Department Note (seen for refill of hydroquinone 4% topical medication for acne). 

A January 2024 VA dermatology note documents a history of facial acne resulting in clogged pores, then treated with Cerave moisturizer. See January 2024 Dermatology Clinic Note, Received July 2024.

In a June 2024 letter, the Veteran's private dermatologist, D.S., M.D., indicated she was receiving treatment on an ongoing basis for acne. See June 2024 Letter, D.S., M.D., Received July 2024. 

A January 2024 VA dermatology note documents: (1) acne on the face for which the Veteran was prescribed topical medications; and (2) a reported history of cyst on the left side of the neck for which she had undergone incision and drainage (I&D) years ago and which she indicated occasionally drains malodorous material. See January 2024 Dermatology Note. However, a subsequent May 2024 VA dermatology note does not document a current diagnosis of cyst on the left side of the neck and notes acne that is well controlled with medication. See May 2024 Dermatology Note. 

Thus, available VA and private treatment records do not document any deep acne, disfigurement of the head or neck, and/or acne scarring. 

In sum, the evidence of record documents acne symptoms consistent with the noncompensable rating criteria and does not demonstrate that a compensable disability rating is warranted for acne at any time during the appeal period. 

Therefore, entitlement to an initial, compensable disability rating for service-connected acne is not warranted. 

REASONS FOR REMAND

1. Entitlement to service connection for neck disorder to include cervical spine multilevel degenerative disease, to include as secondary to service-connected disability is remanded.

2. Entitlement to service connection for back disorder to include degenerative disc and joint disease, to include as secondary to service-connected disability is remanded.

3. Entitlement to service connection for bilateral lower extremity disorder to include sciatica (radiculopathy), to include as secondary to service-connected disability is remanded.

The Veteran contends her diagnosed: (1) cervical spine multilevel degenerative disease; (2) lumbar spine degenerative disc and joint disease; and (3) bilateral lower extremity sciatica (radiculopathies) associated with her lumbar spine disorder
 to service connection for neck disorder to include cervical spine multilevel degenerative disease, to include as secondary to service-connected disability is remanded.

2. Entitlement to service connection for back disorder to include degenerative disc and joint disease, to include as secondary to service-connected disability is remanded.

3. Entitlement to service connection for bilateral lower extremity disorder to include sciatica (radiculopathy), to include as secondary to service-connected disability is remanded.

The Veteran contends her diagnosed: (1) cervical spine multilevel degenerative disease; (2) lumbar spine degenerative disc and joint disease; and (3) bilateral lower extremity sciatica (radiculopathies) associated with her lumbar spine disorder were all caused or aggravated by her service-connected bilateral foot disabilities. See May 2024 Board Hearing Transcript. 

Under the AMA, remands are limited to correction of: (1) duty to assist errors occurring prior to the date of the RO decision on appeal, and (2) RO errors in satisfying a regulatory or statutory duty if correction of such error would have a reasonable possibility of aiding in substantiating the Veteran's claim. See 38 C.F.R. § 20.802(a). 

Remand is warranted to correct a pre-decisional duty to assist error. 38 C.F.R. § 20.802(a). Specifically, remand is warranted to obtain VA medical opinions addressing the nature and etiology of the Veteran's neck, back, and bilateral lower extremity disorders. See McLendon v. Nicholson, 20?Vet. App.?79, 83 (2006).?? 

Pursuant to McLendon, a VA examination is required if the information of record does not contain sufficient competent medical evidence to decide the claim, but: (1) there is evidence of a current disability or symptoms of disability, (2) evidence establishing an in-service event, injury or disease, or that a disease manifested in accordance with presumptive service connection regulations, or occurred which would support incurrence or aggravation; and (3) an indication the current disability may be related to the in-service event. 38?C.F.R. §?3.159; McLendon, 20?Vet. App.?at 83-86. The threshold for finding a link between a current disability such that a medical examination is required is low. Locklear v. Nicholson, 20?Vet. App.?410, 419 (2006).? 

The AOJ has conceded the Veteran's diagnoses of: (1) cervical spine degenerative disc and joint disease; (2) mild degenerative disc signal and bulge at L5-S1; and (3) bilateral lower extremity sciatica (radiculopathy). See April 2020 Statement of the Case. Thus, the evidence of record documents current disabilities. 

The Veteran is service connected for pes planus with fascia and hallux valgus with hammertoe of the second and fifth digits of the bilateral feet. Thus, the evidence of record demonstrates an in-service event/injury. 

During her May 2024 Board hearing, the Veteran testified that she did not sustain any injuries to or develop any problems with her back and/or neck during service, nor does she contend such conditions were incurred in or are otherwise directly related to an in-service event, injury, or illness. See May 2024 Board Hearing Transcript. 

Rather, she contends her service-connected bilateral foot disabilities have altered the way that she walks, which has either caused or aggravated her diagnosed neck, back, and bilateral lower extremity disorders. Id. Thus, there is some indication her neck, back, and bilateral lower extremity disorders may be related to her service-connected bilateral foot disabilities.

While the Veteran is competent to report on her observable symptoms, such as foot pain due to which she walks with an altered gait, she is not competent to opine on whether her bilateral foot disabilities, and any alteration of her gait related thereto, have caused or aggravated her neck, back, and lumbar radiculopathy disorders. The issues of causation and aggravation are medically complex, requiring specialized medical knowledge. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007).?? 

Based on the foregoing, the competent medical evidence of record is insufficient to decide the claim. Therefore, remand is warranted to obtain VA medical opinions addressing the nature and etiology of the Veteran's diagnosed neck, back, and bilateral lower extremity disorders. 

4. Entitlement to service connection for bilateral mycotic nails/onychomycosis to include as secondary to service-connected disability is remanded.

The Veteran contends her diagnosed onychomycosis, affecting the toenails of her bilateral feet,
 and aggravation are medically complex, requiring specialized medical knowledge. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007).?? 

Based on the foregoing, the competent medical evidence of record is insufficient to decide the claim. Therefore, remand is warranted to obtain VA medical opinions addressing the nature and etiology of the Veteran's diagnosed neck, back, and bilateral lower extremity disorders. 

4. Entitlement to service connection for bilateral mycotic nails/onychomycosis to include as secondary to service-connected disability is remanded.

The Veteran contends her diagnosed onychomycosis, affecting the toenails of her bilateral feet, were either caused or aggravated by her service-connected bilateral foot disabilities. 

Remand is warranted to correct a pre-decisional duty to assist error. 38 C.F.R. § 20.802(a). Specifically, remand is warranted to obtain a VA medical opinion addressing the nature and etiology of the Veteran's bilateral onychomycosis disorder. See McLendon v. Nicholson, 20?Vet. App.?79, 83 (2006).?? 

The Veteran is service connected for bilateral pes planus with fascia and hallux valgus with hammer toe of the second and fifth digits.

The AOJ has conceded the Veteran's diagnosis of onychomycosis of the left great toe. See April 2020 Statement of the Case. Treatment records submitted by the Veteran document a diagnosis of painful onychomycosis affecting the toenails of the bilateral feet. See June 2024 Treatment Note, M.F., DMP, Received July 2024.

VA treatment records dated from April 2003 to March 2020 document a diagnosis of onychomycosis (a fungal nail infection) in November 2004, within one year after she underwent surgery on her bilateral feet in August 2003. See November 2004 Podiatry Note. Treatment records thereafter document ongoing treatment for onychomycosis. See e.g., April 2014 Podiatry Consult. Private treatment records the Veteran submitted document ongoing treatment for toenail fungus in 2024. See Family Foot and Ankle Associates of Maryland Treatment Records, Received July 2024.  

During her May 2024 Board hearing, the Veteran conceded that she did not develop onychomycosis during service. See May 2024 Board Hearing Transcript. However, she testified that the condition began following the worsening of her service-connected bilateral foot disabilities. Id.

While the Veteran is not competent to opine on the etiology of her onychomycosis, the evidence of record nonetheless demonstrates that she was diagnosed with the condition, which has persisted to date, within one year after undergoing surgery for her service-connected bilateral foot disabilities. Therefore, there is some indication her onychomycosis may have been caused or aggravated by her service-connected bilateral foot disabilities.

There is no competent medical evidence of record addressing the etiology of the Veteran's onychomycosis and, as such, there is insufficient evidence of record to decide the claim.

Therefore, based on the foregoing, remand is warranted to obtain a VA medical opinion addressing the nature and etiology of the Veteran's onychomycosis. 

5. Entitlement to service connection for headache disorder to include migraine headaches is remanded.

The Veteran contends she developed headaches during service which have persisted to date. See May 2024 Board Hearing Transcript. 

Remand is warranted to correct a pre-decisional duty to assist error. 38 C.F.R. § 20.802(a). Specifically, remand is warranted to obtain a VA examination and medical opinion addressing the nature and etiology of the Veteran's claimed headache disorder. See McLendon v. Nicholson, 20?Vet. App.?79, 83 (2006).?? 

The AOJ has conceded that the Veteran's VA treatment records document a reported history of migraine headaches. See April 2020 Statement of the Case. 

During her May 2024 Board hearing, the Veteran testified: (1) her headaches started during service; (2) she does not recall experiencing headaches prior to entering service; and (3) her headaches persisted after her separation from service, to date. See May 2024 Board Hearing Transcript.

VA treatment records from 2003 do not document any complaints, treatment, and/or diagnosis of headaches until 2014, some 24 years after her separation from service; however, she then reported a history of migraines. See May 2014 Primary Care Note (reports a history of migraines). In February 2015, the Veteran reported experiencing worsened migraines to her mental health provider. See February 2015 Mental Health Note. In June 2016, the Veteran
 Veteran testified: (1) her headaches started during service; (2) she does not recall experiencing headaches prior to entering service; and (3) her headaches persisted after her separation from service, to date. See May 2024 Board Hearing Transcript.

VA treatment records from 2003 do not document any complaints, treatment, and/or diagnosis of headaches until 2014, some 24 years after her separation from service; however, she then reported a history of migraines. See May 2014 Primary Care Note (reports a history of migraines). In February 2015, the Veteran reported experiencing worsened migraines to her mental health provider. See February 2015 Mental Health Note. In June 2016, the Veteran contacted VA to report that she was experiencing symptoms of tinnitus, nasal congestion, and migraine headache, her provider recommended she present to the emergency department for treatment. See June 2016 Telephone Note. The Veteran was subsequently treated in the emergency department for nasal congestion and frontal headache, assessed as allergic rhinitis. See June 2016 Emergency Department Note. 

In July 2016, she reported experiencing tinnitus, post-nasal drip, and aural fullness which her provider indicated was possibly related to migraine headaches, and for which her provider ordered a CT. See July 2016 Otolaryngology Note. An August 2016 CT of the Veteran's sinuses documented multiple mucous retention cysts/polyps in the maxillary sinuses bilaterally, without evidence of acute sinusitis. See August 2016 Radiology Report.  

In September 2018, the Veteran was treated in the emergency department for a reported migraine with symptoms of headache pain, mental fatigue, neck pain, shoulder pain, and nausea, assessed as a likely tension headache due to a non-focal neurological examination. See September 2018 Emergency Department Note. 

In October 2023, the Veteran was treated in the emergency department for symptoms of sinus pressure headache persisting 3 days which she reported was similar to her migraines, assessed as headache. See October 2023 Emergency Department Note. 

In January 2024, the Veteran was treated in the emergency department for complaints of flu-like symptoms to include intermittent fever and chills, productive cough, sore throat, nasal congestion, and a reported migraine persisting 3 days, assessed as viral syndrome. See January 2024 Emergency Department Note. 

In sum, notwithstanding the Veteran's reported history of migraines in 2014 and subsequent treatment for headache symptoms, often associated with nasal congestion and/or sinus pressure, there is no medical evidence of record which clearly documents a current diagnosis of a migraine or other persistent headache disorder. 

However, based on the foregoing, the evidence of record nonetheless documents symptoms of disability.

In its April 2020 statement of the case, the AOJ incorrectly indicated that the Veteran's service treatment records do not document any reports of headaches during service. 

The Veteran points to several service treatment notes in support of her claim to include: (1) a June 1989 service eye examination during which she reported a personal history of headaches, something she denied in her enlistment report of medical history (See June 1989 Service Eye Examination); (2) an October 1988 service treatment record in which she was treated for complaints of blurry vision (without report of headache), assessed as eye strain (See October 1988 Chronological Record of Medical Care); and (3) an August 1987 service treatment note in which she reported experiencing rare frequent or severe headaches (See August 1987 Chronological Record of Medical Care).

The Veteran's documented in-service reports of headaches in August 1987 and in June 1989 are consistent with her testimony that she developed headaches during service (which she contends continued after her separation from service and have persisted to date). 

However, the medical evidence of record is insufficient to decide the claim as it is unclear whether the Veteran has a current diagnosis of a headache disorder, to include migraine headaches, and, if so, whether it is at least as likely as not such headache disorder was incurred in or is otherwise related to her reported history of headaches and/or treatment for eye strain documented in service treatment records. 

Therefore, based on the foregoing, remand is warranted to obtain a VA examination and medical opinion addressing the nature and etiology of the Veteran's headache symptoms.

6. Entitlement to service connection for bilateral hearing loss is remanded.

7. Entitlement to service connection for tinnitus is remanded.

The Veteran contends she has tinnitus and hearing loss that were incurred in or are otherwise related to military noise exposure. 

Remand is warranted to correct a pre-decisional duty to assist error. 38 C.F.R. § 20.802(a). Specifically, remand is warranted to obtain a VA examination and medical opinions addressing the nature and et
 reported history of headaches and/or treatment for eye strain documented in service treatment records. 

Therefore, based on the foregoing, remand is warranted to obtain a VA examination and medical opinion addressing the nature and etiology of the Veteran's headache symptoms.

6. Entitlement to service connection for bilateral hearing loss is remanded.

7. Entitlement to service connection for tinnitus is remanded.

The Veteran contends she has tinnitus and hearing loss that were incurred in or are otherwise related to military noise exposure. 

Remand is warranted to correct a pre-decisional duty to assist error. 38 C.F.R. § 20.802(a). Specifically, remand is warranted to obtain a VA examination and medical opinions addressing the nature and etiology of the Veteran's hearing loss and tinnitus. See McLendon v. Nicholson, 20?Vet. App.?79, 83 (2006).?? 

The Veteran contends she began her military career as an aircraft maintenance technician and was exposed to significant and constant noise on the flight line and from aircraft throughout her training and while performing her duties. She contends she thereafter spent most of her military career working in a warehouse that was located next to the flight line, at which time she was constantly exposed to noise from aircraft, heavy machinery, and tools. Finally, she contends she developed a buzzing in her ears during service (which she did not then know was tinnitus) which continued after her separation from service and has persisted to date. Id.

Notwithstanding her reported noise exposure, during her Board hearing she denied experiencing any subjective hearing loss either during or immediately following her separation from service. Id.

The AOJ has conceded the Veteran's diagnosis of tinnitus. See April 2020 Statement of the Case. The AOJ has not conceded military noise exposure and/or bilateral hearing loss. Id.

VA treatment records document a diagnosis of tinnitus in July 2014, at which time she reported the onset of progressive hearing loss and tinnitus in 2008, some 19 years after her separation from service. See July 2014 Otolaryngology Consult. VA treatment records thereafter document continued complaints of tinnitus and subjective hearing loss. It is unclear from the available evidence of record whether the Veteran has a current hearing loss disability for VA purposes. There is no VA examination of record. However, VA treatment records document a diagnosis of mild high frequency bilateral hearing loss and note a prescription for mild gain hearing aids. See July 2014 Audiology Note.

 Significantly, in its April 2020 statement of the case, there is no indication the AOJ considered the Veteran's reported noise exposure during training and as an aircraft maintenance technician, which is documented in her service personnel and treatment records. See e.g., Military Personnel Record, Received February 2016 (certificate of completion of training for aircraft maintenance specialist). Rather, the AOJ only considered her remaining military occupational specialties, to include as an administrative specialist, a material storage and distribution specialist, and a surgical services specialist. See April 2020 Statement of the Case. 

Therefore, based on the foregoing, remand is warranted to obtain a VA examination and medical opinion addressing: (1) the nature and etiology of the Veteran's diagnosed tinnitus; (2) whether she has a hearing loss disability for VA purposes; and (3) if so, the nature and etiology of her hearing loss.

8. Entitlement to an initial, compensable disability rating for service-connected right toe scar is remanded.

9. Entitlement to an initial, compensable disability rating for service-connected left toe scar is remanded.

The Veteran contends her initial noncompensable disability ratings do not accurately reflect the severity of her service-connected bilateral toe scars. Specifically, she contends her bilateral toe scars are itchy, have not healed properly, and present with nuisance callouses she must regularly file down. See May 2024 Board Hearing Transcript; August 2024 Written Statement. 

Remand is warranted to correct a pre-decisional duty to assist error. 38 C.F.R. § 20.802(a). Specifically, remand is warranted to obtain a VA examination specifically addressing the current severity of the Veteran's bilateral toe scars. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (once VA undertakes to provide an examination, such examination must be adequate).

In June 2016 the Veteran underwent a VA examination, the examiner noted scars on the fifth toes of the bilateral feet, residuals of bilateral fifth toe arthroplasty surgeries in August 2003. See June 2016 VA Examination. The examiner indicated the scars were neither painful nor unstable, with the right toe scar measuring 1.0 cm. by 0.2 cm. and the left toe scar measuring 0.9 cm. by 0.2 cm. Id.

The AOJ
 current severity of the Veteran's bilateral toe scars. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (once VA undertakes to provide an examination, such examination must be adequate).

In June 2016 the Veteran underwent a VA examination, the examiner noted scars on the fifth toes of the bilateral feet, residuals of bilateral fifth toe arthroplasty surgeries in August 2003. See June 2016 VA Examination. The examiner indicated the scars were neither painful nor unstable, with the right toe scar measuring 1.0 cm. by 0.2 cm. and the left toe scar measuring 0.9 cm. by 0.2 cm. Id.

The AOJ did not obtain a separate VA scars examination specifically addressing the severity of the Veteran's bilateral toe scars. 

A June 2017 VA examination also indicates the Veteran's bilateral toe scars were neither painful nor unstable, with a total area of approximately 2-3 cm. See June 2017 VA Examination.

Again, the AOJ did not obtain a separate VA scars examination specifically addressing the severity of the Veteran's toe scars. 

Based on the foregoing, remand is warranted to obtain a VA scars examination specifically addressing the current severity of the Veteran's bilateral toe scars. 

The matters are REMANDED for the following action:

1. In remanding these matters, the Board makes no credibility determination, express or implied at this juncture. 

2. Obtain any outstanding VA treatment records and associate them with the claims file.

3. After the above development of the record is completed, regarding the Veteran's bilateral toe scars, schedule the Veteran for a VA scars examination to address the current severity of her bilateral toe scars. The examiner should discuss all findings in terms of the VA Schedule for Rating Disabilities, Diagnostic Codes 7801-7805 for Scars, noting if each of the identified scars are stable or unstable, deep or superficial, and linear or non-linear, as well as if any pain is present or reported. The pertinent rating criteria must be provided to the examiner, and the findings reported must be sufficiently complete to allow for a rating under all alternate criteria.

4. Regarding the Veteran's claimed neck disorder, forward the claims file to a qualified clinician to obtain a medical opinion addressing the nature and etiology of the Veteran's diagnosed cervical spine multilevel degenerative disease. After reviewing the claims file, including this Remand, the clinician is requested to opine on the following:

(a.) Whether it is at least as likely as not (likelihood is in at least approximate balance or nearly equal, if not greater) the Veteran's diagnosed cervical spine multilevel degenerative disease was either: (1) caused; or (2) aggravated by one or more of her service-connected bilateral foot disabilities?

5. Regarding the Veteran's claimed back disorder, forward the claims file to a qualified clinician to obtain a medical opinion addressing the nature and etiology of the Veteran's diagnosed lumbar degenerative disc and joint disease. After reviewing the claims file, including this Remand, the clinician is requested to opine on the following:

(a.) Whether it is at least as likely as not (likelihood is in at least approximate balance or nearly equal, if not greater) the Veteran's diagnosed lumbar degenerative disc and joint disease was either: (1) caused; or (2) aggravated by one or more of her service-connected bilateral foot disabilities?

6. Regarding the Veteran's claimed bilateral lower extremity disorder, forward the claims file to a qualified clinician to obtain a medical opinion addressing the nature and etiology of the Veteran's diagnosed bilateral lower extremity radiculopathy (sciatica). After reviewing the claims file, including this Remand, the clinician is requested to opine on the following:

(a.) Whether it is at least as likely as not (likelihood is in at least approximate balance or nearly equal, if not greater) the Veteran's diagnosed bilateral lower extremity radiculopathy (sciatica) was either: (1) caused; or (2) aggravated by one or more of her service-connected bilateral foot disabilities?

7. Regarding the Veteran's claimed myotic nails/onychomycosis disorder, forward the claims file to a qualified clinician to obtain a medical opinion addressing the nature and etiology of the Veteran's diagnosed onychomycosis affecting the toenails of her bilateral feet. After reviewing the claims file, including this Remand, the clinician is requested to opine on the following:

(a.) Whether it is at least as likely as not (likelihood is in at least approximate balance or nearly equal, if not greater) the Veteran's diagnosed onychomycosis affecting the toenails of her bilateral feet was either: (1) caused; or (2) aggravated by one or more of her service-connected bilateral foot disabilities?

8
7. Regarding the Veteran's claimed myotic nails/onychomycosis disorder, forward the claims file to a qualified clinician to obtain a medical opinion addressing the nature and etiology of the Veteran's diagnosed onychomycosis affecting the toenails of her bilateral feet. After reviewing the claims file, including this Remand, the clinician is requested to opine on the following:

(a.) Whether it is at least as likely as not (likelihood is in at least approximate balance or nearly equal, if not greater) the Veteran's diagnosed onychomycosis affecting the toenails of her bilateral feet was either: (1) caused; or (2) aggravated by one or more of her service-connected bilateral foot disabilities?

8. Regarding the Veteran's claimed headache disorder, forward the claims file to a qualified clinician to obtain a VA examination and medical opinion addressing the nature and etiology of the Veteran's headache symptoms. After reviewing the claims file, including this Remand, and examining the Veteran, the clinician is requested to opine on the following:

(a.) Does the Veteran have a currently diagnosed headache disorder?

(b.) If so, is it at least as likely as not (likelihood is in at least approximate balance or nearly equal, if not greater) the Veteran's diagnosed headache disorder was incurred in or is otherwise related to an in-service event, injury, or illness, to include the Veteran's reports of headaches documented in service treatment records? See June 1989 Service Eye Examination (personal history of headaches); October 1988 Chronological Record of Medical Care (blurry vision assessed as eye strain); August 1987 Chronological Record of Medical Care (rare frequent or severe headaches).

9. Regarding the Veteran's claimed bilateral hearing loss and tinnitus, forward the claims file to a qualified clinician to obtain a VA examination and medical opinion addressing the nature and etiology of the Veteran's hearing loss symptoms and diagnosed tinnitus. After reviewing the claims file, including this Remand, and examining the Veteran, the clinician is requested to opine on the following:

(a.) Does the Veteran have right and/or left ear hearing disabilities for VA purposes?

(b.) If so, is it at least as likely as not (likelihood is in at least approximate balance or nearly equal, if not greater) the Veteran's hearing loss was incurred in or is otherwise related to an in-service event, injury, or illness, to include her reported military noise exposure during training and while performing her duties as an aircraft maintenance technician and thereafter to constant noise from aircraft and heavy machinery?

(c.) Is it at least as likely as not (likelihood is in at least approximate balance or nearly equal, if not greater) the Veteran's diagnosed tinnitus was incurred in or is otherwise related to an in-service event, injury, or illness, to include her reported military noise exposure during training and while performing her duties as an aircraft maintenance technician and thereafter to constant noise from aircraft and heavy machinery?

A complete rationale containing clear conclusions with supporting data and a reasoned medical explanation connecting the two is required for all medical opinions requested. The clinician(s) should identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical literature, ect., relied upon in reaching the conclusion(s).?    

Note: The Veteran is competent to report on matters of which she has first-hand knowledge such as her observable symptoms and the onset of symptoms.   

If a clinician cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the clinician shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to a given question.  

 

 

G. A. WASIK

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Given, R. A.

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. 


.F.R. § 20.1303.