POSTTRAUMATIC STRESS DISORDER (PTSD)

CHRISTOPHER SEPPANEN · 2026 · Case ID: A26026586

MIXED

Summary

The veteran, who served in the U.S. Army and U.S. Navy, appeals the denial of service connection for several conditions and seeks increased ratings for others. The Board granted service connection for PTSD with panic attacks, awarding an initial 70% rating effective February 6, 2023. Service connection was also granted for a neck disability, a back disability, a right shoulder disability, a bilateral eye disability, sleep apnea, and headaches. The Board denied increased ratings for left and right cubital tunnel syndrome, a right foot fifth digit arthroplasty, and sinusitis, finding the veteran did not meet the criteria for ratings exceeding 10% or for a compensable rating. The Board found the evidence evenly balanced regarding the severity of PTSD for TDIU purposes, but did not grant TDIU. The case was remanded for further development regarding rhinitis, athlete's foot, a left wrist/hand scar, and a nose scar, as the existing examinations were deemed inadequate. Specifically, the rhinitis claim requires diagnostic testing for nasal obstruction, and the other remanded conditions lack sufficient evidence or examination for a decision.

Rationale

Evidence evenly balanced for TDIU; Grant of 70% rating for PTSD

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Diagnostic Code

9411

Docket No.

250822-577713

Full Decision Text

Citation Nr: A26026586
Decision Date: 03/24/26 Archive Date: 03/24/26

DOCKET NO. 250822-577713
DATE: March 24, 2026

ORDER

Entitlement to an initial disability rating of 70 percent for posttraumatic stress disorder (PTSD) with panic attacks, effective February 6, 2023, is granted.

Entitlement to a disability rating in excess of 10 percent for left cubital tunnel syndrome is denied.

Entitlement to a disability rating in excess of 10 percent for right cubital tunnel syndrome is denied.

Entitlement to an initial compensable rating for right foot fifth digit arthroplasty is denied.

Entitlement to a compensable rating for sinusitis is denied.

Entitlement to service connection for a neck disability is granted.

Entitlement to service connection for a back disability is granted.

Entitlement to service connection for a right shoulder disability is granted.

Entitlement to service connection for a bilateral eye disability is granted.

Entitlement to service connection for sleep apnea is granted.

Entitlement to service connection for headaches is granted.

REMANDED

Entitlement to an initial compensable rating for rhinitis is remanded.

Entitlement to service connection for athlete's foot is remanded.

Entitlement to service connection for a left wrist/hand scar is remanded.

Entitlement to service connection for a nose scar is remanded.

FINDINGS OF FACT

1. Since February 6, 2023, the date of service connection, the evidence is at least evenly balanced as to whether the symptoms and impairment caused by the Veteran's PTSD with panic attacks more nearly approximate occupational and social impairment with deficiencies in social relationships, thinking, and mood; the evidence of record and the Veteran's symptomatology does not demonstrate total occupational and social impairment.

2. Throughout the period on appeal, the Veteran's left cubital tunnel syndrome manifested as mild incomplete paralysis of the ulnar nerve.

3. Throughout the period on appeal, the Veteran's right cubital tunnel syndrome manifested as mild incomplete paralysis of the ulnar nerve.

4. For the entire period on appeal, the Veteran's right foot fifth digit arthroplasty disability does not affect all toes.

5. For the entire period on appeal, the Veteran's sinusitis has not resulted in incapacitating episodes requiring prolonged treatment or non-incapacitating episodes characterized by headaches, pain, and purulent discharge or crusting.

6. The Veteran's neck disability began during active service and has been continuous since separation from service.

7. The Veteran's back disability began during active service and has been continuous since separation from service.

8. The Veteran's right shoulder disability began during active service and has been continuous since separation from service.

9. The Veteran's bilateral eye disability had its onset in service.

10. The Veteran's sleep apnea onset in service.

11. The Veteran's headaches onset in service.

CONCLUSIONS OF LAW

1. The criteria for establishing entitlement to an initial disability rating of 70 percent from February 6, 2023, for the Veteran's PTSD with panic attacks have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.21, 4.125, 4.126, 4.130, Diagnostic Code 9411.

2. The criteria for establishing entitlement to a disability rating in excess of 10 percent for left cubital tunnel syndrome have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124(a), Diagnostic Code 8516.

3. The criteria for establishing entitlement to a disability rating in excess of 10 percent for right cubital tunnel syndrome have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.124(a), Diagnostic Code 8516.

4. The criteria for establishing entitlement to an initial compensable rating for right foot fifth digit arthroplasty have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, Diagnostic Code 5282.

5. The criteria for establishing entitlement to a compensable rating for sinusitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7
5107; 38 C.F.R. § 4.124(a), Diagnostic Code 8516.

5. The criteria for establishing entitlement to a compensable rating for sinusitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.97, Diagnostic Code 6513.

6. The criteria for establishing entitlement to service connection for a neck disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

7. The criteria for establishing entitlement to service connection for a back disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

8. The criteria for establishing entitlement to service connection for a right shoulder disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

9. The criteria for establishing entitlement to service connection for a bilateral eye disability have been met. 38 U.S.C. §§ 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303.

10. The criteria for establishing entitlement to service connection for sleep apnea have been met. 38 U.S.C. §§ 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303.

11. The criteria for establishing entitlement to service connection for headaches have been met. 38 U.S.C. §§ 1131, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

Preliminary Matters

The Veteran had honorable active-duty service with the United States Army from October 1993 to January 1998. She also had honorable active-duty service with the United States Navy from April 2008 to June 2009, and from June 2014 to July 2014.

On August 23, 2017, the President signed into law the Veterans Appeals Improvement and Modernization Act, 131 Stat. 1105 (2017), also known as the Appeals Modernization Act (AMA).

This matter is before the Board of Veterans' Appeals (Board) on appeal from September 2024, November 2024, and February 2025 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO).

In August 2025, the Veteran filed VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement (NOD)). The Veteran requested the Evidence Submission docket. Therefore, the Board may only consider the evidence of record at the time of the September 2024, November 2024, and February 2025 rating decisions on appeal, as well as any evidence submitted by the Veteran with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303.

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

Increased Rating

Disability evaluations are determined by comparing the manifestations of a disability with the criteria set forth in the Diagnostic Codes of the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. § Part 4. The percentage ratings represent, as far as can practicably be determined, the average impairment in earning capacity (in civilian occupations) resulting from service-connected disability. 38 C.F.R. § 4.1.
If the evidence is new and relevant, VA will issue another decision on the claim, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included following this decision.

Increased Rating

The evaluation of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14. However, separate ratings may be assigned to different conditions if they do not constitute the same disability or manifestation thereof. See 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 261 (1994).

When 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.

When after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding the degree of disability, such doubt shall be resolved in favor of the claimant. 38 C.F.R. § 4.3.

A schedular rating may be increased if there is objective evidence during examination or treatment of functional loss exceeding that fixed by a schedular rating. See DeLuca v. Brown, 8 Vet. App. 202, 206 (1995); Mitchell v Shinseki, 25 Vet. App. 32 (2011); see also 38 C.F.R. §§ 4.40, 4.45, 4.59.

Separate ratings may be assigned for separate periods of time based on the facts found, a practice known as "staged" ratings. 38 C.F.R. § 4.2. The effective date for a staged rating is when it is factually ascertainable that a particular rating is warranted. Hart v. Mansfield, 21 Vet. App. 505, 509 (2007).

1. Entitlement to an initial disability rating of 70 percent for PTSD with panic attacks, effective February 6, 2023, is granted.

The Veteran asserts entitlement to a higher initial disability rating for her PTSD with panic attacks. The Veteran's PTSD with panic attacks is currently rated at 50 percent.

The Veteran's PTSD with panic attacks is rated under Diagnostic Code 9411, and the General Rating Formula for Mental Disorders pursuant to 38 C.F.R. § 4.130.

Under the General Rating Formula, a 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships.

A 70 percent rating is assigned for occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, judgment, thinking or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near- continuous panic or depression affecting ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships.

A 100 percent rating is assigned for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name.

Under the General Rating Formula, the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013).

The Board finds that after careful consideration of the record, a 70 percent rating is warranted for the Veteran's PTSD with panic attacks for the entire appeal period.

The Veteran underwent a VA psychiatric examination in August 2024. The Veteran reported that she is twice-married. She has been married to her current spouse for approximately 26 years. She described their relationship as having "ups and downs, but trying to keep things moving." She indicated that they are both attending counseling individually where they work on relationship building skills. She has two adult daughters. The Veteran also reported maintaining relationships with her parents and both of her siblings. She indicated that she has lived in the local community for approximately 25 years. She stated that she has a number of friends in the community. Her closer friends tend to come from her civilian and military workplaces. Overall, she described an intact network of social support. The Veteran reported that she was employed on a full-time basis as an account director for Microsoft. At that time, she had been with the company for approximately 15 years.

The examiner noted that the Veteran demonstrated persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others. The examiner also noted that the Veteran had markedly diminished interest in participation in significant activities, and that she had feelings of detachment or estrangement from others. The examiner further indicated the Veteran had irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people of objects, hypervigilance, exaggerated startle response, and sleep disturbance. The duration of the disturbances were more than one month, and the disturbances caused clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The examiner also noted symptoms of anxiety, panic attacks more than once a week, chronic sleep impairment, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. The examiner further noted that the Veteran's reactive symptoms included intrusive thoughts on a daily basis and recurrent nightmares (occurring several times weekly). The Veteran described significant psychiatric/physical distress when presented with cues that remind her of the traumas. She related that at times, such cues (feeling trapped/enclosed or traveling) lead to panic attacks. She estimated that such panic attacks occur several times weekly, as her job requires extensive travel. With respect to negative alterations in mood, she demonstrates significant self-blame. Significant social detachment is also present.

An August 2024 VA mental health note shows that the Veteran reported being bothered nearly every day by the following over the last two weeks: feeling nervous, anxious, or on edge; worrying too much about different things; trouble relaxing; and feeling restless (hard to sit still). She reported experiencing the following more than half the days: not being able to stop or control worrying; becoming easily annoyed or irritable; and afraid as if something awful might happen. She reported being extremely bothered by the following over the past month: disturbing memories, disturbing dreams, re-experiencing events, cued distress, cued physical symptoms, avoiding internal reminders, avoiding external reminders, negative beliefs, blaming self/others, negative feelings, loss of interest, feeling distant from others, difficulty concentrating, and trouble sleeping.

Within the allowable evidentiary window, the Veteran submitted a March 2025 letter from a VA licensed clinical psychologist regarding medical support for a reasonable accommodation request. Due to long-term effects from
sit still). She reported experiencing the following more than half the days: not being able to stop or control worrying; becoming easily annoyed or irritable; and afraid as if something awful might happen. She reported being extremely bothered by the following over the past month: disturbing memories, disturbing dreams, re-experiencing events, cued distress, cued physical symptoms, avoiding internal reminders, avoiding external reminders, negative beliefs, blaming self/others, negative feelings, loss of interest, feeling distant from others, difficulty concentrating, and trouble sleeping.

Within the allowable evidentiary window, the Veteran submitted a March 2025 letter from a VA licensed clinical psychologist regarding medical support for a reasonable accommodation request. Due to long-term effects from combat exposure, the VA licensed clinical psychologist recommended that the Veteran apply for reasonable accommodations and/or FMLA. The VA licensed clinical psychologist stated that, based on a review of the Veteran's medical records, it is clear that the Veteran's primary triggers are intense physical reactions when she perceives being in enclosed spaces such as conference rooms, cars, tunnels, and similar settings; thus, she recommended the following reasonable accommodations: flexible work schedule, telework options, access to larger conference rooms or those with windows when available.

The evidence convincingly shows entitlement to at least a 50 percent evaluation. The medical evidence shows that the Veteran consistently experienced disturbances of motivation and mood. The Veteran also expressed being restless and feeling on edge. She further expressed trouble relaxing and being so restless that it was hard to sit still. The medical evidence further shows several symptoms contemplated in the diagnostic criteria for a 50 percent evaluation, including panic attacks more than once a week. The Board finds that the medical evidence shows that these symptoms create difficulty establishing and maintaining effective work and social relationships, which was noted in the August 2024 VA examination report.

Importantly, however, the evidence also shows that the Veteran's symptoms have met certain criteria for a 70 percent disability rating. The Veteran's PTSD with panic attacks has caused having regular panic attacks. During the August 2024 VA examination, the Veteran reported that panic attacks occurred several times weekly. The August 2024 VA mental health note shows that, during the past month, the Veteran was extremely bothered by several factors, including negative beliefs, blaming self/others, negative feelings, loss of interest, feeling distant from others, difficulty concentrating, and trouble sleeping. The March 2025 letter from a VA licensed clinical psychologist stated that it is clear that the Veteran's primary triggers are intense physical reactions when she perceives being in enclosed spaces such as conference rooms, cars, tunnels, and similar settings. As such, the VA licensed clinical psychologist recommended reasonable accommodations at work.

However, the Board is cognizant that the Veteran's PTSD with panic attacks does not present all the symptoms contemplated by the diagnostic criteria for a 70 percent evaluation. For example, the evidence does not show suicidal ideation or obsessional rituals, and her healthcare providers have consistently noted no neglect of personal appearance or hygiene. Because there is a question of whether the 50 percent evaluation or 70 percent evaluation would be most appropriate, the Board will afford the Veteran the benefit of the doubt that the most persuasive evidence shows that the overall impairment caused by her PTSD with panic attacks more nearly approximates occupational and social impairment with deficiencies in most areas for the entire appeal period. See 38 C.F.R. §§ 4.3, 4.7. Accordingly, an increased rating of 70 percent, but no higher, is granted.

The Board, however, finds that the Veteran has not met or more nearly approximated the criteria for a higher 100 percent disability rating for her PTSD with panic attacks at any time during the appeal period. The record does not indicate total occupational and social impairment, due to symptoms of such a severity as described for a 100 percent evaluation. With respect to social functioning, the Veteran maintains relationships with her spouse, parents, siblings, and friends. Furthermore, the Veteran is working. Thus, it cannot be said that she has "total" occupational and social impairment. Thus, the Board finds that the degree of severity of the Veteran's psychiatric symptoms and functional impairment is not consistent with a 100 percent rating for PTSD with panic attacks at any time during the appeal period.

Accordingly, a 70 percent initial disability rating for PTSD with panic attacks is warranted. The evidence supports the claim, and the benefit sought on appeal is granted.

2. Entitlement to a disability rating in excess of 10 percent for left cubital tunnel syndrome is denied.

See discussion in Paragraph 3

3. Entitlement to a disability rating in excess of 10 percent for right cubital tunnel syndrome is denied.

The Veteran seeks entitlement to higher disability ratings for her left and
occupational and social impairment. Thus, the Board finds that the degree of severity of the Veteran's psychiatric symptoms and functional impairment is not consistent with a 100 percent rating for PTSD with panic attacks at any time during the appeal period.

Accordingly, a 70 percent initial disability rating for PTSD with panic attacks is warranted. The evidence supports the claim, and the benefit sought on appeal is granted.

2. Entitlement to a disability rating in excess of 10 percent for left cubital tunnel syndrome is denied.

See discussion in Paragraph 3

3. Entitlement to a disability rating in excess of 10 percent for right cubital tunnel syndrome is denied.

The Veteran seeks entitlement to higher disability ratings for her left and right cubital tunnel syndrome.

By way of history, on February 6, 2023, the Veteran filed an intent to file a claim. On February 5, 2024, within one year of the February 6, 2023, filing, VA received the Veteran's formal claim for an increased rating for her service-connected bilateral cubital tunnel syndrome See February 2024 VA Form 21-526EZ. In the November 2024 rating decision on appeal, the RO increased the noncompensable ratings to 10 percent, each, effective February 6, 2023. As the Veteran presented her claim for increased rating on February 6, 2023, the appeal period is from that date, to include the one-year look-back period. Gaston v. Shinseki, 605 F.3d 979, 982 Fed. Cir. (2010).

The Veteran's cubital tunnel syndrome of the bilateral upper extremities is currently rated under 38 C.F.R. § 4.124a, Diagnostic Code 8516. Under these criteria, mild incomplete paralysis is rated as 10 percent disabling bilaterally. Moderate incomplete paralysis is rated as 30 percent disabling for the major extremity and 20 percent disabling for the minor extremity. Severe incomplete paralysis is rated as 40 percent disabling for the major extremity and 20 percent disabling for the minor extremity. Complete paralysis is rated as 60 percent disabling for the major extremity and 50 percent disabling for the minor extremity.

With regard to rating neurological disabilities, cranial or peripheral neuritis, characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating, is to be rated on the scale provided for injury of the nerve involved, with a maximum equal to severe, incomplete paralysis. 38 C.F.R. § 4.123.

The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating should be mild, or at most, the moderate degree. 38 C.F.R. § 4.124a.

Neither the Rating Schedule nor the regulations provide definitions for descriptive words such as "mild," "moderate," "moderately severe," and "severe." Spellers v. Wilkie, 30 Vet. App. 211, 219 (2018). Although the Board has, at times, attempted to define these terms using dictionary definitions, this has often proved problematic in clearly articulating the benchmark it employs to reach its conclusions.

The Board "is required to discuss any relevant provisions contained in the M21-1 as part of its duty to provide adequate reasons or bases." Overton v. Wilkie, 30 Vet. App. 257, 264 (2018). Relevant to this case are M21-1 provisions which include detailed definitions of "mild," "moderate," "moderately severe," and "severe" as found in 38 C.F.R. § 4.124a.

The M21-1 describes mild incomplete paralysis as a disability "limited to sensory deficits that are lower graded, less persistent, or affecting a smaller area." Part V, sbpt. iii, ch. 12, sec. A.2.c. Moderate incomplete paralysis, per the M21-1, should be "reserved for the most significant cases of sensory-only impairment," where the sensory involvement covers "a larger area in the nerve distribution." Id. M21-1 examples of a moderate disability include "motor and/or reflex impairment such as weakness or diminished or hyperactive reflexes (with or without sensory impairment) graded as medically moderate." Id. The M21-1 provides that a moderately severe evaluation is available when there is "[m]otor and/or reflex impairment (for example, weakness
that are lower graded, less persistent, or affecting a smaller area." Part V, sbpt. iii, ch. 12, sec. A.2.c. Moderate incomplete paralysis, per the M21-1, should be "reserved for the most significant cases of sensory-only impairment," where the sensory involvement covers "a larger area in the nerve distribution." Id. M21-1 examples of a moderate disability include "motor and/or reflex impairment such as weakness or diminished or hyperactive reflexes (with or without sensory impairment) graded as medically moderate." Id. The M21-1 provides that a moderately severe evaluation is available when there is "[m]otor and/or reflex impairment (for example, weakness or diminished or hyperactive reflexes) at a grade reflecting a higher level of limitation or disability." Id. Atrophy may, but need not, be present for a moderately severe rating. Severe incomplete paralysis, per the M21-1, is reserved for a very high level of limitation when there is "motor and/or reflex impairment (for example, atrophy, weakness, or diminished hyperactive reflexes)." Id. Trophic changes may be seen in "severe longstanding neuropathy cases." Even though severe incomplete paralysis should show findings less than representative for complete impairment of the nerve, sign/symptoms resembling some of those expected in cases of complete paralysis of the nerve may be present. In addition, "neuritis characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain" should be rated as high as severe. Id.

The Board applies them in the instant case to clearly and fully articulate the Board's understanding of these terms and the benchmark employed in reaching its conclusion. Id.; see also LeMon v. McDonough, No. 21-3949, 2022 U.S. App. Vet. Claims LEXIS 1998, *7 (Dec. 16, 2022) (mem dec) (Toth, J.).

Turning to the evidence of record, the Veteran underwent a VA examination for peripheral nerves conditions in September 2024. The Veteran reported symptoms of finger numbness, tingling, and cramping with typing. She wore wrist splints as needed while sleeping. For both upper extremities, the examiner reported that the Veteran had no constant pain, mild intermittent pain, mild paresthesias and/or dysesthesias, and mild numbness. Muscle strength testing showed normal strength for bilateral elbow flexion, bilateral elbow extension, bilateral wrist flexion, bilateral wrist extension, bilateral grip, and bilateral pinch (thumb to index finger). The examiner indicated that the Veteran did not have muscle atrophy. Reflex and sensory examinations revealed all normal results. The examiner also noted that the Veteran did not have trophic changes of the bilateral upper extremities. The examiner concluded that the Veteran had mild incomplete paralysis of the ulnar nerve, bilaterally.

Given the foregoing, the Board finds increased ratings are not warranted. First, the VA examiner characterized the Veteran's cubital tunnel syndrome of the bilateral upper extremities as mild. Second, the VA examiner reported the Veteran had normal strength, normal reflexes, no muscle atrophy, and no trophic changes of the bilateral upper extremities.

For the foregoing reasons, the evidence persuasively supports a rating of 10 percent for the bilateral upper extremities, but no higher. In denying a rating greater than 10 percent for the bilateral upper extremities, the Board finds the benefit of the doubt doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

In reaching this determination, the Board acknowledges that the Veteran filed a non-initial increased rating claim, which entitles her to a one-year look-back period from the date she filed her claim. Gaston, 605 F.3d at 982. Significantly, however, there are no relevant VA treatment records, examinations, or any other evidence, documenting an increase in severity of her left and right cubital tunnel syndrome during the one-year look-back period.

4. Entitlement to an initial compensable rating for right foot fifth digit arthroplasty is denied.

The Veteran generally asserts that her right foot fifth digit arthroplasty is worse than the current evaluation reflects.

The Veteran's right foot fifth digit arthroplasty is currently rated as noncompensable under 38 C.F.R. § 4.71a, Diagnostic Code 5282.

Diagnostic Code 5282 provides that hammertoe of a single toe is rated as noncompensable (0 percent) disabling. Unilateral hammertoe of all toes,
any other evidence, documenting an increase in severity of her left and right cubital tunnel syndrome during the one-year look-back period.

4. Entitlement to an initial compensable rating for right foot fifth digit arthroplasty is denied.

The Veteran generally asserts that her right foot fifth digit arthroplasty is worse than the current evaluation reflects.

The Veteran's right foot fifth digit arthroplasty is currently rated as noncompensable under 38 C.F.R. § 4.71a, Diagnostic Code 5282.

Diagnostic Code 5282 provides that hammertoe of a single toe is rated as noncompensable (0 percent) disabling. Unilateral hammertoe of all toes, without claw foot, is rated 10 percent disabling. 38 C.F.R. § 4.71a, Diagnostic Code 5282.

On VA examination in September 2024, the examiner provided a diagnosis of right fifth digit arthroplasty. The Veteran reported that she had surgery on her right fifth toe in 2009, and that she remained with pain to her right fifth toe with wearing certain shoes. The examiner noted that there was no deformity and no scar visible. The Veteran further reported that "any pressure on it causes pain." The examiner noted that the Veteran experiences right fifth toe pain with wearing pressure causing shoes. Tenderness was noted at the right fifth toe. The Veteran did not report pain with any other toe. Indeed, the examiner only noted pain to the right fifth toe.

Upon review of the record, the Board must find that the evidence is persuasively against the claim. Based on the foregoing, the Board finds that the Veteran's right foot fifth digit arthroplasty does not warrant an initial compensable evaluation under Diagnostic Code 5282. The disability does not affect all toes. Rather, the clinical findings show that the right fifth toe is the only affected toe. Thus, there is no basis upon which to assign an initial compensable evaluation for the Veteran's right foot fifth digit arthroplasty.

Therefore, the Board finds that the weight of the evidence is against the Veteran's claim for a compensable rating for right foot fifth digit arthroplasty. Thus, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

5. Entitlement to a compensable rating for sinusitis is denied.

The Veteran generally asserts that her sinusitis is worse than the current evaluation reflects.

The Veteran's sinusitis is rated as noncompensable under Diagnostic Code 6513. Diagnostic Codes 6510 through 6514 pertain to various types of sinusitis, each of which is rated pursuant to a General Formula for sinusitis set forth in the rating schedule following Diagnostic Code 6514. This General Rating Formula for sinusitis applies in all circumstances in which VA is to evaluate the severity of sinusitis, no matter the specific diagnosis.

Under the General Rating Formula for sinusitis, a noncompensable rating is warranted when the condition is detected by x-ray only. A 10 percent rating is warranted for sinusitis manifested by one or two incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or; three to six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 30 percent is warranted for sinusitis manifested by three or more incapacitating episodes per year of sinusitis requiring prolonged (lasting four to six weeks) antibiotic treatment, or by more than six non-incapacitating episodes per year of sinusitis characterized by headaches, pain, and purulent discharge or crusting. A 50 percent rating is warranted for sinusitis following radical surgery with chronic osteomyelitis, or manifested by near constant sinusitis characterized by headaches, pain, and tenderness of affected sinus, and purulent discharge or crusting after repeated surgeries. 38 C.F.R. § 4.97, Diagnostic Codes 6510-6514.

The Veteran was afforded a VA examination for her sinusitis in September 2024. The Veteran reported current symptoms included intermittent maxillary pressure and nasal congestion. The examiner noted the following findings, signs, or symptoms attributable to chronic sinusitis: episodes of sinusitis, pain on affected sinus, and purulent discharge. The examiner stated that the Veteran had one non-incapacitating episodes of sinusitis characterized by headaches, pain, and purulent discharge or crusting in the past 12 months. The examiner further stated that the Veteran had no incapacitating episodes of sinusitis requiring prolonged (four to six weeks)
38 C.F.R. § 4.97, Diagnostic Codes 6510-6514.

Upon review of the record, the Board must find that the evidence is persuasively against the claim. After carefully reviewing the Veteran's treatment records, the Board finds that there is nothing in the record to show that the Veteran had an incapacitating episode as defined by regulation that also required prolonged use of antibiotics (four to six weeks). There is also nothing in the record that indicates that she had three to six non-incapacitating episodes in the previous 12 months during any portion of the appeal period. The medical evidence does not support any such findings, and the Veteran has not submitted any contrary evidence or argument supporting the claim or contradicting the findings of the VA examiner.

Therefore, the Board finds that the weight of the evidence is against the Veteran's claim for a compensable rating for sinusitis. Thus, the benefit-of-the-doubt rule does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

Service Connection

Generally, to establish service connection, a veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service." Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

Additionally, the Veteran's service personnel records reflect that she is a Persian Gulf War veteran, and Congress has created special rules with regard to such Veterans establishing entitlement to service connection. Service connection may be established for a chronic disability manifested by certain signs or symptoms which became manifest either during active service in the Southwest Asia Theater of Operations during the Persian Gulf War or to a degree of 10 percent or more not later than December 31, 2026, and which, by history, physical examination, and laboratory tests cannot be attributed to any known clinical diagnosis. 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(1).

A qualifying chronic disability means a chronic disability resulting from any of the following (or any combination of the following): an undiagnosed illness; the following medically unexplained chronic multi-symptom illnesses that are defined by a cluster of signs or symptoms: (1) chronic fatigue syndrome; (2) Fibromyalgia; (3) Functional gastrointestinal disorders (FGID); or (4) Any other illness that the Secretary determines meets the criteria in paragraph (a)(2)(ii) of this section for a medically unexplained chronic multi-symptom illness; or any diagnosed illness that the Secretary determines in regulations prescribed under 38 U.S.C. § 1117(d) warrants a presumption of service connection. 38 C.F.R. § 3.317(a).

In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the veteran. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). Board determinations with respect to the weight and credibility of evidence are factual determinations going to the probative value of the evidence. Layno
illness that the Secretary determines in regulations prescribed under 38 U.S.C. § 1117(d) warrants a presumption of service connection. 38 C.F.R. § 3.317(a).

In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the veteran. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). Board determinations with respect to the weight and credibility of evidence are factual determinations going to the probative value of the evidence. Layno v. Brown, 6 Vet. App. 465, 469 (1994). Equal weight is not accorded to each piece of evidence contained in the record; not every item of evidence has the same probative value.

Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Layno, 6 Vet. App. at 465. Lay statements may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 C.F.R. § 3.159; see Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a veteran prevailing in either event, or whether the evidence weighs persuasively against a claim, in which case, the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

6. Entitlement to service connection for a neck disability is granted.

See discussion in Paragraph 8

7. Entitlement to service connection for a back disability is granted.

See discussion in Paragraph 8

8. Entitlement to service connection for a right shoulder disability is granted.

The Veteran seeks entitlement to service connection for disabilities of the neck, back, and right shoulder. As previously noted, the Veteran has qualifying service as a Persian Gulf veteran.

Favorable findings from the November 2024 rating decision on appeal includes a current diagnosis of cervical strain. The Board is bound by this favorable finding. 38C.F.R. §3.104(c).

As for the back and right shoulder, the Veteran has consistently reported that she has experienced back and right shoulder pain since service, specifically her service in Iraq. See February 2024 Veteran statement and February 2024 VA Form 21-526EZ. She states that she has continued to experience back and right shoulder pain and has tried to reduce pain through chiropractic visits, stretching, back supports/ergonomic work chair and the use of Tylenol. VA treatment records show that the Veteran has consistently complained of back and right shoulder pain, reporting that pain in the low back continues to be experienced daily and is near constant. See May 2024 and June 2024 VA treatment records. Pursuant to Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), the term "disability" as used in 38 U.S.C. § 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability." The Veteran is competent to report pain ever since active-duty service. She has consistently reported that her back and right shoulder pain started in service and has continued since then. The Board finds the Veteran's statements competent and credible. This is precisely the type of impairment that the Federal Circuit indicated in Saunders constitutes a disability. Consequently, the current disability requirement has been met with regard to the back and right shoulder claims.

Thus, based on the foregoing, the first element of service connection for each claim has been met.

Next, as regards to an in-service incurrence, the Board notes that, when a veteran has engaged in combat with the enemy during active-duty service, VA must accept satisfactory lay or other evidence that an injury or disease was incurred or aggravated in combat, if such evidence is "consistent with the circumstances, conditions, or hardships of such service." 38 U.S.C. § 1154(b); see also 38 C.F.R. § 3.304(d); see Reeves v Shinseki, 682 F.3d 988, 998 (Fed. Cir. 2012) (citing H. R. Rep. No. 1157, at 3 (1941) (noting that Congress enacted the predecessor statute to section 1154(b) because of its concern that combat veterans faced "major obstacle[s]" when seeking to assemble the medical records necessary to establish that they suffered an injury or disease while in service, that in many instances, medical records do not survive combat conditions, and that due to the exigencies of battle, soldiers may not immediately seek medical treatment for combat-related injuries). VA General Counsel has held that "[t]he ordinary meaning of the phrase 'engaged in combat with the enemy,' as used in 38 U.S.C. § 1154(b), requires that a veteran have participated in events constituting an actual fight or encounter with a military foe or hostile unit or instrumentality." VAOGCPREC. No. 12-99, 65 Fed. Reg. 6,256-58 (2000).

Here, although the Veteran was not awarded a specific decoration indicating combat participation, the Veteran's military personnel records show that she served in an imminent danger pay area from May 2008 to May 2009, suggestive of combat status. The Veteran's military personnel records also show that she was mobilized in support of Operation Enduring Freedom. Thus, the Board finds that the circumstances of the Veteran's service in support of Operation Enduring Freedom are consistent with the hardships of combat service. As such, the evidence weighs in favor of a finding that she engaged in combat. Thus, the Board finds that the Veteran is a combat veteran whose lay evidence is sufficient proof of an in-service injury as it is consistent with the circumstances of combat. 38 U.S.C. § 1154(b). Therefore, an in-service injury has been conceded, and the second element of service connection has been met.

Lastly, turning to the nexus prong, the Board notes that the record does not include a positive nexus opinion for any of the claimed disabilities.

To the extent that the grant of service connection in this matter is based primarily on lay evidence, "nothing in the regulatory or statutory provisions [relating to evidence to be considered] require both medical and competent lay evidence; rather, they make clear that competent lay evidence can be sufficient in and of itself."? Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006).

As discussed above, the evidence shows that the Veteran's disabilities of the neck, back, and right shoulder began in service, specifically during her service in Iraq. The Veteran is competent and credible to report experiencing pain in her neck, back, and right shoulder.

Although a remand for further medical opinions could be accomplished, the Board will not remand for negative evidence. The Board finds that the approximate balance of the evidence is for the claims.

Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for disabilities of the neck, back, and right shoulder is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

9. Entitlement to service connection for a bilateral eye disability is granted.

The Veteran seeks entitlement to service connection for a bilateral eye disability. She contends that her eye condition began during service and has existed since that time. See February 2024 Veteran statement and February 2024 VA Form 21-526EZ.

Favorable findings from the November 2024 decision on appeal include a current diagnosis of bilateral dry eye disease. The RO also conceded to participation in a toxic exposure risk activity (TERA), noting that the Veteran's deployments are consistent with exposures to burn pits, find particulate matter, and other toxins. The Board is bound by these favorable findings of the September 2024 decision. 38 C.F.R. § 3.104(c
disability is granted.

Turning to the question of whether there is a nexus, or causal link, between the current shown disability and service, the Board finds that the weight of the evidence is in favor of a finding that the Veteran's bilateral eye disability began during service and has persisted since that time. The Board finds that the competent and credible evidence shows that the Veteran's bilateral eye condition is chronic and has been recurrent since service. Indeed, her medical treatment records show that the Veteran has been suffering from her bilateral eye condition since service. See September 2024 VA examination report for eye conditions.

Furthermore, the Board finds the Veteran's consistent statements and medical records credible in showing that her bilateral eye condition started in service. The Veteran is competent to report her eye symptoms that began in service and the Board finds the Veteran's statements credible. See 38 C.F.R. § 3.159(a)(2); Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); Layno, 6 Vet. App. at 470. The Board finds that the lay evidence is consistent with other evidence of record, both medical and lay, and further finds that it is competent and credible.

Thus, after resolving any doubt in the Veteran's favor, the Board finds that her bilateral eye condition had its onset in service. Accordingly, service connection is warranted. See Flynn v. Brown, 6 Vet. App. 500, 503 (1994) (noting that "the element of cause and effect has been totally by-passed in favor of a simple temporal relationship between the incurrence of the disability and the period of active duty"); see also 38 C.F.R. § 3.303(a) (service connection connotes many factors but basically it means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces).

In light of the foregoing, the Board finds that the medical and lay evidence shows that the Veteran's bilateral eye condition had its onset in service and has been recurrent since that time. As such, resolving all reasonable doubt in the Veteran's favor, the Board finds that the residuals of the Veteran's bilateral eye injury had their onset during her military service. As such, service connection for a bilateral eye disability is warranted.

10. Entitlement to service connection for sleep apnea is granted.

The Veteran seeks entitlement to service connection for sleep apnea. She contends that her sleep apnea began during her service in Iraq as a result of exposure to burn pits and other environmental conditions. See February 2024 VA Form 21-526EZ. As previously noted, the Veteran has qualifying service as a Persian Gulf veteran and is a combat veteran. Furthermore, participation in a TERA has been conceded. Alternatively, the Veteran has also stated the possibility of her sleep disorder being secondary to her service-connected sinusitis. As the Board is granting the claim on a direct service connection basis, further discussion of the secondary theory of service connection is unnecessary.

Initially, the Board notes that the Veteran's service treatment records do not reflect that the Veteran had any problems related to a sleep disorder upon entry into active service.

A December 2021 private treatment record shows a past medical history of obstructive sleep apnea with CPAP. An August 2023 VA treatment record shows that the Veteran was diagnosed with sleep apnea and was currently using a CPAP machine. A September 2024 VA examination report for sleep apnea shows that the Veteran did not have a diagnosis of sleep apnea. The Board notes that, although a current diagnosis was not established during the most recent VA examination, a diagnosis was nevertheless made during the claim period. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (the existence of a current disability may be satisfied when a claimant has a disability at the time a claim for compensation is filed or during the pendency of that claim even though the disability resolves prior to the Secretary's adjudication of the claim). Therefore, the first element of service connection has been met.

As for the second element of service connection, participation in a TERA has been conceded. See November 2024 rating decision. Therefore, the second element of service connection has been met.

With further regard to the second element of service connection, the Board finds the Veteran competent and credible to report that the current symptoms of her sleep apnea onset during service because such symptoms are readily observable. See Layno, 6 Vet. App. at 465. The Veteran is competent and credible to report readily observable symptoms of snoring and difficulty with sleeping. See id. As previously stated, the Veteran contends that her sleep apnea began during her service in Iraq as a result of exposure to burn pits and other environmental conditions. See February 2024 VA Form 21-526EZ.

Lastly, turning to the nexus prong, the Board notes that the record does not include a positive nexus opinion. While there are no positive opinions of record linking the Veteran's sleep apnea to her active service, the Veteran has indicated, in sum, that she has been suffering from symptoms of snoring and difficulty with sleeping starting in service and continuing to the present day.

Moreover, the record reflects that the Veteran's sleep apnea did not exist prior to service. In addition, the competent and credible statements, as discussed above, show that the Veteran's sleep disorder began during active service and continued post-service. As noted in the preceding paragraph, the Veteran is certainly competent to attest to symptomatology such as snoring and difficulty with sleeping.

Although a remand for a medical opinion could be accomplished, the Board will not remand for negative evidence. The Board finds that the approximate balance of the evidence is for the claim. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for sleep apnea is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

11. Entitlement to service connection for headaches is granted.

The Veteran seeks entitlement to service connection for headaches. She contends that her headache condition began during her service in Iraq as a result of exposure to explosives, rockets, and small arms fire. See February 2024 Veteran statement and February 2024 VA Form 21-526EZ. As previously noted, the Veteran has qualifying service as a Persian Gulf veteran and is a combat veteran.

Favorable findings from the February 2025 rating decision on appeal includes a current diagnosis of tension headaches. The RO also found evidence that a qualifying event, injury, or disease had its onset in service. The RO noted that the Veteran's service treatment records show an occurrence of headaches on April 7, 2009. The Board is bound by these favorable findings of the February 2025 decision. 38 C.F.R. § 3.104(c). Furthermore, as previously indicated, the Veteran is a combat veteran. Thus, the first and second elements of service connection have been met.

With further regard to the second element of service connection, the Board finds the Veteran competent and credible to report that the current symptoms of her headache disability onset during service because such symptoms are readily observable. See Layno, 6 Vet. App. at 465. As previously stated, the Veteran contends that her headache condition began during her service in
's service treatment records show an occurrence of headaches on April 7, 2009. The Board is bound by these favorable findings of the February 2025 decision. 38 C.F.R. § 3.104(c). Furthermore, as previously indicated, the Veteran is a combat veteran. Thus, the first and second elements of service connection have been met.

With further regard to the second element of service connection, the Board finds the Veteran competent and credible to report that the current symptoms of her headache disability onset during service because such symptoms are readily observable. See Layno, 6 Vet. App. at 465. As previously stated, the Veteran contends that her headache condition began during her service in Iraq as a result of exposure to explosives, rockets, and small arms fire. See February 2024 Veteran statement and February 2024 VA Form 21-526EZ.

Lastly, turning to the nexus prong, the Board notes that the record does not include a positive nexus opinion for the claimed headache disability.

As discussed above, the evidence shows that the Veteran's headache disability began in service, specifically during her service in Iraq. The Veteran is competent and credible to report experiencing headache symptoms.

Although a remand for further medical opinions could be accomplished, the Board will not remand for negative evidence. The Board finds that the approximate balance of the evidence is for the claim.

Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for headaches is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

REASONS FOR REMAND

After thorough review of the record, the Board finds that additional evidentiary development is warranted before a final decision may be reached for the remaining issues on appeal.

1. Entitlement to an initial compensable rating for rhinitis is remanded.

The Veteran's rhinitis is rated under 38 C.F.R. § 4.97, Diagnostic Code 6522.

Under Diagnostic Code 6522, allergic rhinitis warrants a 10 percent rating when there are no nasal polyps but there is greater than 50 percent obstruction of nasal passages on both sides or complete obstruction on one side. A maximum rating of 30 percent is warranted when polyps are present. Id.

On VA examination in September 2024, the Veteran reported symptoms of nasal congestion and drainage. The examiner noted the Veteran's diagnosis of allergic rhinitis. The examiner further noted that the Veteran's rhinitis did not cause greater than 50 percent obstruction on both sides and did not cause complete obstruction on the left or right side. The examiner stated that the Veteran did not have nasal polyps. The examiner also noted that the Veteran had permanent hypertrophy of the nasal turbinates. The examiner indicated that the Veteran had not had any imaging studies completed.

The Board finds the September 2024 examination inadequate for failing to obtain any imaging studies or diagnostic testing. While the Board notes that diagnostic testing is not required in most cases, here, such testing is necessary to rate the Veteran's rhinitis condition. The applicable Diagnostic Code 6522 rates rhinitis on the presence of polyps or nasal obstruction that cannot be seen with the naked eye, and therefore, can only be ascertained through diagnostic testing. See 38 C.F.R. § 4.97.

When VA provides an examination, it must ensure that the examination is adequate. Since imaging studies were not conducted, the examiner was unable to adequately assess the severity of the Veteran's rhinitis. A medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record. See Stefl v. Nicholson, 21 Vet. App. 102, 124-25 (2007). The Board cannot make a fully informed decision on the severity of the Veteran's rhinitis because the September 2024 medical examination is inadequate. The RO's failure to obtain an adequate VA examination constitutes a pre-decisional duty-to-assist error. Accordingly, the claim is remanded to correct this pre-decisional duty-to-assist error. See 38 U.S.C. § 5103A; 38 C.F.R. § 20.802.

2. Entitlement
reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record. See Stefl v. Nicholson, 21 Vet. App. 102, 124-25 (2007). The Board cannot make a fully informed decision on the severity of the Veteran's rhinitis because the September 2024 medical examination is inadequate. The RO's failure to obtain an adequate VA examination constitutes a pre-decisional duty-to-assist error. Accordingly, the claim is remanded to correct this pre-decisional duty-to-assist error. See 38 U.S.C. § 5103A; 38 C.F.R. § 20.802.

2. Entitlement to service connection for athlete's foot is remanded.

See discussion in Paragraph 4

3. Entitlement to service connection for a left wrist/hand scar is remanded.

See discussion in Paragraph 4

4. Entitlement to service connection for a nose scar is remanded.

The Veteran seeks entitlement to service connection for athlete's foot, a left wrist/hand scar, and a nose scar.

With regard to the athlete's foot claim, the RO denied the claim on the basis that there is no diagnosis. See September 2024 rating decision. However, an October 2022 private treatment record shows that the Veteran complained of an itchy rash on her foot that had progressively gotten worse in the past few weeks. The record reflects that the Veteran has not been afforded a VA examination in connection with the athlete's foot claim. As there is evidence of symptoms related to athlete's foot, a VA examination is necessary to determine whether there is a diagnosed condition. If so, a VA etiology opinion is also necessary for this claim.

As for the left wrist/hand scar and nose scar claims, the Veteran asserts these conditions are related to her service in Iraq. She states that the scar on her left wrist/hand is a result of lacerations sustained in Iraq, and that the scar on her face is a result of sun exposure in Iraq. As previously noted, the Veteran is a combat veteran. Thus, the Veteran's lay evidence is sufficient proof of an in-service injury as it is consistent with the circumstances of combat. 38 U.S.C. § 1154(b). The Veteran has not been afforded a VA examination for these claimed disabilities. Given that the in-service element has been met as a result of the Veteran's combat service, the RO's failure to provide a VA examination to determine whether there are diagnosed scars of the left wrist/hand and nose constitutes a pre-decisional duty-to-assist error. In view of this, corrective action must be taken.

Accordingly, the claims are remanded to correct these pre-decisional duty-to-assist errors. See 38 U.S.C. § 5103A; 38 C.F.R. § 20.802.

The matters are REMANDED for the following action:

1. Schedule the Veteran for an examination by an appropriate clinician to determine the current level of severity of her service-connected rhinitis. The Veteran's claims file and a copy of this remand should be provided to the examiner and the examination report should reflect that these items were reviewed.

(a) The examiner is asked to fully describe all symptomatology and functional deficits associated with this disability pursuant to the diagnostic criteria described in 38 C.F.R. § 4.97, including Diagnostic Code 6522.

(b) The examiner is directed to ensure imaging tests are conducted to determine whether there is presently any obstruction in the nasal passage, to include nasal polyps.

2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of her claimed athlete's foot. The Veteran's claims file and a copy of this remand should be provided to the examiner and the examination report should reflect that these items were reviewed.

The examiner should confirm whether the Veteran has a current diagnosed condition of athlete's foot.

If a diagnosis is made, the examiner must provide an opinion as to whether the Veteran's athlete's foot at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) originated during service or is otherwise etiologically related to service.

A complete rationale must be provided for all opinions offered. If an opinion cannot be offered without resort to mere speculation, the examiner must fully explain why this is the case and identify what additional evidence, if any, would allow for a more
claims file and a copy of this remand should be provided to the examiner and the examination report should reflect that these items were reviewed.

The examiner should confirm whether the Veteran has a current diagnosed condition of athlete's foot.

3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of her claimed left wrist/hand scar. The Veteran's claims file and a copy of this remand should be provided to the examiner and the examination report should reflect that these items were reviewed.

The examiner should confirm whether the Veteran has a current diagnosed left wrist/hand scar.

If a diagnosis is made, the examiner must provide an opinion as to whether the Veteran's left wrist/hand scar at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) originated during service or is otherwise etiologically related to service.

4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of her claimed nose scar. The Veteran's claims file and a copy of this remand should be provided to the examiner and the examination report should reflect that these items were reviewed.

The examiner should confirm whether the Veteran has a current diagnosed nose scar.

If a diagnosis is made, the examiner must provide an opinion as to whether the Veteran's nose scar at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) originated during service or is otherwise etiologically related to service.

Christopher Seppanen

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Y. MacDonald, Counsel

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

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