PEPTIC ULCER DISEASE

Summary

The veteran, who served from October 1982 to October 1984, appeals the denial of service connection for multiple conditions, including peptic ulcer disease, residual scar status post appendix removal, left hand disability, skin cancer, heart disability, left and right knee disabilities, left hip disability, low back disability, sleep disorder, and diverticulitis. The veteran also sought an increased rating for peptic ulcer disease and residual scar status post appendix removal. The Board denied the claims for an increased rating for peptic ulcer disease, finding the evidence did not meet the criteria for a compensable rating, particularly the need for daily prescribed medication and specific episode frequency. For the residual scar, the Board found the evidence did not meet the criteria for any compensable rating under the applicable diagnostic codes, as the scar was not painful, unstable, or of sufficient size. The Board denied service connection for the left hand, skin cancer, heart, knees, hip, low back, and sleep disorder, finding no current disability or nexus to service based on the lack of evidence in service treatment records and the veteran's own assertions not being probative without medical training. The claim for diverticulitis was denied due to lack of in-service onset, continuity of symptoms, or a nexus opinion linking it to service or a service-connected disability. However, service connection for headaches was granted, based on a favorable VA examiner opinion and the Board resolving reasonable doubt in the veteran's favor, acknowledging documented in-service head trauma and subsequent headaches.

Rationale

No evidence of episodes meeting criteria for 20% or higher rating.; Symptoms not managed by daily prescribed medication.; History of peptic ulcer disease documented by endoscopy/imaging, consistent with noncompensable rating.

Full Decision Text

Citation Nr: A26027730
Decision Date: 03/26/26	Archive Date: 03/26/26

DOCKET NO. 251121-609967
DATE: March 26, 2026

ORDER

Entitlement to an initial compensable rating for peptic ulcer disease is denied.

Entitlement to an initial compensable rating for residual scar status post appendix removal is denied.

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

Entitlement to service connection for skin cancer is denied. 

Entitlement to service connection for a heart disability is denied. 

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

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

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

Entitlement to service connection for a low back disability is denied. 

Entitlement to service connection for a sleep disorder is denied. 

Entitlement to service connection for diverticulitis is denied. 

Entitlement to service connection for headaches is granted.

FINDINGS OF FACT

1. The Veteran's peptic ulcer disease was manifested by not more than a history of peptic ulcer disease documented by endoscopy or diagnostic imaging studies.

2. The Veteran's residual scar status post appendix removal was neither painful or unstable, and the approximate total area was no more than 2.7 square centimeters.

3. The Veteran does not have a left hand disability. 

4. The Veteran does not have a skin cancer disability. 

5. The Veteran does not have a heart disability. 

6. The Veteran does not have a left knee disability. 

7. The Veteran does not have a right knee disability. 

8. The Veteran does not have a left hip disability. 

9. The Veteran does not have a low back disability. 

10. The Veteran does not have a sleep disorder. 

11. The Veteran's diverticulitis did not have its onset in service or within one year of service, and it is not etiologically related to service or a service connected disability.

12. Resolving reasonable doubt in favor of the Veteran, he has a headache disability that is etiologically related to active service.

CONCLUSIONS OF LAW

1. The criteria for an initial compensable rating for peptic ulcer disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.114, Diagnostic Code (DC) 7304.

2. The criteria for an initial compensable rating for a residual scar status post appendix removal have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.118, Diagnostic Code (DC) 7802.

3. The criteria for service connection for a left hand disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303.

4. The criteria for service connection for a skin cancer disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303.

5. The criteria for service connection for a heart disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303.

6. The criteria for service connection for a left knee disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303.

7. The criteria for service connection for a right knee disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303.

8. The criteria for service connection for a left hip disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303.

9. The criteria for service connection for a low back disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303.

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

8. The criteria for service connection for a left hip disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303.

9. The criteria for service connection for a low back disability have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303.

10. The criteria for service connection for a sleep disorder have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303.

11. The criteria for service connection for diverticulitis have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.310.

12. The criteria for service connection for headaches have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from October 1982 to October 1984.

The rating decision on appeal was issued in November 2024 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.  

In the November 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the November 19, 2024, agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. 

The Board notes that the AOJ later adjudicated a new claim for an increased evaluation for peptic ulcer disease in an April 2025 rating decision, awarding a rating of 20 percent effective the date of the new claim, and a subsequent September 2025 rating decision reduced his rating back to a noncompensable rating. Although both of these rating decisions were issued within one year of the November 2025 VA Form 10182, the Veteran specifically indicated in his VA Form 10182 that he was appealing the initial rating assigned in the November 2024 rating decision for his peptic ulcer disease. See Terry v. McDonough, 37 Vet. App. 1 (2023).

Evidence was added to the claims file during a period of time when new evidence was not allowed. As the Board is deciding each of the claims on appeal, it may not consider this evidence in its decision. 38 C.F.R. § 20.300. The Veteran may file a Supplemental Claim 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 with this decision.

At the outset, the Board notes that there are no available post-service medical treatment records. However, the Board notes that the Veteran had not identified any outstanding treatment records at the time of the November 2024 rating decision on appeal. As such, the Board finds that there has been no predecisional duty to assist error with regards to the Veteran's medical treatment records.

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. The basis of disability ratings is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10.

Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria required for that particular rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.
 the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability ratings is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10.

Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria required for that particular rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When a reasonable doubt arises regarding the degree of disability, that reasonable doubt will be resolved in favor of the Veteran. 38 C.F.R. § 4.3.

1. Entitlement to an initial compensable rating for peptic ulcer disease is denied.

The Veteran is currently in receipt of an initial noncompensable evaluation for his service connection peptic ulcer disease pursuant to Diagnostic Code 7304. He contends that he is entitled to a higher disability rating. 

The rating criteria for evaluating gastrointestinal disabilities under 38 C.F.R. § 4.114 were amended effective May 19, 2024. 89 Fed. Reg. 55 (March 20, 2024). If a law or regulation changes during the course of a claim or an appeal, the version more favorable to the claimant will apply, to the extent permitted by any stated effective date in the amendment in question. 38 U.S.C. § 5110(g); see also Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). As the Veteran filed his claim after the May 19, 2024, effective date, the Board will consider only the new rating criteria.

Pursuant to the amended rating criteria associated with DC 7304, a noncompensable rating is assigned for a history of peptic ulcer disease documented by endoscopy or diagnostic imaging studies. A 20 percent rating is assigned for episodes of abdominal pain, nausea, or vomiting, that: last for at least three consecutive days in duration; occur three times or less in the past 12 months; and are managed by daily prescribed medication. A 40 percent rating is assigned for episodes of abdominal pain, nausea, or vomiting, that: last for at least three consecutive days in duration; occur four or more times in the past 12 months; and are managed by daily prescribed medication. A 60 percent rating is assigned for continuous abdominal pain with intermittent vomiting, recurrent hematemesis (vomiting blood) or melena (tarry stools); and manifestations of anemia which require hospitalization at least once in the past 12 months. A 100 percent rating is assigned for post-operative for perforation or hemorrhage, for three months, after which the condition is rated on residuals determined by mandatory VA medical examination. 38 C.F.R. § 4.114, DC 7304.

The Board notes that ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. 38 C.F.R. § 4.114. 

As noted above, there are no medical treatment records during the period on appeal. The only evidence addressing the severity of the Veteran's service connected peptic ulcer disease during the period on appeal is an August 2024 VA examination, which notes a diagnosis of peptic ulcer disease. The Veteran reported that he used over the counter antacids as needed for heartburn and pain; he has not needed to change his diet and is managing the condition with PRN medication. The examiner noted that the Veteran's treatment plan did not include continuous medication for the diagnosed condition. The examiner noted that the Veteran had a history of peptic ulcer disease documented by endoscopy or diagnostic imaging studies. The examiner indicated that the Veteran's peptic ulcer disease did not impact his ability to perform any type of occupational task.

Based on a review of the evidence, the Board finds that the evidence reflects that peptic ulcer disability is the Veteran's predominant disability, and a compensable rating for the Veteran's peptic ulcer disability is not warranted. There is no evidence that the Veteran had symptoms that more closely approximate episodes of abdominal pain, nausea, or vomiting, that: last for at least three consecutive days in duration; occur three times or less in the past 12 months; and are managed by daily prescribed medication
 the diagnosed condition. The examiner noted that the Veteran had a history of peptic ulcer disease documented by endoscopy or diagnostic imaging studies. The examiner indicated that the Veteran's peptic ulcer disease did not impact his ability to perform any type of occupational task.

Based on a review of the evidence, the Board finds that the evidence reflects that peptic ulcer disability is the Veteran's predominant disability, and a compensable rating for the Veteran's peptic ulcer disability is not warranted. There is no evidence that the Veteran had symptoms that more closely approximate episodes of abdominal pain, nausea, or vomiting, that: last for at least three consecutive days in duration; occur three times or less in the past 12 months; and are managed by daily prescribed medication, which would warrant a 20 percent rating. Indeed, the VA examiner indicated only that the Veteran had a history of peptic ulcer disease documented by endoscopy or diagnostic imaging studies, which more closely approximates a noncompensable rating. To the extent that the Veteran indicated that he experienced heartburn or pain, the Veteran specifically indicated that his symptoms were not managed by daily prescribed medication. The Board notes that the criteria in Diagnostic Code 7304 are conjunctive. See Melson v. Derwinski, 1 Vet. App. 334 (1991) (use of the conjunctive "and" in a statutory provision meant that all of the conditions listed in the provision must be met). Cf. Johnson v. Brown, 7 Vet. App. 9 (1994) (only one disjunctive "or" requirement must be met in order for an increased rating to be assigned); see also Tatum v. Shinseki, 23 Vet. App. 152 (2009). Thus, as the objective evidence of record fails to establish that the Veteran's symptoms were manifested by episodes of abdominal pain, nausea, or vomiting, that: last for at least three consecutive days in duration; occur at least three times or less in the past 12 months; and are managed by daily prescribed medication, let alone symptoms that require hospitalization or surgical treatment, the Board finds that a compensable rating under Diagnostic Code 7304 is not warranted. 38 C.F.R. § 4.71a, Diagnostic Code 7304. 

For the reasons and bases stated above, the Board finds that an initial compensable rating for the Veteran's peptic ulcer disease is not warranted. In reaching this decision, the Board has considered the benefit-of-the-doubt doctrine; however, as the evidence is persuasively against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Thus, the Veteran's claim for an increased rating is denied.

2. Entitlement to an initial compensable rating for residual scar status post appendix removal is denied.

The Veteran is currently in receipt of a noncompensable rating for his residual scar status post appendix removal pursuant to Diagnostic Code 7802. He contends that he is entitled to a higher disability rating.

VA amended its regulations governing skin disabilities under 38 C.F.R. § 4.118, effective August 13, 2018. VA's intent is that the claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the Veteran will be applied. For applications filed on or after the effective date, only the new criteria will be applied. 83 Fed. Reg. 32592 (July 13, 2018). As the Veteran filed his claim after the August 13, 2018, effective date, the Board will consider only the new rating criteria.

The amended Diagnostic Code 7801 contemplates burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7801. The criteria provide that a 10 percent rating is awarded when the area of the scar(s) covers at least 6 square inches (39 square centimeters) but less than 12 square inches (77 square centimeters). A 20 percent rating is warranted when the area of the scar(s) covers at least 12 square inches (77 square centimeters) but less than 72 square inches (456 square centimeters). A 30 percent rating is warranted when the area of the scar(s) covers at least 72 square inches (456 square centimeters) but less than 144 square inches (929 square centimeters). A 40 percent rating is assigned when the area of the scar(s) covers at least 144 square inches (929 square centimeters) or greater. 38 C.F.R. § 4.118, Diagnostic 
 6 square inches (39 square centimeters) but less than 12 square inches (77 square centimeters). A 20 percent rating is warranted when the area of the scar(s) covers at least 12 square inches (77 square centimeters) but less than 72 square inches (456 square centimeters). A 30 percent rating is warranted when the area of the scar(s) covers at least 72 square inches (456 square centimeters) but less than 144 square inches (929 square centimeters). A 40 percent rating is assigned when the area of the scar(s) covers at least 144 square inches (929 square centimeters) or greater. 38 C.F.R. § 4.118, Diagnostic 7801. 

Diagnostic Code 7802 provides rating criteria for burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are not associated with underlying soft tissue damage. 38 C.F.R. § 4.118, Diagnostic Code 7802. The criteria states that a 10 percent disability rating is warranted when the area of the scar covers 144 square inches (929 square centimeters) or greater.

Diagnostic Code 7804 provides disability ratings for scars that are unstable or painful. A 10 percent rating is warranted for one or two scars that are unstable or painful. A 20 percent rating is warranted for three or four scars that are unstable or painful. A 30 percent rating is warranted for five or more scars that are unstable or painful. Note (1) states that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) provides that if one or more scars are both unstable and painful, an additional 10 percent should be added to the evaluation based on the total number of unstable or painful scars. Note (3) states that scars evaluated under diagnostic codes 7800, 7801, 7802, or 7805 may also receive an evaluation under this diagnostic code, when applicable. 38 C.F.R. § 4.118, Diagnostic 7804.

Under the old rating criteria, Diagnostic Code 7805 provided that other scars (including linear scars) and other effects of scars evaluated under Diagnostic Codes 7800, 7801, 7802, and 7804 require the evaluation of any disabling effect(s) not considered in a rating provided under Diagnostic Codes 7800-7804 under an appropriate Diagnostic Code. 38 C.F.R. § 4.118, Diagnostic Code 7805 (2017). The Board notes that this diagnostic code is largely unchanged under the new amendments apart from the replacement of the phrase "(including linear scars)" with "and other effects of scars evaluated under diagnostic codes 7800, 7801, 7802, or 7804." 38 C.F.R. § 4.118, Diagnostic Code 7805 (August 13, 2018).

As noted above, there are no medical treatment records during the period on appeal. The only evidence addressing the severity of the Veteran's service connected residual scar status post appendix removal is an August 2024 VA examination, which indicates that the Veteran had, in pertinent part, one anterior trunk scar due to an appendectomy, which was not painful but was intermittently itchy. The examiner indicated that this scar was not painful or unstable, was not due to burns, and measured 9.0 centimeters by 0.3 centimeters. The examiner noted that the Veteran's scar did not result in limitation of function. 

After a review of the evidence, the Board finds that a compensable rating is not warranted for the period on appeal pursuant to Diagnostic Code 7802. In this regard, the Bord notes that the evidence does not reflect that the Veteran's residual scar status post appendix removal covers 144 square inches (929 square centimeters) or greater, as required for a 10 percent rating under the post-amended rating criteria pursuant to Diagnostic Code 7802. Rather, as noted above, the record reflects that the Veteran had no more than one anterior trunk scar measuring no more than approximately 9.0 centimeters by 0.3 centimeters, which is no more than 2.7 square centimeters. Therefore, the Board finds that a compensable evaluation is not warranted for the Veteran's residual scar status post appendix removal under DC 7802 at any time during the period on appeal.

The Board has considered whether other ratings are applicable to the Veteran's residual scar status post appendix. A disability rating under Diagnostic Codes 7801 is not warranted because the Veteran's scar was not at least 6 square inches, as noted for a 10 percent rating under DC 7801 under the post-amended criteria. Nor is a compensable rating warranted under DC 7804
 one anterior trunk scar measuring no more than approximately 9.0 centimeters by 0.3 centimeters, which is no more than 2.7 square centimeters. Therefore, the Board finds that a compensable evaluation is not warranted for the Veteran's residual scar status post appendix removal under DC 7802 at any time during the period on appeal.

The Board has considered whether other ratings are applicable to the Veteran's residual scar status post appendix. A disability rating under Diagnostic Codes 7801 is not warranted because the Veteran's scar was not at least 6 square inches, as noted for a 10 percent rating under DC 7801 under the post-amended criteria. Nor is a compensable rating warranted under DC 7804 because the Veteran's residual scar status post appendix was neither painful nor unstable, as required for a compensable rating under the new rating criteria.

Furthermore, there is no basis to assign a compensable rating for the Veteran's residual scar status post appendix pursuant to DC 7805. While the Veteran has described intermittent itching of his appendectomy scar, there are no additional symptoms resulting in disabling effects noted at any time during the period on appeal, which have not already been considered under DC 7802. The August 2024 VA examiner indicated that the Veteran's scar did not result in limitation of function, and the Veteran has not contended otherwise. Accordingly, the Board finds that the Veteran's impairment due to his residual scar status post appendix is more consistent with a noncompensable disability rating and that the level of disability necessary to support the assignment of a compensable rating under DC 7805 is absent. The Board additionally notes that DC 7800 is not applicable as it relates specifically to scars of the head, face, or neck. 38 C.F.R. § 4.118.

Accordingly, the Board finds that a rating in excess of zero percent is not warranted for the period on appeal for the Veteran's residual scar status post appendix. As the evidence is persuasively against the claim for a higher rating, the benefit of the doubt doctrine is not for application, and the Veteran's claim for an increased rating for his residual scar status post appendix is denied. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102; 4.3; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

Service Connection

Establishing service connection generally requires (1) evidence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, i.e., a nexus, between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection may also be granted for any disease diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Continuity of symptomatology may also provide a basis for a grant of service connection for diseases defined as "chronic" by VA. 38 C.F.R. § 3.303(b), 3.307(a)(3), 3.309(a); Fountain v. McDonald, 27 Vet. App. 258 (2015).

3. Entitlement to service connection for a left hand disability is denied. 

4. Entitlement to service connection for skin cancer is denied. 

5. Entitlement to service connection for a heart disability is denied. 

6. Entitlement to service connection for a left knee disability is denied. 

7. Entitlement to service connection for a right knee disability is denied. 

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

9. Entitlement to service connection for a low back disability is denied. 

10. Entitlement to service connection for a sleep disorder is denied.

The Veteran contends that he has a current left hand disability, skin cancer, heart disability, left and right knee disability, left hip disability, low back disability, and sleep disorder due to his active service. Specifically, he asserts that he has arthritis of the left hand, basal cell carcinoma of the nose, coronary stents, bilateral knee pain, a left hip replacement, lower back pain, and sleep apnea. 

Service treatment records (STRs) are silent for any complaints, treatment, or diagnosis for any left hand disability, skin cancer, heart disability, left or right knee disability, left hip disability, low back disability, or sleep disorder, or any related symptoms. As noted above, there are no available post-service medical treatment records.

After a review of the evidence, the Board finds that the Veteran does not have a current left hand disability, skin
, left hip disability, low back disability, and sleep disorder due to his active service. Specifically, he asserts that he has arthritis of the left hand, basal cell carcinoma of the nose, coronary stents, bilateral knee pain, a left hip replacement, lower back pain, and sleep apnea. 

Service treatment records (STRs) are silent for any complaints, treatment, or diagnosis for any left hand disability, skin cancer, heart disability, left or right knee disability, left hip disability, low back disability, or sleep disorder, or any related symptoms. As noted above, there are no available post-service medical treatment records.

After a review of the evidence, the Board finds that the Veteran does not have a current left hand disability, skin cancer, heart disability, left or right knee disability, left hip disability, low back disability, or sleep disorder and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

In this regard, the only indication that the Veteran has a current left hand disability, skin cancer, heart disability, left or right knee disability, left hip disability, low back disability, or sleep disorder during the period on appeal is in the Veteran's claim of the disorders. The Board notes that the Veteran is competent to report that which he has personally experienced. Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, to the extent that such assertions purport to establish a current disability or the etiology of any such disability, such assertions do not provide persuasive support for the claim, as the Veteran is not shown to possess the medical training to render competent opinions about such complex medical matters. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). Therefore, the Board affords the Veteran's assertion that he has a current left hand disability, skin cancer, heart disability, left or right knee disability, left hip disability, low back disability, or sleep disorder no probative weight.

The Board is cognizant of Saunders v. Wilkie, in which the Federal Circuit held that that "pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability." 886 F.3d 1356, 1363, 1368, 1369 (Fed. Cir. 2018). However, the Federal Circuit also made clear that a veteran cannot demonstrate service connection simply by asserting subjective pain to establish a disability; the Veteran's pain must amount to a functional impairment. To establish the presence of a disability, a veteran must show that the pain reaches the level of a functional impairment of earning capacity. Id. at 1367-68. Here, to the extent that there are complaints of pain, there is no indication that any subjective complaints result in functional impairment of earning capacity. Consequently, the Board finds that, at no time during the pendency of the claim does the Veteran have a current disability associated with his left hand, skin, heart, left or right knee, left hip, low back, or sleep symptoms.

The Board recognizes that the Veteran has not had VA examinations addressing his claimed left hand disability, skin cancer, heart disability, left or right knee disability, left hip disability, low back disability, or sleep disorder. However, the Board finds that examinations were not warranted because the record did not establish a current disability with respect to these claimed disorders. Therefore, it was insufficient to trigger VA's duty to assist by providing medical opinions regarding service connection. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4); see also McLendon v. Nicholson, 20 Vet. App. 79 (2006); Wells v. Principi, 326 F.3d 1381 (Fed. Cir. 2003). Accordingly, the Board finds that the AOJ did not have a duty to obtain a VA opinion with respect to these claims, and there was no pre-decisional duty to assist error in this respect. See Locklear v. Nicholson, 20 Vet. App. 410 (2006); see also McLendon, 20 Vet. App. at 83.

As the evidence of record does not demonstrate that the Veteran does in fact have a current left hand disability, skin cancer, heart disability, left or right knee disability, left
endon v. Nicholson, 20 Vet. App. 79 (2006); Wells v. Principi, 326 F.3d 1381 (Fed. Cir. 2003). Accordingly, the Board finds that the AOJ did not have a duty to obtain a VA opinion with respect to these claims, and there was no pre-decisional duty to assist error in this respect. See Locklear v. Nicholson, 20 Vet. App. 410 (2006); see also McLendon, 20 Vet. App. at 83.

As the evidence of record does not demonstrate that the Veteran does in fact have a current left hand disability, skin cancer, heart disability, left or right knee disability, left hip disability, low back disability, or sleep disorder, the first element of service connection has not been met for the claim on appeal, and no further analysis is necessary. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

Accordingly, the Board finds that the evidence is persuasively against finding that the Veteran has a left hand disability, skin cancer, heart disability, left or right knee disability, left hip disability, low back disability, or sleep disorder. As there is no disability that can be related to active service, the Veteran's claims for service connection must be denied. 38 U.S.C. § 1110; Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998).

11. Entitlement to service connection for diverticulitis is denied.

The Veteran contends that his diverticulitis is due to service. The AOJ found that the Veteran had a diagnosis of diverticulitis. 

STRs are silent for any complaints, treatment, or diagnosis for diverticulitis. In this regard, while the Board acknowledges that STRs reflect numerous complaints of abdominal pain throughout the Veteran's active service, the records reflect that these symptoms were attributed to peptic ulcer disease, duodenitis, and gastritis. There are no available post-service medical treatment records. 

The Veteran was afforded a VA examination in August 2024, which notes a diagnosis of diverticulitis. The record notes that this disability had its onset in 2016, indicating that it was diagnosed after service. He reported that daily fiber and increased water intake helped keep diverticulosis flare-ups down, and he was prescribed antibiotics when his diverticulosis occurs. He described his current symptoms as occasional diarrhea accompanying heartburn pain related to his peptic ulcer disease (PUD). The examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed in service, injury, event, or illness, reasoning that there is a lack of substantiating evidence supporting a nexus between the current diagnosis of diverticulosis and military service. Without chronicity during service or after service, a post-service event, illness, or injury is considered to be a more likely etiology.

After a review of the evidence, the Board finds that the evidence is persuasively against the Veteran's claim for service connection for diverticulitis. 

There is no evidence in this case, nor does the Veteran contend, that his diverticulitis had its onset during his period of active service. Nor is there evidence to suggest the presence of the claimed disability until many years after service, and thus, there is no indication of continuity of symptoms since service or that the Veteran's diverticulitis manifested to a compensable degree within one year of his separation from military service in 1984. Accordingly, service connection for diverticulitis cannot be granted on a direct basis based on in-service incurrence or on a presumptive basis for chronic diseases. 38 C.F.R. §§ 3.307, 3.309.

Moreover, there is no medical opinion of record relating his diverticulitis to his active duty military service or a service connected disability, and the Veteran is not shown to possess the medical training necessary to render competent opinions about the etiology of a disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). Therefore, the Board finds that the Veteran assertion that his diverticulitis is related to his active service or a service connected disability is afforded no probative value.

To the extent that there are deficiencies in the August 2024 VA opinion or did not obtain a secondary service connection opinion, the Board finds that a remand to obtain another VA medical opinion is not warranted, and thus, there has been no pre
581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). Therefore, the Board finds that the Veteran assertion that his diverticulitis is related to his active service or a service connected disability is afforded no probative value.

To the extent that there are deficiencies in the August 2024 VA opinion or did not obtain a secondary service connection opinion, the Board finds that a remand to obtain another VA medical opinion is not warranted, and thus, there has been no pre-decisional duty to assist error because the record contains no probative evidence establishing a possible relationship between diverticulitis and active service or a service connected disability. See McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010) (noting that a conclusory lay statement that a current condition is related to service is insufficient to warrant a medical examination because it would "eliminate the carefully drafted statutory standards governing the provision of medical examinations and require the Secretary to provide such examinations in virtually every veteran's disability case").

Based on the foregoing, the Board finds that the evidence is persuasively against a grant of service connection for diverticulitis. In reaching this conclusion, the Board has considered the benefit-of-the-doubt doctrine. However, as the evidence is persuasively against the Veteran's claim, that doctrine is not applicable, and service connection must be denied. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102.

12. Entitlement to service connection for headaches is granted.

The Veteran contends that he has a headache disorder as a result of his active service. 

The AOJ found STRs document an incident that occurred November 20, 1983, resulting in swelling on frontal skull. The AOJ also found that a nexus, or link, has been established between his claimed issue and an in-service event or injury, noting that headaches were the chief complaint of visit for evaluation following the trauma. The AOJ indicated that there is evidence of chronicity and a nexus has been established. The Board is bound by these favorable findings. 38 C.F.R. § 3.104(c). However, the AOJ found that there was no headache disability. 

STRs are silent for any diagnosis for a headache disorder; however, a November 1983 STR reflects that the Veteran sought treatment for swelling of the frontal skull after a fight, and, on his separation Report of Medical History, the Veteran endorsed a head injury.  

An August 2024 VA examination notes that the Veteran did not have a diagnosis of a headache disorder. The VA examination notes that the Veteran reported that his headaches started in November 1983, after a head injury and have continued intermittently since. The examiner remarked that no diagnosis of headaches was confirmed; however, the original head injury in the service is documented with a headache at the time of injury, and he had symptoms consistent with headaches related to his original head injury. The examiner opined that the claimed condition was at least as likely as not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that the Veteran's claimed condition was headaches, and the "current diagnosis" was headaches. The examiner noted that the Veteran experienced head trauma during a fight in service, and headaches were the chief complaint for evaluation following the trauma. The examiner furthered that the Veteran had no issues related to headaches prior to service; his current diagnosis of headaches is related to the head trauma that occurred during the fight while in service, and a nexus has been established. The examiner also noted that the Veteran has not had any diagnosed headache evaluations since the time of injury in service but was advised to take over the counter medications such as Tylenol and Excedrin by his primary care doctor for the headaches he has been experiencing.

After carefully reviewing and weighing the competent evidence of record, the Board is satisfied that the evidence is at least in approximate balance as to whether the Veteran has a headache disorder that is directly related to service. Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

As noted above, the AOJ has found that STRs reflect an incident that occurred November 20, 1983, resulting in swelling on frontal skull. Thus, the second element, in service incurrence, is satisfied. Additionally, the AOJ found that a nexus has been established, satisfying the third element
 to take over the counter medications such as Tylenol and Excedrin by his primary care doctor for the headaches he has been experiencing.

After carefully reviewing and weighing the competent evidence of record, the Board is satisfied that the evidence is at least in approximate balance as to whether the Veteran has a headache disorder that is directly related to service. Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

As noted above, the AOJ has found that STRs reflect an incident that occurred November 20, 1983, resulting in swelling on frontal skull. Thus, the second element, in service incurrence, is satisfied. Additionally, the AOJ found that a nexus has been established, satisfying the third element of service connection. Thus, the only question before the Board is whether the Veteran has a current headache disability. 

Here, the Board acknowledges that the August 2024 VA examination report notes that the Veteran did not have a diagnosis of a headache disorder; however, the opinion provided by this examiner indicated that, not only that he had a "current diagnosis" of headaches, but that his current diagnosis of headaches is related to the head trauma that occurred during the fight while in service, and he has received treatment for his current headaches. In light of the VA examiner's medical opinion that the Veteran has a current headache diagnosis and receives treatment for his headaches, the Board resolves reasonable doubt in favor of the Veteran and finds that he has a current headache disability. 

Therefore, resolving reasonable doubt in the Veteran's favor, service connection for a headache disorder is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

 

 

Thomas H. O'Shay

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	D. Hite, 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.