POSTTRAUMATIC STRESS DISORDER (PTSD)

JONATHAN B. KRAMER · 2026 · Case ID: A26030562

DENIED

Summary

The veteran, who served honorably in the United States Marine Corps from December 1986 to September 1990, with additional Reserve service until February 1994, appeals the denial of service connection for allergic rhinitis and bilateral lower extremity (BLE) neuropathy, and the denial of an increased rating for PTSD. The Board denied the PTSD increase, finding the evidence did not support deficiencies in most areas of functioning required for a higher rating, despite the veteran's reported symptoms and challenges at work and in his marriage. The Board noted the VA examiner's findings, which indicated reduced reliability and productivity but not the severe impairment needed for a higher rating, and gave greater weight to the VA examination over the veteran's lay statements. For dermatitis, the Board granted a 10% rating effective December 4, 2024, finding the evidence in equipoise and resolving doubt in the veteran's favor due to the use of oral prednisone and a larger rash area noted in private records, though the VA exam showed minimal involvement. Service connection for allergic rhinitis was denied, as the Board found the evidence weighed against a nexus to the veteran's Camp Lejeune water exposure, relying on a VA examiner's opinion that the condition was less likely than not caused by TERA. For BLE neuropathy, the Board denied service connection, finding the veteran did not have a current diagnosis of the condition during the appeal period, despite earlier private diagnoses and favorable findings in some prior VA decisions, and that reported pain did not result in functional impairment as required by Saunders v. Wilkie.

Rationale

Evidence did not support deficiencies in most areas of functioning.; VA examination findings indicated reduced reliability and productivity, not severe impairment.; Board gave greater weight to VA examination findings.

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Docket No.

241217-503229

Full Decision Text

Citation Nr: A26030562
Decision Date: 04/02/26 Archive Date: 04/02/26

DOCKET NO. 241217-503229
DATE: April 2, 2026

ORDER

Entitlement to an initial evaluation in excess of 50 percent of post-traumatic stress disorder (PTSD) is denied.

Entitlement to an initial compensable evaluation prior to December 4, 2024, for dermatitis is denied.

Entitlement to an evaluation of 10 percent, but no higher, as of December 4, 2024, for dermatitis is granted.

Entitlement to an initial compensable evaluation of nephrolithiasis (hereinafter kidney stones) is denied.

Entitlement to service connection for allergic rhinitis is denied.

Entitlement to service connection for bilateral lower extremity (BLE) neuropathy is denied.

FINDINGS OF FACT

1. The Veteran's PTSD was not productive of occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, or mood.

2. Prior to December 4, 2024, the Veteran's dermatitis is not shown to result in involvement of at least 5 percent, but less than 20 percent, of exposed areas or the entire body affected and he is not shown to require intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12- month period.

3. As of December 4, 2024, the Veteran's dermatitis is not shown to result in involvement of at least 5 percent of his exposed body area during flareups/active phases, but does not more nearly approximate characteristic lesions involving more than 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period.

4. During the appeal period the Veteran's kidney stones did not result in colic and did not require catheterization, nor result in recurrent stone formation requiring invasive or non-invasive procedures more than two times per year.

5. The evidence of record persuasively weighs against finding the Veteran's rhinitis condition began during active service or is otherwise related to an in-service injury or disease, to include as due to exposure to contaminated water at Camp Lejeune.

6. The evidence of record persuasively weighs against finding that the Veteran has had BLE neuropathy at any time during or approximate to the pendency of the appeal.

CONCLUSIONS OF LAW

1. The criteria for an initial evaluation in excess of 50 percent for PTSD have not been met. 38 U.S.C. § 1155 (2018); 38 C.F.R. § 4.130, Diagnostic Code 9411.

2. The criteria for an initial compensable evaluation prior to December 4, 2024, for dermatitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7806.

3. The criteria for an evaluation of 10 percent, but no higher, as of December 4, 2024, for dermatitis have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7806.

4. The criteria for entitlement to an initial compensable rating for kidney stones have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.655, 4.1, 4.3, 4.7, 4.115b, Diagnostic Codes (DCs) 7508, 7509.

5. The criteria for entitlement to service connection for rhinitis to include as due to contaminated water at Camp Lejeune, are not met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303(a), 3.307(a)(7), 3.309(f).

6. The criteria to establish service connection for BLE radiculopathy have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303.

REAS
4.115b, Diagnostic Codes (DCs) 7508, 7509.

6. The criteria to establish service connection for BLE radiculopathy have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had honorable active-duty service with the United States Marine Corps from December 1986 to September 1990, with additional periods of Reserve service from September 1990 to February 1994.

These matters are before the Board of Veterans' Appeals (Board) from the January 2024, May 2024, and June 2024 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO).

In the December 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket.

Therefore, the Board may only consider the evidence of record at the time of the relevant agency of original jurisdiction (AOJ) decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303. If evidence was submitted either (1) during the period after the AOJ issued the decision, which was subsequently subject to higher-level review and prior to the date the Board received the VA Form 10182, or (2) more than 90 days following the date the Board received the VA Form 10182, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.303, 20.801.

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

However, because the Board is remanding the claims of service connection for allergic rhinitis and BLE neuropathy, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

The Board acknowledges VA has conceded the Veteran's exposure to Camp Lejeune contaminated water (CLCW) based on his duty station assignment and asbestos based on his military occupational specialty (MOS) of antitank assault-man and guard. See VA Memorandum submitted as Other in May 2023 and August 2023, and DD214: Certificate of Release or Discharge from Active duty submitted February 2017.

INCREASED RATINGS

VA assigns disability ratings by evaluating the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the VA Schedule for Rating Disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4, including §§ 4.1, 4.2, 4.10. In determining the current level of impairment, the disability must be considered in the context of the whole recorded history, including service medical records. 38 C.F.R. § 4.2. If two disability ratings are potentially applicable, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

Each disability is viewed in relation to its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). When considering the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection is required. Fenderson v. West, 12 Vet. App. 119 (1999). Where entitlement to compensation has already been established and
2. If two disability ratings are potentially applicable, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

Each disability is viewed in relation to its history. 38 C.F.R. § 4.1; Peyton v. Derwinski, 1 Vet. App. 282 (1991). When considering the propriety of the initial evaluation assigned, consideration of the medical evidence since the effective date of the award of service connection is required. Fenderson v. West, 12 Vet. App. 119 (1999). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). Staged ratings are warranted if there are decreases or increases in symptomatology that meet the criteria for a different rating for a distinct period. See Hart. v. Mansfield, 21 Vet. App. 505 (2007).

The Court has indicated that the Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value.

When there is an approximate balance between positive and negative evidence, equipoise, the benefit of the doubt doctrine must apply in favor of the Veteran. But when the evidence persuasively favors one side or the other, the claim will be decided on its merits. In those cases, the benefit of the doubt doctrine is inapplicable. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

Entitlement to an initial evaluation in excess of 50 percent for PTSD

The Veteran contends he is entitled to an evaluation in excess of 50 percent for his PTSD. Specifically, he did not provide any lay statements as to why he believes he is entitled to a higher rating for his PTSD.

Procedurally, the Veteran initially filed for service connection for PTSD in July 2023, which was granted at 50 percent disabling effective October 25, 2022, in the May 2024 rating decision. In July 2024 the Veteran filed his Higher-Level Review (HLR) which was denied in the October 2024 HLR rating decision.

The appeal period for review in this opinion is from October 25, 2022, to the May 2024 rating decision. Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). For initial rating claims and increased rating claims, "the effective date can be no earlier than the date it was factually ascertainable" that a veteran's disability was diagnosed or worsened. Swain v. McDonald, 27 Vet. App. 219, 224 n. 4 (2015).

The Veteran's service-connected PTSD is rated under the General Rating Formula for Mental Disorders, 38 C.F.R. § 4.130, Diagnostic Code 9411.

Under the General Rating Formula, the Veteran's current 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; and difficulty in establishing effective work and social relationships.

A 70 percent rating is warranted for occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, 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 the ability to function independently, appropriately and effectively; impaired impulse control (such an unprovoked irritability with periods of violence); spatial
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; and difficulty in establishing effective work and social relationships.

A 70 percent rating is warranted for occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, 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 the ability to function independently, appropriately and effectively; impaired impulse control (such an 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 total schedular rating of 100 percent is warranted for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of mental and personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id.

Under the General Formula for Mental Disorders (General 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. Evaluations under §4.130 are symptom-driven, meaning that symptomatology should be the fact-finder's primary focus when deciding entitlement to a given disability rating under that regulation. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). Severity and duration of the symptoms also play an important role in determining the rating. Id. at 117. The Board notes however that the list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant the rating and are not meant to be exhaustive. The Board need not find all or even some of the symptoms to award a specific rating. 38 C.F.R. § 4.21; Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). If the evidence shows the Veteran suffers symptoms listed in the rating criteria or symptoms of similar severity, frequency, and duration, that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the criteria for a particular rating, the appropriate equivalent rating will be assigned. Id.

Factual background

In VA treatment records in January 2023, the Veteran reported no suicidal ideations, no delusions, and no hallucinations. See CAPRI records submitted July 2023.

In VA treatment records in January 2024 the Veteran reported anxiety and depression based on being investigated by his employer due to inappropriate interactions indicated as promotional persuasion with fellow co-workers. He reported that he was told that he does not socialize well and his communication is unbecoming, he was advised to seek help for his mental health. He endorsed depression, anxiety, racing thoughts, lacking motivation to engage in physical activity, and low motivation for work. He described the work complaint that had been consuming him for the past three years, and he keeps fighting against it. He also described having flashbacks, nightmares, sleep disturbances, appetite issues and feeling stressed. He was noted with an anxious mood, feelings of helplessness and loss, self-pity, loss of control, diminished interest, but denied suicidal and homicidal ideations, he was oriented to all spheres and had sought help to develop understanding and insight. See CAPRI records submitted June 2024.

The Veteran underwent a VA examination in February 2024 that documented his diagnosis of PTSD and found his social and occupational impairment with reduced reliability and productivity. The examiner noted the Veteran was currently married and had been for 28 years, and the relationship was not good at this time, because of "everything at work" was not so good. He reported avoiding social gathering and events, he was hypervigilant and suspicious of others. This caused problems in his marriage. He described that his wife would go out with friends because he was uncomfortable around others. The examiner noted the Veteran had undergone college courses in service but did not have a degree. He currently worked in a Federal Law enforcement training center, and been recommended to retire, due to being "concerned about mental fitness to continue." The examiner indicated he was first seen by a provider in 2023 and was too proud to seek help
examiner noted the Veteran was currently married and had been for 28 years, and the relationship was not good at this time, because of "everything at work" was not so good. He reported avoiding social gathering and events, he was hypervigilant and suspicious of others. This caused problems in his marriage. He described that his wife would go out with friends because he was uncomfortable around others. The examiner noted the Veteran had undergone college courses in service but did not have a degree. He currently worked in a Federal Law enforcement training center, and been recommended to retire, due to being "concerned about mental fitness to continue." The examiner indicated he was first seen by a provider in 2023 and was too proud to seek help but once employment was threatened and his wife threatened to divorce him, he sought mental health treatment. Currently he attended counseling and was on no medications currently.

His symptoms for VA rating purposes were depressed mood, anxiety, suspiciousness, sleep impairment, difficulty in establishing and maintaining effective work and social relationships. He was observed with a depressed mood, congruent affect, was polite and cooperative. He appeared forthright, oriented, with his memory intact. His thought processes were normal and thought content unremarkable, with normal speech.

The medical opinion provided in April 2024 found the Veteran's mental health symptoms are causing clinically significant distress or impairment in social, occupational or other important areas of functioning.

Analysis

The Board finds that an evaluation in excess of 50 percent is not warranted for the Veteran's PTSD. Higher ratings are available for total occupational and social impairment or for occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, or mood. The evidence persuasively weighs against such findings.

The February 2024 VA examination report does not support the finding that there is a level of impairment with deficiencies in most areas. The Veteran has maintained his employment, even with being investigated. He has been married for over 20 years and living with his wife, albeit with challenges in that relationship. He also felt suspicious of others and avoided social gatherings and events which were considered with the endorsement of difficulty in establishing and maintaining effective work and social relationships. After reviewing the record and examining the Veteran, the February 2024 examiner found his PTSD was productive of occupational and social impairment with reduced reliability and productivity. This finding is consistent with the Veteran's contemporaneous treatment records, which indicated work difficulties and stressors based on being investigated and endorsing low motivation for socializing. See CAPRI records submitted June 2024.

The Board finds that the Veteran's PTSD has not manifested to deficiencies in most areas.

Although the Veteran has reported nightmares, flashbacks, and sleep impairment these have not risen to the level of a 70 percent or total disability rating. He has not endorsed nor been found to have panic attacks, near continuous panic, impairment of memory, flattened affect, nor suicidal ideations. His speech has not been affected, his thought processes are intact, nor has he developed irritability with violent outbursts, nor has he exhibited impaired judgments during the appeal period, nor has he been found to be a danger to himself or others. He has maintained a relationship with his wife and continued to live with her and has maintained his employment. Although the Veteran does not socialize as he reported being uncomfortable around others, he has not endorsed complete isolation or withdrawal to warrant the finding of the inability to establish and maintain effective relationships to meet the next higher rating.

In this case, the Veteran's general contentions of an increased rating are outweighed by competent and credible medical evidence which evaluated the true extent of his PTSD. In this regard, the Board notes that the VA examiners have the training and expertise necessary to administer the appropriate tests for a determination of the type and degree of the impairment associated with the Veteran's condition. For these reasons, greater evidentiary weight is placed on the examination findings regarding the type and degree of impairment. While the Board is sympathetic to the Veteran's report of symptoms, the medical evidence does not support a higher evaluation for PTSD at any point during the appeal period. The Board also finds that a staged rating is not appropriate in this case.

The Veteran has also not endorsed nor been found to have reported obsessional rituals; neglect of personal appearance or hygiene; grossly inappropriate behaviors; disorientation to time or place; memory loss for names of close relatives, his own occupation, or his name; or symptoms of similar duration, frequency and severity. Although the Veteran has endorsed a chronic sleep impairment, the symptom is considered in the 50 percent disability rating.

For these reasons, the Board finds that an evaluation in excess of 50 percent is not warranted for the Veteran's PTSD.

Entitlement to an initial compensable evaluation prior to December 4, 2024, for dermatitis

Entitlement to an evaluation of 10 percent, but no higher, as of December
case.

For these reasons, the Board finds that an evaluation in excess of 50 percent is not warranted for the Veteran's PTSD.

Entitlement to an initial compensable evaluation prior to December 4, 2024, for dermatitis

Entitlement to an evaluation of 10 percent, but no higher, as of December 4, 2024, for dermatitis

The Veteran is seeking a compensable rating for his dermatitis.

Procedurally, the Veteran filed for service connection for dermatitis in July 2023 which was granted in the January 2024 rating decision at a non-compensable rate effective July 24, 2023. In July 2024 the Veteran filed his Higher-Level Review (HLR) which was denied in the October 2024 HLR rating decision.

The appeal period for review in this opinion is from July 24, 2023, to the May 2024 rating decision. Gaston v. Shinseki, 605 F.3d 979, 982 (Fed. Cir. 2010). For initial rating claims and increased rating claims, "the effective date can be no earlier than the date it was factually ascertainable" that a veteran's disability was diagnosed or worsened. Swain v. McDonald, 27 Vet. App. 219, 224 n. 4 (2015).

The Veteran's dermatitis is rated under Diagnostic Code 7806, for dermatitis or eczema. As this matter has been pending since July 2023, after the rating criteria for rating skin disabilities was amended effective from August 13, 2018, there is no need to discuss the rating criteria in effect prior to August 13, 2018.

Effective August 13, 2018, VA regulations explicitly state that systemic therapy is treatment that is administered through any route other than the skin, and topical therapy is treatment that is administered through the skin. 38 C.F.R. § 4.118(a).

Additionally, effective August 13, 2018, a new General Rating Formula for the Skin applies to Diagnostic Codes 7806, 7809, 7813 to 7816, 7820 to 7822, and 7824. See 38 C.F.R. § 4.118. Under this formula, a noncompensable rating is assigned for no more than topical therapy required over the past 12-month period and at least one of the following: characteristic lesions involving less than 5 percent of the entire body affected; or characteristic lesions involving less than 5 percent of exposed areas affected. A 10 percent rating is assigned for at least one of the following: characteristic lesions involving at least 5 percent, but less than 20 percent, of the entire body affected; or at least 5 percent, but less than 20 percent, of exposed areas affected; or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12- month period.

A 30 percent rating is assigned at least one of the following: characteristic lesions involving more than 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. A 60 percent rating is assigned for at least one of the following: characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period. Or rate as disfigurement of the head, face, or neck (DC 7800) or scars (DC's 7801, 7802, 7803, 7804, or 7805),
A 60 percent rating is assigned for at least one of the following: characteristic lesions involving more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or constant or near-constant systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required over the past 12-month period. Or rate as disfigurement of the head, face, or neck (DC 7800) or scars (DC's 7801, 7802, 7803, 7804, or 7805), depending on the predominant disability. 38 C.F.R. § 4.118, General Rating for the Skin for DCs 7806, 7809, 7813-7816, 7820-7822, and 7824.

Here, the evidence of record demonstrates that the predominant disability is dermatitis. The Veteran has no disfigurement of the head, face, or neck, or scars associated with his dermitis and therefore no other DC is applicable.

The Board notes that the VA treatment records during the pendency of this appeal continued to show issues with skin rash/dermatitis. In August 2022 the Veteran was noted with a rash across his chest, more prominent under folds of the breasts and transitioned to his upper back. See CAPRI records submitted August 2023.

In the Veteran's November 2023 lay statement, he described his rash as predominantly on the upper torso and chest and back. He reported that the pustules have been biopsied and filled with eosinophiles. He was told it was similar to dry skin and had rash nowhere else. His dermatologist informed him it was not common in a 54-year-old.

In VA treatment records in October 2023 the Veteran was found with rash on his mid-chest and back, was constant, fixed, and ongoing. It was described with little red spots, dry with some pruritus but not severe. He reported nothing makes his rash better or worse, he was given multiple creams over years for dermatitis, but they do not resolve the rash. The Veteran was noted with chronic fixed dermatitis, consistent with atopic dermatitis. The Veteran was also noted with chronic eczema, a condition with no cure, and severity was up and down. See CAPRI records submitted in January 2024.

In VA treatment records the Veteran in October 2023 during a dermatology consultation was noted with a chronic rash, located on mid-chest and back, was found to be constant and fixed ongoing for 15 years, and he was given creams for his rash, of triamcinolone and ketoconazole. The dermatologist noted that if there was no improvement they would consider referral for UV light therapy. See Medical Treatment Record - Government Facility submitted July 2024. As of the date of this opinion the Veteran has not undergone light therapy for his dermatitis.

The Veteran underwent a VA examination in December 2023 for his dermatitis. He reported an intermittent skin rash since around 2007 with red, raised and sometimes painful rash. He noted he used a treatment of topical steroid creams. He was found to have betamethasone noted as topical corticosteroids or other immunosuppressive medications for the past 12 months but noted as only topical for 6 weeks or more but not constant. No treatment or procedures other than those noted in the past 12 months for any skin condition were found. On physical examination his dermatitis was found to be less than 5 percent of his total body area and none of his exposed area. The description of the Veteran's rash was a slightly raised pustular red rash under his left pectoral area. No scarring or disfigurement and no functional impact were noted.

In VA treatment records in January 2024 the Veteran was noted with using triamcinolone cream for treatment of his atopic dermatitis with continued use. In April 2024 in a primary care follow up, the Veteran's rash was noted across his chest, more prominent under the folds of his breasts, and upper back. See CAPRI records submitted in June 2024.

In private dermatology treatment records from December 4, 2025, the Veteran was found with flaky, itchy, moderate red rash on his face, feet, scalp, left leg, and trunk. The doctor noted the Veteran was using treatments of triamcinolone, fluocinonide ointment, ketoconazole cream, and oral prednisone at 20 milligrams. He was also told to begin oral medication of Allegra daily. See Medical Treatment Record Non
continued use. In April 2024 in a primary care follow up, the Veteran's rash was noted across his chest, more prominent under the folds of his breasts, and upper back. See CAPRI records submitted in June 2024.

Analysis

Regarding the period prior to December 4, 2024, the Veteran had no involvement of either the total body area and total exposed area and there were no other significant findings beyond the VA examination finding of less than 5 percent of his total body involvement due to his dermatitis. He also was not shown to require intermittent systemic therapy for a total duration of less than 6 weeks over the past 12- month period. His only treatment is shown to be topical creams and topical corticosteroids. There are no other significant findings of a skin disorder shown in the treatment records for the appeal period prior to December 4, 2024, that would warrant a compensable rating.

From December 4, 2024, the evidence is in equipoise as to whether a 10 percent disability rating is warranted. The Veteran's private treatment records did not specify the percentage of body involvement of the Veteran's dermatitis. However, the private treatment records description included a larger area than the description of his body involvement from the VA examination of December 2023. Furthermore, the Veteran was being treated for his dermatitis with prednisone at 20 milligrams, which is an oral corticosteroid and told to start Allegra daily, an oral antihistamine. See https://www.medicinenet.com/fexofenadine/article.htm. However, it was unclear for how long the Veteran was utilizing this treatment for his dermatitis.

The Board in resolving all doubt in the Veteran's favors finds this more closely resembles the minimal criteria for a 10 percent rating under the General Formula based on the possibility of involvement of at least 5 percent but less than 20 percent of the entire body or intermittent systemic therapy including, but not limited to, corticosteroids, phototherapy, retinoids, biologics, photochemotherapy, PUVA, or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12- month period. The Board also notes that December 4, 2024, is the earliest date in the submitted private treatment records which document the Veteran's use of oral prednisone for treatment of his dermatitis and prescribing Allegra for his dermatitis. Accordingly, the Board affords the Veteran the benefit of the doubt and finds that as of December 4, 2024, the criteria for a 10 percent rating is warranted for dermatitis.

However, the evidence of record as of December 4, 2024, persuasively weighs against the assignment of a rating in excess of 10 percent because the Veteran's dermatitis does not more nearly approximate characteristic lesions involving more than 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or systemic therapy required for a total duration of 6 weeks or more, but not constantly, over the past 12-month period. As discussed above, the VA examination of December 2023 was negative for any objective findings of skin involvement of more than 5 percent of total body involvement, and at no time is there an indication of 20 to 40 percent body involvement or 20 to 40 percent involvement of exposed area. The Veteran's use of oral corticosteroids is for an unknown duration, and it is unclear for how long the Veteran was prescribed the medication for his dermatitis. Based on the record before the Board and resolving all doubt in the Veteran's favor the Board finds the Veteran is entitled to a 10 percent disability rating as of December 4, 2024, but no higher.

The Veteran believes he is entitled to a compensable rating for his dermatitis and has submitted no lay statements that would warrant a higher disability rating. The Veteran is competent to report observable symptoms. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, the medical treatment records do not show that his dermatitis more nearly approximates the criteria in the next higher rating prior to December 4, 2024, or
dermatitis. Based on the record before the Board and resolving all doubt in the Veteran's favor the Board finds the Veteran is entitled to a 10 percent disability rating as of December 4, 2024, but no higher.

The Veteran believes he is entitled to a compensable rating for his dermatitis and has submitted no lay statements that would warrant a higher disability rating. The Veteran is competent to report observable symptoms. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, the medical treatment records do not show that his dermatitis more nearly approximates the criteria in the next higher rating prior to December 4, 2024, or a rating in excess of 10 percent disabling as of that date. The Board has considered whether any other Diagnostic Codes related to disabilities of the skin would provide for a higher disability evaluation. However, the evidence does not reflect that the dermatitis would warrant a higher rating under a different diagnostic code. See 38 C.F.R. § 4.118.

In conclusion, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for a compensable rating for dermatitis for the period prior to December 4, 2024. As the evidence of record persuasively weighs against a compensable rating, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

As of December 4, 2024, the evidence supports a 10 percent rating but no higher for dermatitis.

Entitlement to an initial compensable evaluation of kidney stones

The Veteran contends he is entitled to a compensable evaluation for his kidney stones. The Veteran has submitted no lay statements indicating why he believes he is entitled to a higher disability rating.

Procedurally, the Veteran filed for service connection in July 2023 for kidney stones, he was awarded a non-compensable rate effective July 24, 2023, in the January 2024 rating decision. In July 2024 he filed a HLR claim for increased rating which was denied in the October 2024 rating decision. Therefore, the Board may only consider the evidence of record at the time of the January 2024 AOJ decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303

The Veteran is service connected for kidney stones, which is rated as noncompensable under DC 7508. According to DC 7508, kidney stones are rated as hydronephrosis under DC 7509, except where there is recurrent stone formation requiring invasive or non-invasive procedures more than two times per year. If evaluated under this code, the rating assigned will be 30 percent. 38 C.F.R. § 4.115b, DC 7508.

Pursuant to DC 7509, hydronephrosis warrants a 10 percent rating when there is only an occasional attack of colic, without infection and without requiring catheter drainage. A 20 percent disability rating is warranted for frequent attacks of colic requiring catheter drainage. A 30 percent disability rating is warranted where there are frequent attacks of colic with infection (pyonephrosis) and impaired kidney function. If hydronephrosis is severe, it is rated as renal dysfunction. 38 C.F.R. § 4.115b, DC 7509. The Board notes that a noncompensable rating is appropriate, even when a DC does not specifically provide for this rating, when the criteria for a compensable rating are not met. 38 C.F.R. § 4.31.

In the present case, the Veteran was afforded a VA examination for his kidney stones in December 2023. The examiner documented the Veteran's report of kidney stones in 2021 which was passed with observation and no treatment. He reported no current symptoms and no treatment with medications, along with no hypertension or heart disease due to kidney condition. Contemporaneous urinalysis was normal. No renal dysfunction and no functional impact were found.

The Veteran's medical treatment records consistently document the Veteran's complaints of pain and evaluation of the Veteran for kidney stones as a possible source of pain. Hower during the appeal period the evidence fails to demonstrate any attack of colic, there were no indications of use of catheter drainage, or recurrent stone formation that requires invasive or non-invasive procedures more than two times per year in his
in December 2023. The examiner documented the Veteran's report of kidney stones in 2021 which was passed with observation and no treatment. He reported no current symptoms and no treatment with medications, along with no hypertension or heart disease due to kidney condition. Contemporaneous urinalysis was normal. No renal dysfunction and no functional impact were found.

The Board finds the Veteran has not submitted any lay statements or contentions as to why he is entitled to a higher disability rating.

The record does not show that the requirements for a higher rating have been met, as the record does not show that the Veteran's condition has recurrent stones that require invasive or noninvasive procedures more than two times per year, nor any attacks of colic during the appeal period.

The Veteran's VA medical treatment records document abdominal pain and concerns about kidney stones but do not show findings of recurrent kidney stones. Moreover, the record does not show any attacks of colic, no requirements of catheterization, and no renal dysfunction. Consequently, the Board finds that the weight of the evidence is persuasively against this claim, and the benefit of the doubt rule does not apply. Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021) (en banc). Accordingly, the claim of entitlement to an initial compensable rating for kidney stones must be denied.

SERVICE CONNECTION

In general, service connection requires (1) evidence of a current disability; (2) medical evidence, or in certain circumstances lay evidence, of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the current disability. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d).

A presumption of service connection arises for certain diseases if the disease manifests itself to a degree of 10 percent or more following exposure to contaminants present in the water supply at Camp Lejeune. Service at Camp Lejeune means no less than 30 days of service within the borders of the entirety of the United States Marine Corps Base Camp Lejeune and Marine Corps Air Station New River, North Carolina, during the period beginning on August 1, 1953, and ending on December 31, 1987, as established by military orders or other official service department records. The applicable diseases are kidney cancer, liver cancer, non-Hodgkin's lymphoma, adult leukemia, multiple myeloma, Parkinson's disease, aplastic anemia and other myelodysplastic syndromes, and bladder cancer. 38 C.F.R. §§ 3.307(a)(7), 3.309(f).

Under the PACT Act, effective from August 10, 2022, Section 303 implemented 38 U.S.C. § 1168, requiring a disability examination and medical opinion be requested for certain non-presumptive conditions involving toxic exposure risk activity (TERA). For such claims, VA is required to provide a disability examination and medical opinion when the Veteran submits a claim for compensation, has evidence of a disability, had evidence of participation in a TERA, and such evidence is not sufficient to establish service connection for the disability. A Veteran can claim participation in a TERA explicitly or implicitly through service in a location presumed associated with toxic exposure, or records showing participation in a TERA; or, if VA has conceded exposure in a prior claim, or the file has a claim attributable to toxic exposure. The Veteran was provided with TERA medical opinions for both his claims of rhinitis and BLE neuropathy as discussed below.

The presence of a current disability is the cornerstone of any service connection claim. Without proof of a present disability there can be no claim. See Brammer v. Derwinksi, 3 Vet. App. 223 (1992). The requirement of a current disability is satisfied when the claimant is shown to have the disability either at the time the claimant files a claim for service connection, or during the pendency of that claim even if the disability resolves prior to final adjudication. McClain v. Nicholson, 21 Vet. App. 319, 321 (
a claim attributable to toxic exposure. The Veteran was provided with TERA medical opinions for both his claims of rhinitis and BLE neuropathy as discussed below.

The presence of a current disability is the cornerstone of any service connection claim. Without proof of a present disability there can be no claim. See Brammer v. Derwinksi, 3 Vet. App. 223 (1992). The requirement of a current disability is satisfied when the claimant is shown to have the disability either at the time the claimant files a claim for service connection, or during the pendency of that claim even if the disability resolves prior to final adjudication. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). When the record contains a recent diagnosis of disability prior to the filing of a claim for benefits based on that disability, the report of a diagnosis is relevant evidence that must be addressed in determining whether a current disability existed at the time the claim was filed or during its pendency. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013).

Generally, lay evidence is competent with regard to identification of a disease with unique and readily identifiable features which are capable of lay observation. See Barr v. Shinseki, 21 Vet. App. 303, 308 (2007). A lay person may speak to etiology in some limited circumstances in which nexus is obvious merely through observation, such as sustaining a fall leading to a broken leg. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir 2007). Lay persons may also provide competent evidence regarding a contemporaneous medical diagnosis or a description of symptoms in service which supports a later diagnosis by a medical professional. However, a lay person is not competent to provide evidence as to more complex medical questions, i.e., those which are not capable of lay observation. Lay statements are not competent evidence regarding diagnosis or etiology in such cases. See Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (concerning rheumatic fever); Jandreau, at 1377, n. 4 ('sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer'); 38 C.F.R. § 3.159(a)(2).

The Secretary shall consider all information and lay and medical evidence of record in a case and make appropriate determinations as to competence, credibility, and weight. 38 U.S.C. § 5107; 38 C.F.R. § 3.303; Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience, if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159.

When there is an approximate balance between positive and negative evidence, equipoise, the benefit of the doubt doctrine must apply in favor of the Veteran. But when the evidence persuasively favors one side, the claim will be decided on its merits and the benefit of the doubt doctrine is inapplicable. 38 U.S.C. § 5107; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

Entitlement to service connection for allergic rhinitis

The Veteran contends he is entitled to service connection for allergic rhinitis.

Procedurally, the Veteran filed for service connection in July 2023 which was denied in the January 2024 rating decision. In July 2024 the Veeran filed a HLR which was denied in the October 2024 rating decision. Therefore, the Board may only consider the evidence of record at the time of the January 2024 AOJ decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303

In May 2023 and August 2023 VA submitted VA Memoranda which noted the Veteran was exposed to contaminated water at Camp Lejeune (CLCW). See Other submitted in May 2023 and August 2023.

In the October 2024 rating decision, the RO found the Veteran was exposed to CLCW
denied in the October 2024 rating decision. Therefore, the Board may only consider the evidence of record at the time of the January 2024 AOJ decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303

In May 2023 and August 2023 VA submitted VA Memoranda which noted the Veteran was exposed to contaminated water at Camp Lejeune (CLCW). See Other submitted in May 2023 and August 2023.

In the October 2024 rating decision, the RO found the Veteran was exposed to CLCW and was diagnosed with allergic rhinitis. The Board is bound by the favorable findings.

The Board notes that the Veteran's entrance examination of February 1986 and separation examination in September 1990 are silent as to any diagnosis of complaints of rhinitis. To the extent that the Veteran's service treatment records are legible the evidence does not show a diagnosis, complaint, or treatment for allergic rhinitis beyond treatment of acute illnesses due in service. Furthermore, the Veteran does not contend that his allergic rhinitis began during service.

In private treatment records the Veteran was prescribed a prednisone dose pack in April 2022 for allergic rhinitis and rhinorrhea. See Medical Treatment Record- Non-Government Facility submitted July 2023.

The Veteran underwent a VA examination in December 2023 for respiratory conditions in which he reported a chronic hacking cough since 2007, and the examiner found that in the absence of any known respiratory pathology it was likely a result of his reflux and allergic rhinitis.

The VA examination in December 2023 for rhinitis noted a diagnosis of allergic rhinitis from 2023 and the Veteran reported an onset in 2008 with longstanding issues with allergies, runny nose, post-nasal drip, and sneezing. He reported using Flonase and Claritin. He was found with greater than 50 percent obstruction on both sides, and permanent hypertrophy of nasal turbinates, with no nasal polyps and no granulomatous conditions. The examiner provided a medical opinion for his chronic cough claim in December 2023 which found that the Veteran's service treatment records were silent for cough outside the setting of acute illness and no objective evidence to indicate a current diagnosis for the claimed condition of chronic cough. The examiner noted "this is likely a result of his reflux and allergic rhinitis." For allergic rhinitis the examiner noted the diagnosis seasonal allergic rhinitis in April 2022.

The VA examiner in December 2023 found that a systemic review published by the National Center for biotechnology information performed a thorough meta-analysis of all available research for causation of sinusitis and allergic rhinitis, which were noted to share a highly similar and overlapping pathophysiology, and found only light associations with certain professions involving long-term airborne toxin irritant exposures. The examiner noted the 2021 meta-analysis provided an overview of causation of sinusitis with increased incidence of sinusitis in the setting of chronic particulate matter exposure. In this case the examiner found there was no evidence of long-term particulate matter exposure, and no other findings of any specific exposure which provides a "likely cause of chronic allergic rhinitis or sinusitis." Therefore, his allergic rhinitis was less likely than not caused by his TERA.

The Board finds the TERA medical opinion to be adequate for VA purposes. The examiner addressed the Veteran's contentions that his rhinitis has been found to be due to particulate matter and found his rhinitis was not due to the TERA of the Veteran, specifically the Veteran's exposure to CLCW, noted as "caused by his TERA."

By virtue of the Veteran's service at Camp Lejeune during the period of water contamination, he is presumed to have been exposed to contaminated water. 38 C.F.R. §§ 3.307(a)(7). Certain diseases are presumed by VA to be related to exposure to contaminated water at Camp Lejeune; however, the Veteran's current allergic rhinitis is not a disability recognized as entitled to presumptive service connection based upon the Veteran's in-service exposure to CLCW under 38 C.F.R. § 3.309(f). As such, the presumption for diseases related to exposure to CLCW is inapplicable. However, service connection may still be awarded if the evidence shows that a disability is directly related to service. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

The Board recognizes that the Veteran has a current diagnosis of allergic rhinitis. As mentioned, the Veteran is presumed to
to be related to exposure to contaminated water at Camp Lejeune; however, the Veteran's current allergic rhinitis is not a disability recognized as entitled to presumptive service connection based upon the Veteran's in-service exposure to CLCW under 38 C.F.R. § 3.309(f). As such, the presumption for diseases related to exposure to CLCW is inapplicable. However, service connection may still be awarded if the evidence shows that a disability is directly related to service. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

The Board recognizes that the Veteran has a current diagnosis of allergic rhinitis. As mentioned, the Veteran is presumed to have been exposed to contaminated water during his Camp Lejeune service. Thus, the first two elements of service connection are established. See Shedden, 381 F.3d at 1167.

With regard to nexus, the Board is most persuaded by the opinion offered by the December 2023 VA examiner. The examiner determined that the diagnosed allergic rhinitis is less likely as not caused by or the result of the Veteran's TERA. Reasoning included the fact that the Veteran's allergic rhinitis has been accepted as being caused by exposure to fine particulate matter but has not been found to be caused by contaminated water.

The examiner thoroughly reviewed the Veteran's claims file, reviewed the relevant medical literature, and provided an opinion as to whether the Veteran's diagnosed condition was related to the Veteran's TERA. The Board finds this opinion adequate, providing sufficient information to decide the appeal and a sound basis for a decision on the Veteran's claim. 38 C.F.R. § 3.159(c)(4); Barr v. Nicholson, 21 Vet. App. 303 (2007); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006).

While the Veteran may believe that his allergic rhinitis is related to service, to include CLCW, he is not competent to provide that opinion. See Jandreau, 492 F.3d at 1376-77. Specifically, such an opinion requires specialized medical knowledge and is not capable of lay observation. Accordingly, the Veteran's lay statements are not competent evidence of an etiologic relationship between the claimed skin condition and service.

As the only competent and credible medical opinions of record, uncontradicted by any of the other competent and credible evidence, the Board affords the VA medical opinion to have considerable probative value on appeal. In the absence of a nexus between the Veteran's allergic rhinitis and service, to include exposure to CLCW, service connection cannot be established.

Accordingly, the evidence is persuasively against the claim. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for allergic rhinitis, to include as due to exposure CLCW, is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

Entitlement to service connection for BLE neuropathy

The Veteran contends he is entitled to service connection for BLE neuropathy. Specifically, he contends he has pain in his right big toe, foot, and spasms in his calf, buttocks, and right-side tingling. See November 2023 Statement in Support of Claim.

Procedurally, the Veteran filed for service connection in July 2022 for BLE neuropathy which was denied in the November 2022 rating decision. He filed a HLR claim in March 2023 for BLE neuropathy which found there was a duty to assist error and transferred the claim to the Supplemental review for further development in the June 2023 rating decision. In the June 2024 supplemental claim rating decision, the RO found new and relevant evidence had been submitted to readjudicate the Veteran's claim but denied service connection of BLE neuropathy.

In July 2024 the Veteran filed another HLR claim which was denied in the October 2024 rating decision. Therefore, the Board may only consider the evidence of record at the time of the June 2024 AOJ decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303.

As an initial matter the RO in the November 2022 rating decision made a favorable finding that the Veteran had been diagnosed with BLE neuropathy, with complaints of sciatic pain. The June 2023 rating decision made the same favorable finding of a diagnosis of BLE neuropathy, with a complaint of sciatic pain on November 9,
October 2024 rating decision. Therefore, the Board may only consider the evidence of record at the time of the June 2024 AOJ decision, which was subsequently subject to higher-level review, as well as any evidence submitted by the Veteran or representative with, or within 90 days from receipt of, the VA Form 10182. 38 C.F.R. § 20.303.

The June 2024 rating decision made favorable findings of new and relevant evidence having been received and the Veteran had been diagnosed with a disability of BLE neuropathy in the July 20, 2023, VA examination.

However, the October 2024 rating decision overturned the favorable finding of a diagnosed disability in the June 2024 rating decision favorable finding of, "You have been diagnosed with a disability. VA contract exam dated 7/20/2023 shows a diagnosis of bilateral lower extremity neuropathy." This favorable finding was overturned and the RO indicated that they had not found evidence of a diagnosis of BLE neuropathy.

The Board notes that the July 2023 VA examination found no diagnosis of BLE neuropathy.

The RO found that in the October 2024 rating decision that the Veteran did not have a diagnosis of BLE neuropathy and overturned the favorable findings of the Veteran having a diagnosis of BLE neuropathy during the appeal period.

The Board acknowledges that the rating decisions of November 2022 and June 2023 noted a favorable finding of a current diagnosis from VAMC records of November 2021 with reports of sciatic pain. In reviewing these VA treatment records the Veteran only reported sciatic pain and was not diagnosed with BLE neuropathy.

In reviewing the Veteran's private treatment records the Veteran reported right flank pain radiating to his right lower quadrant and was diagnosed with neuropathy in October 2020. In July 2021 in private treatment records, he was also found with neuropathic pain and diagnosed with neuropathy and was using different medications for his neuropathic pain. In August 2022 the Veteran underwent an MRI because of complaints of low back and radiating pain, he was noted with a history of radiculopathy, he was not diagnosed with BLE neuropathy. He was found to have minimal disc bulging and mild bilateral neuroforaminal stenosis in his lumbar. See Medical Treatment Record- Non-Government Facility submitted July 2023.

The Board finds that the Veteran was diagnosed in October 2020 and July 2021 with neuropathy in private treatment records which is over a year prior to the Veteran's original claim of service connection for BLE neuropathy in July 2022. A current disability diagnosed at any point within the appeal period, even if the disability resolves during the appeal period (becomes asymptomatic) may be subject to service connection. See McClain v. Nicholson, 21 Vet. App. 219 (2007). The Court holds that when the record contains a recent diagnosis of disability prior to a veteran filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency. See Romanowsky v. Shinseki, 26. Vet. App. 298 (2013).

The Board finds that during the appeal the Veteran has not been diagnosed with BLE neuropathy. He did not have a current diagnosis of BLE neuropathy during the pendency of the appeal.

The evidence fails to show any findings, complaints, diagnosis, or treatment of BLE neuropathy in his service treatment records.

The Veteran filed for service connection for a low back disability in July 2023 that was denied in a May 2024 rating decision. He filed a HLR request in July 2024 and was denied in the October 2024 rating decision. This issue was appealed in a December 2024 Notice of Disagreement, and he was denied service connection in the October 2025 Board decision. The Veteran does not have a service-connected lumbar spine disability.

The Veteran's back VA examination in April 2024 found he had degenerative disc disease (DDD). His sensory and reflex examinations were both normal.

In July 2023 the Veteran underwent a VA examination for peripheral neuropathy that found the Veteran did not have a diagnosis of BLE neuropathy. The Veteran reported an onset of 1990 with intermittent right lower back and rib pain that radi
2024 rating decision. He filed a HLR request in July 2024 and was denied in the October 2024 rating decision. This issue was appealed in a December 2024 Notice of Disagreement, and he was denied service connection in the October 2025 Board decision. The Veteran does not have a service-connected lumbar spine disability.

The Veteran's back VA examination in April 2024 found he had degenerative disc disease (DDD). His sensory and reflex examinations were both normal.

In July 2023 the Veteran underwent a VA examination for peripheral neuropathy that found the Veteran did not have a diagnosis of BLE neuropathy. The Veteran reported an onset of 1990 with intermittent right lower back and rib pain that radiates across the back and down to the buttock and described muscle fasciculations of the lower right ribs and "lats." The examiner noted a negative MRI and EMG from May 2018, and he was treated with gabapentin with limited benefit, and impacted his job as a law enforcement driving instructor. His sensory and reflex examinations were normal. The examiner found there was no pathology to warrant a diagnosis of neuropathy or radiculopathy after reviewing the diagnostic testing.

The examiner provided a TERA medical opinion that found there was no pathology to warrant a diagnosis or condition that could be related to toxic exposure or the TERA of the Veteran.

By virtue of the Veteran's service at Camp Lejeune during the period of water contamination, he is presumed to have been exposed to contaminated water. 38 C.F.R. §§ 3.307(a)(7). Certain diseases are presumed by VA to be related to exposure to contaminated water at Camp Lejeune; however, the Veteran's claim of BLE neuropathy is not a disability recognized as entitled to presumptive service connection based upon the Veteran's in-service exposure to CLCW under 38 C.F.R. § 3.309(f). As such, the presumption for diseases related to exposure to CLCW is inapplicable.

However, service connection may still be awarded if the evidence shows that a disability is directly related to service. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). However, the threshold question before the Board is whether the Veteran has a current disability.

The Board accords the greatest probative weight to the VA examination report addressed above, dated July 2023. This examiner found that the Veteran does not have a peripheral neuropathy disability, with no lower extremity weakness, reduced reflexes or sensation. The examiner further opined there are no findings, signs or symptoms to support a peripheral neuropathy diagnosis even taking into account the Veteran's lay statements. The Board acknowledges the Veteran's reported symptoms. However, the VA examiner persuasively opined that the Veteran does not have an established lower extremity peripheral neuropathy disability.

The Board is cognizant of the holding in Saunders v. Wilkie, which stated that where pain causes functional impairment, a disability for VA compensation purposes exists, even if there is no underlying diagnosis. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). In sum, pain alone resulting in functional impairment is in fact a disability and should not be summarily discounted as a bar to benefits based on the finding of no current diagnosis.

However, even in light of Saunders, the Veteran still does not have a present disability of bilateral lower extremity neuropathy, as he does not have a diagnosis and the VA examiner found that any pain associated did not result in any functional loss or functional impairment. Based on such evidence, the Board finds this case is distinguished from Saunders, and the Veteran's lay statements of have been considered and his claimed symptoms reported by him affecting his bilateral lower extremities do not result in functional impairment rising to the level of a VA disability for compensation purposes. Indeed, as described above, the medical evidence does not demonstrate the objective evidence of functional impairment required by Saunders. Specifically, it is reiterated that in the July 2023 and April 2023 examinations for the lumbar spine, both of which included detailed and significant testing for neurological abnormalities of the lower extremities, found not impairment of function. Accordingly, the Board determines the Veteran does not have an established current diagnosis of BLE neuropathy, which is a requirement for service connection. See Brammer, 3 Vet. App. at 223.

In sum, the Board determines the Veteran does not have a current disability for BLE neuropathy, and the evidence is persuasively against the claims. As there is not an approximate balance of positive and negative evidence, the benefit-of-the-doubt doctrine is not applicable and service connection for BLE neuropathy is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. §
both of which included detailed and significant testing for neurological abnormalities of the lower extremities, found not impairment of function. Accordingly, the Board determines the Veteran does not have an established current diagnosis of BLE neuropathy, which is a requirement for service connection. See Brammer, 3 Vet. App. at 223.

JONATHAN B. KRAMER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board C. Teich, 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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