EPILEPSY

Summary

The veteran, who served from July 2002 to July 2006, appeals a March 2025 rating decision concerning seizure disorder and dermatitis. The Board granted an increased rating of 20 percent for seizure disorder, effective June 28, 2023, finding that the Veteran experienced minor seizures with a frequency of two or more times within a six-month period, aligning with the criteria for a 20 percent rating. The Board noted the Veteran's intent to file in January 2025, supporting the earlier effective date. The claim for dermatitis, including acne and basal cell carcinoma, was remanded due to a pre-decisional duty to assist error. The VA examiner's opinion on basal cell carcinoma was deemed incomplete as it did not adequately address the Veteran's specific exposures, such as pesticide-treated uniforms, DEET, fuels, industrial pollution, and smoke from oil fires, which were noted in service treatment records. The Board found the Veteran's claim for dermatitis should encompass basal cell carcinoma and acne, as these were mentioned in treatment records and the examiner's report. The case was remanded for a comprehensive addendum opinion addressing the nexus between these conditions and the Veteran's conceded in-service exposures.

Rationale

Competent, consistent lay testimony emphasizing convulsive and post-convulsive characteristics may establish frequency.; Veteran experiences minor seizures two or more times within a six-month period.; Evidence in approximate balance that seizure disorder manifested with blurred vision and twitching consistent with January 2025 VA exam findings.

Full Decision Text

Citation Nr: A26033389
Decision Date: 04/10/26	Archive Date: 04/10/26

DOCKET NO. 250811-579088
DATE: April 10, 2026

ORDER

An increased rating of 20 percent, but no higher, for seizure disorder from June 28, 2023, is granted. 

REMANDED

Entitlement to service connection for dermatitis to include acne and basal cell carcinoma is remanded. 

FINDINGS OF FACT

1. The evidence of record is in approximate balance that the Veteran's seizure disorder manifested with at least two minor seizures within the last six months that had a frequency of between 0-4 times per week. 

2. The Veteran has not had a major seizure within the last 2 years of the applicable appeal period. 

CONCLUSION OF LAW

The criteria for an increased rating of 20 percent but no higher for seizure disorder from June 28, 2023 are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.121, 4.124a Diagnostic Code (DC) 8911.

REASONS AND BASES FOR FINDINGS AND CONCLUSION

The Veteran served on active duty from July 2002 to July 2006. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2025 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). 

In the August 2025 VA Form 10182, Decision Review Request: Board Appeal, the Veteran elected the Direct Review docket.  Based upon the selection of the Direct Review option, the Board may only consider the evidence of record as of 3/17/2025 (seizure disorder) and 10/08/2024 (dermatitis) -the date of the rating decisions on appeal.  See 38 C.F.R. §§ 20.301. If the Veteran submitted evidence that was added to the record after 3/17/2025 (seizure disorder) or 10/08/2024 (dermatitis), the Board did not consider it. If the Veteran wishes to have VA consider any evidence that was not considered, a supplemental claim should be submitted identifying such evidence.  See 38 C.F.R. § 3.2501.

The Board observes that the Veteran listed additional issues in the August 2025 VA Form 10182 Notice of Disagreement. Specifically, he sought to appeal the denial of his claims for service connection for scar of the pilonidal cyst, hearing loss for the right ear, bilateral tinnitus, and dermatitis. However, his claim for entitlement to service connection for pilonidal cyst scar, hearing loss for the right ear, and bilateral tinnitus were already on appeal before the Board. See VA Form 10182 Notice of Disagreement received 6/19/2024. Those claims were adjudicated in an October 2025 Board decision, and are no longer before the Board.  

However, the Board finds that the Veteran's claim for entitlement to service connection for dermatitis, although mentioned in the introduction of the October 2025 Board decision, was not adjudicated since there are no findings of facts or conclusions of law with respect to dermatitis. Further, a reading of the decision does not support the conclusion that the claim was subsumed with his pilonidal cyst scar claim, which was decided. 

Accordingly, the Board finds that the claim for entitlement to service connection for dermatitis is before it since the Veteran's listing of that issue in the August 2025 VA Form 10182 could be interpreted as a timely appeal of the October 2024 rating decision. Therefore, service connection for dermatitis will be adjudicated in this decision.    

An increased rating of 20 percent, but no higher, for seizure disorder from June 28, 2023, is granted. 

The Veteran contends that his seizure disorder which was rated at 10 percent and increased to 20 percent effective January 10, 2025 warrants a higher evaluation and an earlier effective date for the grant of the 20 percent increase rating. See VA Form 10182 Notice of Disagreement received 8/11/2025 at page 1. 

The Veteran was granted service connection for seizure disorder in 2006 at 10 percent disabling. The Veteran filed an intent to file June 28, 2024. Accordingly, the Board finds that because the filing was within a year from the date he filed a VA 21-526 Veterans Application for Compensation in January 2025 seeking an increased rating for his seizure disorder, any increase may go back to
 seizure disorder which was rated at 10 percent and increased to 20 percent effective January 10, 2025 warrants a higher evaluation and an earlier effective date for the grant of the 20 percent increase rating. See VA Form 10182 Notice of Disagreement received 8/11/2025 at page 1. 

The Veteran was granted service connection for seizure disorder in 2006 at 10 percent disabling. The Veteran filed an intent to file June 28, 2024. Accordingly, the Board finds that because the filing was within a year from the date he filed a VA 21-526 Veterans Application for Compensation in January 2025 seeking an increased rating for his seizure disorder, any increase may go back to the date of the intent to file. 

Therefore, the Board finds that appealing the March 2025 rating decision is the most beneficial for the Veteran since the VA examination in January 2025 can be considered and an earlier effective date of June 28, 2024 is possible given his intent to file. 38 C.F.R. §3.155. Alternatively, if the Veteran appealed his October 2024 rating decision, via the Direct Review Lane, the January 2025 VA examination could not be considered, and his claim would be remanded for a pre-decisional duty to assist error which would mean additional delay. Further, the earliest effective date in that scenario would still be June 28, 2024, since that was the date he filed his Supplemental Claim for an increase rating for seizure disorder. Therefore, the entire period from June 28, 2024 is March 31, 2025 may be considered for any increase for his seizure disorder. 

Analysis   

The Veteran is rated 20 percent for generalized epilepsy under 38 C.F.R. § 4.124a, DC 8911.  DC 8911 applies to petit mal epilepsy and provides that the disability is to be rated under the general rating formula for minor seizures.  Note (1) defines a major seizure as one characterized by the generalized tonic-clonic convulsion with unconsciousness.  Note (2) provides that a minor seizure consists of a brief interruption in consciousness or conscious control associated with staring or rhythmic blinking of the eyes or nodding of the head ("pure" petit mal), or sudden jerking movements of the arms, trunk, or head (myoclonic type) or sudden loss of postural control (akinetic type).

Under the General Rating Formula for Major and Minor Epileptic Seizures provides that both the frequency and type of seizures a veteran experiences are considered in determining the appropriate rating, a 10 percent rating is assigned for a confirmed diagnosis of epilepsy with a history of seizures. A 20 percent disability rating is warranted when at least one major seizure occurred in the last two years; or at least two minor seizures occurred in the last six months. A 40 percent disability rating is warranted where at least one major seizure occurred in the last six months or occurred two times in the last year; or there was an average of at least five to eight minor seizures weekly.  A 60 percent disability rating is warranted where there is an average of at least one major seizure in four months over the last year; or nine to ten minor seizures occurred per week.  An 80 percent disability rating is assigned where there is at least one major seizure in three months over the last year; or more than ten minor seizures weekly.  A 100 percent disability rating is warranted where there is an average of at least one major seizure per month over the last year.

Note 1 to the general rating formula provides that when continuous medication is shown necessary for the control of epilepsy, the minimum evaluation will be 10 percent. This rating will not be combined with any other rating for epilepsy.

Note 2 to the general rating formula provides that in the presence of major and minor seizures, the predominating type should be rated.

Note 3 to the general rating formula provides that there will be no distinction between diurnal and nocturnal major seizures. 

Competent, consistent lay testimony emphasizing convulsive and immediate post-convulsive characteristics may be accepted to establish the frequency of seizures or epileptic attacks.  The frequency of seizures should be ascertained under the ordinary conditions of life (while not hospitalized).  38 C.F.R. § 4.121. 

The Veteran received a VA examination in January 2025. The VA examiner confirmed his diagnosis of seizure disorder. The Veteran reported that since its onset in 2004, he has not had a major seizure in a while and stopped taking his medication in 2007. That said, he reported experiencing twitching in his body every couple of months. See C&P Exam received 1/28/2025 at page 1. The Veteran reported his current symptoms as blurriness and twitching.
 may be accepted to establish the frequency of seizures or epileptic attacks.  The frequency of seizures should be ascertained under the ordinary conditions of life (while not hospitalized).  38 C.F.R. § 4.121. 

The Veteran received a VA examination in January 2025. The VA examiner confirmed his diagnosis of seizure disorder. The Veteran reported that since its onset in 2004, he has not had a major seizure in a while and stopped taking his medication in 2007. That said, he reported experiencing twitching in his body every couple of months. See C&P Exam received 1/28/2025 at page 1. The Veteran reported his current symptoms as blurriness and twitching. Id. at page 2. The January 2025 VA examiner found that the Veteran experiences minor seizures that have occurred two or more times within a six-month period, and there frequency is between 0-4 times per week. Id. at page 4. The Veteran had no major seizures within the last two years. The January 2025 VA examiner found no pertinent physical findings or complications and found no minor psychomotor seizures. Accordingly, the Veteran is entitled to a 20 percent rating based upon the finding of 2 minor seizures in the last 6 months. 38 C.F.R. §4.124a, DC 8911. A higher, 40 percent rating is denied since the record does not show, nor has the Veteran alleged experiencing 1 major seizure in the last 6 months, or 2 in the last year, or averaging 5 to 8 minor seizures weekly. 38 C.F.R. §4.124a, DC 8911.  

A review of the Veteran's treatment records shows that the Veteran has been off seizure medication for 20 years, and his providers list his seizures as resolved. See Capri received 9/17/2024 at page 11. That said, the Board finds that the Veteran is competent to report twitching and blurry vision which he experiences two or more times within a six-month period and with a frequency of 0-4 times per week, per the findings of the January 2025 VA examination. Further, the Board has considered the look back period, to see if it was factually ascertainable that the Veteran's reports of blurry vision and twitching began within a year from his date of claim, June 28, 2024. The Board finds that the evidence is in approximate balance that his seizure disorder manifested with blurred vision and twitching as reported in the January 2025 VA examination because a June 2023 Capri treatment note showed a report of twitching and seizure like activity in his arms and legs lasting a few seconds. See Capri received 1/17/2025 at page 112. Since that report is consistent with the report at the January 2025 VA examination, the Board finds that the evidence of record is in approximate balance that the increase in disability was factually ascertainable a year prior to his filing date. See Jackson v. McDonough, 37 Vet. App. 277, 292 (2024) (stating that Congress separated supplemental claims and increased compensation claims for good reason: increased compensation claims allow for a 1-year look back via 38 U.S.C. § 5110(b)(3)). Accordingly, the Board finds that a 20 percent rating but no higher is warranted from June 28, 2023 for seizure disorder is granted. 

REASONS FOR REMAND

Entitlement to service connection for dermatitis to include acne and basal cell carcinoma is remanded. 

The Veteran contends that his military service caused his dermatitis.  In the October 2024 rating decision, the RO made the following favorable findings: that the Veteran participated in a toxic exposure risk activity, that he met the minimum requirements for presumptive service connection, and that his claimed disability, dermatitis, may be presumptively linked to service. See Rating Decision Narrative received 10/08/2024 at page 3. 

Since the Board finds that there was a pre-decisional duty to assist error in not providing a complete medical opinion, a remand is required. 38 C.F.R. § 20.802(a).

The August 2023 VA examiner diagnosed the Veteran with basal cell carcinoma, which was noted as first described in July 2011 as eczematous dermatitis. He was also diagnosed with acne in 2002, which the August 2023 VA examiner found resolved, and pilonidal cyst, which was adjudicated in the October 2025 Board decision. 

At the outset, the Board finds that the Veteran's claim for dermatitis should include basal cell carcinoma since the condition was mistakenly diagnosed as eczema/dermatitis in the Veteran's treatment record in
cisional duty to assist error in not providing a complete medical opinion, a remand is required. 38 C.F.R. § 20.802(a).

The August 2023 VA examiner diagnosed the Veteran with basal cell carcinoma, which was noted as first described in July 2011 as eczematous dermatitis. He was also diagnosed with acne in 2002, which the August 2023 VA examiner found resolved, and pilonidal cyst, which was adjudicated in the October 2025 Board decision. 

At the outset, the Board finds that the Veteran's claim for dermatitis should include basal cell carcinoma since the condition was mistakenly diagnosed as eczema/dermatitis in the Veteran's treatment record in 2011 and it is reasonable to assume he intended to claim this condition as well when he filed for entitlement to service connection for dermatitis. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). Additionally, the Veteran's claim should also address acne since the August 2023 VA examiner diagnosed that condition though she stated it had resolved at the time of the VA examination. Accordingly, the Board finds that the Veteran's claim should read: entitlement to service connection for dermatitis to include acne and basal cell carcinoma. 

Although the August 2023 VA examiner opined that basal cell carcinoma was not related to military service, the Board finds that the opinion is incomplete since it did not adequately address the Veteran's exposures and whether his basal cell carcinoma is at least as likely as not related to those exposures. Here, the Veteran served in the Southwest Asia Theater of Operations and was exposed to pesticide treated uniforms, DEET insect repellent, JPS and other fuels, industrial pollution, smoke from oil fire, and sand/dust. See Medical Treatment Record received 8/28/2004 at page 65; see also STR-Medical received 7/25/2023 at page 57. Since the August 2023 VA examiner did not address each of those exposures but instead made a general statement that his exposures would not "be expected to cause, contribute to or aggravate the development of basal cell carcinoma" without going into the listed exposures, the Board finds the opinion is incomplete.  

This matter is REMANDED for the following action:

1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's dermatitis to include acne and basal cell carcinoma is at least as likely as not related to service to include conceded in-service exposures. The VA examiner is asked to opine and discuss the Veteran's exposures listed in his STRs: pesticide treated uniforms, DEET insect repellent, JPS and other fuels, industrial pollution, smoke from oil fire, and sand/dust. See Medical Treatment Record received 8/28/2004 at page 65; see also STR-Medical received 7/25/2023 at page 57.

2. If deemed necessary to provide the medical opinion, schedule the Veteran for a Gulf War examination to determine the nature and etiology of diagnosed acne and basal cell carcinoma. The examiner must review the entire claims file, including a copy of this remand.

The examiner is asked to provide responses to the following:

A)	Is the etiology of the Veteran's acne and basal cell carcinoma (1) inconclusive, (2) partially understood, or (3) fully understood?

This determination must be based on the Veteran's specific case and cannot be based on the etiology of the disease or disability population as a whole.

B)	Is the pathophysiology of the Veteran's acne and basal cell carcinoma (1) inconclusive, (2) partially understood, or (3) fully understood?

This determination must be based on the Veteran's specific case and cannot be based on the pathophysiology of the disease or disability population as a whole.

C)	If both the etiology and pathophysiology are partially understood or fully understood, then is it at least as likely as not (a 50 percent or greater probability) that the Veteran's [insert diagnosis] was incurred in, or is otherwise related to, active service?

A comprehensive rationale for all opinions is to be provided.  All pertinent evidence, including both lay and medical, should be considered.  If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training).

 

 

CHRISTOPHER A. WENDELL

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	S. Dixon

The Board's decision in this case is binding only with respect to the instant matter decided