SHOULDER IMPAIRMENT OF

B. D. WATSON · 2026 · Case ID: A26034608

DENIED

Summary

The veteran, who served in the U.S. Army from December 1990 to May 1991, appeals the denial of service connection for several conditions. The Board denied entitlement to service connection for left shoulder rotator cuff tendinosis, finding that while the veteran received treatment for left shoulder pain in service, the condition was not severe and did not persist to a compensable degree. The Board found the private medical opinion inadequate for failing to address intervening causes and lack of continuity, while the VA examiner's opinion, finding the condition less likely than not related to service, was deemed persuasive. The Board also denied service connection for bilateral restless leg syndrome, noting the absence of objective evidence in service treatment records or post-service records, and found the private opinion inadequate for failing to provide a diagnosis or address medical literature. The VA examiner found no objective evidence of RLS. Service connection for chronic fatigue syndrome (CFS) as due to an undiagnosed illness was denied, as the Board found no competent evidence of CFS, with the first diagnosis occurring 28 years after service, and the VA examiner's opinion that the veteran did not meet CFS criteria was found persuasive. Finally, the Board denied a compensable rating for dermatophytosis tina pedis with dermatographism, finding the evidence weighed against a compensable rating as the condition required only topical therapy and affected less than 5% of the body or exposed areas.

Rationale

Service treatment records showed treatment for acute left shoulder pain, but it was resolving.; Post-service records showed normal x-rays in 1994, with tendinosis and partial tearing noted in 2020.; Private opinion found condition as likely as not related to service, but was deemed inadequate by the Board for not addressing intervening causes or lack of continuity.; VA examiner opined condition was less likely than not incurred in or caused by service, finding it more likely due to intervening causes like nursing and mothering duties.; Board found VA opinion persuasive and evidence weighed against service connection.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250430-540061

Full Decision Text

Citation Nr: A26034608
Decision Date: 04/14/26 Archive Date: 04/14/26

DOCKET NO. 250430-540061
DATE: April 14, 2026

ORDER

Entitlement to service connection for left shoulder rotator cuff tendinosis (previously rated as left shoulder condition) is denied.

Entitlement to service connection for left lower extremity restless leg syndrome is denied.

Entitlement to service connection for right lower extremity restless leg syndrome is denied.

Entitlement to service connection for chronic fatigue syndrome (CFS) as due to an undiagnosed illness is denied.

Entitlement to a compensable rating for dermatophytosis tina pedis with dermatographism (claimed as dermatosis: neck, face, ears, feet) is denied.

FINDINGS OF FACT

1. The evidence persuasively weighs against a finding that the Veteran's shoulder rotator cuff tendinosis (previously rated as left shoulder condition) began during active service or within one year of service, or is otherwise related to an in-service injury, event, or disease.

2. The evidence persuasively weighs against a finding that the Veteran's left lower extremity restless leg syndrome began during active service or within one year of service, or is otherwise related to an in-service injury, event, or disease.

3. The evidence persuasively weighs against a finding that the Veteran's right lower extremity restless leg syndrome began during active service or within one year of service, or is otherwise related to an in-service injury, event, or disease.

4. Chronic fatigue syndrome as due to an undiagnosed illness is not indicated by the record.

5. The Veteran's dermatophytosis tina pedis with dermatographism (claimed as dermatosis: neck, face, ears, feet) has not required more than topical therapy over the relevant 12-month period and has not resulted in characteristic lesions involving more than 5 percent of either the entire body affected or the exposed area affected.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for left shoulder rotator cuff tendinosis (previously rated as left shoulder condition) have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for entitlement to service connection for left lower extremity restless leg syndrome have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for entitlement to service connection for right lower extremity restless leg syndrome have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for entitlement to service connection for chronic fatigue syndrome (CFS) as due to an undiagnosed illness have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.317.

5. The criteria for entitlement to a compensable rating for dermatophytosis tina pedis with dermatographism (claimed as dermatosis: neck, face, ears, feet) have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7813.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from December 1990 to May 1991.

The case comes before the Board of Veterans' Appeals (Board) on appeal from a March 2025 rating decision issued by a Department of Veterans Affairs (VA) Regional Office, the agency of original jurisdiction (AOJ).

In the April 2025 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 March 2025 AOJ decision on appeal, 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 on appeal 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,
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 March 2025 AOJ decision on appeal, 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 on appeal 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 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.

Service Connection???

Service connection may be granted for a disability resulting from disease or injury. Service connection will be granted if the evidence?demonstrates?that a current disability resulted from an injury or disease incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a).?????

Establishing service connection?generally requires?competent evidence of three things: (1) 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 injury or disease diagnosed after discharge when all the evidence, including that pertinent to service,?establishes?that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d).

In addition, under 38 U.S.C. § 1117(a)(1), compensation is warranted for a Persian Gulf Veteran who exhibits objective indications of a "qualifying chronic disability" that became manifest during service on active duty in the Armed Forces in the Southwest Asia theater of operations during the Persian Gulf War or following such service. See 38 C.F.R. § 3.317(a)(1)(i). A "qualifying chronic disability" may include (a) undiagnosed illness, (b) a medically unexplained chronic multi-symptom illness (MUCMI), to include chronic fatigue syndrome, fibromyalgia, and irritable bowel syndrome, that is defined by a cluster of signs or symptoms, or (c) any diagnosed illness that the Secretary determines, in regulations, warrants a presumption of service connection. 38 U.S.C. § 1117(a)(2).

For VA purposes, the diagnosis of chronic fatigue syndrome requires: (a) new onset of debilitating fatigue severe enough to reduce daily activity to less than 50 percent of the usual level for at least 6 months; (b) the exclusion, by history, physical examination, and laboratory tests, of all other clinical conditions that may produce similar symptoms; and (c) six or more of the following: (1) acute onset of the condition; (2) low grade fever; (3) non-exudative pharyngitis; (4) palpable or tender cervical or axillary lymph nodes; (5) generalized muscle aches or weakness; (6) fatigue lasting 24 hours or longer after exercise; (7) headaches (of a type, severity or pattern that is different from headaches in the pre-morbid state); (8) migratory joint pains; (9) neuropsychological symptoms; or (10) sleep disturbance. 38 C.F.R. § 4.88(a). ?????

The Board must analyze the credibility and probative value of the evidence, account for the evidence that it finds persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant.?Kahana v. Shinseki, 24?Vet. App.?428, 433 (2011). This includes weighing the credibility and probative value of lay evidence against the remaining evidence of record.?See King v. Shin
a type, severity or pattern that is different from headaches in the pre-morbid state); (8) migratory joint pains; (9) neuropsychological symptoms; or (10) sleep disturbance. 38 C.F.R. § 4.88(a). ?????

The Board must analyze the credibility and probative value of the evidence, account for the evidence that it finds persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant.?Kahana v. Shinseki, 24?Vet. App.?428, 433 (2011). This includes weighing the credibility and probative value of lay evidence against the remaining evidence of record.?See King v. Shinseki, 700 F.3d 1339 (Fed. Cir. 2012);?Kahana, 24 Vet. App. at 433-34.?????

The Veteran is competent to report symptoms experienced.?See?Layno?v. Brown, 6 Vet. App. 465, 469 (1994). However, he is not considered competent to medically attribute such symptoms to any?particular disability?because such is a complicated medical issue that requires medical knowledge and?expertise?that the Veteran has not been shown to?possess.?See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011);?Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (2006).????

A claimant bears the evidentiary burden to?establish?all elements of a service connection claim, including the nexus requirement.?Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009). A Veteran is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to a claim. If the evidence persuasively favors one side or the other, there is not an approximate balance, and the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107; 38 C.F.R. § 3.102;?Lynch v. McDonough, 21 F.4th?776 (2021).?

1. Entitlement to service connection for left shoulder rotator cuff tendinosis (previously rated as left shoulder condition) is denied.

The Veteran asserts that she is entitled to service connection for a left shoulder condition.

As a matter of background, the AOJ initially denied service connection for a left shoulder condition in December 1994. In June 2024, the Veteran filed a VA Form 21-526EZ, Fully Developed Claim (Compensation), and service connection was again denied in the March 2025 rating decision on appeal.

The Board is bound by previous favorable findings, and the June 2025 rating decision found that the Veteran has been diagnosed with left shoulder rotator cuff tendinosis and that a qualifying event, injury, or disease had its onset during the Veteran's service. Specifically, the Veteran's service treatment records (STRs) show treatment for acute left shoulder pain.

However, as outlined below, the evidence persuasively weighs against a finding that the Veteran has left shoulder rotator cuff tendinosis that is related to her service. As such, service connection cannot be established.

Although the Veteran was treated for left shoulder pain while in service, an April 1991 treatment note indicates that her left shoulder pain was resolving.

Post-service treatment records include complaints of left shoulder pain and a diagnosis of degenerative joint disease (DJD) in April 1994. Despite this, the Veteran had normal x-rays of the left shoulder in April 1994 and August 1994. Years later, a November 2019 x-ray showed minor degenerative changes and a January 2020 MRI showed tendinosis and partial tearing of the left shoulder.

In April 2024, private clinician M.T., DC examined the Veteran and diagnosed her with pain of the left shoulder. Dr. M.T. wrote that the Veteran's condition has persisted since active military service and that it is as likely as not that the condition is directly and causally related to her military service.

The Veteran was afforded a VA examination for Shoulder and Arm Conditions in March 2025. At that time, the Veteran reported that she had left shoulder pain intermittently over the years after her deployment to Saudi Arabia in 1991. She added that she could "go one and a half years without a problem with the left shoulder and then it would hurt again." According to the Veteran, her shoulder pain became significantly worse and constant in 2020 and again in 2023.

After interviewing the Veteran and reviewing the record, the
the left shoulder. Dr. M.T. wrote that the Veteran's condition has persisted since active military service and that it is as likely as not that the condition is directly and causally related to her military service.

After interviewing the Veteran and reviewing the record, the examiner opined that the Veteran's left shoulder condition was less likely than not incurred in or caused by the complaints of left should pain during service. The examiner noted that between 1993 and 2009, the Veteran worked as a nursing assistant and licensed practical nurse, and she also raised two children. The examiner also wrote that there was no notation of any left shoulder pain or problem when the Veteran established care with the Gulf Coast VA in June 2009.

According to the examiner, the Veteran's initial left shoulder injury in 1991 was not severe and she did not seek treatment for left shoulder pain until 1994 and then in 2019. Based on the medical records, radiologic studies, and the Veteran's lay statements, the examiner concluded that it is more likely that the Veteran had an acute, mild left shoulder injury which recovered, and she later developed rotator cuff tendinosis over the years due to her duties as a nurse and mother.

Based on the foregoing, the record lacks persuasive evidence that the Veteran's current left shoulder condition manifested in service or to a compensable degree in the first year following her separation from service. Besides the Veteran's DJD diagnosis and normal imaging in 1994, there is no other evidence of shoulder problems until 2019. Consequently, service connection for a left shoulder condition on the basis that such became manifest in service and persisted, or on a presumptive basis (as a chronic disease under 38 U.S.C. § 1112 or an undiagnosed illness and medically unexplained chronic multi-symptom illness under 38 C.F.R. § 3.317), is not warranted.

The Board has considered the evidence above and finds the opinion from Dr. M.T. inadequate. Dr. M.T. wrote that the Veteran's condition has persisted since military service; this opinion does not discuss the lack of evidence of shoulder complaints between 1991 and 1994 and between 1994 and 2019. Moreover, Dr. M.T.'s opinion does not consider any intervening causes of the Veteran's left shoulder pain.

The only competent evidence in the record that addresses the question of service connection is the March 2025 VA medical opinion which states that the Veteran's left shoulder condition is not related to service. As this opinion was based on a full review of the record as well as an interview and examination of the Veteran, the Board finds it persuasive.

Further, the Veteran's own statements relating her left shoulder condition to service are not competent evidence, as she is a layperson and lacks the training to provide an adequate opinion regarding medical etiology. Specifically, the Veteran lacks the training to opine whether her left should condition, in the absence of credible evidence of continuity, as here, is related to an incident in service. ?See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board rather than a legal issue to be addressed by the Veterans Court.)?Also, the record does not show that the Veteran has training or education in musculoskeletal conditions or the?medical field. Therefore,?lay evidence of the etiology is not competent nexus evidence as it is not capable of lay observation.?See Barr v. Nicholson, 21?Vet. App.?303, 307-08 (2007);?Layno?v. Brown, 6?Vet. App.?465,469-70. Thus, the Veteran is not competent or qualified, as a layperson, to?render?an opinion on medical causation.??

In light of the foregoing, the Board concludes that the evidence persuasively weighs against the Veteran's claim of entitlement to service connection for a left shoulder condition. Accordingly, it must be denied.

2. Entitlement to service connection for left lower extremity restless leg syndrome is denied.

3. Entitlement to service connection for right lower extremity restless leg syndrome is denied.

The Veteran contends that she is entitled to service connection for restless leg syndrome of the left and right
-08 (2007);?Layno?v. Brown, 6?Vet. App.?465,469-70. Thus, the Veteran is not competent or qualified, as a layperson, to?render?an opinion on medical causation.??

2. Entitlement to service connection for left lower extremity restless leg syndrome is denied.

3. Entitlement to service connection for right lower extremity restless leg syndrome is denied.

The Veteran contends that she is entitled to service connection for restless leg syndrome of the left and right lower extremities.

STRs are silent with regard to any complaints, treatment, or diagnoses of restless leg syndrome.

Similarly, post-service treatment records lack any evidence of restless leg syndrome, including complaints of numbness or tingling in the Veteran's lower extremities. In September 2024, the Veteran told Dr. M.T. that she has suffered with restless leg syndrome (RLS) in the bilateral legs since her Gulf War service. Dr. M.T. then diagnosed the Veteran with RLS and opined that it is as likely as not that it is directly and causally related to her military service.

In November 2024, the Veteran underwent a VA examination for Peripheral Nerves Conditions. During the interview, the Veteran stated that she had been told she probably has RLS, but she was unable to recall who told her, when, and where they told her. After interviewing the Veteran and reviewing the record, the examiner noted that there was no objective evidence of RLS on exam and there was no objective confirmation of RLS found in the file. Accordingly, the examiner concluded that the Veteran does not have a peripheral nerve condition or peripheral neuropathy.

After considering the above, the Board finds the April 2024 opinion of Dr. M.T. to be inadequate. Dr. M.T. failed to describe how she determined that the Veteran had a current diagnosis of restless leg syndrome. While the Veteran is competent to report symptoms experienced and any diagnoses she has received from medical professionals, she is not competent to essentially provide a self-diagnosis of restless leg syndrome. The exam report does not indicate that Dr. M.T. examined the Veteran, and she did not address the Veteran's medical records or any relevant medical literature in order to support a diagnosis.

Accordingly, the Board finds the February 2025 VA examination to be of great probative value as it is consistent with the objective evidence of record.

Overall, the persuasive weight of the evidence is against finding that the Veteran has a diagnosis of restless leg syndrome that is related to her service.

The Board has considered the Veteran's lay statements but notes that the Veteran is not competent to provide a diagnosis in this case. The issue is medically complex and requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n. 4 (Fed. Cir. 2007). Consequently, the Board gives no probative weight to the Veteran's statements that she has restless leg syndrome.

Therefore, for the reasons discussed above, the Board finds that the evidence of record fails to establish that the Veteran has been diagnosed with restless leg syndrome at any point during the appeal period. As such, the criteria for service connection are not met. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3, Gilbert v. Derwinski, 1?Vet. App.?49, 53-56 (1990). Entitlement to service connection for left and right lower extremity restless leg syndrome is denied.

4. Entitlement to service connection for chronic fatigue syndrome (CFS) as due to an undiagnosed illness is denied.

The Veteran asserts that she is entitled to service connection for CFS as due to an undiagnosed illness. Specifically, the Veteran claims that she has been tired all the time since 1994. See November 2024 CFS VA Examination.

In the March 2025 rating decision, the AOJ found favorably that the Veteran performed service in the Gulf War/Southwest Asia, that she participated in a toxic exposure risk activity (TERA), and that her claimed disability is a chronic disease which may be presumptively linked to her military service under 38 C.F.R. § 3.317. Accordingly, it is undisputed that the Veteran is a "Persian Gulf" Veteran within the meaning of § 3.317.

However, the evidence persuasively weighs against a finding that the Veteran has been diagnosed with chronic fatigue syndrome, a qualifying chronic disability under 38 U.S.C. § 1117(a
November 2024 CFS VA Examination.

According to STRs, the only time the Veteran complained of fatigue during her active duty service was in April 1991. At that time, she attributed her fatigue to medication she was taking.

Post-service records show that the Veteran complained of fatigue in July/August 1994, September 1997, June 2009, and November 2001. In 1997, the Veteran also reported that she sleeps for 3 or 4 hours per night and experiences night sweats and racing thoughts. She also identified work and family stressors. The Veteran was later diagnosed with fatigue in October 2019.

During a private consultation and examination in April 2024, the Veteran stated that she has suffered with CFS since active duty. The examiner, M.T., DC, diagnosed the Veteran with CFS and opined that it is as likely as not that the Veteran's CFS is directly and causally related to the Veteran's military service and to Gulf War Syndrome per the provisions published in Gulf War Winter 2016.

The Veteran underwent a VA examination in November 2024, in which the examiner found no objective evidence of CFS. The examiner noted that the Veteran's hypothyroidism and anxiety/depression may produce similar symptoms and found that the Veteran does not have and has not had any findings, signs, and symptoms attributable to CFS. Ultimately, the examiner opined that the Veteran does not meet the criteria for a diagnosis of CFS.

Based on the foregoing, there is no evidence that the Veteran's fatigue manifested in service or to a compensable degree in the first year following her separation from service. According to the record, the first diagnosis of fatigue occurred in 2019, approximately 28 years after separation from service. Consequently, service connection for fatigue on the basis that such became manifest in service and persisted, or on a presumptive basis (as a chronic disease under 38 U.S.C. § 3.317), is not warranted.

There is also no competent evidence that the Veteran's fatigue is otherwise related to service. The Board finds the April 2024 opinion of Dr. M.T. to be inadequate. Dr. M.T. failed to describe how she determined that the Veteran had a current diagnosis of CFS. While the Veteran is competent to report symptoms experienced and any diagnoses she has received from medical professionals, she is not competent to essentially provide a self-diagnosis of CFS. The exam report does not indicate that Dr. M.T. examined the Veteran, and she did not address the Veteran's medical records or any relevant medical literature in order to support a diagnosis.

The record does not reflect that the Veteran has a "qualifying chronic disability," to include an undiagnosed illness or medically unexplained chronic multi-symptom illness that is defined by a cluster of signs or symptoms, manifested by constant fatigue pursuant to 38 C.F.R. § 3.317.

The only competent evidence in the record is the November 2024 VA medical opinion which stated that the Veteran does not meet the criteria for a diagnosis of CFS. As the opinion was based on a full review of the record, VA regulations, and an interview and examination of the Veteran, the Board finds it persuasive.

Furthermore, the Veteran's own statements relating her fatigue to service are not competent medical evidence, as she is a layperson and lacks the training to provide an adequate opinion regarding medical etiology. Specifically, the Veteran lacks the training to opine whether CFS, in the absence of credible evidence of continuity, as here, is related to an incident in service. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board rather than a legal issue to be addressed by the Veterans Court. Also, the record does not show that the Veteran has training or education in the medical field. Therefore, lay evidence of the etiology is not competent nexus evidence as it is not
is a layperson and lacks the training to provide an adequate opinion regarding medical etiology. Specifically, the Veteran lacks the training to opine whether CFS, in the absence of credible evidence of continuity, as here, is related to an incident in service. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board rather than a legal issue to be addressed by the Veterans Court. Also, the record does not show that the Veteran has training or education in the medical field. Therefore, lay evidence of the etiology is not competent nexus evidence as it is not capable of lay observation. See Barr v. Nicholson, 21?Vet. App.?303, 307-08 (2007); Layno v. Brown, 6?Vet. App.?465,469-70. Thus, the Veteran is not competent or qualified, as a layperson, to render an opinion on medical causation.??

In light of the above, the Board concludes that the evidence persuasively weighs against the Veteran's claim of entitlement to service connection for CFS as due to an undiagnosed illness. Accordingly, it must be denied.

5. Entitlement to a compensable rating for dermatophytosis tina pedis with dermatographism (claimed as dermatosis: neck, face, ears, feet) is denied.

In the March 2025 rating decision on appeal, the AOJ granted service connection for dermatophytosis tina pedis with dermatographism (claimed as dermatosis: neck, face, ears, feet) and assigned an evaluation of 0 percent under Diagnostic Code 7813, effective July 6, 2023. The Veteran asserts that she is entitled to a compensable rating. See April 2025 Notice of Disagreement.

Disability evaluations are?determined?by the application of the facts presented to the VA's Schedule for Rating Disabilities (Rating Schedule) at?38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably?determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155;?38 C.F.R. § 4.1.?

Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria?required?for that evaluation.?Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Reasonable doubt as to the degree of disability will be resolved in the Veteran's favor. 38 C.F.R. § 4.3.?

Where an increase in the level of a disability is at issue, the primary concern is the present level of disability. ?Francisco v. Brown,?7?Vet. App.?55?(1994). ?Where the evidence?contains?factual findings that?demonstrate?distinct time periods in which the service-connected disability?exhibits?symptoms that would?warrant?different evaluations?during the course of?the appeal, the assignment of staged ratings is?appropriate.?See?Fenderson v. West, 12 Vet. App. (1999);?Hart v. Mansfield, 21 Vet. App. (2007).?

In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined?in accordance with?38 C.F.R. § 4.25. ?Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a Veteran's service-connected disabilities. ?38 C.F.R. § 4.14.

The 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), 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.

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).

The Veteran underwent a VA Examination for Skin Diseases in November 2024. At that time, she reported no current symptoms except the presence of a dry, pink, scaly patch on her left foot which she described as "mild" with slight itching. The examiner noted that the Veteran has been treated with medication in the past 12 months; specifically, she has used topical corticosteroids or other immunosuppressive medications for less than 6 weeks.

Upon physical examination, the examiner noted tinea pedis left foot at margin of arch impacting less than 5 percent of the total body area and none of the exposed area. They noted that the Veteran had a skin condition currently without any visible characteristic lesions at the time of the examination. There were no benign or malignant neoplasms or metastases related to the Veteran's skin condition nor did it cause scarring or disfigurement of the head, face, or neck.

Accordingly, the Board finds that the evidence of record persuasively weighs against the assignment of a compensable rating because the Veteran's skin condition has required 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.

The Board acknowledges that the Veteran believes that her skin condition has been more severe than the assigned disability rating reflects. Moreover, the Veteran is competent to report observable symptoms, to include intermittent rashes. These reports are credible; however, the record does not show that the Veteran's skin condition more nearly approximates the criteria of a compensable rating. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).

Additionally, 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 Veteran's skin condition would warrant a higher rating under a different diagnostic code. See 38 C.F
Veteran believes that her skin condition has been more severe than the assigned disability rating reflects. Moreover, the Veteran is competent to report observable symptoms, to include intermittent rashes. These reports are credible; however, the record does not show that the Veteran's skin condition more nearly approximates the criteria of a compensable rating. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007).

In conclusion, the Board finds that the evidence of record persuasively weighs against the Veteran's claim for a compensable rating for dermatophytosis tina pedis with dermatographism (claimed as dermatosis: neck, face, ears, feet). As the evidence of record persuasively weighs against a compensable rating, the benefit-of-the-doubt rule does not apply and the claim is denied. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

B. D. WATSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Klu, E. S.

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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