SCARS DISFIGURING

MICHAEL MARTIN · 2026 · Case ID: A26036694

MIXED

Summary

The veteran, who served from November 2012 to March 2014 and May 2014 to May 2020, appeals the denial of service connection for facial or neck scars and headaches. The Board denied the claims for scars, finding no current disability and that the evidence weighed against the claim, as service treatment records did not confirm scars and a VA examiner found none visualized. For headaches, the Board acknowledged the Veteran's reported headaches during service but found the evidence weighed against a service connection, noting the VA examiner's opinion that current headaches were less likely than not related to service due to a lack of chronicity in service treatment records. The Board denied these claims, stating the evidence did not support a finding of service connection and did not warrant application of the benefit of the doubt. The Board remanded claims for erectile dysfunction, insomnia (as an acquired psychiatric disability), obstructive sleep apnea, IBS, urinary frequency, left ankle disability, and right hip disability. These remands were primarily due to inadequate VA medical opinions that failed to address the Veteran's contentions, provide sufficient rationale, or consider all relevant evidence, necessitating further development and addendum opinions.

Rationale

No current disability confirmed by service treatment records or VA exam; VA examiner found no visible scars; Evidence weighs against claim, not in approximate balance

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250902-582891

Full Decision Text

Citation Nr: A26036694
Decision Date: 04/21/26 Archive Date: 04/21/26

DOCKET NO. 250902-582891
DATE: April 21, 2026

ORDER

Entitlement to service connection for facial or neck scars is denied.

Entitlement to service connection for headaches is denied.

REMANDED

Entitlement to service connection for erectile dysfunction is remanded.

Entitlement to service connection for an acquired psychiatric disability, claimed as insomnia, is remanded.

Entitlement to service connection for obstructive sleep apnea is remanded.

Entitlement to service connection for a digestive disability, claimed as irritable bowel syndrome (IBS), is remanded.

Entitlement to service connection for a urinary disability, claimed as urinary frequency, is remanded.

Entitlement to service connection for a left ankle disability is remanded.

Entitlement to service connection for a right hip disability is remanded.

FINDINGS OF FACT

1. The evidence for consideration persuasively weighs against finding that the Veteran has had the claimed facial or neck scars at any time during or proximate to the pendency of the claim.

2. The evidence for consideration persuasively weighs against finding that the Veteran's current unspecified headaches began during active service, or are otherwise related to an in-service event, injury, or disease.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for facial or neck scars have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303.

2. The criteria for entitlement to service connection for headaches have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from November 2012 to March 2014 and from May 2014 to May 2020.

The rating decisions on appeal were issued in March 2025 and April 2025. They constitute initial decisions.

In his September 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), for this appeal, the Veteran elected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the March 2025 and April 2025 Regional Office (RO) decisions on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the RO decisions on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

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

Regarding the issues remanded herein, any evidence the Board could not consider will be considered by the RO in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

The September 2025 VA Form 10182 for this appeal identifies a June 2022 rating decision as the decision being appealed for the claim for entitlement to service connection for obstructive sleep apnea. That VA Form 10182 is not a timely appeal of the June 2022 rating decision. See 38 C.F.R. § 20.203(b). However, the Board has accepted the VA Form 10182 as a timely appeal of the denial of the claim in the March 2025 rating decision.

Finally, the September 2025 VA Form 10182 for this appeal also attempts to appeal an August 2024 rating decision's denial of the claim for entitlement to service connection for left knee instability. That VA Form 10182 is not a timely appeal of the August 2024 rating decision, and there is no RO decision issued during the one-year period prior to receipt of the VA Form 10182 that decided that issue. Therefore, the issue has not properly been appealed to the Board, and the Board has not included it in this appeal.

The Board has limited the discussion below to the relevant evidence required to support its findings of fact and
timely appeal of the denial of the claim in the March 2025 rating decision.

The Board has limited the discussion below to the relevant evidence required to support its findings of fact and conclusions of law, as well as to address any specific contentions regarding the case as raised directly by the Veteran or reasonably raised by the record. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Robinson v. Peake, 21 Vet. App. 545, 552 (2008). The Veteran should not assume that evidence that is not explicitly discussed in the decision has been overlooked. See Timberlake v. Gober, 14 Vet. App. 122 (2000) (noting that the law requires only that reasons for rejecting evidence favorable to the claimant be addressed).

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

The existence of a current disability is the cornerstone of a claim for VA disability compensation. 38 U.S.C. § 1110; see Degmetich v. Brown, 104 F.3d 1328, 1332 (1997) (holding that interpretation of 38 C.F.R. § 1110 as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary). In the absence of proof of a present disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

1. Entitlement to service connection for facial or neck scars

The Veteran seeks to be service connected for facial or neck scars. In a November 2024 statement, he asserts that the claimed scars "are directly related to my active duty military service." He attributes the claimed neck scars to an in-service surgery to remove a cyst and says that the "scar is still visible and it's embarrassing when people look at it." He also says, "I also have scars on my head, specifically on my face, neck and scalp. The scars on my face are flat and lighter than the rest of my skin." He does not explain why he believes the claimed scars on his face and scalp are related to his active service.

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The Board concludes that the Veteran does not have a current disability of facial or neck scars and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

The service treatment records show that in December 2014 the Veteran reported a 3-year history of a cyst on the left side of his neck and that he desired to have the cyst removed. On examination, the Veteran had a compressible nodule on the left neck that was about 1.3 centimeters in diameter. He was assessed with dermoid cyst of the skin and referred for an evaluation for excision of the cyst. In January 2015, the cyst was addressed through administration of a Kenalog injection. There are no further medical treatment records showing treatment for the cyst through further injections or through surgery, and there are no medical treatment records that mention a left neck scar relating to the in-service cyst. There are also no medical treatment records mentioning scars of the face or scalp during service, or documenting in
a cyst on the left side of his neck and that he desired to have the cyst removed. On examination, the Veteran had a compressible nodule on the left neck that was about 1.3 centimeters in diameter. He was assessed with dermoid cyst of the skin and referred for an evaluation for excision of the cyst. In January 2015, the cyst was addressed through administration of a Kenalog injection. There are no further medical treatment records showing treatment for the cyst through further injections or through surgery, and there are no medical treatment records that mention a left neck scar relating to the in-service cyst. There are also no medical treatment records mentioning scars of the face or scalp during service, or documenting in-service injuries or diseases that may have caused such scars.

The Veteran was afforded a VA scars/disfigurement examination in March 2025. On examination, the VA examiner found that no scars could be visualized. The examiner therefore determined that no diagnosis of a current scar condition was warranted. Accordingly, the VA examination does not show that the Veteran had a current disability of a neck or facial scar during the pendency of the claim.

The Board acknowledges the Veteran's reports of facial and neck scars. As discussed above, the service treatment records confirm that he had a left neck cyst that was addressed through a Kenalog injection during his active service. Although he is competent to report conditions that are observable through the senses, such as scars, see Layno v. Brown, 6 Vet. App. 465, 469 (1994), the medical treatment records do not confirm that he had the claimed neck and facial scars during or in proximity to the review period. Moreover, the VA examiner determined that no such scars could be visualized on examination. The Board finds the examiner's determination in that regard to the be probative because the examiner based it on an in-person examination of the Veteran. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Prejean v. West, 13 Vet. App. 444 (2000). Thus, the VA examiner's probative findings contradict the Veteran's reports. The Board attributes greater weight to the medical treatment records and to the examiner's findings than to the Veteran's reports because the examiner interviewed the Veteran and thoroughly examined him to determine whether he had the claimed facial and neck scars. See Caluza v. Brown, 7 Vet. App. 498 (1995); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (lack of contemporaneous medical evidence does not, in and of itself, render lay evidence not credible, but may be considered in conjunction with other factors).

In view of the foregoing, the Board finds that the evidence for consideration persuasively weighs against finding that the Veteran has had the claimed facial or neck scars at any time during or proximate to the pendency of the claim. As stated above, in the absence of proof of a current disability, there can be no valid claim for service connection. Brammer, 3 Vet. App. at 225. Accordingly, without evidence of current neck or facial scars, the Board need not address the other elements of service connection. Consequently, the Board concludes that the evidence for and against the claim is not in approximate balance, but rather weighs against the claim. Because there is not an approximate balance in the weight of the evidence, the doctrine of reasonable doubt is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); Lynch v. McDonough, 999 F.3d. 1391 (Fed. Cir. 2021).

2. Entitlement to service connection for headaches

The Veteran seeks to be service connected for headaches. He told a March 2025 VA headaches examiner that his headaches began in 2014 and that they had a gradual onset and progression with sharp and dull left temple headache and yawning. In the September 2025 VA Form 10182 for this appeal, he stated, "I am experiencing more frequent and worse headaches."

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The Board concludes that, although the Veteran has a current diagnosis of unspecified headaches, and evidence shows that he reported headaches at times during his active service, the evidence for consideration persuasively weighs against finding that the Veteran's current unspecified headaches began during service or are otherwise related to an in-service event, injury, or disease.

The service treatment records show that the Veteran reported headaches at times during his active service, to
In the September 2025 VA Form 10182 for this appeal, he stated, "I am experiencing more frequent and worse headaches."

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The service treatment records show that the Veteran reported headaches at times during his active service, to include in October 2015 when he reported a slight headache in conjunction with frequent vomiting, in November 2016 when he reported headache in conjunction with frequent coughing, and in April 2019 when he reported headache in conjunction with sinus pressure. They also show that he denied current headaches at many treatment visits, and did not report headaches at his several periodic health assessments, to include a May 2020 periodic health assessment conducted just prior to his separation from active service.

The March 2025 VA examiner diagnosed the Veteran with unspecified headaches and opined that the unspecified headaches were less likely than not incurred in service or caused by an in-service event, injury, or illness. As a rationale for that opinion, the examiner explained that the service treatment records do not show chronic complaints, evaluation, treatment, or other documentation of headaches other than acute encounters of headaches related to acute sinusitis, vomiting episodes, and during upper respiratory infection, which usually resolves with antibiotic use. In addition, post-service records show no further evaluation and treatment of chronic headaches. Thus, there is no evidence of chronicity. The Board finds that the examiner's opinion is probative because it is based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. See Nieves-Rodriguez, 22 Vet. App. 295; Prejean, 13 Vet. App. 444. As stated above, the service treatment records show that the Veteran did complain of headaches in conjunction with other symptoms, but denied headaches at other times. The VA examiner explained that the service treatment records show acute headaches, but not chronic headaches to which the current unspecified headaches may be related.

The Board acknowledges the Veteran's beliefs that his current unspecified headaches are related to an in-service event, injury, or disease. However, he is not considered competent to provide a nexus opinion regarding this issue because the issue is medically complex and requires specialized knowledge and expertise. See Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Consequently, his assertions are not probative and do not weigh against the March 2025 VA examiner's opinion.

In summary, the evidence for consideration persuasively weighs against finding that the Veteran's current unspecified headaches began during active service, or are otherwise related to an in-service event, injury, or disease. In view of the foregoing, the Board concludes that the evidence for and against the claim is not in approximate balance, but rather weighs against the claim. Because there is not an approximate balance in the weight of the evidence, the doctrine of reasonable doubt is not for application, and the claim must be denied. 38 U.S.C. § 5107(b); Lynch, 21 F.4th 776.

REASONS FOR REMAND

1. Entitlement to service connection for erectile dysfunction is remanded.

The Veteran seeks to be service connected for erectile dysfunction, which he contends is secondary to pain caused by his service-connected right shoulder and left knee disabilities. In March 2025, a VA examiner opined that the Veteran's current erectile dysfunction is less likely than not proximately due to or the result of his service-connected right shoulder disability and/or left knee disability. However, the Board finds those opinions to be inadequate for adjudication purposes because they do not adequately address the Veteran's contentions, the evidence that the Veteran submitted in support of the claim, and whether the Veteran's erectile dysfunction may have been aggravated by his service-connected disabilities. Therefore, the issue must be remanded so that an addendum opinion may be obtained. See 38 C.F.R. § 20.802(a).

2. Entitlement to service connection for an acquired psychiatric disability, claimed as insomnia, is remanded.

The Veteran seeks to be service connected for insomnia. A February 2025 VA mental disorder examiner diagnosed the Veteran with unspecified anxiety disorder and explained that the Veteran's claimed insomnia is subsumed in
However, the Board finds those opinions to be inadequate for adjudication purposes because they do not adequately address the Veteran's contentions, the evidence that the Veteran submitted in support of the claim, and whether the Veteran's erectile dysfunction may have been aggravated by his service-connected disabilities. Therefore, the issue must be remanded so that an addendum opinion may be obtained. See 38 C.F.R. § 20.802(a).

2. Entitlement to service connection for an acquired psychiatric disability, claimed as insomnia, is remanded.

The Veteran seeks to be service connected for insomnia. A February 2025 VA mental disorder examiner diagnosed the Veteran with unspecified anxiety disorder and explained that the Veteran's claimed insomnia is subsumed in that diagnosis. Therefore, the Board has expanded the claim to include all diagnosed acquired psychiatric disabilities and not only the claimed insomnia. See Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). The February 2025 VA examiner rendered a negative nexus opinion, but the provided rationale for the opinion states only that the Veteran's claimed insomnia is subsumed in his diagnosis of unspecified anxiety disorder. The examiner did not provide an opinion as to the diagnosed unspecified anxiety disorder despite noting in the examination report that, "Records highlight noticeable anxiety during medical exam while in service." She did not explain what records highlight anxiety during service. The Board finds that the issue must be remanded so that an addendum opinion may be obtained to determine whether the Veteran's diagnosed unspecified anxiety disorder had its onset during his active service or may otherwise be related to an in-service event, injury, or disease. See 38 C.F.R. § 20.802(a).

3. Entitlement to service connection for obstructive sleep apnea is remanded.

The Veteran seeks to be service connected for obstructive sleep apnea, which he asserts began during his active service. He has reported that he has had problems sleeping all of his life, but that he began to snore loudly and have apneic episodes while sleeping during his active service. He has also submitted a third-party witness statement in which his brother says that the Veteran did not snore prior to joining the military, but has since began to snore loudly and have periods where he does not breathe while sleeping. In July 2023, a VA examiner provided a negative nexus opinion. However, the rationale for that opinion discusses the Veteran's BMI, which is in the obese range, and the Veteran's reports of sleep disturbances that preceded active service. The opinion does not reflect consideration of the Veteran's reports of loud snoring and apneic episodes that developed during service. Therefore, the opinion is inadequate for adjudication purposes, and the issue must be remanded for an addendum opinion.

4. Entitlement to service connection for a digestive disability, claimed as IBS, is remanded.

5. Entitlement to service connection for a urinary disability, claimed as urinary frequency, is remanded.

6. Entitlement to service connection for a left ankle disability is remanded.

7. Entitlement to service connection for a right hip disability is remanded.

The Veteran has competently reported digestive, urinary, left ankle, and right hip symptoms. See Layno, 6 Vet. App. at 469. He has attributed his digestive and urinary symptoms to working a midnight shift during his active service. He has attributed his left ankle and right hip symptoms to physical training and playing basketball during his active service. The Board finds that the evidence of record at the time that the April 2025 rating decision was issued was sufficient to meet the low threshold to trigger VA's duty to assist in providing a VA examination as to the claimed digestive, urinary, left ankle, and right hip disabilities. See 38 U.S.C. § 5103A(d)(2); 38 C.F.R. § 3.159(c)(4)(i); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). However, no such examination was provided. Therefore, the Board finds that the issues must be remanded so that the Veteran may be scheduled for VA examinations as to his claimed digestive, urinary, left ankle, and right hip disabilities. See 38 C.F.R. § 20.802(a).

The matters are REMANDED for the following action:

1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's erectile dysfunction is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) due to or aggravated by a service-connected disability.

The opinion must address the Veteran's contention that pain from his service-connected musculoskeletal disabilities caused or aggravated his erectile dysfunction. It must reflect consideration of the statement and
Therefore, the Board finds that the issues must be remanded so that the Veteran may be scheduled for VA examinations as to his claimed digestive, urinary, left ankle, and right hip disabilities. See 38 C.F.R. § 20.802(a).

The matters are REMANDED for the following action:

Aggravation is defined as any worsening of the disease. Causation and aggravation must be addressed separately. The examiner must note that an opinion to the effect that one disability "is not caused by or a result of" another disability does not answer the question of aggravation and will necessitate a further opinion. See El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013).

2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's diagnosed unspecified anxiety disorder at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) had its onset during his active service or is otherwise related to an in-service event, injury, or disease.

The opinion must address the February 2025 VA mental disorders examination in which the examiner states that the Veteran's claimed insomnia is subsumed in his diagnosis of unspecified anxiety disorder and that, "Records highlight noticeable anxiety during medical exam while in service." If the examiner agrees with those statements, he or she must explain what evidence show "noticeable anxiety" during the Veteran's active service. If the examiner disagrees with the statements, he or she must also explain that opinion.

3. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's diagnosed obstructive sleep apnea at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) had its onset during the Veteran's active service or is otherwise related to an in-service event, injury, or disease.

The opinion must address the Veteran's reports, to include in the statement received in March 2023, that he has had sleep difficulties all of his life, but that he began to snore loudly and have apneic episodes while sleeping during his active service. The Veteran's brother provided a similar report in a statement received in March 2023.

4. Schedule the Veteran for VA examinations for the claimed digestive disability, urinary disability, left ankle disability, and right hip disability. The examiner(s) must review the claims file.

If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner(s) should consider them a "disability" for the purpose of providing the requested opinions below.

The examiner(s) are asked to provide a response to the following for each disability:

Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the claimed disability had its onset during the Veteran's active service or is otherwise related to an in-service event, injury, or disease.

Provide a rationale to support the opinion(s).

For the claimed digestive disability and urinary disability, the opinion must reflect consideration of the Veteran's assertion that he developed a digestive condition, claimed as irritable bowel syndrome, and a urinary condition, claimed as urinary frequency, after working a midnight shift for years during his active service.

For the claimed left ankle and right hip disabilities, the opinion must reflect consideration of the Veteran's assertion that he had left ankle and right pain due to physical training exercises and playing basketball during active service, and that he sprained his left ankle while playing basketball at the base, but did not seek medical attention for the sprain "because I didn't think the injury was severe enough."

In providing the requested opinions, the examiner(s) consider the Veteran's description of the in-service injury and symptoms as well as post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of the current disability, this should be noted. Stated another way, do the Veteran's reports about the symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible?

MICHAEL MARTIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board T. J. Anthony, Counsel

The Board

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