MOUTH INJURIES OF

Summary

The Veteran, an Army Veteran who served from June 2021 to June 2023, appeals the denial of service connection for anorexia and a disability manifested by insomnia. The Veteran claimed anorexia, stating that during basic training, a three-day confinement without food or water led to stomach pains and weight loss. He also claimed insomnia, asserting it was secondary to his service-connected adjustment disorder with mixed anxiety and depressed mood. The Board denied service connection for anorexia, finding the weight of the evidence against a diagnosis, noting that service treatment records showed no weight issues during service and post-service records indicated no change in appetite or significant weight loss until a later period. The Board found the Veteran's lay assertions alone insufficient to warrant a VA examination for anorexia, as VA treatment records did not diagnose the condition. For insomnia, the Board denied service connection, noting that service treatment records did not document sleep problems. A VA psychiatric examination diagnosed adjustment disorder with mixed anxiety and depressed mood and found insomnia to be a symptom of this service-connected condition, not a separate diagnosis. The Board concluded that the Veteran did not have a diagnosis of anorexia or a disability manifested by insomnia independent of his service-connected adjustment disorder. The Board also considered the Saunders v. Wilkie decision regarding pain and functional impairment but found it distinguishable, as the Veteran retained employment and did not demonstrate functional impairment of earning capacity.

Rationale

Weight of evidence against diagnosis; No diagnosis in service treatment records; Post-service records did not diagnose anorexia; Lay assertions alone insufficient for VA exam

Full Decision Text

Citation Nr: A26037152
Decision Date: 04/21/26	Archive Date: 04/21/26

DOCKET NO. 250528-548183
DATE: April 21, 2026

ORDER

Service connection for anorexia is denied.

Service connection for a disability manifested by insomnia is denied.

FINDINGS OF FACT

1. The Veteran does not have a diagnosis of anorexia.

2. The Veteran does not have a diagnosis of a disability manifested by insomnia that is independent of his service-connected adjustment disorder with mixed anxiety and depressed mood.

CONCLUSIONS OF LAW

1. The criteria for service connection for anorexia have not been met. 38 U.S.C.§§ 1110, 5107; 38 C.F.R.§§ 3.102, 3.303, 3.304.

2. The criteria for service connection for a disability manifested by insomnia have not been met. 38 U.S.C.§§ 1110, 5107; 38 C.F.R.§§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from June 2021 to June 2023. 

This appeal stems from a March 2025 Appeals Modernization Act (AMA) rating action. In the March 2025 rating action, the Agency of Original Jurisdiction (AOJ) denied, in part, service connection for anorexia and a disability manifested by insomnia. 

In May 2025, the Veteran filed VA Form 10182, Notice of Disagreement, and selected the Direct Review Lane. Accordingly, in adjudicating the issues on appeal, the Board is required to consider the evidence of record at the time of AOJ's March 2025 rating decision. 38 C.F.R. § 20.301.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, he 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, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

The Veteran seeks service connection for anorexia and a disability manifested by insomnia. After a brief recitation of the laws and regulations governing service connection, the Board will adjudicate the claims. 

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 military service. 38 U.S.C.§ 1110; 38 C.F.R.§ 3.303. Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service (nexus). Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

i) The claim for service connection for anorexia is denied. 

The Veteran seeks service connection for anorexia. He maintains that when he was diagnosed with Covid during basic training, he was locked in a room for three (3) days without food or water. Since that time, he contends that he has had stomach pains if he tries to eat more than once a day. See VA Form 21-526, Veterans Application for Compensation and Pension, received by VA in October 2024. 

Here, the Board will deny the claim because the weight of the evidence is against a finding that the Veteran has, or has had, anorexia at any time during the appeal period.

The Veteran's service treatment records (STRs) reflect that he received the COVID-19 vaccination in September 2021. There is no evidence contemporaneous to the administration of the vaccine, or for the remainder of the Veteran's period of service, that he had eating issues or any weight-related problems, symptoms or diagnosis. To this end, October 2021 and December 2021 records reflect that the Veteran had not experienced any changes in his weight. A March 2022 report reflects that he did not have any current (then) weight loss. In fact, during service, the Veteran gained weight. Notably, a September 17, 2021 report reflects that the Veteran weighed 164.2 pounds, and, when seen in February 28, 2022, he weighed 179 pounds. 

Post-service VA treatment reports reflect that when he presented to a clinic in May 
 the administration of the vaccine, or for the remainder of the Veteran's period of service, that he had eating issues or any weight-related problems, symptoms or diagnosis. To this end, October 2021 and December 2021 records reflect that the Veteran had not experienced any changes in his weight. A March 2022 report reflects that he did not have any current (then) weight loss. In fact, during service, the Veteran gained weight. Notably, a September 17, 2021 report reflects that the Veteran weighed 164.2 pounds, and, when seen in February 28, 2022, he weighed 179 pounds. 

Post-service VA treatment reports reflect that when he presented to a clinic in May 2024, he weighed 139.6 pounds. When seen in early October 2024, the Veteran reported that there had not been any change in his weight or appetite. See VA treatment report, dated October 8, 2024. In April 2025 he weighed 144 pounds.  These reports are quiescent for any diagnosis of anorexia or weight-related problems, symptoms or diagnosis. 

The most probative and credible evidence establishes that the Veteran does not have a diagnosis of anorexia. In the absence of disability, there can be no valid claim. See Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992).

While the Veteran has not been provided with a VA examination to investigate a link between his claimed anorexia and military service, the Board finds that one is not warranted. Unfortunately, here, the only evidence indicating the Veteran has anorexia comes from his lay assertions within the context of seeking service connection. The Veteran's generalized lay assertions alone, however, are not sufficient to trigger the need for a VA examination under Mclendon v. Nicholson, 20 Vet. App. 79, 81 (2006). See Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010) (rejecting a Veteran's argument that his "conclusory generalized statement that his service illness caused his present medical problems was enough to entitle him to a medical examination under the standard of [38 U.S.C. § 5103A (d)(2)(B).]").

Essentially, while the Veteran weighs less than he did in service, the VA treatment records which have investigated his reports of weight loss have not diagnosed any specific disorder such as anorexia.

Finally, the Board considered whether the circumstances warrant a Toxic Exposure Risk Activity (TERA) examination. However, because the Veteran does not have anorexia and has not been shown to have been exposed to a TERA, a TERA examination is not required. See 38 U.S.C. §§ 101 (38), 1168, 1710(e)(1)(c). A TERA examination is only warranted when a Veteran submits evidence of a disability and evidence of participation in a toxic exposure risk activity during active military service. Neither of these requirements have been shown on either examination and/or treatment or administrative records. See October 2023 TERA Memorandum to the file. 

Accordingly, service connection for anorexia is denied.

ii) The claim for service connection for a disability manifested by insomnia is denied. 

The Veteran seeks service connection for a disability manifested by insomnia. He contends that his insomnia is secondary to his service-connected adjustment disorder with mixed anxiety and depressed mood. 

The Veteran's STRs do not document any sleep-related problems or sleep disturbance. 

The post-service medical evidence includes VA treatment records, dated in July 2024 and October 2024, reflecting that the Veteran reported having sleep disparities and waking up from dreams, respectively. A chronic sleep condition was not diagnosed at either visit. 

A VA psychiatric examination in October 2024 diagnosed the Veteran with adjustment disorder mixed with anxiety and depressed mood. The examiner noted the Veteran's problems with insomnia, but opined that there was no diagnosis because this condition was a symptom of his adjustment disorder mixed with anxiety and depressed mood. See October 2024 VA Mental Disorders Disability Benefits Questionnaire (DBQ) and opinion. The examiner's opinion and diagnosis have not been contradicted or challenged by other medical evidence. As such, the Borad finds that the Veteran does not have a diagnosis of chronic insomnia independent of his service connected adjustment disorder and depressed mood.

In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection for a disability manifested by insomnia is denied.

Conclusion

Furthermore, the Board has considered this appeal in light of Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). In
4 VA Mental Disorders Disability Benefits Questionnaire (DBQ) and opinion. The examiner's opinion and diagnosis have not been contradicted or challenged by other medical evidence. As such, the Borad finds that the Veteran does not have a diagnosis of chronic insomnia independent of his service connected adjustment disorder and depressed mood.

In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection for a disability manifested by insomnia is denied.

Conclusion

Furthermore, the Board has considered this appeal in light of Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). In Saunders, the United States Court of Appeals for the Federal Circuit (Federal Circuit) concluded that pain may be considered a disability for VA purposes, even when there is no identified underlying diagnosis, if it results in a functional impairment of earning capacity. The Federal Circuit ultimately held in Saunders that in order to establish the presence of a disability, a Veteran will need to show that pain reaches the level of functional impairment of earning capacity. Id. at 1368. That noted, the Board finds the present case to be readily distinguishable from Saunders. Here, there is no competent medical evidence suggesting functional impairment of earning capacity in the record. Notably, an October 2024 VA Mental Disorders Disability Benefits Questionnaire (DBQ), and associated VA treatment records, reflect that the Veteran retained employment during the appeal period stocking shelves for a large corporation. Quite simply, there exists no basis for finding that a threshold of functional impairment of earning capacity has been met. Absent such evidence, there can be no finding of a disability per Saunders. Without any supporting records or testimony, the Board concludes that the weight of the evidence is against a determination that the Veteran has had anorexia or a disability manifested by insomnia that is separate from the service-connected adjustment disorder with mixed anxiety and depressed mood at any time during the pendency of the claim.

The Board acknowledges that the Veteran is considered competent to report the observable manifestations of his claimed disabilities, such as difficulty eating more than one meal a day and sleep-related problems. See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). Although lay persons are competent to provide opinions on some medical issues, as to the specific issues in this case, such as whether the Veteran has a current diagnosis of a claimed disorder and the date of onset of such disorder, they fall outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Accordingly, his opinions are not significantly probative and are outweighed by the medical evidence of record, as well as his own statements when seen by VA that he was not experiencing any weight problems or changes in appetite, and a VA examiner's conclusion that his insomnia was a symptom of the service-connected adjustment disorder with mixed anxiety and depression. In sum, the weight of the evidence is against a finding that the Veteran had an in-service, or current diagnoses, of anorexia or disability manifested by insomnia that is independent of the service-connected adjustment disorder with mixed anxiety and depression. The claims are denied.

 

 

MATTHEW W. BLACKWELDER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Carole Kammel, 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.