DERMATOPHYTOSIS (RINGWORM)

Summary

The Veteran, who served in the Army across multiple periods between October 1980 and August 2007, appeals the denial of service connection for several conditions, including fibroids, partial hysterectomy, chronic vaginal infection, alopecia, heat casualty/eczema, and chronic fungus of the toes. The Board found that new and relevant evidence was received for fibroids, partial hysterectomy, chronic vaginal infection, alopecia, and heat casualty/eczema, allowing these claims to be readjudicated. However, the Board determined that the evidence for chronic fungus of the toes was not new and relevant, and that claim remains denied. The Board granted service connection for fibroids, noting that the evidence was in relative equipoise and resolving doubt in the Veteran's favor, supported by a private medical opinion that linked the condition to an in-service notation. Service connection for a partial hysterectomy was also granted as secondary to the newly service-connected fibroids, based on a private medical opinion concluding it was a direct result. The claims for chronic vaginal infection, alopecia, and heat casualty/eczema were remanded for new VA examinations and opinions, as the prior VA opinions were found inadequate or internally inconsistent regarding nexus to service.

Rationale

Evidence received was not new and relevant; Did not tend to prove a matter at issue

Full Decision Text

Citation Nr: A26038006
Decision Date: 04/23/26	Archive Date: 04/23/26

DOCKET NO. 200822-105650
DATE: April 23, 2026

ORDER

The claim for service connection for chronic fungus with toes remains denied because the evidence submitted is not new and relevant.

New and relevant evidence having been received, the claim for service connection for fibroids may be readjudicated.

New and relevant evidence having been received, the claim for service connection for alopecia may be readjudicated.

New and relevant evidence having been received, the claim for service connection for chronic vaginal infection may be readjudicated.

New and relevant evidence having been received, the claim for service connection for partial hysterectomy may be readjudicated.

New and relevant evidence having been received, the claim for service connection for heat casualty/eczema may be readjudicated.

Entitlement to service connection for fibroids is granted.

Entitlement to service connection for partial hysterectomy is granted as secondary to now-service-connected fibroids. 

REMANDED

Entitlement to service connection for chronic vaginal infection is remanded.

Entitlement to service connection for alopecia is remanded.

Entitlement to service connection for heat casualty/eczema is remanded.

FINDINGS OF FACT

1. A February 2010 rating decision denied, in relevant part, service connection for partial hysterectomy and a December 2019 rating decision denied, in relevant part, service connection for fibroids, chronic vaginal infection, chronic fungus of the toes, alopecia, and a heat casualty/eczema condition.

2. In March of 2020, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested review of the February 2010 and December 2019 rating decisions based on the receipt of new and relevant evidence.

3. In July of 2020, the RO issued the rating decision that is currently on appeal, finding that new and relevant evidence had not been received as to any of the respective claims for service connection.

4. Pursuant to the claimed chronic fungus of the toes condition, the evidence received after the issuance of the December 2019 rating decision either was previously part of the record before agency adjudicators and/or does not contain information that tends to prove a matter at issue.

5. Pursuant to the claimed partial hysterectomy, fibroids, chronic vaginal infection, alopecia, and heat casualty/eczema condition, the evidence received after the issuance of the February 2010 and December 2019 rating decisions was not previously part of the record before agency adjudicators and contains information that tends to prove matters at issue.

6. The evidence of record is at least in relative equipoise as to whether the Veteran has a fibroids condition that is related to her active service.

7. The Veteran's claimed partial hysterectomy condition was caused by her now-service-connected fibroids.

CONCLUSIONS OF LAW

1. The February 2010 and December 2019 rating decisions which denied, in relevant part, service connection for partial hysterectomy, fibroids, chronic vaginal infection, chronic fungus of the toes, alopecia, and a heat casualty/eczema condition are final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.203, 20.1103.

2. Evidence received since the December 2019 rating decision pursuant to the chronic fungus of the toes condition is not new and relevant, and that claim for service connection may not be readjudicated. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156 (d), 3.2501.

3. Evidence received since the February 2010 and December 2019 rating decisions pursuant to the claims for service connection for partial hysterectomy, fibroids, chronic vaginal infection, alopecia, and a heat casualty/eczema condition is new and relevant, and those claims may be readjudicated. 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.156 (d), 3.2501.

4. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for a fibroids condition have been met. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for entitlement to service connection for a partial hysterectomy condition as due to service-connected fibroids have been met. 38 U.S.C. §§ 1110, 1131, 5107 (b); 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES
.F.R. §§ 3.156 (d), 3.2501.

4. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for a fibroids condition have been met. 38 U.S.C. §§ 1101, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for entitlement to service connection for a partial hysterectomy condition as due to service-connected fibroids have been met. 38 U.S.C. §§ 1110, 1131, 5107 (b); 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from October 1980 to July 1984, from September 1986 to December 1992, from January 2003 to March 2004 and from August 2005 to August 2007; she also served in the U.S. Army Reserve. In August of 2020, the Veteran filed a notice of disagreement (NOD) in which she requested review pursuant to the hearing lane in response to a May 3, 2019 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). However, that NOD was not timely with respect to the May 2019 decision, but may instead be interpreted as a disagreement with a July 2020 rating decision. Thereafter, the Veteran presented testimonial evidence at a videoconference hearing before the undersigned Veterans Law Judge in July of 2024 and a transcript is of record. Thus, only the evidence of record as of the date of the rating decision on appeal as well as evidence received at the hearing and/or within 90 days following the hearing may be considered. See 38 C.F.R. § 20.302 (a). The only exception is if, as relevant in part here, the Board finds that there was pre-decisional error by the RO.

As a final initial matter, the Board observes that portions of the Veteran's service treatment records are unavailable. See December 2009 VA Memorandum. In addition, the RO informed the Veteran later that month that these records are unavailable. See December 2009 Correspondence. The Court of Appeals for Veterans Claims (Court) has held that in cases where records once in the hands of the government are lost, the Board has a heightened obligation to explain its findings and conclusions and to consider carefully the benefit-of-the-doubt rule. See O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). The Board's consideration of the Veteran's case has been undertaken with this heightened duty in mind.

New and Relevant Evidence

In general, rating decisions that are not timely appealed are final. See 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. However, under the modernized review system, also known as the Appeals Modernization Act (AMA), a claimant may continuously pursue a claim or issue by filing a supplemental claim following notice of a decision by the AOJ or the Board. 38 C.F.R. § 3.2500 (c).

If new and relevant evidence is presented or secured with respect to a supplemental claim, the claim will be readjudicated in consideration of all evidence of record. 38 C.F.R. § 3.2501. New evidence is evidence not previously part of the actual record before agency adjudicators. Relevant evidence is information that tends to prove or disprove a matter at issue in a claim. 38 C.F.R. § 3.2501 (a)(1).

1. New and relevant evidence having been received, the claim for service connection for fibroids may be readjudicated.

2. New and relevant evidence not having been received, the claim for service connection for chronic fungus of the toes may not be readjudicated.

3. New and relevant evidence having been received, the claim for service connection for alopecia may be readjudicated.

4. New and relevant evidence having been received, the claim for service connection for chronic vaginal infection may be readjudicated.

5. New and relevant evidence having been received, the claim for service connection for partial hysterectomy may be readjudicated.

6. New and relevant evidence having been received, the claim for service connection for heat casualty/eczema may be readjudicated.

Addressing the relevant procedural history, and as noted above, service connection for a partial hysterectomy condition was denied in a February 2010 rating decision. A December 2019 rating decision denied, in relevant part, service connection for fibroids, chronic vaginal infection, chronic fungus of the toes, alopecia, and a heat casualty/eczema
judicated.

4. New and relevant evidence having been received, the claim for service connection for chronic vaginal infection may be readjudicated.

5. New and relevant evidence having been received, the claim for service connection for partial hysterectomy may be readjudicated.

6. New and relevant evidence having been received, the claim for service connection for heat casualty/eczema may be readjudicated.

Addressing the relevant procedural history, and as noted above, service connection for a partial hysterectomy condition was denied in a February 2010 rating decision. A December 2019 rating decision denied, in relevant part, service connection for fibroids, chronic vaginal infection, chronic fungus of the toes, alopecia, and a heat casualty/eczema condition.

It was respectively determined in regard to the claimed partial hysterectomy condition, fibroids, and chronic fungus with toes that there was no evidence of a current diagnosis relevant to the appeal period that could be related to the Veteran's military service. It was also determined in regard to the claimed chronic vaginal infection, alopecia, and a heat casualty/eczema condition that the record lacked evidence showing that the respective disabilities were incurred in or linked to service.

The evidence at the time of both the February 2010 and December 2019 rating decisions consisted of service treatment records and service personnel records; VA treatment records and examination reports were also accompanying the December 2019 rating decision. The Veteran was respectively notified of these decisions in March of 2010 and in December of 2019 and of her appellate rights, but she did not appeal. There was no relevant evidence received within one year of the issuance of those decisions, and they are each therefore final as to the evidence then of record and not subject to revision on the same factual basis.

In the July 2020 rating decision on appeal, the RO denied readjudicating the respective claims for service connection once again. Despite conceding current disabilities pursuant to the claimed partial hysterectomy condition, fibroids, chronic vaginal infection, alopecia, and heat casualty/eczema condition at that time, the RO determined that the record still lacked evidence that tended to prove a matter at hand, namely that any of these conditions could be related to the Veteran's active service. 

Pertinent evidence added to the claims file includes hearing testimony attested to by the Veteran in which she referred to interactions with medical professionals and provided additional details about the onset of the respectively claimed partial hysterectomy condition, fibroids, chronic vaginal infection, alopecia, and heat casualty/eczema conditions. The Veteran is competent to relay what a medical professional told her. Layno v. Brown, 6 Vet. App. 465 (1994). Moreover, the evidence is presumed credible for purposes of readjudication. See, e.g., Justus v. Principi, 3 Vet. App. 510, 513 (1992). The evidence also includes both VA and private medical evidence that have been associated with the claims file. These records are "new" because they were not previously of record at the time of the prior final rating decision, and they were received within an applicable evidentiary window. Further, they are "relevant" because when viewed most favorably to the Veteran, they tend to prove a matter at issue in a claim, namely, a nexus between the claimed conditions and the Veteran's military service.

Based on all of the above, the Board finds that the criteria for readjudicating the claim for service connection for a partial hysterectomy, fibroids, chronic vaginal infection, alopecia, and a heat casualty/eczema condition have been met. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156.

Addressing the remaining claimed fungus condition, the above-referenced records are still "new" because they were not previously of record at the time of the prior final rating decision, and they were received within an applicable evidentiary window. However, they are not "relevant" because they do not tend to prove a matter at issue in a claim, namely, that the Veteran has been diagnosed with a chronic fungus of the toes condition, a fact that she herself affirmed at her Board hearing. Based on all of the above, the Board finds that the criteria for readjudicating the claim for service connection for a chronic fungus with toes condition have not been met and that claim remains denied. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156.

Service Connection

Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1153; 38 C.F.R. §§ 3.303, 3.304. Service connection may also be granted for any disease diagnosed after discharge when all the evidence, including
, a fact that she herself affirmed at her Board hearing. Based on all of the above, the Board finds that the criteria for readjudicating the claim for service connection for a chronic fungus with toes condition have not been met and that claim remains denied. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156.

Service Connection

Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1153; 38 C.F.R. §§ 3.303, 3.304. Service connection may also be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship, or nexus, between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). 

In addition to the foregoing, secondary service connection may be granted for a disease or injury which resulted from a service-connected disability or was aggravated thereby. 38 C.F.R. § 3.310. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. Further, any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease, will also be service connected.

Reasonable doubt concerning any matter material to the determination is resolved in the Veteran's favor. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102.

7. Entitlement to service connection for fibroids is granted.

In this case, the Veteran has contended that, "[w]hen I was in the military... I was diagnosed with fibroids." See e.g. July 2024 Board Hearing Transcript. VA has already conceded that the Veteran has a fibroids condition. See July 2020 Rating Decision. The Board is bound by this and the other favorable findings contained therein. See AMA, Pub. L. No. 115-55, § 5104A, 131 Stat. 1105, 1106-07. With respect to an in-service injury or disease, it is also observed that similar to the assertions made by the Veteran, the available service treatment records contain an August 1991 notation regarding "mid-abdominal pain" which was noted to be a "possible fibroid". 

In regard to a nexus, the Board observes that a privately authored medical opinion was associated with the claims file on multiple occasions and most recently in July of 2024 within 90 days following the hearing. Therein, it was provided among other detailed rationale in support of a positive conclusion that, "[a]fter a comprehensive review of [the Veteran's] medical records, [her] abnormal cervical findings reported August 12, 1991 was in fact her enlarge uterus and uterine fibroids."

The Board has also considered the December 2019 VA opinion which states in support of a negative nexus opinion that, "uterine fibroid is a disease with a clear and specific etiology and diagnosis that is less likely than not incurred from active service based on medical records containing clinical note in in 2000 of large uterine fibroid which suggest fibroid did not incurred from active service."

After weighing the evidence, the Board finds a significant difference in the depth and support for the VA clinician's opinion in comparison with the opinion authored by the private clinician. Significantly, while the VA clinician also offered a conclusion, there is insufficient supportive rationale thus deeming this opinion inadequate, and standing alone, it would have necessitated a remand so that an additional opinion could be authored. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (a medical opinion "must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions").

In contrast, the private opinion is based on an accurate and comprehensive review of the pertinent evidence in the claims file, to include the conceded in-service notation, and provides adequate supporting rationale to support the opinions stated. The clinician was aware of the Veteran's medical history, provided a fully articulated opinion, and furnished a reasoned analysis. The Board therefore attaches significant probative value to this opinion, and the most probative
, and standing alone, it would have necessitated a remand so that an additional opinion could be authored. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (a medical opinion "must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions").

In contrast, the private opinion is based on an accurate and comprehensive review of the pertinent evidence in the claims file, to include the conceded in-service notation, and provides adequate supporting rationale to support the opinions stated. The clinician was aware of the Veteran's medical history, provided a fully articulated opinion, and furnished a reasoned analysis. The Board therefore attaches significant probative value to this opinion, and the most probative value in this case, as it is well reasoned, detailed, consistent with other evidence of record, and included access to the accurate background of the Veteran. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000).

Given the foregoing, the Board has resolved any lingering doubt in the Veteran's favor and the claim for entitlement to service connection for fibroids is granted. 38 U.S.C. § 5107 (b); see also Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

8. Entitlement to service connection for partial hysterectomy is granted as secondary to now-service-connected fibroids. 

Turning next to the claimed partial hysterectomy condition, it is observed that the Veteran has asserted that this condition is related to her fibroids. See e.g. July 2024 Board Hearing Transcript. It is uncontroverted that the medical evidence of record, including opinions authored by both private and VA examiners, confirms that the Veteran has had a partial hysterectomy; indeed, this was conceded by VA in the rating decision currently on appeal. There is also no question regarding the Veteran's now-service-connected fibroids, which she has been afforded service connection for herein. Thus, the most relevant question before the Board at this juncture is whether the Veteran's hysterectomy condition was caused or aggravated by her service-connected fibroids.

In regard to a nexus, multiple probative medical nexus opinions are of record, all of which were provided by medical professionals who are presumed to have the training and expertise to opine on hysterectomy conditions. For the sake of brevity, the Board will only highlight the details of the evidence most relevant to this grant.

Most influentially, the Board again notes that the Veteran has submitted a privately authored positive medical opinion on multiple occasions and most recently in July of 2024 within 90 days following the hearing. It was concluded in that opinion, which contained detailed rationale and in which that clinician clearly outlined the referenced medical evidence, in relation to the Veteran's fibroids that, "as a direct result she had to undergo a hysterectomy for the treatment of this".

It is also observed that on other occasions, the evidence of record has been interpreted differently which resulted in a negative conclusion. See e.g. December 2019 VA Opinion. However, because each of the opinions of record constitutes competent, credible medical evidence of record, the Board finds that the lingering doubt in this case should be resolved in the Veteran's favor. On that basis, the Veteran's claim for service connection for a partial hysterectomy is granted as secondary to her fibroids. 38 U.S.C. § 5107 (b); see also Lynch, 21 F.4th 776.

REASONS FOR REMAND

1. Entitlement to service connection for chronic vaginal infection is remanded.

2. Entitlement to service connection for alopecia is remanded.

3. Entitlement to service connection for heat casualty/eczema is remanded.

Given that it has now been determined that new and relevant evidence has been received sufficient to readjudicate each of these claims, the Board finds that a remand is warranted so that the RO may consider the merits of each claim in the first instance. Further, given the addition of the new evidence outlined above, the Veteran should be afforded new examinations with a VA clinician from which opinions may be authored in order to ensure that VA has an accurate depiction of the nature of his claimed disabilities. This is especially necessary as the December 2019 VA opinions authored in regard to the claimed alopecia and heat casualty/eczema conditions rely entirely on solely on a purported absence of medical records corroborating an in-service injury or disease as the sole basis for finding no nexus. See Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007). 

Further, the opinion authored in regard to the claimed vaginal condition appears internally inconsistent as it was stated that it is, "less likely than not incurred from service based on medical records containing clinical notes in 1981 reporting of sexually transmitted disease
 from which opinions may be authored in order to ensure that VA has an accurate depiction of the nature of his claimed disabilities. This is especially necessary as the December 2019 VA opinions authored in regard to the claimed alopecia and heat casualty/eczema conditions rely entirely on solely on a purported absence of medical records corroborating an in-service injury or disease as the sole basis for finding no nexus. See Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007). 

Further, the opinion authored in regard to the claimed vaginal condition appears internally inconsistent as it was stated that it is, "less likely than not incurred from service based on medical records containing clinical notes in 1981 reporting of sexually transmitted disease including vaginitis which suggest current vaginal infections did not incurred from service but a continuation from prior service events." Significantly, the assertion of, "a continuation from prior service events" suggests an in-service onset which contrasts with the negative nexus reached. Given the foregoing, the prior failure to have obtained new opinions was a pre-decisional error that should be corrected during the forthcoming remand. 

The matters are REMANDED for the following actions:

1. Schedule the Veteran for VA examinations with an appropriate VA clinician(s) to determine the nature and etiology of the Veteran's claimed (i) chronic vaginal infection, (ii) alopecia and (iii) heat casualty/eczema conditions. The clinician must be provided with and review the entire claims file, to include a copy of this remand and it should be confirmed that such records were available for review. After administering all relevant tests and recording results, and following a confirmed review of the evidence of record, to include the Veteran's lay statements, the clinician should clarify with a full rationale:

(a.) Whether it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the claimed condition onset during active duty, during a period of ACDUTRA, or is causally or etiologically related to any in-service event, disease, or injury. 

In so opining, in-service notations should be reconciled to the extent that they are available, to include the numerous in-service notations relating to the claimed chronic vaginal condition.

(Continued on the next page)

?

It is emphasized that a full rationale must be provided for all conclusions reached which should wholly address and reconcile to the extent possible the lay contentions recorded in the record. The clinician is also advised that the absence of medical records corroborating an in-service injury or disease cannot be used as the sole basis for finding no nexus between a current disability and the Veteran's military service and will necessitate an additional remand for a new opinion. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation, and the clinician is additionally asked to reconcile to the extent possible any conflicting evidence or opinions of record. A clear basis for all opinions should be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the clinician is unable to provide any of the requested information without resorting to speculation, he or she should so state, and further explain why it is not feasible to provide a medical opinion.

2. Thereafter, readjudicate the claims on appeal after considering the pertinent evidence and recharacterizing the claims as necessary based upon the evidence uncovered during the remand.

 

 

MICHAEL MARTIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	K. Smith, 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.