DERMATITIS OR ECZEMA

A. ISHIZAWAR · 2026 · Case ID: A26038702

MIXED

Summary

The veteran served in the Army from August 2007 to November 2010, with subsequent service in the Army Reserves. He appealed the February 2021 rating decision, which granted service connection for atopic dermatitis at 0% and denied claims for a low back disorder, left knee disorder, right knee disorder, medial tibial stress syndrome (MTSS) of both legs, and hemorrhoids. The Board reviewed the evidence of record at the time of the February 2021 decision, plus evidence submitted within 90 days of the withdrawal of a hearing request. For atopic dermatitis, the Board denied a compensable rating, finding the evidence did not support the criteria for a higher rating based on the severity and treatment duration, consistent with the December 2020 VA examination. For the low back disorder, the Board granted service connection, finding it was bound by a favorable May 2024 AOJ finding that the disability was related to service, despite a different diagnosis in the initial denial. For tinnitus, the Board granted service connection, finding the evidence in equipoise and resolving doubt in the veteran's favor, based on a September 2023 VA opinion that provided a positive nexus to military noise exposure. For left and right knee patellofemoral pain syndrome, the Board granted service connection, finding the evidence in equipoise and resolving doubt in the veteran's favor, based on an October 2024 VA opinion that acknowledged the in-service parachute injury and linked it to the current knee conditions. The claims for MTSS of both legs and hemorrhoids were remanded for additional development and opinions regarding etiology.

Rationale

Atopic dermatitis did not meet criteria for compensable rating under DC 7806; Did not affect 5% of body/exposed area; Did not require systemic therapy for 6+ weeks; No evidence of disfigurement under DC 7800

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210526-162438

Full Decision Text

Citation Nr: A26038702
Decision Date: 04/24/26 Archive Date: 04/24/26

DOCKET NO. 210526-162438
DATE: April 24, 2026

ORDER

A compensable initial rating for atopic dermatitis is denied.

Service connection for a low back disability, diagnosed as degenerative arthritis of the spine, intervertebral disc syndrome (IVDS), and spinal stenosis, prior to February 9, 2024, is granted.

Service connection for tinnitus is granted.

Service connection for left knee patellofemoral pain syndrome is granted.

Service connection for right knee patellofemoral pain syndrome is granted.

REMANDED

Entitlement to service connection for medial tibial stress syndrome, left leg is remanded.

Entitlement to service connection for medial tibial stress syndrome, right leg is remanded.

Entitlement to service connection for hemorrhoids is remanded.

FINDINGS OF FACT

1. Atopic dermatitis affected less than 5 percent of the total body area and none of the exposed body area and required the use of topical corticosteroids for six weeks or more.

2. At all times relevant to the period on appeal, the Veteran has been diagnosed with a low back disability, diagnosed as degenerative arthritis of the spine, IVDS, and spinal stenosis.

3. In a May 2024 rating decision, the Veteran was awarded service connection for a back disability, diagnosed as lumbosacral strain, osseous & subluxation stenosis of lumbar foramina, effective February 9, 2024; the Board is bound by the favorable finding that the Veteran's back disability is a result of his military service.

4. Resolving all reasonable doubt in the Veteran's favor, his tinnitus is a result of military service.

5. Resolving all reasonable doubt in the Veteran's favor, his left knee patellofemoral pain syndrome is a result of military service.

6. Resolving all reasonable doubt in the Veteran's favor, his right knee patellofemoral pain syndrome is a result of military service.

CONCLUSIONS OF LAW

1. The criteria for a compensable initial rating for atopic dermatitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.118, Diagnostic Code (DC) 7806.

2. The criteria for service connection for a low back disability, diagnosed as degenerative arthritis of the spine, IVDS, and spinal stenosis prior to February 9, 2024, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for tinnitus have been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

4. The criteria for service connection for left knee patellofemoral pain syndrome have been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for service connection for right knee patellofemoral pain syndrome have been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from August 2007 to November 2010 with subsequent service in the Army Reserves.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a February 2021 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In this decision, the Veteran was granted service connection for atopic dermatitis with a noncompensable (0 percent) initial rating and denied claims for service connection for a low back disorder, left knee disorder, right knee disorder, medial tibial stress syndrome (MTSS) of the left leg, MTSS of the right leg, and hemorrhoids.

In May 2021, the Veteran filed a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) in which he elected the Hearing docket. He was scheduled for a hearing before the Board on
Appeals (Board) on appeal from a February 2021 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In this decision, the Veteran was granted service connection for atopic dermatitis with a noncompensable (0 percent) initial rating and denied claims for service connection for a low back disorder, left knee disorder, right knee disorder, medial tibial stress syndrome (MTSS) of the left leg, MTSS of the right leg, and hemorrhoids.

In May 2021, the Veteran filed a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement) in which he elected the Hearing docket. He was scheduled for a hearing before the Board on March 21, 2025. However, in a March 18, 2025, submission, and through his then-attorney, he notified the Board that he wished to withdraw the hearing request for this appeal. Therefore, the Board considers the hearing request to be withdrawn and the Board may only consider the evidence of record at the time of the February 2021 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his attorney within 90 days following receipt of the withdrawal of the hearing request in March 2025. 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 20.801.

For the issues decided below, 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 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.

For the remanded issues of entitlement to service connection for MTSS of the left leg, MTSS of the right leg, and hemorrhoids, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Finally, while this appeal was pending, the Veteran's former attorney submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim in February 2024 requesting review of the February 2021 rating decision with regard to the denial of service connection for a low back disorder. According to 38 C.F.R. § 3.2500(a), within one year from the date on which the AOJ issues a notice of a decision on a claim or issue, a claimant may elect to seek administrative review by filing a request for a higher-level review before the AOJ or filing an appeal to the Board. A claimant may also file a supplemental claim before the AOJ at any time after VA issues notice of a decision on an issue within a claim. However, a claimant who has filed for administrative review under one of the options available under 38 C.F.R. § 3.2500(a) may not, while that review is pending final adjudication, file for review under a different available option. See 38 C.F.R. § 3.2500(b). Despite this prohibition against concurrent elections, the AOJ accepted the February 2024 supplemental claim and, in a rating decision dated in May 2024, granted service connection for lumbosacral strain, osseous & subluxation stenosis of lumbar foramina, rated 40 percent, effective February 9, 2024. Although the February 2024 supplemental claim was a prohibited concurrent election as the Veteran already had an appeal for the same issue pending before the Board, the Board will not disturb the award made in the March 2025 rating decision. Moreover, the Board finds that the issue of entitlement to service connection for a low back disorder prior to February 9, 2024, remains on appeal before the Board. See Concepcion-Maldonado v. Collins, 38 Vet. App. 294, 302 (2025) ("mootness if a case-specific inquiry requiring the Court to reckon with the individual circumstances of the appeal and the implications for appellant's ability to obtain full relief.").

In this regard, the May 2024 rating decision stated that service connection for lumbosacral strain, osse
already had an appeal for the same issue pending before the Board, the Board will not disturb the award made in the March 2025 rating decision. Moreover, the Board finds that the issue of entitlement to service connection for a low back disorder prior to February 9, 2024, remains on appeal before the Board. See Concepcion-Maldonado v. Collins, 38 Vet. App. 294, 302 (2025) ("mootness if a case-specific inquiry requiring the Court to reckon with the individual circumstances of the appeal and the implications for appellant's ability to obtain full relief.").

In this regard, the May 2024 rating decision stated that service connection for lumbosacral strain, osseous & subluxation stenosis of lumbar foramina was being granted, effective February 9, 2024, as that was the date the Supplemental Claim was received. However, review of the claims file shows that February 9, 2021, is the date of the original rating decision that denied service connection for a low back disorder. This rating decision, in turn, was issued in response to a VA Form 21-526EZ, Fully Developed Claim, filed on April 23, 2020, in which the Veteran requested service connection for a low back disorder. The Veteran has been continuously pursuing the claim since that time. 38 C.F.R. § 3.2500(c).

Initial Rating

Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4.

Entitlement to a compensable initial rating for atopic dermatitis.

The Veteran's atopic dermatitis has been rated noncompensable under 38 C.F.R. § 4.118, DC 7806 for dermatitis or eczema. The criteria for DC 7806 are found under the General Rating Formula for the Skin, which provides as follows:

" 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, psoralen with long-wave ultraviolet-A light (PUVA), or other immunosuppressive drugs required for a total duration of less than 6 weeks over the past 12-month period (10 percent).

" Characteristic lesions involving 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 (30 percent).

" 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, (PUVA), or other immunosuppressive drugs required over the past 12-month period (60 percent).

Or rate as disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801, 7802, 7804, or 7805), depending upon the predominant disability.

DC 7800 provides that scar(s) of the head, face, or neck are to be rated as follows:

" one characteristic of disfigurement (10 percent).

" visible or palpable tissue loss and either gross distortion or asymmetry of one features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or two or three characteristics of disfigurement (30 percent).

" visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or with four or five characteristics of disfigurement (50 percent).

" visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of
ment (10 percent).

" visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or with six or more characteristics of disfigurement (80 percent).

Note (1) to DC 7800 provides that the eight characteristics of disfigurement for purposes of evaluation under § 4.118 are:

" scar 5 or more inches (13 or more cm.) in length.

" scar at least one-quarter inch (0.6 cm.) wide at widest part

" surface contour of scar elevated or depressed on palpation

" scar adherent to underlying tissue

" skin hypo-or hyper-pigmented in an area exceeding six square inches (39 sq. cm.)

" skin texture abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 sq. cm.)

" underlying soft tissue missing in an area exceeding six square inches (39 sq. cm.)

" skin indurated and inflexible in an area exceeding six square inches (39 sq. cm.).

A note preceding 38 C.F.R. § 4.118 provides that, for the purposes of this section, "systemic therapy is treatment that is administered through any route (orally, injection, suppository, intranasally) other than the skin, and topical therapy is treatment that is administered through the skin."

Regarding the meaning of "systemic therapy" prior to the new definition of the term in the revised criteria, the Court in Johnson v. McDonald, 27 Vet. App. 497, 505 (2016) held that use of a topical steroid constituted "systemic therapy" within the meaning of DC 7806. In Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017), the Federal Circuit reversed this decision and determined that "constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs" under DC 7806 is generally not inclusive of topical corticosteroids. The Federal Circuit found that "systemic therapy means 'treatment pertaining to or affecting the body as a whole,' whereas topical therapy means 'treatment pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied'."

Thus, according to the Federal Circuit, all applications of topical corticosteroids do not constitute systemic therapy. The Federal Circuit also held that a topical corticosteroid treatment could meet the definition of systemic therapy if it was administered on a large enough scale such that it affected the body as a whole, and the use of a topical corticosteroid could be considered either systemic therapy or topical therapy based on the factual circumstances of each case.

Turning to the evidence, in a December 2020 VA Skin Conditions Disability Benefits Questionnaire (DBQ), the examiner diagnosed atopic dermatitis that currently affected the Veteran's bilateral extremities. The Veteran described onset of the disability as occurring in 2009 and affecting the neck, torso, and bilateral extremities. He indicated that he received oral and topical medications at that time and that the symptoms had been stable since.

The examiner noted current symptoms affecting the anterior bilateral extremities. Treatment in the previous 12 months included topical corticosteroids or other immunosuppressive medications for a total of 6 weeks or more, but not constant. No other treatment procedures were documented. The examiner found that the eczema covered less than 5 percent of the total body area, and none of the exposed area. There was no scarring or disfigurement.

In June 2025, and within 90 days of the hearing request withdrawal, the Veteran submitted copies of September 2023 and October 2024 Skin Condition DBQs, but while the Board considered the findings at these examinations, they are not pertinent to the period prior to the February 2021 rating decision. In this regard, the DBQ is concerned with the use of corticosteroids or other treatments for only the previous 12 months, which in this case would be September 2022 at the earliest. Moreover, nothing in the September 2023 or October 2024 Skin Condition DBQs suggests that the Veteran's atopic dermatitis was more severe during the period prior to February 2021 than documented at the December 2020 VA examination. Importantly, the question to be addressed in this case is whether the correct decision was made at the time of February 2021rating decision; therefore, although the September 2023 and October 2024 Skin Condition DBQs were received during an appropriate evidentiary window, it has limited relevancy because it does not address the level severity of the Veteran's atopic dermatitis during the pre-decisional period, which was prior to the February 2021 rating decision.

Review of the treatment evidence of record does not reflect that atopic dermatitis affects a greater percentage of the exposed or total body area than noted at the VA examination. No use of systemic corticosteroids was reported.

Thus, the medical evidence does not reflect that the Veteran's atopic dermatitis affected at least 5 percent of the exposed or total body area or that it required systemic therapy during a 12-month period. The medical evidence, therefore, does not support a compensable initial rating for atopic dermatitis under DC 7806.

The Board has considered the lay statements in support of the appeal. In an April 2020 Memorandum for Record, the Veteran stated that he had suffered from lesions of the hands, neck, stomach, legs, and feet since service with the severity fluctuating across the affected regions over time. In a June 2025 statement, he reported that he had been experiencing flare-ups of his skin symptoms since at least April 2020 and that these flare-ups required the use of corticosteroids or other immunosuppressive medications. However, the severity of symptoms and treatment described in these statements is consistent with the findings in the VA examinations and does not support a compensable rating.

Finally, as the Veteran has reported that the atopic dermatitis has affected his neck, the Board considered whether a higher rating was warranted under DC 7800. However, there was no scarring, hypo- or hyper-pigmentation, abnormal skin texture, loss of underlying soft tissue, or indurated or inflexible skin to support a compensable rating under DC 7800 for atopic dermatitis affecting the neck.

Accordingly, a compensable initial rating for atopic dermatitis is not warranted. The appeal is denied.

Service Connection

Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009).

Entitlement to service connection for degenerative arthritis of the spine, IVDS, spinal stenosis, prior to February 9, 2024.

The Veteran contends that he sustained a lower back injury while performing airborne exercises in service, and that he has had chronic low back problems since this time.

At all times relevant to the period on appeal, the Veteran has been diagnosed with a back disorder. In this regard, an MRI performed in September 2020 showed multilevel disc findings of the lumbar spine with borderline spinal stenosis at the L4-5 level, with findings lateralizing somewhat to the left at the LS-SI and the T12-Ll level. A September 2020 VA Back Condition DBQ diagnosed degenerative arthritis of the spine, IVDS, and spinal stenosis

As indicated above, in a May 2024 rating decision, the AOJ made a favorable finding that the Veteran's back disability
performing airborne exercises in service, and that he has had chronic low back problems since this time.

As indicated above, in a May 2024 rating decision, the AOJ made a favorable finding that the Veteran's back disability is related to his military service, and awarded service connection for lumbosacral strain, osseous & subluxation of the lumbar foramina, effective February 9, 2024. The Board is bound by the AOJ's May 2024 favorable finding. Favorable findings made by the AOJ are generally binding on the Board, unless rebutted by evidence that identifies a clear and unmistakable error in the favorable finding. 38 U.S.C. § 5104A; 38 C.F.R. §§ 3.104(c); 20.801(a). Such evidence is not present in this case. Further, while the diagnosis in September 2020 is different from the disability for which service connection was granted, there is no evidence to suggest that the two diagnoses are not different characterizations of the same disability manifestations or that the latter diagnosis is not a progression of the former.

Based on the foregoing, the Board finds that a nexus has been established and the criteria for service connection for a back disability, diagnosed as degenerative arthritis of the spine, IVDS, and spinal stenosis, have been met. Accordingly, the Veteran's claim for service connection for a back disability prior to February 9, 2024, is granted.

Entitlement to service connection for tinnitus.

Tinnitus is recognized by VA as a "chronic disease" under 38?C.F.R. §?3.309(a); therefore, the presumptive provisions of 38?C.F.R. §§?3.303(b), 3.307, and 3.309 apply.?Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013); Fountain v. McDonald, 27?Vet. App.?258 (2015).

Initially, the February 2021 rating decision rendered a favorable finding of a current diagnosis of intermittent tinnitus. A favorable finding was also rendered as to the Veteran's military occupational specialty (MOS) of All Source Intelligence having a low probability of noise exposure. The Board is generally bound by favorable findings of the AOJ, and the favorable findings made in the February 2021 rating decision are consistent with the evidence.

Specifically, a current diagnosis of tinnitus was noted during a June 2020 VA Hearing Loss and Tinnitus Disability Benefits Questionnaire (DBQ). Further, the examiner indicated that the Veteran had military noise exposure from heavy machinery and weapons fire and that, contrary to the rating decision, his MOS had a high probability of noise exposure. In addition, in an April 2020 Memorandum for Record, the Veteran described noise exposure from military weapon ranges and training exercises, specifically small arms fire, and grenade and artillery simulators Therefore, the elements of a current diagnosis and in-service incurrence were met.

At the June 2020 VA audiological examination, the onset of tinnitus was reported as unknown. The examiner opined that the Veteran's tinnitus was less likely as not related to military noise exposure. In support of this opinion, the examiner noted that while there was no entrance or exit examination in the file, the Veteran had denied tinnitus on a 2008 audiological examination and did not report tinnitus on a 2010 audiological examination. However, the lack of diagnosis is an insufficient basis for a negative opinion. See Hensley v. Brown, 5 Vet. App. 155 (1993).

In contrast, in a copy of a September 2023 Hearing Loss and Tinnitus DBQ submitted in June 2025, the examiner provided a positive nexus to service. The examiner noted that the Veteran reported onset of tinnitus in May 2008 on an M16 weapons qualification range and stated that individuals who reliably have ringing in their ears after noise exposure probably have experienced an injury to the auditory system in the form of at least a significant threshold shift. In this regard, the examiner noted that there was no enlistment audiogram to determine if there were any significant changes in hearing threshold or hearing loss was present at enlistment. However, the examiner observed that audiometric data dated in September 2010 revealed a mild hearing loss for the left ear, and an audiogram dated in June 2012 showed a moderate to mild hearing loss for the left. The examiner also indicated that Hearing Conservation Data audiograms dated in September 2011 and May 2015 revealed a significant threshold shift when compared to the reference audiogram dated in June 2006. Therefore, the examiner concluded that the Veteran's tinnitus was at least as likely as not the result of military noise exposure.

A copy of an October 2024 Hearing Loss and Tinnitus DBQ received in June 2025 also provided a positive nexus. The examiner noted that the Veteran reported onset of tinnitus in 2008/2009 after exposure to range noise. The examiner observed that the Veteran had an MOS of Intelligence Officer and was assigned to Infantry Brigade, which was consistent with military personnel records, and which indicated exposure to weapons, mortars, artillery and hand grenades. The examiner stated that such noise exposure was known in research to cause damage to hair cells in the cochlea which could lead to hearing loss and/or tinnitus. The examiner reported that there was no enlistment audiogram but observed that there was evidence of a threshold shift in the right ear on an audiogram dated in May 2015. The examiner concluded that a nexus was established.

In light of these opinions, the Board determines that the evidence in favor of and against finding a nexus between the Veteran's tinnitus and his military service is at least in equipoise. Therefore, his tinnitus is at least as likely as not a result of his military service. The appeal is granted.

Entitlement to service connection left and knee patellofemoral syndrome.

The Board notes that the Veteran claimed service connection for disorders of the left and right knees as secondary to his low back disability. See April 2020 VA Form 21-526EZ. However, the Board will consider all potential theories of entitlement.

Initially, the February 2021 rating decision rendered a favorable finding of current diagnoses of left knee strain and right knee strain, which is consistent with findings in a September 2020 VA Knee and Lower Leg DBQ. In addition, in June 2025, the Veteran submitted a copy of an October 2024 VA opinion in which the examiner noted diagnoses of patellofemoral pain syndrome in the left and right knees. Therefore, the criterion of a current disability is established.

There is also evidence of disease, event, or injury in service. Specifically, the Veteran has described in medical evidence, including VA examinations, and lay statements how during service in November 2009, he experienced a hard landing after a parachute jump when his suspension lines became entangled with another jumper's suspension lines. See, e.g., April 2020 Memorandum for Record. Thus, the criterion of in-service incurrence is also met.

At the September 2020 VA Knee and Lower Leg DBQ, the examiner opined that the Veteran's left and right knee disabilities were less likely as not related to military noise exposure. The rationale for the opinion was that the claims file was negative for evaluation, treatment or diagnosis of a bilateral knee disorder during or within a year post-service. The examiner stated that a nexus was not established. However, the opinion relied on the lack of evidence of a knee disability in service treatment records, which renders the opinion inadequate. See Hensley, supra.

Another negative VA opinion was received in January 2021. The examiner specifically considered the Veteran's reported in-service injury during a parachute jump but upon reviewing relevant research found that, while data supported acute injury associated with parachute jumps, there was no evidence of late onset disorders associated with parachute jumps. Therefore, the examiner concluded that the Veteran's left and right knee strains were less likely than not incurred in or caused by any Airborne School jumps done more than 10 years ago. The examiner stated that a nexus was not established.

In contrast, in the aforementioned October 2024 VA opinions, the examiner found that the left and right patellofemoral pain syndrome was at least as likely as not a result of military service. The examiner acknowledged that service treatment records
was received in January 2021. The examiner specifically considered the Veteran's reported in-service injury during a parachute jump but upon reviewing relevant research found that, while data supported acute injury associated with parachute jumps, there was no evidence of late onset disorders associated with parachute jumps. Therefore, the examiner concluded that the Veteran's left and right knee strains were less likely than not incurred in or caused by any Airborne School jumps done more than 10 years ago. The examiner stated that a nexus was not established.

In contrast, in the aforementioned October 2024 VA opinions, the examiner found that the left and right patellofemoral pain syndrome was at least as likely as not a result of military service. The examiner acknowledged that service treatment records (STRs) were negative for recurrent symptoms, evaluation, diagnosis, or treatment for chronic disorder related to the Veteran's knees. However, the examiner observed that the Veteran's military records showed that he was awarded a parachutist badge and that it was a known medical fact that parachuting put abnormal, traumatic pressure on joints, especially the knees, feet, ankles, hips and spine, and as a result, chronic joint disabilities usually followed.

The examiner also indicated that there was documentation confirming the Veteran's line of duty parachute injury in 2009 which included a hard landing. Therefore, the examiner concluded that the evidence was at least in equipoise if not reflective of a greater likelihood that the Veteran's current left and right knee symptoms and diagnosis were directly related to an in-service injury and had their onset in service.

As discussed, the first VA opinion received in September 2020 was inadequate. The January 2021 and October 2024 VA opinions reflect consideration of the Veteran's parachute jumps and injury in service, as well as medical literature on the subject, but the examiners reached different conclusions regarding etiology. The Board, therefore, finds that these opinions are at least in equipoise.

Accordingly, resolving all reasonable doubt in the Veteran's favor, the Board determines that his left and right knee patellofemoral pain syndrome was incurred in military service. The appeals are granted.

REASONS FOR REMAND

Pursuant to the modernized review system, also known as the Appeals Modernization Act (AMA), an appeal may be remanded to correct an error in development or adjudication that was made prior to the decision on appeal.

Entitlement to service connection for MTSS, left leg is remanded.

Entitlement to service connection for MTSS, right leg is remanded.

In a November 2020 statement, the Veteran described having pain in his shins as a result of daily physical training in service, which included running up to 6 miles and road marches of 12 miles while carrying up to 50 pounds. He reported that his Commander and First Sergeant told him he had shin splints and allowed him to do alternative physical training until the pain subsided. He denied seeking medical treatment for the shin pain in service. He described having lower leg pain since service and indicated that he was referred to orthopedics and diagnosed with shin splints after reporting the pain during September to October 2020 physical therapy for his back.

A September 2020 VA Knee and Lower Leg DBQ did not note a diagnosis of shin splints. However, the examiner indicated that the Veteran had had a diagnosis but that the condition was acute and had resolved. No opinion was requested for the MTSS claim, and the examiner did not provide one.

Nevertheless, for rating purposes, the Veteran is considered to have a current disability if it was present contemporaneous with the claim, or proximate thereto, but had resolved. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Therefore, an opinion should have been obtained regarding the MTSS. Not doing so was a pre-decisional error.

Entitlement to service connection for hemorrhoids is remanded.

In an April 2020 Memorandum of Record, the Veteran described experiencing intermittent bleeding in his stool in service, particularly in connection with field exercises. In an August 2024 statement (received in June 2025), he stated that he first noticed hemorrhoid symptoms after a field training exercise in December 2009. He denied seeking treatment in service, but he is competent to speak to the symptoms he experienced.

A September 2009 VA examiner noted the Veteran's report of hemorrhoid symptoms starting in service when he noticed rectal bleeding in 2008 and that the symptoms had progressed since service. The examiner diagnosed hemorrhoids but found that the disorder was less likely as not related to military service. The rationale for the opinion was that the claims file was negative for evaluation, treatment or diagnosis of hemorrhoids during or within a year
stool in service, particularly in connection with field exercises. In an August 2024 statement (received in June 2025), he stated that he first noticed hemorrhoid symptoms after a field training exercise in December 2009. He denied seeking treatment in service, but he is competent to speak to the symptoms he experienced.

A September 2009 VA examiner noted the Veteran's report of hemorrhoid symptoms starting in service when he noticed rectal bleeding in 2008 and that the symptoms had progressed since service. The examiner diagnosed hemorrhoids but found that the disorder was less likely as not related to military service. The rationale for the opinion was that the claims file was negative for evaluation, treatment or diagnosis of hemorrhoids during or within a year post-service. As discussed above, the lack of findings of a disorder in service treatment records is an insufficient rationale for a negative opinion. See Hensley, supra. Further, this opinion did not consider the Veteran's self-report of hemorrhoid symptoms in service and since or explain why his statements were apparently discounted.

There is no other opinion of record regarding the etiology of the Veteran's hemorrhoids, and not obtaining an adequate opinion prior to the initial decision was a pre-decisional error.

The matters are REMANDED for the following actions:

1. Obtain an addendum opinion as to the etiology of the Veteran's MTSS of the left and right legs. The clinician must review the claims file, including a copy of this remand, and then respond to the following:

" Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any MTSS of the left and right legs diagnosed during the appeal period had its onset in or is a result of the Veteran's military service?

The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, the examiner should provide a reason for doing so.

If the examiner determines that a physical examination of the Veteran is needed in order to provide the requested medical opinion, such should be arranged.

A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question.

2. Obtain an addendum opinion as to the etiology of the Veteran's hemorrhoid disorder. The clinician must review the claims file, including a copy of this remand, and then respond to the following:

" Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any hemorrhoid disorder diagnosed during the appeal period had its onset in or is a result of the Veteran's military service?

If the examiner determines that a physical examination of the Veteran is needed in order to provide the requested medical opinion, such should be arranged.

A. ISHIZAWAR

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board K.M. Schaefer, 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.

.F.R. § 20.1303.

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