NASAL SEPTUM DEVIATION OF

MICHAEL MARTIN · 2026 · Case ID: A26040136

MIXED

Summary

The Veteran, who served in the Marine Corps from January 2017 to January 2021, appeals the denial of service connection for multiple conditions, including deviated nasal septum, anxiety, sleep disturbance, erectile dysfunction, headaches, acid reflux, hypertension, irritable bowel syndrome, jaw, left shoulder, bilateral wrists, left ankle, and left foot conditions, as well as hearing loss and a pilonidal cyst. The Board granted service connection for a deviated nasal septum, finding the Veteran's lay statements credible and the evidence in approximate balance, resolving any doubt in his favor. For all other claimed conditions, the Board denied service connection, citing a lack of probative evidence of current disability or a link to service. The service treatment records were largely absent of complaints or diagnoses for these denied conditions, and post-service records did not establish them either. The Veteran's own assertions were deemed not probative for establishing disability or nexus. The Board also noted the Veteran's failure to attend scheduled VA examinations for several denied conditions, stating the duty to assist is not one-way and a decision must be made on the existing record. The case was remanded for further VA examinations for depressive disorder, left hip, right hip, right ankle, and right foot conditions, as the threshold for providing examinations was met but not fulfilled by the RO. The Board found the evidence weighed against these remanded claims, and the examiner is to provide opinions on nexus and aggravation.

Rationale

Benefit of the doubt applied; Lay statements found credible and probative; Evidence in approximate balance

Service Branch

MARINE CORPS

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250430-543287

Full Decision Text

Citation Nr: A26040136
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 250430-543287
DATE: April 29, 2026

ORDER

Entitlement to service connection for deviated nasal septum is granted.

Entitlement to service connection for anxiety and sleep disturbance is denied.

Entitlement to service connection for erectile dysfunction, also claimed as low testosterone, is denied.

Entitlement to service connection for headaches is denied.

Entitlement to service connection for acid reflux is denied.

Entitlement to service connection for hypertension (high blood pressure) is denied.

Entitlement to service connection for irritable bowel syndrome is denied.

Entitlement to service connection for a jaw condition is denied.

Entitlement to service connection for a left shoulder condition is denied.

Entitlement to service connection for a left wrist condition is denied.

Entitlement to service connection for a right wrist condition is denied.

Entitlement to service connection for a left ankle condition is denied.

Entitlement to service connection for a left foot condition is denied.

Entitlement to service connection for hearing loss is denied.

Entitlement to service connection for pilonidal cyst (tailbone) is denied.

REMANDED

Entitlement to service connection for depressive disorder is remanded.

Entitlement to service connection for a left hip condition, claimed as greater trochanteric pain syndrome (lateral hip pain), is remanded.

Entitlement to service connection for a right hip condition, claimed as greater trochanteric pain syndrome (lateral hip pain), is remanded.

Entitlement to service connection for limitation of motion of right ankle, also claimed as limitation of range of motion, is remanded.

Entitlement to service connection for metatarsalgia, right foot, is remanded.

FINDINGS OF FACT

1. Affording the Veteran the benefit of the doubt, he currently has a deviated nasal septum that had its onset during his active service.

2. There is no probative evidence for consideration showing that the Veteran currently has a disability of anxiety and sleep disturbance, erectile dysfunction, headaches, acid reflux, hypertension, irritable bowel syndrome, a jaw condition, a left shoulder condition, a left wrist condition, a right wrist condition, a left ankle condition, or a left foot condition, or that he had such a disability at any time proximate to the pendency of the claim.

3. There is no probative evidence for consideration showing that the Veteran had a hearing loss disability, as defined in 38 C.F.R. § 3.385, during or proximate to the pendency of the claim.

4. There is no probative evidence for consideration showing that any current pilonidal cyst that the Veteran may have had during or in proximity to the pendency of the claim had its onset during his active service or may otherwise be related to an in-service event, injury, or disease.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for deviated nasal septum have 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 anxiety and sleep disturbance have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303.

3. The criteria for entitlement to service connection for erectile dysfunction, also claimed as low testosterone, have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303.

4. 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.

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

6. The criteria for entitlement to service connection for hypertension (high blood pressure) have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303.

7. The criteria for entitlement to service connection for irritable bowel syndrome have not been met.
159, 3.303.

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

6. The criteria for entitlement to service connection for hypertension (high blood pressure) have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303.

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

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

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

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

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

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

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

14. The criteria for entitlement to service connection for hearing loss have not been met. 38 U.S.C. §§ 1110, 5103, 5107A; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.385.

15. The criteria for entitlement to service connection for pilonidal cyst (tailbone) 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 January 2017 to January 2021.

The rating decisions on appeal were issued in July 2024 and April 2025 and constitute initial decisions.

In his April 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 July 2024 and April 2025 Regional Office (RO) decisions on appeal with respect to the issues decided in each of those decisions. 38 C.F.R. § 20.301. Any evidence submitted after the RO decision on appeal cannot be considered by the Board in considering the issues decided in each of those decisions. 38 C.F.R. §§ 20.300, 20.301, 20.801.

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
RO decision on appeal cannot be considered by the Board in considering the issues decided in each of those decisions. 38 C.F.R. §§ 20.300, 20.301, 20.801.

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 deviated nasal septum

The Veteran seeks to be service connected for a deviated septum. In a November 2024 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, the Veteran stated that the claimed deviated septum is due to "Blows to the face/nose from marine corps martial arts."

The Veteran's service treatment records show that he had normal clinical evaluations of the head, face, nose, and sinuses at the time of his February 2015 examination for entrance into active service. However, the evaluation of his sinuses at a December 2020 medical examination for separation from active service was abnormal for a left-of-center deviated septum.

There are no post-service medical treatment records documenting complaint of or treatment for a deviated septum. However, the Board finds that once a deviated nasal septum has been diagnosed by a competent medical profession, the continued presence of the deviated nasal septum is within the scope of lay observation. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). Therefore, the Veteran's reports that the deviated nasal septum diagnosed at the medical examination for separation from active service has continued through the present is considered competent evidence of a current disability that has existed since active service. The Board finds no reason to doubt the Veteran's credibility in that regard. Therefore, his lay statements are probative in establishing that he currently has a deviated nasal septum that had its onset during his active service.

Accordingly, the Board finds that the evidence is at least in approximate balance as to whether the Veteran has a current disability of a deviated nasal septum that had its onset during his active service. Any remaining doubt is resolved in the Veteran's favor, and the Board therefore concludes that entitlement to service connection for deviated nasal septum must be granted. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.
current disability that has existed since active service. The Board finds no reason to doubt the Veteran's credibility in that regard. Therefore, his lay statements are probative in establishing that he currently has a deviated nasal septum that had its onset during his active service.

2. Entitlement to service connection for anxiety and sleep disturbance

3. Entitlement to service connection for erectile dysfunction, also claimed as low testosterone

4. Entitlement to service connection for headaches

5. Entitlement to service connection for acid reflux

6. Entitlement to service connection for hypertension (high blood pressure)

7. Entitlement to service connection for irritable bowel syndrome

8. Entitlement to service connection for a jaw condition

9. Entitlement to service connection for a left shoulder condition

10. Entitlement to service connection for a left wrist condition

11. Entitlement to service connection for a right wrist condition

12. Entitlement to service connection for a left ankle condition

13. Entitlement to service connection for a left foot condition

The Veteran seeks to be service connected for anxiety and sleep disturbance; erectile dysfunction, which he also claimed as low testosterone; headaches; acid reflux; hypertension (high blood pressure); irritable bowel syndrome; and conditions of the jaw, left shoulder, bilateral wrists, left ankle, and left foot.

He did not present any contentions with regard to the claims for anxiety, erectile dysfunction, headaches, a jaw condition, a left shoulder condition, a bilateral wrist condition, a left ankle condition, and a left foot condition prior to issuance of the July 2024 rating decision on appeal as to those issues. However, in the November 2024 VA Form 21-526EZ, which was received only after issuance of the July 2024 rating decision, he stated that his erectile dysfunction or low testosterone is due to heavy drinking and tobacco use; his headaches or migraines are due to blows to the head from ground fighting; his jaw condition is related to grinding his teeth during his sleep and misalignment in his jaw due to blows to the head; his left shoulder condition is due to wear and tear from pullups, pushups, and ground fighting, and due to the strap of his backpack cutting off circulation; his wrist condition is due to pushups and doing self-defense techniques; his left ankle condition is due to sprains and twists from running, hiking, and rucking in full combat gear; and his left foot condition is related to constantly being on his feet, having wet socks, and not changing his socks for several days at a time. In a May 2025 VA Form 21-526EZ, which was also received only after issuance of the July 2024 rating decision, he asserted that he had anxiety during service due to consistent, excessive, and peristent worry and fear over everyday situations that started when he was in bootcamp and from experiencing a new stressful environment away from his family.

He did present contentions with regard to the claims for acid reflux, hypertension, and irritable bowel syndrome prior to issuance of the April 2025 rating decision on appeal as to those issues. Specifically, in his November 2024 claim, he asserted that his acid reflux is related to consuming energy drinks, eating hot sauce, and eating oranges; his hypertension is related to stress and diet in the military; and his irritable bowel syndrome is related to stress and diet, irregular eating habits that included not eating for several days and then binge eating, and irregular diet including eating MREs and chow hall food.

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 there is no probative evidence for consideration that the Veteran had a current diagnosis of anxiety or sleep disturbance, erectile dysfunction or low testosterone, headaches, an acid reflux disability, hypertension, irritable bowel syndrome, or disabilities of the jaw, left shoulder, bilateral wrists, left ankle, or left foot and did not have such a diagnosis at any time during the pendency of the claims or recent to the filing of the claims. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (
at least as likely as not related to an in-service injury, event, or disease.

The service treatment records are absent for any complaint of or treatment for anxiety, sleep disturbance, erectile dysfunction, headaches, acid reflux, hypertension, irritable bowel syndrome, or conditions of the jaw, left shoulder, bilateral wrists, left ankle, or left foot. He denied anxiety, headaches, and bone, joint, muscle, and nerve problems on an October 2017 driver health history report. He denied current health concerns and reported excellent general overall health at a December 2017 periodic health assessment. He denied headaches or pain at a December 2018 periodic health assessment. Although he reported left shoulder pain, left wrist pain, headaches, and difficulty falling and staying asleep on an October 2020 report of medical history for separation from active service, the October 2020 report of medical examination for separation from active service shows that he had normal evaluations of the head, heart, chest, vascular system, upper extremities, lower extremities, feet, and neurological system, and that he had a normal psychiatric evaluation. No diagnosis was provided regarding the left shoulder pain, left wrist pain, headaches, and sleep difficulties the Veteran reported on the October 2020 report of medical history. A December 2020 mental health questionnaire shows that he reported that he was "superalert" or watchful and had trouble falling or staying asleep "A little bit", but denied any other psychiatric symptoms in the prior month. The service treatment records also do not show that the Veteran was diagnosed with hypertension or that he had blood pressure readings within VA's regulatory definition of hypertension, which is found in 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1). Accordingly, the service treatment records do not show that the Veteran was diagnosed with the claimed disabilities in proximity to the claims.

The post-service medical treatment records for consideration also show no diagnoses for such disabilities. They show that in January 2023 the Veteran reported pain in the feet, ankles, lower back, wrists, knees, and shoulders, but that he was not diagnosed any particular condition relating to those complaints. He also reported fatigue and anxiety, and was therefore referred for mental health treatment. However, on referral he stated that he was not interested in mental health care, but that he wanted to a file a claim and was feeling "fine, just making sure I have things set up." No diagnosis was provided through that referral. The post-service medical treatment records also do not show that the Veteran was diagnosed with hypertension or that he had blood pressure readings within VA's regulatory definition of hypertension. Accordingly, the post-service medical treatment records also do not show that the Veteran was diagnosed with the claimed disabilities during or in proximity to the claims.

The Board has considered the Veteran's assertions in the November 2024 and May 2025 VA Forms 21-526EZ. However, the Veteran is not considered competent to diagnose a specific disability or to relate a disability to a particular cause, as doing so requires medical knowledge and expertise that he has not been shown to possess. 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 in either establishing the existence of a current service-connectable disability or establishing a link between a current disability and his active service.

The record shows that, prior to issuing the July 2024 rating decision, the RO attempted to schedule the Veteran for VA examinations in relation to his claimed headaches and for conditions of the jaw, left shoulder, bilateral wrists, left ankle, and left foot. However, the Veteran did not report for examinations scheduled in June 2024. Although VA has a duty to assist the Veteran in substantiating his claims, that duty is not a one-way street. The Veteran must cooperate in VA's efforts to assist him. Woods v. Gober, 14 Vet. App. 214, 224 (2000); see also Hurd v. West, 13 Vet. App. 449, 452 (2000); 38 C.F.R. § 3.159(c). There is no indication in the record that the RO's efforts to contact the Veteran to schedule the examinations were inadequate. The May 2024 letter informing the Veteran that examinations would be scheduled was returned to VA as undeliverable. However, that letter was properly sent to the Veteran's last address of record, and there is no indication that the Veteran informed the RO of a new address prior to the July 2024 being issued. Moreover, the Veteran has not presented good cause for not reporting to the June 2024 examinations. As a result, the Board must make a decision based on the evidence for consideration. See 38 C.F.R. § 3.655 (When a claimant, without good cause, fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record).

The Veteran was not afforded VA examinations as to the claimed anxiety and sleep disturbance, erectile dysfunction and low testosterone, acid reflux, irritable bowel syndrome, and hypertension. VA will provide a medical examination when there is: (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service or establishing that certain diseases manifested during an applicable presumptive period for which the veteran qualifies; and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability; but insufficient competent medical evidence on file for VA to make a decision on the claim. 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). In this case, at the time of issuance of the July 2024 rating decision, there was no indication in the record that the Veteran had a diagnosis of an anxiety disorder, erectile dysfunction, or a low testosterone disability, and there was no evidence of an in-service event, injury, or disease to which such conditions could be related. At the time of issuance of the April 2025 rating decision, there was no evidence that the Veteran had a current acid reflux disability, irritable bowel syndrome, or hypertension. Therefore, the threshold for providing such examinations was not met prior to issuance of the respective rating decisions, and no such examination was required.

In summary, there is no probative evidence for consideration showing that the Veteran currently has a disability of anxiety and sleep disturbance, erectile dysfunction, headaches, acid reflux, hypertension, irritable bowel syndrome, a jaw condition, a left shoulder condition, a left wrist condition, a right wrist condition, a left ankle condition, or a left foot condition, or that he had such a disability at any time proximate to the pendency of the claim.. In view of the foregoing, the Board concludes that the evidence for and against the claims is not in approximate balance, but rather weighs against the claims. Because there is not an approximate balance in the weight of the evidence, the doctrine of reasonable doubt is not for application, and the claims must be denied. 38 U.S.C. § 5107(b); Lynch, 21 F.4th 776.

14. Entitlement to service connection for hearing loss

The Veteran seeks to be service connected for hearing loss, which he contends is due to in-service exposure to noise.

For the purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies of 500, 1,000, 2,000, 3,000 and 4,000 Hertz (Hz) is 40 decibels (dB) or greater; or when the thresholds for at least 3 of these frequencies are 26 dB or greater; or when speech recognition
38 U.S.C. § 5107(b); Lynch, 21 F.4th 776.

14. Entitlement to service connection for hearing loss

The Veteran seeks to be service connected for hearing loss, which he contends is due to in-service exposure to noise.

The question for the Board is whether the Veteran has a bilateral hearing loss disability that began during service or is related to an in-service event, injury, or disease.

The record does not show that the Veteran had a right or left ear hearing loss disability for VA purposes, as defined by 38 C.F.R. § 3.385, at any time during the review period or in proximity to the claim for service connection. See Romanowsky, 26 Vet. App. at 294; McClain, 21 Vet. App. at 321.

The medical treatment records for consideration do not include any testing that shows the Veteran had a hearing loss disability in either ear during or in proximity to the pendency of the claim. The results of testing conducted at a March 2025 VA hearing loss and tinnitus examination were as follows:

HERTZ

500 1000 2000 3000 4000

RIGHT 10 5 10 15 10

LEFT 15 20 20 35 25

Speech audiometry using the Maryland CNC word list revealed speech recognition scores of 96 percent in the right ear and 100 percent in the left ear. The audiometric and speech recognition findings at the March 2025 VA examination do not reflect a right or left ear hearing loss disability for VA purposes, as defined in 38 C.F.R. § 3.385.

The Board acknowledges the Veteran's assertions that he has hearing loss. The Veteran, as a lay witness, is competent to report that he has difficulty hearing; however, he is not considered competent to diagnose a hearing loss disability for VA compensation purposes. See Layno, 6 Vet. App. at 469; Kahana, 24 Vet. App. 428; Jandreau, 492 F.3d at 1376-77. Diagnosing a hearing loss disability for VA purposes requires specialized diagnostic testing. The Veteran has not been shown to possess the medical knowledge and expertise to make such medical determinations. Therefore, his contentions do not constitute competent evidence that he has a current hearing loss disability for VA purposes. As such, his statements do not weigh against the probative value of the objective audiological test results of record, which do not reflect auditory thresholds or speech recognition scores that satisfy the criteria for a hearing loss disability under 38 C.F.R. § 3.385.

As discussed 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. Without evidence of a current hearing loss disability, the Board need not address the other elements of service connection. 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.

15. Entitlement to service connection for pilonidal cyst (tailbone)

The Veteran seeks to be service connected for a pilonidal cyst. He has not presented any contentions as to why he believes the claimed disability is 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, although the post service treatment records mention a history of treatment for a pilonidal cyst with excision in November 2021, there is no probative evidence for consideration showing that any pilonidal cyst that the Veteran may have had was incurred in active service or is otherwise related to an in-service event, injury, or disease.

The service treatment records show no complaint
to be service connected for a pilonidal cyst. He has not presented any contentions as to why he believes the claimed disability is 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 service treatment records show no complaint of or treatment for a pilonidal cyst. The only mention of a pilonidal cyst in the medical treatment records for consideration is in a January 2023 VA treatment note, which states that the Veteran reported a prior surgical history of "excision of pilonidal cyst 11/22/21". November 2021 was more than 10 months after the Veteran's separation from active service. As stated above, the Veteran has presented no contentions as to the claim that might place the onset or initial diagnosis of a pilonidal cyst during his active service or that might otherwise link a current pilonidal cyst to an in-service event, injury, or disease.

In summary, there is no probative evidence for consideration showing that any current pilonidal that the Veteran may have had during or in proximity to the pendency of the claim had its onset during his active service or may otherwise be 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 depressive disorder is remanded.

2. Entitlement to service connection for a left hip condition, claimed as greater trochanteric pain syndrome (lateral hip pain), is remanded.

3. Entitlement to service connection for a right hip condition, claimed as greater trochanteric pain syndrome (lateral hip pain), is remanded.

4. Entitlement to service connection for limitation of motion of right ankle, also claimed as limitation of range of motion, is remanded.

5. Entitlement to service connection for metatarsalgia, right foot, is remanded.

The Board finds that the low threshold for providing examinations as to the claimed depressive disorder, left hip condition, right hip condition, right ankle condition, and right foot condition were met at the time that the April 2025 rating decision was issued. However, no such examination was provided. Therefore, the issues must be remanded so that he may be afforded VA examinations as to the claims.

The matters are REMANDED for the following action:

1. Schedule the Veteran for a VA examination for the claimed depressive disorder.

The examiner is asked to provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any diagnosed depressive disorder had its onset during active service or may otherwise be related to an in-service event, injury, or disease.

The opinion must reflect consideration of the Veteran's contentions regarding the claimed disability on his November 2024 VA Form 21-526EZ as to the claim. It should also consider the Veteran's report of frequent trouble sleep on the October 2020 report of medical history for separation from active service.

2. Schedule the Veteran for VA examinations for the claimed left hip condition, right hip condition, right ankle condition, and right foot condition.

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

The examiner is asked to provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any left hip disability, right hip disability, and/or right ankle disability had its onset during his active service or may otherwise be related to an in-service event, injury, or disease.

Regarding the Veteran's claimed metatarsalgia of the right foot, the examiner is asked to provide an opinion as to whether it is at least as likely as not that the right foot fracture of the 5th metatarsal noted at the time of the Veteran's examination for entrance into active service was permanently aggravated
a "disability" for the purpose of providing the opinion requested below.

Regarding the Veteran's claimed metatarsalgia of the right foot, the examiner is asked to provide an opinion as to whether it is at least as likely as not that the right foot fracture of the 5th metatarsal noted at the time of the Veteran's examination for entrance into active service was permanently aggravated during his active service. The opinion must reflect consideration of the Veteran's report of recurring pain on the outer side of the right foot on his October 2020 report of medical history for separation from active service.

The opinion must reflect consideration of the Veteran's contentions regarding the claimed left hip condition, right hip condition, right ankle condition, and right foot condition in his November 2024 VA Form 21-526EZ, Application for Disability Compensation and Related Compensation Benefits, as to the claim. He has attributed those conditions to walking in boots; spraining or twisting his ankles while running, hiking, and rucking in full combat gear; constantly being on his feet, wearing wet socks, and not changing his socks for days at a time.

In providing the requested opinion, 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?

(Continued on the next page)

This remand is interlocutory in nature, and the Board intimates no opinion as to the credibility of the Veteran's lay reports of his symptoms. See Miller v. Wilkie, 32 Vet. App. 249, 259-62 (2020) (A medical opinion may inform the Board's understanding of the medical feasibility and credibility of lay statements). The examiner may determine those reports not to be credible based on factors such as internal consistency, facial plausibility, and consistency with other information. See Caluza v. Brown, 7 Vet. App. 498 (1995). The examiner may also consider a lack of contemporaneous medical treatment records documenting complaints or treatment for the reported symptoms. However, the examiner may not rely solely on a lack of such records. In other words, a lack of contemporaneous medical treatment records must be considered only in conjunction with other credibility factors. See 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).

MICHAEL MARTIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board T. J. Anthony, 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.

Analyze in VA Law Explorer