DERMATOPHYTOSIS (RINGWORM)

Summary

The Veteran, an Air Force Veteran who served from June 1993 to October 1993, appeals the denial of service connection for pseudofolliculitis barbae (PFB) and the remand of claims for obstructive sleep apnea and hypertension. The Veteran sought readjudication of his PFB claim, which was initially denied in April 2019. He later submitted a supplemental claim in July 2019, followed by a higher-level review request in April 2020. The Board's August 2021 decision reviewed the PFB claim based on evidence from the April 2019 decision, while the sleep apnea and hypertension claims were reviewed based on evidence from the December 2019 supplemental claim decision. The Board found a July 1993 service treatment record noting a PFB diagnosis and treatment, along with the Veteran's credible testimony at a November 2024 hearing regarding continuity of symptoms, sufficient to grant service connection for PFB. The Board applied the benefit of the doubt, finding the evidence did not persuasively weigh against service connection. The claims for obstructive sleep apnea and hypertension were remanded. For sleep apnea, the Board found a low threshold met for potential nexus to service, warranting a VA examination to determine etiology. The hypertension claim was remanded as secondary to the sleep apnea claim, as it was inextricably intertwined. Service connection for PFB was granted.

Rationale

July 1993 service treatment record notes diagnosis and treatment for PFB; Veteran's testimony at November 2024 hearing is credible; Credible reports of continuity of symptoms; Benefit of the doubt resolved in Veteran's favor

Full Decision Text

Citation Nr: A26040186
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 210730-176014
DATE: April 29, 2026

ORDER

Service connection for pseudofolliculitis barbae (PFB) is granted.

REMANDED

Service connection for obstructive sleep apnea is remanded.

Service connection for hypertension is remanded.

FINDING OF FACT

The evidence reasonably supports a finding that the Veteran's PFB is etiologically related to his active duty service.

CONCLUSION OF LAW

With resolution of reasonable doubt in the Veteran's favor, the criteria for a grant of service connection for PFB have been met.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.  

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the Air Force from June 1993 to October 1993.

With regard to the PFB claim, the rating decision that led to this appeal was issued in April 2019 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In July 2019, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of service connection for obstructive sleep apnea and high blood pressure, most recently addressed in a June 2018 rating decision.  In December 2019, the Agency of Original Jurisdiction (AOJ) issued a supplemental claim decision, which found that new and relevant evidence had been received and denied the claim based on the evidence of record at the time of that decision.  

In April 2020, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of the April 2019 and December 2019 decisions.  In August 2020, the AOJ issued the HLR decision on appeal, which considered the evidence of record at the time of the prior April 2019 decision with regard to the PFB claim and December 2019 decision with regard to the sleep apnea and hypertension claims.  

In the August 7, 2021 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket.  A Board hearing was held on November 4, 2024.  Therefore, the Board may only consider the evidence of record at the time of the April 2019 decision with regard to the PFB claim and the December 2019 decision with regard to the sleep apnea and hypertension claims, which were subsequently subject to higher-level review, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing.  38 C.F.R. § 20.302(a). 

Evidence was added to the claims file with the April 2020 HLR request, which was during a period of time when new evidence was not allowed.  As the Board is deciding the PFB claim, it may not consider this evidence in its decision with regard to that claim.  38 C.F.R. § 20.300.  The Veteran may file a Supplemental Claim 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 claim, considering the new evidence in addition to the evidence previously considered.  Id.  Specific instructions for filing a Supplemental Claim are included with this decision.  As the Board is remanding the sleep apnea and hypertension claims for further development, this additional evidence will be considered by the AOJ in the adjudication of those claims.

1. PFB

The Veteran contends that he has PFB that had its onset during active duty service.

Service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service.  38 U.S.C. § 1110; 38 C.F.R. § 3.303.  Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service.  38 C.F.R. § 3.303(d).

Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. 
 resulting from disease or injury incurred in or aggravated by service.  38 U.S.C. § 1110; 38 C.F.R. § 3.303.  Regulations also provide that service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service.  38 C.F.R. § 3.303(d).

Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury.  Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). 

The benefit of the doubt rule provides that a veteran will prevail in a case where the positive evidence is in approximate balance with the negative evidence.  38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.  It is only when the weight of the evidence is persuasively against the claim that the claim must be denied.  Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).     

A July 1993 service treatment record notes that the Veteran was placed on a profile for PFB, with a recommendation to shave with clippers instead of a razor.  

During the November 2024 hearing, the Veteran testified that his symptoms had continued to the present and that he had not sought treatment because he was already using clippers and figured that nothing more could be done.  His testimony is credible.  

The record includes a service treatment records noting a diagnosis of and treatment for PFB and credible reports of continuity of symptoms.  PFB is a type of disorder associated with symptoms capable of lay observation.  In light of the totality of the circumstances, and after resolving all reasonable doubt in the Veteran's favor, the evidence does not weigh persuasively against finding that the Veteran's PFB is not etiologically related to his active duty service.  Accordingly, the Board finds that granting service connection for PFB is the decision that is the most consistent with VA's policy to administer the law under a broad and liberal interpretation consistent with the facts of the case. 38 C.F.R. § 3.303(a).

REASONS FOR REMAND

With regard to all of the issues remanded below, the Board emphasizes that it is not determining whether or not the Veteran's or others' lay statements, including regarding the onset and continuity of symptoms, are credible at this time, as the additional development set forth in the directives below could impact that determination.  Although the Board is requesting medical opinions regarding the lay contentions, this is for thoroughness and not based on a finding that the contentions are credible.  

1. Service connection for obstructive sleep apnea is remanded.

VA must provide an examination with regard to a claim for disability compensation when there is competent evidence of a disability that may be associated with an in-service disease, injury or event, but there is insufficient information to make a decision on the claim.  See McLendon v. Nicholson, 20 Vet. App. 79 (2006).  VA has conceded that he has a current diagnosis of obstructive sleep apnea and, in July 2019, he submitted multiple statements reporting that his symptoms had their onset during his active duty service and continued thereafter.  The threshold for determining whether the evidence "indicates" that there "may" be a nexus between a current disability and an in-service event, injury, or disease is a low one.  Id. at 83.  This evidence meets that threshold.  Because this error in the duty to assist occurred prior to the rating decision on appeal, a remand is warranted to afford the Veteran a VA examination.  

2. Service connection for hypertension is remanded.

The Veteran contends that his hypertension is secondary to his obstructive sleep apnea.  For that reason, his claim for service connection for this issue is inextricably intertwined with this remand and the Board cannot fairly proceed in adjudicating it until the sleep apnea claim has been resolved.  See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991); see also Tyrues v. Shinseki, 23 Vet. App. 166, 178 (2009).  No development will be requested for this issue because no predecisional duty to assist error is identified.

The matters are REMANDED for the following action:

1. Arrange for an examination by an appropriate clinician for the purpose of determining the etiology of the Veteran's obstructive sleep apnea
 reason, his claim for service connection for this issue is inextricably intertwined with this remand and the Board cannot fairly proceed in adjudicating it until the sleep apnea claim has been resolved.  See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991); see also Tyrues v. Shinseki, 23 Vet. App. 166, 178 (2009).  No development will be requested for this issue because no predecisional duty to assist error is identified.

The matters are REMANDED for the following action:

1. Arrange for an examination by an appropriate clinician for the purpose of determining the etiology of the Veteran's obstructive sleep apnea.? The entire claims file and a copy of this remand must be made available to the clinician for review.? 

The clinician must provide an opinion as to whether any sleep apnea during the period on appeal had its origin in service or is related to the Veteran's active service.  

Although an independent review of the claims file is required, the Board calls the clinician's attention to the statements the Veteran submitted in July 2019, including two from nurses who are competent to express medical opinions.

The rationale for any opinion expressed should be provided.  Note that the fact that a disability is not mentioned or diagnosed in treatment records cannot serve as the sole basis for a negative finding and that chronicity of care is not a requirement for service connection.  If an opinion cannot be made without resort to speculation, the clinician should so state and provide reasoning as to why a conclusion would be so outside the norm that such an opinion is not possible. 

 

 

LESLEY A. REIN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	R. Frank, 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.