Case A26040293

PAUL SORISIO · 2026 · Case ID: A26040293

MIXED

Summary

The Veteran, who served in the U.S. Army from January 2007 to March 2010, appeals several denials and remands from the Board of Veterans' Appeals. The Veteran sought service connection for headaches, eczema, hemorrhoids, a respiratory disorder, and obstructive sleep apnea (OSA), as well as increased ratings for IBS and hemorrhoids, and an earlier effective date for several claims. The Board granted an effective date of August 28, 2014, for the headache claim, finding it was continuously pursued since the initial August 2014 filing. Service connection for eczema was granted with an effective date of February 7, 2021, based on a timely supplemental claim following an intent to file. However, the Board denied service connection for hemorrhoids, respiratory disorder, and OSA, citing a lack of current diagnosis or insufficient evidence of nexus to service. The claim for an earlier effective date for hemorrhoids was also denied as no claim was filed prior to February 7, 2021. The Board granted a 30 percent rating for IBS for the entire period on appeal, finding the Veteran's symptoms met the criteria for severe IBS. The case was remanded for further development on TDIU, GERD, bilateral hearing loss, and eczema, due to duty to assist errors, including missing SSA wage information, conclusory medical opinions, and inadequate examinations.

Rationale

Claim continuously pursued since August 28, 2014.; Effective date of August 28, 2014, warranted.

Service Branch

ARMY

Special Benefit

TDIU

Docket No.

250502-539341

Full Decision Text

Citation Nr: A26040293
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 250502-539341
DATE: April 29, 2026

ORDER

An effective date of August 28, 2014, for the grant of service connection for tension headaches is granted.

An effective date of February 7, 2021, for eczema is granted.

An effective date prior to February 7, 2021, for the grant of service connection for hemorrhoids is denied.

Service connection for a respiratory disorder is denied.

Service connection for obstructive sleep apnea (OSA) is denied.

An initial compensable rating for hemorrhoids is denied.

An initial compensable rating for headaches is denied.

For the period on appeal, a rating of 30 percent, but no higher, for irritable bowel syndrome (IBS) is granted.

REMANDED

Entitlement to restoration of a total rating based on individual unemployability (TDIU) effective July 1, 2025, is remanded.

Entitlement to service connection for gastroesophageal reflux disease (GERD) is remanded.

Entitlement to service connection for bilateral hearing loss is remanded.

Entitlement to an initial compensable rating for eczema is remanded.

FINDINGS OF FACT

1. The Veteran submitted a claim for service connection for a headache disorder on August 28, 2014, which remained pending prior to it was readjudicated on November 5, 2021.

2. The Veteran has continuously pursued his headache claim since November 5, 2021.

3. The Veteran's claim for eczema was initially denied in an August 2013 rating decision which became final when he did not appeal the denial or submit new and material evidence to reopen the claim within a year.

4. An intent to file was submitted on February 7, 2021, and within one year, the Veteran submitted a supplemental claim on September 7, 2021, that included a claim for service connection for eczema.

5. The record contains no informal claim, formal claim, or written intent to file reasonably related to a claim for entitlement to service connection for hemorrhoids prior to February 7, 2021.

6. The Veteran has not had a respiratory disorder diagnosis at any time during or approximate to the pendency of the claim.

7. The Veteran has not had an OSA diagnosis at any time during or approximate to the pendency of the claim.

8. During the rating period on appeal, the Veteran's hemorrhoids were mild to moderate without prolapsed internal hemorrhoids or external hemorrhoids with episodes of thrombosis.

9. During the rating period on appeal, the Veteran experienced headaches without characteristic prostrating attacks occurring on average once a month over the last several months or any functional impact.

10. For the rating period on appeal, the Veteran's IBS more nearly manifested as severe, with diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress.

CONCLUSIONS OF LAW

1. The criteria for an effective date of August 28, 2014, for the grant of service connection for a headache disorder are met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.156, 3.400.

2. The criteria for an effective date of February 7, 2021, for the grant of service connection for an eczema disorder are met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155, 3.156, 3.400, 3.2501(d).

3. The criteria for an effective date prior to February 7, 2021, for the grant of service connection for hemorrhoids are not met. 38 U.S.C. §§ 5107, 5110; 38 C.F.R. §§ 3.102, 3.1, 3.151, 3.114, 3.400.

4. The criteria for service connection for a respiratory disorder are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for service connection for OSA are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for an initial compensable rating for hemorrhoids are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.114, Diagnostic Code (DC
151, 3.114, 3.400.

4. The criteria for service connection for a respiratory disorder are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for service connection for OSA are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for an initial compensable rating for hemorrhoids are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.114, Diagnostic Code (DC) 7336.

7. The criteria for an initial compensable rating for migraine-headaches are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, DC 8100.

8. For the period on appeal prior to November 7, 2022, the criteria for a rating of 30 percent for IBS are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.114, DC 7319.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served in the United States Army from January 2007 to June 2007 and from September 2007 to March 2010.

A November 5, 2021, rating decision denied service connection for bilateral hearing loss. A July 11, 2022, rating decision continued a 10 percent rating for IBS, granted service connection for hemorrhoids, and denied service connection for a respiratory disorder, GERD, and OSA. The Veteran filed a supplemental claim in November 2022 for the claims from the above rating decisions.

A May 9, 2023, rating decision increased the rating for IBS to 30 percent effective March 1, 2023, continued the noncompensable rating for hemorrhoids, granted service connection with a noncompensable rating for eczema effective August 10, 2022, and continued the denials for bilateral hearing loss and OSA. A June 2, 2023, rating decision denied service connection for a respiratory disorder. A June 14, 2023, rating decision denied service connection for GERD and headaches. A November 15, 2023, rating decision granted TDIU effective July 3, 2023.

In November 2023, the Veteran submitted a higher-level review request of the May 9, 2023, rating decision (IBS effective date only; hemorrhoids and eczema increased ratings and effective dates; service connection for OSA and bilateral hearing loss); the June 2, 2023, rating decision (respiratory); June 14, 2023 (GERD and headaches); and November 15, 2023, rating decision (TDIU).

A May 1, 2024, rating decision granted an effective date of November 7, 2022, for TDIU and Dependents' Educational Assistance; an effective date of November 7, 2022 for the 30 percent IBS rating; continued the noncompensable ratings for hemorrhoids and eczema; denied an earlier effective date for eczema; denied service connection for bilateral hearing loss, respiratory disorder, and OSA, and identified duty to assist errors for service connection for GERD and headaches.

A September 11, 2024, rating decision granted service connection for headaches. An October 1, 2024, rating decision denied service connection for GERD. A March 6, 2025, rating decision discontinued TDIU effective June 1, 2025.

The Veteran timely appealed the May 1, 2024 rating decision (IBS rating, hemorrhoids/eczema rating and effective date, and service connection for bilateral hearing loss, respiratory disorder, and OSA), September 11, 2024 (headaches), October 1, 2024 (GERD), March 6, 2025 (TDIU) rating decision to the Board and requested the Board's Direct Review docket in a May 2, 2025 VA Form 10182. The Board recognizes some of the ratings decisions listed above included additional issues. However, the Veteran only appealed the above issues.

Based upon the selection of the Direct Review do
effective June 1, 2025.

Based upon the selection of the Direct Review docket, the Board may consider the evidence of record as of May 9, 2023 (IBS effective date, hemorrhoids/eczema increased rating and effective dates, service connection for bilateral hearing loss and OSA), and June 2, 2023 (respiratory disorder)-the dates of the rating decisions which prompted the higher-level review requested. 38 C.F.R. § 20.301. Additionally, the Board may only consider the evidence of record as September 11, 2024 (headaches - duty to assist error identified after the November 2023 higher-level review request), October 1, 2024 (GERD - duty to assist error identified after the November 2023 higher-level review request), and March 6, 2025 (TDIU)-the dates of the remaining rating decisions on appeal. See 38 C.F.R. § 20.301. If the Veteran submitted evidence that was added to the record after May 9, 2023, June 2, 2023, September 11, 2024, October 1, 2024, and March 6, 2025, the Board did not consider it. If the Veteran wishes to have VA consider any evidence that was not considered, a supplemental claim should be submitted identifying such evidence. February 7, 2021See 38 C.F.R. § 3.2501.

The Board recognizes the Veteran's attorney submitted a privacy request in April 2024. See 4/10/2024, SF 180 Request Pertaining to Military Records. However, the attorney was informed that additional information was needed in August 2024. See 8/21/2024, PA/FOIA No Signature Letter. No further information was provided by the Veteran or his representative, and as such, the Board does not find there is a pending privacy request.

Regarding the IBS claim, the Veteran's attorney contends the assignment of the 30 percent rating should be earlier than November 7, 2022. See 12/22/2023, VA Form 20-0996. Based on his contentions, and the procedural history of the Veteran's IBS disorder, the Board finds it more beneficial to the Veteran to recharacterize his claim as described above as an increased rating claim for the period on appeal.

Effective Date

The assignment of effective dates of awards is generally governed by 38 U.S.C. § 5110 and 38 C.F.R. § 3.400. Except as otherwise provided, the effective date of an evaluation and an award of pension, compensation, or dependency and indemnity compensation based on an original claim or a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim or the date the claim arose, whichever is later. 38 C.F.R. § 3.400. Generally, the effective date for the grant of service connection will be the day following separation from active service or the date entitlement arose, if the claim is received within one year after discharge from service.

Any communication or action indicating an intent to apply for one or more benefits under the laws administered by VA from a claimant may be considered an informal claim. Such informal claim must identify the benefit sought. Upon receipt of an informal claim, if the formal claim has not been filed, an application form will be forwarded to the claim for execution. If received within one year from the date it was sent to the claimant, it will be considered filed as of the date of the receipt of the formal claim. 38 C.F.R. § 3.155. "A claim for benefits, whether formal or informal, remains pending until it is finally adjudicated." Cogburn v. Shinseki, 24 Vet. App. 205, 210 (2010).

For claims for an increase in a service-connected disability, if an increase in disability occurred within one year prior to the claim, the increase is effective as of the date the increase was "factually ascertainable." If the increase occurred more than one year prior
will be forwarded to the claim for execution. If received within one year from the date it was sent to the claimant, it will be considered filed as of the date of the receipt of the formal claim. 38 C.F.R. § 3.155. "A claim for benefits, whether formal or informal, remains pending until it is finally adjudicated." Cogburn v. Shinseki, 24 Vet. App. 205, 210 (2010).

For claims for an increase in a service-connected disability, if an increase in disability occurred within one year prior to the claim, the increase is effective as of the date the increase was "factually ascertainable." If the increase occurred more than one year prior to the claim, the increase is effective the date of claim. If the increase occurred after the date of claim, the effective date is the date of increase. 38 U.S.C. § 5110(b)(3); 38 C.F.R. § 3.400(o); VAOPGCPREC 12-98.

There are specific provisions for claims regarding revision of a decision based on a supplemental claim and continuously pursued claims. At any time after VA issues notice of a decision on an issue within a claim, a claimant may file a supplemental claim. 38 C.F.R. § 3.2500(a)(2).

If a claimant continuously pursues an issue by timely filing in succession a supplemental claim, or other review options including a request a higher-level review, an appeal to the Board, or a notice of appeal to the Court of Appeals for Veterans Claims, the effective date will be fixed in accordance with the date of receipt of the initial claim or date entitlement arose, whichever is later. Continuous pursuit requires any review option be filed within one year of the issuance of the decision with which the Veteran disagrees. 38 C.F.R. § 3.2500(h)(1). As noted by the United States Court of Appeals for Veterans Claims (Court) in Calhoun v. McDonough, a continuously pursued claim under the AMA is not final, thus allowing for an effective date of an award as early as the date of the first claim in a continuously pursued claim. Calhoun v. McDonough, 37 Vet. App. 96 (2024).

1. Entitlement to an effective date prior to February 7, 2021, for the grant of service connection for tension headaches

The Veteran, through his attorney representative, contends an effective date prior to February 7, 2021, for the grant of service connection for headaches is warranted.

The Board will first address the procedural history of the Veteran's migraine/headaches claim. The Veteran filed a claim for his headaches on August 28, 2014. See 8/28/2014, VA 21-526EZ. His claim was denied in an April 2015 rating decision to which the Veteran submitted a notice of disagreement in February 2016. See 4/27/2015, Rating Decision - Narrative; 2/22/2016, NOD. A statement of the case (SOC) was issued on March 8, 2018. See 3/8/2018, SOC. The Veteran submitted a VA 21-526EZ within 60 days of the March 2018 SOC on April 25, 2018. See 4/25/2018, VA 21-526EZ. The Veteran was informed on May 1, 2018, that he had a pending appeal for headaches and that any additional evidence would be forward to the processing team. See 5/1/2018, Subsequent Development Letter.

The Veteran next filed a supplemental claim for his headaches on September 7, 2021. See 9/7/2021, VA Form 20-0995 Supplemental Claim. His claim was denied in November 2021, and the Veteran filed a supplemental claim for his headaches in November 2022 within one year of the prior denial. See 11/5/2021, Rating Decision - Narrative; 11/8/2021, Notification Letter; 11/7/2022, VA Form 20-0995. The Veteran's claim was again denied in a June 2023 rating decision. See 6/14/2023, Rating Decision. The Veteran requested higher-level review in December 2023, and a duty to assist error was identified in May 2024. See 12/22/2023, VA Form 20-0996; 5/1/2024, Rating Decision - Narrative. His claim was granted in a September 2024 rating decision and assigned an effective date of February 7, 2021. See 9/11/2024, Rating Decision
; 11/8/2021, Notification Letter; 11/7/2022, VA Form 20-0995. The Veteran's claim was again denied in a June 2023 rating decision. See 6/14/2023, Rating Decision. The Veteran requested higher-level review in December 2023, and a duty to assist error was identified in May 2024. See 12/22/2023, VA Form 20-0996; 5/1/2024, Rating Decision - Narrative. His claim was granted in a September 2024 rating decision and assigned an effective date of February 7, 2021. See 9/11/2024, Rating Decision - Narrative.

After a review of the record, the Board finds based on the above procedural history, the Board finds that the date of receipt of the claim was August 28, 2014, which remained pending until it was granted in the September 2024 rating decision. In this regard, the Veteran's initial claim was not finally adjudicated until the September 2024 rating decision, as the Veteran submitted a VA 21-526EZ within 60 days of his March 2018 SOC. The Board recognizes if this was an attempted appeal for the headache claim in the March 2018 SOC, it was not on the correct form. However, in May 2018, the AOJ informed the Veteran that he had a pending appeal for headaches and his 526EZ would be sent to the processing team. No further development or adjudication was done for the headaches claim. Additionally, the Veteran was not informed that his 526EZ was not the correct form to appeal the SOC. Also, a substantive appeal in the legacy system did not need to be on a VA Form 9 and it could be waived. See Percy v. Shinseki, 23 Vet. App. 37, 45-47 (2009). As such, the Board finds the Veteran's claim dates to August 28, 2014, when he first filed his claim for headaches, and it remained pending until September 2024 as he continuously pursued his headache claim once he filed his September 2021 supplemental claim. Here, an effective date is assigned based on the date of the claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. As such, an effective date of August 28, 2014, is warranted.

2. Entitlement to an effective date prior to August 10, 2022, for eczema

The Veteran, through his attorney representative, asserts entitlement to an effective date prior to August 10, 2022, for the grant of service connection for eczema.

Turning to the procedural history of the Veteran's claim, the Veteran first filed a claim for eczema in January 2012. See 1/25/2012, VA 21-526. His claim was denied in an August 2013 rating decision, and it became final when it was not appealed, and no new and material evidence was submitted. See 8/28/2013, Rating Decision - Narrative. As such, when the Veteran sought to reopen his claim in 2021, he needed to file a Supplemental Claim since he was seeking readjudication of a previously denied claim. 38 U.S.C.S. §§ 5104C(b), 5108.

The Veteran filed an intent to file on February 7, 2021. See 2/8/2021, Notification Letter. The Veteran filed a supplemental claim on September 7, 2021. See 9/7/2021, VA Form 20-0995 Supplemental Claim. His claim was denied in a November 2021 rating decision. See 11/5/2021, Rating Decision - Narrative; 11/8/2021, Notification Letter. He submitted an additional supplemental claim in November 2022. See 11/7/2022, VA Form 20-0995 Supplemental Claim. His claim was granted in May 2023 and assigned an effective date of August 10, 2022. See 5/9/2023, Rating Decision. The grant was based on the Veteran's exposures during service. While the AOJ characterized the grant as based on a toxic exposure presumptive, a review of the April 2023 medical opinion shows the positive nexus was that the Veteran had exposures during service and those exposures are known to cause the Veteran's eczema, rather than the Veteran's condition being a PACT Act presumptive disorder. See 4/25/2023, C&P Exam.

The PACT Act established additional presumptive diseases for
, VA Form 20-0995 Supplemental Claim. His claim was granted in May 2023 and assigned an effective date of August 10, 2022. See 5/9/2023, Rating Decision. The grant was based on the Veteran's exposures during service. While the AOJ characterized the grant as based on a toxic exposure presumptive, a review of the April 2023 medical opinion shows the positive nexus was that the Veteran had exposures during service and those exposures are known to cause the Veteran's eczema, rather than the Veteran's condition being a PACT Act presumptive disorder. See 4/25/2023, C&P Exam.

The PACT Act established additional presumptive diseases for in-service TERA. As applicable to Persian Gulf Veterans, the PACT Act also created a broader presumption for exposure to burn pits and other toxins (BPOT), to include fine particulate matter. However, the PACT Act did not establish eczema as a new or modified presumptive condition. 38 C.F.R. § 3.309; 38 U.S.C. § 1116(a)(2). That said, even if a disease is not listed as presumed, direct service connection must be presumed. See Combee v. Brown, 34 F.3d 1039, 1043-44 (Fed. Cir. 1994).

The Veteran next filed a higher-level review request in December 2023. See 12/22/2023, VA Form 20-0996. An earlier effective date was denied in May 2024. See 5/1/2024, Rating Decision - Narrative.

After review of the claims file, the Board finds an effective date of February 7, 2021. The Veteran filed an intent to file on February 7, 2021. The Veteran submitted a supplemental claim on September 7, 2021. The claims file shows this was received before his VA 21-526EZ also submitted on September 7, 2021, and the Board resolves reasonable doubt in favor of the Veteran and finds the supplemental claim was the first completed claim filed within one year of the February 2021 intent to file. According to 38 C.F.R. § 3.155(d)(1)(ii), if VA receives a complete claim within one year of filing an Intent to File that meets the requirements of § 3.155(b), it will be considered filed as of the date of receipt of the Intent to File. Also, if more than one complete claim for a benefit is filed within one year of an Intent to File, only the first claim filed will be associated with the intent to file a claim. Accordingly, any open Intent to File will be absorbed by the next valid claim that is received, even if consideration of the Intent to File is not beneficial to the effective date. Here, the February 7, 2021, intent to file was absorbed by the September 7, 2021, supplemental claim. As such, the Board finds that an effective date of February 7, 2021, is warranted for the grant of service connection for eczema. Therefore, an earlier effective date of February 7, 2021, but no earlier, is warranted.

3. Entitlement to an effective date prior to February 7, 2021, for the grant of service connection for hemorrhoids

The Veteran asserts entitlement to an earlier effective date for the grant of service connection for hemorrhoids.

Turning to the procedural history of the claim, the Veteran filed a claim for hemorrhoids on September 7, 2021. See 9/7/2021, VA 21-526EZ. His claim was granted in a July 2022 rating decision and assigned an effective date of February 7, 2021. See 7/11/2022, Rating Decision - Narrative.

In this matter, the Board finds an effective date prior to February 7, 2021, for the Veteran's hemorrhoids is not warranted. Initially, the Board acknowledges the Veteran's contentions regarding his belief that he is entitled to an earlier effective date. However, the record does not reflect that Veteran expressed an intent to file for VA compensation related to his hemorrhoids disorder prior to February 7, 2021.

An effective date is assigned based on the date of the claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. The Veteran filed an intent to file on February 7, 2021. An effective date is assigned based on the date of the claim, or the date entitlement arose, whichever is later. As such, an effective date prior to February 7
Board acknowledges the Veteran's contentions regarding his belief that he is entitled to an earlier effective date. However, the record does not reflect that Veteran expressed an intent to file for VA compensation related to his hemorrhoids disorder prior to February 7, 2021.

Here, the claims file does not show the Veteran filed a claim, either formal or informal, prior to February 7, 2021, related to the Veteran's hemorrhoids claim. The Board is sympathetic to the Veteran's belief that an earlier effective date is warranted. However, VA did not receive a claim for compensation prior to that date, and the effective date of the award of compensation based on an original claim is the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110(a); 38 C.F.R. §§ 3.1(p), 3.400(b)(2).

Service Connection

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. In order to establish entitlement to service connection, there must generally be 1) evidence of a current disability; 2) medical, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and 3) causal connection between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection may also be granted for a disability, which is proximately due to, or aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either caused or aggravated by a service-connected disease or injury. Allen v. Brown, 7 Vet. App. 43, 448-49 (1995).

Service connection for certain diseases may also be established on a presumptive basis by showing that such a disease manifested itself to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). In such cases, the disease is presumed under the law to have had its onset in service even though there is no evidence of such disease during the period of service. 38 C.F.R. § 3.307 (a).

A nexus between a current disability and an in-service injury or event may be established by evidence of continuity of symptomatology, if the condition is a chronic disease enumerated under 38 U.S.C. § 1101. Walker v. Shinseki, 708 F.3d 1331, 1338-40 (Fed. Cir. 2013). Bilateral hearing loss and tinnitus (organic diseases of the nervous system) are chronic diseases. See 38 U.S.C. §§ 1101, 1112.

The Veteran is competent to report symptoms and experiences observable by his senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed Cir. 2009).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

4. Entitlement to service connection for a respiratory disorder

The Veteran asserts service connection for a respiratory disorder.

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
a claim for disability benefits. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed Cir. 2009).

4. Entitlement to service connection for a respiratory disorder

The Veteran asserts service connection for a respiratory disorder.

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 the Veteran does not have a current diagnosis of respiratory disorder and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

The Veteran believes he has a respiratory disorder due to burn pit exposures during service. See 9/7/2021, VA 21-526EZ. While the Veteran may believe that he has respiratory disorder, he is not competent to provide a diagnosis in this case. The issue is medically complex as it requires a knowledge of the respiratory system. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). In light of this, the Board finds that he is not competent to diagnose a respiratory disorder without specialized training, education, or skills. As such, his statement regarding a diagnosis is not competent and lacks weight.

The Veteran underwent examinations for his respiratory disorder claim in May 2023. See 5/26/2023, C&P Exam. Based on an in-person examination and records review, the May 2023 examiner determined the Veteran did not have a respiratory condition. His history of shortness of breath in 2013 was noted and that he had previously used an albuterol inhaler. On and off shortness of breath was noted. A Chest x-ray was performed and the results were normal. Pulmonary Function Testing was also performed which was normal, and no functional impact was noted.

A Gulf War examination was also performed in May 2023. See, 6/4/2023, C&P Exam. There were no diagnosed illnesses with no etiology or any additional signs/symptoms that may represent an undiagnosed illness or diagnosed medically unexplained chronic multi symptom illness. No functional impact was reported.

After reviewing the competent lay and medical evidence, the Board finds that entitlement to service connection for any respiratory disorder is not warranted. The competent evidence does not reflect that the Veteran has been diagnosed with any respiratory disorder during the period on appeal or approximate to the filing that began this appeal. The Board acknowledges his potential belief that he has a respiratory disorder. However, his treatment records do not show a diagnosis of any respiratory disorder. See 7/13/2023, CAPRI. In particular, the VA treatment records list all of the health-related problems the Veteran has had, and a respiratory condition is not listed. These are places were such a diagnosis, or related residuals would normally be recorded. As such, the lack of notations in these records regarding any respiratory disorder is probative and a factor that tends to weigh against claim.

The Board also acknowledges the U.S. Court of Appeals for the Federal Circuit found that pain alone can constitute a "disability" under § 1110, because pain can cause functional impairment. Saunders v. Wilkie, 886 F.3d 1356, 1367-68 (Fed. Cir. 2018). However, even in light of Saunders, the Veteran still does not have a present disability for any respiratory disorder, and the VA examination reports reflect a lack of functional impairment or indication of how his earning capacity is impacted. Based on the foregoing, the Board finds that this case is distinguished from the Saunders case.

In the absence of proof of a current disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223 (1992); Gilpin v. Brown, 155 F.3d 1353 (Fed. Cir. 1998) (finding that service connection may not be granted unless a current disability exists). The Veteran has not submitted any medical evidence that shows he has any respiratory disorder, to include functional impairment from respiratory issues. 38 U.S.C. § 5107(a). In this regard, the Board finds that the record provides no
earning capacity is impacted. Based on the foregoing, the Board finds that this case is distinguished from the Saunders case.

In the absence of proof of a current disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223 (1992); Gilpin v. Brown, 155 F.3d 1353 (Fed. Cir. 1998) (finding that service connection may not be granted unless a current disability exists). The Veteran has not submitted any medical evidence that shows he has any respiratory disorder, to include functional impairment from respiratory issues. 38 U.S.C. § 5107(a). In this regard, the Board finds that the record provides no indication of any respiratory disorder during the appellate period. Here, because there is no diagnosis of any respiratory disorder, service connection cannot be granted as the first element is not met. Brammer v. Derwinski, 3 Vet. App. 223 (1992).

The Board acknowledges his belief that he may have a possible respiratory disability during the period on appeal. However, as explained above, the Board has found that he is not competent to provide a diagnosis in this case.

In sum, as most of the evidence weighs against the claim (that is to say, is neither in approximate balance nor nearly equal), the benefit-of-the-doubt rule is inapplicable, and the claim is denied. 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 4th 776, 781-82 (Fed. Cir. 2021).

5. Entitlement to service connection for OSA

The Veteran asserts service connection for OSA.

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 the Veteran does not have a current diagnosis of OSA and has not had one at any time during the pendency of the claim or recent to the filing of the claim. Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

The Veteran believes he has OSA due to his service-connected posttraumatic stress disorder (PTSD). See 9/7/2021, VA 21-526EZ. While the Veteran may believe that he has OSA, he is not competent to provide a diagnosis in this case. The issue is medically complex as it requires a knowledge of the respiratory system. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). In light of this, the Board finds that he is not competent to diagnose OSA without specialized training, education, or skills. As such, his statement regarding a diagnosis is not competent and lacks weight.

The Veteran underwent examinations for his claim in September 2021. See 11/2/2021, C&P Exam. Based on an in-person examination and records review, the examiner determined the Veteran did not have OSA. His history of difficulty with sleeping and snoring was acknowledged. Persistent daytime hypersomnolence was noted. The Veteran did not require medication or the use of a breathing assistance device. A sleep study was performed and was negative for sleep apnea. See 11/3/2021, C&P Exam. No functional impact was noted.

After reviewing the competent lay and medical evidence, the Board finds that entitlement to service connection for OSA is not warranted. The competent evidence does not reflect that the Veteran has been diagnosed with OSA during the period on appeal or approximate to the filing that began this appeal. The Board acknowledges his potential belief that he has OSA. However, his treatment records do not show a diagnosis of OSA. See 7/13/2023, CAPRI. In particular, the VA treatment records list all of the health-related problems the Veteran has had, and OSA is not listed. These are places were such a diagnosis, or related residuals would normally be recorded. As such, the lack of notations in these records regarding any OSA is probative and a factor that tends to weigh against claim.

The Board also acknowledges the U.S. Court of Appeals for the Federal Circuit found that pain alone can constitute a "dis
OSA during the period on appeal or approximate to the filing that began this appeal. The Board acknowledges his potential belief that he has OSA. However, his treatment records do not show a diagnosis of OSA. See 7/13/2023, CAPRI. In particular, the VA treatment records list all of the health-related problems the Veteran has had, and OSA is not listed. These are places were such a diagnosis, or related residuals would normally be recorded. As such, the lack of notations in these records regarding any OSA is probative and a factor that tends to weigh against claim.

The Board also acknowledges the U.S. Court of Appeals for the Federal Circuit found that pain alone can constitute a "disability" under § 1110, because pain can cause functional impairment. Saunders v. Wilkie, 886 F.3d 1356, 1367-68 (Fed. Cir. 2018). However, even in light of Saunders, the Veteran still does not have a present disability for OSA, and the VA examination reports reflect a lack of functional impairment or indication of how his earning capacity is impacted. Based on the foregoing, the Board finds that this case is distinguished from the Saunders case.

In the absence of proof of a current disability, there can be no valid claim for service connection. Brammer v. Derwinski, 3 Vet. App. 223 (1992); Gilpin v. Brown, 155 F.3d 1353 (Fed. Cir. 1998) (finding that service connection may not be granted unless a current disability exists). The Veteran has not submitted any medical evidence that shows he has OSA. 38 U.S.C. § 5107(a). In this regard, the Board finds that the record provides no indication of OSA during the appellate period. Here, because there is no diagnosis of OSA, service connection cannot be granted as the first element is not met. Brammer v. Derwinski, 3 Vet. App. 223 (1992).

The Board acknowledges his belief that he may have OSA disability during the period on appeal. However, as noted above, the Board has found that he is not competent to provide a diagnosis in this case.

Increased Rating

Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The percentages are based on the average impairment of earning capacity as a result of service-connected disability, and separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. All reasonable doubt as to the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3.

Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, the Board must also consider staged ratings. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007).

Where a DC does "not explicitly contemplate a veteran using medication to allay symptoms of a service-connected disability, the Board... must discount the beneficial effects of medication used." Ingram v. Collins, 38 Vet. App. 130, 135 (2025) (citing Jones v. Shinseki, 26 Vet. App. 56, 61 (2012)).

The evaluation of the same disability under several diagnostic codes, known as pyramiding, must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of or overlapping with the symptomatology of the other. Esteban v. Brown, 6 Vet. App. 259, 262 (1994); 38 C.F.R. § 4.14.

The Veteran is competent to report symptoms and experiences observable by his senses. See Jandre
. App. 130, 135 (2025) (citing Jones v. Shinseki, 26 Vet. App. 56, 61 (2012)).

The Veteran is competent to report symptoms and experiences observable by his senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a).

6. Entitlement to an initial compensable rating for hemorrhoids

The Veteran asserts entitlement to an initial compensable rating for his hemorrhoids. The Veteran is rated under DC 7336 for hemorrhoids.

VA amended the criteria for rating digestive disabilities effective from May 19, 2024. These new regulations apply to all applications for benefits received by VA or that are pending before the agency of original jurisdiction on or after May 19, 2024. Claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the veteran will be applied. The Board may not apply a current regulation prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). However, the Board is not precluded from applying prior versions of the applicable regulation to the period on or after the effective dates of the new regulation if the prior version was in effect during the pendency of the appeal.

Under the old criteria, prior to May 19, 2024, mild or moderate hemorrhoids were to be rated as noncompensable (0 percent). Large or thrombotic, irreducible, hemorrhoids with excessive redundant tissue, evidencing frequent recurrences, were to be rated as 10 percent disabling. Finally, hemorrhoids with persistent bleeding and with secondary anemia, or with fissures were to be rated as 20 percent disabling. 38 C.F.R. § 4.114, DC 7336.

Under the new criteria, in effect from May 19, 2024 (DC 7336), a 10 percent rating is warranted for prolapsed internal hemorrhoids with two or less episodes per year of thrombosis; or external hemorrhoids with three or more episodes per year of thrombosis. A 20 percent rating is warranted for internal or external hemorrhoids with persistent bleeding and anemia; or continuously prolapsed internal hemorrhoids with three or more episodes per year of thrombosis. Id.

Words such as "moderate," and "mild" are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence so that decisions will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, it is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for an increased disability rating. 38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6.

Absent an express definition, it is presumed that VA regulations employ words using their ordinary dictionary meanings at the time the regulations were promulgated. See Nielson v. Shinseki, 607 F.3d 802, 805-06 (Fed. Cir. 2010) (stating that when terms are not defined, it is a basic principle of statutory interpretation that they are deemed to have their ordinary meaning).

According to the Merium-Webster Dictionary, "mild" means "not severe." "Moderate" is defined as "tending toward the mean or average amount or dimension." Merriam-Webster Online Dictionary, available at: https://www.merriamwebster.com/dictionary/moderate. "Severe" is defined as "very painful or harmful." Merriam-Webster Online Dictionary, available at: https://www.merriamwebster.com/dictionary/severe.

For this case, the Board interprets "Mild or moderate" hemorrhoids to mean hemorrhoids that are less severe than those that are "Large or thrombotic, irreducible, with excessive redundant tissue, evidencing frequent recurrences" or "With persistent bleeding and with secondary anemia, or with fiss
"Moderate" is defined as "tending toward the mean or average amount or dimension." Merriam-Webster Online Dictionary, available at: https://www.merriamwebster.com/dictionary/moderate. "Severe" is defined as "very painful or harmful." Merriam-Webster Online Dictionary, available at: https://www.merriamwebster.com/dictionary/severe.

The Veteran underwent an examination in September 2021 for his claim. See 11/2/2021, C&P Exam. The Veteran reported pain and bloody stool. He did not have any treatment, medications, or surgery. He had mild or moderate small external hemorrhoids. On examination, small or moderate external hemorrhoids were noted. No functional impact was reported.

In March 2023, an additional examination was performed. See 3/14/2023, C&P Exam. He reported itching and slight bleeding once per week. He used preparation H as needed and his condition had stayed the same. He had mild to moderate internal/external hemorrhoids with occasional bleeding. On examination, no hemorrhoids were noted, but skin tags were seen. No functional impact was reported.

The Veteran's most recent examination was scheduled in August 2023. See 8/8/2023, C&P Exam. Small external hemorrhoids were noted. Occasional bleeding was reported, and no continuous medication was documented. Mild or moderate internal/external hemorrhoids were acknowledged on examination. No functional impact was found.

After review of the competent and probative evidence, the Board finds that an initial compensable rating is not warranted under the old or new criteria. In this regard, the Veteran has small external hemorrhoids that he treats at times with preparation H. There is no indication from the medical evidence of record of the Veteran's statements that his symptoms are more nearly approximated as large or thrombotic, irreducible, hemorrhoids with excessive redundant tissue, evidencing frequent recurrences or prolapsed internal hemorrhoids with two or less episodes per year of thrombosis. The Board recognizes the Veteran's use of medication. However, the evidence still does not show that a higher rating would be warranted. See generally, Ingram v. Collins, 38 Vet. App. 130, 135 (2025). The Veteran has reported his symptoms have remained the same. He occasionally has bleeding and itching. The VA examiners assessed that the Veteran had "mild to moderate" symptoms. A physical examination revealed "small or moderate external hemorrhoids." There is no functional impact. The Board finds that this relevant competent medical evidence tends to show that the Veteran's hemorrhoids are no more than moderate. There are no large, thrombotic, or irreducible hemorrhoids with excessive redundant tissue, evidencing frequent recurrences. Additionally, the Veteran does not have prolapsed internal hemorrhoids with two or less episodes per year of thrombosis. As such, an initial compensable rating is not warranted.

As the weight of the evidence is persuasively against a finding that the Veteran's hemorrhoids warrant an initial compensable rating, the claim must be denied, and the benefit of the doubt doctrine does not apply. Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021) (en banc).

7. Entitlement to an initial compensable rating for headaches

The Veteran asserts entitlement to an initial compensable rating for his headaches. He is currently rated under DC 8100.

Headaches are rated pursuant to 38 C.F.R. § 4.124a, Diagnostic Code (DC) 8100, for migraine. Under DC 8100, in pertinent part, a 10 percent rating is warranted for characteristic prostrating attacks average one in two months over the last several months. A 30 percent rating is warranted for migraines with characteristic prostrating attacks occurring on an average once a month over the last several months. A 50 percent rating is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. A 50 percent rating is the highest schedular rating under DC 8100.

Here, because of the successive nature of the rating criteria in DC 8100, such that the evaluation for each higher disability rating includes the criteria of each lower disability rating (at least what could be considered most of them), each of the criteria in the 50 percent rating must be met in order to warrant such a rating. Section
in two months over the last several months. A 30 percent rating is warranted for migraines with characteristic prostrating attacks occurring on an average once a month over the last several months. A 50 percent rating is warranted for migraines with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. A 50 percent rating is the highest schedular rating under DC 8100.

Though Diagnostic Code 8100 does not provide a definition for "prostrating," prostration is defined as "extreme exhaustion or powerlessness." DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 1554 (31st ed. 2007). Similarly, the term "productive of severe economic inadaptability" is also not defined in veterans' law. However, the Court has stated that this term is not synonymous with being completely unable to work and VA has conceded that the phrase "productive of" could be read to mean either "producing" or "capable of producing" economic inadaptability. See Pierce v. Principi, 18 Vet. App. 440, 446-47 (2004) (stating that nothing in DC 8100 requires that the claimant be completely unable to work in order to qualify for a 50% rating").

Additionally, "Characteristic" is "a trait, quality, or property or a group of them distinguishing an individual, group, or type." WEBSTER'S THIRD NEW INTERNATIONAL DICTIONARY OF THE ENGLISH LANGUAGE UNABRIDGED 376 (1966). "Prostrating" means "lacking in vitality or will: powerless to rise: laid low." Id. at 1822. "Completely" is defined as "to complete degree: entirely." Id. at 465. In other words, the headaches must render the veteran entirely powerless. Johnson v. Wilkie, 30 Vet. App. 245, 252 (2018).

The Veteran underwent an examination for his headaches in April 2023. See 4/26/2023, C&P Exam. The Veteran indicated his disorder had remained consistent. He reported tension headaches as well as sensitivity to light. They would last for a few hours, and he would take over the counter NSAIDs to relieve his symptoms. Constant head pain and sensitivity to light was noted. The pain in his head would last than one day and would be located on the back of his head and neck. He did not have characteristic prostrating attacks of migraine/non-migraine headache pain. He did not have prostrating and prolonged attacks of migraines/non-migraine pain productive of severe economic inadaptability. No functional impact was reported.

In May 2023, an additional examination was performed. See 5/26/2023, C&P Exam. The Veteran indicated his disorder had remained consistent. He would take ibuprofen as needed which was typically every two to three weeks. His headaches would last two hours with medication. He had pulsating or throbbing head pain, pain on both sides of the head, and pain at the back of his neck. His head pain would last less than one day and would be on both sides of his head. He did not have characteristic prostrating attacks of migraine/non-migraine headache pain. He did not have prostrating and prolonged attacks of migraines/non-migraine pain. No functional impact was reported.

The Veteran's VA treatment records also address his headaches. See 7/13/2023, CAPRI. At times, tension headaches and headaches were noted. At other times, the Veteran denied headaches.

After reviewing the competent and probative, the Board finds an initial compensable rating is not warranted for the Veteran's headaches. In this regard, the Board finds the Veteran's symptoms are not more nearly approximated as characteristic prostrating attacks averaging one in two months over the last several months. For example, the Veteran's VA treatment records show mild to moderate headaches without functional impairment or any impact on the Veteran's day to day activities. Additionally, the VA examination of records found the Veteran did not have characteristic prostrating attacks averaging one in two months over the last several months. The Veteran's symptoms are mild to moderate and or more or less
At times, tension headaches and headaches were noted. At other times, the Veteran denied headaches.

After reviewing the competent and probative, the Board finds an initial compensable rating is not warranted for the Veteran's headaches. In this regard, the Board finds the Veteran's symptoms are not more nearly approximated as characteristic prostrating attacks averaging one in two months over the last several months. For example, the Veteran's VA treatment records show mild to moderate headaches without functional impairment or any impact on the Veteran's day to day activities. Additionally, the VA examination of records found the Veteran did not have characteristic prostrating attacks averaging one in two months over the last several months. The Veteran's symptoms are mild to moderate and or more or less consistent. There is no indication there are characteristic prostrating attacks. Additionally, the Veteran takes over-the-counter medication. However, the evidence does not show that he would have characteristic prostrating attacks without the medication. His headaches have been described as tension headaches and mild to moderate. See generally Ingram, 38 Vet. App. at 135.

As most of the evidence weighs against the claim (that is to say, is neither in approximate balance nor nearly equal), the benefit-of-the-doubt rule is inapplicable and the claim for an increased rating for headaches is denied. Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021) (en banc).

8. Entitlement to an effective date prior to November 7, 2022, for the grant of the 30 percent rating for IBS.

The Veteran receives a 10 percent rating for IBS prior to November 7, 2022, and 30 percent thereafter. Here, the period on appeal dates to September 7, 2021, the date the Veteran filed his September 7, 2021, claim. See 9/7/2021, VA 21-526EZ. The Board recognizes there was a February 2021 intent to file. However, as discussed above, the Board finds that the supplemental claim was the first completed claim filed within one year of the February 2021 intent to file. 38 C.F.R. § 3.155(d)(1)(ii). He is rated under DC 7319.

Under Diagnostic Code 7319, a 10 percent rating was warranted for IBS manifested by moderate symptoms, described as frequent episodes of bowel disturbance with abdominal distress. A 30 percent rating is warranted where the disability is severe, and there is diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress. A 30 percent rating is the maximum rating under Diagnostic Code 7319. 38 C.F.R. § 4.114.

Descriptive words such as "moderate" and "severe" as used in the various diagnostic codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence for "equitable and just decisions." 38 C.F.R. § 4.6. Definitions for moderate and severe were provided in section 6 above and the Board employes the same ones in this context.

VA regulation recognizes that there are diseases of the digestive system, particularly within the abdomen, which, while differing in the site of pathology, produce a common disability picture characterized in the main by varying degrees of abdominal distress or pain, anemia and disturbances in nutrition. 38 C.F.R. § 4.113. Consequently, certain coexisting diseases in this area do not lend themselves to distinct and separate disability evaluations without violating the fundamental principle relating to pyramiding as outlined in 38 C.F.R. § 4.114. Id. Rather, a single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. 38 C.F.R. § 4.114. With regard to the schedule of ratings for the digestive system, § 4.114 expressly prohibits, in pertinent part, the combination of ratings under Diagnostic Codes 7301 to 7329, inclusive which include the schedular criteria for irritable colon syndrome (Diagnostic Code 7319).

The rating criteria for digestive disabilities were revised effective May 19, 2024. Schedule for Rating Disabilities: Digestive System, 89 Fed. Reg. 19,735 (March 20, 2024) (codified at 38 C.F.R. § 4.114). Diagnostic Code 7319 was recharacterized to be for irritable bowel syndrome. A 10 percent rating is warranted for IBS manifested by abdominal pain related to defecation at least once during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension. A20 percent rating requires abdominal pain related to defecation for at least three days per month during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension. A 30 percent rating requires abdominal pain related to defecation at least one day per week during the previous three months; and two or more of the following: (1) change in stool frequency, (2) change in stool form, (3) altered stool passage (straining and/or urgency), (4) mucorrhea, (5) abdominal bloating, or (6) subjective distension. 38 U.S.C. § 4.114, Diagnostic Code 7319.

The Veteran underwent an examination for his IBS in September 2021, See 11/2/2021, C&P Exam. The Veteran reported constant diarrhea, abdominal pain, and cramping. The Veteran also had bloating and used dicyclomine. No surgical treatment was noted. The Veteran's signs and symptoms included constant diarrhea, cramping, and bloating. He had occasional episodes of bowel disturbance with abdominal distress.

In March 2023, an additional examination was performed. See 3/14/2023, C&P Exam. The Veteran reported cramping, bloating, and soft and water bowel movements. The Veteran used Bentyl twice per day. The examiner indicated the Veteran had episodes of bowel disturbance with more or less constant abdominal distress.

The most recent examination is from August 2023. See 8/8/2023, C&P Exam. The\ Veteran reported abdominal cramping, acid reflux, and diarrhea. He used dicyclomine. He reported diarrhea four times daily. Abdominal cramping on daily basis was also reported.

After review of the relevant competent and probative lay and medical evidence, the Board finds a rating of 30 percent is warranted for the entire rating period on appeal. This is the maximum schedular rating. See Sabonis v. Brown, 6 Vet. App. 426 (1994). The Board finds the Veteran's symptoms were more nearly approximated as severe, as there is diarrhea, or alternating diarrhea and constipation, with more or less constant abdominal distress throughout the period on appeal. The Board recognizes the 2021 examiner reported lesser symptoms. However, the Veteran's statements at the examinations have mostly shown constant abdominal pain, bloating, diarrhea, and cramping. The Veteran has used various medications during the period on appeal. See generally Ingram v. Collins, 38 Vet. App. 130, 135 (2025). As such, the Board will resolve reasonable doubt in favor of the Veteran and finds a rating of 30 percent is warranted. 38 C.F.R. § 4.3. Therefore, the most probative evidence shows that the Veteran's IBS symptoms were more nearly approximated by the 30 percent rating during the period on appeal.

REASONS FOR REMAND

1. Entitlement to restoration of a TDIU effective July 1, 2025, is remanded.

In November 2024, the AOJ notified the Veteran that it received information from the Social Security Administration (SSA) that he "earned wages above the poverty threshold for calendar year 2023." See 11/2/2024, Individual Unemployment Annual Eligibility Letter. As such, it proposed to discontinue his eligibility to TDIU based upon evidence that he sustained gainful employment.

In March 2025, the AOJ implemented its proposal. See 3/6/2025, Rating Decision - Narrative. The
during the period on appeal.

REASONS FOR REMAND

1. Entitlement to restoration of a TDIU effective July 1, 2025, is remanded.

In March 2025, the AOJ implemented its proposal. See 3/6/2025, Rating Decision - Narrative. The AOJ discontinued TDIU, effective June 1, 2025.

In this matter, the evidence from SSA which prompted the discontinuation is not of record and that the lack of such records constitutes a pre-decisional duty to assist error. Therefore, the claim must be remanded to obtain all outstanding records that could have an impact on the Veteran's eligibility for TDIU benefits. 38 C.F.R. § 20.802(a).

2. Entitlement to service connection for gastroesophageal reflux disease is remanded.

The Veteran asserts service connection for GERD.

The October 2024 rating decision favorable findings included a diagnosis of GERD as well as participation in toxic exposure risk activity (TERA).

Turning to the medical opinions of record, the May 2023 examiner provided a negative TERA opinion. See 5/26/2023, C&P Exam. The examiner stated there was no pathology. The June 2023 addendum indicated that the Veteran reported his symptoms had resolved and he was not on medications. See 6/4/2023, C&P exam.

The Board does not find this opinion to have probative value as the examiner found the Veteran did not have a GERD diagnosis at the time of the examination when his VA treatment records and examinations show he does have a diagnosis.

A subsequent opinion was provided in May 2024. See 5/29/2024, C&P Exam. The examiner indicated the Veteran had a diagnosis of GERD.

In August 2024, an examiner found the Veteran's GERD was not secondary to his service-connected PTSD as the conditions are unrelated. See 9/7/2024, C&P Exam.

The most recent opinion is from September 2024. See 9/28/2024, C&P Exam. The examiner identified risk factors that outweigh TERA risk factors.

The Board acknowledges examinations and medical opinions were obtained. However, the opinions are conclusory and without adequate rationale. Moreover, the opinions are not specific to Veteran and cite only general medical principles. Bailey v. O'Rourke, 30 Vet. App. 54, 60 (2018) (stating that reliance on the absence of medical literature supporting nexus without discussing the specific facts of the case renders an opinion inadequate). In this matter, the Board finds that an additional medical opinion is necessary to cure the pre-decisional duty to assist error in the 2023 and 2024 medical opinions. As such, the Board finds that an addendum opinion is warranted as such is required to cure the pre-decisional duty to assist error. 38 C.F.R. § 20.802(a).

3. Entitlement to service connection for bilateral hearing loss is remanded.

The Veteran asserts service connection for bilateral hearing loss. Initially, the Board broadly construes the Veteran's September 2021 and subsequent November 2022 supplemental bilateral hearing loss claims as the Veteran contending that his hearing had worsened since his claim was denied in June 2014. See 6/17/2014, Rating Decision - Narrative; 9/7/2021, VA Form 20-0995; 11/7/2022, VA Form 20-0995.

In a claim of service connection for impaired hearing, demonstration of the first Shedden element, that is the existence of a current disability is subject to the additional requirements of § 3.385, which provides that service connection for impaired hearing shall not be established until the hearing loss meets pure tone and/or speech recognition criteria. Under this regulation, hearing status will be considered a disability for the purposes of service connection when the auditory thresholds in any of the frequencies of 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; the auditory thresholds for at least three of these frequencies are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385.

The May 202
a current disability is subject to the additional requirements of § 3.385, which provides that service connection for impaired hearing shall not be established until the hearing loss meets pure tone and/or speech recognition criteria. Under this regulation, hearing status will be considered a disability for the purposes of service connection when the auditory thresholds in any of the frequencies of 500, 1000, 2000, 3000, or 4000 Hertz is 40 decibels or greater; the auditory thresholds for at least three of these frequencies are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385.

The May 2024 rating decision on appeal favorable findings included noise exposure during service. See 5/9/2023, Rating Decision - Narrative. The Board recognizes the May 2023 rating decision that prompted the higher-level review request in December 2023 found new and relevant evidence had not been submitted. However, the May 2024 rating decision tends to show the Veteran's claim was readjudicated. As such, the Board finds there is an implicit finding that new and relevant evidence had been received.

However, there is no medical opinion as to whether the Veteran has bilateral hearing loss for VA purposes that is related to service. Under these circumstances, the Board finds that a remand is warranted to cure a pre-decisional duty to assist error. The Veteran has not been scheduled specifically for a VA examination to determine whether he has hearing loss that is related to service, to include conceded noise exposure. Based on the above facts and pertinent regulation (38 C.F.R. § 3.159(c)), the Board finds that criteria for providing an examination were indicated. Thus, the Veteran is to be afforded an examination to determine to cure this pre-decisional duty to assist error.

4. Entitlement to an initial compensable rating for eczema is remanded.

The Veteran asserts entitlement to increased initial rating for his eczema. He receives a noncompensable rating under DC 7806.

Turning to the relevant evidence in the claims file, the Veteran underwent an examination in April 2023. See 4/26/2023, C&P Exam. The Veteran reported that he had rash over his body that was not present. VA treatment records showed he used desonide 0.05 percent. His topical medical was used for six weeks or more in the past 12 months, but not constant. His eczema was noted as without any visible characteristic lesions at the time of the examination.

In this matter, the Board finds that a remand is warranted to cure a pre-decisional duty to assist error. The Board acknowledges that while the Veteran was scheduled for and completed an examination, the findings do not reflect or address the Veteran's symptoms for his disorder during flare-ups or during active symptom periods. Importantly, the VA examination report does not reflect that the clinician ascertained the severity of the conditions during flare-ups. Ardison v. Brown, 6 Vet. App. 405, 407-08 (1994) (concluding that examination during a remission phase of a skin condition was not adequate). As such, the Board finds that an examination is warranted as such is necessary to address this inconsistency in the 2023 VA examination report and to cure this pre-decisional duty to assist error.

The matters are REMANDED for the following action:

1. The AOJ must obtain and associate with the claims file any outstanding records from the Social Security Administration (SSA), to include evidence that the Veteran earned wages above the poverty threshold for the calendar year 2023. If the search for such records has negative results, the claims file must be properly documented as to the unavailability of these records.

2. Schedule the Veteran for an audiological examination, by an audiologist to determine the nature and etiology of any hearing disability. Then, address whether:

(a.) It is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any bilateral hearing disability (1) began during active service, (2) manifested within one year after discharge (March 2010) from service, (3) was noted during service with continuity of the same symptomatology since service, or (4) is otherwise related to military service, to include the Veteran's conceded hazardous noise exposure.

3. Obtain an addendum opinion or schedule the Veteran for an examination, if necessary, by an appropriate examiner to determine the nature and etiology of the Veteran's GERD disorder. Then, address whether:

(a.) It is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that his disorder is related to an in-service injury, event, or
any bilateral hearing disability (1) began during active service, (2) manifested within one year after discharge (March 2010) from service, (3) was noted during service with continuity of the same symptomatology since service, or (4) is otherwise related to military service, to include the Veteran's conceded hazardous noise exposure.

(a.) It is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that his disorder is related to an in-service injury, event, or disease, to include participation in toxic exposure risk activity or activities?

(b.) If no, is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that his disorder was either 1) caused by any service-connected disability OR 2) did the Veteran's disability get worse because of his service-connected disabilities, to include medications taken for his service-connected disorders?

In answering the questions pertaining to worsening, inform the examiner that worsening includes the natural progression of his disability that can be attributed to service-connected disabilities. For example, an inability to undergo knee surgery due to low hematocrit caused by medication prescribed for service-connected leukemia can cause the natural progression of the knee disability.

In forming an opinion, the examiner must consider (1) the total potential exposure through all applicable military deployments; and (2) the synergistic, combined effect of all toxic exposure risk activities.

4. Schedule the Veteran for an examination by a clinician to determine the current severity of his service-connected eczema. To the extent that it is reasonable and practical, coordinate with the Veteran to schedule the examination during an active stage of the condition.

**If the examination is not during flare-ups, the effects of a flare-up should be estimated to the extent reasonably possible.**

5. Inform EACH examiner that a comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training).

Paul Sorisio

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board G.M., 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.

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