HEARING LOSS

YVETTE R. WHITE · 2026 · Case ID: A26040428

MIXED

Summary

The Veteran, who served in the U.S. Navy from May 2019 to November 2023, appeals the denial of service connection and increased ratings for multiple conditions, including bilateral hearing loss, lymphedema, stress incontinence, migraines, psychiatric conditions, gastrointestinal issues, allergic rhinitis, tinnitus, vitiligo, female sexual arousal disorder (FSAD), and C-section scars. The Board reviewed the evidence of record as of October 7, 2024, and any evidence submitted between October 7, 2025, and January 5, 2026. The Veteran also contends she is unemployable due to her service-connected conditions, raising the issue of entitlement to Total Disability based on Individual Unemployability (TDIU). The Board denied service connection for bilateral hearing loss and lymphedema, finding the evidence weighed against these claims. Increased ratings for stress incontinence, migraines, psychiatric conditions, gastrointestinal issues, allergic rhinitis, tinnitus, vitiligo, FSAD, and C-section scars were also denied, as the evidence did not support the claimed severity or manifestations. However, the Board remanded the claims for an increased rating for a back condition, left knee strain, and seborrheic dermatitis, citing inadequate VA examinations and the need to address flare-ups and pain. The TDIU claim was also remanded for further development.

Rationale

No current diagnosis of bilateral hearing loss; Evidence persuasively weighs against finding of current bilateral hearing loss

Service Branch

NAVY

Special Benefit

TDIU

Docket No.

251007-598379

Full Decision Text

Citation Nr: A26040428
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 251007-598379
DATE: April 29, 2026

ORDER

Entitlement to service connection for bilateral hearing loss is denied.

Entitlement to service connection for lymphedema is denied.

Entitlement to an initial rating in excess of 40 percent for service-connected stress incontinence is denied.

Entitlement to an initial rating in excess of 30 percent for service-connected migraines is denied.

Entitlement to an initial rating in excess of 50 percent for service-connected adjustment disorder with mixed anxiety and depressed mood (psychiatric conditions) is denied.

Entitlement to an initial rating in excess of 30 percent for service-connected Crohn's disease with adult hypertrophic pyloric stenosis, chronic inactive gastritis, chronic fatigue, and anemia (gastrointestinal conditions) is denied.

Entitlement to an initial rating in excess of 10 percent for service-connected allergic rhinitis is denied.

Entitlement to an initial rating in excess of 10 percent for service-connected tinnitus is denied.

Entitlement to an initial compensable rating for service-connected vitiligo is denied.

Entitlement to an initial compensable rating for service-connected female sexual arousal disorder (FSAD) is denied.

Entitlement to an initial compensable rating for service-connected C-section scar is denied.

Entitlement to an initial rating in excess of 10 percent for painful C-section scar is denied.

REMANDED

Entitlement to an initial rating in excess of 10 percent for service-connected degenerative disc disease (back condition) is remanded.

Entitlement to an initial rating in excess of 10 percent for service-connected left knee strain is remanded.

Entitlement to an initial compensable rating for service-connected seborrheic dermatitis with tinea capitis (dermatitis) is remanded.

Entitlement to a total disability based on individual unemployability (TDIU) is remanded.

FINDINGS OF FACT

1. The Veteran does not currently have bilateral hearing loss for VA disability compensation purposes.

2. The evidence persuasively weighs against finding that the Veteran has a diagnosis of lymphedema at any time during the period on appeal.

3. The evidence persuasively weighs against finding that the Veteran's service-connected stress incontinence has manifested with symptomatology requiring the use of an appliance or the wearing of absorbent materials that must be changed more than four times per day at any time during the period on appeal.

4. The evidence persuasively weighs against finding that the Veteran' service-connected migraines have manifested with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability at any time during the period on appeal.

5. The evidence persuasively weighs against finding that the frequency, severity, and duration of the symptomatology associated with the Veteran's service-connected psychiatric conditions have more closely approximated occupational and social impairment with deficiencies in most areas, or total occupational and social impairment, at any time during the period on appeal.

6. The evidence persuasively weighs against finding that the Veteran's gastrointestinal conditions manifested with malnutrition or serious complications at any time during the period prior to May 19, 2024.

7. The evidence persuasively weighs against finding that the Veteran's gastrointestinal conditions manifested with malnutrition, serious complications, recurrent abdominal pain, or diarrhea, or was unresponsive to treatment, at any time during the period beginning May 19, 2024.

8. The evidence persuasively weighs against finding that the Veteran's allergic rhinitis manifested with polyps at any time during the period on appeal.

9. For the entire period on appeal, the Veteran is in receipt of a 10 percent rating for her tinnitus, the schedular maximum under Diagnostic Code (DC) 6260, and there are no manifestations of such disability that are not contemplated by the currently assigned schedular rating.

10. The evidence persuasively weighs against finding that the Veteran's vitiligo has affected exposed areas at any time during the period on appeal.

11. The Veteran's FSAD is rated a noncompensable, the sole schedular rating permitted for FSAD. The Veteran is in receipt of special monthly compensation (SMC) based on loss of use of a creative organ.

12. The Veteran's service-connected C-section scar measures one square centimeter and is painful but not associated with underlying soft tissue damage and is not unstable.

CONCLUSIONS OF LAW

1. The criteria to establish entitlement to service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.
11. The Veteran's FSAD is rated a noncompensable, the sole schedular rating permitted for FSAD. The Veteran is in receipt of special monthly compensation (SMC) based on loss of use of a creative organ.

12. The Veteran's service-connected C-section scar measures one square centimeter and is painful but not associated with underlying soft tissue damage and is not unstable.

CONCLUSIONS OF LAW

1. The criteria to establish entitlement to service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.385.

2. The criteria to establish entitlement to service connection for lymphedema have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

3. The criteria for an initial rating in excess of 40 percent for the Veteran's service-connected stress incontinence have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.115a, 4.115b, DC 7542.

4. The criteria for an initial rating in excess of 30 percent for the Veteran's service-connected migraines have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 3.2500, 4.1, 4.3, 4.14, 4.124a, DC 8100.

5. The criteria for an initial rating in excess of 50 percent for the Veteran's service-connected psychiatric conditions have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.130, DC 9440.

6. The criteria for an initial rating in excess of 30 percent for the Veteran's service-connected gastrointestinal conditions have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.114, DCs 7307, 7319, 7323 (2023); 38 C.F.R. § 4.114, DCs 7307, 7326 (2025).

7. The criteria for an initial rating in excess of 10 percent for the Veteran's service-connected allergic rhinitis have not been me. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.97, DC 6522.

8. There is no legal basis for the assignment of a disability rating higher than the current 10 percent for the Veteran's service-connected tinnitus. 38 U.S.C. § 1155; 38 C.F.R. § 4.87, DC 6260.

9. The criteria for an initial compensable rating for the Veteran's service-connected vitiligo have not been met. 38 U.S.C. §§ 1155; 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.118, DC 7823

10. There is no legal basis for the assignment of a compensable rating the Veteran's service-connected FSAD. 38 U.S.C. § 1155; 38 C.F.R. § 4.116, DC 7632.

11. The criteria for an initial compensable rating for the Veteran's service-connected C-section scar have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, DC 7802.

12. The criteria for an initial rating in excess of 10 percent for the Veteran's service-connected painful C-section scar have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, DC 7804.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty
rating for the Veteran's service-connected C-section scar have not been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, DC 7802.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Navy from May 2019 to November 2023.

These matters come before the Board of Veterans' Appeals (Board) on appeal from on October 2024 rating decision issued by a Department of Veterans Affairs (VA) regional office.

In an October 2025 VA Form 10182, the Veteran requested review of these matters under the Board's evidence submission docket. Under this docket, a Board decision is based on the evidence at the time of the prior decision, as well as evidence submitted by a claimant or their representative within 90 days of the appeal to the Board. 38 C.F.R. § 20.303. As such, the Board may only consider the evidence of record as of October 7, 2024, the date of notification of the decision on appeal, as well as any evidence submitted by the Veteran or her representative between October 7, 2025, and January 5, 2026. See October 2024 VA Correspondence.

If evidence was associated with the claims file during a period of time when additional evidence was not allowed, the Board has not considered it in this decision. 38 C.F.R. § 20.300. If the Veteran would like VA to consider any evidence that was added to the claims file that the Board could not consider, she may file a supplemental claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the 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 an initial matter, the Board notes that, in a November 2023 rating decision, the Agency of Original Jurisdiction (AOJ) awarded service connection and assigned initial ratings for: psychiatric conditions, rated at 50 percent; stress incontinence, rated at 40 percent; gastrointestinal conditions, rated at 30 percent; migraines, rated at 30 percent; allergic rhinitis, rated at 10 percent; back condition, rated at 10 percent; left knee strain, rated at 10 percent; tinnitus, rated at 10 percent; painful C-section scar, rated at 10 percent; and, C-section scar, FSAD, vitiligo, and dermatitis, each rated as noncompensable. The AOJ also denied service connection for bilateral hearing loss and lymphedema.

Thereafter, in May 2024, additional service treatment records (STRs) were associated with the claims file. See STR-Medical, received May 2024. In response to such records, the AOJ issued the rating decision on appeal, which continued the awards and denials contained in the November 2023 rating decision.

Service Connection

Service connection on a direct basis requires evidence of three elements: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the current disability and the disease or injury incurred or aggravated during active service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Service connection on a secondary basis may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); Allen v. Brown, 8 Vet. App. 374 (1995).

In order to prevail on the issue of secondary service connection, the record must show: (1) a current disability; (2)
be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Service connection on a secondary basis may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); Allen v. Brown, 8 Vet. App. 374 (1995).

In order to prevail on the issue of secondary service connection, the record must show: (1) a current disability; (2) a service-connected disability; and (3) a medical nexus between the current disability and the service-connected disability. See Wallin v. West, 11 Vet. App. 509 (1998); Allen v. Brown, supra.

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

1. Entitlement to service connection for bilateral hearing loss is denied.

The Veteran seeks service connection for bilateral hearing loss.

Impaired hearing is considered to be a disability for VA purposes when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz (Hz) 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.

Unfortunately, the evidence of record does not show that the Veteran has auditory thresholds in any of the frequencies that is 40 or above, auditory thresholds of 26 or above in three of the frequencies, or speech recognition scores of 94 percent or less.

Specifically, in an August 2022 VA audiological examination report, puretone thresholds, in decibels, were recorded as follows:

HERTZ

500 1000 2000 3000 4000

RIGHT 25 20 25 25 25

LEFT 20 20 15 20 20

Additionally, speech recognition, using the Maryland CNC Test, was documented as 94 percent for the right ear and 96 percent for the left ear. See August 2022 VA Hearing Loss and Tinnitus Disability Benefits Questionnaire (DBQ).

Given the above, the Board is unable to find that the Veteran currently has bilateral hearing loss for VA disability compensation purposes. As such, the first element of service connection, a current diagnosis, has not been met.

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, supra. Absent proof of a current disability, there can be no valid claim. Boyer v. West, supra; Brammer v. Derwinski, supra.

As the Board is unable to find that the Veteran currently has bilateral hearing loss for VA disability compensation purposes, there is no current disability. Therefore, the analysis ends, and the claim of entitlement to service connection for bilateral hearing loss must be denied. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, supra.

In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the evidence persuasively weighs against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102.

If the Veteran believes that her hearing has worsened since the August 2022 VA examination, such that the current severity meets the minimum requirements to be considered hearing loss for VA disability compensation purposes, she is encouraged to submit a supplemental claim, along with new and relevant evidence, seeking readjudication of the issue of entitlement to service connection for bilateral hearing loss. As noted above, instructions for filing a supplemental claim are included with this decision.

2. Entitlement to service connection for lymphedema is denied.

The Veteran contends that she is entitled to service connection for lymphedema, which she asserts is caused by her service-connected gastrointestinal conditions.

As indicated above, the first element of service connection, whether on
. § 3.102.

2. Entitlement to service connection for lymphedema is denied.

The Veteran contends that she is entitled to service connection for lymphedema, which she asserts is caused by her service-connected gastrointestinal conditions.

As indicated above, the first element of service connection, whether on a direct or secondary basis, is a current disability. See Shedden v. Principi, supra; Allen v. Brown, supra. As to this element, the evidence conflicts.

The Veteran's medical records are silent with respect to a current diagnosis of, or complaints or treatment indicative of, lymphedema. See Hampton VA Medical Center (VAMC) records, received October 2024 in CAPRI; Richmond VAMC records, received October 2024 in CAPRI; Columbia VAMC records, received October 2024 in CAPRI. Indeed, such records reveal that the Veteran has consistently denied experiencing pain or swelling of the lower extremities. See id. Additionally, in June 2022, the Veteran underwent a VA examination in which the examiner determined that there was no evidence of lymphedema. See June 2022 VA Hematologic and Lymphatic Conditions DBQ, received August 2022.

Indeed, the only indication in the record that the Veteran has experienced such condition during the period on appeal consists of the Veteran's report, both in a correspondence and in a private evaluation, that she experiences swelling and pain in her legs, lasting for several days, when she has a flare-up of her gastrointestinal conditions. See December 2025 Correspondence, received January 2026; December 2025 Private Evaluation, received January 2026.

However, while the Veteran is competent to report symptomatology, there is no indication that she possesses the necessary skills or education to assign such symptomatology to a particular diagnosis. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

Additionally, as noted above, the Veteran's medical records reveal that she has consistently denied experiencing pain or swelling of her lower extremities. See Hampton VAMC records; Richmond VAMC records; Columbia VAMC records. The Board finds such denials to be particularly probative as such were made in the course of seeking medical treatment. See Rucker v. Brown, 10 Vet. App. 67, 73 (1997) (statements made for the purposes of medical treatment may be afforded greater probative value because there is a strong incentive to tell the truth in order to receive proper care).

In short, the Board finds the Veteran's December 2025 report that she has experienced pain and swelling of the lower extremities since service to be outweighed by her medical records in which she consistently denied experiencing pain or swelling of the lower extremities.

Further, though the Veteran has submitted a private evaluation in which the private clinician opined that the Veteran's lymphedema is at least as likely as not caused by her gastrointestinal conditions, such opinion was based largely on the Veteran's report of experiencing pain and swelling of the lower extremities during flare-ups of her gastrointestinal conditions. See December 2025 Private Evaluation.

As discussed above, the Board finds the Veteran's report that she has experienced pain and swelling of the lower extremities since service to be outweighed by her medical records in which she consistently denied experiencing such. Moreover, the mere transcription of the Veteran's report of a current diagnosis or symptoms does not transform such report into competent medical evidence. See LeShore v. Brown, 8 Vet. App. 406 (1995).

Given the above, the Board finds that the first element of service connection, a current disability, has not been met.

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 (Fed. Cir. 1997). Absent proof of a current disability, there can be no valid claim. Boyer v. West, 210 F.3d 1351 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223 (1992). In the absence of a current disability, the analysis ends,
that the first element of service connection, a current disability, has not been met.

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 (Fed. Cir. 1997). Absent proof of a current disability, there can be no valid claim. Boyer v. West, 210 F.3d 1351 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223 (1992). In the absence of a current disability, the analysis ends, and the claims of entitlement to service connection for IBS, functional abdominal pain syndrome, and chronic fatigue syndrome must be denied. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, supra.

Increased Ratings

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

Where a claimant timely appeals the rating initially assigned for the service-connected disability, VA must consider whether the claimant is entitled to "staged" ratings to compensate them for times since filing the claim when their disability may have been more severe than at other times during the course of the appeal. See Fenderson v. West, 12 Vet. App. 119, 126 (1999).

If two ratings are potentially applicable, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In view of the number of atypical instances, it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. 38 C.F.R. § 4.21. It is the defined and consistently applied policy of VA to administer the law under a broad interpretation, consistent with the facts shown in every case. Any reasonable doubt regarding the degree of disability is resolved in favor of the Veteran. 38 C.F.R. §§ 3.102, 4.3.

3. Entitlement to an initial rating in excess of 40 percent for service-connected stress incontinence is denied.

Under 38 C.F.R. § 4.115a, which addresses genitourinary system dysfunctions, a 20 percent rating is warranted for stress incontinence that requires the wearing of absorbent materials that must be changed less than two times per day. A 40 percent rating is warranted for stress incontinence that requires the wearing of absorbent materials that must be changed two to four times per day. Lastly, a 60 percent rating is warranted for stress incontinence that requires the use of an appliance or the wearing of absorbent materials that must be changed more than four times per day.

Factual Background

The Veteran's medical records reveal that she denied experiencing urinary leakage in July 2024. Such records are otherwise silent with respect to complaints or treatment indicative of stress incontinence. See STR-Medical; Hampton VAMC records; Richmond VAMC records; Columbia VAMC records.

In June 2022, the Veteran underwent a VA examination in which she reported experiencing urinary leakage with laughing, coughing, or sneezing. The examiner noted a diagnosis of stress incontinence and attributed such to a gynecological condition and that such required the use of absorbent material that is changed two to four times per day. See June 2022 VA Gynecological Conditions DBQ, received August 2022.

In December 2025, the Veteran underwent a private vocational assessment in which she reported that she experienced urinary incontinence approximately every other week, typically during a flare-up of her Crohn's disease. She also reported that she did not wear absorbent materials while at home, but that she would wear such outside of the home. See December 2025 Private Vocational Assessment, received January 2026.

In a December 2025 correspondence, the Veteran reported that her stress incontin
attributed such to a gynecological condition and that such required the use of absorbent material that is changed two to four times per day. See June 2022 VA Gynecological Conditions DBQ, received August 2022.

In a December 2025 correspondence, the Veteran reported that her stress incontinence requires her to wear absorbent pads which have to be changed up to five times per day. See December 2025 Correspondence.

Analysis

The Veteran seeks a higher rating for her service-connected stress incontinence. As this is an appeal as to the initial rating assigned, the relevant temporal focus is from November 7, 2023, the date of the award of service connection to present.

The Veteran's stress incontinence is currently rated at 40 percent, which contemplates the wearing of absorbent materials that must be changed two to four times per day. As such, to warrant a higher rating, the evidence must show that the Veteran's stress incontinence manifests with urinary leakage that requires the use of an appliance or the wearing of absorbent materials that must be changed more than four times per day.

The record does not indicate, nor has the Veteran contended, that her stress incontinence manifests with urinary leakage that requires the use of an appliance. See STR-Medical; Hampton VAMC records; Richmond VAMC records; Columbia VAMC records; June 2022 VA Gynecological Conditions DBQ; December 2025 Private Vocational Assessment; December 2025 Correspondence. As such, this matter turns on whether the Veteran's stress incontinence has manifested with urinary leakage requiring the use of absorbent materials that must be changed more than four times per day. As to this, the evidence conflicts.

Weighing in favor of such a finding is a December 2025 correspondence in which the Veteran reported that her stress incontinence required her to change absorbent pads up to five times per day. See December 2025 Correspondence.

On the other hand, weighing against such a finding is a June 2022 VA examination report, in which the examiner noted that the Veteran's stress incontinence required the use of absorbent materials that are changed two to four times per day. See June 2022 Gynecological Conditions DBQ.

Similarly, in a December 2025 private vocational assessment, though the Veteran reported that she wore absorbent pads when outside her home, she also reported experiencing urinary incontinence approximately every other week. See December 2025 Private Vocational Assessment. In other words, the Veteran reported that she experienced urinary incontinence, or leakage, approximately two days per month, which would mean that her stress incontinence did not require the changing of absorbent materials on most days.

Further weighing against such a finding are the Veteran's medical records, in which she denied experiencing urinary leakage as recently as July 2024. See STR-Medical; Hampton VAMC records; Richmond VAMC records; Columbia VAMC records. The Board finds such denial of experiencing urinary leakage to be particularly probative as such was made in the course of seeking medical treatment. See Rucker v. Brown, supra.

In short, the Board finds the Veteran's report that her stress incontinence requires the use of absorbent materials that must be changed up to five times per day to be outweighed by the medical examinations of record which report that she changes such absorbent pads no more than four times per day, as well as her medical records in which she reported that she does not experience urinary leakage (thereby indicating that she does not need to change absorbent pads).

Given the above, the Board finds that the evidence persuasively weighs against a finding that the Veteran's service-connected stress incontinence has manifested with urinary leakage requiring the use of an appliance or the use of absorbent materials that must be changed more than four times per day at any time during the period on appeal. Therefore, a rating in excess of the currently assigned 40 percent is denied.

In reaching this conclusion, the Board has considered the applicability of the benefit-of the-doubt doctrine; however, as the evidence persuasively weighs against the claim, that doctrine does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

2. Entitlement to
above, the Board finds that the evidence persuasively weighs against a finding that the Veteran's service-connected stress incontinence has manifested with urinary leakage requiring the use of an appliance or the use of absorbent materials that must be changed more than four times per day at any time during the period on appeal. Therefore, a rating in excess of the currently assigned 40 percent is denied.

2. Entitlement to an initial rating in excess of 30 percent for service-connected migraines is denied.

Under DC 8100, which addresses migraines, a 50 percent rating is warranted when such manifests with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. A 30 percent rating is warranted for migraines that manifest with characteristic prostrating attacks occurring, on average, once a month over the last several months. A 10 percent rating is warranted for migraines that manifest with characteristic prostrating attacks occurring, on average, once every two months over the last several months. Lastly, a noncompensable rating is warranted for migraines that manifest with less frequent attacks. 38 C.F.R. § 4.124a, DC 8100.

Factual Background

The Veteran's medical records reveal that she experienced a migraine during service, but has consistently denied experiencing headaches since service. See STR-Medical; Hampton VAMC records; Richmond VAMC records; Columbia VAMC records.

In June 2022, the Veteran underwent a VA examination in which she reported experiencing headaches with sensitivity to lights every few weeks. She also reported that, when experiencing a headache, she would go to a dark place, like a stairwell or bathroom, and that her headaches would resolve within 20 minutes of taking medication. The examiner noted that the Veteran's migraines manifested with pulsating or throbbing head pain which was localized to the right side of the head and sensitivity to light. The examiner also noted that the Veteran experienced characteristic prostrating attacks of migraine/non-migraine headache pain more frequently than once a month, but that she did not experience very prostrating and prolonged attacks of migraines/non-migraine pain productive of severe economic inadaptability. See June 2022 VA Headaches DBQ, received August 2022.

In December 2025, the Veteran underwent a private vocational assessment in which she reported that she experienced migraines approximately every two weeks, lasting approximately 30 minutes, during which she had to lay down in a dark room. See December 2025 Private Vocational Assessment.

In a December 2025 correspondence, the Veteran reported that she experiences four or more migraines per month, during which she must lie down in a dark room. She also reported that, with medication, her migraines last about 30 minutes, but without medication, her migraines last for hours. See December 2025 Correspondence.

Analysis

The Veteran seeks a higher initial rating for her service-connected migraines. As this is an appeal as to the initial rating assigned, the relevant temporal focus is from November 7, 2023, the date of award of service connection, to present.

The Veteran's migraines are currently rated at 30 percent. As such, to warrant a higher rating, the evidence must show that, at some point during the period on appeal, the Veteran's migraines manifested with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. As to this, the evidence conflicts.

Potentially weighing in favor of such a finding is a December 2025 correspondence, in which the Veteran reported experiencing four or more migraines per month, during which she must lie down in a dark room. In such correspondence she also reported that, without medication, her migraines last for hours. See December 2025 Correspondence.

On the other hand, weighing against such a finding is a June 2022 VA examination report in which the examiner determined that, though the Veteran experienced characteristic prostrating attacks of migraine/non-migraine headache pain more frequently than once a month, she did not experience very prostrating and prolonged attacks of migraines/non-migraine pain productive of severe economic inadaptability. See June 2022 VA Headaches DBQ.

Similarly, in a December 2025 private vocational assessment, the Veteran reported experiencing migraines approximately every two weeks (or two per month), lasting approximately 30 minutes. See December 2025 Private Vocational Assessment.

Further weighing against
last for hours. See December 2025 Correspondence.

Further weighing against such a finding are the Veteran's medical records, in which she has consistently denied experiencing headaches. See Hampton VAMC records; Richmond VAMC records; Columbia VAMC records. The Board finds such denials to be particularly probative as such were made in the course of seeking medical treatment. See Rucker v. Brown, supra.

In short, the Board finds the Veteran's report that she experiences migraines four or more times per month, lasting several hours without medication, to be outweighed by the medical examinations of record in which she reported experiencing migraines every couple or few weeks, as well as her medical records in which she has consistently denied experiencing headaches.

Given the above, the Board finds that the evidence persuasively weighs against finding that the Veteran's service-connected migraines have manifested with very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability at any time during the period on appeal. Therefore, a rating in excess of the currently assigned 30 percent is denied.

3. Entitlement to an initial rating in excess of 50 percent for service-connected psychiatric conditions is denied.

The rating analysis for psychiatric disorders is symptom driven. See Golden v. Shulkin, 29 Vet. App. 221, 225 (2018); Vazquez-Claudio v. Shinseki, supra. ("The regulation's plain language highlights its symptom-driven nature."). The "such symptoms as" language of the diagnostic codes for mental disorders in 38 C.F.R. § 4.130 means "for example" and does not represent an exhaustive list of symptoms that must be found before granting the rating of that category. Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). However, while the symptoms listed do not form an exhaustive list, such symptoms serve as examples of the type and degree of symptoms that would justify the associated rating. See Bankhead v. Shulkin, 29 Vet. App. 10 (2017). Accordingly, while each of the examples needs not be proven in any one case, the symptoms must be analyzed considering those given examples.

Additionally, assessing whether a particular rating is warranted "requires a two-part analysis." Emerson v. McDonald, 28 Vet. App. 200, 212 (2016). It requires an initial assessment of the symptoms displayed by the veteran, and if they are of the kind enumerated in the rating criteria, an assessment of whether those symptoms result in the level of occupational and social impairment contemplated by the relevant rating criteria. See id.

Under the General Formula, a noncompensable rating is assigned when a mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication.

A 10 percent rating is assigned when there is occupational and social impairment due to mild or transient symptoms which decrease work efficiency and the ability to perform occupational tasks only during periods of significant stress, or when symptoms are controlled by continuous medication.

A 30 percent rating is assigned when symptoms such as depressed mood; anxiety; suspiciousness; panic attacks (weekly or less often); chronic sleep impairment; or mild memory loss caused occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal).

A 50 percent rating is assigned when symptoms such as flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; or difficulty in establishing and maintaining
when symptoms such as depressed mood; anxiety; suspiciousness; panic attacks (weekly or less often); chronic sleep impairment; or mild memory loss caused occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal).

A 70 percent rating is assigned when there is occupational and social impairment, with deficiencies in most areas (such as work, school, family relations, judgment, thinking, or mood), and the impairment is attributable to symptoms such as: suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships.

A 100 percent rating is assigned when there is total occupational and social impairment due to symptoms such as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation, or own name.

Factual Background

The Veteran's medical records reveal that she has consistently presented alert and fully oriented, appropriately dressed with adequate grooming and hygiene, and with depressed mood, intact attention, concentration, and memory. Such records also reveal that she has consistently denied experiencing suicidal or homicidal ideation. Lastly, such records reveal that she has reported feeling anxious, has trouble relaxing, and is easily irritable, but that her symptoms do not make it difficult to work, take care of things at home, or get along with others. See Hampton VAMC records; Richmond VAMC records; Columbia VAMC records.

In June 2022, the Veteran underwent a VA examination in which she reported experiencing depression and nervousness. She also reported getting along with coworkers and supervisors, but that she tried to stay to herself. The examiner noted that the Veteran's symptoms consisted of depressed mood, anxiety, panic attacks that occur weekly or less often, chronic sleep impairment, disturbances of motivation and mood, and difficulty adapting to stressful circumstances. The examiner observed that the Veteran presented fully oriented, appropriately addressed, and with good hygiene, normal affect and speech, and linear and logical thought processes. Ultimately, the examiner concluded that the Veteran's symptomatology manifested with occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. See June 2022 VA Mental Disorders DBQ, received August 2022.

In December 2025, the Veteran underwent a private vocational assessment in which she reported that she experienced depressive symptoms, lack of motivation, and negligible energy, intrusive thoughts that impair her ability to maintain concentration and focus, and panic attacks approximately two to three times per month. She also reported that she had minimal social interactions due to her anxiety. See December 2025 Private Vocational Assessment.

In a December 2025 correspondence, the Veteran reported experiencing severe anxiety and depression, constant fatigue, loss of motivation, and poor concentration, which rendered it "extremely hard" to perform everyday tasks like brushing her teeth, bathing, or cleaning her home. She also reported an inability to tolerate crowds, panic attacks almost daily, and periods of compulsive movement when she is unable to stop pacing, tapping, or rocking back and forth. The Veteran further reported that she no longer had any friends because she avoided social interactions. See December 2025 Correspondence.

Analysis

The Veteran seeks a higher rating for her service-connected psychiatric conditions. Importantly, as this is an appeal as to the initial rating assigned, the relevant temporal focus is from November 7, 2023, the date of award of service connection, to present.

The Veteran's service-connected psychiatric conditions are currently rated at 50 percent. As such, to warrant a higher rating, the evidence must show, at a minimum, that the Veteran's symptoms more nearly approx
daily, and periods of compulsive movement when she is unable to stop pacing, tapping, or rocking back and forth. The Veteran further reported that she no longer had any friends because she avoided social interactions. See December 2025 Correspondence.

Analysis

As discussed above, a 70 percent rating is assigned when there is occupational and social impairment, with deficiencies in most areas (such as work, school, family relations, judgment, thinking, or mood), and the impairment is attributable to symptoms such as: suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); or inability to establish and maintain effective relationships.

Here, the record shows that the Veteran has consistently denied experiencing suicidal ideation and has consistently presented fully oriented and with normal speech. See Hampton VAMC records; Richmond VAMC records; Columbia VAMC records; June 2022 VA Mental Disorders DBQ. Additionally, there is no indication in the record, nor has the Veteran contended, that she experiences impaired impulse control. See id.; December 2025 Private Vocational Assessment; December 2025 Correspondence.

Instead, the record shows that the Veteran's psychiatric conditions have primarily manifested with symptomatology contemplated by the criteria for 30 percent and 50 percent ratings.

Specifically, the record shows that the Veteran has experienced depressed mood, anxiety, panic attacks that occur weekly or less often, chronic sleep impairment, which are contemplated by the criteria for a 30 percent rating. Additionally, the record shows that the Veteran has experienced disturbances of motivation and mood, which is contemplated by the criteria for a 50 percent rating. See id.

The Board acknowledges that the record contains evidence that is potentially suggestive of a 70 percent rating.

Specifically, in the June 2022 VA examination, the examiner noted that the Veteran's symptomatology included difficulty adapting to stressful circumstances. See June 2022 VA Mental Disorders DBQ.

However, having one or more symptoms within the identified criteria for a higher rating does not automatically trigger the granting of a higher rating; it is the overall disability picture that the Board must consider. See 38 C.F.R. § 4.7.

Here, though the June 2022 examiner noted that the Veteran experienced difficulty adapting to stressful circumstances, the examiner ultimately concluded that the Veteran's psychiatric conditions did not manifest with occupational and social impairment with deficiencies in most areas, as required for a 70 percent rating, but rather manifested occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation, which is the criteria for a 50 percent rating. See June 2022 VA Mental Disorders DBQ.

The Board also acknowledges that the Veteran has reported experiencing panic attacks most days, periods of compulsive movement, and difficulty performing everyday tasks such as bathing and brushing her teeth. See December 2025 Correspondence. The Board also acknowledges that the Veteran, through her representative, has argued that the Veteran's reported daily panic attacks constitutes near-continuous panic, that her reported compulsive movement constitutes obsessional rituals which interfere with routine activities, and her reported difficulty performing everyday tasks constitutes neglect of personal appearance and hygiene, all of which are symptomatology contemplated by the criteria for a 70 percent rating. See January 2026 Appellate Brief.

However, though the Veteran reported that she experienced near-daily panic attacks in her December 2025 correspondence, in her December 2025 vocational assessment she reported experiencing panic attacks two or three times per month. See December 2025 Private Vocational Assessment. Additionally, the Veteran's medical records reveal that she has consistently denied feeling "panicky," that is, feelings of panic. See Hampton VAMC records; Richmond VAMC records; Columbia VAMC records. The Board finds such denials of feelings of panic to be particularly probative as such were made in the course
all of which are symptomatology contemplated by the criteria for a 70 percent rating. See January 2026 Appellate Brief.

However, though the Veteran reported that she experienced near-daily panic attacks in her December 2025 correspondence, in her December 2025 vocational assessment she reported experiencing panic attacks two or three times per month. See December 2025 Private Vocational Assessment. Additionally, the Veteran's medical records reveal that she has consistently denied feeling "panicky," that is, feelings of panic. See Hampton VAMC records; Richmond VAMC records; Columbia VAMC records. The Board finds such denials of feelings of panic to be particularly probative as such were made in the course of seeking medical treatment. See Rucker v. Brown, supra.

In short, the Board finds that the Veteran's report of experiencing near-daily panic attacks is outweighed by the medical examinations of record in which she reported experiencing panic attacks weekly or less often, as well as her medical records in which she denied experiencing feelings of panic.

Similarly, though the Veteran has reported difficulty performing everyday tasks, such report is outweighed by the Veteran's medical records which show that she has consistently presented appropriately dressed and with adequate grooming and hygiene. See Hampton VAMC records; Richmond VAMC records; Columbia VAMC records.

Lastly, though the Veteran's representative has argued that the Veteran's reported compulsive movements constitute obsessional rituals that interfere with routine activities, the record does not indicate, nor has the Veteran contended, that her reported compulsive movements interfere with such.

Given the above, the Board finds that the evidence persuasively weighs against a finding that the Veteran's service-connected psychiatric conditions have more nearly approximated occupational and social impairment with deficiencies in most areas at any time during the period on appeal. Therefore, a rating in excess of the currently assigned 50 percent is denied.

4. Entitlement to an initial rating in excess of 30 percent for service-connected gastrointestinal conditions is denied.

The Veteran's service-connected gastrointestinal conditions are currently rated pursuant to DC-7307-7323. Hyphenated diagnostic codes are used when a rating under one code requires the use of an additional diagnostic code to identify the basis for the rating. 38 C.F.R. § 4.27. Additionally, when a veteran has multiple service-connected digestive system conditions, such as the case here, a single evaluation is assigned under the DC that reflects the predominant disability picture. 38 C.F.R. § 4.114 (2023); 38 C.F.R. § 4.114 (2025).

Here, the use of a hyphenated code reflects that the Veteran's gastrointestinal conditions, which include chronic gastritis (DC 7307), are rated pursuant to DC 7323, which, prior to May 19, 2024, addressed ulcerative colitis. Notably, prior to such date, the rating schedule did not provide a specific DC for Crohn's disease and, therefore, the Veteran's symptoms were rated by analogy under DC 7323.

Under the version of DC 7323 in effect prior to May 19, 2024, a 10 percent rating was assigned for moderate symptoms with infrequent exacerbations. A 30 percent rating was warranted for moderately severe symptoms with frequent exacerbations. A 60 percent rating was warranted for severe symptoms, with numerous attacks a year and malnutrition, the health only fair during remissions. Lastly, a 100 percent rating was warranted for pronounced symptoms, resulting in marked malnutrition, anemia, and general debility, or with serious complications such as liver abscess. 38 C.F.R. § 4.114, DC 7323 (2023).

However, the rating criteria applicable to the digestive system were revised effective May 19, 2024. 89 Fed. Reg. 55 (March 20, 2024). As part of such revision, a specific DC for Crohn's disease, DC 7326, was added. See 38 C.F.R. § 4.114 (2023); 38 C.F.R. § 4.114, DC 7326 (2025). Importantly, when a condition is specifically identified in the rating schedule, it may not be rated by analogy. See Copeland v. McDonald, 27 Vet. App. 333 (2015).

Under the revised DC
).

Under the revised DC 7326, a 10 percent rating is warranted for minimal to mild symptomatic inflammatory bowel disease that is managed with oral or topical agents (other than immunosuppressants or other biologic agents) and that is characterized by recurrent abdominal pain with three or less daily episodes of diarrhea and no signs of systemic toxicity. A 30 percent rating is warranted for mild to moderate inflammatory bowel disease that is managed with oral or topical agents (other than immunosuppressants or other biologic agents) and that is characterized by three or less daily episodes of diarrhea and minimal signs of toxicity, such as fever, tachycardia, or anemia. A 60 percent rating is warranted for moderate inflammatory bowel disease that is managed on an outpatient basis with immunosuppressants or other biologic agents and that is characterized by recurrent abdominal pain, four to five daily episodes of diarrhea, and intermittent signs of toxicity, such as fever, tachycardia, or anemia. Lastly, a 100 percent rating is warranted for severe inflammatory bowel disease that is unresponsive to treatment, requires hospitalization at least once per year, and results in either an inability to work or is characterized by recurrent abdominal pain and at least two of the following: (1) six or more episodes per day of diarrhea; (2) six or more episodes per day of rectal bleeding; (3) recurrent episodes of rectal incontinence; or (4) recurrent abdominal distension. 38 C.F.R. § 4.114, DC 7326 (2025).

Factual Background

The Veteran's medical records reveal a report of four episodes of diarrhea per day in April 2024, but that she has denied experiencing diarrhea thereafter. Such records also reveal that the Veteran's Crohn's has been treated with certolizumab injections since April 2024, and that such was previously treated with simethicone. Further, her medical records reveal that the Veteran has consistently denied experiencing abdominal pain, fever, rectal bleeding, or swelling in the lower extremities. See Hampton VAMC records; Richmond VAMC records; Columbia VAMC records.

In June 2022, the Veteran underwent VA examinations regarding her gastrointestinal conditions, in which she reported experiencing intermittent abdominal discomfort and pain, bloating, bowel urgency, diarrhea, and nocturnal stools. The examiner noted a diagnosis of Crohn's disease and that such was treated with Runflexis infusions and sulfasalazine. The examiner also noted diagnoses of adult hypertrophic pyloric stenosis and chronic gastritis. The examiner stated that the Veteran's symptoms consisted of diarrhea, nausea, vomiting, anemia, bloating, fecal urgency, nocturnal stooling, and hematochezia, and that the Veteran experienced more or less constant abdominal distress. See June 2022 VA Intestinal Conditions DBQ, received August 2022; June 2022 VA Stomach and Duodenal Conditions DBQ, received August 2022.

In a December 2025 correspondence, the Veteran reported that her Crohn's disease is treated with biologic agent medications, but that she continues to experience intermittent abdominal pain and a minimum of four episodes of diarrhea per day. See December 2025 Correspondence.

In December 2025, the Veteran underwent a private vocational assessment, in which she reported experiencing diarrhea three to four times per day, abdominal discomfort every other day, and vomiting monthly. She also reported experiencing flare-ups every two weeks, during which she experienced diarrhea six to eight times per day. See December 2025 Private Vocational Assessment.

Analysis

The Veteran seeks a higher rating for her service-connected gastrointestinal conditions. Importantly, as this is an appeal as to the initial rating assigned, the relevant temporal focus is from November 7, 2023, the date of award of service connection, to present.

As noted above, the rating criteria applicable to the digestive system were revised effective May 19, 2024. 89 Fed. Reg. 55 (March 20, 2024);
diarrhea three to four times per day, abdominal discomfort every other day, and vomiting monthly. She also reported experiencing flare-ups every two weeks, during which she experienced diarrhea six to eight times per day. See December 2025 Private Vocational Assessment.

Analysis

As noted above, the rating criteria applicable to the digestive system were revised effective May 19, 2024. 89 Fed. Reg. 55 (March 20, 2024); 38 C.F.R. § 4.114 (2023); 38 C.F.R. § 4.114 (2025). When regulations are revised during the course of an appeal, as here, the Board is required to consider the claim in light of both the former and the revised schedular criteria and apply the regulation more favorable to the claimant. However, if an increased rating is warranted under the revised criteria, that award may not be made effective before the effective date of the change; there is no prohibition against assigning a rating under the older criteria for the entire period on appeal. See Kuzma v. Principi, supra.

Period Prior to May 19, 2024

Prior to May 19, 2024, the rating schedule did not provide a specific DC for Crohn's disease and, therefore, the Veteran's symptoms were rated by analogy under DC 7323.

The Veteran is currently rated at 30 percent for her service-connected gastrointestinal conditions, which, under DC 7323, contemplates moderately severe symptoms with frequent exacerbations. As such, to warrant a higher rating for the period prior to May 19, 2024, the evidence must show that the Veteran's symptoms more closely approximated the criteria for a 60 percent rating, severe symptoms with numerous attacks per year and malnutrition, or the criteria for a 100 percent rating, pronounced symptoms, resulting in marked malnutrition, anemia, and general debility, or with serious complications such as liver abscess.. See 38 C.F.R. § 4.114, DC 7323 (2023).

Notably, in light of the conjunctive "and" in the criteria, all criteria must be met to establish entitlement to such. See, e.g., Heuer v. Brown, 7 Vet. App. 379, 385 (1995). In other words, to warrant a 60 percent rating, the record must establish that the Veteran's gastrointestinal conditions manifested with both numerous attacks per year AND malnutrition. Similarly, to warrant a 100 percent rating, the record must establish that the Veteran's gastrointestinal conditions manifested with marked malnutrition, anemia, AND general debility, or, alternatively, manifested with serious complications such as liver abscess.

Here, the record does not show, nor has the Veteran contended, that she has experienced malnutrition. See STR-Medical; Hampton VAMC records; Richmond VAMC records; Columbia VAMC records; June 2022 VA Intestinal Conditions DBQ; June 2022 VA Stomach and Duodenal Conditions DBQ; December 2025 Correspondence. Similarly, the record does not show, nor has the Veteran contended, that her gastrointestinal conditions have manifested with serious complications. See id. As such, the Board is unable to find that, for the period prior to May 19, 2024, the Veteran's gastrointestinal conditions manifested with symptomatology more nearly approximating the criteria for a 60 percent or 100 percent rating under DC 7323.

The Board has considered other DCs applicable to the Veteran's gastrointestinal conditions but finds them to be of no greater benefit to the Veteran.

Specifically, the Board has considered rating the Veteran's Crohn's disease under DC 7319, as analogous to irritable colon syndrome. However, DC 7319 provides for a maximum rating of 30 percent. 38 C.F.R. § 4.114, DC 7319 (2023). As such, the Board finds that rating the Veteran's gastrointestinal conditions under DC 7319 would be of no greater benefit to the Veteran.

Similarly, the Board has considered rating the Veteran's gastrointestinal conditions under DC 7307, which addresses her chronic gastritis. However, to warrant a rating in excess of the currently assigned 30 percent, the evidence must show that her gastrointestinal conditions have manifested with severe hemorrhages or large ulcerated or eroded areas. See 38 C.F.R. § 4.114, DC 730
However, DC 7319 provides for a maximum rating of 30 percent. 38 C.F.R. § 4.114, DC 7319 (2023). As such, the Board finds that rating the Veteran's gastrointestinal conditions under DC 7319 would be of no greater benefit to the Veteran.

Here, the record does not show, nor has the Veteran contended, that her chronic gastritis has manifested with either severe hemorrhages or large ulcerated or eroded areas. Indeed, the record indicates that Veteran's chronic gastritis has been characterized as inactive. See STR-Medical; Hampton VAMC records; Richmond VAMC records; Columbia VAMC records; June 2022 VA Intestinal Conditions DBQ; June 2022 VA Stomach and Duodenal Conditions DBQ; December 2025 Correspondence. As such, the Board finds that rating the Veteran's gastrointestinal conditions under DC 7307 would be of no greater benefit to the Veteran.

Lastly, the Board acknowledges that the Veteran, through her attorney, has argued that, as the Veteran's Crohn's disease is treated with biologic agent medications and she has reported experiencing at least four episodes of diarrhea per day, a 60 percent rating is warranted, effective November 7, 2023, under DC 7326.

There appears to be confusion on the part of the Veteran's attorney. While post-revision DC 7326 addresses Crohn's disease and the criteria contemplates the type of medication utilized and the frequency of diarrhea, the pre-revision version of DC 7326 addresses chronic enterocolitis and instructs that such should be rated under DC 7319, which provides a maximum rating of 30 percent. See 38 C.F.R. §§ 4.114, DCs 7319, 7326 (2023); 38 C.F.R. § 4.114, DC 7326 (2025). As such, the attorney appears to argue that the Board should apply the revised DC 7326 retroactively.

However, as discussed above, when an increased rating is warranted under revised criteria, that award may not be made effective before the effective date of the change. See Kuzma v. Principi, supra. In other words, the revised DC 7326 may not be applied prior to May 19, 2024. As such, the attorney's contention that a rating of 60 percent under the revised DC 7326, effective November 7, 2023, lacks any legal merit.

In sum, the evidence persuasively weighs against finding that the Veteran's gastrointestinal conditions manifested with malnutrition or serious complications at any time prior to May 19, 2024. As such, for the period prior to May 19, 2024, a rating in excess of the currently assigned 30 percent must be denied.

Period Beginning May 19, 2024

The Veteran is currently rated at 30 percent for her service-connected gastrointestinal conditions, which, under the prior version of DC 7323, contemplates moderately severe symptoms with frequent exacerbations. As such, to warrant a higher rating under the prior
the course of an appeal, as here, the Board is required to consider the claim in light of both the former and the revised schedular criteria and apply the regulation more favorable to the claimant. However, if an increased rating is warranted under the revised criteria, that award may not be made effective before the effective date of the change; there is no prohibition against assigning a rating under the older criteria for the entire period on appeal. See Kuzma v. Principi, supra.

The Veteran is currently rated at 30 percent for her service-connected gastrointestinal conditions, which, under the prior version of DC 7323, contemplates moderately severe symptoms with frequent exacerbations. As such, to warrant a higher rating under the prior criteria, the evidence must show that the Veteran's symptoms more closely approximated the criteria for a 60 percent rating, severe symptoms with numerous attacks per year and malnutrition, or the criteria for a 100 percent rating, pronounced symptoms, resulting in marked malnutrition, anemia, and general debility, or with serious complications such as liver abscess.. See 38 C.F.R. § 4.114, DC 7323 (2023).

As discussed above, given the use of the conjunctive "and" in the criteria, all criteria must be met to establish entitlement to such. See, e.g., Heuer v. Brown, supra. In other words, to warrant a 60 percent rating, the record must establish that the Veteran's gastrointestinal conditions manifested with both numerous attacks per year AND malnutrition. Similarly, to warrant a 100 percent rating, the record must establish that the Veteran's gastrointestinal conditions manifested with marked malnutrition, anemia, AND general debility, or, alternatively, manifested with serious complications such as liver abscess.

Here, the record does not show, nor has the Veteran contended, that she has experienced malnutrition. See STR-Medical; Hampton VAMC records; Richmond VAMC records; Columbia VAMC records; June 2022 VA Intestinal Conditions DBQ; June 2022 VA Stomach and Duodenal Conditions DBQ; December 2025 Correspondence. Similarly, the record does not show, nor has the Veteran contended, that her gastrointestinal conditions have manifested with serious complications. See id. As such, the Board is unable to find that the Veteran's gastrointestinal conditions have manifested with symptomatology more nearly approximating the criteria for a 60 percent or 100 percent rating under the prior version of DC 7323.

With respect to the new criteria, as noted above, the revisions added a specific DC for Crohn's disease, DC 7326. Under the revised version of DC 7326, which specifically addresses Crohn's disease, a 60 percent rating is warranted for moderate inflammatory bowel disease that is managed on an outpatient basis with immunosuppressants or other biologic agents and that is characterized by recurrent abdominal pain, four to five daily episodes of diarrhea, and intermittent signs of toxicity, such as fever, tachycardia, or anemia. Lastly, a 100 percent rating is warranted for severe inflammatory bowel disease that is unresponsive to treatment, requires hospitalization at least once per year, and results in either an inability to work or is characterized by recurrent abdominal pain and at least two of the following: (1) six or more episodes per day of diarrhea; (2) six or more episodes per day of rectal bleeding; (3) recurrent episodes of rectal incontinence; or (4) recurrent abdominal distension. 38 C.F.R. § 4.114, DC 7326 (2025).

Given the use of the conjunctive "and" in the criteria, all criteria must be met to establish entitlement to such. See, e.g., Heuer v. Brown, supra. In other words, to warrant a 60 percent rating under DC 7326, the record must establish that the Veteran's gastrointestinal conditions are managed on an outpatient basis with immunosuppressants or other biologic agents AND manifest with: (1) recurrent abdominal pain; (2) four to five daily episodes of diarrhea; AND (3) intermittent signs of toxicity, such as fever, tachycardia, or anemia. Similarly, to warrant a 100 percent rating, the record must establish that the Veteran's gastrointestinal conditions are unresponsive to treatment, requires hospitalization at least once per year, AND (A) results in either an inability to work, OR (B) manifests with recurrent abdominal pain AND AT LEAST TWO of the following: (1) six or more episodes per day of diarrhea; (2) six or more episodes per day of rectal bleeding; (3) recurrent episodes of rectal in
ologic agents AND manifest with: (1) recurrent abdominal pain; (2) four to five daily episodes of diarrhea; AND (3) intermittent signs of toxicity, such as fever, tachycardia, or anemia. Similarly, to warrant a 100 percent rating, the record must establish that the Veteran's gastrointestinal conditions are unresponsive to treatment, requires hospitalization at least once per year, AND (A) results in either an inability to work, OR (B) manifests with recurrent abdominal pain AND AT LEAST TWO of the following: (1) six or more episodes per day of diarrhea; (2) six or more episodes per day of rectal bleeding; (3) recurrent episodes of rectal incontinence; or (4) recurrent abdominal distension. 38 C.F.R. § 4.114, DC 7326 (2025).

Here, the record reveals that the Veteran's gastrointestinal conditions are treated with certolizumab injections on an outpatient basis. See Hampton VAMC records; Richmond VAMC records; Columbia VAMC records. Additionally, the Veteran has reported experiencing intermittent abdominal pain and a minimum of four episodes of diarrhea per day, with flare-ups every two weeks during which she experiences six to eight episodes of diarrhea per day. See December 2025 Correspondence; December 2025 Private Vocational Assessment.

However, though the Veteran reported that she experiences intermittent abdominal pain and at least four episodes of diarrhea per day, her medical records reveal that, during the period beginning May 19, 2024, she has consistently denied experiencing abdominal pain or diarrhea. See Hampton VAMC records; Richmond VAMC records; Columbia VAMC records. The Board finds such denials of experiencing abdominal pain or diarrhea to be particularly probative as such were made in the course of seeking medical treatment. See Rucker v. Brown, supra.

In short, the Board finds that the Veteran's reports of experiencing recurrent abdominal pain and diarrhea up to eight times per day are outweighed by her medical records in which she denied experiencing abdominal pain or diarrhea. As such, the Board finds that the evidence persuasively weighs against finding that, since May 19, 2024, the Veteran's gastrointestinal conditions have manifested with recurrent abdominal pain or four to five daily episodes of diarrhea, as contemplated by the criteria for a 60 percent rating.

Further, the Veteran's medical records reveal that, in June 2024, her Crohn's disease was notes as being in remission. See Columbia VAMC records. As such, the Board is unable to find that the Veteran's Crohn's disease has been unresponsive to treatment, as contemplated by the criteria for a 100 percent rating.

In sum, the evidence persuasively weighs against finding that the Veteran's gastrointestinal conditions manifested with abdominal pain or diarrhea during the period beginning May 19, 2024. As such, for the period beginning May 19, 2024, a rating in excess of the currently assigned 30 percent must be denied.

5. Entitlement to an initial rating in excess of 10 percent for service-connected allergic rhinitis is denied.

Under DC 6522, which addresses allergic rhinitis, a 10 percent rating is warranted when there are no nasal polyps but there is greater than 50 percent obstruction of nasal passages on both sides or complete obstruction on one side. A maximum rating of 30 percent is warranted when polyps are present. 38 C.F.R. § 4.97, DC 6522.

Factual Background

The Veteran's medical records are silent with respect to complaints or treatment indicative of allergic rhinitis, to include nasal polyps. See Hampton VAMC records; Richmond VAMC records; Columbia VAMC records.

In June 2022, the Veteran underwent a VA examination in which she reported experiencing seasonal allergies manifesting with rhinorrhea, congestion, sore throat, and dry cough. The examiner noted that the Veteran's nasal passages were greater than 50 percent obstructed on both sides, but that there were no nasal polyps. See June 2022 VA Sinusitis/Rhinitis DBQ, received August 2022.

Analysis

The Veteran seeks a higher rating for her service-connected allergic rhinitis. Importantly, as this is an appeal as to the initial rating assigned, the relevant temporal focus is from November 7, 2023, to current.

AMC records; Columbia VAMC records.

Analysis

The Veteran's allergic rhinitis is currently rated at 10 percent. As such, to warrant a higher rating, the evidence must show that, at some point during the period on appeal, the Veteran's allergic rhinitis manifested with polyps. See 38 C.F.R. § 4.97, DC 6522.

Here, the record does not show that the Veteran has experienced nasal polyps at time during the period on appeal. Specifically, in a June 2022 VA examination, the examiner noted that the Veteran did not have nasal polyps. See June 2022 VA Sinusitis/Rhinitis DBQ. Additionally, the Veteran's medical records are silent with respect to a diagnosis of nasal polyps, or complaints or treatment indicative thereof. See Hampton VAMC records; Richmond VAMC records; Columbia VAMC records.

Notably, the Veteran has not contended otherwise. Indeed, aside from the act of appealing the initial rating assigned, neither the Veteran nor her attorney has provided any evidence or argument in support of such appeal.

Given the above, the Board finds that the evidence persuasively weighs against finding that the Veteran's allergic rhinitis has manifested with nasal polyps at any time during the period on appeal. As such, a rating in excess of 10 percent for the Veteran's allergic rhinitis is denied.

6. Entitlement to an initial rating in excess of 10 percent for service-connected tinnitus is denied.

The Veteran's tinnitus is currently rated under 38 C.F.R. § 4.87, DC 6260. Under DC 6260, only a single 10 percent rating is warranted for tinnitus, whether the sound is perceived as being in one ear, both ears, or in the head. 38 C.F.R. § 4.87, DC 6260, Note (2); see Smith v. Nicholson, 451 F. 3d, 1344 (Fed. Cir. 2006). This is the maximum schedular rating assignable for tinnitus.

The Board has considered whether extraschedular consideration is warranted for the Veteran's tinnitus. Extraschedular ratings are a way to compensate veterans for disability symptoms that fall outside the schedular rating criteria. See Thun v. Peake, 22 Vet. App. 111 (2008). Here, the Veteran has not reported experiencing any symptoms aside from experiencing recurrent ringing. See June 2022 VA Hearing Loss and Tinnitus DBQ. In other words, the Veteran has not reported experiencing any symptoms that fall outside the rating criteria under DC 6260.

Indeed, aside from the act of appealing the initial rating assigned, neither the Veteran nor her attorney has provided any evidence or argument in support of such appeal.

Accordingly, as there is no legal basis upon which to award an evaluation in excess of 10 percent, the claim for an increased rating must be denied. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994).

7. Entitlement to an initial compensable rating for service-connected vitiligo is denied.

Under DC 7823, which addresses vitiligo, a noncompensable rating is warranted when no exposed areas are affected. A maximum 10 percent rating is warranted when exposed areas are affected. 38 C.F.R. § 4.118, DC 7823.

Factual Background

The Veteran's medical records reveal complaints of chronic vitiligo. See Hampton VAMC records; Richmond VAMC records; Columbia VAMC records.

In June 2022, the Veteran underwent a VA examination in which the examiner noted a diagnosis of vitiligo that was treated
426, 430 (1994).

7. Entitlement to an initial compensable rating for service-connected vitiligo is denied.

Factual Background

The Veteran's medical records reveal complaints of chronic vitiligo. See Hampton VAMC records; Richmond VAMC records; Columbia VAMC records.

In June 2022, the Veteran underwent a VA examination in which the examiner noted a diagnosis of vitiligo that was treated with topical hydrocortisone. The examiner also noted that the no exposed areas were affected by the Veteran's vitiligo. See June 2022 VA Skin Diseases DBQ, received August 2022.

Analysis

The Veteran seeks a higher rating for her service-connected vitiligo. Importantly, as this is an appeal as to the initial rating assigned, the relevant temporal focus is from November 7, 2023, to current.

The Veteran's vitiligo is currently rated as noncompensable. As such, to warrant a higher rating, the evidence must show that, at some point during the period on appeal, the Veteran's vitiligo affected exposed areas. See 38 C.F.R. § 4.118, DC 7823.

Here, the record does not show that exposed areas have been affected by the Veteran's vitiligo at time during the period on appeal. Specifically, in a June 2022 VA examination, the examiner noted that the Veteran's vitiligo did not affect exposed areas. See June 2022 VA Skin Diseases DBQ. Additionally, though the Veteran's medical records note complaints of chronic vitiligo, such are silent with respect to such affecting exposed areas. See Hampton VAMC records; Richmond VAMC records; Columbia VAMC records.

Given the above, the Board finds that the evidence persuasively weighs against finding that the Veteran's vitiligo has affected exposed areas at any time during the period on appeal. As such, a compensable rating for the Veteran's vitiligo is denied.

8. Entitlement to an initial compensable rating for service-connected FSAD is denied.

The Veteran seeks a higher rating for her service-connected FSAD. Importantly, as this is an appeal as to the initial rating assigned, the relevant temporal focus is from November 7, 2023, to current.

Under DC 7632, which addresses FSAD, the only available schedular rating is noncompensable. 38 C.F.R. § 4.116, DC 7632. As such, a compensable rating for FSAD under DC 7632 may not be assigned.

The Board has considered whether extra-schedular consideration is warranted for the Veteran's FSAD. Extra-schedular ratings are a way to compensate veterans for disability symptoms that fall outside the schedular rating criteria. See Thun v. Peake, 22 Vet. App. 111 (2008). Here, the Veteran has not reported experiencing any symptoms aside from a lack of interest in sex. See June 2022 VA Gynecological Conditions DBQ. In other words, the Veteran has not reported experiencing any symptoms that fall outside the rating criteria under DC 6260.

Indeed, aside from the act of appealing the initial rating assigned, neither the Veteran nor her attorney has provided any evidence or argument in support of such appeal.

In light of the above, the Board finds that the persuasive weight of the evidence is against the Veteran's claim. Therefore, the benefit of the doubt doctrine is not for application. Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021) (only when the evidence persuasively favors one side or the other is the benefit of the doubt doctrine not for application). Accordingly, the Veteran's claim is denied.

Lastly, the Board notes that the rating schedule prompts consideration of SMC under 38 C.F.R. § 3
of appealing the initial rating assigned, neither the Veteran nor her attorney has provided any evidence or argument in support of such appeal.

Lastly, the Board notes that the rating schedule prompts consideration of SMC under 38 C.F.R. § 3.350(a). However, SMC has already been considered and assigned for "loss of use of a creative organ" effective November 7, 2023.

9. Entitlement to an initial compensable rating for service-connected C-section scar is denied.

10. Entitlement to an initial rating in excess of 10 percent for painful C-section scar is denied.

The Veteran seeks higher ratings for her service-connected C-section scar and painful C-section scar. Importantly, as this is an appeal as to the initial rating assigned, the relevant temporal focus is from November 7, 2023, the date of award of service connection, to present.

The Veteran's C-section scar is currently rated as noncompensable under DC 7802, which addresses scars not of the head, face, or neck, that are not associated with underlying soft tissue damage, and at 10 percent under DC 7804, which addresses scars that are painful or unstable.

Under DC 7802, a 10 percent rating is assigned for a scar or scars measuring 929 square centimeters or greater. 38 C.F.R. § 4.1118, DC 7802. Here, the record shows that the Veteran has a single C-section scar, located on her pelvis, measuring one square centimeter. See June 2022 VA Scars DBQ, received August 2022. As such, the criteria for a compensable rating for the Veteran's C-section scar, under DC 7802, have not been met as the evidence does not show that such scar affects an area of at least 929 square centimeters.

With respect to DC 7804, a 10 percent rating is warranted for one two scars that are unstable or painful, a 20 percent rating is warranted for three or four scars that are unstable or painful, and a 30 percent rating is warranted for five or more scars that are unstable or painful. 38 C.F.R. § 4.118, DC 7804. Additionally, if a scar or scars are both unstable and painful, an additional 10 percent is added to the rating for such scar or scars. See id., Note (2).

As the Veteran is currently in receipt of a 10 percent rating for her C-section scar under DC 7804, to warrant a higher rating the evidence must show, at a minimum, that the Veteran has three or more scars that are either unstable or painful, or that her C-section scar is both unstable AND painful.

Here, as discussed above, the Veteran's C-section scar is a single scar. See June 2022 VA Scars DBQ. Additionally, while the record establishes that such scar is painful, the record does not indicate that such scar is unstable. See id. As such, the Board is unable to find that the Veteran's C-section scar constitutes three or more scars or that such scar is both painful and unstable.

Given the above, the Board finds that the evidence persuasively weighs against finding that the Veteran's C-section scar has affected an area of 929 square centimeters or more at any time during the period on appeal. As such, a compensable rating under DC 7802 for the Veteran's C-section scar is denied.

Similarly, the Board finds that the evidence persuasively weighs against finding that the Veteran's C-section has been both painful and unstable, or constituted three or more scars, at any time during the period on appeal. As such, a rating in excess of 10 percent for the Veteran's painful C-section scar, under DC 7804, is denied.

REASONS FOR REMAND

As an initial matter, the Board notes that, when evidence of unemployability is submitted during the course of an appeal of an assigned disability rating, a claim for entitlement to a TDIU will be considered to have been raised by the record as "part and parcel" of the underlying claim. Rice v. Shinseki, 22 Vet. App. 447, 453-454 (2009).

Here, the Veteran has contended that she is unemployable due to her service-connected conditions. See January 2026 VA Form 21-8940. As such, the Board finds that the issue of entitlement to a TDIU has been raised by the record and is properly before the Board on appeal.

1. Entitlement to an initial rating in excess of 10 percent for service-connected back condition is remanded.

The Board regrets the delay associated with this remand. However, based on a review of the evidence of record, the Board finds that a remand is necessary to allow the Agency of Original Jurisdiction (AOJ) to correct pre-decisional duty to assist errors; specifically, to allow the AOJ to afford the Veteran with an adequate examination regarding the nature and severity of her service-connected back condition.

In June 2022, the Veteran underwent a VA examination in which the examiner documented an abnormal initial ROM, with forward flexion to 90 degrees, extension to 5 degrees, and bilateral lateral flexion and rotation to 20 degrees each, with pain on forward flexion, extension, left lateral flexion and left lateral rotation. See June 2022 VA Back Conditions DBQ, received August 2022.

However, though the examiner noted that the Veteran experienced pain on forward flexion, the documented ROM for such constitutes full movement. As such, the Board finds the examination to be inadequate to the extent it is unclear whether the documented ROMs reflect the degree in which the Veteran experienced, or would experience, pain. See 38 C.F.R. §§ 4.40, 4.59; Deluca v. Brown, 8 Vet. App. 202 (1995); Burton v. Shinseki, 25 Vet. App. 1 (2011).

Given the above, the Board finds that a new examination is necessary to ascertain the nature and severity of the Veteran's service-connected back condition. See Barr v. Nicholson, 21 Vet. App. 120 (2007).

Additionally, the June 2022 examiner noted that the Veteran did not experience flare-ups and would not experience additional functional impairment following repeated use over time. See June 2022 VA Back Conditions DBQ.

However, the Veteran's medical records reveal that, following such examination, but prior to the October 2024 rating decision on appeal, the Veteran reported that the severity of her back pain increased with prolonged sitting or lying down. See Hampton VAMC records; Richmond VAMC records; Columbia VAMC records. In other words, the Veteran's medical records appear to indicate that the Veteran experiences flare-ups of her back condition.

Therefore, based on the Veteran's reports indicating an increase in severity of her service-connected back condition following the June 2022 examination, but prior to the October 2024 rating decision, the Board finds that the failure to afford the Veteran with a new examination to ascertain the current nature and severity of the Veteran's service-connected back condition constituted a pre-decisional duty to assist error. See Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994). As such, a remand is required to allow the AOJ to afford the Veteran with an examination to determine the current severity of her service-connected back condition.

2. Entitlement to an initial rating in excess of 10 percent for service-connected left knee strain is remanded.

The Board regrets the delay associated with this remand. However, based
finds that the failure to afford the Veteran with a new examination to ascertain the current nature and severity of the Veteran's service-connected back condition constituted a pre-decisional duty to assist error. See Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994). As such, a remand is required to allow the AOJ to afford the Veteran with an examination to determine the current severity of her service-connected back condition.

2. Entitlement to an initial rating in excess of 10 percent for service-connected left knee strain is remanded.

The Board regrets the delay associated with this remand. However, based on a review of the evidence of record, the Board finds that a remand is necessary to allow the AOJ to correct a pre-decisional duty to assist error; specifically, to afford the Veteran with an adequate examination regarding the nature and severity of her service-connected left knee strain.

In June 2022, the Veteran underwent a VA examination in which she reported intermittent pain in her left knee with prolonged standing, going up stairs, or with heavy lifting. The Veteran also reported experiencing flare-ups of moderate severity every other day, lasting approximately 30 minutes, precipitated by prolonged standing, going up stairs, or heavy lifting, and alleviated by rest and Tylenol. However, the examiner did not address the functional impacts of repeated use over time or flare-ups. See June 2022 VA Knee and Lower Leg Conditions DBQ, received August 2022. As such, the Board finds the examination inadequate to the extent it did not satisfy the requirements of 38 C.F.R. § 4.59 or Sharp v. Shulkin, 29 Vet. App. 26 (2017).

Given the above, the Board finds that a new examination is necessary to ascertain the nature and severity of the Veteran's service-connected left knee strain. See Barr v. Nicholson, supra.

3. Entitlement to an initial compensable rating for service-connected dermatitis is remanded.

The Veteran's dermatitis is rated under DC 7806, which instructs that such condition should be evaluated under the General Rating Formula for the Skin (General Skin Formula), which sets ratings based upon the percentage of the entire body affected, the percentage of exposed areas affected, the type of treatment needed, and the duration of such treatment. The General Skin Formula also instructs that, alternatively, a rating could be assigned based on disfigurement of the head, face, or neck, or based on scars, both of which are based, in part, on the measured size of the affected area. 38 C.F.R. § 4.118.

In June 2022, the Veteran underwent a VA examination in which the examiner noted that the Veteran's dermatitis was treated with a topical shampoo less than five percent of the total body area and less than five percent of exposed areas. The examiner also noted with scaly skin on the nape of the neck; no measurement was provided. See June 2022 VA Skin Diseases DBQ, received August 2022. Notably, under DC 7800, which addresses disfigurement of the head, face, and neck, a compensable rating may be warranted if certain characteristics of disfigurement are present, including abnormal texture in an area exceeding six square inches. See 38 C.F.R. § 4.118, DC 7800.

As the June 2022 examiner noted that the Veteran's dermatitis manifested with abnormal texture, but did not provide a measurement of the affected area, the Board finds the examination to be inadequate to such extent.

Given the above, the Board finds that a remand is necessary to allow the AOJ to afford the Veteran with an examination regarding the severity of her dermatitis. See Barr v. Nicholson, supra.

4. Entitlement to a TDIU is remanded.

The Board regrets the delay associated with this remand. However, the Board finds that this matter is inextricably intertwined with the issues remanded herein. Therefore, a remand is required. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991).

Accordingly, the matters are REMANDED for the following action:

1. Schedule the Veteran for an examination with an appropriate clinician regarding the nature and severity of her
Board finds that a remand is necessary to allow the AOJ to afford the Veteran with an examination regarding the severity of her dermatitis. See Barr v. Nicholson, supra.

4. Entitlement to a TDIU is remanded.

Accordingly, the matters are REMANDED for the following action:

1. Schedule the Veteran for an examination with an appropriate clinician regarding the nature and severity of her service-connected back condition. The entire claims file must be provided to, and reviewed by, the examiner, and any indicated tests, studies, or evaluations should be performed.

The examiner is asked to:

(a.) Obtain the Veteran's detailed lay history, including onset and progression of symptomatology. IF THE VETERAN DESCRIBES FLARE-UPS, DOCUMENT THE FREQUENCY, DURATION, AND SEVERITY THEREOF.

(b.) Test and document the ROM for the thoracolumbar spine in active motion, passive motion, weight-bearing, and non-weight-bearing, on both an initial and after repetitive use basis. For each ROM, the examiner is asked to EXPLICITLY identify the degree in which pain IS FIRST EVIDENCED by the Veteran's visible behavior. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, a thorough explanation should be provided.

(c.) Identify the nature and severity of all current manifestations of the Veteran's back condition. The extent of any weakened movement, excess fatigability, and incoordination should be described. Any additional impairment due to such should be assessed in terms of the degree of additional ROM loss. Additional limitation following repetitive use over time, if any, must also be noted.

(d.) If the Veteran describes flare-ups, after documenting the frequency, severity, and duration thereof, express an opinion as to whether there would be additional functional impairment during such flare-ups. The examiner should assess such impairment in terms of the degree of additional ROM loss and provide an explanation as to how such was determined.

(e.) Indicate whether any medications the Veteran uses affects the severity of her back condition. If so, identify each medication and clearly explain how such medication affects the condition. If any such medication is productive of ameliorative effects, clearly identify such effects and opine as to the severity of the Veteran's back condition absent such medication.

" Any opinion expressed by the examiner should be accompanied by a complete rationale. If medical literature is relied upon in rendering a determination, the examiner should identify and specifically cite each reference material utilized. If the examiner is unable to offer an opinion without resort to speculation, a thorough explanation as to why an opinion cannot be rendered should be provided.

" The examiner is reminded that the Veteran is competent to report symptoms, treatment, and injuries, and that her reports must be taken into account in formulating the requested opinions.

2. Schedule the Veteran for an examination with an appropriate clinician regarding the nature and severity of her service-connected left knee strain. The entire claims file must be provided to, and reviewed by, the examiner, and any indicated tests, studies, or evaluations should be performed.

The examiner is asked to:

(a.) Obtain the Veteran's detailed lay history, including onset and progression of symptomatology. IF THE VETERAN DESCRIBES FLARE-UPS, DOCUMENT THE FREQUENCY, DURATION, AND SEVERITY THEREOF.

(b.) Test and document the ROM for both knees in active motion, passive motion, weight-bearing, and non-weight-bearing, on both an initial and after repetitive use basis. For each ROM, the examiner is asked to EXPLICITLY identify the degree in which pain IS FIRST EVIDENCED by the Veteran's visible behavior. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, a thorough explanation should be provided.

(c.) Identify the nature and severity of all current manifestations of the Veteran's left knee strain. The extent of any weakened movement, excess fatigability, and incoordination should be described. Any additional impairment due to such should be assessed in terms of the degree of additional ROM loss. Additional limitation following repetitive use over time, if any, must also be noted.

(e.) Indicate whether any medications the Veteran uses affects the severity of her left knee strain. If so, identify each medication and clearly explain how such medication affects the condition. If any such medication is productive of ameliorative effects, clearly identify such effects and opine as to the severity of the Veteran's left knee strain absent such medication.

" The examiner is reminded that the Veteran is competent to report symptoms, treatment, and injuries, and that her reports must be taken into account in formulating the requested opinions.

3. After completing any development warranted by the record, schedule the Veteran for an examination with an appropriate clinician regarding the nature and severity of her service-connected dermatitis. The entire claims file must be provided to, and reviewed by, the examiner, and any indicated tests, studies, or evaluations should be performed.

The examiner is asked to:

(a.) Obtain the Veteran's detailed lay history, including onset and progression of symptomatology.

(b.) Complete the relevant sections of the appropriate rating examinations, including measurements of any affects areas, to the extent possible.

(Continued on the next page)

" The examiner is reminded that the Veteran is competent to report symptoms, treatment, and injuries, and that her reports must be taken into account in formulating the requested opinions.

YVETTE R. WHITE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board J.T. Martin III, 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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