POSTTRAUMATIC STRESS DISORDER (PTSD)

K.A. KENNERLY · 2026 · Case ID: A26040669

MIXED

Summary

The veteran, who served in the United States Air Force from October 1984 to October 1994, with foreign service in the Southwest Asia theater of operations and recipient of the Southwest Asia Service Medal with two Bronze Stars, appeals the denial of service connection for several conditions including PTSD, acquired psychiatric disorders, memory loss, chronic fatigue, sleep disturbances, sleep apnea, tinea, bilateral plantar fasciitis, deviated septum, and hernia disability. The Board reviewed new evidence submitted for these claims, finding it not relevant for PTSD, acquired psychiatric disorders, memory loss, chronic fatigue, sleep disturbances, sleep apnea, and tinea, thus denying readjudication for these conditions. Service connection for bilateral plantar fasciitis, deviated septum, and hernia disability was denied as not incurred during service or etiologically related to an in-service event. However, the Board found new evidence relevant for traumatic arthritis of the lumbosacral spine/low back pain and granted service connection for residuals of testicular denervation and varicosectomy, noting this was related to an in-service vasectomy. The claim for traumatic arthritis of the lumbosacral spine/low back pain was also remanded due to an inadequate VA medical opinion, which failed to clarify whether the degenerative disc disease noted was age-appropriate at the time of examination or diagnosis, and because the wife's testimony was deemed speculative for establishing nexus. The Board found the appellant's wife's testimony insufficient to establish nexus, characterizing it as speculative and biased.

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210514-159755

Full Decision Text

Citation Nr: A26040669
Decision Date: 04/30/26 Archive Date: 04/30/26

DOCKET NO. 210514-159755
DATE: April 30, 2026

ORDER

Readjudication of the claim for entitlement to service connection for posttraumatic stress disorder (PTSD) is denied.

Readjudication of the claim for entitlement to service connection for an acquired psychiatric disorder to include adjustment disorder with mixed anxiety and depressed mood, depression, and anxiety is denied.

Readjudication of the claim for entitlement to service connection for memory loss/memory problems is denied.

Readjudication of the claim for entitlement to service connection for chronic fatigue is denied.

Readjudication of the claim for entitlement to service connection for sleep difficulties/sleep disturbances is denied.

Readjudication of the claim for entitlement to service connection for sleep apnea is denied.

Readjudication of the claim for entitlement to service connection for tinea is denied.

Readjudication of the claim for entitlement to service connection for traumatic arthritis of the lumbosacral spine/low back pain (also claimed as traumatic arthritis) is granted.

Entitlement to service connection for residuals of testicular denervation and varicosectomy (claimed as groin and testicular pain) is granted.

Entitlement to service connection for bilateral plantar fasciitis is denied.

Entitlement to service connection for a deviated septum is denied.

Entitlement to service connection for a hernia disability is denied.

REMANDED

Entitlement to service connection for a back disability (claimed as traumatic arthritis of the lumbosacral spine and low back pain) is remanded.

FINDINGS OF FACT

1. New evidence received since the June 2014 denial of service connection for PTSD is not relevant.

2. New evidence received since the April 2015 denial of service connection for adjustment disorder with mixed anxiety and depressed mood is not relevant.

3. New evidence received since the April 2015 denial of service connection for memory loss/memory problems is not relevant.

4. New evidence received since the April 2015 denial of service connection for chronic fatigue is not relevant.

5. New evidence received since the April 2015 denial of service connection for sleep difficulties/sleep disturbances is not relevant.

6. New evidence received since the April 2015 denial of service connection for sleep apnea is not relevant.

7. New evidence received since the April 2015 denial of service connection for tinea is not relevant.

8. New evidence received since the April 2015 denial of service connection for traumatic arthritis of the lumbar spine/low back pain is relevant.

9. The appellant's testicular denervation and varicosectomy is related to his in-service vasectomy.

10. The appellant's bilateral plantar fasciitis was not incurred during service and is not otherwise etiologically related to an in-service injury, event, or illness

11. The appellant's deviated septum was not incurred during service and is not otherwise etiologically related to an in-service injury, event, or illness.

12. The appellant's hernia disability was not incurred during service and is not otherwise etiologically related to an in-service injury, event, or illness.

CONCLUSIONS OF LAW

1. The criteria for readjudication of the claim for entitlement to service connection for PTSD are not met. 38 U.S.C. §§ 5103A, 5108; 38 C.F.R. § 3.2501.

2. The criteria for readjudication of the claim for entitlement to service connection for an acquired psychiatric disorder, to include adjustment disorder with mixed anxiety and depressed mood, depression, and anxiety are not met. 38 U.S.C. §§ 5103A, 5108; 38 C.F.R. § 3.2501.

3. The criteria for readjudication of the claim for entitlement to service connection for memory loss/memory problems are not met. 38 U.S.C. §§ 5103A, 5108; 38 C.F.R. § 3.2501.

4. The criteria for readjudication of the claim for entitlement to service connection for chronic fatigue are not met. 38 U.S.C. §§ 5103A, 5108; 38 C.F.R. § 3.2501.

5. The criteria for readjudication of the claim for entitlement to service connection for sleep difficulties/sleep disturbances are not met. 38 U.S.C. §§ 5103A, 5108; 38 C.F.R. § 3.2501.

6. The criteria for readjudication of the claim for entitlement to service connection for sleep apnea are not met. 38 U.S.C. §§ 5103A,
2501.

4. The criteria for readjudication of the claim for entitlement to service connection for chronic fatigue are not met. 38 U.S.C. §§ 5103A, 5108; 38 C.F.R. § 3.2501.

5. The criteria for readjudication of the claim for entitlement to service connection for sleep difficulties/sleep disturbances are not met. 38 U.S.C. §§ 5103A, 5108; 38 C.F.R. § 3.2501.

6. The criteria for readjudication of the claim for entitlement to service connection for sleep apnea are not met. 38 U.S.C. §§ 5103A, 5108; 38 C.F.R. § 3.2501.

7. The criteria for readjudication of the claim for entitlement to service connection for tinea are not met. 38 U.S.C. §§ 5103A, 5108; 38 C.F.R. § 3.2501.

8. The criteria for readjudication of the claim for entitlement to service connection for traumatic arthritis of the lumbosacral spine/low back pain are met. 38 U.S.C. §§ 5103A, 5108; 38 C.F.R. § 3.2501.

9. The criteria for entitlement to service connection for residuals of testicular denervation and varicosectomy are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

10. The criteria for entitlement to service connection for bilateral plantar fasciitis are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

11. The criteria for entitlement to service connection for a deviated septum are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

12. The criteria for entitlement to service connection for a hernia disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The appellant served on active duty in the United States Air Force from October 1984 to October 1994. The appellant is the recipient of numerous medals and awards including the Southwest Asia Service Medal with two Bronze Stars. He has foreign service in the Southwest Asia theater of operations.

Procedural History

These matters come before the Board of Veterans' Appeals (Board) on appeal from February 2021 and March 2021 rating decisions issued by the Department of Veterans Affairs (VA) Veterans Benefits Administration, the agency of original jurisdiction (AOJ). VA timely received the appellant's May 2021 notice of disagreement (NOD), via VA Form 10182, with the denial of readjudication of the claims for adjustment disorder with mixed anxiety and depressed mood, chronic fatigue, memory loss/memory problems, sleep apnea, sleep difficulties/sleep disturbances, tinea, traumatic arthritis of the lumbosacral spine/low back pain and the denial of service connection for bilateral plantar fasciitis, a deviated septum, and a hernia disability in the February 2021 rating decision and the denial of service connection for testicular denervation and varicosectomy in the March 2021 rating decision. The appellant selected the Board's Hearing docket. On November 14, 2024, he testified at a virtual hearing before the undersigned Veterans Law Judge of the Board, and a transcript of the hearing is of record.

Applicable Evidentiary Window

The Board may only consider the evidence of record before the AOJ at the time of its decision on the issue(s) on appeal, evidence submitted by the appellant or his representative at the Board hearing, to include testimony provided at the hearing; and evidence submitted within 90 days following the Board hearing. 38 C.F.R. § 20.300(a), 302(a). If additional evidence was submitted between the dates of the AOJ decision and the hearing, the Board will not consider it unless it is resubmitted during the 90 days following each of these actions. If the appellant would like VA to consider any evidence that was added to the claims file that the Board could not consider, the appellant may file a supplemental claim (VA Form 20-0995) and submit or identify this
time of its decision on the issue(s) on appeal, evidence submitted by the appellant or his representative at the Board hearing, to include testimony provided at the hearing; and evidence submitted within 90 days following the Board hearing. 38 C.F.R. § 20.300(a), 302(a). If additional evidence was submitted between the dates of the AOJ decision and the hearing, the Board will not consider it unless it is resubmitted during the 90 days following each of these actions. If the appellant would like VA to consider any evidence that was added to the claims file that the Board could not consider, the appellant 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(s), considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a supplemental claim are included with this decision. See also Cook v. McDonough, 36 Vet. App. 175 (2023). With respect to the claim for entitlement to service connection for a back disability, as the claim is remanded herein, any evidence the Board could not consider will be considered by the AOJ. 38 C.F.R. § 3.103(c)(2)(ii).

New and Relevant Evidence

The February 2021 rating decision found that new and relevant evidence had been received to readjudicate the claim of service connection for bilateral plantar fasciitis, a deviated septum, and a hernia disability, and the March 2021 rating decision found that new and relevant evidence had been received to readjudicate the claim of service connection for testicular denervation and varicosectomy. These are favorable findings by the AOJ and the Board will proceed to address these claims on the merits. See 38?U.S.C. § 5104A; 38?C.F.R. § 3.104(c).

Recharacterization of Issue on Appeal

The February 2021 rating decision on appeal was characterized as entitlement to service connection for adjustment disorder with mixed anxiety and depressed mood. However, the Board has recharacterized the claim as one for an acquired psychiatric disorder pursuant to Clemons v. Shinseki, 23 Vet. App. 1, 5 (Vet. App. 2009). In Clemons v. Shinseki, the United States Court of Appeals for Veterans Claims (CAVC) held that, in determining the scope of a claim, the Board must consider the claimant's description of the claim, symptoms described, and the information submitted or developed in support of the claim. See Clemons, 23 Vet. App. at 5. Accordingly, the Board has classified the issue as one for an acquired psychiatric disorder to account for the totality of the appellant's associated symptoms.

Readjudication

Under the Appeals Modernization Act (AMA), when a claim has been previously disallowed it may not thereafter be readjudicated, unless the appellant submits a supplemental claim along with new and relevant evidence. 38 U.S.C. § 5108; 38 C.F.R. § 3.2501. New evidence is evidence that was not previously part of the actual record before agency adjudicators at the time of the prior denial. 38 C.F.R. § 3.2501(a)(1). Relevant evidence is information that tends to prove or disprove a matter at issue in a claim. Relevant evidence includes evidence that raises a theory of entitlement that was not previously addressed. Id.

1. Readjudication of the claim for entitlement to service connection for PTSD.

The appellant is seeking readjudication of his previously denied claim for entitlement to service connection for PTSD. He contends that his acquired psychiatric disorder is related to his service or his in-service vasectomy. See Board Hearing Transcript, November 14, 2024.

Analysis

In a June 2014 rating decision, the claim for entitlement to service connection for PTSD was denied because the evidence did not show a confirmed diagnosis of PTSD. See Rating Decision, June 9, 2014.

In the February 2021 rating decision on appeal, the AOJ, inter alia, denied readjudication of the claim for entitlement to service connection for PTSD because no evidence showed a diagnosis of PTSD. See Rating Decision, February 12, 2021.

New evidence received since the June 2014 rating decision includes a September 2014 statement from the appellant, a VA Gulf War Update article, VA treatment records, private treatment records, a June 2019 statement from the appellant, various VA examination reports and unrelated medical opinions for other
decision, the claim for entitlement to service connection for PTSD was denied because the evidence did not show a confirmed diagnosis of PTSD. See Rating Decision, June 9, 2014.

New evidence received since the June 2014 rating decision includes a September 2014 statement from the appellant, a VA Gulf War Update article, VA treatment records, private treatment records, a June 2019 statement from the appellant, various VA examination reports and unrelated medical opinions for other claimed disabilities, a September 2020 statement from the appellant, the November 2024 Board hearing transcript, a December 2024 letter from the appellant's private physician, a January 2025 letter from the appellant's pastor, and a January 2025 statement from the appellant. This evidence is new because it was not part of the record at the time of the June 2014 rating decision.

However, these records are silent as to any diagnosis of PTSD under the DSM-5 criteria. As such, these records do not tend to prove the appellant has a current diagnosis of PTSD which was the basis of the previous denial. Therefore, these records, albeit new, are not relevant to the issue of readjudication of the claim of entitlement to service connection for PTSD. Further, the appellant has not provided additional statements indicating that he was informed by a medical professional that he was diagnosed with PTSD. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). As such, his lay statements are not relevant as they do not relate to a matter at issue.

Accordingly, because new and relevant evidence has not been presented, the appellant's claim of service connection for PTSD may not be readjudicated. The benefit sought on appeal remains denied. 38 U.S.C. §§ 5103A(h), 5108(a); 38 C.F.R. § 3.2501.

2. Readjudication of the claim for entitlement to service connection for an acquired psychiatric disorder to include adjustment disorder with mixed anxiety and depressed mood, depression, and anxiety.

The appellant is seeking readjudication of his previously denied claim for entitlement to service connection for adjustment disorder with mixed anxiety and depressed mood. He contends that his acquired psychiatric disorder is related to his service or his in-service vasectomy. See Board Hearing Transcript, November 14, 2024.

Analysis

In an April 2015 rating decision, the claim for entitlement to service connection for adjustment disorder with mixed anxiety and depressed mood (also claimed as depression) to include as secondary to the service-connected disability of irritable bowel syndrome (IBS) and diarrhea was denied because the evidence continued to show the disorder was not related to the already service-connected IBS and diarrhea and there was no evidence that the adjustment disorder with mixed anxiety and depressed mood was incurred in or caused by service or occurred within the applicable presumptive period. See Rating Decision, April 2, 2015.

In the February 2021 rating decision on appeal, the AOJ, inter alia, denied readjudication of the claim for service connection for adjustment disorder with mixed anxiety and depressed mood (claimed as depression) because no evidence contained a medical opinion associating his disorder with his military service. See Rating Decision, February 12, 2021.

New evidence received since the April 2015 rating decision includes VA treatment records, private treatment records, a June 2019 statement from the appellant, various VA examination reports and unrelated medical opinions for other claimed disabilities, a September 2020 statement from the appellant, the November 2024 Board hearing transcript, a December 2024 letter from the appellant's private physician, a January 2025 letter from the appellant's pastor, and a January 2025 statement from the appellant. This evidence is new because it was not part of the record at the time of the April 2015 rating decision.

However, these records do not contain a medical opinion addressing whether his acquired psychiatric disorder is related to his active service or his in-service vasectomy. As such, these records do not tend to prove or disprove whether the appellant's acquired psychiatric disorder is related to his active service, which was the basis of the previous denial. Therefore, these records, albeit new, are not relevant to the issue of readjudication of the claim of entitlement to service connection for an acquired psychiatric disorder. Further, the appellant has not provided additional statements indicating that he was informed by a medical professional that his acquired psychiatric disorder is related to his active service or
because it was not part of the record at the time of the April 2015 rating decision.

However, these records do not contain a medical opinion addressing whether his acquired psychiatric disorder is related to his active service or his in-service vasectomy. As such, these records do not tend to prove or disprove whether the appellant's acquired psychiatric disorder is related to his active service, which was the basis of the previous denial. Therefore, these records, albeit new, are not relevant to the issue of readjudication of the claim of entitlement to service connection for an acquired psychiatric disorder. Further, the appellant has not provided additional statements indicating that he was informed by a medical professional that his acquired psychiatric disorder is related to his active service or his vasectomy. As such, his lay statements are not relevant to his claim as they do not relate to a matter at issue.

Accordingly, as new and relevant evidence has not been presented, the claim for service connection for an acquired psychiatric disorder may not be readjudicated.

3. Readjudication of the claim for entitlement to service connection for memory loss/memory problems.

4. Readjudication of the claim for entitlement to service connection for chronic fatigue.

5. Readjudication of the claim for entitlement to service connection for sleep difficulties/sleep disturbances.

6. Readjudication of the claim for entitlement to service connection for sleep apnea.

The appellant is seeking readjudication of his claims for service connection for memory loss/memory problems, chronic fatigue, sleep difficulties/sleep disturbances, and sleep apnea. He contends that these disabilities are related to his service in the Gulf War. See Board Hearing Transcript, November 14, 2024. Additionally, he contends his sleep apnea symptoms began during service.

Analysis

In an April 2015 rating decision, the claim for entitlement to service connection for memory loss/memory problems (also claimed as Gulf War syndrome) was denied because the evidence did not show a currently diagnosed disability. See Rating decision, April 2, 2015. The claim for entitlement to service connection for chronic fatigue (also claimed as Gulf War syndrome) was denied because the evidence continued to show that the disability was not incurred in or aggravated by military service, to include his service in Southwest Asia. The evidence showed that chronic fatigue resulted from sleep apnea. See Rating Decision, April 2, 2015. The claim for entitlement to service connection for sleep difficulties/sleep disturbances (also claimed as Gulf War syndrome) was denied because the evidence continued to show the claimed disability was not incurred in or aggravated by military service, to include his service in Southwest Asia. The evidence established that the disability resulted from sleep apnea and esophageal reflux. See Rating Decision, April 2, 2015. Additionally, the claim for entitlement to service connection for sleep apnea (also claimed as Gulf War syndrome) was denied because the evidence continued to show that the disability was not incurred in or aggravated by military service, to include his service in Southwest Asia. See Rating Decision, April 2, 2015.

In the February 2021 rating decision on appeal, the AOJ denied readjudication of the claims because the evidence did not show a currently diagnosed memory loss disability, a currently diagnosed chronic fatigue disability, or a currently diagnosed sleep difficulties/sleep disturbances disability and did not contain a medical opinion associating his current sleep apnea to his service. See Rating Decision, February 12, 2021.

However, the new evidence is not relevant because the evidence does not contain a diagnosis of a memory loss or memory problem disability, chronic fatigue syndrome (CFS) or a chronic fatigue disability, or a sleep difficulty, sleep disturbance, or sleep disorder disability other than sleep apnea. Further, the new records do not contain a medical opinion addressing whether the appellant's sleep apnea was incurred in service or is etiologically related to service, nor do the records contain a medical opinion linking his symptoms to his Gulf War service.

Therefore, these records, albeit new, are not relevant as they do not relate to a matter at issue. Further, the appellant has not provided additional statements indicating that he was informed by a medical professional that he has a diagnosis of a memory loss or
relevant because the evidence does not contain a diagnosis of a memory loss or memory problem disability, chronic fatigue syndrome (CFS) or a chronic fatigue disability, or a sleep difficulty, sleep disturbance, or sleep disorder disability other than sleep apnea. Further, the new records do not contain a medical opinion addressing whether the appellant's sleep apnea was incurred in service or is etiologically related to service, nor do the records contain a medical opinion linking his symptoms to his Gulf War service.

Therefore, these records, albeit new, are not relevant as they do not relate to a matter at issue. Further, the appellant has not provided additional statements indicating that he was informed by a medical professional that he has a diagnosis of a memory loss or memory disability, CFS or a chronic fatigue disability, or a sleep difficulty, sleep disturbance, or sleep disorder disability other than sleep apnea. He also has not provided any statements that he was informed by a medical professional that his sleep apnea was incurred during service or is etiologically related to his service or that his symptoms are related to his Gulf War service. His assertion and his spouse's assertion that his symptoms may represent a Gulf War syndrome illness was considered by the AOJ in the April 2015 rating decision. As such, their lay statements are not relevant to the claims as they do not relate to a material fact at issue.

Accordingly, as new and relevant evidence has not been presented, the claims for service connection for memory loss/memory problems, chronic fatigue, sleep difficulties/sleep disturbances, and sleep apnea may not be readjudicated.

7. Readjudication of the claim for entitlement to service connection for tinea.

The appellant contends that he has a current skin disability that is related to his service. See Board Hearing Transcript, November 14, 2024.

Analysis

In an April 2015 rating decision, the claim for entitlement to service connection for tinea (also claimed as infection of scrotum, skin condition, neck rash, and Gulf War syndrome) was denied because the evidence did not show a current diagnosed disability. See Rating Decision, April 2, 2015. In the February 2021 rating decision on appeal, the AOJ denied readjudication of the claim because the evidence did not show a currently diagnosed chronic disability. See Rating Decision, February 12, 2021.

However, the new evidence is not relevant because the evidence does not contain a diagnosis of a chronic tinea or skin disability, nor do the records contain a medical opinion linking his symptoms to his Gulf War service. While the appellant testified at his Board hearing that he experiences a skin rash a couple of times a year that he treats with a cream given to him by his VA medical provider, this lay assertion itself is not new. Specifically, in an April 2015 VA medical opinion, the clinician noted the appellant's lay reports of continuing to have an intermittent rash that has been treated with a steroid cream. See VA Medical Opinion, April 2, 2015. Moreover, his assertion that his symptoms may represent a Gulf War syndrome illness is not a new theory of entitlement as it was considered by the AOJ in the April 2015 rating decision.

Accordingly, as new and relevant evidence has not been presented, the claim for service connection for tinea may not be readjudicated.

8. Readjudication of the claim for entitlement to service connection for traumatic arthritis of the lumbosacral spine/low back pain.

The appellant contends that his back disability is due to being hit by a truck during service. See Board Hearing Transcript, November 14, 2024.

Analysis

In an April 2015 rating decision, the appellant's claim for entitlement to service connection for traumatic arthritis of the lumbosacral spine/low back pain was denied because the evidence continued to show that the disability was not incurred in or aggravated by service and did not develop to a compensable degree within the specified time period after release from service to qualify for presumptive service connection. See Rating Decision, April 2, 2015.

In the February 2021 rating decision on appeal, the AOJ declined readjudication of the claim because the evidence did not
appellant contends that his back disability is due to being hit by a truck during service. See Board Hearing Transcript, November 14, 2024.

Analysis

In the February 2021 rating decision on appeal, the AOJ declined readjudication of the claim because the evidence did not contain a supported medical opinion associating his current back disability with his military service. See Rating Decision, February 12, 2021.

In this case, as a registered nurse, the appellant's wife's Board hearing testimony is relevant because her testimony speaks to a matter at issue, a nexus between the appellant's current back disability and an in-service injury. As new and relevant evidence has been presented, readjudication of the claim for entitlement to service connection for traumatic arthritis of the lumbosacral spine/low back pain is warranted.

Service Connection

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

9. Entitlement to service connection for testicular denervation and varicosectomy (claimed as groin and testicular pain).

The appellant contends that he has experienced continuous pain since his February 1994 vasectomy. See Board Hearing Transcript, November 14, 2024. He contends that he underwent a testicular denervation and varicosectomy and continues to experience pain.

Analysis

In the March 2021 rating decision, the AOJ favorably found that (1) the appellant had been diagnosed with a disability as VA treatment records reported he underwent a bilateral testicular denervation and varicosectomy in December 2018 and a February 2021 VA examination confirmed the history of a diagnosis of testicular denervation and varicosectomy in December 2018 and (2) service treatment records (STRs) reported he underwent a vasectomy in service in 1994. Favorable findings made by the AOJ are generally binding on the Board, unless rebutted by evidence that identifies a clear and unmistakable error in the favorable finding. 38 U.S.C. § 5104A; 38 C.F.R. §§ 3.104(c); 20.801(a). Such evidence is not present in this case. Accordingly, both the first and second elements of Shedden are met. The remaining question is whether there is a nexus between his vasectomy in service and his post-service testicular denervation and varicosectomy and residuals thereof.

VA treatment records document the appellant's reports of testicular pain since his vasectomy. See, e.g., VA Urology Note, September 5, 2018. He underwent a bilateral denervation and bilateral varicosectomy in December 2018, which he reported resolved his testicle pain. See VA Urology Note, April 3, 2019. The appellant subsequently reported that the bilateral vas denervation slightly reduced the pain to the testicles but not to his groin or back. See Appellant's Statement, September 23, 2020. During his Board hearing, he testified that he continued to experience groin pain. See Board Hearing Transcript, November 14, 2024. He testified that he has had two other procedures performed and has received injections, which relieves the pain for about a week. The appellant is competent to report his symptoms, and the Board finds his report of continued pain since his in-service vasectomy is credible. See Layno v. Brown, 6 Vet. App. 465 (1994).

In addition, in July 2019, a VA clinician opined that the bilateral testicular and groin pain status post vasectomy was incurred during service. See VA Medical Opinion, July 29, 2019. The clinician explained that a review of the medical records indicated the appellant had a vasectomy in 1994 during his active service, and citing to the Mayo Clinic, noted that risk factors for vasectomy includes chronic scrotal pain following vasectomy, ranging from dull and aching to sharp. The clinician found that the current examination and symptoms were consistent with the literature, and therefore, the appellant had a diagnosis of bilateral testicular and groin pain status post vasectomy that was incurred during service. This opinion is highly probative as the opinion contains a clear conclusion with supporting data and reasoned medical explanation. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008).

In February 2021, a VA clinician opined that the appellant's claimed groin and testicular pain was not likely related to his service. See VA Medical Opinion, February 8, 2021. The clinician noted that his separation physical in April 1993 did not show the disability and evidence was not supplied to the disability occurring within 1 year of separation. The AOJ subsequently requested an addendum opinion because the evidence shows the appellant did not have his vasectomy until 1994. However, the clinician reiterated the prior opinion and added that there was no dispute that the vasectomy occurred in 1994. See VA Addendum, February 25, 2021. These opinions are afforded no probative weight as they are not supported by adequate rationale, as the appellant's vasectomy was performed in 1994 while he was still on active service.

In considering the evidence of record, the evidence here supports that the appellant's groin and testicular pain which led to his bilateral testicular denervation and varicosectomy and residuals thereof is related to his in-service vasectomy. Accordingly, the claim is granted.

10. Entitlement to service connection for bilateral plantar fasciitis.

The appellant contends that his bilateral plantar fasciitis began during his active service due to wearing boots that did not have padding. See Board Hearing Transcript, November 14, 2024.

Analysis

In the February 2021 rating decision, the AOJ favorably found that the appellant had been diagnosed with a disability, as a February 2021 rating decision contained a diagnosis of bilateral plantar fasciitis. See Rating Decision, February 12, 2021.

The appellant's STRs are silent for complaints, findings, or treatment for bilateral plantar fasciitis. An April 1993 Report of Medical Examination documented a normal clinical finding of his feet, and the appellant denied having foot trouble. See Report of Medical Examination, April 19, 1993; Report of Medical History, April 19, 1993. In November 1994, just prior to his separation from service, the appellant was provided with a general VA medical examination, and his feet were normal. See VA General Medical Examination Report, November 23, 1994.

Post-service, a July 2008 private treatment record documented the appellant's request for an exam and orthotic casting secondary to general foot soreness and pain in the heels and arches, present for 1 year, and gradually worsening. See Private Treatment Record, I. Podiatry
normal clinical finding of his feet, and the appellant denied having foot trouble. See Report of Medical Examination, April 19, 1993; Report of Medical History, April 19, 1993. In November 1994, just prior to his separation from service, the appellant was provided with a general VA medical examination, and his feet were normal. See VA General Medical Examination Report, November 23, 1994.

Post-service, a July 2008 private treatment record documented the appellant's request for an exam and orthotic casting secondary to general foot soreness and pain in the heels and arches, present for 1 year, and gradually worsening. See Private Treatment Record, I. Podiatry Group, July 29, 2008. He reported a strong family history of foot problems and use of orthotics, and the assessment was "overuse tenosynovitis with pronation and plantar fasciitis, bilateral." A March 2011 VA treatment record noted he had left foot pain from his boots. See VA Primary Care Progress Note, March 10, 2011.

In July 2019, a VA clinician opined that the appellant's bilateral plantar fasciitis was not incurred in or caused by the claimed in-service injury, event or illness. See VA Medical Opinion, July 29, 2019. The clinician reported that there was no continuity of care for foot pain immediately after discharge from active duty, and he started reporting foot pain about 15 years after discharge from active duty. The clinician determined that this timeline did not support the notion that the foot pain was due to serving in the military. Therefore, the clinician concluded that the plantar fasciitis was not incurred during active duty.

In February 2021, a VA clinician opined that the appellant's claimed bilateral plantar fasciitis was not likely related to his service. See VA Medical Opinion, February 8, 2021. The clinician noted that his separation physical in April 1993 did not show the disability and evidence was not supplied to the disability occurring within 1 year of separation. Additionally, the clinician reported that a podiatry exam on April 1, 2024, showed no pes planus like the separation exam, and his pes planus was noted at a later time. The clinician also noted that the appellant's post-service employment required frequent standing on the assembly line.

In December 2024, the appellant's private physician provided a letter stating that the appellant was seen on September 19, 2014, for greater than one year history of bilateral plantar fasciitis/pain, with the right foot worse than the left. See Letter, Dr. D.B., MD, December 10, 2024. His x-rays were normal, and he was recommended to use a tennis ball in the morning for exercising the foot, pads, and supportive shoes with good arch. Dr. D.B. reported the appellant had not been seen by him for this issue since then.

In this case, the evidence is persuasively against finding that the appellant's bilateral plantar fasciitis was incurred during his active service or is otherwise etiologically related to his active service. As noted above, his STRs do not reflect an in-service event, injury, or illness. The appellant's lay statements have been considered, including his testimony that he had foot pain in service that he did not report and his contention of foot pain since service. He is competent to report his symptoms; however, these lay assertions are not overall supported by the record, as he denied experiencing foot pain in April 1993 and did not report having foot pain at his general VA medical examination in November 1994. Further, when he sought treatment in July 2008, he reported that his foot pain had been present for 1 year. Thus, the evidence is against finding that he has experienced foot pain since service.

Moreover, both the July 2019 and February 2021 VA clinicians opined that his bilateral plantar fasciitis was not incurred in service and was not otherwise related to his service. There is no contrary opinion of record. While the appellant believes his bilateral plantar fasciitis is related to his service, he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires specialized medical education. Jandreau, supra. Consequently, the Board gives more probative weight to the competent medical evidence, which does not support that his bilateral plantar fasciitis is related to his service.

As the evidence persuasively weighs against a finding that the appellant's bilateral plantar fasciitis disability was incurred in or is related to his service
clinicians opined that his bilateral plantar fasciitis was not incurred in service and was not otherwise related to his service. There is no contrary opinion of record. While the appellant believes his bilateral plantar fasciitis is related to his service, he is not competent to provide a nexus opinion in this case. The issue is medically complex, as it requires specialized medical education. Jandreau, supra. Consequently, the Board gives more probative weight to the competent medical evidence, which does not support that his bilateral plantar fasciitis is related to his service.

As the evidence persuasively weighs against a finding that the appellant's bilateral plantar fasciitis disability was incurred in or is related to his service, the benefit-of-the-doubt doctrine is not for application. See 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). Accordingly, service connection for bilateral plantar fasciitis is denied.

11. Entitlement to service connection for a deviated septum.

The appellant contends that he broke his nose during his active service, which resulted in a deviated septum. See Board Hearing Transcript, November 14, 2024.

Analysis

The appellant's STRs are silent for complaints, findings, or treatment for a deviated septum or nose injury. An April 1993 medical examination indicated a normal clinical evaluation of his nose and sinuses. See Report of Medical Examination, April 19, 1993. In November 1994, just prior to his separation from service, the appellant was provided with a general VA medical examination, and his nose and sinuses were normal. See VA General Medical Examination Report, November 23, 1994.

In October 2016, the appellant had a scan of his sinuses performed, which showed his nasal septum deviated toward the right, contacting the middle and inferior turbinates. See VA Computed Tomography (CT) Scan of the Sinuses, October 14, 2016. The assessment was a deviated septum, and the appellant reported to his medical provider that he thought he broke his nose approximately 30 years prior. See VA Otolaryngology Consult, December 2, 2016. He had a septoplasty performed in April 2017. See VA Otolaryngology Post Operative Note, April 14, 2017.

In July 2019, the appellant was provided with a VA examination, and at this examination, the appellant reported that he started having nasal polyps and a deviated septum in 1985 when he joined the military and started working around chemicals associated with airplanes. See VA Sinusitis/Rhinitis and Other Conditions of the Nose, Throat, Larynx, and Pharynx DBQ, July 29, 2019. He reported he had surgery in 2017. The VA clinician found that there was no diagnosis of a deviated septum. See VA Medical Opinion, July 29, 2019. There was no pathology to render a diagnosis, and x-rays of the nose indicated that the septum was normal and midline.

In a September 2020 statement, the appellant reported that while on the flight line on active duty, he hit himself in the nose with a speed wrench while he was putting a panel on the wing of an airplane right before it took off, and due to the time constraints of launching the airplane, he was unable to seek medical attention. See Appellant's Statement, September 23, 2020. He believes he broke his nose when this incident happened.

In February 2021, a VA clinician opined that the appellant's claimed deviated septum was not likely related to his service. See VA Medical Opinion, February 8, 2021. The clinician noted that his separation physical in April 1993 did not show the disability and evidence was not supplied to the disability occurring within 1 year of separation.

During his Board hearing, the appellant testified that he had current diagnoses of nasal polyps and sinusitis or rhinitis. See Board Hearing Transcript, November 14, 2024. He testified that he previously had a deviated septum asserted that he broke his nose in service but did not seek medical treatment for it during service.

The evidence here is persuasively against finding that the appellant's deviated septum was incurred during service or is otherwise related to his service. As noted above, his STRs are silent for a nose injury or deviated septum. The Board acknowledges the appellant's testimony that he did not seek treatment for his claimed nose injury during service. However, both the April 1993 medical examination and the November 1994 VA general medical examination found that his nose and sinuses were normal, and it was not until 2016 that it was determined that the appellant had a deviated septum. This extended period of time before manifestation of a deviated septum weighs against finding that his deviated septum was incurred during service. See Maxson v. Gober, 230 F.3d 1330, 1333 (Fed. Cir. 2000). Further, the February 2021 VA clinician opined that his deviated septum was not related to his service, and there is no medical opinion of record linking his deviated septum to his active service. Overall, the evidence here does not support that the appellant's deviated septum was incurred during service or is related to his service.

Moreover, his deviated septum was repaired in 2016, and the evidence does not indicate he has residuals or a current disability related to the deviated septum or septoplasty. Rather, his septum is now normal and midline. Regarding his claimed nasal polyps, sinusitis, and rhinitis, the appellant was granted service connection for chronic sinusitis and allergic rhinitis in a June 2025 rating decision, and those issues are not before the Board. See Rating Decision, June 2, 2025.

As the evidence persuasively weighs against a finding that the appellant's deviated septum was incurred in or is related to his service, the benefit-of-the-doubt doctrine is not for application. See 38 U.S.C. § 5107(b); Lynch, supra. Accordingly, the claim is denied.

12. Entitlement to service connection for a hernia disability.

The appellant contends that his inguinal hernias were incurred during his active service. See Board Hearing Transcript, November 14, 2024. He contends that his inguinal hernias were repaired in 2016 and that he continued to experience pain.

Analysis

In the February 2021 rating decision, the AOJ favorably found that the appellant had been diagnosed with a disability, and a VA examination and VA treatment records confirmed a diagnosis of umbilical hernia in 2013 and bilateral inguinal hernia in 2016. See Rating Decision, February 12, 2021. Therefore, the appellant has a current disability with respect to his claim.

The appellant's STRs show an assessment of a probable intermittent left inguinal ligament strain in June 1992 but do not reflect a diagnosis or treatment for a hernia. See STR, June 8, 1992. An undated counseling for elective sterilization during service noted he was negative for a hernia. In November 1994, just prior to his separation from service, the appellant was provided with a general VA medical examination, and the section for hernia documented a "normal" finding. See VA General Medical Examination Report, November 23, 1994.

Post-service treatment records reflect that in September 2012, the appellant presented for treatment of an umbilical hernia, which began 1 year prior when he noticed that he would have umbilical pain with any heavy lifting or strenuous exercise. See VA General Surgery Note, September 13, 2012. He reported that over the year, the pain had increased and radiated as a pulling sensation to both sides of the umbilicus. He had the umbilical hernia repaired in January 2013. See VA General Surgery Note, January 7, 2013.

In September 2015, he presented for evaluation of a symptomatic bilateral inguinal hernia. See VA Surgery Resident Outpatient Note, September 17, 2015. He reported that he first started having lower abdominal/groin pain and discomfort about 6 to 8 months prior. The pain was exacerbated by physical activity. He had
See VA General Surgery Note, September 13, 2012. He reported that over the year, the pain had increased and radiated as a pulling sensation to both sides of the umbilicus. He had the umbilical hernia repaired in January 2013. See VA General Surgery Note, January 7, 2013.

In September 2015, he presented for evaluation of a symptomatic bilateral inguinal hernia. See VA Surgery Resident Outpatient Note, September 17, 2015. He reported that he first started having lower abdominal/groin pain and discomfort about 6 to 8 months prior. The pain was exacerbated by physical activity. He had not noticed any bulging himself, rather an ultrasound performed in August revealed a fat-containing bilateral inguinal hernia, with the right greater than the left. He underwent a laparoscopic bilateral inguinal hernia repair in December 2015. See VA General Surgery Operative Note, December 4, 2015.

In July 2019, the appellant was provided with a VA examination, and at this examination, he reported that his umbilical hernia started in approximately 2010 and his left and right inguinal hernias started with pain in the groin area several years ago. See VA Hernias DBQ, July 29, 2019. The clinician opined that the hernias were not incurred in or caused by the claimed in-service injury, event, or illness. See VA Medical Opinion, July 29, 2019. The clinician stated that there was no indication of a hernia during active duty or immediately after discharge from service, and there was no continuity of care. The clinician noted that the appellant reported hernia problems more than 15 years after his discharge from service. Therefore, the clinician concluded that the status post left and right inguinal hernia repair and status post umbilical hernia repair were not likely due to serving in the military.

In February 2021, another VA clinician also opined that the appellant's claimed hernia was not likely related to his service. See VA Medical Opinion, February 8, 2021. The clinician noted that his separation physical in April 1993 did not show the disability and evidence was not supplied to the disability occurring within 1 year of separation.

During his Board hearing, the appellant testified that he was having issues with his hernia during service. See Board Hearing Transcript, November 14, 2024. He testified that he had his hernias repaired but continued to experience pain. His wife testified that she thought he had his hernias prior to his vasectomy but that they were not fixed because they were not causing any problems.

The evidence here is persuasively against finding that the appellant's hernias were incurred during service or are otherwise etiologically related to his active service. As noted above, his STRs do not reflect a hernia in service, and an abnormal hernia was not noted on his November 1994 VA examination. Further, both the July 2019 and February 2021 VA clinicians opined that his hernias were not incurred in service and are not otherwise related to his service. There is no competent and credible evidence that the appellant's hernia was incurred during service or is otherwise etiologically related to his active service.

The Board acknowledges the appellant's Board hearing testimony, as well as his wife's belief that his hernias were present during service. The appellant is competent to report his symptoms. However, in September 2012, he reported to his medical providers that his umbilical hernia began 1 year prior, and in September 2015, he reported that his bilateral inguinal hernia began approximately 6 to 8 months prior. Such evidence is inconsistent with his Board hearing testimony that his hernias were present during his active service, and thus, their lay reports of a hernia being incurred during service are not supported.

As the evidence persuasively weighs against a finding that the appellant's hernia disability was incurred in or is related to his service, the benefit-of-the-doubt doctrine is not for application. See 38 U.S.C. § 5107(b); Lynch, supra. As such, the claim is denied.

REASONS FOR REMAND

Under the AMA, VA's duty to assist ends when VA issues the notice of decision on a claim or returned claim and does not recommence unless a supplemental claim is submitted, or a claim is returned to the AOJ for correction of an error. 38 U.S.C. § 5103A(e); 38 C.F.R. § 3.159(c).

Given the limitations
asively weighs against a finding that the appellant's hernia disability was incurred in or is related to his service, the benefit-of-the-doubt doctrine is not for application. See 38 U.S.C. § 5107(b); Lynch, supra. As such, the claim is denied.

REASONS FOR REMAND

Given the limitations of when the duty to assist applies, remand by the Board in the AMA is proper for correction of (1) duty to assist errors occurring prior to the date of the AOJ decision on appeal (i.e., pre-decisional duty to assist errors); and (2) AOJ errors in satisfying a regulatory or statutory duty, if correction of such error would have a reasonable possibility of aiding in substantiating the appellant's claim. 38 C.F.R. § 20.802(a).

While additional delay is regrettable, remand is necessary in order to correct the pre-decisional duty to assist error discussed below.

13. Entitlement to service connection for a back disability.

Remand of the claim is warranted to obtain an adequate VA medical opinion addressing whether the appellant's current back disability is related to his active service.

In 2014, a VA clinician opined that the appellant's back disability was not incurred in service or caused by the claimed in-service injury, event, or illness. See VA Medical Opinion, April 8, 2014. As rationale, the clinician stated that the appellant "was diagnosed with mild lumbar degenerative disc disease, this would represent an age-appropriate finding." However, without further information, this rationale is insufficient. It is unclear whether the clinician determined that the finding was age-appropriate at the time of his VA examination in 2014 or at the time of his diagnosis in November 2008. See Private Treatment Record, D.B., MD, November 21, 2008. As such, remand is necessary to obtain a new medical opinion. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) ("Once [VA] undertakes the effort to provide an examination when developing a service-connection claim . . . [VA] must provide an adequate one").

While the appellant's wife's Board hearing testimony was sufficient to warrant readjudication of the claim, her testimony is insufficient to establish a nexus in this case. Her testimony relating the appellant's back disability to his service was speculative in nature and as the appellant's spouse, her testimony and opinion is biased towards the appellant rather than a neutral opinion based on the entirety of the record. See McLendon v. Nicholson, 20 Vet. App. 79, 85 (2006) (stating that a speculative medical opinion as to causation cannot a establish medical nexus to service). Accordingly, remand of the claim is necessary to obtain a new VA medical opinion.

By this remand, the Board makes no determination, express or implied, concerning the credibility of any lay statements on file.

The matter is REMANDED for the following action:

1. Schedule the appellant for an examination to determine the nature and etiology of his back disability. The clinician must review the claims file and a copy of this Remand.

The clinician is asked to address the following:

State whether it is likely (an approximate balance of positive and negative evidence) that the appellant's back disability was incurred during service or is related to his active service, to include being hit by a vehicle during his active service.

The clinician is advised that the appellant is competent to report his symptoms and history, and such reports must be considered. If the clinician rejects the appellant's reports, the clinician must provide a reason for doing so. The Board does not make any credibility determinations at this time with respect to the appellant's lay statements.

All opinions must be supported by a clear rationale. The clinician is asked to explain in detail the underlying reasoning for his or her opinion, to include citing to relevant evidence, supporting factual data, prior medical opinions, and medical literature, as appropriate.

If any requested opinion cannot be provided without resorting to mere speculation, the clinician must explain why a more definitive response is not possible or feasible. In other words, merely saying he or she cannot respond will not suffice.

2. Thereafter, readjudicate the claim.

K.A. KENNERLY

Veterans Law Judge

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