BONE NEOPLASM BENIGN

Summary

The veteran, who served from August 2012 to July 2013, appeals the denial of service connection for multiple conditions, including ganglion cyst, bilateral shoulder pain, pes planus with plantar fasciitis, contact dermatitis, hypertension, meralgia paresthetica, pectoral muscle strain, vitamin D deficiency, prediabetes, thrombocytopenia, and pseudofolliculitis barbae (PFB). The veteran also appeals the remand of claims for joint pain and non-allergic rhinitis. Regarding the denied claims, the Board found that the evidence did not establish that these conditions were manifested during, or a result of, active military service, nor did they manifest within a year of separation. For hypertension, the Board resolved reasonable doubt in the veteran's favor, finding it at least as likely as not related to service, and granted service connection. For vitamin D deficiency and prediabetes, the Board noted these are not compensable disabilities. For thrombocytopenia and PFB, the Board found the criteria for a compensable rating were not met based on the severity and treatment criteria. The Board remanded the claims for joint pain and non-allergic rhinitis due to a pre-decisional duty to assist error. In both instances, the VA examiner failed to provide an adequate etiology opinion linking the conditions to service or in-service complaints. For rhinitis, the examiner noted no evidence of pre-service onset, but an addendum opinion was needed to address potential presumptive toxic exposure. For joint pain, an addendum opinion was required to assess the association between in-service complaints and current symptoms.

Rationale

No evidence of in-service manifestation or result; No manifestation within one year of separation

Full Decision Text

Citation Nr: A26040791
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 250822-578838
DATE: April 30, 2026

ORDER

Entitlement to service connection for ganglion cyst is denied.

Entitlement to service connection for chronic shoulder pain, bilateral is denied.

Entitlement to service connection for bilateral pes planus with plantar fasciitis is denied.

Entitlement to service connection for contact dermatitis is denied.

Entitlement to service connection for hypertension is granted.

Entitlement to service connection for meralgia paresthetica is denied.

Entitlement to service connection for pectoral muscle strain is denied.

Entitlement to service connection for vitamin D deficiency is denied.

Entitlement to service connection for prediabetes is denied.

Entitlement to a compensable disability rating for thrombocytopenia is denied.

Entitlement to a compensable disability rating for pseudofolliculitis barbae (PFB) is denied.

REMANDED

Entitlement to service connection for joint pain is remanded.

Entitlement to service connection for non-allergic rhinitis is remanded.

FINDINGS OF FACT

1. The most probative evidence of record shows that ganglion cyst was not manifested during, or a result of, active military service nor did it manifest within a year of separation.

2. The most probative evidence of record shows that bilateral shoulder disability was not manifested during, or a result of, active military service nor did it manifest within a year of separation.

3. The most probative evidence of record shows that pes planus was not manifested during, or a result of, active military service nor did it manifest within a year of separation.

4. The most probative evidence of record shows that dermatitis was not manifested during, or a result of, active military service nor did it manifest within a year of separation.

5. Resolving reasonable doubt in the Veteran's favor, his hypertension is at least as likely as not related to service.

6. The most probative evidence of record shows that meralgia paresthetica was not manifested during, or a result of, active military service nor did it manifest within a year of separation.

7. The most probative evidence of record shows that pectoral muscle strain was not manifested during, or a result of, active military service nor did it manifest within a year of separation.

8. The laboratory finding of low vitamin D is not a disability for VA benefits purposes.

9. Pre-diabetes is not a disability for which VA compensation benefits are payable.

10. During the period on appeal, the Veteran's thrombocytopenia did not manifest in a platelet count higher than 30,000 but not higher than 50,000, not requiring treatment.

11. The Veteran's PFB manifested as affecting less than five percent of his entire body, and none of his exposed areas, and does not require medication.

CONCLUSIONS OF LAW

1. The criteria for service connection for ganglion cyst have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1154, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385 (2022).

2. The criteria for service connection for bilateral shoulder pain have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1154, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385 (2022).

3. The criteria for service connection for pes planus have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1154, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385 (2022).

4. The criteria for service connection for dermatitis have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1154, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385 (2022).

5. The criteria for entitlement to service connection for hypertension are met.  38 U.S.C. §§ 1110, 1131,
38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385 (2022).

4. The criteria for service connection for dermatitis have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1154, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385 (2022).

5. The criteria for entitlement to service connection for hypertension are met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for service connection for meralgia paresthetica have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1154, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385 (2022).

7. The criteria for service connection for pectoral muscle strain have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1154, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385 (2022).

8. The criteria for service connection for vitamin D deficiency have not been met. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1154, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.385 (2022).

9. The criteria for service connection for a pre-diabetes disability have not been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

10. The criteria for a compensable rating for thrombocytopenia are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.117, Diagnostic Code 7705.

11. The criteria for a compensable evaluation for PFB have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.40, 4.45, 4.59, 4.71, 4.118, Diagnostic Code 7806.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from August 2012 to July 2013.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2024 and January 2025 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO).

The Veteran chose the direct review lane when submitting his VA Form 10182, Notice of Disagreement. In the direct review lane, the Board reviews the evidence of record at the time of the agency of original jurisdiction (AOJ) rating decision for each issue. 38 C.F.R. § 20.301.

The Board notes that the Veteran listed several issues on his August 2025 VA Form 10182, including entitlement to service connection for headaches, left knee disability, low back disability, and right knee disability. However, these issues were denied in an April 2016 rating decision. As the rating decision was issued more than a year prior to the submission of the VA Form 10182, they are not currently on appeal. If the Veteran wishes to appeal these issues, he may submit a supplemental claim.

Service Connection

Establishing service connection generally requires competent evidence showing: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381, F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for
 April 2016 rating decision. As the rating decision was issued more than a year prior to the submission of the VA Form 10182, they are not currently on appeal. If the Veteran wishes to appeal these issues, he may submit a supplemental claim.

Service Connection

Establishing service connection generally requires competent evidence showing: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381, F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d).

Where a veteran who served for ninety days or more during a period of war (or during peacetime service after December 31, 1946) develops certain chronic diseases, such as hypertension, to a degree of 10 percent or more within one year from separation from service, such diseases may be presumed to have incurred in service even though there is no evidence of such disease during the period of service. This presumption is rebuttable by evidence to the contrary. 38 C.F.R. §§ 3.307, 3.309.

Where the veteran asserts entitlement to a chronic disease, but there is insufficient evidence of a diagnosis in service, the veteran can establish service connection by demonstrating a continuity of symptomatology since service, if the chronic disease is listed under 38 C.F.R. § 3.309(a). 38 C.F.R. § 3.303(b), Walker v. Shinseki, 708 F.3d 1331, 1337-39 (Fed. Cir. 2013). For disabilities that are not listed as chronic under 38 C.F.R. § 3.303(b), service connection may be based upon a showing of in-service incurrence or aggravation under 38 C.F.R. § 3.303(a), or by showing that a disease that was first diagnosed after service is related to service under 38 C.F.R. § 3.303(d).

The determination of whether the requirements of service connection have been met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). In making these determinations, the Board must consider and assess the credibility and weight of all evidence in the claim file, including the medical and lay evidence, to determine its probative value. In doing so, the Board must provide its reasoning for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Barr v. Nicholson, 21 Vet. App. 303 (2007).

When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. A claimant need only demonstrate an approximate balance of positive and negative evidence in order to prevail.  See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). 

1. Entitlement to service connection for ganglion cyst

See May 2024 Fully Developed Claim. 

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury or disease.

A review of the Veteran's service treatment records (STRs) shows no reports, treatment, or diagnosis of a cyst or any disability related to the Veteran's left hand third finger. 

An October 2017 VA treatment record notes treatment for a ganglion cyst on the Veteran's left third finger. The Veteran reported that the cyst had been present for three months. The treating clinician reported that there was no history of trauma. 

The Veteran was afforded a VA examination in July 2024. The VA examiner noted a diagnosis of ganglion cyst on the Veteran's left hand. The Veteran reported a symptom onset in 2017. Following the examination, the VA examiner opined that the Veteran's ganglion cyst is at least as likely than not incurred in or caused by his service. In support of this opinion, the VA examiner reasoned that the Veteran's ganglion
 disability related to the Veteran's left hand third finger. 

An October 2017 VA treatment record notes treatment for a ganglion cyst on the Veteran's left third finger. The Veteran reported that the cyst had been present for three months. The treating clinician reported that there was no history of trauma. 

The Veteran was afforded a VA examination in July 2024. The VA examiner noted a diagnosis of ganglion cyst on the Veteran's left hand. The Veteran reported a symptom onset in 2017. Following the examination, the VA examiner opined that the Veteran's ganglion cyst is at least as likely than not incurred in or caused by his service. In support of this opinion, the VA examiner reasoned that the Veteran's ganglion cyst is related to the left third finger injury in service. 

In considering the evidence of record under the laws and regulations above, the Board finds that the Veteran's ganglion cyst is not due to an in-service injury, incurrence, or disease. Therefore, it does not warrant granting service connection.

The Board notes that the Veteran has a current diagnosis of ganglion cyst. See July 2024 VA Examination Report. However, there is no probative evidence of a connection (nexus) between his service and the disability. See Shedden, supra.

The Board has considered the Veteran's statements and finds him competent to report his symptoms. However, the determination of whether the Veteran's current bilateral shoulder disability is related to his service is a complex medical question that requires medical expertise. Jandreau v. Nicholson, 492 F.3d. 1372 (2007); Davidson v. Shinseki, 581 F.3d 1313, 1316. The Veteran himself reports a symptom onset in 2017. 

The Board notes the positive etiology opinion provided by the July 2024 VA examiner. However, the Board affords the opinion low probative value. Despite reporting that the Veteran's current ganglion cyst is related to an in service finger injury, there is no evidence of said finger injury in the Veteran's STRs and his VA treatment records show no history of trauma to his finger and a symptom onset in February 2017. 

The medical evidence also does not suggest any manifestation of a ganglion cyst within a year of separation. As such, there is no evidence of record to warrant grant service connection for ganglion cyst on a presumptive basis. 38 C.F.R. § 3.309.

Thus, the Board finds the persuasive weight of the evidence is against the claim of entitlement to service connection for ganglion cyst, and there are no doubts to be resolved. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

2. Entitlement to service connection for chronic shoulder pain, bilateral

The Veteran asserts entitlement to service connection for bilateral shoulder pain. Specifically, the Veteran contends that, since 2013, he has had persistent bilateral shoulder pain. See May 2024 Fully Developed Claim. 

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury or disease.

A review of the Veteran's service treatment records (STRs) shows no complaints, treatment, or diagnosis of any shoulder disability. 

The Veteran was afforded a VA examination in July 2024. The VA examiner noted diagnoses of bilateral shoulder pain and shoulder impingement syndrome. The Veteran reported a symptom onset in 2012. Following the examination, the VA examiner opined that the Veteran's bilateral shoulder disability is less likely than not incurred in or caused by his service. In support of this opinion, the VA examiner reasoned that there is a lack of evidence that pain started while in the military. The VA examiner further reported that the Veteran has not sought medical attention for his shoulder pain. 

In considering the evidence of record under the laws and regulations above, the Board finds that the Veteran's bilateral shoulder pain is not due to an in-service injury, incurrence, or disease. Therefore, it does not warrant granting service connection.

The Board notes that the Veteran has a current diagnosis of bilateral shoulder pain and shoulder impingement syndrome. See July 2024 VA Examination Report. However, there is no probative evidence of a connection (nexus) between his service and the disability. See Shedden, supra.

The Board has considered the Veteran's statements and finds him competent to report his symptoms. However, the determination of whether the Veteran's current bilateral shoulder disability is related to his service is a complex medical question that requires medical expertise. Jandreau v. Nicholson, 492 F.3d. 1372 (2007); Davidson v. Shinseki, 581 F.3d 1313, 1316. A review of the
.

The Board notes that the Veteran has a current diagnosis of bilateral shoulder pain and shoulder impingement syndrome. See July 2024 VA Examination Report. However, there is no probative evidence of a connection (nexus) between his service and the disability. See Shedden, supra.

The Board has considered the Veteran's statements and finds him competent to report his symptoms. However, the determination of whether the Veteran's current bilateral shoulder disability is related to his service is a complex medical question that requires medical expertise. Jandreau v. Nicholson, 492 F.3d. 1372 (2007); Davidson v. Shinseki, 581 F.3d 1313, 1316. A review of the Veteran's medical records does not relate his current bilateral shoulder disability to service.

The Board gives great probative weight to the opinion of the July 2024 VA examiner. The VA examiner conducted thorough examinations; analyzed medical findings; considered lay evidence; and supported the conclusion that that the Veteran's bilateral shoulder disability is less likely as not related to the Veteran's military service. 

The medical evidence also does not suggest any manifestation of shoulder disability within a year of separation. As such, there is no evidence of record to warrant granting service connection for bilateral shoulder disability on a presumptive basis. 38 C.F.R. § 3.309.

Thus, the Board finds the persuasive weight of the evidence is against the claim of entitlement to service connection for bilateral shoulder pain, and there are no doubts to be resolved. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

3. Entitlement to service connection for bilateral pes planus with plantar fasciitis

The Veteran asserts entitlement to service connection for pes planus, claimed as flat feet. Specifically, the Veteran contends that he was diagnosed with flat feet in 2007 and was treated in service in 2013. See May 2024 Fully Developed Claim. 

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury or disease.

A review of the Veteran's service treatment records (STRs) shows no complaints, treatment, or diagnosis of any foot disability. The Veteran denied numbness or tingling in his feet in June 2013. 

A June 2021 VA treatment record notes the Veteran's complaint of bilateral foot pain after walking a certain amount of distance and he requested shoe inserts. The treating clinician noted a diagnosis of pes planus. 

The Veteran was afforded a VA examination in July 2024. The VA examiner noted diagnoses of pes planus and plantar fasciitis. The Veteran reported a symptom onset in 2007 and that he was diagnosed with mild asymptomatic flat feet. Following the examination, the VA examiner opined that the Veteran's flat feet are at least as likely as not incurred in or cased by his service. In support of this opinion, the VA examiner reasoned that the Veteran's current bilateral foot pain is related to the foot pain reported in service.  

In considering the evidence of record under the laws and regulations above, the Board finds that the Veteran's pes planus is not due to an in-service injury, incurrence, or disease. Therefore, it does not warrant granting service connection.

The Board notes that the Veteran has a current diagnosis of pes planus. See July 2024 VA Examination Report. However, there is no probative evidence of a connection (nexus) between his service and the disability. See Shedden, supra.

The Board has considered the Veteran's statements and finds him competent to report his symptoms. However, the determination of whether the Veteran's current pes planus is related to his service is a complex medical question that requires medical expertise. Jandreau v. Nicholson, 492 F.3d. 1372 (2007); Davidson v. Shinseki, 581 F.3d 1313, 1316. 

The Board notes the positive etiology opinion provided by the July 2024 VA examiner. However, the Board affords the opinion low probative value. Despite reporting that the Veteran's current pes planus is related to in service foot pain, there is no evidence of said foot pain in the Veteran's STRs, and his VA treatment records show a symptom onset in 2021. 

The medical evidence also does not suggest any manifestation of pes planus within a year of separation. As such, there is no evidence of record to warrant granting service connection for pes planus on a presumptive basis. 38 C.F.R. § 3.309.

Thus, the Board finds the persuasive weight of the evidence is against the claim of entitlement to service connection for pes planus, and there are no
2024 VA examiner. However, the Board affords the opinion low probative value. Despite reporting that the Veteran's current pes planus is related to in service foot pain, there is no evidence of said foot pain in the Veteran's STRs, and his VA treatment records show a symptom onset in 2021. 

The medical evidence also does not suggest any manifestation of pes planus within a year of separation. As such, there is no evidence of record to warrant granting service connection for pes planus on a presumptive basis. 38 C.F.R. § 3.309.

Thus, the Board finds the persuasive weight of the evidence is against the claim of entitlement to service connection for pes planus, and there are no doubts to be resolved. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

4. Entitlement to service connection for contact dermatitis

The Veteran asserts entitlement to service connection for dermatitis, claimed as skin issues. Specifically, the Veteran contends that, since returning from Afghanistan in 2013, he has experienced skin irritation. See May 2024 Fully Developed Claim. 

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury or disease.

A review of the Veteran's service treatment records (STRs) shows no complaints, treatment, or diagnosis of dermatitis. The Veteran denied skin rashes and/or lesions in June 2013. 

The Veteran was afforded a VA examination in July 2024. The VA examiner noted a diagnosis of contact dermatitis. The Veteran reported a symptom onset in 2013 after returning from Afghanistan. Following the examination, the VA examiner opined that the Veteran's dermatitis is less likely than not caused by TERA. In support of this opinion, the VA examiner reasoned that contact dermatitis is an itchy rash caused by direct contact with a substance or allergic reaction to it. The VA examiner reported that the most common causes of this reaction are exposure to cosmetics, fragrances, jewelry, and plants. The VA examiner further reported that there is no literature linking toxic exposure to contact dermatitis. 

In considering the evidence of record under the laws and regulations above, the Board finds that the Veteran's dermatitis is not due to an in-service injury, incurrence, or disease. Therefore, it does not warrant granting service connection.

The Board notes that the Veteran has a current diagnosis of contact dermatitis. See July 2024 VA Examination Report. However, there is no probative evidence of a connection (nexus) between his service and the disability. See Shedden, supra.

The Board has considered the Veteran's statements and finds him competent to report his symptoms. However, the determination of whether the Veteran's current dermatitis is related to his service is a complex medical question that requires medical expertise. Jandreau v. Nicholson, 492 F.3d. 1372 (2007); Davidson v. Shinseki, 581 F.3d 1313, 1316. The July 2024 VA examiner opined that the Veteran's dermatitis is less likely than not caused by TERA in service. Furthermore, the Veteran denied skin issues in service. See June 2013 STR. 

The medical evidence also does not suggest any manifestation of dermatitis within a year of separation. As such, there is no evidence of record to warrant granting service connection for dermatitis on a presumptive basis. 38 C.F.R. § 3.309.

Thus, the Board finds the persuasive weight of the evidence is against the claim of entitlement to service connection for dermatitis, and there are no doubts to be resolved. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

5. Entitlement to service connection for hypertension

The Veteran asserts entitlement to service connection for hypertension. Specifically, the Veteran contends that, since 2017, multiple in-clinic and home checks have identified hypertension and that weight gain and high BMI place him at a higher risk for weight-related complications. See May 2024 Fully Developed Claim. 

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury or disease.

The Board first notes that the AOJ made the following favorable findings pertaining to Veteran's claim: (a) that the Veteran has a diagnosis of hypertension, and (b) that participation in toxic exposure risk activity (TERA) was conceded based on Veteran's service in Southwest Asia. The Board is bound by such favorable findings. 38 U.S.C. § 5104A.

A review of the Veteran's service treatment
 identified hypertension and that weight gain and high BMI place him at a higher risk for weight-related complications. See May 2024 Fully Developed Claim. 

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury or disease.

The Board first notes that the AOJ made the following favorable findings pertaining to Veteran's claim: (a) that the Veteran has a diagnosis of hypertension, and (b) that participation in toxic exposure risk activity (TERA) was conceded based on Veteran's service in Southwest Asia. The Board is bound by such favorable findings. 38 U.S.C. § 5104A.

A review of the Veteran's service treatment records (STRs) shows no complaints, treatment, or diagnosis of hypertension. The Veteran's blood pressure readings in service were 118/70, 118/60, 126/79, and 132/66. See March 2010, April 2010, March 2011, August 2012 STRs. 

The Veteran was afforded a VA examination in July 2024. The VA examiner noted a diagnosis of hypertension. The Veteran reported a symptom onset in 2017. Following the examination, the VA examiner opined that the Veteran's hypertension is at least as likely as not incurred in or caused by his service. In support of this opinion, the VA examiner reasoned that the Veteran had toxic exposure to particulate matter during service and developed elevated blood pressure readings, with some falling into the category of hypertension. 

In considering the evidence of record under the laws and regulations above, the Board finds that the Veteran's hypertension is due to his presumed in-service toxic exposure. Therefore, it warrants granting service connection.

Specifically, the July 2024 VA examiner reported that the Veteran's hypertension is at least as likely as not related to his presumed toxic exposure to particulate matter in service. Therefore, the Board finds that the evidence is at least in an approximate balance as to whether his hypertension is etiologically related to his active service, to include any toxic exposure risk activities.

For these reasons, after resolving any reasonable doubt in favor of the Veteran, the entitlement to service connection for hypertension is warranted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see also Lynch v. McDonough, 21 F.4th 776 (2021).

6. Entitlement to service connection for meralgia paresthetica

The Veteran asserts entitlement to service connection for meralgia paresthesia. Specifically, the Veteran contends that he has had pain in his thighs after carrying heavy equipment in Afghanistan in 2013. See May 2024 Fully Developed Claim. 

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury or disease.

A review of the Veteran's service treatment records (STRs) shows no complaints, treatment, or diagnosis of any thigh pain. 

A March 2017 VA treatment record notes the Veteran's report of bilateral thigh pain that began one year prior. 

The Veteran was afforded a VA examination in July 2024. The VA examiner noted a diagnosis of meralgia paresthetica. The Veteran reported a symptom onset in 2013 while serving in Afghanistan. Following the examination, the VA examiner opined that the Veteran's meralgia is less likely than not caused by TERA. In support of this opinion, the VA examiner reasoned that meralgia paresthetica is a condition caused by root entrapment and not related to toxic exposure. 

In considering the evidence of record under the laws and regulations above, the Board finds that the Veteran's meralgia paresthesia is not due to an in-service injury, incurrence, or disease. Therefore, it does not warrant granting service connection.

The Board notes that the Veteran has a current diagnosis of meralgia paresthesia. See July 2024 VA Examination Report. However, there is no probative evidence of a connection (nexus) between his service and the disability. See Shedden, supra.

The Board has considered the Veteran's statements and finds him competent to report his symptoms. However, the determination of whether the Veteran's current meralgia paresthesia is related to his service is a complex medical question that requires medical expertise. Jandreau v. Nicholson, 492 F.3d. 1372 (2007); Davidson v. Shinseki, 581 F.3d 1313, 1316. A review of the Veteran's medical records does not relate his current meralgia paresthesia to service.

The Board gives great probative weight to the opinion of the July 2024 VA examiner. The
nexus) between his service and the disability. See Shedden, supra.

The Board has considered the Veteran's statements and finds him competent to report his symptoms. However, the determination of whether the Veteran's current meralgia paresthesia is related to his service is a complex medical question that requires medical expertise. Jandreau v. Nicholson, 492 F.3d. 1372 (2007); Davidson v. Shinseki, 581 F.3d 1313, 1316. A review of the Veteran's medical records does not relate his current meralgia paresthesia to service.

The Board gives great probative weight to the opinion of the July 2024 VA examiner. The VA examiner conducted thorough examinations; analyzed medical findings; considered lay evidence; and supported the conclusion that the Veteran's meralgia paresthesia is less likely as not related to the Veteran's TERA during service. Furthermore, there is no evidence of meralgia paresthesia in his STRs, and the Veteran himself reported a symptom onset in 2016. See March 2017 VA Treatment Record. 

The medical evidence also does not suggest any manifestation of meralgia paresthesia within a year of separation. As such, there is no evidence of record to warrant granting service connection for meralgia paresthesia on a presumptive basis. 38 C.F.R. § 3.309.

Thus, the Board finds the persuasive weight of the evidence is against the claim of entitlement to service connection for meralgia paresthesia, and there are no doubts to be resolved. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

7. Entitlement to service connection for pectoral muscle strain

The Veteran asserts entitlement to service connection for pectoral muscle strain, claimed as chest pain. Specifically, the Veteran contends that, since 2015, he has had episodic chest pain. See May 2024 Fully Developed Claim.

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury or disease.

A review of the Veteran's service treatment records (STRs) shows no complaints, treatment, or diagnosis of any pectoral muscle strain or pectoral pain. The Veteran denied chest pain in June 2013. 

A June 2023 VA treatment record notes the Veteran's report of chest pain that occurred only once.

The Veteran was afforded a VA examination in July 2024. The VA examiner noted a diagnosis of pectoral muscle strain. The Veteran reported a symptom onset in 2015. Following the examination, the VA examiner opined that the Veteran's pectoral muscle strain is at least as likely as not incurred in or caused by his service. In support of this opinion, the VA examiner reasoned that the Veteran's current muscle strain is related to his chest pain during service. 

In considering the evidence of record under the laws and regulations above, the Board finds that the Veteran's pectoral muscle strain is not due to an in-service injury, incurrence, or disease. Therefore, it does not warrant granting service connection.

The Board notes that the Veteran has a current diagnosis of pectoral muscle strain. See July 2024 VA Examination Report. However, there is no probative evidence of a connection (nexus) between his service and the disability. See Shedden, supra.

The Board has considered the Veteran's statements and finds him competent to report his symptoms. However, the determination of whether the Veteran's current pectoral muscle strain is related to his service is a complex medical question that requires medical expertise. Jandreau v. Nicholson, 492 F.3d. 1372 (2007); Davidson v. Shinseki, 581 F.3d 1313, 1316. 

The Board notes the positive etiology opinion provided by the July 2024 VA examiner. However, the Board affords the opinion low probative value. Despite reporting that the Veteran's current pectoral muscle strain is related to in service chest pain, there is no evidence of said chest pain in the Veteran's STRs, and the Veteran himself denied chest pain in June 2013. The first mention of chest pain in the Veteran's medical records is in June 2023. 

The medical evidence also does not suggest any manifestation of pectoral muscle strain within a year of separation. As such, there is no evidence of record to warrant granting service connection for pes planus on a presumptive basis. 38 C.F.R. § 3.309.

Thus, the Board finds the persuasive weight of the evidence is against the claim of entitlement to service connection for
 probative value. Despite reporting that the Veteran's current pectoral muscle strain is related to in service chest pain, there is no evidence of said chest pain in the Veteran's STRs, and the Veteran himself denied chest pain in June 2013. The first mention of chest pain in the Veteran's medical records is in June 2023. 

The medical evidence also does not suggest any manifestation of pectoral muscle strain within a year of separation. As such, there is no evidence of record to warrant granting service connection for pes planus on a presumptive basis. 38 C.F.R. § 3.309.

Thus, the Board finds the persuasive weight of the evidence is against the claim of entitlement to service connection for pectoral muscle strain, and there are no doubts to be resolved. 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

8. Entitlement to service connection for vitamin D deficiency

The Veteran asserts entitlement to service connection for vitamin D deficiency. Specifically, the Veteran contends that, since 2017, his labs have shown low vitamin D. See May 2024 Fully Developed Claim.

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury or disease.

A review of the Veteran's service treatment records (STRs) shows no test results, treatment, or diagnosis of low vitamin D. 

An April 2017 VA treatment record shows normal vitamin D levels.

A December 2021 VA treatment record shows vitamin D deficiency. 

Vitamin D deficiency is a laboratory finding rather than a disability. Disability "refers to the functional impairment of earning capacity." See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018).

Considering Saunders, the evidence does not suggest that low vitamin D causes an impairment of earning capacity. The Veteran has not alleged any disabling physical or mental limitation as a result of low vitamin D. Further, the VA treatment records do not show any conditions or symptoms related to low vitamin D levels that cause impairment. Specifically, the December 2021 VA treatment record noted that the Veteran was placed on vitamin D supplements after routine bloodwork; however, there were no additional symptoms related to his vitamin D deficiency reported.

In this case, competent evidence does not identify a disability for VA compensation purposes for the claim; without this element the claim cannot succeed. In the absence of proof of a current disability, there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Accordingly, service connection for vitamin D deficiency is not warranted and the claim is denied.

9. Entitlement to service connection for prediabetes 

The Veteran asserts entitlement to service connection for prediabetes. 

Service connection is warranted for a disability when the evidence shows that the disability resulted from an injury or disease incurred in or aggravated during service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Generally, laboratory test results are not, in and of themselves, disabilities subject to disability compensation. However, as a disability for VA purposes refers to the functional impairment of earning capacity, service connection may be warranted where laboratory tests show a condition resulting in functional impairment, even if no formal diagnosis is applied. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Nonetheless, in the absence of evidence of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223 (1992).

The Board finds that the evidence of record does not show a diagnosis of diabetes mellitus.  A review of the medical records shows that the Veteran has only been diagnosed with pre-diabetes and has not received any treatment or medication in relation to that pre-diagnosis. See April 2021 VA Treatment Record. While there may be some evidence of elevated blood sugar readings, the weight of the evidence does not show that those readings have resulted in a confirmed diagnosis of diabetes mellitus, or in any disability resulting in functional limitation of earning capacity.

The Veteran himself, in asserting the claim, does not contend that he has been diagnosed with diabetes, and instead notes explicitly that he has pre-diabetes. The Board finds that the pre-diabetes designation notes only a laboratory finding and does not constitute a diagnosed disability or findings of a disability. Therefore, the Board must find that a compensable disability is not shown to be present.

Here, none of the Veteran's medical records indicate, nor has he contended, that he has experienced any impairment of earning capacity due to his pre-diabetic status. Additionally, the Board notes
, the weight of the evidence does not show that those readings have resulted in a confirmed diagnosis of diabetes mellitus, or in any disability resulting in functional limitation of earning capacity.

The Veteran himself, in asserting the claim, does not contend that he has been diagnosed with diabetes, and instead notes explicitly that he has pre-diabetes. The Board finds that the pre-diabetes designation notes only a laboratory finding and does not constitute a diagnosed disability or findings of a disability. Therefore, the Board must find that a compensable disability is not shown to be present.

Here, none of the Veteran's medical records indicate, nor has he contended, that he has experienced any impairment of earning capacity due to his pre-diabetic status. Additionally, the Board notes that pre-diabetes means higher than normal blood sugar levels that, without lifestyle changes, could develop to diabetes mellitus.

Additionally, there is no express basis on which to award service connection for pre-diabetes. The VA Schedule for Rating Disabilities has no reference to a separate disability rating for pre-diabetes. 38 C.F.R. Part 4; Marcelino v. Shinseki, 29 Vet. App. 155 (2018) (exclusion of a disorder from the rating schedule is an indication that the condition is not a disability).

The Board is unable to find that the Veteran's pre-diabetes constitutes a disability for VA compensation purposes.

As the Board is unable to find that the Veteran's pre-diabetes constitutes a disability for VA compensation purposes, the analysis ends and the claim of entitlement to service connection for pre-diabetes must be denied. Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998).

Thus, in this case, while pre-diabetes may be a risk factor for disability, it is not itself a disability for VA purposes, and the evidence does not show any functional impairment due to pre-diabetes. Accordingly, there is no basis for awarding service connection for pre-diabetes, and the appeal must be denied.

Increased Rating

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 there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that evaluation.  Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7.

Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance. Francisco v. Brown, 7 Vet. App. 55, 58 (1994).  However, separate ratings may be assigned for separate periods of time based on the facts found.  This practice is known as "staged" ratings." Hart v. Mansfield, 21 Vet. App. 505 (2007). The relevant temporal focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability for the time period beginning one year before the claim was filed until VA makes a final decision on the claim. Id.

When evaluating a service-connected disability based on limitation of motion, the Board must take into consideration functional loss due to pain under 38 C.F.R. § 4.40 and functional loss due to weakness, fatigability, incoordination or pain on movement of a joint under 38 C.F.R. § 4.45. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see Johnson v. Brown, 9 Vet. App. 7 (1996). A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the Veteran. 38 C.F.R. § 4.40; Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Nonetheless, a rating higher than the minimum compensable rating is not assignable under any diagnostic code relating to range of motion where pain does not cause a compensable functional loss. Rather, the "pain must affect some aspect of 'the normal working movements of the body' such as 'excursion, strength, speed, coordination, and endurance,' "as defined in 38 C.F.R. § 4.40, before a higher rating may be assigned. See Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011).

10. Entitlement to a compensable disability rating for thrombocytopenia

The Veteran asserts entitlement to a compensable disability rating for thrombocytopenia. 

The Veteran's thromb
 minimum compensable rating is not assignable under any diagnostic code relating to range of motion where pain does not cause a compensable functional loss. Rather, the "pain must affect some aspect of 'the normal working movements of the body' such as 'excursion, strength, speed, coordination, and endurance,' "as defined in 38 C.F.R. § 4.40, before a higher rating may be assigned. See Mitchell v. Shinseki, 25 Vet. App. 32, 37 (2011).

10. Entitlement to a compensable disability rating for thrombocytopenia

The Veteran asserts entitlement to a compensable disability rating for thrombocytopenia. 

The Veteran's thrombocytopenia is rated under Diagnostic Code (DC) 7705, for Immune Thrombocytopenia. 

During the pendency of this appeal, VA issued a final rule revising the portion of the VA Schedule for Rating Disabilities that addresses the hematologic and lymphatic systems.  Effective December 9, 2018, the final rule updated medical terminology, added certain hematologic diseases, and provided detailed and updated criteria for evaluating conditions pertaining to the hematologic and lymphatic systems. In cases where rating criteria are amended during the course of the appeal, such as this case, the Board must consider both the former and current schedular criteria. If an increased rating is warranted under the new, revised criteria, the award may not be made effective before the effective date of change. See Kuzma v. Principi, 341 F.3d 1327, 1328 (Fed. Cir. 2003).  

Additionally, in Karnas, the United States Federal Circuit held that the more favorable regulations should apply to the Veteran. See Karnas v. Derwinski, 1 Vet. App. 308 (1991). However, the Federal Circuit overruled Karnas to the extent that it allowed for retroactive application and conflicted with U.S. Supreme Court and Federal Circuit precedents. Id. Thus, Karnas allows the old criteria to be applied before and after the effective date of the amendment, if such is more favorable to the Veteran. Id.  

Under DC 7705, the old rating criteria prior to December 9, 2018, for "primary, idiopathic or immune thrombocytopenia" assigned a noncompensable rating for a stable platelet count of 100,000 or more, without bleeding. A 30 percent disability rating is assigned for a stable platelet count between 70,000 and 100,000, without bleeding. A 70 percent disability rating is assigned for a platelet count between 20,000 and 70,000, not requiring treatment, without bleeding. A 100 percent rating is assigned for a platelet count less than 20,000 with active bleeding, requiring treatment with medication and transfusions. 38 C.F.R. § 4.117.

Under the revised, updated criteria for DC 7705, which has now been renamed as the rating criteria for "immune thrombocytopenia," effective December 9, 2018, a 10 percent disability rating is assigned for a platelet count higher than 30,000 but not higher than 50,000, not requiring treatment. A 30 percent rating is assigned with a platelet count higher than 30,000 but not higher than 50,000, with either immune thrombocytopenia or mild mucous membrane bleeding which requires oral corticosteroid therapy or intravenous immune globulin. A 70 percent rating is assigned when the thrombocytopenia requires immunosuppressive therapy; or for a platelet count higher than 30,000 but not higher than 50,000, with history of hospitalization because of severe bleeding requiring intravenous immune globulin, high-dose parenteral corticosteroids, and platelet transfusions. A maximum, 100 percent rating is assigned if chronic refractory thrombocytopenia requires chemotherapy; or with a platelet count 30,000 or below despite treatment. 38 C.F.R. § 4.117 (Revised December 9, 2018).

The Veteran was afforded a VA examination in December 2024. The Veteran reported bleeding gums while brushing his teeth. The VA examiner noted that the Veteran's condition does not require continuous medication and that he has not completed any treatment but is under watchful waiting. The Veteran's condition is active. The VA examiner reported anemia and low-normal platelet counts due to his thrombocytopenia. The VA examiner noted tests with platelet counts of 124,000, 129,000, 148,000, 158,000, and 151,000. The
 count 30,000 or below despite treatment. 38 C.F.R. § 4.117 (Revised December 9, 2018).

The Veteran was afforded a VA examination in December 2024. The Veteran reported bleeding gums while brushing his teeth. The VA examiner noted that the Veteran's condition does not require continuous medication and that he has not completed any treatment but is under watchful waiting. The Veteran's condition is active. The VA examiner reported anemia and low-normal platelet counts due to his thrombocytopenia. The VA examiner noted tests with platelet counts of 124,000, 129,000, 148,000, 158,000, and 151,000. The VA examiner reported that the Veteran's thrombocytopenia does not impact his ability to work. 

Upon a review of the evidence of record, the Board finds that a compensable rating for service-connected thrombocytopenia is not warranted. As demonstrated by the December 2024 VA examination, the Veteran's disability does not manifest in a platelet count higher than 30,000 but not higher than 50,000, not requiring treatment. Instead, the Veteran's platelet count has been consistently above 100,000. Thus, a 10 percent rating is not warranted.

Based upon the foregoing, the Board finds that a compensable rating for service-connected thrombocytopenia is denied.

11. Entitlement to a compensable disability rating for pseudofolliculitis barbae (PFB)

The Veteran asserts entitlement to a compensable disability rating for his service-connected pseudofolliculitis barbae (PFB). 

The Veteran's PFB is rated under DC 7806. Under Diagnostic Code 7806, a noncompensable rating is warranted where less than 5 percent of the entire body or less than 5 percent of the exposed areas affected, and; no more than topical therapy required during the past 12-month period. A 10 percent disability rating in warranted where at least five percent, but less than twenty percent, of the entire body, or at least five percent, but less than twenty percent, of exposed areas affected, or intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period. A 30 percent disability rating is warranted where 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected; or, systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly, during the past 12-month period. A 60 percent rating is warranted where more than 40 percent of the entire body or more than 40 percent of exposed areas affected; or, constant or near-constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period. 38 C.F.R. § 4.118.

The Veteran was afforded a VA examination in July 2024. The VA examiner noted a diagnosis of pseudofolliculitis barbae. The Veteran reported a symptom onset in 2012 with skin irritation and extreme itching sensation without a rash. The VA examiner noted that the Veteran has not been treated with medication in the past 12 months for his skin condition. The VA examiner reported that the Veteran's PFB covers less than five percent of his exposed body area. The VA examiner noted that the Veteran' PFB is nonvisible due to his beard. 

After a thorough review of the evidence of record, the Board finds that a compensable rating is not warranted for the Veteran's service connected PFB.

The Board notes that under the General Rating Formula for Skin Disorders, a compensable rating requires at least five percent, but less than twenty percent of the entire body affected, or at least five percent, but less than twenty percent of exposed areas affected. The Veteran's July 2024 VA examination indicated that the Veteran's skin condition affects less than five percent of the total body. Therefore, the Veteran's affected areas did not meet the five percent threshold necessary for a compensable disability rating.

Accordingly, a compensable disability rating, under Diagnostic Code 7806 based upon the percentage of areas affected is not warranted.

Further, the Federal Circuit Court has held that systemic therapy means "treatment pertaining to or affecting the body as a whole," whereas topical therapy means treatment pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied, and that nothing in Diagnostic Code 7806 displaces the accepted understandings of systemic therapy and topical therapy to permit a topical therapy that affects "only the area to which
 of the total body. Therefore, the Veteran's affected areas did not meet the five percent threshold necessary for a compensable disability rating.

Accordingly, a compensable disability rating, under Diagnostic Code 7806 based upon the percentage of areas affected is not warranted.

Further, the Federal Circuit Court has held that systemic therapy means "treatment pertaining to or affecting the body as a whole," whereas topical therapy means treatment pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied, and that nothing in Diagnostic Code 7806 displaces the accepted understandings of systemic therapy and topical therapy to permit a topical therapy that affects "only the area to which it is applied" to count as a systemic therapy under the Code. However, the use of a topical corticosteroid could be considered either systemic therapy or topical therapy based on the factual circumstances of each case and does not automatically mean systemic therapy because Diagnostic Code 7806 distinguishes between systemic and topical therapy. Johnson v. Shulkin, 862 F.3d 1351 (Fed. Cir. 2017).

However, the record is silent for medication administered for PFB. Accordingly, a compensable disability rating under Diagnostic Code 7806 based upon treatment of the Veteran's skin condition is not warranted at any time during the appeal period. 38 C.F.R. § 4.118.

The Board has considered all potentially applicable provisions of 38 C.F.R. § 4.118 for skin disorders, whether or not they have been raised by the Veteran. In this case, the Board finds no provision upon which to assign the Veteran a compensable disability rating for PFB.

Therefore, as the evidence of record does not support the Veteran's claim for a compensable rating for his service connected PFB, the benefit of the doubt doctrine does not apply, and his claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

REASONS FOR REMAND

1. Entitlement to service connection for joint pain is remanded.

The Veteran asserts entitlement to service connection for non-allergic rhinitis.

The Veteran was afforded a VA examination in July 2024. The VA examiner noted a diagnosis of non-allergic rhinitis. The Veteran reported a symptom onset date in 2009. The VA examiner reported that the Veteran claimed sinusitis, but the examiner could not render a diagnosis of sinusitis and that his symptoms are consistent with chronic rhinitis. 

An addendum opinion was obtained in November 2024. The VA examiner reported that there is no evidence to suggest that the Veteran's rhinitis pre-existed service as his entrance exam was silent to any rhinitis or hay fever symptoms. 

The Board notes that the Veteran has at least one qualifying deployment that satisfies the criteria for presumptive toxic exposure. See January 2023 VA Memorandum. 

The Board finds that remand is warranted to correct a pre decisional duty to assist error. As there are no competent opinions within the record concerning service connection for rhinitis, whether on a direct basis, or a presumptive basis related to TERA participation, the Board cannot make an adequate finding of fact on the third element of service connection. The AOJ's failure to obtain adequate opinion(s) is a predecisional duty to assist error that requires a remand to correct. 38 C.F.R. § 20.802(a).

2. Entitlement to service connection for non-allergic rhinitis is remanded.

The Veteran asserts entitlement to service connection for joint pain. Specifically, the Veteran contends that he has had persistent joint pain since 2013. See May 2024 Fully Developed Claim. 

The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury or disease.

A review of the Veteran's service treatment records (STRs) shows a report of joint pain in June 2013. 

The Veteran was afforded a VA Gulf War examination in July 2024. The VA examiner noted that the Veteran reported joint pain in his hands, fingers, knees, and shoulders. 

The Board finds that remand is warranted to correct a predecisional duty to assist error. Specifically, the July 2024 VA examiner did not provide an etiology opinion regarding the Veteran's reported joint pain. As the Veteran reported joint pain in service and currently reports joint pain, an addendum opinion is required to determine any association between the in service complaints and the current reported joint pain.

The matters are REMANDED for the following action:

1. Obtain addendum medical opinion(s) from appropriate
 a report of joint pain in June 2013. 

The Veteran was afforded a VA Gulf War examination in July 2024. The VA examiner noted that the Veteran reported joint pain in his hands, fingers, knees, and shoulders. 

The Board finds that remand is warranted to correct a predecisional duty to assist error. Specifically, the July 2024 VA examiner did not provide an etiology opinion regarding the Veteran's reported joint pain. As the Veteran reported joint pain in service and currently reports joint pain, an addendum opinion is required to determine any association between the in service complaints and the current reported joint pain.

The matters are REMANDED for the following action:

1. Obtain addendum medical opinion(s) from appropriate clinician(s) addressing the following question concerning the Veteran's rhinitis. If necessary, schedule the Veteran for a VA medical examination. The examiner must review the claims file, including this opinion.

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

The examiner is asked to provide a response to the following:

(a.) Is the Veteran's rhinitis at least as likely as not related to service and conceded participation in Toxic Exposure Risk Activities (TERAs) during military service?

Any opinion expressed by an 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 resorting to speculation, a thorough explanation as to why an opinion cannot be rendered should be provided.

2. Obtain an addendum opinion from an appropriate clinician, regarding the Veteran's reported joint pain. The claims file and a copy of this remand must be made available to the examiner.  The need for an additional examination of the Veteran is left to the discretion of the clinician selected to write the addendum opinion.  The examiner should respond to the following:

(Continued on the next page)

?

(a.) Whether it as least as likely as not that the Veteran's reported joint pain, was caused by or otherwise related to his active-duty service?  Please explain why or why not.

The VA examiner must address the Veteran's in service report of joint pain in June 2013.

 

 

Ardie A. Bland

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	A.C. Slaughter, Associate 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.