Citation Nr: A25035114 Decision Date: 04/16/25 Archive Date: 04/16/25 DOCKET NO. 231031-388338 DATE: April 16, 2025 ORDER Entitlement to an initial 30 percent rating prior to May 26, 2024, for sinusitis is granted. Entitlement to an initial 30 percent rating for gastroesophageal reflux disease (GERD) is granted. Entitlement to an initial rating greater than 10 percent prior to May 26, 2024, for asthma is denied. Entitlement to an initial rating greater than 30 percent for allergic rhinitis is denied. Entitlement to a compensable disability rating for left inguinal hernia, status-post repair, is denied. Entitlement to an initial compensable rating for scar, status-post left inguinal hernia repair, is denied. Entitlement to service connection for fatigue as due to in-service participation in a toxic exposure risk activity (TERA) is denied. Entitlement to service connection for a right shoulder disability (claimed as right shoulder and arm joint pain) as due to in-service participation in a TERA is denied. Entitlement to service connection for a right wrist disability (claimed as right wrist joint pain) as due to in-service participation in a TERA is denied. Entitlement to service connection for a bilateral leg disability (claimed as bilateral leg joint pain) as due to in-service participation in a TERA is denied. Entitlement to service connection for a left shoulder disability (claimed as left shoulder and arm joint pain) as due to in-service participation in a TERA is denied. Entitlement to service connection for a left wrist disability (claimed as left wrist joint pain) as due to in-service participation in a TERA is denied. Entitlement to service connection for muscle tension headaches, including as due to an undiagnosed illness or residuals of a neck injury, is denied. Readjudication of the claim of service connection for seborrheic dermatitis is not warranted. Readjudication of the claim of service connection for obstructive sleep apnea (OSA) is not warranted. FINDINGS OF FACT 1. The record evidence shows that, prior to May 26, 2024, the Veteran's service-connected sinusitis is manifested by, at worst, headaches, pain, purulent discharge, and 7 or more non-incapacitating episodes of sinusitis per year. 2. The record evidence shows that the Veteran's service-connected GERD is manifested by, at worst, persistently recurrent epigastric distress, dysphagia, pyrosis, reflux, regurgitation, substernal and shoulder pain, 4 or more episodes of sleep disturbance and nausea per year lasting 10 days or more, and 2 episodes of vomiting per year lasting less than 1 day throughout the appeal period. 3. The record evidence shows that, prior to May 26, 2024, the Veteran's service-connected asthma is manifested by, at worst, the intermittent use of inhalational bronchodilator therapy and less frequently than monthly visits to a physician for required care of exacerbations. 4. The record evidence shows that the Veteran currently is in receipt of the maximum schedular rating for his service-connected allergic rhinitis throughout the appeal period. 5. The record evidence shows that the Veteran's service-connected allergic rhinitis is manifested by, at worst, greater than 50 percent obstruction of the nasal passage on both sides, complete obstruction on the left side of the nasal passage, permanent hypertrophy of the nasal turbinates, and nasal polyps throughout the appeal period. 6. The record evidence shows that the Veteran's service-connected left inguinal hernia, status-post repair, is manifested by, at worst, a left inguinal hernia which appeared operable, remediable, and readily reducible without the need for support by a truss or belt throughout the appeal period. 7. The record evidence shows that the Veteran's service-connected scar, status-post left inguinal hernia repair, is manifested by, at worst, a left inguinal scar measuring 4 cm x 0.5 centimeters (cm) which is not painful, unstable, due to burns, or with underlying tissue damage throughout the appeal period. 8. The record evidence shows that the Veteran served in combat in the southwest Asia theater of operations during the Persian Gulf War; thus, his in-service participation in a TERA is conceded. 9. The record evidence shows that the Veteran does not experience any current disability due to his claimed fatigue, right shoulder disability (claimed as right shoulder joint pain), or right wrist disability (claimed as right wrist joint pain) which is related to active service as due to his conceded in-service participation in a TERA. 10. The record evidence shows that the Veteran's current bilateral leg disability (claimed as bilateral leg joint pain), left shoulder disability (claimed as left shoulder joint pain), and left wrist disability (claimed as left wrist joint pain) are not related to active service as due to his conceded in-service participation in a TERA. 11. The record evidence shows that the Veteran's current muscle tension headaches are not related to active service or any incident of service, including as due to an undiagnosed illness or residuals of a neck injury. 12. The Veteran's original claim of service connection for seborrheic dermatitis was included in statements on a VA Form 21-526, "Veteran's Application For Compensation Or Pension," dated on December 4, 2017, and date-stamped as received on December 22, 2017, by VA. 13. In a rating decision dated on September 2, 1998, and issued to the Veteran and his former service representative on September 18, 1998, the Agency of Original Jurisdiction (AOJ) denied, in pertinent part, a claim of service connection for seborrheic dermatitis (characterized as seborrheic dermatitis, claimed as skin rash, as due to undiagnosed illness); this decision was not appealed and became final. 14. New and relevant evidence was not received after the September 1998 rating decision on the issue of entitlement to service connection for seborrheic dermatitis. 15. The Veteran's original claim of service connection for OSA was included in statements on a VA Form 21-526EZ, "Application For Disability Compensation And Related Benefits," dated on August 20, 2019, and date-stamped as received electronically that same day by VA. 16. In a rating decision dated on November 13, 2019, and issued to the Veteran and his service representative on November 14, 2019, the AOJ denied, in pertinent part, a claim of service connection for OSA; this decision was not appealed and became final. 17. New and relevant evidence was not received after the November 2019 rating decision on the issue of entitlement to service connection for OSA. CONCLUSIONS OF LAW 1. The criteria for an initial 30 percent rating prior to May 26, 2024, for sinusitis have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.96, 4.97, Diagnostic Code (DC) 6602. 2. The criteria for an initial 30 percent rating for GERD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.114, DC 7399-7346 (effective prior to May 19, 2024). 3. The criteria for an initial rating greater than 10 percent prior to May 26, 2024, for asthma have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.96, 4.97, DC 6602. 4. The criteria for an initial rating greater than 30 percent for allergic rhinitis have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.96, 4.97, DC 6522. 5. The criteria for a compensable disability rating for left inguinal hernia, status-post repair, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.114, DC 7338. 6. The criteria for an initial compensable rating for scar, status-post left inguinal hernia repair, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.118, DC 7802. 7. The criteria for service connection for fatigue as due to in-service exposure to as due to in-service participation in a TERA have not been met. 38 U.S.C. §§ 1110, 1117, 1118, 1119, 1120, 1131, 1168, 5103, 5103A, 5107; 38 C.F.R. §§ 3.303, 3.304. 8. The criteria for service connection for a right shoulder disability (claimed as right shoulder and arm joint pain) as due to in-service participation in a TERA have not been met. 38 U.S.C. §§ 1110, 1117, 1118, 1119, 1120, 1131, 1168, 5103, 5103A, 5107; 38 C.F.R. §§ 3.303, 3.304. 9. The criteria for service connection for a right wrist disability (claimed as right wrist joint pain) as due to in-service participation in a TERA have not been met. 38 U.S.C. §§ 1110, 1117, 1118, 1119, 1120, 1131, 1168, 5103, 5103A, 5107; 38 C.F.R. §§ 3.303, 3.304. 10. The criteria for service connection for a bilateral leg disability (claimed as bilateral leg joint pain) as due to in-service participation in a TERA have not been met. 38 U.S.C. §§ 1110, 1117, 1118, 1119, 1120, 1131, 1168, 5103, 5103A, 5107; 38 C.F.R. §§ 3.303, 3.304. 11. The criteria for service connection for a left shoulder disability (claimed as left shoulder and arm joint pain) as due to in-service participation in a TERA have not been met. 38 U.S.C. §§ 1110, 1117, 1118, 1119, 1120, 1131, 1168, 5103, 5103A, 5107; 38 C.F.R. §§ 3.303, 3.304. 12. The criteria for service connection for a left wrist disability (claimed as left wrist joint pain) as due to in-service participation in a TERA have not been met. 38 U.S.C. §§ 1110, 1117, 1118, 1119, 1120, 1131, 1168, 5103, 5103A, 5107; 38 C.F.R. §§ 3.303, 3.304. 13. The criteria for service connection for muscle tension headaches, including as due to an undiagnosed illness or residuals of a neck injury, have not been met. 38 U.S.C. §§ 1110, 1117, 1118, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.303, 3.304, 3.310, 3.317. 14. The criteria for readjudication of the claim of service connection for seborrheic dermatitis have not been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(d), 3.2501. 15. The criteria for readjudication of the claim of service connection for OSA have not been met. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(d), 3.2501. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active U.S. Army service from April 1989 to September 1996, including in combat in the southwest Asia theater of operations during the Persian Gulf War. This appeal has a complicated procedural history. In April 2022, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of claims of service connection for seborrheic dermatitis and for OSA most recently addressed in September 1998 and November 2019 rating decisions, respectively. He also filed multiple new claims for service connection and for increased ratings on this VA Form 20 0995. In January 2023, the AOJ issued the currently appealed supplemental claim decision which found, in pertinent part, that new and relevant evidence had not been received with respect to either of the previously adjudicated service connection claims for seborrheic dermatitis and for OSA. Therefore, the Board must determine whether new and relevant evidence has been received based only on the evidence of record at the time of the January 2023 AMA supplemental claim decision on appeal. The AOJ also granted, in pertinent part, service connection for scar, status-post left inguinal hernia repair, and assigned an initial zero percent rating effective April 27, 2022, and denied an increased rating claim for left inguinal hernia, status-post repair, in the January 2023 supplemental claim decision. In a supplemental claim decision issued in April 2023, the AOJ granted, in pertinent part, claims of service connection for GERD, assigning an initial 10 percent rating effective August 10, 2022, and for asthma, assigning an initial zero percent rating effective April 27, 2022. In a separate supplemental claim decision currently on appeal also issued in April 2023, the AOJ readjudicated a claim of service connection for muscle tension headaches, including as due to an undiagnosed illness or residuals of a neck injury, and denied this claim on the merits. In the currently appealed September 2023 AMA rating decision, the AOJ granted, in pertinent part, claims of service connection for sinusitis, assigning an initial 10 percent rating effective April 4, 2023, and for allergic rhinitis, assigning an initial 30 percent rating effective April 4, 2023, assigned an initial 10 percent rating effective April 4, 2023, for asthma, denied higher initial ratings for GERD and for scar, status-post left inguinal hernia repair, denied an increased (compensable) rating for left inguinal hernia, status-post repair, and denied claims of service connection for fatigue, a bilateral leg disability (claimed as bilateral leg joint pain), a bilateral shoulder disability (claimed as bilateral shoulder and arm joint pain), and for a bilateral wrist disability (claimed as bilateral wrist joint pain). In the October 2023 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket and identified the January, April, and September 2023 rating decisions as the rating decisions on appeal. Thus, the Board only may consider the evidence of record at the time of the January, April, or September 2023 AOJ decisions on appeal, respectively. 38 C.F.R. § 20.301. Any evidence submitted after these AOJ decisions on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. Evidence was added to the claims file during a period of time when new evidence was not allowed. As the Board is deciding the claims listed above, it may not consider this evidence in its decision. 38 C.F.R. § 20.300. If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, then he 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 claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. The Board notes that, in statements on his April 2022 VA Form 20 0995, the Veteran limited his currently appealed service connection claims for fatigue, a right shoulder disability, a right wrist disability, a bilateral leg disability, a left shoulder disability, and for a left wrist disability to consideration of whether his in-service participation in a TERA caused or contributed to any of these claimed disabilities. Thus, these service connection claims are characterized as stated above. The Board next notes that the Veteran expressed multiple generic areas of disagreement, including "service connection, effective date, disability evaluation" with respect to each of the claims listed on his October 2023 VA Form 10182. The Board notes in this regard that the Veteran could not disagree with service connection as a basis for his appeal for any claim where service connection already was in effect when he submitted his VA Form 10182 in October 2023. Given that the Veteran's areas of disagreement with the rating decisions on appeal were unclear due to their generic nature, his service representative submitted an appellate brief in December 2023 limiting the issues on appeal to the claims listed above. The Veteran subsequently refiled each of his currently appealed claims for increased ratings or higher initial ratings by submitting another VA Form 21 526EZ electronically to the AOJ in August 2024. In response, the AOJ issued a February 2025 rating decision which assigned, in pertinent part, a higher initial 50 percent rating effective May 26, 2024, for sinusitis, a higher initial 30 percent rating effective May 26, 2024, for asthma, and denied higher initial rating claims for GERD, allergic rhinitis, and for scar, status-post left inguinal hernia repair. This procedural history persuasively suggests to the Board that the Veteran seeks higher ratings for each of his service-connected disabilities. Having reviewed the record evidence, the Board finds that the claims on appeal should be characterized as stated above. Neither the Veteran nor his representative has raised any other issues nor have any other issues been reasonably raised by the record, to include entitlement to an additional disability rating, an extraschedular rating for a service-connected disability, service connection for another disability as secondary to a service-connected disability, or to a total disability rating based on individual unemployability (TDIU). See Doucette v. Shulkin, 28 Vet. App. 366, 369 370 (2017) (confirming that Board not required to address issues unless specifically raised by claimant or reasonably raised by record evidence). 1. Entitlement to an initial rating greater than 10 percent prior to May 26, 2024, for sinusitis The Board is persuaded that the evidence supports assigning an initial 30 percent rating prior to May 26, 2024, for the Veteran's service-connected sinusitis. He essentially contends that this disability is more disabling than currently and initially evaluated prior to May 26, 2024. The Board agrees. Consistent with his lay assertions, the record evidence shows that, prior to May 26, 2024, the service-connected sinusitis is manifested by, at worst, headaches, pain, purulent discharge, and 7 or more non-incapacitating episodes of sinusitis per year. These findings support assigning a higher initial 30 percent rating prior to May 26, 2024, for the Veteran's service-connected sinusitis under DC 6602. See 38 C.F.R. § 4.97, DC 6602. For example, on VA sinusitis DBQ in September 2023, the Veteran's complaints included daily sinus congestion, headaches, purulent nasal discharge, watery and itchy eyes, itchy and running nose, sneezing, and a scratchy throat. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. He used Flonase nasal spray and Zyrtec daily and Benadryl as needed for treatment. He reported trouble breathing and going to the emergency room the night before this examination. "He was treated with steroid injection, Benadryl and Zyrtec." The Veteran had maxillary sinusitis with daily episodes of sinusitis, daily headaches, pain of the affected sinus, tenderness of the affected sinus, daily purulent discharge, and bilateral ear pain. He had 7 or more non-incapacitating episodes of sinusitis characterized by headaches, pain, and purulent discharge in the previous 12 months. He had not had any incapacitating episodes of sinusitis requiring prolonged (4 to 6 weeks) antibiotic treatment in the previous 12 months. He had not had sinus surgery or radical sinus surgery. A computerized tomography (CT) scan of the Veteran's sinuses taken in April 2017 showed moderate to severe ethmoid sinus mucosal thickening and mild maxillary sinus mucosal thickening. The diagnoses included chronic sinusitis. Consistent with the Veteran's lay assertions, the record evidence shows that, prior to May 26, 2024, his service-connected sinusitis is manifested by, at worst, headaches, pain, purulent discharge, and 7 or more non-incapacitating episodes of sinusitis per year. These findings supports assigning a higher initial 30 percent rating prior to May 26, 2024, for the Veteran's service-connected sinusitis under DC 6602. Id. There is no indication that, prior to May 26, 2024, the Veteran had radical sinus surgery with chronic osteomyelitis or near constant sinusitis as is required for a maximum initial 50 percent rating under DC 6602. Id. The September 2023 VA sinusitis DBQ examiner specifically found that the Veteran had not had sinus surgery or radical sinus surgery. In summary, and after resolving any reasonable doubt in the Veteran's favor, the Board finds that the criteria for an initial 30 percent rating prior to May 26, 2024, for sinusitis have been met. 2. Entitlement to an initial rating greater than 10 percent for GERD The Board next is persuaded that the evidence supports assigning an initial 30 percent rating for the Veteran's service-connected GERD. He essentially contends that this disability is more disabling than currently and initially evaluated. The Board agrees. Consistent with his lay assertions, the record evidence shows that the service-connected GERD is manifested by, at worst, persistently recurrent epigastric distress, dysphagia, pyrosis, reflux, regurgitation, substernal and shoulder pain, 4 or more episodes of sleep disturbance and nausea per year lasting 10 days or more, and 2 episodes of vomiting per year lasting less than 1 day throughout the appeal period (i.e., since he filed his service connection claim for this disability). These findings support assigning a higher initial 30 percent rating for the Veteran's service-connected GERD under the former DC 7399-7346 throughout the appeal period. See 38 C.F.R. § 4.114, DC 7399-7346 (effective prior to May 19, 2024). The Board notes initially that, although the rating criteria for evaluating digestive system disabilities were revised during the appeal period, and although the revised rating criteria cannot be applied prior to their effective date, it will apply the version of the rating criteria which is more favorable to the Veteran. The record evidence shows that, on VA esophageal conditions DBQ in March 2023, the Veteran's complaints included daily symptoms "of dysphagia, heartburn, reflux, regurgitation, substernal chest pain and shoulder pain, sleep disturbance and nausea along with intermittent vomiting." The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran's treatment plan included taking TUMS as needed. He had persistently recurrent epigastric distress, dysphagia, pyrosis, reflux, regurgitation, substernal and shoulder pain, 4 or more episodes of sleep disturbance and nausea per year lasting 10 days or more, and 2 episodes of vomiting per year lasting less than 1 day. He did not have an esophageal stricture. The diagnosis was GERD. On VA esophageal conditions DBQ in September 2023, the Veteran's complaints included occasional chest pain, shortness of breath, and pyrosis due to his reflux. "He sleeps with his head elevated." The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran took Pepcid daily to treat his GERD which "has slightly helped." He had persistently recurrent epigastric distress, pyrosis, reflux, substernal pain, and 4 or more episodes of sleep disturbance and nausea per year lasting 1 day or less. He did not have an esophageal stricture. The diagnosis was GERD. Consistent with the Veteran's lay assertions, the record evidence shows that his service-connected GERD is manifested by, at worst, persistently recurrent epigastric distress, dysphagia, pyrosis, reflux, regurgitation, substernal and shoulder pain, 4 or more episodes of sleep disturbance and nausea per year lasting 10 days or more, and 2 episodes of vomiting per year lasting less than 1 day throughout the appeal period (i.e., since he filed his service connection claim for this disability). These findings support assigning a higher initial 30 percent rating for the Veteran's service-connected GERD under the former DC 7399-7346 throughout the appeal period. Id. The Board notes here that application of the revised rating criteria for evaluating digestive system disabilities would not result in a higher initial rating for the Veteran's service-connected GERD because the revised DC 7346 requires the presence of an esophageal stricture. See 89 Fed. Reg. 19743 44 (May 26, 2024) codified at 38 C.F.R. § 4.114, DC 7346 (effective May 26, 2024). VA examinations in March and September 2023 both found that the Veteran did not have an esophageal stricture. There is no indication that the Veteran experiences symptoms of similar frequency, severity, and duration as is required for an initial rating greater than 30 percent under the former DC 7346. See 38 C.F.R. § 4.114, DC 7346 (effective prior to May 26, 2024). For example, although VA examination in March 2023 noted that the Veteran had 2 episodes of vomiting per year lasting less than 1 day as a result of his service-connected GERD, there is no indication in the record evidence that this symptom (which is listed in the 50 percent criteria under the former DC 7346) is accompanied by material weight and hematemesis or melena with moderate anemia or other symptom combinations productive of considerable health impairment as is required for a maximum initial 50 percent rating under the former DC 7346. Id. And no episodes of vomiting were reported on subsequent VA examination in September 2023. Taken together, the record evidence as a whole supports assigning a higher initial 30 percent rating for the service-connected GERD under the former DC 7346 throughout the appeal period (i.e., since the Veteran filed his service connection claim for this disability). In summary, and after resolving any reasonable doubt in the Veteran's favor, the Board finds that the criteria for an initial 30 percent rating for GERD have been met. 3. Entitlement to an initial rating greater than 10 percent prior to May 26, 2024, for asthma The Board next is not persuaded that the evidence supports granting the Veteran's claim of entitlement to an initial rating greater than 10 percent prior to May 26, 2024, for asthma. The Veteran essentially contends that his service-connected asthma is more disabling than currently and initially evaluated. The Board disagrees. Contrary to his lay assertions, the record evidence shows that, prior to May 26, 2024, the service-connected asthma is manifested by, at worst, the intermittent use of inhalational bronchodilator therapy and less frequently than monthly visits to a physician for required care of exacerbations. These findings support the 10 percent rating currently and initially assigned prior to May 26, 2024, for the service-connected asthma under DC 6602. See 38 C.F.R. §§ 4.96, 4.97, DC 6602. For example, on VA respiratory conditions DBQ in March 2023, the Veteran's complaints included intermittent shortness of breath and chest tightness. He treated his asthma with an albuterol inhaler as needed. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran's respiratory condition did not require the use of oral or parenteral corticosteroid medications, inhaled medications, oral bronchodilators, antibiotics, or outpatient oxygen therapy for treatment. He had not had any asthma attacks with episodes of respiratory failure in the previous 12 months. He had not any physician visits for required care of exacerbations. Pulmonary function testing showed pre-bronchodilator FVC of 114 percent predicted value, FEV-1 of 95 percent of predicted value, and FEV-1/FVC of 84 percent of predicted value. The VA examiner stated that the Veteran's FEV-1 most accurately reflected the Veteran's level of disability. This examiner also stated that the Veteran gave "poor effort" on pulmonary function testing and post-bronchodilator testing could not be performed as a result. This examiner concluded that pulmonary function testing was not valid for VA purposes due to the Veteran's poor effort. The diagnosis was asthma. On VA respiratory conditions DBQ in September 2023, no complaints were noted. "Veteran reports [that] he was symptomatic with [shortness of breath] and chest tightness for years and got [diagnosed] with asthma starting around 1997. He uses an albuterol inhaler once a week." The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran's respiratory condition did not require the use of oral or parenteral corticosteroid medications, oral bronchodilators, antibiotics, or outpatient oxygen therapy for treatment. His respiratory condition required the use of inhaled medications or intermittent inhalational bronchodilator therapy. He had not had any asthma attacks with episodes of respiratory failure in the previous 12 months. He had less frequently than monthly physician visits for required care of exacerbations in the previous 12 months. Pulmonary function testing showed pre-bronchodilator FVC of 114 percent of predicted value, FEV-1 of 95 percent of predicted value, and FEV-1/FVC of 84 percent of predicted value. The VA examiner stated that the Veteran's FEV-1 most accurately reflected the Veteran's level of disability. This examiner also stated, "Pre-bronchodilator results are normal." The diagnosis was asthma. Contrary to the Veteran's lay assertions, the record evidence shows that, prior to May 26, 2024, his service-connected asthma is manifested by, at worst, the intermittent use of inhalational bronchodilator therapy and less frequently than monthly visits to a physician for required care of exacerbations. These findings support the 10 percent rating currently and initially assigned prior to May 26, 2024, for the service-connected asthma under DC 6602. Id. There is no indication that, prior to May 26, 2024, the Veteran's service-connected asthma requires at least daily inhalational or oral bronchodilator use or inhalational anti-inflammatory medication as is required for a higher initial 30 percent rating under DC 6602. Id. As noted on VA examination in September 2023, the service-connected asthma only required the intermittent use of inhalational bronchodilator therapy. In other words, the record evidence more nearly approximates the criteria for the initial 10 percent rating currently in effect prior to May 26, 2024, for the Veteran's service-connected asthma. The Veteran and his service representative otherwise have not identified or submitted any evidence demonstrating his entitlement to an initial rating greater than 10 percent prior to May 26, 2024, for his service-connected asthma. The evidence persuasively weighs against the claim. Therefore, the benefit of the doubt rule does not apply. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). In summary, the Board finds that the criteria for an initial rating greater than 10 percent prior to May 26, 2024, for asthma have not been met. 4. Entitlement to an initial rating greater than 30 percent for allergic rhinitis The Board next is not persuaded that the evidence supports granting the Veteran's claim of entitlement to an initial rating greater than 30 percent for allergic rhinitis. The Veteran essentially contends that this disability is more disabling than currently and initially evaluated. The Board disagrees. The Board notes initially that the Veteran currently is in receipt of the maximum schedular rating for his service-connected allergic rhinitis throughout the appeal period (i.e., since he filed his service connection claim for this disability). Contrary to the Veteran's lay assertions, the record evidence shows that his service-connected allergic rhinitis is manifested by, at worst, greater than 50 percent obstruction of the nasal passage on both sides, complete obstruction on the left side, permanent hypertrophy of the nasal turbinates, and nasal polyps. These findings support the 30 percent rating currently and initially assigned for the service-connected allergic rhinitis under DC 6522 throughout the appeal period (i.e., since he filed his service connection claim for this disability). See 38 C.F.R. §§ 4.96, 4.97, DC 6522. For example, on VA sinusitis DBQ in September 2023, the Veteran's complaints included daily sinus congestion, headaches, purulent nasal discharge, watery and itchy eyes, itchy and running nose, sneezing, and a scratchy throat. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran's allergic rhinitis symptoms were greater than 50 percent obstruction of the nasal passage on both sides, complete obstruction on the left side, permanent hypertrophy of the nasal turbinates, and nasal polyps. The Veteran did not have complete obstruction on the right side. He also did not have any granulomatous condition. A CT scan taken in April 2017 showed a left nasal cavity mass with a polyp being "the most likely etiology." The Veteran's allergic rhinitis did not interfere with his ability to work. The diagnoses included rhinitis. Contrary to the Veteran's lay assertions, the record evidence shows that his service-connected allergic rhinitis is manifested by, at worst, greater than 50 percent obstruction of the nasal passage on both sides, complete obstruction on the left side, permanent hypertrophy of the nasal turbinates, and nasal polyps. These findings support the 30 percent rating currently and initially assigned for the service-connected allergic rhinitis under DC 6522 throughout the appeal period (i.e., since he filed his service connection claim for this disability). Id. The Board again notes that the Veteran currently is in receipt of the maximum schedular rating for his service-connected allergic rhinitis throughout the appeal period. He does not contend - and the record evidence does not show - that the maximum 50 percent schedular rating currently and initially assigned for his service-connected allergic rhinitis throughout the appeal period does not compensate him adequately for the disability which experiences throughout the appeal period. The September 2023 VA sinusitis DBQ examiner specifically found that the Veteran's allergic rhinitis did not impact his ability to work. In other words, the Board finds that the maximum 30 percent rating assigned for the service-connected allergic rhinitis throughout the appeal period adequately compensates him for the impairment he experiences in his earning capacity as a result of this disability. The Veteran and his service representative otherwise have not identified or submitted any evidence demonstrating his entitlement to an initial rating greater than 30 percent for his service-connected allergic rhinitis. The evidence persuasively weighs against the claim. Therefore, the benefit of the doubt rule does not apply. See Lynch, 21 F.4th at 776. In summary, the Board finds that the criteria for an initial rating greater than 30 percent for allergic rhinitis have not been met. 5. Entitlement to a compensable disability rating for left inguinal hernia, status-post repair The Board next is not persuaded that the evidence supports assigning a compensable disability rating for left inguinal hernia, status-post repair. The Veteran essentially contends that his service-connected left inguinal hernia, status-post repair, is more disabling than currently evaluated. The Board disagrees. Contrary to the Veteran's lay assertions, the record evidence shows that his service-connected left inguinal hernia, status-post repair, is manifested by, at worst, a left inguinal hernia which appeared operable, remediable, and readily reducible without the need for support by a truss or belt throughout the appeal period. These findings support the zero percent (non-compensable) rating assigned for the service-connected left inguinal hernia, status-post repair under either the former or revised DC 7338. See 38 C.F.R. § 4.114, DC 7338. The Board notes initially that it is undisputed that the Veteran had left inguinal hernia surgical repair in 1995 during active service. On VA hernias DBQ in September 2022, the Veteran's complaints included "pains and burning sensation from the hernia repair," trouble sleeping, "good days and bad days, and the bad days are outweighing the good days. His condition is interfering with his daily activities. He has trouble walking at times and dealing with a burning and tingling pain." The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran's left inguinal hernia surgical repair in 1995 was noted. He also postoperative recurrent left inguinal hernia which appeared operable and remediable. Physical examination showed a small left inguinal hernia which was readily reducible with no indication for support by a truss or belt, and a scar in the left inguinal region measuring 3 centimeters (cm) x 0.5 cm which was not painful or unstable. The VA examiner stated that the Veteran's hernia condition impacted his ability to work. "Recurrent hernia is symptomatic at times. Occasionally the pain becomes severe enough that he cannot stand or walk, and he has to miss work." The diagnosis was inguinal hernia. On VA hernias DBQ in November 2022, the Veteran's complaints included continued pain in the left groin with "lifting and tugging." The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran's left inguinal hernia surgical repair in 1995 was noted. Physical examination showed no true hernia protrusion on the left side, no indication for support by a truss or belt, and a left inguinal hernia repair scar in the left groin measuring 5 cm x 1 cm. The VA examiner stated that the Veteran's hernia condition impacted his ability to work. "Limited productivity and efficiency due to limited mobility and pain in groin." The diagnoses were inguinal hernia and left inguinal hernia repair. On VA hernias DBQ in January 2023, the Veteran's complaints included "occasional sharp left groin pain while bending over. The Veteran denies seeking medical attention for concerns and denies medications and use of assistive device." The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran's left inguinal hernia surgical repair in 1995 was noted. Physical examination showed no true hernia protrusion on the left side, no indication for support by a truss or belt, and a scar in the left inguinal region measuring 4 cm x 0.5 cm. The VA examiner stated that the Veteran's hernia condition impacted his ability to work. "The Veteran has difficulty performing occupational tasks involving heavy lifting due to inguinal hernia, left, status post repair." The diagnosis was left inguinal hernia, status-post repair. On VA hernias DBQ in September 2023, the Veteran's complaints included "some recent increased discomfort." The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran's left inguinal hernia surgical repair in 1995 was noted. Physical examination showed no hernia detected on the left side, no indication for support by a truss or belt, and a left inguinal scar measuring 4 cm x 0.5 cm. The VA examiner stated that the Veteran's hernia condition did not impact his ability to work. The diagnosis was inguinal hernia. Contrary to the Veteran's lay assertions, the record evidence shows that his service-connected left inguinal hernia, status-post repair, is manifested by, at worst, a left inguinal hernia which appeared operable, remediable, and readily reducible without the need for support by a truss or belt throughout the appeal period. These findings support the zero percent (non-compensable) rating assigned for the service-connected left inguinal hernia, status-post repair under either the former or revised DC 7338. Id. The former DC 7338 provides a minimum compensable 10 percent rating for a postoperative recurrent inguinal hernia which was readily reducible and well supported by a truss or belt. See 38 C.F.R. § 4.114, DC 7338 (effective prior to May 19, 2024). The revised DC 7338 provides a minimum compensable 10 percent rating for an irreparable hernia (new or recurrent) present for 12 months or more with hernia size smaller than 3 cm. See 38 C.F.R. § 4.114, DC 7338 (effective May 19, 2024). Here, although the Board acknowledges that VA hernias DBQ in September 2022 found a postoperative left inguinal hernia which was readily reducible, there was no indication for support by a truss or belt. Subsequent VA hernias DBQs in November 2022 and in January 2023 found no true hernia protrusion on the left side and no indication for support by a truss or belt. The Veteran's most recent VA hernias DBQ in September 2023 showed no hernia detected on the left side and no indication for support by a truss or belt. Taken together, the record evidence as a whole shows that the symptomatology attributable to the Veteran's service-connected left inguinal hernia, status-post repair, more nearly approximates the criteria for a zero percent (non-compensable) rating under either the former or revised rating criteria throughout the appeal period. The Veteran and his service representative otherwise have not identified or submitted any evidence demonstrating his entitlement to a compensable disability rating for his service-connected left inguinal hernia, status-post repair. The evidence persuasively weighs against the claim. Therefore, the benefit of the doubt rule does not apply. See Lynch, 21 F.4th at 776. In summary, the Board finds that the criteria for a compensable disability rating for left inguinal hernia, status-post repair, have not been met. 6. Entitlement to an initial compensable rating for scar, status-post left inguinal hernia repair The Board next is not persuaded that the evidence supports assigning an initial compensable rating for the Veteran's service-connected scar, status-post left inguinal hernia repair. He essentially contends that his post-surgical left inguinal hernia repair scar is more disabling than currently and initially evaluated. The Board disagrees. Contrary to the Veteran's lay assertions, the record evidence shows that his service-connected scar, status-post left inguinal hernia repair, is manifested by, at worst, a left inguinal scar measuring 4 cm x 0.5 cm which is not painful, unstable, due to burns, or with underlying tissue damage throughout the appeal period. These findings support the zero percent (non-compensable) rating currently and initially assigned for the service-connected scar, status-post left inguinal hernia repair, under DC 7802 throughout the appeal period. See 38 C.F.R. § 4.118, DC 7802. For example, on VA scars DBQ in September 2023, no relevant complaints were noted. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. Physical examination showed a left inguinal scar measuring 4 cm x 0.5 cm which was not painful, unstable, due to burns, or with underlying tissue damage. There was no limitation of function associated with this scar. This scar did not impact the Veteran's ability to work. The diagnoses included left inguinal scar. Contrary to the Veteran's lay assertions, the record evidence shows that his service-connected scar, left inguinal hernia repair, is manifested by, at worst, a left inguinal scar measuring 4 cm x 0.5 cm which is not painful, unstable, due to burns, or with underlying tissue damage throughout the appeal period. These findings support the zero percent (non-compensable) rating currently and initially assigned for this disability under DC 7802 throughout the appeal period. Id. The Board notes that a minimum compensable 10 percent rating is warranted under DC 7802 for a scar which is 144 square inches (929 square centimeters) or greater. Id. Here, VA scars DBQ in September 2023 showed that the Veteran's left inguinal scar measured 4 cm x 0.5 cm for a total area of 2 square cm. The Veteran also is in receipt of a separate compensable 10 percent rating effective May 26, 2024, for painful scars, status-post left inguinal hernia repair. The Board cannot compensate the Veteran twice for any pain which he experiences as a result of his post-left inguinal hernia repair scar without violating the express prohibition against pyramiding found in the Rating Schedule. See 38 C.F.R. § 4.14; see also Esteban v. Brown, 6 Vet. App. 259, 261 62 (1994). Taken together, the record evidence as a whole supports the zero percent (non-compensable) rating currently and initially assigned for the service-connected scar, left inguinal hernia repair, throughout the appeal period because the symptomatology attributable to this disability more nearly approximates the regulatory criteria for a zero percent rating under DC 7802. See 38 C.F.R. § 4.118, DC 7802. The Veteran and his service representative otherwise have not identified or submitted any evidence demonstrating his entitlement to an initial compensable rating for his service-connected scar, left inguinal hernia repair. The evidence persuasively weighs against the claim. Therefore, the benefit of the doubt rule does not apply. See Lynch, 21 F.4th at 776. In summary, the Board finds that the criteria for an initial compensable rating for a scar, left inguinal hernia repair, have not been met. 7. Entitlement to service connection for fatigue, a right shoulder disability, and for a right wrist disability, each as due to in-service participation in a TERA The Board next is not persuaded that the evidence supports granting the Veteran's claims of service connection for fatigue, a right shoulder disability, and for a right wrist disability, each as due to in-service participation in a TERA. As noted in the Introduction, the Veteran essentially contends that his conceded in-service participation in a TERA while in combat the southwest Asia theater of operations during the Persian Gulf War caused or contributed to his claimed fatigue, right shoulder disability (which he characterized as right shoulder and arm joint pain), and right wrist disability (which he characterized as right wrist joint pain). The Board disagrees. Contrary to the Veteran's lay assertions, the record evidence shows that he does not experience any current disability due to any of these claimed disabilities which is related to active service as due to his conceded in-service participation in a TERA. Because the Veteran limited this appeal for service connection to consideration of whether his conceded in-service participation in a TERA caused or contributed to each of these claimed disabilities, the Board's review will be limited to this theory of entitlement. The Board notes initially that it is bound by any favorable findings made by the AOJ under the AMA in the absence of CUE. The AOJ made the same favorable finding for each of these claims when it conceded the Veteran's in-service participation in a TERA. The record evidence also does not support granting service connection for fatigue, a right shoulder disability, and for a right wrist disability, each as due to in-service participation in a TERA. It shows instead that the Veteran does not experience any current disability due to any of these claimed disabilities which is related to active service as due to his conceded in-service participation in a TERA. For example, on VA chronic fatigue syndrome Disability Benefits Questionnaire (DBQ) in January 2023, the Veteran's complaints included "low energy off and on. He states [that] he currently remains physically active. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran stated that his fatigue began in 2009 and "he sought medical attention for gradually decreased energy and sluggishness....He states he was prescribed an antidepressant and was instructed to consume more red meat and to remain physically active." Continuous medication was not required for control of chronic fatigue syndrome. Other clinical conditions that may produce similar symptoms were excluded by history, physical examination and/or laboratory tests to the extent possible. The Veteran did not now have and had not had any findings, signs and symptoms attributable to chronic fatigue syndrome. The VA examiner stated, "The Veteran does not meet the VA criteria for Chronic Fatigue Syndrome diagnosis." This examiner also stated, "There is no objective medical evidence to support the Veteran's claim of chronic fatigue syndrome." On VA wrist conditions DBQ in January 2023, no relevant complaints were noted. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. This examiner stated, "The Veteran sought medical attention for left wrist pain after falling onto the left wrist during active service." This examiner also stated, "The Veteran reports continued left wrist pain which causes difficulty with carrying and holding heavy items. He states [that] he takes Aleve as needed." Range of motion testing of the right wrist showed a full range of motion without pain actively and passively. On VA wrist conditions DBQ in September 2023, the VA examiner stated that the Veteran "denies any right wrist symptoms." The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran denied any flare-ups of right wrist pain. Range of motion testing of the right wrist was normal. The VA examiner concluded that there was no diagnosis of a right wrist disability "because there are no findings, signs and or symptoms to support a diagnosis." On VA shoulder and arm conditions DBQ in September 2023, the Veteran's complaints included constant right shoulder pain since 2017 which worsened at night. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. Range of motion testing of the right shoulder was normal. The VA examiner stated that there was no diagnosis of right arm joint pain or right shoulder joint pain "because there are no findings, signs and or symptoms to support a diagnosis" for either of these claimed disabilities. On VA chronic fatigue syndrome DBQ in September 2023, the Veteran's complaints included "onset of fatigue over the past year. He thinks it is related to insomnia, anxiety and moodiness. He feels tiredness all the time." The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. Continuous medication was not required for treatment of chronic fatigue syndrome. The Veteran did not now have and had not had any findings, signs, or symptoms attributable to chronic fatigue syndrome. The VA examiner concluded, "For the...claimed condition of fatigue there is no diagnosis because there are no findings, signs and or symptoms to support a diagnosis." This examiner also concluded that the Veteran did not currently have chronic fatigue syndrome. In multiple medical nexus opinions dated later in September 2023, the VA examiner who conducted the wrist conditions DBQ and shoulder and arm conditions DBQ opined that it is less likely than not that the Veteran's claimed fatigue, right shoulder disability, and right wrist disability are related to his in-service participation in a TERA, after considering the total potential exposure through all of the Veteran's applicable military deployments and the synergistic combined effect of all of the Veteran's TERAs. This physician also opined that it is less likely than not that the Veteran's claimed right arm joint pain is related to his in-service participation in a TERA, after considering the total potential exposure through all of the Veteran's applicable military deployments and the synergistic combined effect of all of the Veteran's TERAs. The rationale for each of these opinions was based on a review of the claims file. The rationale for each of these opinions also was, "There is no pathology to warrant a diagnosis or condition that can be related to the claimed toxic exposure." It is undisputed that the Veteran participated in an in-service TERA. The record evidence shows that he does not experience any current disability due to his claimed fatigue, right shoulder disability, or right wrist disability which is related to active service as due to his in-service participation in a TERA. The January 2023 VA chronic fatigue syndrome DBQ examiner found that the Veteran's complaints of fatigue did not meet the VA definition of chronic fatigue syndrome (or fatigue). This examiner also found that there was "no objective medical evidence to support the Veteran's claim of chronic fatigue syndrome." A different VA examiner subsequently concluded in September 2023 that "there are no findings, signs and or symptoms to support a diagnosis" of a right shoulder disability (which the Veteran also characterized as right arm joint pain) or a right wrist disability (which the Veteran also characterized as right wrist joint pain). This same VA examiner also opined in September 2023 that it is less likely than not that the Veteran's claimed fatigue, right shoulder disability, and right wrist disability are related to active service as due to his in-service participation in a TERA. All of these opinions were fully supported. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (finding that a medical opinion "must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). A service connection claim must be accompanied by evidence which establishes that the claimant currently has a disability. Rabideau v. Derwinski, 2 Vet. App. 141, 144 (1992); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). Service connection is not warranted in the absence of proof of current disability. The Board has considered whether the Veteran experienced fatigue, a right shoulder disability (which he also characterized as right arm joint pain), or a right wrist disability (which he also characterized as right wrist joint pain) at any time during the pendency of this appeal. Service connection may be granted if there is a disability at some point during the claim even if it later resolves or becomes asymptomatic. McClain v. Nicholson, 21 Vet. App. 319 (2007). In Romanowsky v. Shinseki, 26 Vet. App. 289 (2013), the Court held that, when the record evidence contains a recent diagnosis of disability prior to a claimant filing a claim for benefits based on that disability, the report of diagnosis is relevant evidence which the Board must address in determining whether a current disability existed at the time the claim was filed or during the pendency of a claim. Here, there is no evidence - other than the Veteran's unsupported lay assertions - that he was diagnosed as having fatigue, a right shoulder disability (also characterized as right arm joint pain), or a right wrist disability (also characterized as right wrist joint pain) contemporaneously to when he filed his service connection claims for these disabilities in April 2022 such that the Board must address whether a current disability existed at that time or during the pendency of this appeal under Romanowsky. See Romanowsky, 26 Vet. App. at 289. The Veteran and his service representative otherwise have not identified or submitted any evidence demonstrating his entitlement to service connection for fatigue, a right shoulder disability, or a right wrist disability, each as due to in-service participation in a TERA. The evidence persuasively weighs against the claims. Therefore, the benefit of the doubt rule does not apply. See Lynch, 21 F.4th at 776. In summary, the Board finds that service connection for fatigue, a right shoulder disability, and for a right wrist disability, each as due to in-service participation in a TERA, is not warranted. 8. Entitlement to service connection for a bilateral leg disability (claimed as bilateral leg joint pain), a left shoulder disability, and for a left wrist disability, each as due to in-service participation in a TERA The Board next is not persuaded that the evidence supports granting the Veteran's claims of service connection for a bilateral leg disability (claimed as bilateral leg joint pain), a left shoulder disability (which he characterized as left shoulder and arm joint pain), and for a left wrist disability (which he characterized as left wrist joint pain), each as due to in-service participation in a TERA. The Veteran essentially contends that his conceded in-service participation in a TERA while in combat in the southwest Asia theater of operations during the Persian Gulf War caused or contributed to each of these disabilities. The Board disagrees. Contrary to the Veteran's lay assertions, the record evidence shows that his current bilateral leg disability, left shoulder disability, and left wrist disability are not related to active service as due to his conceded in-service participation in a TERA. As with the other service connection claims adjudicated above, the Veteran limited his appeal for service connection to consideration of whether his conceded in-service participation in a TERA caused or contributed to his current bilateral leg disability, left shoulder disability, and left wrist disability. Thus, the Board's review will be limited to consideration of this theory of entitlement. The Board notes initially that it is bound by any favorable findings made by the AOJ under the AMA in the absence of CUE. The AOJ made the same favorable finding for each of these claims when it conceded the Veteran's in-service participation in a TERA. The record evidence also does not support granting service connection for a bilateral leg disability, a left shoulder disability, and for a left wrist disability, each as due to in-service participation in a TERA. It shows instead that each of these current disabilities is not related to active service as due to the Veteran's conceded in-service participation in a TERA. For example, on VA wrist conditions DBQ in January 2023, the Veteran's complaints included "continued left wrist pain which causes difficulty with carrying and holding heavy items. He states [that] he takes Aleve as needed." The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. Physical examination of the left wrist showed an abnormal range of motion which did not contribute to functional loss actively and passively with dorsiflexion to 60 degrees, palmar flexion to 55 degrees, ulnar deviation to 35 degrees, and radial deviation to 15 degrees, and pain significantly limiting functional ability on repeated use over time. The VA examiner stated, "The Veteran has difficulty performing occupational tasks involving carrying and holding heavy items due to left wrist sprain." The diagnosis was chronic left wrist sprain. On VA shoulder and arm conditions DBQ in September 2023, the Veteran's complaints included constant right shoulder pain since 2017 which worsened at night. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. He reported incurring a left rotator cuff tear in 2006 while offloading a truck and undergoing immediate surgical repair. Range of motion testing of the left shoulder was normal actively and passively with pain on flexion and abduction. Physical examination of the left shoulder showed pain on active and passive motion not resulting in or causing functional loss, and mild tenderness to palpation in the subacromial space. The VA examiner stated, "For the...claimed condition of joint pain, left arm there is no diagnosis because there are no findings, signs and or symptoms to support a diagnosis." The diagnosis was left rotator cuff tear. On VA wrist conditions DBQ in September 2023, no relevant complaints were noted. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran stated that he fell and fractured his left wrist during active service. The VA examiner stated, "He has been told he has a fracture and fusion is recommended but he has refused. There are no records confirming left wrist fracture." The Veteran reported flare-ups of left wrist pain 3 times a week which were mild to moderate in intensity, lasted for hours, and did not result in functional impairment. He described his functional loss or impairment of the left wrist as "[d]ifficulty with heavy lifting on the left and prolonged grip." Physical examination of the left wrist showed an abnormal range of motion actively and passively with dorsiflexion to 60 degrees, palmar flexion to 80 degrees, ulnar deviation to 45 degrees, and radial deviation to 20 degrees with pain on dorsiflexion, pain on active and passive motion not resulting in or causing functional loss, mild tenderness to palpation on the dorsal wrist, and no additional limitation of motion on repetitive testing. The diagnosis was chronic left wrist sprain. On VA knee and lower leg DBQ in September 2023, the Veteran's complaints included bilateral joint pain beginning earlier in the year. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. This examiner stated, "He denies trauma. He has some popping. He has not been seen or evaluated. He takes no medications." He denied flare-ups of bilateral knee pain. He described his functional impairment as "[d]ifficulty squatting." He also denied any history of instability or recurrent subluxation or history of frequent effusion of the knees. Range of motion testing of the bilateral knees was normal. Physical examination of the bilateral knees showed mild tenderness to palpation in the inferior patellae, and normal joint stability. The diagnosis was bilateral knee strain. In multiple medical nexus opinions dated later in September 2023, the VA examiner who conducted the wrist conditions DBQ and the knee and lower leg DBQ opined that the Veteran's current bilateral leg disability (characterized as bilateral knee strain), left shoulder disability (which was diagnosed as left shoulder rotator cuff tear), and left wrist disability were not related to active service as due to his conceded in-service participation in a TERA, after considering the total potential exposure through all of the Veteran's applicable military deployments and the synergistic combined effect of all of the Veteran's TERAs. The rationale for each of these opinions was based on a review of the claims file. With respect to the current bilateral leg disability (characterized as bilateral knee strain), the rationale also was "there is no medical or scientific evidence available that provides any indication of a relationship between the development of the condition(s) at issue and the TERA. Toxin exposure cannot [p]hysically cause knee pathology." With respect to the current left shoulder disability, the rationale also was that this disability (diagnosed as left shoulder rotator cuff tear) "was caused by work related trauma in 2006. There is no association between military [service] and his work injury." With respect to the current left wrist disability, the rationale also was "[the] Veteran had a traumatic work injury in 2006 causing a left wrist injury." It again is undisputed that the Veteran participated in an in-service TERA while in combat in the southwest Asia theater of operations during the Persian Gulf War. Nevertheless, contrary to his lay assertions, the record evidence shows that his current bilateral leg disability (diagnosed as bilateral knee strain), left shoulder disability (diagnosed as left rotator cuff tear), and left wrist disability (diagnosed as chronic left wrist sprain) are not related to active service as due to his conceded in-service participation in a TERA. The VA examiner specifically opined in multiple medical nexus opinions dated in September 2023 that it is less likely than not that each of these disabilities is related to active service as due to the Veteran's conceded in-service participation in a TERA. All of these opinions were fully supported. See Stefl, 21 Vet. App. at 124. The Veteran and his service representative otherwise have not identified or submitted any evidence demonstrating his entitlement to service connection for a bilateral leg disability, a left shoulder disability, and for a left wrist disability, each as due to in-service participation in a TERA. The evidence persuasively weighs against the claims. Therefore, the benefit of the doubt rule does not apply. See Lynch, 21 F.4th at 776. In summary, the Board finds that service connection for a bilateral leg disability, a left shoulder disability, and for a left wrist disability, each as due to in-service participation in a TERA, is not warranted. 9. Entitlement to service connection for muscle tension headaches, including as due to an undiagnosed illness or residuals of a neck injury The Board next is not persuaded that the evidence supports granting the Veteran's claim of service connection for muscle tension headaches, including as due to an undiagnosed illness or residuals of a neck injury. The Veteran essentially contends that he incurred his current muscle tension headaches during active service, including as due to an undiagnosed illness initially experienced while in combat in the southwest Asia theater of operations during the Persian Gulf War, and experienced continuous post-service disability. He alternatively contends that he incurred residuals of a neck injury during active service which caused or contributed to his current muscle tension headaches. However, the record evidence shows that his current muscle tension headaches are not related to active service or any incident of service, including as due to an undiagnosed illness or residuals of a neck injury. The Board notes initially that service connection is not in effect for residuals of a neck injury. The Board also notes initially that the available service treatment records show that he denied any relevant pre-service medical history at his enlistment physical examination in March 1989 prior to his entry onto active service in April 1989 when clinical evaluation was normal. On outpatient treatment in September 1989, the Veteran complained of "pain when moving [his] neck." He had a full range of motion. His pain was on the right side of his neck running down to his waist. Objective examination showed tenderness in the right scapula muscle and a full range of motion in the neck. The Veteran denied any relevant in-service medical history at his separation physical examination in September 1996 when clinical evaluation again was normal. The Board notes that the absence of contemporaneous records does not preclude granting service connection for a claimed disability. See, for example, Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (no authority prohibits the Board's sensible inference that there should be some corroborative record of an injury officially reported or medical treatment actually received); Barr v. Nicholson, 21 Vet. App. 303 (2007) ("Board may not reject as not credible any uncorroborated statements merely because the contemporaneous medical evidence is silent as to complaints or treatment for the relevant condition or symptoms"); see also 38 C.F.R. § 3.303(d) ("Service connection may 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.") The post-service evidence also does not support granting service connection for muscle tension headaches, including as due to an undiagnosed illness or residuals of a neck injury. It shows instead that the Veteran's current muscle tension headaches are not related to active service or any incident of service. For example, on VA headaches DBQ in January 2023, the Veteran's complaints included twice weekly headaches "within bilateral temples" while at rest "and 'sitting and doing nothing.'" He took Aleve as needed for his headache pain. The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. The Veteran experienced pulsating or throbbing head pain and pain on both sides of his head. His typical head pain lasted less than 1 day and was located on both sides of his head. The VA examiner opined that it is less likely than not that the Veteran's current tension headaches are related directly to active service. The rationale for this opinion was based on a review of the claims file. The rationale also was that the Veteran's current headaches was not related to his reported in-service headaches. The VA examiner next opined that the Veteran's diagnosis of tension headaches was a disease with a clear and specific etiology and diagnosis. The rationale for this opinion was based on a review of the claims file. The rationale also was: Tension headaches occur when neck and scalp muscles become tense or contract. The muscle contractions can be a response to stress, depression, head injury, or anxiety. Additional tension headache triggers include alcohol use, caffeine, colds, flu, sinus infection, eye strain, excessive smoking, dental problems, fatigue, and overexertion....Therefore, it is less likely than not that the tension headaches are related to exposure events in-service in the [southwest] Asia[] theater [of operations]." The diagnosis was tension headaches. On VA headaches DBQ in March 2023, the Veteran's complaints included "continued pain to the [right] or [left] frontal region of the head, lasting [around] 2 hours and occurring every other day." The VA examiner reviewed the Veteran's electronic claims file, including service treatment records and post-service VA treatment records. He took Aleve and Tylenol as needed for his headache pain. He experienced pulsating or throbbing head pain which worsened with physical activity. He also experienced nausea and sensitivity to light. His typical head pain lasted less than 1 day. The diagnosis was tension headaches. The Veteran's voluminous post-service VA outpatient treatment records show that he reported to the emergency room (ER) at a VA Medical Center in April 2023 complaining of increased neck pain and headaches after he fell off of a ladder twice 3 4 days earlier. He reported that he landed on the back of his head and his neck when he fell off of the ladder. He denied any loss of consciousness. He "ambulated to triage with [a] steady gait, [was] alert and oriented to communication" and was not in any acute distress. His vital signs were stable. He rated his acute pain as 8/10 on a pain scale (with 10/10 being the worst imaginable pain). He felt pain in his neck, back, and right shoulder. Physical examination showed he was alert, oriented, in no acute distress, a supple neck, pupils equal, round, and reactive to light and accommodation, extraocular movements intact, a regular heart rate and rhythm, clear lungs to auscultation bilaterally, no neck tenderness, minimal midline cervical tenderness at C5 6, a restricted range of motion in the neck, no midline lumbar tenderness, no paravertebral muscle tenderness in the cervical or lumbar spine, a full range of motion in the back, deep tendon reflexes intact and symmetrical bilaterally, negative straight leg raising bilaterally, 5/5 strength of the bilateral lower extremities, no swelling, erythema, heat, or tenderness in the right shoulder, "[n]o laxity at any joint," and a full range of motion in the right shoulder. X-rays of the cervical spine and right shoulder showed no fractures. The assessment included neck pain. He was given pain medication and discharged home. It is undisputed that the Veteran served in combat in the southwest Asia theater of operations during the Persian Gulf War. It also is undisputed that service connection currently is not in effect for residuals of a neck injury. Contrary to the Veteran's lay assertions, the record evidence shows that his current muscle tension headaches are not related to active service or any incident of service, including as due to an undiagnosed illness initially incurred while in combat in the southwest Asia theater of operations during the Persian Gulf War or residuals of a neck injury. The January 2023 VA headaches DBQ examiner specifically opined that the Veteran's diagnosis of tension headaches was a disease with a clear and specific etiology and diagnosis and not an undiagnosed illness or medically unexplained chronic multi-symptom illness (MUCMI) initially incurred while in combat in the southwest Asia theater of operations during the Persian Gulf War. This examiner also opined that it is less likely than not that the Veteran's current tension headaches are related directly to active service. These opinions were fully supported. See Stefl, 21 Vet. App. at 124. The Veteran and his service representative otherwise have not identified or submitted any evidence demonstrating his entitlement to service connection for muscle tension headaches, including as due to an undiagnosed illness or residuals of a neck injury. The evidence persuasively weighs against the claim. Therefore, the benefit of the doubt rule does not apply. See Lynch , 21 F.4th at 776. In summary, the Board finds that service connection for muscle tension headaches, including as due to an undiagnosed illness or residuals of a neck injury, is not warranted. 10. Whether new and relevant evidence has been received to readjudicate claims of service connection for seborrheic dermatitis and for OSA The Board finally finds that readjudication of the claims of service connection for seborrheic dermatitis and for OSA is not warranted. The Veteran essentially contends that his conceded in-service participation in a TERA caused or contributed to his claimed seborrheic dermatitis and OSA. He also contends that new and relevant evidence has been received sufficient to readjudicate each of these claims. Under the AMA, VA will readjudicate a claim if new and relevant evidence is presented or secured. 38 U.S.C. § 5108; 38 C.F.R. §§ 3.156(d), 3.2501. "Relevant evidence" is evidence that tends to prove or disprove a matter in issue. 38 C.F.R. §§ 3.156(d), 3.2501. The question in this case is whether the Veteran submitted evidence after the prior final denial of his claim of service connection for seborrheic dermatitis in September 1998 and his claim of service connection for OSA in November 2019, respectively, and, if so, whether that evidence is new and relevant to either of these claims. The Board again notes that it is bound by any favorable findings made by the AOJ under the AMA in the absence of CUE. The AOJ made the same favorable findings for each of these claims in the currently appealed rating decision issued in January 2023: (1) the Veteran had sufficient service to meet the minimum requirements for presumptive service connection; and (2) he served in southwest Asia from December 27, 1990, to July 8, 1991. New evidence is defined in the regulations governing supplemental claims filed under the AMA as "evidence not previously part of the actual record before agency adjudicators." Relevant evidence is defined as "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." See 38 C.F.R. § 3.2501(a). It is undisputed that, in order to readjudicate a supplemental claim filed under the AMA, the evidence received must be new and relevant. Id. (emphasis added.) It also is undisputed that the most recent final denial of the Veteran's service connection claim for seborrheic dermatitis occurred in the September 1998 rating decision. The AOJ essentially concluded in that decision that, although the Veteran had active service in southwest Asia during an applicable presumptive period, seborrheic dermatitis was not shown during active service and there was no medical nexus between the claimed seborrheic dermatitis and service. Thus, the claim was denied. It further is undisputed that the most recent final denial of his service connection claim for OSA occurred in the November 2019 rating decision. The AOJ essentially concluded in that decision that, although the Veteran had active service in southwest Asia during an applicable presumptive period, OSA was not shown during or after active service and there was no evidence of current disability due to the claimed OSA which was related to service. Thus, the claim was denied. In the currently appealed rating decision issued in January 2023, the AOJ essentially found that new and relevant evidence had not been received sufficient to readjudicate the previously denied service connection claims for seborrheic dermatitis and for OSA. The AOJ again concluded that, although the Veteran served in the southwest Asia theater of operations during the Persian Gulf War, the record evidence did not show a diagnosis of either seborrheic dermatitis or OSA during or after active service. Thus, the claims were not readjudicated. This appeal followed. The Board does not dispute that new evidence has been received since the September 1998 rating decision, which denied service connection for seborrheic dermatitis, and the November 2019 rating decision, which denied service connection for OSA. This evidence consists of the Veteran's April 2022 VA Form 20 0995, lay statements from him, and additional VA outpatient treatment records. This evidence clearly is "evidence not previously part of the actual record before agency adjudicators" when the claims were adjudicated in the most recent denials in September 1998 and November 2019, respectively. The Board also finds that the new evidence received since the prior rating decisions issued in September 1998 and November 2019 is not relevant to the issues of whether readjudication of the service connection claims for seborrheic dermatitis or for OSA, respectively, is warranted. In this case, the new evidence received since September 1998 and November 2019, respectively, is not relevant because it is not "information that tends to prove or disprove a matter at issue in a claim." Here, the AOJ previously conceded that he served in the southwest Asia theater of operations during an applicable presumptive period in both the September 1998 and November 2019 rating decisions. More importantly, he did not present any evidence to support his theory that he incurred seborrheic dermatitis and OSA during active service and experiences current disability due to either of these claimed disabilities which is related to active service or any incident of service, including as due to his conceded in-service participation in a TERA. As the AOJ concluded in the currently appealed January 2023 rating decision, there is no new evidence which tends to prove or disprove any of these issues. In other words, there is no new evidence which shows that the Veteran incurred either seborrheic dermatitis or OSA during active service, including as due to in-service participation in a TERA. There also is no new evidence which shows that he experiences current disability due to either his claimed seborrheic dermatitis or his claimed OSA which is attributable to active service. Continued on the next page The Board finds that the evidence received since September 1998, although new, is not relevant to the issue of whether readjudication of the service connection claim for seborrheic dermatitis is warranted. The Board also finds that the evidence received since November 2019, although new, is not relevant to the issue of whether readjudication of the service connection claim for OSA is warranted. In summary, because new and relevant evidence has not been received, the Board finds that the criteria for readjudication of the claims of service connection for seborrheic dermatitis and for OSA are not met. S. Sorathia Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael T. Osborne, 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.