text:
Citation Nr: 26001001
Decision Date: 01/28/26	Archive Date: 01/28/26

DOCKET NO. 16-09 872
DATE: January 28, 2026

ORDER

Entitlement to service connection for migraine headaches (hereafter migraines) is granted.

Entitlement to service connection for obstructive sleep apnea (OSA) is granted.

FINDINGS OF FACT

1. Affording the Veteran all reasonable doubt, his migraines onset during service.

2. Affording the Veteran all reasonable doubt, his OSA had its onset during service.

CONCLUSIONS OF LAW

1. The criteria for service connection for migraines have been met.  38 U.S.C.

�� 1131, 5107; 38 C.F.R. �� 3.303.

2. The criteria for service connection for OSA have been met.  38 U.S.C. �� 1131, 5107; 38 C.F.R. �� 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from July 1986 to July 1989.

The issue of migraines is before the Board of Veterans' Appeals (Board) on appeal from a July 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO).

The issue of OSA is before the Board on appeal from an April 2017 rating decision.

The Veteran appeared for a Board hearing in February 2019 before the undersigned Veterans Law Judge.  A copy of the transcript is associated with the record.

These matter were remanded by the Board in June 2019, January 2021, May 2021, August 2022, and August 2023 for additional development. These matters have now returned to the Board for appellate consideration. The Board finds there has been substantial compliance with its remand directives.  See Stegall v. West, 11 Vet. App. 268, 271 (1998).  Further, the Board notes that the Board is granting the benefits sought on appeal, and therefore, any failure in this regard would not be prejudicial.

In the August 2015 appeal for service connection for migraines, the Veteran also appealed the issue of an increased rating for bilateral hearing loss, requesting a 10 percent disability rating.  The only issue remaining on that appeal is that of migraines, as the other was granted in full, and the Veteran is now in receipt of a 20 percent disability rating, effective March 17, 2016.

In the June 2017 appeal for service connection for OSA, the Veteran also appealed the issue of service connection for depression with anxiety.  The only issue remaining on that appeal is that of OSA, as the other issue was granted and the Veteran is now service connected for an acquired psychiatric disorder to include posttraumatic stress disorder with major depressive disorder, effective February 2, 2017.

A claimant is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence on any issue material to the claim.  38 U.S.C. � 5107; 38 C.F.R. � 3.102.  If the positive and negative evidence is in approximate balance or nearly equal-which includes but is not limited to equipoise-the claimant receives the benefit of the doubt.  Lynch v. McDonough, 21 F.4th 776, 781 (Fed. Cir. 2021).  If the evidence persuasively favors one side or the other, there is not an approximate balance, and therefore the benefit-of-the-doubt-rule does not apply.  Id. at 781-82.

1. Entitlement to service connection for migraines.

The Veteran seeks service connection for migraines, either on a direct basis, including due to exposure to jet fuel, or on a secondary basis due to his service-connected tinnitus and/or acquired psychiatric disorder.  See November 2015 Statement in Support of Claim.  As the Board is granting on a direct basis due to onset of symptoms during service, other theories of entitlements need not be discussed further herein.

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated during service. 38 U.S.C. � 1131; 38 C.F.R. � 3.303.  In order to establish service connection on a direct basis, the record must contain: (1) the existence of a present 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).

A January 2023 Toxic Exposure Risk Activity (TERA) Memorandum confirmed the Veteran was exposed to jet fuel during service.

The Veteran was diagnosed with migraines in 2014.  See November 2014 Headaches Disability Benefits Questionnaire (DBQ).  Additional VA examiners have also made the same diagnosis.  Therefore, the first criteria for direct service connection is met.

Concerning the second element, the Veteran first sought treatment for his migraines in approximately 2014.  Prior to that he self-medicated.  The Veteran has consistently reported throughout treatment for migraines that they onset during service or within six months following service.  See February 2022 VA examination report, February 2020 VA examination report, November 2014 examination report, February 2019 hearing transcript, November 2015 medical treatment record, and December 2016 neurology clinic note.  Post-service medical treatment records show continual treatment for his migraine condition since 2014.  The Board affords all of this evidence probative value, including the Veteran's credible lay statements of onset, chronicity and continuity.

The Veteran was afforded several VA examinations for his migraines.  While none of them provide a positive nexus to service or find that his migraines were caused by a service-connected condition, the examiners make some noteworthy observations and conclusions.  The April 2023 examiner found it "entirely plausible" that the Veteran experienced headaches during service due to extensive exposure to jet fuel, as well as within one year following separation from service, but the examiner concluded they would likely be acute headaches, not migraines.  The examiner also noted that the Veteran's May 1989 separation exam did not report headaches.

The Veteran submitted medical literature in February 2019 that he asserts shows a relationship between exposure to jet fuel and migraine headaches.  The March 2022 examiner acknowledged that jet fuel has been associated with neurologic effects to include headaches.  Further, the examiner stated that symptoms of a headache condition would have begun in service during the time he was exposed to jet fuel.  As previously detailed, the Veteran has in fact reported onset in service.

Regarding the third element, the Board notes that there is no positive nexus opinion for direct service connection for the Veteran's diagnosed migraines.  However, there is evidence of record in support of this claim, to include the Veteran's lay reports of headaches during service, although he did not seek treatment at that time.  Although the Veteran is not able to opine on the etiology of his migraines, he is competent to establish the onset and presence of observable symptomatology.  See Barr v. Nicholson, 21 Vet. App. 303, 303 (2007).  The Veteran's statements about the onset of his migraines are credible and entitled to probative weight, as they are internally consistent, although not reflected in service treatment records.  Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Barr, 21 Vet. App. at 307-08; Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); Layno v. Brown, 6 Vet. App. 465, 470 (1994).

In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine.  The Board finds the evidence of record is at least in equipoise as to whether the Veteran's migraines had their onset during service.  Resolving all doubt in the Veteran's favor, therefore, the Board finds service connection for migraines is warranted on a direct basis.  38?U.S.C. �?5107; 38 C.F.R. �?3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

2. Entitlement to service connection for OSA.

The Veteran and his representative claim he is entitled to service connection for OSA and that his OSA is due to his tinnitus and/or acquired psychological disability.  See July 2023 Appellate Brief and February 2019 hearing transcript.

The medical evidence of record shows that the Veteran has a current diagnosis of OSA.  Such diagnosis was confirmed by the Veteran's medical treatment records, a sleep study from 2016, and VA clinicians.

The Veteran has consistently asserted that his symptoms of OSA onset in 1987 while he was in the Persian Gulf.  He reports sleep walking, snoring, and that he would stop breathing.  See January 2020 Sleep Apnea Disability Benefits Questionnaire.  See also August 2022 medical treatment record.

The Veteran was afforded VA examinations in March 2017, January 2020, and February 2022, and VA has provided opinions and addendum opinions on direct and secondary opinions, some of which have previously been found to be inadequate by the Board.  There is no positive nexus opinion of record.  Examiners concluded his OSA is less likely than not incurred in or caused by service, less likely than not proximately due to or the result of the Veteran's service-connected conditions, that there is no evidence of aggravation due to his service-connected disabilities, and that his OSA is less likely than not caused by a toxic exposure risk activity (TERA).

Despite not having a positive medical opinion of record, there is evidence of record in support of this claim, to include the Veteran's lay reports of sleep walking, snoring, and breathing cessation during service, although he did not seek treatment at that time.  Although the Veteran is not able to opine on the etiology of his OSA, he is competent to establish the onset and presence of observable symptomatology.  See Barr v. Nicholson, 21 Vet. App. 303, 303 (2007).  The Veteran's statements about the onset of his sleeping problems are credible and entitled to probative weight, as they are internally consistent, although not reflected in service treatment records.  Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Barr, 21 Vet. App. at 307-08; Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); Layno v. Brown, 6 Vet. App. 465, 470 (1994).

In reaching the above conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine.  The Board finds the evidence of record is at least in equipoise as to whether the Veteran's OSA had its onset during service.  Resolving all doubt in the Veteran's favor, therefore, the Board finds service connection for OSA is warranted.  38?U.S.C. �?5107; 38 C.F.R. �?3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Nathaniel Doan

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Scherba, Heather L.

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.


series: legacy

judge_norm: JENNIFER HWA

judge_role: Veterans Law Judge

disposition: remanded

condition: shoulder

text:
Citation Nr: 26002001
Decision Date: 02/12/26	Archive Date: 02/12/26

DOCKET NO. 17-67 509
DATE: February 12, 2026

REMANDED

Entitlement to a rating in excess of 30 percent for the Veteran's service-connected left shoulder disorder is remanded.

REASONS FOR REMAND

The Veteran served on active duty in the U.S. Marine Corps from December 1990 to September 1996 and in the U.S. Army from June 2004 to January 2006, from June 2007 to July 2008, from January 2009 to January 2012, and from April 2012 to April 2013, including service in the Southwest Asia theatre of operations during the Persian Gulf War.  This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO).

In August 2022, the Veteran testified at a virtual hearing before the undersigned Veterans Law Judge (VLJ); a transcript of that hearing is of record.

In March 2023, the Board remanded the Veteran's claim for an increased evaluation for his service-connected left shoulder disorder.  See March 2023 Board Decision.  The appeal returned to the Board in February 2024, at which time the Board granted an increased 30 percent rating for the Veteran's left shoulder disability but denied a rating in excess of 30 percent.  See February 2024 Board Decision.

The Veteran subsequently appealed that decision to the U.S. Court of Appeals for Veterans Claims (Court/CAVC).  Pursuant to a May 2025 Joint Motion for Partial Remand (JMPR) filed by the parties, the Court vacated the portion of the Board's February 2024 decision denying a rating higher than 30 percent for the service-connected left shoulder disorder and remanded the appeal back to the Board for additional development and adjudication consistent with the terms of the JMPR.  See May 2025 JMPR; June 2025 CAVC Order.

The Veteran's appeal thus returned to the Board in October 2025, at which time the Board remanded the claim for a higher rating for the service-connected left shoulder pathology to the Agency of Original Jurisdiction (AOJ) for additional development pursuant to the May 2025 JMPR.  See October 2025 Board Decision (finding that the April 2023 VA shoulder examination report, obtained pursuant to the prior March 2023 Board remand, was inadequate because the examiner "'did not indicate where pain began based on visible behavior,' despite the Board's clear instruction" that the VA examiner "'explicitly identify the degree in which pain is first evidenced by the Veteran's visible behavior.'"  See id. (quoting the May 2025 JMPR and citing Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with its remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand) and D'Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that only substantial rather than strict compliance with the Board's remand directives is required under Stegall)).

The AOJ undertook the requested development and confirmed and continued the 30 percent evaluation assigned the service-connected left shoulder condition in a November 2025 supplemental statement of the case (SSOC).  As such, the appeal has again returned to the Board.

1. Entitlement to a rating in excess of 30 percent for the Veteran's service-connected left shoulder disorder is remanded.

Unfortunately, yet another remand of this appeal is required to ensure compliance with the terms of the JMPR and afford the Veteran every possible consideration.

In this regard, as noted above, and as emphasized in the prior October 2025 Board remand, the parties to the JMPR indicated that the Board erred in its reliance upon the April 2023 VA examination report to deny a rating higher than 30 percent for the Veteran's left (non-dominant) shoulder disorder.  See May 2025 JMPR; October 2025 Board Decision.  Specifically, the parties noted that the prior March 2023 Board remand instructed the AOJ to obtain a new VA examination of the left shoulder and further required that the examining VA clinician document the Veteran's left shoulder range of motion and "explicitly identify the degree in which pain is first evidenced by the Veteran's visible behavior."  See id.; March 2023 Board Decision.  However, the parties noted that the April 2023 VA examiner "did not indicate where pain began based on visible behavior," despite the Board's clear instruction.  See May 2025 JMPR.  See also April 2023 VA Shoulder and Arm Conditions Disability Benefits Questionnaire (DBQ).

Accordingly, in light of these findings, the Board concluded that the April 2023 VA examination report was inadequate to rate the Veteran's service-connected left shoulder pathology and thus remanded the appeal for a new VA examination, again instructing that, "[f]or each ROM, the examining clinician is asked to explicitly identify the degree in which pain is first evidenced by the Veteran's visible behavior."  See October 2025 Board Decision (emphasis in original).

The AOJ obtained an October 2025 VA examination and accompanying medical opinion in October 2025.  See October 2025 VA Shoulder and Arm Conditions and Medical Opinion DBQs.  The examining VA clinician diagnosed left rotator cuff tendinitis and left shoulder "[d]egenerative changes s[tatus ]p[ost] surgical repair" and further identified "[a]bnormal" left shoulder range of motion, limited on active motion to 70 degrees of flexion, 60 degrees of abduction, 20 degrees of internal rotation, and 30 degrees of external rotation.  See October 2025 VA Shoulder and Arm Conditions DBQ (further finding that pain, fatigability, weakness, and lack of endurance "significantly limits [the Veteran's] functional ability" during flare-ups and on repeated use over time and estimating range of during such periods as limited to 50 degrees of flexion, 400 degrees of abduction, 10 degrees of internal rotation, and 20 degrees of external rotation).  However, although the examiner identified objective evidence of pain on motion of the left shoulder in all spheres, the October 2025 examining VA clinician again failed to identify the point at which the pain began or state that pain was present throughout the Veteran's left shoulder ROM, despite the Board's explicit instruction in the prior March 2023 and October 2025 remands.  See id.; October 2025 VA Medical Opinion DBQ (copying and pasting the language from the Board's October 2025 remand, including the instruction that "THE EXAMINING CLINICIAN IS ASKED TO EXPLICITLY IDENTIFY THE DEGREE IN WHICH PAIN IS FIRST EVIDENCED BY THE VETERANS VISIBLE BEHAVIOR," but providing no information responsive to this request (emphasis in original)).

As such, in light of the foregoing, the Board finds that the October 2025 VA examination report, obtained pursuant to the October 2025 Board remand, is inadequate to rate the Veteran's service-connected left shoulder pathology.  See id.; see also 38 C.F.R. � 4.2 (stating that if the findings on an examination report do not contain sufficient detail, it is incumbent upon the rating board to return the report as inadequate for evaluation purposes); Stefl v. Nicholson, 21 Vet. App. 120, 124-25 (2007) (holding that "the mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision as to what weight to assign to the doctor's opinion"); Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991) (where the record does not adequately reveal the current state of the claimant's disability, a VA examination must be conducted).  See, too, Kowalski v. Nicholson, 19 Vet. App. 171 (2005) (stating that VA has discretion to schedule a Veteran for a medical examination where it deems an examination necessary to make a determination on the Veteran's claim).

Remand for a new VA examination is thus required.

The matter is REMANDED for the following action:

1. Obtain any outstanding VA treatment records and associate them with the Veteran's claims file.

2. Thereafter, upon receipt of all additional records, and any additional notification and/or development deemed warranted, schedule the Veteran for an appropriate VA examination to determine the current nature and severity of his service-connected left shoulder pathology (currently characterized as left shoulder tendonitis with degenerative changes, status post surgical repair).  The examination should be scheduled with an examiner who has not yet conducted an examination or provided an opinion in this case, if possible, and may be conducted via telehealth or similar service if deemed necessary.

The entire claims file and a copy of this REMAND must be made available to the examiner prior to the examination.  The examiner must note in the examination report that the evidence in the claims file, including specifically a copy of this REMAND, and copies of the Board's prior remands, has been reviewed.

All indicated tests and studies should be accomplished, and all clinical findings should be reported in detail.  If possible, the appropriate Disability Benefits Questionnaires (DBQs) should be filled out for this purpose.  The examiner should provide additional diagnoses or make a change to a diagnosis where medically justified, with an explanation of the justification for any such change.  See 38 C.F.R. � 4.13 (reflecting that the aim of the reconciliation of the various diagnoses and etiological theories of record is to identify and maintain, or continue, the diagnosis or etiology upon which service connection for the disability was initially granted).

The examiner should identify and describe in detail all orthopedic and neurological manifestations of the Veteran's service-connected left shoulder condition.  Additionally, the examiner must also specifically state whether the Veteran has any symptoms due solely to any other service-connected or nonservice-connected conditions.

After examining the Veteran, evaluating the current nature and severity of his service-connected left shoulder disability, reviewing the Veteran's full history by conducting a complete review of the claims file (including all available lay statements, private and VA medical treatment records, and examination reports), the examiner must:

(i)  Test and document the range of motion (ROM) for each joint in question in active motion, passive motion, weight- bearing, and non-weight-bearing, on both an initial and after-repetitive-use basis, and, if possible, with range of motion measurements of the opposite undamaged joint.  For each ROM, the examining clinician is asked to explicitly identify the degree in which pain is first evidenced by the Veteran's visible behavior.  If unable to conduct the required testing or if the determination is made that the required testing is not necessary in this case, the examiner must provide a thorough explanation.

(ii)  Attempt to elicit information regarding the severity, frequency, and duration of any reported flare-ups, and the degree of functional loss during any such flare-ups.  The examiner should assess such impairment in terms of the degree of additional ROM loss and provide an explanation as to how any such determination was made.  If it is not possible to provide a specific ROM measurement, or an opinion regarding flare-ups, symptoms, or functional impairment based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements.

(iii)  Identify the nature and severity of all current manifestations of the Veteran's service-connected left shoulder pathology. The examiner should describe the extent of any weakened movement, excess fatigability, and incoordination found to be present in terms of the degree of additional ROM loss.  Additional limitation following repetitive use over time, if any, must also be noted.

(iv)  Identify any symptoms and functional impairments due to his service-connected left shoulder disability, to the extent possible, and discuss the effect of the Veteran's disability on any occupational functioning and activities of daily living.

The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions.  In this regard, the Board emphasizes that the Veteran is competent to report his symptoms and history, and such statements by the Veteran regarding symptomatology and medical history must be specifically acknowledged and considered in formulating any opinions concerning the onset and severity of his disability.  If such reports are rejected by the examiner, a reason for doing so must be provided.

All examination findings, along with the complete explanation for all opinions expressed, must be set forth in the examination report.  If the examiner is unable to answer any question without a resort to speculation, then he or she should so indicate and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner does not have the knowledge or training.

JENNIFER HWA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	L. McCabe, 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.


judge_norm: WILLIAM H DONNELLY

disposition: denied

condition: diabetes

condition: radiculopathy

text:
Citation Nr: 26003001
Decision Date: 03/05/26	Archive Date: 03/05/26

DOCKET NO. 15-22 798
DATE: March 5, 2026

ORDER

Entitlement to service connection for diabetes mellitus type II is denied.

REMANDED

Entitlement to service connection for peripheral neuropathy of the left upper extremity is remanded.

Entitlement to service connection for peripheral neuropathy of the right upper extremity is remanded.

Entitlement to service connection for peripheral neuropathy of the left lower extremity is remanded.

Entitlement to service connection for peripheral neuropathy of the right lower extremity is remanded.

FINDING OF FACT

The evidence of record persuasively weighs against finding that the Veteran had diabetes mellitus type II at any time during or approximate to the pendency of the claim.

CONCLUSION OF LAW

The criteria for entitlement to service connection for diabetes mellitus type II have not been met.  38 U.S.C. �� 1110, 1131, 5107; 38 C.F.R. �� 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty with the United States Navy from November 1971 to December 1974.  These matters come before the Board of Veterans' Appeals (Board) on appeal from an October 2014 rating decision of the Department of Veterans Affairs (VA) agency of original jurisdiction (AOJ).  The Veteran died in June 2016.  The Appellant, his surviving spouse, has been substituted as the claimant for this claim.

These matters were previously remanded by the Board in June 2020, September 2021, August 2022, April 2023, and March 2024.  Those remands also included the issue of entitlement to service connection for squamous cell carcinoma spheroidal sinus, which was granted in a December 2024 rating decision.  Thus, that issue is no longer before the Board.

The Veteran had requested a hearing in a May 2016 statement.  The Appellant withdrew that hearing request in February 2020.

With respect to the matter decided herein, the AOJ has duties to notify and assist claimants in substantiating a claim for VA benefits.  38 U.S.C. �� 5100, 5102, 5103, 5103A, 5107, 5126; 38 C.F.R. �� 3.102, 3.159, 3.326(a).  These duties have been satisfied in this case.  The Veteran had actual knowledge of the elements necessary to substantiate a VA claim through a May 2014 VA Form 21-526EZ and October 2014 VA claim development letter.  See Sanders v. Nicholson, 487 F.3d 881 (Fed. Cir. 2007); Vazquez-Flores v. Peake, 22 Vet. App. 37 (2008).

The AOJ associated the Veteran's service records, VA medical center (VAMC) records, Social Security Administration records, and private treatment records with the claims file.  All released or submitted private treatment records have been associated with the claims file.  No other relevant records have been identified and are outstanding.

The AOJ provided an appropriate VA medical opinion.  It is adequate because it made findings necessary to identify current disabilities, considered the evidence in the claims file, and applied medical knowledge to the Veteran's specific facts.  Thus, the AOJ has satisfied its duty to assist with the procurement of relevant records.  38 U.S.C. � 5103A; 38 C.F.R. � 3.159(c).  Neither the Appellant nor her representative has raised any issues with the duties to notify or assist.  See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016).

The Appellant contends that service connection is warranted for diabetes mellitus type II.  Because the evidence does not show that he had a diagnosis of diabetes mellitus, this issue is denied.

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service.  See 38 U.S.C. �� 1110, 1131; 38 C.F.R. � 3.303(a).  "To establish a right to compensation for a present disability, a veteran must show: '(1) the existence of a present 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' - the so-called 'nexus' requirement."  Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

The Board concludes that the Veteran did not have a diagnosis of diabetes mellitus type II at any time during the pendency of the claim or recent to the filing of the claim.  Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007).

Although the Veteran reported having diabetes mellitus in several lay statements such as the November 2014 notice of disagreement and May 2015 VA Form 9, the medical records contradict his statements.  He denied being diabetic in multiple records and forms, including a May 2007 VAMC radiology pre-procedure note, August 2012 patient medical history form for private treatment, and November 2013 medical history form for private treatment.  A January 2014 private treatment record indicated in its review of systems that the Veteran did not have a history of diabetes.  A May 2014 private examination listed many diagnoses - left cranial nerve palsy, neoplasm of sphenoidal sinus, degenerative disc disease, diplopia,  photophobia, headaches, hypertension, hepatitis C, renal insufficiency, and peripheral vascular disease - but not diabetes mellitus.

The Board acknowledges that a December 2023 VA medical opinion stated diabetes mellitus type II was presumptively due to in-service exposure to herbicide agents.  That VA medical opinion did not identify any evidence it relied on to find a current diagnosis, however, and the Board gives the opinion no weight.  In contrast, a March 2024 VA medical opinion considered the evidence of record, including the December 2023 opinion, and determined that the "medical records are silent for a diabetes mellitus diagnosis."  To support this determination, the VA medical opinion cited screenings "in 2008, 2012, and 2014 and all three times, his hga1c was negative.  He did have two borderline blood sugars but the 90 day average was negative at 5.7."  The VA medical opinion noted that "Below 5.7% is normal" and "6.5% or higher on two separate tests indicates diabetes," but the "Veteran has not had two hga1c at 6.5 and does not meet the diagnostic criteria for diabetes type II."  Because this opinion reviewed the evidence and cited criteria to support its finding, the Board gives it significant weight.

Although the Veteran believed he had a current diagnosis of diabetes mellitus type II, the evidence does not demonstrate his competence to provide a diagnosis.   The issue is medically complex, requiring specialized medical education to interpret complicated diagnostic medical testing.  Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007).  Consequently, the Board gives more probative weight to the contemporaneous medical records that did not include diabetes diagnoses as well as the competent March 2024 medical opinion.

In sum, the evidence is neither evenly nor approximately balanced regarding whether service connection for diabetes mellitus type II is warranted.  Rather, the evidence persuasively weighs against the claim, and the benefit-of-the-doubt doctrine is not for application.  Lynch v. McDonough,?21 F.4th 776, 781-82 (Fed. Cir. 2021) ("[T]he benefit-of-the-doubt rule?does not apply[] when the evidence persuasively favors one side or the other").  Entitlement to service connection for diabetes mellitus type II is denied.

REASONS FOR REMAND

Remand is necessary to obtain VA medical opinions related to the claims for bilateral upper and lower extremity peripheral neuropathy.  The March 2024 Board remand directed the AOJ to obtain VA medical opinions that addressed whether peripheral neuropathy is related to in-service herbicide-agent exposure, without simply relying on a finding that the Veteran's peripheral neuropathy was not early-onset in nature.  The AOJ failed to obtain any opinion related to peripheral neuropathy.  Thus, these matters must be remanded to obtain the requested VA medical opinions.  See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that the Board errs as a matter of law when it fails to ensure compliance with its remand orders).

The matters are REMANDED for the following action:

1. Obtain a VA medical opinion from an appropriate clinician regarding the Veteran's peripheral neuropathy of the upper and lower extremities.  After thoroughly reviewing the claims file, including the relevant medical records and the earlier medical opinions, the clinician should respond to these questions

(a) Is it at least as likely as not (a likelihood that is approximately evenly balanced or nearly equal, if not higher) that the Veteran's left upper extremity peripheral neuropathy had its onset in service or was related to any in-service disease, injury, or event, including his exposure to herbicide agents during his naval service?

(b) Is it at least as likely as not (a likelihood that is approximately evenly balanced or nearly equal, if not higher) that the Veteran's right upper extremity peripheral neuropathy had its onset in service or was related to any in-service disease, injury, or event, including his exposure to herbicide agents during his naval service?

(c) Is it at least as likely as not (a likelihood that is approximately evenly balanced or nearly equal, if not higher) that the Veteran's left lower extremity peripheral neuropathy had its onset in service or was related to any in-service disease, injury, or event, including his exposure to herbicide agents during his naval service?

(d) Is it at least as likely as not (a likelihood that is approximately evenly balanced or nearly equal, if not higher) that the Veteran's right lower extremity peripheral neuropathy had its onset in service or was related to any in-service disease, injury, or event, including his exposure to herbicide agents during his naval service?

The clinician should prepare a clear rationale thoroughly explaining the answers to questions 1(a)-1(d).  If the clinician finds that the same rationale applies to neuropathy in all four extremities, it would be appropriate to prepare a single, comprehensive opinion answering all four questions.  SIMPLY STATING THAT PERIPHERAL NEUROPATHY WHICH DID NOT HAVE AN EARLY ONSET IS NOT PRESUMPTIVELY ASSOCIATED WITH HERBICIDE EXPOSURE IS NOT SUFFICIENT TO SUPPORT AN UNFAVORABLE OPINION.  The clinician should discuss the likely effects of 2,4-D, 2,4,5-T, TCDD, cacodylic acid, and picloram.

2. Then, readjudicate the claim.  If the benefits sought remain denied, issue a supplemental statement of the case and return the matters to the Board, if otherwise in order.

WILLIAM H. DONNELLY

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	W. Ripplinger, 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.


judge_norm: CHRISTOPHER SEPPANEN

condition: headache

text:
Citation Nr: 26004001
Decision Date: 03/31/26	Archive Date: 03/31/26

DOCKET NO. 16-26 867
DATE: March 31, 2026

REMANDED

Entitlement to a rating in excess of 30 percent for service connected tension headaches is remanded.

REASONS FOR REMAND

The Veteran had active service from September 1990 to June 1991.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO).

The Board notes that there is an extensive procedural history.  Most recently, in February 2025, the Board denied his increase ratings claim on appeal.  The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court).  In November 2025, the Court issued a joint motion for partial remand (JMPR) decision in which it vacated the February 2025 Board decision.  The issue is once again before the Board.

1. Entitlement to a rating in excess of 30 percent for service connected tension headaches is remanded.

The records show that the last VA examination was in August 2019, almost seven years ago.  Since the August 2019 VA examination, the treatment records show possible worsening of his condition.  For instance, in a May 2025 VA treatment record, he stated that on some weeks he has migraine headaches everyday lasting for several hours.  See June 2025 CAPRI.

Given the foregoing, the Board finds that a more contemporaneous examination is needed to evaluate the current nature and severity of the Veteran's migraine headaches.  See Allday v. Brown, 7 Vet. App. 517 (1995); Caffrey v. Brown, 6 Vet. App. 377 (1994); Snuffer v. Gober, 10 Vet. App. 400 (1997).  Accordingly, the Board finds that a remand is warranted in order to afford a new VA examination to the Veteran as the records show possible worsening.

The matter is REMANDED for the following action:

Schedule the Veteran for a VA examination from an appropriate medical professional.  The electronic claims file must be made available to be reviewed by the examiner.  All indicated diagnostic tests should also be completed.

The examiner should determine the current level of severity of any reported migraine/tension headaches and perform any necessary testing.

A detailed rationale for the opinions must be provided.  If the examiner is unable to offer the requested opinions, it is essential that the examiner offer a rationale for the conclusion that an opinion(s) could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge.

Christopher Seppanen

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	P. Noh

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.


judge_norm: L STEPANICK

disposition: dismissed

condition: psychiatric

condition: tbi

condition: heart

condition: hypertension

text:
Citation Nr: 26005001
Decision Date: 04/28/26	Archive Date: 04/28/26

DOCKET NO. 19-25 810
DATE: April 28, 2026

ORDER

The issue of entitlement to a higher rating for a psychiatric disorder is dismissed.

REMANDED

The issue of entitlement to service connection for a traumatic brain injury (TBI) is remanded.

The issue of entitlement to service connection for coronary artery disease (CAD) is remanded.

The issue of entitlement to service connection for hypertension is remanded.

FINDING OF FACT

In a March 2026 rating decision, the agency of original jurisdiction (AOJ) implemented a February 2026 Board of Veterans' Appeals (Board) decision by awarding a 100 percent rating for the Veteran's service-connected acquired psychiatric disorder effective November 1, 2017.

CONCLUSION OF LAW

The criteria for dismissal of the issue of entitlement to a higher rating for a psychiatric disorder are met.  38 U.S.C. � 7105; 38 C.F.R. � 19.55.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service from February 1971 to November 1972. The Veteran's appeals related to TBI and a psychiatric disorder come to the Board on appeal from an April 2018 rating decision and were last remanded by the Board in June 2023. The Veteran's appeals related to CAD and hypertension come to the Board on appeal from an April 2018 rating decision and were last remanded by the Board in September 2023.

1. The issue of entitlement to a higher rating for a psychiatric disorder is dismissed.

All questions of law and fact necessary to a decision by the Secretary of Veterans Affairs under a law that affects the provision of benefits by the Secretary to veterans or their dependents or survivors are subject to review on appeal to the Secretary. Decisions in such appeals are made by the Board. 38 C.F.R. � 20.104(a). The Board may dismiss any appeal which fails to identify the specific determination with which the claimant disagrees. 38 U.S.C. � 7105(d).

Prior to the issuance of this decision, in February 2026, the Board granted the Veteran a 100 percent rating for his psychiatric disorder. In a March 2026 rating decision, the AOJ implemented that award, assigning a 100 percent rating effective November 1, 2017, the date of the Veteran's claim for increase. This award represents a full grant of the benefit sought in this appeal.

When, during the pendency of an appeal and prior to a Board decision being issued, the Veteran or Appellant's claim is granted, the case must be dismissed. This is true where a grant of benefits represents a full grant of the benefit sought on appeal and, thus, there is no longer a case or controversy as to the matter.  As the February 2026 Board decision represented a full grant of this claim for increase, there is no longer a case or controversy as to this matter and the appeal as to the Veteran's claim for a higher rating for a psychiatric disability must be dismissed. 38 U.S.C. � 7105.

REASONS FOR REMAND

1. Entitlement to service connection for a TBI is remanded.

2. Entitlement to service connection for CAD is remanded.

3. Entitlement to service connection for hypertension is remanded.

Following the last AOJ adjudication of these issues in supplemental statements of the case, additional relevant VA-created evidence was associated with the claims file. While evidence submitted by the Veteran is subject to automatic waiver of AOJ consideration, evidence not submitted by the Veteran is not subject to automatic waiver. VA sent a request for waiver in March 2026, to which the Veteran did not respond. As such, these matters must be remanded for AOJ consideration of the additional evidence.

(Continued on the next page)

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The matters are REMANDED for the following action:

Readjudicate the issues of entitlement to service connection for a TBI, CAD, and hypertension, considering the evidence received since the last prior adjudications.

L. STEPANICK

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	J. Baker, 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.


series: ama

judge_norm: S SORATHIA

disposition: vacated

benefit: reduction

text:
Citation Nr: A26000001
Decision Date: 01/03/26	Archive Date: 12/19/25

DOCKET NO. 241223-502271
DATE: January 3, 2026

ORDER

The November 20, 2025, Board of Veterans' Appeals (Board) decision, which denied claims challenging the rating reduction from 50 percent to 20 percent effective July 1, 2024, for bilateral hearing loss and the rating reduction from 20 percent to 10 percent effective July 1, 2024, for left knee instability, is vacated.

The December 2024 appeal challenging the rating reduction from 50 percent to 20 percent effective July 1, 2024, for bilateral hearing loss and the rating reduction from 20 percent to 10 percent effective July 1, 2024, for left knee instability is dismissed.

FINDINGS OF FACT

1.  In an AMA Higher Level Review (HLR) rating decision dated on April 23, 2024, and issued to the Veteran and his former attorney on April 24, 2024, the Agency of Original Jurisdiction (AOJ) essentially denied, in pertinent part, the Veteran's claims challenging the propriety of the rating reduction from 50 percent to 20 percent for service-connected bilateral hearing loss and the rating reduction from 20 percent to 10 percent for service-connected left knee instability, each effective July 1, 2024.

2.  The Veteran, through his attorney, disagreed with the April 2024 AMA HLR rating decision with respect to the claims challenging the propriety of the rating reduction from 50 percent to 20 percent for service-connected bilateral hearing loss and the rating reduction from 20 percent to 10 percent for service-connected left knee instability, each effective July 1, 2024, in statements on a VA Form 10182, "Decision Review Request: Board Appeal (Notice Of Disagreement)," dated on December 23, 2024, and date-stamped as received electronically that same day by VA.

3.  In statements on a VA Form 21-4138, "Statement In Support Of Claim," dated on March 6, 2025, and date-stamped as received electronically by VA that same day, the Veteran, through his attorney, withdrew his appeal challenging the propriety of the rating reduction from 50 percent to 20 percent for service-connected bilateral hearing loss and the rating reduction from 20 percent to 10 percent for service-connected left knee instability, each effective July 1, 2024.

4.  On November 20, 2025, the Board issued a decision which denied the Veteran's claims challenging the rating reduction from 50 percent to 20 percent effective July 1, 2024, for bilateral hearing loss and the rating reduction from 20 percent to 10 percent effective July 1, 2024, for left knee instability.

5.  The withdrawal of the appeal was associated with the claims file prior to the Board promulgating a decision on the appeal.

CONCLUSIONS OF LAW

1.  The criteria for vacating the November 20, 2025, Board decision, which denied claims challenging the rating reduction from 50 percent to 20 percent effective July 1, 2024, for bilateral hearing loss and the rating reduction from 20 percent to 10 percent effective July 1, 2024, for left knee instability, have been met.  38 U.S.C. � 7103(c); 38 C.F.R. � 20.1001(a).

2.  The criteria for withdrawal of an appeal by the appellant have been met.  38 U.S.C. � 7105; 38 C.F.R. � 20.205.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active U.S. Army service from October 1986 to October 1989 and from July 1994 to March 1996.  He also had additional unverified service.

1. The November 20, 2025, Board decision, which denied claims challenging the rating reduction from 50 percent to 20 percent effective July 1, 2024, for bilateral hearing loss and the rating reduction from 20 percent to 10 percent effective July 1, 2024, for left knee instability, is vacated

The Board may reconsider and, if necessary, vacate an appellate decision at any time where there is an obvious error of fact or law.  Reconsideration in this manner may occur either on a motion filed at the Board by an appellant or on the Board's own motion (as in this appeal).  See 38 U.S.C. � 7103(c); 38 C.F.R. � 20.1001(a).

In its November 20, 2025, decision, the Board denied the Veteran's claims challenging the rating reduction from 50 percent to 20 percent effective July 1, 2024, for bilateral hearing loss and the rating reduction from 20 percent to 10 percent effective July 1, 2024, for left knee instability.  Unfortunately, a review of the claims file shows that the Veteran, through his attorney, had withdrawn his appeal challenging these two different rating reductions in March 2025 prior to the November 2025 Board decision.

The Board finds that it incorrectly adjudicated the Veteran's claims challenging the rating reduction from 50 percent to 20 percent effective July 1, 2024, for bilateral hearing loss and the rating reduction from 20 percent to 10 percent effective July 1, 2024, for left knee instability in the November 2025 decision rather than dismissing them.  This is an obvious error of law and vacatur is warranted.  Accordingly, the criteria for vacating the November 20, 2025, Board decision, which denied claims challenging the rating reduction from 50 percent to 20 percent effective July 1, 2024, for bilateral hearing loss and the rating reduction from 20 percent to 10 percent effective July 1, 2024, for left knee instability, have been met.

2.  The appeal challenging the propriety of the rating reduction from 50 percent to 20 percent effective July 1, 2024, for bilateral hearing loss and the rating reduction from 20 percent to 10 percent effective July 1, 2024, for left knee instability is dismissed

The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed.  38 U.S.C. � 7105.  An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision.  Withdrawal may be made by the appellant or by his or her authorized representative.  38 C.F.R. � 20.205.  In the present case, as noted above, the appellant, through his attorney, has withdrawn this appeal; hence, there remain no allegations of errors of fact or law for appellate consideration.  Accordingly, the appeal is dismissed.

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.