judge_norm: NATHANIEL DOAN

text:
Citation Nr: A26035000
Decision Date: 04/15/26	Archive Date: 04/15/26

DOCKET NO. 200630-446125
DATE: April 15, 2026

ORDER

Service connection for osteoarthritis and degenerative arthritis of the lumbar spine is granted.

FINDING OF FACT

The Veteran's lumbar spine condition, diagnosed as osteoarthritis and degenerative arthritis of the lumbar spine, has continued since its onset in service following his fall in 1972.

CONCLUSION OF LAW

The criteria for service connection for lumbar spine condition, diagnosed as osteoarthritis and degenerative arthritis of the lumbar spine, have been met. 38?U.S.C. ��?1110, 5107; 38?C.F.R. ��?3.102, 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from September 1972 to November 1975.

A rating decision was issued under the legacy system in November 2014, and the Veteran submitted a timely notice of disagreement.  In May 2020, the agency of original jurisdiction (AOJ) issued a supplemental statement of the case (SSOC).  The Veteran opted the claim into the modernized review system, also known as the Appeals Modernization Act (AMA), by submitting a June 2020 VA Form 10182, Decision Review Request: Board Appeal, identifying the May 2020 SSOC.  Therefore, the May 2020 SSOC is the decision on appeal.

Unfortunately, the Veteran's election to opt into the AMA was missed and a legacy decision was issued by the Board in August 2020. However, in May 2024, such was corrected when the August 2020 decision was vacated by the Board. Accordingly, the appeal is now properly before the Board in the modernized review system, the AMA.

In the June 30, 2020, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on September 25, 2024.

Therefore, the Board may only consider the evidence of record at the time of the May 2020 SSOC, as well as any evidence submitted by the Veteran at the hearing or within 90 days following the hearing. 38 C.F.R. �?20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the May 2020 SSOC and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. �� 20.300, 20.302(a), 20.801.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service.?38?C.F.R. �?3.303(a). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service.? 38?C.F.R. �?3.303(d).?Direct service connection may not be granted without evidence of a current disability; in-service incurrence or aggravation of a disease or injury; and a nexus between the claimed in-service disease or injury and the present disease or injury. Id.; see also Caluza v. Brown, 7?Vet. App.?498, 506 (1995) aff'd, 78 F.3d 604 (Fed. Cir. 1996).

Where a veteran served for at least 90 days during a period of war or after December 31, 1946, and manifests certain chronic diseases, such as organic diseases of the nervous system, to a degree of 10 percent within one year from the date of termination of such service, such disease shall be presumed to have been incurred or aggravated in service, even though there is no evidence of such disease during the period of service. 38 U.S.C. �� 1101, 1112, 1137; 38 C.F.R. �� 3.307, 3.309.

Alternatively, when a disease at 38 C.F.R. � 3.309(a) is not shown to be chronic during service or the one-year presumptive period, service connection may also be established by showing continuity of symptomatology after service. 38 C.F.R. � 3.303(b). However, the use of continuity of symptoms to establish service connection is limited only to those diseases listed at 38 C.F.R. � 3.309(a), such as arthritis, and does not apply to other disabilities which might be considered chronic from a medical standpoint. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. � 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); 38 C.F.R. � 3.102.

Entitlement to service connection for osteoarthritis and degenerative arthritis of the lumbar spine of the lumbar spine.

The Veteran contends that his current lumbar spine disability is due to service; specifically, he asserts that he fell during service and his pain has continued since such time.

The record reflects that the Veteran has complained of and sought both private and VA treatment for his chronic back pain for decades. Notably, an October 2014 imaging report of the lumbar spine reflects diagnoses of degenerative disc disease and osteoarthritis. The January 2020 VA examiner indicated a diagnosis of degenerative arthritis of the spine. Accordingly, the Board finds that the first element of service connection, a current disability, is met.

With regard to the second element, an in-service event, injury, or onset, the Veteran's service treatment records (STRs) reflect that in December 1972 and January 1973 the Veteran sought treatment for back pain. The Board finds that the second element of service connection is met.

With regard to the final element of service connection, the Board notes that the Veteran has consistently reported that his back pain began in service and has continued since such time.

In this regard, in his August 2014 claim, the Veteran claimed, "continuous back issues since active duty." At his October 2014 VA examination, the Veteran reported that his back pain began in 1973 after he fell down the stairs in service and that such have continued and worsened since. At his July 2019 Board hearing, the Veteran testified that he fell down the stairs during service and sought treatment for such. Upon VA examination in January 2020, the Veteran again reported that his back pain started during service after his fall down the stairs during service in 1972. He reported pain going down to buttocks, legs, and feet.

At his September 2024 Board hearing, the Veteran again reported that he sustained a fall down the stairs during service in December 1972, that he sought treatment for such during service, and that such symptoms have continued since service.

Both the October 2014 and January 2020 VA examiners provided negative nexus opinions, however, neither opinion addressed the December 1972 and January 1973 documentation of back pain in the Veteran's STRs, nor did they address the Veteran's lay statements concerning his continued symptoms in and since service. Accordingly, the Board finds that such opinions have low probative value.

Moreover, the Board finds that the Veteran's service from September 1972 to November 1975 satisfies the service requirement for presumptive service connection under 38 C.F.R. � 3.307. There is probative evidence of record in support of this claim, to include the Veteran's lay reports of back pain in and since service. The Board finds that the Veteran continued to experience symptoms of back pain since his separation from service.

The Board finds that the Veteran was competent to report that he experienced back pain symptoms since service. Notably, the Veteran testified at both Board hearings and reported at both VA examinations that he has had these symptoms since service. His statements are credible and entitled to probative weight, as they were internally consistent and consistent with other evidence of record which shows that these symptoms were attributable to osteoarthritis and degenerative arthritis of the spine. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007); Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); Layno v. Brown, 6 Vet. App. 465, 470 (1994).

Based on the foregoing, the Board finds that continuity of symptomatology has been established by the evidence of record. Accordingly, service connection for lumbar spine condition, diagnosed as osteoarthritis and degenerative arthritis of the lumbar spine, is granted. 38 U.S.C. � 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. � 3.102.

In effectuating the benefit granted herein, the AOJ is to consider the neurological symptoms that were associated with the Veteran's lumbar spine disorder.

Nathaniel Doan

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	N. M. Younan

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: L CHU

judge_role: Veterans Law Judge

disposition: denied

disposition: remanded

condition: headache

text:
Citation Nr: A26036000
Decision Date: 04/17/26	Archive Date: 04/17/26

DOCKET NO. 250523-548012
DATE: April 17, 2026

ORDER

Entitlement to an initial disability rating in excess of 50 percent for unspecified trauma or stressor related disorder is denied.

REMANDED

Entitlement to an initial compensable disability rating for tension headaches is remanded.

FINDING OF FACT

For the entire period on appeal, the severity, frequency, and duration of the Veteran's symptoms of unspecified trauma or stressor related disorder did not more closely approximate occupational and social impairment with deficiencies in most areas.

CONCLUSION OF LAW

The criteria for entitlement to an initial disability rating in excess of 50 percent for unspecified trauma or stressor related disorder have not been met. 38 U.S.C. �� 1155, 5107; 38 C.F.R. �� 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9499-9411.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from June 2017 to June 2024.

In a June 2024 rating decision, the Veteran was originally granted entitlement to service connection for unspecified trauma or stressor related disorder with an initial rating of 50 percent, and entitlement to service connection for tension headaches with an initial noncompensable rating.

In November 2024, the Veteran filed a VA Form 20-0996: Request for Higher-Level Review seeking, in relevant part, higher ratings for unspecified trauma or stressor related disorder and tension headaches, which were denied in a March 2025 Higher-Level Review (HLR) rating decision.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from the March 2025 HLR rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). Because the March 2025 rating decision on appeal was issued after February 19, 2019, it is subject to the Appeals Modernization Act ("AMA"). 38 C.F.R. �� 3.2400(a)(1); 19.2(a).

In the Veteran's May 2025 VA Form 10182 Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the June 2024 rating decision, which was subject to review in the March 2025 HLR rating decision on appeal. 38 C.F.R. � 20.301. Any evidence submitted after the June 2024 rating decision cannot be considered by the Board. 38 C.F.R. �� 20.300, 20.301, 20.801.

Entitlement to an initial disability rating in excess of 50 percent for unspecified trauma or stressor related disorder

The Veteran contends that he is entitled to an increased rating in excess of 50 percent for his unspecified trauma or stressor related disorder. See November 2024 VA Form 20-0996: Request for HLR.

Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes (DCs) identify the various disabilities. 38 U.S.C. � 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. � 4.1.

Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). The Board will also consider the appropriateness of "staged" ratings based on the facts found. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). Further, the evaluation of the same disability under various diagnoses is to be avoided. 38 C.F.R. � 4.14.

If a reasonable doubt arises regarding the degree of disability after careful consideration of all procurable and assembled data, such doubt will be resolved in favor of the claimant. 38 C.F.R. � 4.3. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. � 4.7.

The Veteran's unspecified trauma or stressor related disorder is currently rated under Diagnostic Code 9499-9411, which is rated under the schedule of ratings for mental disorders, 38 C.F.R. � 4.130. In relevant part, the rating criteria are as follows:

A 50 percent disability rating is warranted when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped, speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short and long term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. � 4.130.

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

The highest rating of 100 percent is warranted when there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. � 4.130.

The list of symptoms under the rating criteria above are meant to be examples of symptoms that would warrant the respective rating, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). However, a veteran may only qualify for a given disability rating under � 4.130 by demonstrating symptoms associated with that percentage, or others of similar severity, frequency, and duration, and that those symptoms have resulted in the type of occupational and social impairment associated with that percentage. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117-18 (Fed. Cir. 2013).

Further, when evaluating a mental disorder, the Board must consider the "frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission." 38 C.F.R. � 4.126(a). The Board must also "assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of examination." Id.

For the reasons explained below, the Board has determined that a rating in excess of 50 percent is not warranted for the Veteran's unspecified trauma or stressor related disorder.

In January 2023, the Veteran sought treatment for mental health symptoms and reported that he was under a lot of stress at work, which caused issues in his relationship with his wife. He reported increasing anxiety and difficulty with his mood. Additionally, he expressed concern over time spent away from his spouse, including time spent away after the expected birth of their first child. The clinician indicated that target symptoms included anxiety, behavioral symptoms, depression, relationship issues, and work stress. He denied any satisfaction from work and indicated that he generally felt displeased. He reported difficulty finding interest or pleasure at home and becoming anxious when thinking about work. Over the past month, he reported little interest or pleasure in doing things more than half the days; feeling down, depressed, or hopeless several days; trouble feeling or staying asleep or sleeping too much several days; feeling tired or little energy nearly every day; feeling bad about himself several days; and trouble concentrating nearly every day.

In June 2023, it was noted that the Veteran experienced functional interference with work performance and problems with colleagues, and that his functional status level with work/family/social was somewhat difficult.

In August 2023, it was indicated that the Veteran had a low to moderate level of distress; no significant relationship distress; subthreshold insomnia; serious mental distress; and minor depressive symptoms. The Veteran reported that he had difficulty with focus, concentration, and procrastination. He was evaluated for ADHD using the DSM, and it was noted that he had inattention; often failed to give close attention to details or made careless mistakes at work or during activities; often had difficulty sustaining attention in tasks or play activities; often did not follow through on instructions and failed to finish chores or duties in the workplace; often had difficulty organizing tasks and activities; often lost things necessary for tasks or activities; and often was easily distracted by extraneous stimuli. The treating clinician found that he met the criteria for ADHD inattentive type but noted that they would discuss further testing to meet the Army standards for diagnosis.

In September 2023, the Veteran reported stress and anxiety. He indicated that he went back to work and was given a new job to do with no training, which he found frustrating. He reported that he enjoyed having a job to do but felt ill prepared for it. He stated that any time he was surprised by something, he got anxious.

In October 2023, the Veteran reported that he was trying to watch his sleep and exercise. He indicated that his insomnia was better. Later that month, he reported better sleep, feeling better throughout the day, less tired, and losing some weight. He stated that his wife was frustrated with him because he did not remember things and had difficulty focusing on things. Additionally, he indicated that he used to have a good memory but that he had to start writing things down to remember them. He further stated that he had always been pretty shy and usually just had a couple of close friends. The clinician noted that the Conners CPT3 did not show support for an ADHD diagnosis.

A VA examination was obtained in January 2024. The Veteran reported depressive/anxiety-related symptoms that significantly interfered with social and relationship functioning since onset. He was diagnosed with unspecified trauma or stressor related disorder. The Veteran reported developing significant anxiety-related symptoms associated with markers with his job (phone calls, text messages, alarms). He reported anxiety-related symptoms in large crowds or unfamiliar places. He indicated that his anxiety-related symptoms persisted for up to 5-10 minutes. Additionally, he reported developing significant depressive symptoms in parallel to his anxiety-related symptoms in 2018. He further reported dissociative symptoms that manifested while driving (zoning out, losing track of time). He averaged 8-10 hours of very disturbed sleep nightly, with nightmares/night terrors once every two weeks. He denied suicidal or homicidal ideation, hallucinations, mania, or delusions following service. The examiner indicated that while the Veteran did not meet the full criteria for PTSD, he had some symptoms of PTSD, including marked physiological reactions to internal or external cues that symbolized or resembled an aspect of the traumatic event; avoidance of or efforts to avoid external reminders; feelings of detachment or estrangement from others; problems with concentration; and sleep disturbance. Additionally, his symptoms of unspecified trauma or stressor related disorder included depressed mood; anxiety; chronic sleep impairment; impaired judgment; impaired abstract thinking; disturbance of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. The examiner indicated that the Veteran had no attention/concentration problems or significant memory difficulties. The examiner found that the Veteran's unspecified trauma or stressor related disorder resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.

The Veteran's treatment providers regularly documented that he was appropriately dressed and groomed; oriented to person, place, time, and situation; and denied that he exhibited hallucinations or delusions. Additionally, they consistently noted that his speech was normal, his thought process was intact, and his insight and judgment were fair.

In the Veteran's November 2024 Request for Higher-Level Review, his representative argued that the Veteran was entitled to a 70 percent rating because the January 2024 VA examination noted difficulty in establishing and maintaining effective work and social relationships and the clinic notes from his active duty supported that anxiety was causing relationship issues.

After careful consideration of the evidence of record, the Board concludes that the Veteran's symptomatology more closely approximates social and occupational impairment with reduced reliability and productivity, rather than occupational and social impairment with deficiencies in most areas, which is required for the higher 70 percent rating, for the following reasons.

The medical evidence shows that the Veteran exhibited symptoms of anxiety, depression, difficulty concentrating, difficulty sleeping, nightmares, avoidance, detachment, impaired judgment, impaired abstract thinking, disturbance of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. The Board finds that these symptoms resulted in occupational impairment consistent with the assigned 50 percent rating. Specifically, the evidence shows that the Veteran's psychiatric symptoms interfered with work performance, resulted in difficulty concentrating, caused anxiety associated with markers from his job, and resulted in difficulty establishing and maintaining effective work relationships. While the Board acknowledges that the Veteran's unspecified trauma or stressor related disorder limited his occupational ability, the Board finds that these limitations are contemplated by a 50 percent rating, which accounts for occupational impairment with reduced reliability and productivity due to symptoms such as disturbances of motivation and mood and difficulty in establishing and maintaining effective work and social relationships.

Additionally, the Board acknowledges that the evidence of record demonstrates difficulty in social relationships; however, the Board finds that this impairment more nearly approximates a 50 percent evaluation. The record reflects that the Veteran's unspecified trauma or stressor related disorder caused issues in his relationship with his wife, anxiety symptoms in large crowds or unfamiliar places, and difficulty establishing and maintaining social relationships. However, the record also shows that the Veteran maintained a relationship with his wife and that he had a couple of close friends. While the Board acknowledges that the Veteran's social relationships were impaired by his unspecified trauma or stressor related disorder, the Board finds that the level of this impairment more nearly approximates a 50 percent evaluation of social impairment with reduced reliability and productivity, as opposed to social impairment with deficiencies in most areas. Additionally, the Board has considered the Veteran's representative's argument that a 70 percent rating is warranted because the January 2024 VA examination noted difficulty in establishing and maintaining effective work and social relationships and his active-duty clinic notes supported that anxiety was causing relationship issues. However, the Board notes that difficulty establishing and maintaining effective work and social relationships is explicitly contemplated by the 50 percent rating criteria and therefore does not warrant a higher 70 percent rating. Furthermore, as previously discussed, the Board finds that the relationship issues caused by the Veteran's unspecified trauma or stressor related disorder are not so severe as to rise to the level of occupational and social impairment with deficiencies in most areas. Rather, such impairment is more approximately contemplated by a 50 percent rating, which accounts for occupational and social impairment with deficiencies in most areas.

Furthermore, while the Veteran endorsed symptoms of anxiety, depression, and some memory impairment, these symptoms are contemplated by the 50 percent rating criteria, which accounts for impairment of short and long-term memory and disturbances of motivation and mood.

Moreover, in the January 2024 VA examination report, the examiner found that the Veteran's unspecified trauma or stressor related disorder resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, which is the level of severity described under the 30 percent rating. While the adjudicator makes the determination as to what evaluation is warranted for the Veteran's service-connected unspecified trauma or stressor related disorder, the VA examiner's conclusion is evidence against a finding that the condition caused occupational and social impairment with deficiencies in most areas to warrant a 70 percent rating or higher.

As for the other criteria required for a 70 percent rating, the Board finds that the documented symptomatology does not rise to the requisite level of severity. The record does not suggest that the Veteran exhibited obsessional rituals, impaired impulse control, spatial disorientation, or neglect of personal appearance or hygiene. The Veteran's speech and thoughts were regularly documented as normal rather than illogical, obscure, or irrelevant. Furthermore, the Veteran was regularly documented as appropriately dressed and groomed, which goes against finding that he neglected his personal appearance or hygiene.  Additionally, there was no evidence of suicidal ideation; obsessional rituals that interfered with routine activities; near continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control; spatial disorientation; or inability to establish and maintain effective relationships. While the Board acknowledges that the evidence shows the Veteran experienced difficulty in adapting to stressful circumstances, including work, the Board finds that the severity and frequency of this symptom alone does not rise to the level contemplated by a 70 percent rating.

Based on the foregoing, the Board finds that the Veteran's psychiatric symptoms are more closely approximated by the assigned 50 percent rating. As described above, the evidence persuasively weighs against the Veteran showing occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood; nor are his symptoms of similar severity, frequency, and duration to warrant an increased 70 percent disability rating. As the Board has found that the disability picture does not rise to the level of severity of the 70 percent rating, it follows that the Board finds that the disability picture does not rise to the level of severity of the 100 percent rating.

In sum, considering the total disability picture, the Board finds that the evidence persuasively weighs against an initial rating in excess of 50 percent for the Veteran's unspecified trauma or stressor related disorder. Therefore, the benefit of the doubt doctrine is not for application and the claim is denied. 38 C.F.R. � 4.7.

REASONS FOR REMAND

Entitlement to an initial compensable disability rating for tension headaches is remanded.

The issue of entitlement to an initial compensable disability rating for tension headaches is remanded to correct a pre-decisional error to assist the Veteran in the development of his claim. 38 C.F.R. � 20.802(a).

The Veteran contends that he is entitled to a higher disability rating for his tension headaches. See November 2024 VA Form 20-0996: Request for HLR.

A VA examination for the Veteran's tension headaches was obtained in February 2024. The Veteran reported recurring migraines and that he always had to be ready with medication in order to accomplish daily tasks. He indicated that he treated with naproxen as needed. He reported recurring extreme head pain due to migraines. The examiner indicated that the Veteran's treatment plan did not include taking medication for the diagnosed condition. Additionally, the examiner indicated that the Veteran experienced head pain that was pulsating or throbbing, on both sides of the head, and worsened with physical activity. The Veteran's non-headache symptoms associated with headaches included sensitivity to light and sensitivity to sound. The examiner indicated that the duration of the typical head pain was less than one day and that it occurred on both sides of the head. The examiner noted that the Veteran did not have characteristic prostrating attacks of migraine/non-migraine headache pain and did not have completely prostrating and prolonged attacks of migraines/non-migraine pain. She found that the Veteran's headache condition impacted his ability to work. She further explained that, while the Veteran's headaches did not cause extreme exhaustion, powerlessness, debilitation, or incapacitation with substantial inability to engage in ordinary activities, the headaches affected some of his concentration at work, which affected his productivity, though it was not enough to be considered debilitating or prostrating attacks.

The Board finds there was a pre-decisional duty to assist error in failing to obtain a medical opinion that is sufficient to make an informed decision on the claim. See 38 U.S.C. �� 5103A(a), 5103A(d)(2)(C); 38 C.F.R. � 3.159(c)(4). Once VA undertakes efforts to provide a VA examination, it must ensure that it is an adequate one. See Barr v. Nicholson, 21 Vet. App. 303 (2007).

The Board finds the February 2024 VA examination insufficient for rating purposes because it is internally inconsistent. Specifically, while the Veteran indicated that he treated with naproxen as needed and that he took medication in order to accomplish daily tasks, later in the examination report the examiner indicated that the Veteran's treatment plan did not include taking medication for the diagnosed condition. This finding conflicts with the Veteran's lay report; however, the examiner did not reconcile this contradiction.

Additionally, the Jones v. Shinseki, the United States Court of Appeals for Veterans Claims (Court) held that the Board may not consider the ameliorative effects of medication when assigning a disability evaluation when those effects are not explicitly contemplated by the rating criteria. 26 Vet. App. 56, 61 (2012). Recently, in Ingram v. Collins, the Court reaffirmed its central holding in Jones and held that the Board must discount the beneficial effects of medication when assigning a rating for a musculoskeletal disability because the applicable diagnostic codes and regulations pertaining to musculoskeletal disabilities do not explicitly contemplate medication use. 38 Vet. App. 130 (2025).

The Board finds the February 2024 VA examination insufficient for rating purposes because it did not comply with Jones v. Shinseki, recently reaffirmed in Ingram v. Collins, in assessing the severity of the Veteran's tension headaches. The Board notes that the Veteran's tension headache is evaluated under Diagnostic Code 8100. This diagnostic code does not explicitly contemplate the use of medication to alleviate symptoms. During the February 2024 VA examination, the Veteran reported treating with naproxen as needed and taking medication in order to accomplish daily tasks. However, the examiner did not indicate whether her findings as to the severity of the Veteran's migraines accounted for the effects of medication. Furthermore, as noted above, the examiner did not acknowledge the Veteran's use of medication as part of his treatment plan for tension headaches. The Board is prohibited from making medical findings as to the severity of the Veteran's tension headaches without the use of medication. See Colvin v. Derwinski, 1?Vet. App.?171, 174?(1991). As such, the information is insufficient to allow the Board to make an informed decision as to the severity of the Veteran's tension headaches during the period on appeal. Accordingly, remand is warranted to obtain a new medical opinion.

The matter is REMANDED for the following action:

Obtain a new medical opinion from an appropriately qualified clinician to determine the nature and severity of the Veteran's service-connected tension headaches. All indicated tests must be accomplished. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. It is up to the discretion of the reviewing clinician as to whether a new examination is necessary to provide an adequate opinion.

The examiner must describe the Veteran's tension headaches in detail and specifically note the character, frequency, and duration of the Veteran's headaches, to include whether they are prostrating, prolonged, or productive of severe economic inadaptability. The examiner must consider the Veteran's reported symptoms and noted impairment. The examiner should also comment upon the functional impairment resulting from such disability.

Pursuant to the Court's holdings in Jones v. Shinseki, 26 Vet. App. 56, 61 (2012) and Ingram v. Collins, 38 Vet. App. 130 (2025), the examiner must opine on what the severity of the Veteran's tension headache symptoms would be without the ameliorative effects of medication, including naproxen.

The examiner must consider the Veteran's report that he takes medication for his tension headaches in order to accomplish daily tasks.

A complete rationale must be offered for the opinion expressed, including a discussion of the evidence and medical principles which led to the conclusions reached.

If the examiner is unable to provide the requested opinion without resort to speculation, he or she should so state; however, a complete rationale for such a finding should be provided.

L. CHU

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	E. Corcoran, Associate Counsel

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. � 20.1303.


judge_norm: DONNIE R HACHEY

disposition: granted

condition: tinnitus

text:
Citation Nr: A26037000
Decision Date: 04/21/26	Archive Date: 04/21/26

DOCKET NO. 250515-545958
DATE: April 21, 2026

ORDER

Entitlement to service connection for tinnitus is granted.

FINDING OF FACT

The Veteran's tinnitus started during active service and continued to the present.

CONCLUSION OF LAW

The criteria to establish service connection for tinnitus have been met.  38 U.S.C. �� 1110, 5107; 38 C.F.R. �� 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from April 2011 to April 2015, September 2021 to May 2022, and from November 2024 to June 2025.

In a March 2024 rating decision, the Agency of Original Jurisdiction (AOJ) denied service connection for tinnitus.  In an October 2024 rating decision, the AOJ found a duty to assist error had been identified during the higher-level review for tinnitus.  After completing development, the AOJ most recently denied service connection for tinnitus on the merits in an April 2025 rating decision.

In May 2025, the Veteran submitted a VA Form 10182, appealing the issue of entitlement to service connection for tinnitus; nevertheless, the "Date of Decision(s)" listed were March 2024, October 2024, and April 2025.  Here, the March 2024 rating decision was issued over a year before May 2025, and, as a result, the Veteran's VA Form 10182 was untimely as to that decision.  Further, the October 2024 rating decision was an interlocutory decision that was not appealable to the Board.  However, the Veteran has continuously pursued his service connection claim for tinnitus, and the Board finds his appeal of the April 2025 rating decision is timely and warrants adjudication.

In the May 2025 VA Form 10182, the Veteran elected the Direct Review docket.  Therefore, the Board may only consider the evidence of record at the time of the April 2025 AOJ decision on appeal.  38 U.S.C. � 7113(a).

The allowable time to switch dockets at the Board has not expired.  However, as the Board is granting this appeal full, any further pause would only cause unnecessary delay to the appeals process with no additional benefit to the Veteran.  Accordingly, adjudication is appropriate.  See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994); Williams v. McDonough, 37 Vet. App. 305 (2024).

Service Connection

A veteran is entitled to VA disability compensation if there is a disability resulting from personal injury suffered or disease contracted in the line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty in active service.  38 U.S.C. � 1110.

Generally, to establish a right to compensation for a present disability, a veteran must show: (1) a present disability; (2) an 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.  Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that a disease was incurred in service.  38 C.F.R. � 3.303(d).

The first two Shedden elements are met and are not in dispute.  The Veteran has tinnitus and VA conceded military noise exposure to loud noises from heavy equipment such as tractors and generators.  38 C.F.R. � 3.104(c).  Further, the Veteran has stated that his tinnitus began in service and continued ever since.  See January 2024 Veteran statement.

Because tinnitus is a condition capable of lay observation, the Veteran is competent to testify as to his observed symptoms and the actual existence of the condition.  The Board finds that the Veteran's assertions are credible.

Because the Veteran's tinnitus began in service and continued thereafter, service connection for tinnitus is warranted.  See Lynch v. McDonough, 21 F.4th 776, 781-82 (2021); 38 C.F.R. � 3.102.

DONNIE R. HACHEY

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M. Salazar, 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: R BISIGNANI

condition: psychiatric

text:
Citation Nr: A26038000
Decision Date: 04/23/26	Archive Date: 04/23/26

DOCKET NO. 250808-582777
DATE: April 23, 2026

ORDER

Entitlement to service connection for an acquired psychiatric disorder is granted.

FINDING OF FACT

The Veteran has an acquired psychiatric disability that is related to military service.

CONCLUSION OF LAW

The Veteran's acquired psychiatric disability was incurred during his military service.  38 U.S.C. � � 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. �� 3.102, 3.159, 3.303, 3.304(f), (2021).

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from February 1966 to December 1967.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a December 2024 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).

In August 2025 and then in a clarification letter in September 2025, the Veteran submitted VA Form 10182 Decision Review Request: Board Appeal (Notice of Disagreement) and selected Hearing with a Veterans Law Judge Board review option, indicating he wanted a Board hearing and the opportunity to submit additional evidence in support of the appeal within 90 days of hearing.

In a December 2025 Board hearing, the Veteran testified before the undersigned Veterans Law Judge. A hearing transcript has been associated with the claims file.

Therefore, the Board may only consider the evidence of record at the time of the AOJ's December 2024 rating decision, which is considered the decisions on appeal, as well as any evidence submitted by the Veteran at the hearing or within 90 days following the hearing. 38 C.F.R. � 20.302 (a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. �� 20.300, 20.302(a), 20.801.

The Board notes that the January 2025 rating decision denied service connection for an unspecified depressive disorder.

However, the Board acknowledges that the scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record.  Clemons v. Shinseki, 23 Vet. App. 1 (2009).  The Board will accordingly consider entitlement to service connection for any and all psychiatric disorders.

Service Connection

Laws and Regulations

Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service.  38 U.S.C. � 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."  Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

In relevant part, 38 U.S.C. � 1154(a) requires that the VA give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim to disability or death benefits.  Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional."  Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed.Cir.2007).  In fact, competent medical evidence is not necessarily required when the determinative issue involves either medical etiology or a medical diagnosis. Id. at 1376-77; see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

Once evidence is determined to be competent, the Board must determine whether such evidence is also credible.  See Layno, supra (distinguishing between competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted").

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant.  38 U.S.C. � 5107(b).

Acquired Psychiatric Disorder

The Veteran contends that he has a psychiatric disorder as a result of service to include an in-service accident where the Veteran was aboard a tanker which crashed into a ship that it was refueling. He additionally noted that fellow sailors of his died while they were out at sea.

At his December 2025 hearing, the Veteran testified that he served aboard the U.S.S. Sabine where he experienced multiple traumatic experiences. The Veteran noted that the USS Sabine, which was a fueling tanker, crashed into the U.S.S. Intrepid which was an aircraft carrier. The Veteran's representative also noted that this event was conceded by the RO in the December 2024 rating decision.

The Veteran also testified that an officer was buried at sea while he was aboard and 3 other sailors also died in an incident where they inhaled toxic chemicals in tanks. The Veteran also had an incident where he was beaten up during time in Naples, Italy where he thinks he lost consciousness.

The Veteran underwent a VA examination on December 6, 2024. The diagnosis was unspecified depressive disorder. The examiner noted that a mental condition had been formally diagnosed but symptoms were not severe enough either to interfere with occupational and social functioning or to require continuous medication. It was noted though that he had been seen for VA treatment in June 2024 and diagnosed with adjustment disorder with anxiety and depressed mood. On examination, the Veteran had depressed mood.

In a December 23, 2024, VA examination that included only a review of the records, the diagnosis was adjustment disorder with depressive and anxious symptoms. The examiner opined that it was less likely than not that the Veteran's acquired psychiatric disorder was incurred in or caused by the claimed in-service event, injury or illness. The examiner who conducted the record review indicated that the Veteran's medical records were silent for any mental health issues related to the reported in-service events and the Veteran's separation examination was also negative for mental health issues.

After resolving all reasonable doubt in favor of the Veteran, the Board finds service connection for an acquired psychiatric disorder to include adjustment disorder with depressive and anxious symptoms is warranted as the Board finds there is at least an approximate balance of evidence as to whether the Veteran has a current acquired psychiatric disorder to include adjustment disorder with depressive and anxious symptoms that is related to is service.

As reflected above, the Veteran has a diagnosis of adjustment disorder with depressive and anxious symptoms. However, a veteran seeking disability benefits must establish not only the existence of a disability, but also an etiological connection between his military service and the disability.  Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); D'Amico v. West, 209 F.3d 1322, 1326 (Fed. Cir. 2000); Hibbard v. West, 13 Vet. App. 546, 548 (2000).

Additionally, the evidence is sufficient to decide the claim, as it shows onset of acquired psychiatric disorder symptoms in service continuing until the post-service diagnosis.

In this respect, the Veteran competently and credibly indicated that symptoms of his acquired psychiatric disorder began in service and have continued since that time. This is sufficient to establish the onset of the acquired psychiatric disorder in service, which warrants a finding of service connection.  38 C.F.R. � 3.303(a) ("service connection connotes many factors but basically it means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces"); Flynn v. Brown, 6 Vet. App. 500, 503 (1994) ("Congress has designed and fully intends to maintain a beneficial non-adversarial system of veteran's benefits.  This is particularly true of service-connected disability compensation where the element of cause and effect has been totally by-passed in favor of a simple temporal relationship between the incurrence of the disability and the period of active duty").  See also Dallas v. McDonough, No. 20-1215, 2021 U.S. App. Claims LEXIS 235, *4 (Feb. 18, 2021) (mem dec., Falvey, J.) (noting that the question for the Board in a direct service connection case is "not whether military service caused the Veteran's disability but 'whether the Veteran has a current disability that began during service'"); Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992) (single judge decisions may be relied upon for any persuasiveness or reasoning they contain).

To the extent that the grant of service connection for an acquired psychiatric disorder is based upon the plausible, consistent, and credible lay evidence, "[n]othing in the regulatory or statutory provisions [relating to evidence to be considered] requires both medical and competent lay evidence; rather, they make clear that competent lay evidence can be sufficient in and of itself". Buchanan, 451 F.3d at 1335.

As noted above, the December 2024 VA examiner opined that it was less likely than not that the Veteran's acquired psychiatric disorder was incurred in or caused by the claimed in-service event, injury or illness.

However, this opinion, conducted after a record review, was seemingly based on the fact that the records did not show that the Veteran was treated for mental issues in service. As noted above though, the Veteran credibly testified as to in-service incidents that resulted in his current acquired psychiatric disorder disability.

As a result, the Board finds that there is an approximate balance of positive and negative evidence regarding the question of whether the Veteran has a current acquired psychiatric disorder disability that was caused by his service.

Additionally, a remand for a new VA examination is not necessary because the evidence of record is sufficient to grant the Veteran's claim, and a remand would only serve to unnecessarily delay final adjudication of the claim.

(Continued on the next page)

?

In sum, for the reasons and bases discussed above, all doubt is resolved in favor of the Veteran, and service connection for an acquired psychiatric disorder disability, is warranted.  See 38 U.S.C. � 5107(b).

R. Bisignani

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	James A. DeFrank

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: PAULETTE VANCE BURTON

condition: gi

text:
Citation Nr: A26039000
Decision Date: 04/27/26	Archive Date: 04/27/26

DOCKET NO. 200506-86837
DATE: April 27, 2026

ORDER

Entitlement to service connection for internal or external hemorrhoids is granted.

FINDING OF FACT

Resolving reasonable doubt in the Veteran's favor, the probative evidence of record indicate that the Veteran's hemorrhoids condition is at least as likely as not related to an in-service injury, event, or illness.

CONCLUSION OF LAW

The criteria for service connection for hemorrhoids have 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 in the United States Marine Corp Reserve from January 2008 to March 2009 and the United States Army from September 2010 to March 2011, April 2011 to August 2011, and March 2013 to April 2014.

This matter comes before the Board of Veterans' Appeals (Board) from an April 2020 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) which denied service connection for internal or external hemorrhoids. See April 2020 rating decision.

In the May 2020 VA Form 10182 Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on April 30, 2024, before the undersigned Veterans Law Judge (VLJ).  The transcript has been added to the file.  See April 2024 Hearing Transcript. Therefore, the Board may only consider the evidence of record at the time of the April 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. � 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. �� 20.300, 20.302(a), 20.801.

Service Connection

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

The standard of proof to be applied in decisions on claims for VA benefits is set forth in 38 U.S.C. � 5107(b). Under that provision, VA shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. Id.; see also Gilbert v. Derwinski, 1 Vet. App. 49 (1990).

1. Entitlement to service connection for internal or external hemorrhoids is granted.

The Veteran was given a Compensation & Pension (C&P) examination in November 2019. See November 2019 C&P Exam. The Veteran was diagnosed with internal or external hemorrhoids at the examination. As such, the first element of service connection has been satisfied.

The Veteran reported in service injury or illness. Id. The Veteran had a hemorrhoidecotmy operation in 2009 due to severe symptoms. Id. The Veteran's symptoms continued over the years, mostly with straining. The Veteran treats his condition with OTC medications as needed. Id.

The November 2019 examiner provided a positive nexus opinion and opined that the Veteran's condition was at least as likely as not incurred in or caused by an in-service injury, event or illness. See November 2019 medical opinion. The examiner provided the following rationale:

After extensive medical records review and research. Noted treatment in STRs for hemorrhoids with hemorrhoidecotmy procedure noted in Jan 2009. Continued treatments with suppositories and creams. As condition had onset with treatment in service with continued treatments since discharge, at least as likely as not incurred in or caused by service.

The RO denied service connection stating that the injury did not occur during qualifying service. See April 2020 rating decision. During the April 2024 Hearing, the Veteran representative noted that unfortunately, the Department of Veterans Affairs did not recognize that the original injury was in an active period in the Line of Duty. The RO indicated that the Veteran wasn't on active duty when his condition occurred.

However, during the April 2024 Hearing, the Veteran testified that his condition did in fact occur and continue in service. The Veteran had symptoms while on active duty.  The Veteran testified that:

December 2008, January 2009, I attended Marine Corps OCS in Quantico, Virginia. During my time at the OCS, is when I developed hemorrhoids, and this specific instance is I had an external thrombosed hemorrhoid. Which essentially got infected and caused a blood clot and they had to operate on it. Based off of that, I was what the Marine Corps deemed not physically qualified to continue with training and was basically sent home from training. From that, I received an LOD or a Line of Duty to have follow-up treatment at the Luke Air Force Base which is local to Phoenix, where I live, and to get follow-up treatment in regard to that hemorrhoids that occurred at Marine Corps OCS.

The Veteran further testified that while he was in the Army, he continued to have issues and instances with hemorrhoids.

A June 2024 Military History Information Report shows honorable service in the Marine Corps reserves from January 9, 2009, to July 9, 2009.

Health records from the Copper Clinic Medical Group which is the Air Force Base at Luke note hemorrhoids on May 8, 2009. The patient category noted is USMC Active Reserve showing Marine Corps Reserve status. See Medical Treatment Record - Government Facility

The RO indicated that the Veteran wasn't on active duty when hemorrhoids occurred. But based on the Veteran's testimony and health records, he was in fact at OCS at Quantico when his condition occurred. The Veteran testified that prior to reporting to Quantico, he did not have any issues with hemorrhoids or had never received treatment for hemorrhoids prior to service.

(CONTINUED ON NEXT PAGE.)

?

The Board therefore finds that the competent evidence of record indicates that the Veteran has a current internal/external hemorrhoids disability that was present in service and has continued ever since. As the Board finds that the evidence for and against the claim is in approximate balance; therefore, the benefit of the doubt must be resolved in favor of the Veteran, and entitlement to service connection for hemorrhoids is warranted. 38 U.S.C. � 5107 (b) (2018); Lynch v. McDonough, 999 F.3d 1391 (Fed. Cir. 2021).

Paulette Vance Burton

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Gaminchi, Yasmin

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: B MULLINS

text:
Citation Nr: A26040000
Decision Date: 04/29/26	Archive Date: 04/29/26

DOCKET NO. 260318-639382
DATE: April 29, 2026

ORDER

Entitlement to service connection for the Veteran's cause of death is granted.

FINDING OF FACT

The Veteran's death certificate lists the cause of death as motor neuron disease with respiratory failure.

CONCLUSION OF LAW

The criteria for establishing entitlement to service connection for the cause of the Veteran's death have been met. 38 U.S.C. �� 1110, 1310; 38 C.F.R. �� 3.102, 3.303, 3.304, 3.309, 3.312, 3.318.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had honorable active duty service in the United States Army from March 1954 to December 1955. He died in August 1999. The appellant is his surviving spouse.

The claim for cause of death was denied in a February 2026 rating decision. In the March 2026 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the appellant elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the February 2026 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. � 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. �� 20.300, 20.301, 20.801.

If the appellant would like VA to consider any evidence that was submitted that the Board could not consider, the appellant may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. � 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim, 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 acknowledges that the time for a docket switch waiver has not yet elapsed and that the appellant has not submitted a waiver of her right to switch dockets. See Williams v. McDonough, 37 Vet. App. 305 (2024). Notwithstanding, the appeal has been advanced on the docket and the appellant's choice of direct review indicates she is seeking the fastest review possible. See also April 2025 Statement in Support of the Case (requesting the VA make a decision as soon as possible). Accordingly, the Board will proceed with the appeal.

The appellant contends that service connection is warranted for the cause of the Veteran's death.

After consideration of the evidence and applicable law, the Board finds that entitlement to service connection for the cause of the Veteran's death is warranted.

Generally, service connection may be established for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. � 1110; 38 C.F.R. � 3.303 (a). Service connection may also be established for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. � 3.303(d). Under 38 C.F.R. � 3.303 (b), service connection may be established when the evidence, regardless of its date, shows that a Veteran had a chronic condition in service or during the applicable presumptive period. Certain listed chronic diseases may be presumed to be service connected if manifested to a compensable degree within a year following separation from service. 38 U.S.C. �� 1101, 1112, 1113, 1137; 38 C.F.R. �� 3.307(a), 3.309(a). For such chronic diseases specified in 38 C.F.R. � 3.309(a), service connection may also be established based on continuity of symptomatology. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

A death will be considered to result from a service-connected disability when the evidence establishes that a disability which is causally related to service, was either the principal or a contributory cause of the Veteran's death. 38 U.S.C. � 1310; 38 C.F.R. � 3.312 (a). For a service-connected disability to constitute a principal (or primary) cause of death, it must be shown that such disability, singly or jointly with some other condition, was the immediate or underlying cause of death or was etiologically related thereto. 38 C.F.R. � 3.312(b). For a service-connected disability to constitute a contributory cause of death, it must be shown to have contributed substantially and materially to the Veteran's death; combined to cause death; aided or lent assistance to the production of death; or resulted in debilitating effects and general impairment of health to an extent that would render the Veteran materially less capable of resisting the effects of other disease or injury causing death, as opposed to merely sharing in the production of death. 38 C.F.R. � 3.312(c). Although there are primary causes of death which by their very nature are so overwhelming that eventual death can be anticipated irrespective of coexisting conditions, even in such cases, consideration must be given to whether there may be a reasonable basis to hold that a service-connected condition was of such severity as to have a material influence in accelerating death, where the service-connected condition affected a vital organ and was of itself of a progressive or debilitating nature. 38 C.F.R. � 3.312(c).

There is a presumption of service connection for veterans who develop ALS at any time after separation from service, unless (1) there is affirmative evidence it was not incurred in, or aggravated by, service; (2) there is affirmative evidence that it is due to the Veteran's willful misconduct; or (3) the Veteran did not have continuous active service of 90 days or more. 38 C.F.R. � 3.318.

There is no affirmative evidence that the Veteran developed ALS was not incurred in or aggravated by service or due to his willful misconduct. The Veteran had continuous active-duty service of 90 days or more.

The Veteran died in August 1999. See August 1999 death certificate. Cause of death was respiratory failure due to motor neuron disease. Id.

The appellant submitted several buddy statements from the Veteran's children, sister, brother, nephew, and friends attesting to the Veteran having been diagnosed with or having had symptoms of amyotrophic lateral sclerosis (ALS). Of note, the Veteran's oldest child attested to his diagnosis of ALS in 1997. See May 2024 Sworn Buddy statement. She attested to the progression of the disease and rapid decline of the Veteran. Id.

After several attempts to obtain a proper VA 21-4142 Authorization for release of Information, the appellant notified the VA she had no other medical documentation to submit at the time and requested the VA to make a decision as soon as possible. See April 2025 Statement in Support of Claim.

The Board notes that ALS is recognized as a motor neuron disease. See Amyotrophic Lateral Sclerosis (ALS), https://www.ninds.nih.gov/health-information/disorders/amyotrophic-lateral-sclerosis-als.

The Board has considered remand to obtain a medical opinion as to the cause of death, but such a request could be construed as obtaining additional evidence for the sole purpose of denying a claim, which is impermissible.  38 C.F.R. � 3.304(c) ("The development of evidence in connection with claims for service connection will be accomplished when deemed necessary but it should not be undertaken when evidence present is sufficient for this determination"); Andrews v. McDonough, 34 Vet. App. 216, 225 (2021) ("Remand is inappropriate where the predominant purpose is not to allow the Board to make a fully informed decision unencumbered by error but to allow VA to obtain more evidence so that it can properly deny the claim").

The above evidence is sufficient to decide the claim.  Based on the available evidence, the Board finds that the Veteran had an ALS diagnosis. See generally Buddy Statements.

As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, and entitlement to service connection for ALS is warranted.  38 U.S.C. � 5107(b); 38 C.F.R. � 3.102.

As the cause of death resulted from a motor neuron disorder, to include ALS, entitlement to service connection for cause of death is warranted.

B. MULLINS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Jarman, Timothy

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: PAUL SORISIO

condition: arthritis

text:
Citation Nr: A26041000
Decision Date: 04/30/26	Archive Date: 04/30/26

DOCKET NO. 211104-195714
DATE: April 30, 2026

REMANDED

Entitlement to service connection for degenerative joint disease of the left femur is remanded.

REASONS FOR REMAND

The Veteran served on active duty from May 3, 1978 to May 24, 1978. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2021 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO).

Based upon the selection of the Hearing docket, the Board may consider the evidence of record as of September 8, 2021-the date of the rating decision on appeal, and evidence submitted at or within 90 days of the June 16, 2025 Board hearing. See 38 C.F.R. �� 20.302. If the Veteran submitted evidence that was added to the record after September 8, 2021 and before the June 16, 2025 Board hearing, or more than 90 days following the Board hearing, the Board did not consider it. If the Veteran wishes to have VA consider any evidence that was not considered, a supplemental claim should be submitted identifying such evidence. See 38 C.F.R. � 3.2501.

The September 2021 rating decision found that new and relevant evidence had been received to readjudicate the claim of entitlement to service connection for degenerative joint disease of the left femur.  This is a favorable finding by the agency of original jurisdiction (AOJ), and the Board will proceed to the address the claim on the merits.  See 38?U.S.C. � 5104A; 38?C.F.R. � 3.104(c).

Entitlement to service connection for degenerative joint disease of the left femur is remanded.

The Veteran contends that his pre-service left femur condition was aggravated beyond its natural progression by his active-duty service. The Veteran testified that at age 17, he had hip surgery and pins were placed in his hip. However, at age 18, he had the pins removed and had no trouble with his hips until he entered the military and started training. See Hearing Transcript received 6/16/2025 at page 4.

At the outset, the Board finds that the Veteran's left hip condition was noted upon entrance into service. 38 C.F.R. � 3.304(b). Specifically, the Veteran's lower extremity was found to be abnormal, and in the notes section of the Report of Medical Examination (box #37) his left femur condition was discussed in detail. See STR-Medical received 10/15/1998 at pages 3-4. Therefore, the claim is for service connection based on aggravation of a pre-existing condition.

In general, service connection will be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C � 1131; 38 C.F.R. � 3.303(a).

When a defect, infirmity, or disorder is noted on the enlistment examination, the only benefits that can be awarded are for aggravation pursuant to 38 U.S.C. � 1153 and 38 C.F.R. � 3.306. See Wagner v. Principi, 370 F.3d 1089, 1096 (Fed. Cir. 2004). A pre-existing injury or disease will be presumed to have been aggravated by active service where there is an increase in disability during such service, unless there is a specific finding that the increase in disability was due to the natural progress of the disease. 38 C.F.R. � 3.306(a). In such claims, the evidence of record must simply show that there was an increase in disability during service to trigger the presumption of aggravation; the burden then shifts to the government to show a lack of aggravation by establishing "that the increase in disability is due to the natural progress of the disease." See id. at 1096 (citing 38 U.S.C. � 1153). This requires the government to show by clear and unmistakable evidence that any increase in disability was due to the natural progress of the condition. See Cotant v. Principi, 17 Vet. App. 116, 130-32 (2003); see also 38 C.F.R. � 3.306(b).

As discussed at the June 2025 Board hearing, the burden of proof is on the Veteran to show worsening during service. See Hearing Transcript received 6/16/2025 at page 3. At the June 2025 Board hearing, the Veteran stated that he would get a statement from his current provider, Dr. S. Though the Veteran has not submitted a statement within the 90-day period, he is advised that since this matter is being remanded back to the RO to correct a pre-decisional duty to assist error, the record will be open and he may submit additional evidence if he chooses. 38 C.F.R. � 3.103(c)(2)(ii).

The Board finds there was a pre-decisional duty to assist error in not providing the Veteran with an adequate medical opinion, and as such this matter is being remanded to correct the error. 38 C.F.R. � 20.802(a). Here, the Veteran received a VA examination and medical opinion in April 1999 that diagnosed degenerative joint disease, status post-pinning of left slipped capital femoral epithesis but the VA examiner did not address whether his condition increased in severity during service, nor whether the increase in severity was clearly and unmistakably due to the natural progress of the disease. For these reason, this VA opinion is inadequate.

VA has a duty to assist the Veteran with his claim, which includes providing an adequate VA medical opinion. Based on the above, the Board finds that a remand is required for a new medical opinion that addresses whether the Veteran's pre-existing condition was aggravated by his service. 38 U.S.C. �5103A(f)(2)(A); 38 C.F.R. � 20.802(a).

This matter is REMANDED for the following action:

Obtain an addendum opinion from an appropriate clinician for the Veteran's left femur condition. A new physical examination is not required unless deemed necessary by the clinician. The examiner is to review the claims file to become familiar with the Veteran's relevant medical history.

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

a)	Did the Veteran's left femur condition, which existed prior to service, at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) increase in severity during service?

b)	If so, was the increase in severity clearly and unmistakably (i.e., undebatable) due to the natural progress of the disease?

A comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be given without resorting to speculation, the examiner should explain why 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).

Paul Sorisio

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	S. Dixon

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: STEVEN D REISS

condition: heart

text:
Citation Nr: 26000001
Decision Date: 01/02/26	Archive Date: 01/02/26

DOCKET NO. 17-49 300
DATE: January 2, 2026

ORDER

The Veteran's March 29, 2016, substantive appeal (VA Form 9) was timely filed as to the Statement of the Case (SOC) dated January 15, 2016, and January 22, 2016.

Service connection for a traumatic brain injury (TBI) and residuals, to include migraines and a psychiatric disability, is granted.

REMANDED

Service connection for a cardiac disability is remanded.

FINDINGS OF FACT

1. On January 15, 2016, and January 22, 2016, VA issued two separate SOCs regarding the issues of service connection for a TBI and cardiac disability.

2. On March 15, 2016, and March 23, 2016, the Veteran requested an extension to file his substantive appeal.  After VA denied his request for an extension, the Veteran filed a VA Form 9 on March 29, 2016.

3. The Veteran had good cause for his extension request to file a substantive appeal.  As such, the Veteran's VA Form 9 was timely filed as to both January 15, 2016, and January 22, 2016, SOCs.

4. Resolving doubt in the Veteran's favor, the Veteran's TBI, manifested by migraines and a psychiatric disability, had its onset in service.

CONCLUSIONS OF LAW

1. A timely substantive appeal (VA Form 9) was submitted.  38 U.S.C. � 7105; 38 C.F.R. �� 3.102, 3.109(b), 19.22, 19.30, 19.34, 19.52.

2. The criteria for service connection for a traumatic brain injury (TBI) and residuals have been met.  38 U.S.C. �� 1110, 1131, 1154(a), 5107(b); 38 C.F.R. �� 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty with the United States Marine Corps from October 1971 to October 1975 and from August 1977 to February 1982.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from September 2013 and September 2014 rating decisions.

In September 2014, the Veteran submitted a Notice of Disagreement (NOD) with the September 2013 rating decision, which denied service connection for a cardiac disability, and, in September 2015, the Veteran submitted a NOD with the September 2014 rating decision, which denied service connection for TBI.

As will be discussed further below, in January 2016, the RO then issued two separate SOCs.  On March 15, 2016, and March 23, 2016, the Veteran requested an extension to file his substantive appeal, which the RO denied.  On March 29, 2016, the Veteran then filed his substantive appeal.  On April 1, 2016, the RO notified the Veteran that the substantive appeal was untimely.

In April 2017, the Veteran filed an NOD, appealing the finding that the substantive appeal was untimely.  In July 2017, the RO then issued an SOC.  In September 2017, the Veteran filed a timely VA Form 9.

In July 2025, the Veteran testified at a Board hearing held before the undersigned Veterans Law Judge.

Timeliness of the VA Form 9.

The Veteran now seeks to have his VA Form 9 considered timely such that his legacy claim may proceed.

In the legacy system of VA appeals (i.e., the process to appeal decisions issued by the agency of original jurisdiction (AOJ) prior to February 19, 2019), appellate review of a decision is initiated when the Veteran files timely notice of disagreement.

The AOJ then issues an SOC explaining the reasons for the decision.  The Veteran then must file a substantive appeal to appeal to the Board of Veterans' Appeals.  38 U.S.C. � 7105(a); 38 C.F.R. �� 19.22, 20.200.

A substantive appeal consists of a properly completed VA Form 9 ("Appeal to Board of Veterans' Appeals") or correspondence containing the necessary information.  38 C.F.R. � 19.22.

A substantive appeal must be filed within 60 days from the date that the AOJ mails the SOC to the Veteran (and his or her appointed representative), or within the remainder of the one-year period from the date of mailing of the notification of the determination being appealed, whichever period ends later.  38 C.F.R. �� 20.200, 20.300, 20.302.  The date of mailing of the SOC will be presumed to be the same as the date of the SOC, and the date of mailing the letter of notification of the determination will be presumed to be the same as the date of that letter for purposes of determining whether an appeal has been timely filed.  38 U.S.C. � 7105(d); 38 C.F.R. �� 19.30, 19.52.

Upon request, the time period for filing a substantive appeal may be extended for a reasonable period for good cause shown.  However, a request for such an extension should be in writing and must be made prior to the expiration of the time limit for filing the substantive appeal.  38 U.S.C. � 7105(d)(3); 38 C.F.R. � 3.109(b), 19.53.

In the legacy system of VA appeals, the formality of perfecting an appeal to the Board is part of a statutory and regulatory scheme that requires the filing of both a notice of disagreement and a formal appeal.  Roy v. Brown, 5 Vet. App. 554 (1993).  Questions as to timeliness or adequacy of response shall be determined by the Board.  38 U.S.C. � 7105(d)(3).

Additionally, receipt of a substantive appeal is not a mandatory jurisdictional requirement, and VA may waive any issue of timeliness in the filing of a substantive appeal, either explicitly or implicitly, where appropriate.  Percy v. Shinseki, 23 Vet. App. 37 (2009).

Here, the evidence shows that the Veteran had good cause to request an extension of time to submit his substantive appeal.   During the July 2025 hearing, the Veteran testified that, in 2015 and 2016, he was struggling with many health issues, including TBI and cardiovascular issues, and had changes in his medications, which affected his ability to function.

In a subsequent October 2025 Statement, the Veteran reported that, at the time he filed an extension to file his substantive appeal, he was struggling to get his medications restored through VA and had recently been in the emergency room for a cardiac incident.  The Veteran further stated that, several days after his extension request was denied by VA, he tried to commit suicide.

As such, the Board finds that the Veteran timely perfected his appeal before the Board and that the issues of service connection for a TBI and for a cardiac disability are now properly before the Board.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred or aggravated during active military service.  38 U.S.C. � 1110, 1131; 38 C.F.R. � 3.303(a).  Disorders diagnosed after discharge will be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service.  38 C.F.R. � 3.303(d).

Generally, service connection requires (1) the existence of a present disability, (2) in-service incurrence or aggravation of an injury or disease, 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 (Fed. Cir. 2004).

Lay evidence, if competent and credible, may serve to establish a nexus in certain circumstances.  See Davidson v. Shinseki, 581 F.3d 1313 (2009) (noting that lay evidence is not incompetent merely for lack of contemporaneous medical evidence).  When considering whether lay evidence may be competent, the Board must determine, on a case-by-case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent.  Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that "[w]hether lay evidence is competent and sufficient in a particular case is a factual issue.").

As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, consistency with other evidence submitted on behalf of the Veteran, and the Veteran's demeanor when testifying at a hearing.  See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996).

And, finally, when the evidence is in approximate balance in the Veteran's favor or nearly equal regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant.  38 U.S.C. � 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

Service connection for a TBI and residuals, manifested by migraines and a psychiatric disability, is granted.

The Veteran seeks service connection for a head injury, diagnosed as a TBI and residuals, to include migraines and a psychiatric disability.  Specifically, the Veteran reported that, during service, he was hit by a moped, sustaining a serious injury to his head.  The Veteran contends that, due to the head trauma in service, he experiences migraines, loss of vision due to those migraines, and psychiatric symptoms.

During the July 2025 hearing, the Veteran testified that, in 1980, during service, he was hit with a moped, resulting in a serious head injury.  The Veteran testified that, after he was hit with the moped, he was confused, got up, and made his way back to the barracks to wash the blood and vomit off himself.  He stated that the accident disrupted his life, that he gave up his career in the Marine Corps, lost his fianc�e, and moved away to Alaska to hide and get away from everyone.  The Veteran stated that he had other head traumas during his first period of service but that his service treatment records were lost and could not be located to verify.  He further testified that his 1980 accident, the traumas earlier on, and the 2006 accident all contributed to the current symptoms he now experiences, to include his psychiatric symptomatology.

Based on the evidence of record, the Board finds that service connection for a TBI and residuals is warranted.  38 U.S.C. � 1110, 1131; 38 C.F.R. � 3.303(d); Shedden, 381 F.3d at 1166-67.

First, the Board finds that the Veteran has several current disabilities and that there has been an in-service injury or aggravation of an injury or disease.

In an August 2013 VA examination, the VA examiner diagnosed the Veteran with a TBI and noted the Veteran's exposure to two blasts in service.  The examiner stated that there is objective evidence on testing of moderate impairment of memory, attention, concentration, and executive functions resulting in moderate functional impairment.  The examiner further stated that the Veteran has word-finding difficulty, trouble with planning, and his short-term memory is impaired.

In an August 2014 VA examination, the VA examiner diagnosed the Veteran with migraines including migraine variants.  The examiner noted that the Veteran's service treatment records document his moped accident in 1980.  The Veteran's June 1980 records document that he was treated at the emergency room and that he had various abrasions, contusions, and lacerations.

In a June 2023 VA examination, the VA examiner diagnosed the Veteran with anxiety disorder, unspecified.  During the examination, the Veteran reported incurring a head injury during an accident with a moped in 1980.  The Veteran stated that, before the accident, he was engaged to be married and had a good relationship with his peers and command staff and that, after the accident, he ended his relationship with his fianc�e.  The Veteran further reported that he felt like he had a complete personality change after the accident and decided to live in Alaska in isolation.

In a December 2011 private opinion, a private examiner stated that, per his clinical review, the Veteran had a serious head injury in service and now has psychomotor slowing.

In a June 2012 private opinion, the Veteran's private physician stated that the Veteran is being treated for visual migraines, for which he has suffered due to previous head injuries.  She stated that the Veteran sustained a head injury when the Veteran was twenty-five and was hit by a moped, and again in 2006, when he was hit in the head.  The private examiner opined that it is at least as likely as not that the previous head injury while on active duty contributes to his present medical condition.

In a September 2025 opinion, a private examiner stated that she has been treating the Veteran since June 2017.  She stated that the Veteran has been diagnosed with posttraumatic stress disorder, panic disorder, social anxiety disorder, and unspecified depressive disorder.  The examiner stated that the Veteran's symptoms are highly likely to be a direct result of military service-related trauma exposure from service in the Marine Corps.

In determining the probative value to be assigned to a medical opinion, the Board must consider three factors.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008).  The initial inquiry in determining probative value is to assess whether a medical expert was fully informed of the pertinent factual premises (i.e., medical history) of the case.  A review of the claims file is not required since a medical professional can also become aware of the relevant medical history by having treated a Veteran for a long period of time or through a factually accurate medical history reported by a Veteran.  Id. at 303-04; see also Kowalski v. Nicholson, 19 Vet. App. 171, 179 (2005) ("although the Board may reject a medical opinion that is based on facts provided by the veteran that have previously been found to be inaccurate (Reonal) and may reject such a medical opinion because other facts present in the record contradict the facts provided by the veteran that formed the basis for the opinion (Swann), the Board may not disregard a medical opinion solely on the rationale that the medical opinion was based on a history given by the veteran.").

The second inquiry involves consideration of whether the medical expert provided a fully articulated opinion.  Id.  A medical opinion that is equivocal in nature or expressed in speculative language does not provide the degree of certainty required for medical nexus evidence.  See McLendon v. Nicholson, 20 Vet. App. 79 (2006).

The third and final factor in determining the probative value of an opinion involves consideration of whether the opinion is supported by a reasoned analysis.  Therefore, a medical opinion containing only data and conclusions is not entitled to any weight.  In fact, a review of the claims file does not substitute for a lack of a reasoned analysis.  See Nieves-Rodriguez, 22 Vet. App. at 304; see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions.").

Additionally, a medical opinion is adequate when the medical expert discussed the relevant facts of a Veteran's case, including the Veteran's report of symptoms and medical history, such that the opinion and rationale sufficiently inform the Board of the expert's judgment on the medical question.  Miller v. Wilkie, 32 Vet. App. 249, 254 (2020).

The Board finds the June 2012 and September 2025 private opinions to be highly probative.  The private examiners both treated the Veteran and had opportunity to review his entire medical history.  Additionally, the private examiners provided fully articulated opinion supported by a reasoned analysis and thoroughly discussed the Veteran's lay statements.

Furthermore, the Board finds that the consistent lay statements from the Veteran constitute competent and credible evidence that the Veteran sustained a head injury in service and that his migraine and psychiatric symptoms began in service and have since continued to the present.  See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); Barr, 21 Vet. App. at 310; 38 C.F.R. � 3.159 (a)(2).

Accordingly, resolving all reasonable doubt in the Veteran's favor, service connection for a TBI and residuals, to include migraines and a psychiatric disability, is warranted.  38 U.S.C. � 5107; 38 C.F.R. � 3.102.  See Flynn v. Brown, 6 Vet. App. 500, 503 (1994) (noting that "the element of cause and effect has been totally by-passed in favor of a simple temporal relationship between the incurrence of the disability and the period of active duty"); see also 38 C.F.R. � 3.303(a) (Service connection connotes many factors but basically it means that the facts, shown by evidence, establish that a particular injury or disease resulting in disability was incurred coincident with service in the Armed Forces).

REASONS FOR REMAND

Service connection for a cardiac disability is remanded.

The Veteran seeks service connection for a cardiac disability, which he contends began in service and has continued since then.

In a December 2011 private opinion, a private examiner opined that the Veteran's current cardiac problems are due to the experiences and/or trauma that the Veteran experienced during his military service.  The examiner reasoned that the Veteran was sound upon entry, had medical visits for cardiovascular problems in service, and that the Veteran's statements regarding his cardiovascular symptomatology show chronicity of service.

To date, no VA examination or opinion has been made regarding the onset, etiology, and nature of his cardiac condition.

In light of the evidence presented, the Board finds that the "low threshold: requirement under McLendon v. Nicholson, 20 Vet. App. 79 (2006) is met, and the Veteran should be afforded a VA examination to determine the onset, nature, and etiology of his cardiac condition.

The matters are REMANDED for the following action:

1. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service cardiac disability.

2. Schedule a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible).

The examiner must identify any cardiovascular conditions found to be present.

The examiner is asked to state whether any diagnosed cardiovascular conditions are due to the Veteran's military service or caused by any service-connected disabilities.  A complete rationale must be given for all opinions and conclusions expressed.

In offering these opinions, the examiner must acknowledge and discuss the Veteran's competent lay reports and credible testimony regarding the nature and onset his cardiovascular conditions.

STEVEN D. REISS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	B. Mountjoy, Associate Counsel

The Board's decision in this case is binding only with respect to the instant matter decided.  This decision is not precedential and does not establish VA policies or interpretations of general applicability.  38 C.F.R. � 20.1303.