INTERVERTEBRAL DISC SYNDROME

KRISTI L. GUNN · 2026 · Case ID: A26015343

MIXED

Summary

The veteran, who served from March 1985 to March 1989, appeals decisions denying service connection for obesity and bilateral hearing loss, and seeking an earlier effective date for long QT syndrome and grade 1 diastolic dysfunction. The Board granted service connection for a back disability, a right knee disability, obstructive sleep apnea, and non-alcoholic steatohepatitis. The Board denied service connection for obesity, finding no functional impairment independent of other service-connected conditions. The claim for an earlier effective date for long QT syndrome and grade 1 diastolic dysfunction was denied because the claim stream began with a November 2023 supplemental claim, and no exceptions applied for an earlier date. The appeal for bilateral hearing loss was dismissed due to lack of jurisdiction, as the appeal was filed more than one year after the last relevant decision without good cause. The Board remanded the claim for a urinary disability due to a duty to assist error, as no VA examination or nexus opinion was obtained for this condition, which the veteran asserted was related to her service-connected back disability.

Rationale

Present disability conceded by VA; In-service incurrence documented by fall from horse in May 1987; Nexus established by treating provider's opinion linking in-service injuries to present back symptomatology

Special Benefit

EARLIER EFFECTIVE DATE

Docket No.

251030-603600

Full Decision Text

Citation Nr: A26015343
Decision Date: 02/19/26 Archive Date: 02/19/26

DOCKET NO. 251030-603600
DATE: February 19, 2026

ORDER

Entitlement to service connection for a back disability is granted.

Entitlement to service connection for a right knee disability is granted.

Entitlement to service connection for obstructive sleep apnea is granted.

Entitlement to service connection for non-alcoholic steatohepatitis is granted.

Entitlement to service connection for obesity is denied.

Entitlement to an earlier effective date prior to July 20, 2023, for the grant of service connection for long QT syndrome and grade 1 diastolic dysfunction is denied.

Entitlement to service connection for bilateral hearing loss is dismissed.

REMANDED

Entitlement to service connection for a urinary disability is remanded.

FINDINGS OF FACT

1. Resolving reasonable doubt in the Veteran's favor, her obesity was caused by her service-connected posttraumatic stress disorder (PTSD).

2. Resolving reasonable doubt in the Veteran's favor, her back disability is etiologically related to service.

3. Resolving reasonable doubt in the Veteran's favor, her right knee disability is etiologically related to service.

4. Resolving reasonable doubt in the Veteran's favor, her obstructive sleep apnea was caused by obesity due to her service-connected PTSD.

5. Resolving reasonable doubt in the Veteran's favor, her non-alcoholic steatohepatitis was caused by obesity due to her service-connected PTSD.

6. The evidence of record does not establish that the Veteran's obesity causes functional impairment independent of the symptomatology of her service-connected disabilities.

7. The claim stream giving rise to the grant of service connection for long QT syndrome and grade 1 diastolic dysfunction began with the filing of a supplemental claim on November 29, 2023. The Veteran submitted an intent to file on July 20, 2023, within one year prior to the November 2023 supplemental claim.

8. Prior to July 20, 2023, the issue of service connection for a cardiac disability, to include long QT syndrome, was most recently adjudicated in a February 2018 rating decision.

9. No new and material evidence or Notice of Disagreement was received within one year following the February 2018 rating decision. No relevant service records were newly associated with the claims file after the February 2018 rating decision.

10. The agency of original jurisdiction did not render a decision on the issue of service connection for bilateral hearing loss within one year prior to the receipt of the October 2025 Notice of Disagreement.

CONCLUSIONS OF LAW

1. The criteria for service connection for a back disability have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for a right knee disability have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for obstructive sleep apnea have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

4. The criteria for service connection for non-alcoholic steatohepatitis have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310.

5. The criteria for service connection for obesity have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.102, 3.303.

6. The criteria for an earlier effective date prior to July 20, 2023, for the grant of service connection for long QT syndrome and grade 1 diastolic dysfunction have not been met. 38 U.S.C. § 5110(a)(3).

7. The criteria for dismissal of the appeal in relation to service connection for bilateral hearing loss have been met. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.2500(a), 20.203.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from March 1985 to March 1989.

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

In January 2025, the Veteran submitted VA Form 20-0996
38 U.S.C. § 5110(a)(3).

7. The criteria for dismissal of the appeal in relation to service connection for bilateral hearing loss have been met. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.2500(a), 20.203.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from March 1985 to March 1989.

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

In January 2025, the Veteran submitted VA Form 20-0996, Decision Review Request: Higher-Level Review (HLR), and requested review of a December 2024 decision. In April 2025, the agency of original jurisdiction (AOJ) issued an HLR decision, which considered the evidence of record at the time of the prior December 2024 decision. The Higher-Level Reviewer denied service connection for obesity but determined that there had been a duty to assist error for the Veteran's remaining claims. The Higher-level Reviewer transferred the remaining claims to the Supplemental Claim decision review option for additional development. In September 2025, the AOJ issued a supplemental claim decision, which granted service connection for long QT syndrome with grade 1 diastolic dysfunction and denied service connection for a back disability, non-alcoholic steatohepatitis, a right knee disability, and obstructive sleep apnea.

In October 2025, the Veteran submitted VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), and selected the Direct Review docket. Therefore, the Board may only consider the evidence of record at the time of the AOJ decisions on appeal (April 29, 2025, for obesity, and September 16, 2025, for the remaining claims). 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decisions on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801.

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

As the Board is remanding the Veteran's urinary disability service connection claim, any evidence that the Board could not consider will be considered by the AOJ in the adjudication of that claim. 38 C.F.R. § 3.103(c)(2)(ii).

1. Entitlement to service connection for a back disability is granted.

The Veteran seeks service connection for a back disability. Specifically, the Veteran asserts that she has experienced ongoing back pain since service due to three in-service incidents: a fall caused by loss of consciousness following a Cesarean section in 1986, being thrown from a horse in 1987, and a backward fall onto a crane track in February 1987.

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).

VA has conceded that the "present disability" service connection requirement has been satisfied. See Rating Decision, September 2025.

The "in-service incurrence" service connection requirement is satisfied by a service treatment record documenting a fall from a horse in May 1987.

Resolving reasonable doubt in the Veteran's favor, the "nexus" service connection requirement is satisfied by an April 2021 letter from her treating provider. In the letter, the provider opined that the Veteran's in-service injuries more likely than not contributed to her present back symptomatology because both the provider's personal experience and medical literature support a finding that incidents like these "can result in acute, traumatic low back pain, with direct injury to the spinal articulations, discs, tendons and ligaments, and more likely than not, will promote degenerative change within the lumbar spine, such as has been demonstrated and documented in [the Veteran's] case through history, examination, and MRI findings
a horse in May 1987.

The Board acknowledges a VA nexus opinion rendered in December 2024, which found that the Veteran's back disability was more likely caused by obesity than in-service injuries due to an absence of objective evidence of chronicity or continuity since service. This opinion is inadequate for adjudication because the examiner did not explain why there was an expectation that the Veteran's back symptoms would be documented if her account was credible. See Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011) (reasoning that treating silence in the record as substantive negative evidence generally requires a showing that the disability is one that would have been noted in the course of medical evaluations or treatment, or is one for which the veteran would have sought treatment). Therefore, the VA medical opinion is accorded no probative weight.

As all three requirements have been satisfied, entitlement to service connection for a back disability is granted.

2. Entitlement to service connection for a right knee disability is granted.

The Veteran seeks service connection for a right knee disability.

VA has conceded that the "present disability" service connection requirement has been satisfied. See Rating Decision, September 2025. VA has also conceded that the "in-service incurrence" service connection requirement has been satisfied, in that a May 1987 service treatment record documents a right knee injury after a fall from a horse.

Resolving reasonable doubt in the Veteran's favor, the "nexus" service connection requirement is satisfied by the Veteran's competent and credible report that she has experienced recurrent knee pain since the in-service incident. This report is competent because it attests to matters capable of lay observation and credible because it has remained consistent over time, including in an account to a treating provider two years before the Veteran first sought service connection for her right knee disability. See Fed. R. Evid. 803(4), n.4 (noting a "patient's strong motivation to be truthful" in making statements about a present condition "to a physician for purposes of diagnosis and treatment"); Physical Medicine Rehab Consult, May 2019 ("Patient reports she fell off a horse in 1987 and landed on her knees, and since then she's been dealing with bilateral knee pain on and off. After a few years, she was told that she had arthritis and it might get progressively worse.").

As all three requirements have been satisfied, entitlement to service connection for a right knee disability is granted.

3. Entitlement to service connection for obstructive sleep apnea is granted.

4. Entitlement to service connection for non-alcoholic steatohepatitis is granted.

The Veteran seeks service connection for obstructive sleep apnea (OSA) and non-alcoholic steatohepatitis (NASH).

Service connection may be established on a secondary basis for a disability that is caused or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310(a). Obesity may serve as an "intermediate step" in a causal chain between a service-connected disability and another present disability. VA Office of General Counsel Precedent Opinion 1-2017.

In a September 2017 VA treatment record, the Veteran's treatment mental health provider indicated that the Veteran's service-connected posttraumatic stress disorder (PTSD) caused "poor coping skills with high risk behaviors which has directly led to obesity." Moreover, a June 2025 VA nexus opinion stated that common PTSD symptoms such as hyperarousal, avoidance, and mood disturbances may lead to maladaptive coping strategies, including physical inactivity and emotional eating. Therefore, resolving reasonable doubt in the Veteran's favor, the relevant evidence of record establishes
). Obesity may serve as an "intermediate step" in a causal chain between a service-connected disability and another present disability. VA Office of General Counsel Precedent Opinion 1-2017.

In a September 2017 VA treatment record, the Veteran's treatment mental health provider indicated that the Veteran's service-connected posttraumatic stress disorder (PTSD) caused "poor coping skills with high risk behaviors which has directly led to obesity." Moreover, a June 2025 VA nexus opinion stated that common PTSD symptoms such as hyperarousal, avoidance, and mood disturbances may lead to maladaptive coping strategies, including physical inactivity and emotional eating. Therefore, resolving reasonable doubt in the Veteran's favor, the relevant evidence of record establishes that her service-connected PTSD caused her obesity.

In April 2024, a VA examiner rendered nexus opinions attributing the Veteran's NASH and OSA to obesity. Similarly, a February 2018 VA medical opinion attributed the Veteran's NASH and OSA to "genetic [factors], sedentary lifestyle, poor diet/lack of exercise, etc." and a September 2024 VA medical opinion noted that the most common risk factors for sleep apnea include excess weight or obesity.

As the relevant evidence of record indicates that the Veteran's NASH and OSA were caused by obesity due to the Veteran's service-connected PTSD, entitlement to service connection for NASH and OSA is warranted.

5. Entitlement to service connection for obesity is denied.

The Veteran seeks service connection for obesity.

Obesity may be considered a disability for service connection purposes "if it results in the functional impairment of earning capacity." Adams v. Collins, 38 Vet. App. 273, 284 (2025). Veterans may not be compensated twice for the same symptomatology. Brady v. Brown, 4 Vet. App. 203, 206 (1993). Therefore, service connection for obesity is warranted only if it results in the functional impairment of earning capacity independent of symptoms caused by other service-connected disabilities.

The Veteran was afforded VA examinations for obesity in February 2018 and December 2024. The February 2018 examiner completed an Endocrine Disease Disability Benefits Questionnaire (DBQ). In the DBQ, the examiner indicated that the Veteran had a diagnosis of obesity but that the obesity had no functional impact. The December 2024 completed an Eating Disorders DBQ. In the DBQ, the examiner documented no functional impact other than exacerbation of the Veteran's mental health symptoms, which was "subsumed under PTSD diagnosis."

After careful review of the record, including the Veteran's VA treatment records and VA examination reports, the Board finds no evidence that the Veteran's obesity has had a functional impact independent of the symptomatology of the Veteran's service-connected disabilities. Therefore, service connection must be denied.

The Board emphasizes that its finding that the Veteran's PTSD caused her obesity is binding on all subsequent VA adjudicators unless rebutted by evidence that identifies a clear and unmistakable error. 38 C.F.R. § 3.104(c). Therefore, although service connection cannot be granted for obesity based on the current evidence of record, obesity may serve as an intermediate step in establishing secondary service connection for additional disabilities. Moreover, if the Veteran wishes to submit evidence that her obesity has caused the functional impairment of earning capacity, she may file a Supplemental Claim. If the evidence is new and relevant, the agency of original jurisdiction will issue a new decision on the claim.

6. Entitlement to an earlier effective date prior to July 20, 2023, for the grant of service connection for long QT syndrome and grade 1 diastolic dysfunction is denied.

The Veteran seeks an earlier effective date prior to July 20, 2023, for the grant of service connection for long QT syndrome and grade 1 diastolic dysfunction.

In December 2017, the Veteran filed her initial service connection claim for long QT syndrome. In February 2018, the agency of original jurisdiction (AOJ) issued a rating decision denying service connection. The Veteran did not file a Notice of Disagreement in relation to the February 2018 decision.

On July 20, 2023, the Veteran submitted an intent to file.

In November 2023, the Veteran submitted a supplemental claim seeking to reopen the issue of service connection for long QT syndrome. In December 2024, the AOJ issued a decision on the Veteran's November 2023 supplemental claim, confirming and continuing the denial of service connection for long QT syndrome. In January 2025, the Veteran submitted a higher-level review request. In the September 2025 decision on appeal, the agency of original jurisdiction granted service connection for long QT syndrome and grade 1 diastolic dysfunction, and assigned an effective date of July 20, 2023.

In general, for supplemental claims received more
2018 decision.

On July 20, 2023, the Veteran submitted an intent to file.

In general, for supplemental claims received more than one year after the date of a prior AOJ decision, the effective date of a grant of service connection may be no earlier than the date that the supplemental claim was received. 38 U.S.C. § 5110(a)(3). There are limited exceptions to this rule.

One exception occurs when a claimant submits an intent to file, then submits a complete application for benefits on a form prescribed by VA's Secretary appropriate to the benefit sought within one year of receipt of the intent to file. Under such circumstances, VA will consider the complete claim filed as of the date the intent to file was received. 38 C.F.R. § 3.155(b).

A second exception relates to claims initially decided under the "legacy" review system in effect prior to February 19, 2019. In cases where a decision on an initial claim was issued prior to February 19, 2019, an effective date may be assigned in accordance with the initial claim if a Notice of Disagreement or new and material evidence was received within the one-year appeal period following the decision. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 3.156(b), 20.1103. "New evidence" means evidence not previously part of the actual record before agency adjudicators. "Material evidence" means existing evidence that, by itself or when considered with the previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. 38 C.F.R. § 3.156(a).

A third exception relates to "continuous pursuit." Under the modernized review system in effect as of February 19, 2019, a claimant may continuously pursue a claim by filing a supplemental claim, higher-level review request, or appeal to the Board within one year following notice of a decision on an initial or supplemental claim. 38 C.F.R. § 3.2500(c)(1), (h)(1). The effective date of a continuously pursued claim "will be fixed in accordance with the date of receipt of the initial claim in the claims stream or the date that entitlement arose, whichever is later, if a claimant continuously pursues an issue by timely filing in succession any of the available review options" within one year of the issuance of each decision. 38 C.F.R. § 3.2500(h)(1).

A fourth exception concerns relevant service records received after a previous denial of service connection. At any time after VA issues a decision on a claim, if VA receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, VA must reconsider the claim. 38 C.F.R. § 3.156(c)(1). An award based entirely or in part on such records is effective on the date entitlement arose or the date VA received the previously decided claim, whichever is later. 38 C.F.R. § 3.156(c)(3).

The February 2018 decision denying service connection for long QT syndrome became final because there was no Notice of Disagreement or new and material evidence received within the one-year appeal period. Therefore, the claim stream that gave rise to the grant of long QT syndrome and grade 1 diastolic dysfunction began with the filing of a supplemental claim in November 2023. The AOJ appropriately assigned an effective date of July 20, 2023, because the Veteran's intent to file was received within one year prior to the November 2023 supplemental claim; however, the effective date of service connection can be no earlier than July 20, 2023, because the Veteran did not have a pending service connection claim for a cardiac disability at that time.

None of the exceptions would afford the Veteran an earlier effective date prior to July 20, 2023. No new and material evidence with respect to a cardiac disability was received within one year of the February 2018 rating decision. The Veteran did not file a Notice of Disagreement within one year following the February 2018 rating decision. And relevant service department records were not
date of July 20, 2023, because the Veteran's intent to file was received within one year prior to the November 2023 supplemental claim; however, the effective date of service connection can be no earlier than July 20, 2023, because the Veteran did not have a pending service connection claim for a cardiac disability at that time.

None of the exceptions would afford the Veteran an earlier effective date prior to July 20, 2023. No new and material evidence with respect to a cardiac disability was received within one year of the February 2018 rating decision. The Veteran did not file a Notice of Disagreement within one year following the February 2018 rating decision. And relevant service department records were not associated with the claims file after the February 2018 rating decision. Accordingly, an effective date prior to July 20, 2023, for the grant of service connection for long QT syndrome with grade 1 diastolic dysfunction must be denied.

The Board notes that the Veteran's October 2025 Notice of Disagreement referenced a September 2025 claim of clear and unmistakable error (CUE). The Veteran's September 2025 CUE statement asserted that the assignment of a single rating for long QT syndrome and grade 1 diastolic dysfunction constituted CUE. The Veteran raised the same argument in a December 2025 higher-level review request, which has not yet been adjudicated. The Board does not have jurisdiction over a claim of AOJ CUE that was not raised first before, and adjudicated by, the AOJ. See Jarrell v. Nicholson, 20 Vet. App. 326, 334 (2006). However, the CUE claim is referred to the AOJ for adjudication in the first instance.

7. Entitlement to service connection for bilateral hearing loss is dismissed.

The Veteran indicated in her October 2025 Notice of Disagreement that she wished to appeal the denial of service connection for bilateral hearing loss.

The issue of service connection for bilateral hearing loss was most recently adjudicated in a June 2023 rating decision. The Veteran did not file a supplemental claim or higher-level review request for the issue of bilateral hearing loss after this decision. The Veteran did not seek to appeal the issue to the Board until the October 2025 Notice of Disagreement.

In general, a Notice of Disagreement must be filed within one year from the date that VA mails notice of a decision. 38 C.F.R. §§ 3.2500(a)(1), 20.203(b). An extension for the time of filing may be granted, if the claimant submits an extension request in writing to the Board and demonstrates good cause. 38 C.F.R. § 20.203(c).

In her October 2025 VA Form 10182, the Veteran requested review of service connection for bilateral hearing loss, which was not adjudicated within the prior year. The Veteran did not submit an extension request in writing, with a showing of good cause. Therefore, the Board does not have the jurisdiction to render a decision, and the appeal must be dismissed.

REASONS FOR REMAND

Entitlement to service connection for a urinary disability is remanded.

In adjudicating a claim, VA must consider "entitlement to any additional benefits for complications of the claimed condition. 38 C.F.R. § 3.155(d)(2).

In a June 2021 written statement, the Veteran asserted that her back disability "affects [her] ability to void properly." Therefore, the Veteran's back service connection claim reasonably encompasses a service connection for a urinary disability.

After review of the record, the Board finds that the claim must be remanded to correct a duty to assist error that occurred prior to the September 2025 rating decision on appeal. 38 C.F.R. § 20.802(a). Specifically, VA has not yet afforded the Veteran a VA examination or obtained a medical nexus opinion in relation to the claimed urinary disability. See 38 U.S.C. § 5103A(d)(1) (establishing that VA's duty to assist includes providing a medical examination and obtaining a medical opinion when there is competent evidence that the claimant has a current disability, or persistent or recurrent symptoms of disability, associated with active service but there is insufficient medical evidence to make a decision on the claim).

The matter is REMANDED for the following action:

1. Schedule the Veteran for a VA examination by an appropriate clinician for her urinary disability. The examiner must review the claims file, to include this Remand, and attest to having fully reviewed it. The examiner must elicit a full history from the Veteran and consider all additional lay statements of record.

2. The examiner is asked to provide a response to the following inquiries:

(a) Is it at least as likely as not (likelihood is
a medical examination and obtaining a medical opinion when there is competent evidence that the claimant has a current disability, or persistent or recurrent symptoms of disability, associated with active service but there is insufficient medical evidence to make a decision on the claim).

The matter is REMANDED for the following action:

2. The examiner is asked to provide a response to the following inquiries:

(a) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran has a urinary disability that was caused by her service-connected back disability?

(b) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran has a urinary disability that was aggravated (worsened beyond its natural progression, even if only temporarily or incrementally) by her service-connected back disability?

The term "at least as likely as not" means that the weight of the medical evidence both for and against a conclusion is at least approximately balanced, or nearly equal, and therefore it is at least as medically sound to find in favor of the conclusion as it is to find against the conclusion.

The examiner is advised that, while the extent to which a scientific theory is accepted in the scientific community is a relevant consideration, a positive nexus opinion for service connection requires only an approximate balance of positive and negative evidence. Scientific consensus or certainty is not required.

Any opinions expressed must include a thorough rationale specific to the circumstances of the Veteran's case. If medical literature is relied upon, the examiner should identify and specifically cite each reference material and discuss how it relates to the Veteran's particular medical history. If the examiner is unable to offer an opinion without resort to speculation, a thorough explanation should be provided as to why an opinion cannot be rendered.

In providing the requested opinion, the examiner must address the Veteran's assertions on examination and any additional lay statements of record. The Veteran is competent to attest to factual matters of which she has first-hand knowledge, and if there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation.

The examiner is reminded that an absence of documented treatment in or after service is an insufficient basis, by itself, for a negative opinion.

The examiner is reminded that if positive and negative evidence is in approximate balance as to any issue, the Veteran should receive the benefit of the doubt.

KRISTI L. GUNN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Karp, B.

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.

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