MALARIA

KRISTI L. GUNN · 2025 · Case ID: 25013762

MIXED

Summary

The Veteran, who served from July 1969 to February 1971, including service in Vietnam, passed away in April 2023. His surviving spouse is the Claimant. The case involves appeals from June 2013, April 2018, and May 2018 rating decisions. The Veteran sought a higher rating for service-connected malaria, service connection for cold spells, and service connection for an eye disability secondary to diabetes mellitus, type II. The Board denied a higher rating for malaria, finding no evidence of active disease or residuals. However, the Board granted service connection for cold spells, recharacterizing the Veteran's claims and resolving reasonable doubt in his favor, noting his credible testimony of symptoms and the presence of active malaria during service. The Board also granted service connection for an eye disability (glaucoma suspect and pigment dispersion) secondary to service-connected diabetes mellitus, type II. This was based on conflicting medical opinions, with the Board finding approximate balance and resolving doubt in the Veteran's favor, despite some opinions suggesting no link. The claim for Total Disability based on Individual Unemployability (TDIU) was remanded for further development, as it was inextricably intertwined with the assignment of disability ratings and effective dates for the granted conditions.

Rationale

No evidence of active malaria or relapse confirmed by blood smears.; No residuals impacting other body systems found.; October 2023 VA opinion found cold spells not related to malaria.

Special Benefit

ACCRUED BENEFITS; TDIU

Diagnostic Code

6304

Docket No.

17-63 017

Full Decision Text

Citation Nr: 25013762
Decision Date: 11/06/25 Archive Date: 11/06/25

DOCKET NO. 17-63 017
DATE: November 6, 2025

ORDER

Entitlement to a compensable disability rating for malaria, for accrued benefits purposes, is denied.

Entitlement to service connection for cold spells, for accrued benefits purposes, is granted.

Entitlement to service connection for an eye disability, to include glaucoma suspect and pigment dispersion, as secondary to service-connected diabetes mellitus, type II, for accrued benefits purposes, is granted.

REMANDED

Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities, for accrued benefits purposes, is remanded.

FINDINGS OF FACT

1. The persuasive evidence of record does not support a finding that the Veteran's malaria was active or productive of residual liver impairment, spleen impairment, or other significant and non-transient residuals.

2. The evidence is in approximate balance as to whether the Veteran had cold spells related to military service.

3. The evidence is in approximate balance as to whether the Veteran had an eye disability, to include glaucoma suspect and pigment dispersion, secondary to his service-connected diabetes mellitus, type II.

CONCLUSIONS OF LAW

1. The criteria for an initial compensable disability rating for malaria have not been met. 38 U.S.C. §§ 1155, 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 4.7, 4.14, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 6304.

2. The criteria for service connection for cold spells have been met. 38 U.S.C. §§ 1110, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.385.

3. The criteria for service connection for an eye disability, to include glaucoma suspect and pigment dispersion, as secondary to service-connected diabetes mellitus, type II, for accrued benefits purposes, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from July 1969 to February 1971. Unfortunately, he passed away in April 2023; the Claimant is his surviving spouse.

These matters come before the Board of Veteran's Appeals (Board) from June 2013, April 2018, and May 2018 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO).

In the June 2013 rating decision, the RO, in relevant part, denied granting a compensable disability rating for service-connected malaria. In July 2013, the Veteran filed a timely notice of disagreement (NOD) and in October 2017, the RO issued a statement of the case (SOC). In November 2017, the Veteran timely submitted a substantive appeal and requested a Central Office hearing. In December 2019, the Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing is associated with the claims file.

In the April 2018 rating decision, the RO, in relevant part, denied service connection for an eye condition, and, in the May 2018 rating decision, the RO denied entitlement to a TDIU. In June 2018, the Veteran submitted a timely NOD. In September 2018, the RO issued SOCs, and in October 2018, the Veteran filed timely substantive appeals.

In an August 2019 decision, the Board remanded the claims for entitlement to service connection for an eye condition and a TDIU for additional development. And, in a December 2019 decision, the Board remanded the issue of entitlement to a compensable rating for service-connected malaria, to include residuals, for additional development.

Most recently, in August 2020 and March 2023 decisions, the Board remanded these matters for further development. These matters are now back before the Board for adjudication.

1. Entitlement to a compensable disability rating for malaria, for accrued benefits purposes, is denied.

The Claimant seeks a higher disability rating for the Veteran's service-connected malaria. By way of history, the Veteran was in receipt of a noncompensable disability rating for his service-connected malaria as of February 20, 1972. The
And, in a December 2019 decision, the Board remanded the issue of entitlement to a compensable rating for service-connected malaria, to include residuals, for additional development.

Most recently, in August 2020 and March 2023 decisions, the Board remanded these matters for further development. These matters are now back before the Board for adjudication.

1. Entitlement to a compensable disability rating for malaria, for accrued benefits purposes, is denied.

The Claimant seeks a higher disability rating for the Veteran's service-connected malaria. By way of history, the Veteran was in receipt of a noncompensable disability rating for his service-connected malaria as of February 20, 1972. The Veteran contended that he suffered cold spells as a result of his malaria. He stated that coming back from a combat mission when he was in Vietnam, he couldn't stand and was burning up. At the hospital, they were treating him, and he went from burning up to being extremely cold. He did not believe that he recovered because his symptoms had been getting worse. He reported getting so cold he could not function. See December 2019 Hearing Tr.

Legal Framework

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities. Ratings are based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1.

In cases in which a claim for a higher initial evaluation stems from an initial grant of service connection for the disability at issue, multiple ("staged") ratings may be assigned for different periods of time during the pendency of the appeal. See generally Fenderson v. West, 12 Vet. App. 119 (1999). 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. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, the regulations do not give past medical reports precedence over current findings. See Francisco v. Brown, 7 Vet. App. 55 (1994); 38 C.F.R. § 4.2. Staged ratings are, however, appropriate for an increased rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings.

The relevant focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. See generally Hart v. Mansfield, 21 Vet. App. 505 (2007).

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

The Veteran is seeking a compensable rating for his service-connected malaria. His malaria condition is currently assigned a noncompensable rating under Diagnostic Code 6304. 38 C.F.R. § 4.88b.

The rating criteria for malaria were revised effective August 11, 2019. 84 Fed. Reg. 28227, 28230 (June 18, 2019). Prior to the revisions, malaria was assigned a 100 percent rating if it was an active disease.

The Note for malaria stated "the diagnosis of malaria depends on the identification of the malarial parasites in blood smear. If the veteran served in an endemic area and presents signs and symptoms compatible with malaria, the diagnosis may be based on clinical grounds alone. Relapses must be confirmed by the presence of malarial parasites in blood smears." 38 C.F.R. § 4.88b. If the malaria is inactive, residuals are to be rated such as liver or spleen damage under the appropriate system. Id.

After August 11, 2019, malaria is evaluated using the General Rating Formula for Infectious Diseases. A 100 percent rating is assigned for an active disease. After the active disease has resolved, rate at 0 percent for infection. Any residual disability of infection is rated within the appropriate body system. 38 C.F.R. § 4.88b, Diagnostic Code 6304.

Note 1 for Diagnostic Code 6304 states that the diagnosis of malaria, both initially and during relapse, depends on the identification of the malarial parasites in blood smears or other specific diagnostic laboratory tests such as antigen detection, immunologic (immunochromatographic) tests, and molecular testing such as polymerase chain reaction tests. Note 2 for Diagnostic Code 6304 says to rate under the appropriate body system any residual disability of infection, which includes, but is not limited to, liver or splenic damage, and central nervous system conditions.

Factual Background

In September 2017 and March 2020, the Veteran was afforded VA examinations. He was noted to have been diagnosed with malaria in February 1972. The March 2020 report indicates that a February 2020 malaria test was negative. The status of the disease was determined to be inactive and there were no other pertinent physical findings or complications. In a March 2020 VA medical opinion, a VA examiner opined that the Veteran's malaria is not "active." He explained that in October 2014 parasite smear, there were no blood parasites.

In March 2020, the Veteran was provided a VA examination. The Veteran reported cold spells daily, and that he had seen multiple doctors for his condition and that the doctors were unable to find any diagnoses for his condition. On examination, the Veteran's malaria was determined to be inactive. A blood test was also negative for blood parasites. No symptoms or residuals attributable to malaria were found. No other pertinent physical findings, complications, conditions, signs, or symptoms were found to be related to the Veteran's malaria. No change was noted in the Veteran's diagnosis. See also September 2017 VA Examination (same); March 2013 VA Examiantion.

The March 2020 examiner then opined, after reviewing the Veteran's medical history and assertions, that it is less likely than not that the Veteran's claimed condition was proximately due to or the result of malaria. He explained that it is less likely than not that the Veteran's malaria is active, as there is no recent illness or treatment. No residuals symptoms were consistent with malaria were found. And the Veteran additionally asserted that he and his physicians are not sure why he was having cold spells.

In an October 2023 VA addendum opinion, an examiner opined that cold spells were not caused by or aggravated by the Veteran's malaria. She explained that the cold spells represent a nonspecific symptom which are not synonymous with a diagnosis of malaria and do not represent a common symptom of malaria (particularly, in the absence of fever). In a subsequent December 2024 VA addendum opinion, a VA examiner asserted that chills represent a well-established symptomatic manifestation of malaria in the medical literature, and there are no more likely alternate etiologies. Finally, in a March 2025 VA addendum opinion, an examiner opined that the cold spells represent a systemic response to the hematologic condition of malaria. The malaria should be considered active at the time of the chills.

Discussion

After a careful review of the record and applicable legal framework, the Veteran did not meet the criteria for a higher rating for service-connected malaria. Specifically, there is no evidence that the Veteran experienced a relapse of malaria or has been hospitalized for a relapse, nor is there evidence that a relapse was confirmed by the presence of malarial parasites in blood smears. Additionally, a review of the private and VA medical treatment records do not reflect any clinical evidence demonstrating either liver or spleen damage secondary to malaria.

In so finding, the Board has considered whether the Veteran can achieve separate ratings for his service-connected malaria based upon residuals impacting other body systems. There is no evidence that the Veteran's service-connected malaria resulted in or was associated with any damage to any other system of the body, to include the central nervous system.

In reaching these determinations, the Board has considered and weighed the evidence of record, to include the Veteran's contentions regarding his cold spells and the multiple VA opinions addressing whether the Veteran's cold spells were a residual of his malaria. The Board finds that the October 2023 VA opinion is of significant probative value. It is consistent with the evidence of record and provides adequate rationale. Contrastingly, the Board affords the December 2024 and March 2025 VA addendum opinions, less probative value. In this regard the examiner fails to reconcile his findings that the Veteran had active malaria at the time of his cold spells (daily) with consistent negative blood testing, indicating that the Veteran's malaria was not active during the appeal period or approximate, thereto. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007).

The Board also acknowledges that that the Veteran is competent to report observable symptoms, such as cold spells, and that statements attesting to his symptoms are credible. See Layno v. Brown, 6 Vet. App. 465 (1994). While the Veteran is competent to report symptoms, however, he is not competent to diagnose whether such symptoms constituted a residual affecting a system of the body or whether he had malarial parasites in blood smears or other specific diagnostic laboratory tests. Moreover, the Board will address the Veteran's contentions regarding cold spells further in the next section, as the Board finds that service connection for cold spells is warranted on a separate basis.

Given the foregoing, the weight of the evidence supports a finding that the currently assigned noncompensable rating is warranted for the Veteran's malaria. Accordingly, the persuasive evidence weights against the claim and the benefit of the doubt doctrine is not for application as to this claim. As such, the claim for an increased rating for malaria, for accrued benefits purposes is denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

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 established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 U.S.C. § 1131; 38 C.F.R. § 3.310 (a). In order to prevail on the issue of secondary service connection, the record must show: (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc).

In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge).

The Board has reviewed the entire record but will only discuss the evidence necessary to explain its decision. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record but does not have to discuss each piece of evidence); see Timberlake v. Gober, 14 Vet.
fully consider the lay assertions of record. A layperson is competent to report on the onset and continuity of his current symptomatology. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge).

The Board has reviewed the entire record but will only discuss the evidence necessary to explain its decision. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record but does not have to discuss each piece of evidence); see Timberlake v. Gober, 14 Vet. App. 122 (2000) (the law requires only that the Board address its reasons for rejecting evidence favorable to the Veteran).

When the evidence is evenly balanced or approximately so with regard to whether service connection is warranted, VA shall resolve reasonable doubt in favor of the Claimant. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). To deny a claim on its merits, the evidence must persuasively weigh against the claim. Id. (only when the evidence persuasively favors one side, or another is the benefit of the doubt doctrine not for application).

1. Entitlement to service connection for cold spells, for accrued benefits purposes, is granted.

In Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009), the Court held that a claim should not be limited to the disorder as characterized by the Veteran but must be characterized and addressed based on the reasonable expectations of the non-expert Claimant and the evidence in processing the claim. Here, the Veteran had sought a higher rating for his service-connected malaria by reason that he experienced cold spells. In this regard, he stated that coming back from a combat mission when he was in Vietnam, he couldn't stand and was burning up. At the hospital, they were treating him, and he went from burning up to being extremely cold. He did not believe that he recovered because his symptoms had been getting worse. He reported getting so cold he could not function. See December 2019 Hearing Tr.

As noted above, the Board has found that a higher rating for service-connected malaria is not warranted in this case. However, given the Veteran's contentions, pursuant to Clemons, the Board has recharacterized the Veteran's contentions as one for service connection for cold spells related to service.

Next, following a review of the evidence of record and the applicable legal criteria, the Board finds that, resolving reasonable doubt in favor of the Veteran, his cold spells were related to service.

In this regard, the Veteran had competently, consistently, and credibly reported cold spells that result in functional impairment of earning capacity. Consequently, there is a current disability. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). With respect to the second element of service connection, the Veteran's service treatment records (STRs) are silent for complaints, treatment, or a diagnosis of cold spells. However, he was diagnosed with active malaria during service, and he consistently, competently, and credibly reported experiencing cold spells during service following his diagnosis. Therefore, affording the Veteran the benefit of the doubt, the Board finds that the second element of service connection, that of an in-service injury or event, has been met.

The salient question is thus whether the Veteran's cold spells were related to service. The Board notes that the Veteran was competent to report observable symptoms, such as cold spells. See Layno v. Brown, 6 Vet. App. 465 (1994). He has also consistently, competently, and credibly reported continued symptomology since service. There are no opinions of record to the contrary. Accordingly, affording the Veteran the benefit of the doubt, the Board finds that the third element of service connection has been met. 38 C.F.R. § 3.303(b). As such, entitlement to service connection for cold spells is warranted and the claim is granted, for accrued benefits purposes.

In granting this claim, the Board notes for the Claimant that any assignment of compensation will be considered by the AOJ in the first instance. However, this decision may not result in an increase in compensation as cold spells, in and of themselves, might not
4). He has also consistently, competently, and credibly reported continued symptomology since service. There are no opinions of record to the contrary. Accordingly, affording the Veteran the benefit of the doubt, the Board finds that the third element of service connection has been met. 38 C.F.R. § 3.303(b). As such, entitlement to service connection for cold spells is warranted and the claim is granted, for accrued benefits purposes.

In granting this claim, the Board notes for the Claimant that any assignment of compensation will be considered by the AOJ in the first instance. However, this decision may not result in an increase in compensation as cold spells, in and of themselves, might not be a disability for which additional compensation may be warranted. Nonetheless, the Board knows that acknowledgement of a symptom, and its connection to service, or in this case to a service-connected disability, is often validating for veterans and their families. The Board hopes this decision provides some closure.

2. Entitlement to service connection for an eye disability, to include glaucoma suspect and pigment dispersion, as secondary to service-connected diabetes mellitus, type II, for accrued benefits purposes, is granted.

The Claimant is seeking service connection for an eye disorder experienced by the Veteran. Specifically, the Veteran contended that his eye disabilities were related to service. In the alternative, he contended his eye disabilities were secondary to his service-connected diabetes mellitus, type II. See January 2018 Claim.

Following a review of the evidence of record and the applicable legal criteria, the Board finds that, resolving reasonable doubt in favor of the Veteran, entitlement to service connection for an eye disability, to include glaucoma suspect and pigment dispersion, is warranted. As the evidence indicates that service connection is warranted on a secondary basis, and the Veteran contended that service connection was warranted on such basis, the Board will not address direct service connection.

In this case, the Veteran was diagnosed with open angle with borderline glaucoma findings, pigment iris degeneration, blepharitis, epiphora/dry eye syndrome, and cataracts. The Veteran was service connected for diabetes mellitus, type II. Therefore, the first and second elements of service connection have been met.

The salient question is thus whether the Veteran's eye disabilities were related to service. In this regard, the Board notes that the AOJ has attempted to obtain multiple medical opinions concerning the nature and etiology of the Veteran's eye disabilities. See May 2021 VA Medical Opinion; October 2023 VA Medical Opinion; April 2025 VA Medical Opinion. These medical opinions collectively support a finding that the Veteran's open angle with borderline glaucoma findings, pigment iris degeneration, blepharitis, epiphora/dry eye syndrome, and cataracts were not related to service or caused by or aggravated by his service-connected diabetes mellitus, type II. Notably, however, in the October 2023 VA medical opinion, the VA examiner also contrastingly opined that the Veteran's glaucoma suspect and pigment dispersion were caused by the Veteran's diabetes mellitus, type II. See October 2023 VA Medical Opinion at 5.

The Board acknowledges that none of the opinions of record are without flaws and the Board could certainly remand again for clarification from a VA examiner, however finds that remanding for an addendum opinion is inappropriate and unnecessary in this case. Given the history of inadequate development despite multiple Board remands, and the length of time this case has been pending, the Board will not make the Claimant wait for additional development or for the development of negative evidence. Instead, the Board will find the medical opinions of record to be of are equal persuasive value. Doing so will enable the Board to find that the evidence of record is in approximate balance as to whether there is a medical and factual basis to grant the appeal and to resolve reasonable doubt in favor of the Veteran. As such, there is no prejudice to the Claimant in adjudicating this matter based on the evidence currently of record and without additional delay.

Given the foregoing, the Board finds that the weight of the medical evidence of record persuasively shows that the Veteran's blepharitis, epiphora/dry eye syndrome, and cataracts were not related to service, nor were they caused by or aggravated by his service connected diabetes mellitus, type II. However, the persuasive evidence of record supports a finding that the Veteran's glaucoma suspect and pigment dispersion were caused by the Veteran's diabetes mellitus, type II. As such, the Board finds that the three elements of secondary service connection have been met, and entitlement to service connection for an eye disability, to include glaucoma suspect and pigment dispersion, for accrued
currently of record and without additional delay.

REASONS FOR REMAND

1. Entitlement to a TDIU due to service-connected disabilities, for accrued benefits purposes, is remanded.

As set forth, this decision grants service connection for cold spells and an eye disability, but the AOJ has yet to assign the disability ratings and effective dates.

Thus, the TDIU claim is inextricably intertwined at this time with the assigment of disability ratings and effective dates, and must also be remanded. See Harris v. Derwinski, 1 Vet. App. 180 (1991).

The matter is REMANDED for the following action:

1. Obtain any relevant outstanding VA treatment records, and any private treatment records identified by the Claimant. All records and/or responses received should be associated with the claims file.

2. After any development deemed warranted, adjudicate the Veteran's claim for a TDIU. If necessary, refer the claim to VA's Director of Compensation Service for extraschedular consideration pursuant to 38 C.F.R. §4.16(b).

(Continued on the next page)

3. After completing the requested actions, and any additional notification and/or development deemed warranted, readjudicate the issue on appeal. If the benefits sought on appeal remain denied, furnish to the Claimant and her representative an appropriate supplemental statement of the case (SSOC) that includes clear reasons and bases for all determinations, and afford them the appropriate time period for response.

KRISTI L. GUNN

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board M. Kaufer, 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.

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