DEGENERATIVE ARTHRITIS

Summary

The veteran, who served from July 1972 to March 1981 and received the Combat Action Ribbon, appeals the denial of service connection for several conditions. The Board granted service connection for lumbar and cervical spine disabilities, including incomplete quadriplegia with chronic fatigue, finding the evidence in approximate balance and resolving doubt in the veteran's favor, despite post-service injuries complicating the nexus. Service connection was also granted for bladder and bowel incontinence, found to be secondary to the service-connected spine disabilities. The veteran's respiratory disability, including neuromuscular respiratory disorder and left lung atelectasis, was granted secondary to the service-connected spine and neck disabilities, supported by medical opinions attributing the condition to quadriplegia and prolonged recumbent positioning. Service connection for a disability manifesting in loss of balance and incoordination was granted, linked to the service-connected TBI, with the Board finding the evidence sufficient despite a prior remand for further development. Foot pain was granted service connection directly, with the Board affording the veteran the benefit of the doubt due to ongoing pain since service and the difficulty in obtaining pre-2003 SSA records. Loss of hair on the lower extremities and chills were granted service connection secondary to service-connected diabetes mellitus, with favorable medical opinions linking these conditions to the diabetes and the veteran's TBI. The Board noted that while asbestos exposure and potential lung cancer were mentioned, no asbestos-related lung disease was medically identified.

Rationale

Evidence in approximate balance regarding link to combat injuries; Resolving all doubt in veteran's favor; AOJ awarded TBI/vertigo based on accepted in-service injury

Full Decision Text

Citation Nr: 25014740
Decision Date: 12/10/25	Archive Date: 12/10/25

DOCKET NO. 15-12 468
DATE: December 10, 2025

ORDER

Entitlement to service connection for a lumbar and cervical spine disabilities, to include incomplete quadriplegia with chronic fatigue (claimed as joint and muscle pain and chronic fatigue) is granted.

Entitlement to service connection for bowel and bladder incontinence is granted.

Entitlement to service connection for a respiratory disability, to include neuromuscular respiratory disorder and left lung atelectasis (claimed as shortness of breath), is granted.  

Entitlement to service connection for disability manifesting in loss of balance and incoordination is granted. 

Entitlement to service connection for disability manifesting in foot pain is granted.

Entitlement to service connection for disability manifesting in loss of hair to the lower extremities is granted. 

Entitlement to service connection for disability manifesting in chills is granted. 

FNDINGS OF FACT

1. The evidence is in approximate balance as to whether the Veteran's lumbar and cervical spine disabilities, to include incomplete quadriplegia with chronic fatigue, are related to combat injuries sustained while on active duty.

2. The evidence favors a finding that the Veteran's bladder and bowel incontinence is related to his now service-connected lumbar and cervical spine disabilities.

3. The evidence favors a finding that the Veteran's respiratory disability, to include neuromuscular respiratory disorder and left lung atelectasis, is related to his now service-connected lumbar and cervical spine disabilities.

4. The evidence favors a finding that the Veteran has a disability manifesting in loss of balance and incoordination that is related to his service-connected traumatic brain injury (TBI).

5. The evidence is in approximate balance as to whether the Veteran has a disability manifesting in foot pain that is related to combat injuries sustained while on active duty.

6. The evidence favors a finding that the Veteran has a disability manifesting in loss of hair of the lower extremities that is related to his service-connected diabetes mellitus.  

7. The evidence favors a finding that the Veteran has a disability manifesting in chills that is related to his service-connected diabetes mellitus.  

CONCLUSIONS OF LAW

1. The criteria for the award of service connection for lumbar and cervical spine disabilities, to include incomplete quadriplegia with chronic fatigue (claimed as joint and muscle pain and chronic fatigue), have been met.  38 U.S.C. §§ 1110, 1131, 1154(b); 38 C.F.R. § 3.303. 

2. The criteria for the award of service connection for bladder and bowel incontinence have been met.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310.

3. The criteria for the award of service connection for a respiratory disability, to include neuromuscular respiratory disorder and left lung atelectasis (claimed as shortness of breath) have been met.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310.

4. The criteria for the award of service connection for a disability manifesting in loss of balance and incoordination have been met.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310.

5. The criteria for the award of service connection for a disability manifesting in foot pain have been met.  38 U.S.C. §§ 1110, 1131, 1154(b); 38 C.F.R. § 3.303.

6. The criteria for the award of service connection for a disability manifesting in loss of hair of the lower extremities have been met.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310.

7. The criteria for the award of service connection for a disability manifesting in chills have been met.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from July 1972 to March 1981, and is a recipient of the Combat Action Ribbon.

These matters come before the Board of Veterans' Appeals (Board) on appeal of January 2013 and July 2015 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO).  

In
 §§ 3.303, 3.310.

7. The criteria for the award of service connection for a disability manifesting in chills have been met.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from July 1972 to March 1981, and is a recipient of the Combat Action Ribbon.

These matters come before the Board of Veterans' Appeals (Board) on appeal of January 2013 and July 2015 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO).  

In January 2019, the Veteran testified during a video conference hearing before the undersigned Veterans Law Judge.  A transcript of the hearing is associated with the claims file.

Clarification of issues on appeal

The Board remanded the issues on appeal most recently in a March 2024 decision.  

Included within the remand were the Veteran's requests for compensation under the provisions of 38 U.S.C. § 1151 for a traumatic brain injury (TBI), incontinence, and cervical and lumbar spine disorders resulting from injuries sustained at VA facilities on March 25, 2010, and January 2011.  

In a subsequent April 2025 rating decision, the AOJ awarded service connection for a TBI based on a finding that such was related specifically to an in-service head injury.  In a December 2025 rating decision, the AOJ made the TBI service-connection award effective the date VA received the Veteran's § 1151 claim in February 2011.  

Section 1151 provides for compensation for a disability "as if" it were service connected.  In other words, it creates an alternate means of attaining benefits attendant to service connection in the absence of entitlement to full-service connection.  As indicated above, service connection for a TBI has now been awarded.  Therefore, no additional monetary or ancillary benefit can be awarded under § 1151 for that disability.   

On this basis, it appears that the AOJ construed the TBI award as sufficient to moot the Veteran's § 1151 claim; however, the Veteran's § 1151 claim included more than just a request for compensation for a TBI.  Indeed, in addition to a TBI, the Veteran also requested compensation for cervical spine, lumbar spine and incontinence disabilities under the provisions of 38 C.F.R. § 1151.  The Board finds that a remand is not required to instruct the AOJ to address these facets of the Veteran's § 1151 claim in a Supplemental Statement of the Case (SSOC) because the Board is able to grant entitlement to service connection for the same disabilities herein.  Thus, the Board finds that this AOJ error in failing to readjudicate the remainder of the Veteran's § 1151 claim (for compensation based on additional disability other than TBI) in the July 2025 SSOC to be harmless, in light of the fact that it is able to grant entitlement to service connection for the claimed cervical spine, lumbar spine and incontinence disabilities on alternate theories below.  

In March 2024, the Board also remanded the issues of entitlement to service connection for a disability manifesting in dizziness, and for a disability manifesting in loss of balance and incoordination.  The AOJ granted entitlement to service connection for vertigo (claimed as dizziness), as secondary to the Veteran's TBI, in its April 2025 rating decision.  This award represents a full grant of the Veteran's request for service connection for dizziness.  However, the AOJ did not readjudicate the Veteran's service-connection claims for a disability manifesting in loss of balance and incoordination in a rating decision or in the July 2025 SSOC.  The Board finds this failure to readjudicate to be harmless error, as the Board is able to grant the benefit sought in this decision. 

Finally, the Board observes that the Veteran has submitted several pages of argument in support of the assignment of higher monthly compensation rates, disability ratings, or earlier effective dates for compensation awards that are not part of this appeal stream.  Indeed, this decision only addresses those issues that were pending within the VA's Legacy appeal system under Docket Number 15-12 468, and is limited to the issues as listed above. 

1. Entitlement to service connection for a lumbar and cervical spine disabilities, to include incomplete quadriplegia with chronic fatigue (claimed as joint and muscle pain and chronic fatigue) is granted.

2. Entitlement to service connection for bowel and bladder disability (claimed as incontinence) is granted.

3
. 

Finally, the Board observes that the Veteran has submitted several pages of argument in support of the assignment of higher monthly compensation rates, disability ratings, or earlier effective dates for compensation awards that are not part of this appeal stream.  Indeed, this decision only addresses those issues that were pending within the VA's Legacy appeal system under Docket Number 15-12 468, and is limited to the issues as listed above. 

1. Entitlement to service connection for a lumbar and cervical spine disabilities, to include incomplete quadriplegia with chronic fatigue (claimed as joint and muscle pain and chronic fatigue) is granted.

2. Entitlement to service connection for bowel and bladder disability (claimed as incontinence) is granted.

3. Entitlement to service connection for a respiratory disability, to include neuromuscular respiratory disorder and left lung atelectasis (claimed as shortness of breath), is granted.  

Service connection is granted for disability resulting from disease or injury that was incurred in or aggravated by active service.  38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).  Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

Service connection may also be granted when a claimed disability is found to be proximately due to or the result of a service-connected disability. 38 C.F.R. § 3.310.

The Veteran seeks entitlement to service connection for joint and muscle pain related to his neck and spinal cord.  Specifically, he states his was injured during combat while serving in Vietnam.  See, e.g., February 2021 correspondence.  

There is no dispute that the Veteran has current cervical and lumbar spine disabilities.  An August 2021 VA-contract examiner specifically diagnosed the Veteran with degenerative disc disease and spinal stenosis of the cervical spine, along with incomplete quadriplegia.  The same examiner identified degenerative arthritis, degenerative disc disease and spinal stenosis of the Veteran's lumbar spine, again with incomplete quadriplegia.  

Concerning in-service disease or injury, pursuant to a November 2020 Joint Motion for Remand granted by the Court of Appeals for Veterans Claims (the Court), the Board has accepted that the Veteran suffered injury to his neck and back during combat service pursuant to 38 U.S.C. § 1154(b), notwithstanding a lack of documented treatment within his service treatment records.  The Veteran has specifically described injuring his neck and back in a two-story fall down a ladder under combat conditions in 1973.  Notably, the AOJ has already accepted as true that, in this same fall, the Veteran suffered a TBI, and it awarded service connection for this disability in April 2025.  

The August 2021 examiner opined against a relationship between the Veteran's cervical and lumbar spine disabilities and any in-service neck or back injury based on medical evidence on file showing that the Veteran suffered intervening post-service neck and back injuries in a 2003 motor vehicle accident (MVA).  The examiner relied on medical records on file contemporaneous with, and dated within the years following the 2003 accident that suggest the Veteran experienced little to no problems with his back or neck prior to the accident, but a significant degree of disability after the accident.  Because there was no actual imaging records, or other documentation of neck or back complaints prior to 2003, the examiner was "unable to establish a baseline for any chronic degenerative spine or joint changes that may have developed prior to the July 2003 MVA."   The examiner did recognize that it was possible that repetitive loadbearing, ship duties and chronic use were the points of origin for the Veteran's conditions, but that a relationship to service could not be made without any documentation of problems prior to 2003.

The Veteran does not deny re-injuring his back and neck in the 2003 motor vehicle accident.  His contention is that, notwithstanding any aggravation that may have occurred in 2003, he still experienced back and neck problems that existed since his original combat-related injury in 1973.  See, e.g., an August 12, 2015 VA Spinal Cord Injury Note (noting the Veteran's report of in-service injury to his head, back and neck, and that he was hurt, but went back to his duties without any documented care).  The Veteran indicated that this fall injury started his whole spinal condition, and it just worsened over time for years.  He indicated that the 2003 MVA triggered new and worsening symptoms, and that he suffered additional exacerbating injuries on VA property in 2010 and 2011.  See,
 aggravation that may have occurred in 2003, he still experienced back and neck problems that existed since his original combat-related injury in 1973.  See, e.g., an August 12, 2015 VA Spinal Cord Injury Note (noting the Veteran's report of in-service injury to his head, back and neck, and that he was hurt, but went back to his duties without any documented care).  The Veteran indicated that this fall injury started his whole spinal condition, and it just worsened over time for years.  He indicated that the 2003 MVA triggered new and worsening symptoms, and that he suffered additional exacerbating injuries on VA property in 2010 and 2011.  See, id.

These intervening post-service spine and neck injuries do complicate the inquiry in this case.  In an attempt to gain further information about the state of the Veteran's disabilities during the time period shortly after his 2003 accident, the Board, on two occasions, instructed the AOJ to secure all of the medical and adjudicative records pertaining to the Veteran's 2003 claim for Social Security Administration (SSA) disability benefits.  It appears from the SSA's responses that the department only maintained a very limited number of documents pertaining to the Veteran's 2003 award.  While the AOJ once again did not comply with the Board's recent remand instructions to specifically inform the Veteran if complete SSA records were unavailable, for the reasons discussed below, the Board finds another remand to provide such notice is not necessary.

Under 38 U.S.C. § 1154(b), in the case of any veteran who engaged in combat with the enemy in active service with a military, naval, air, or space organization of the United States during a period of war, campaign, or expedition, the Secretary shall accept as sufficient proof of service-connection of any disease or injury alleged to have been incurred in or aggravated by such service satisfactory lay or other evidence of service incurrence or aggravation of such injury or disease, if consistent with the circumstances, conditions, or hardships of such service, notwithstanding the fact that there is no official record of such incurrence or aggravation in such service, and, to that end, shall resolve every reasonable doubt in favor of the veteran.  So it is in this case.  As noted above, the AOJ has already accepted that the Veteran suffered a TBI during the same in-service combat-related fall, and awarded service connection for the same, notwithstanding the fact that no such injury was documented in service treatment records, and notwithstanding the fact that post-service medical evidence documented that the Veteran suffered post-service head trauma injuries in 2010 and 2011.  The award was based largely on a January 2025 medical opinion linking the Veteran's current TBI symptoms to injuries sustained in the in-service fall.  That examiner accepted the Veteran's report of injury to the head and spine.  A different January 2025 examiner linked the Veteran's vertigo to the Veteran's head and neck injury in service, and the AOJ accepted this as true in awarding service connection for vertigo.  

After considering (1) the AOJ's favorable actions in awarding service connection for TBI and vertigo based on the opinions of medical examiners who accepted as true the presence of additional disability due to the Veteran's in-service injury to the head, neck and back; (2) the Veteran and his spouse's own competent reports of neck and back problems since service, that were exacerbated by post-service injury in 2003, 2010 and 2011; and (3) the fact that all efforts to obtain relevant treatment reports from the SSA-which may have shed light on the nature of the Veteran's neck and spine disabilities just before and shortly after his 2003 motor vehicle accident-have been futile, the Board will find that the evidence for and against the Veteran's service-connection claim for his cervical spine and lumbar spine disabilities, which now include incomplete quadriplegia, is in approximate balance.  Resolving all doubt in the Veteran's favor, the benefits sought on appeal are granted.

The Veteran attributes chronic fatigue to his now service-connected neck and spine disabilities.  Although a July 2023 VA-contract examiner determined that the Veteran did not have "chronic fatigue syndrome," as defined by VA, the medical records clearly attribute symptoms of chronic fatigue to his service-connected spine, neck and extremity disabilities.  Accordingly, the Board will acknowledge fatigue as a service-connected symptom of his spine and neck disabilities, and to this extent the claim for service connection for fatigue is granted. 

The Board also notes that a December 2024 examiner linked the Veteran's bladder incontinence specifically to his quadriplegia, noting that a spinal cord injury causing quadriplegia typically affects the function of organs related to the pelvic region, like
 Veteran attributes chronic fatigue to his now service-connected neck and spine disabilities.  Although a July 2023 VA-contract examiner determined that the Veteran did not have "chronic fatigue syndrome," as defined by VA, the medical records clearly attribute symptoms of chronic fatigue to his service-connected spine, neck and extremity disabilities.  Accordingly, the Board will acknowledge fatigue as a service-connected symptom of his spine and neck disabilities, and to this extent the claim for service connection for fatigue is granted. 

The Board also notes that a December 2024 examiner linked the Veteran's bladder incontinence specifically to his quadriplegia, noting that a spinal cord injury causing quadriplegia typically affects the function of organs related to the pelvic region, like the bladder and bowels due to the disruption of nerve signals to those areas.  A prior August 2021 examiner addressed the presence of impairment of rectal sphincter control and constipation due to neurogenic bowel, and similarly attributed the disability to damage to the spinal cord.  As such, the Veteran's bladder and bowel incontinence is at least as likely as not related to his service-connected spine disabilities, and service-connection for both is granted on a secondary basis. 

The Veteran has also claimed entitlement to service connection for a respiratory disability manifesting in shortness of breath.  He has submitted private records of care noting that his progressive shortness of breath is likely neuromuscular in etiology, attributed to his quadriplegia and wheelchair dependence.  See, e.g., a June 6, 2022 private treatment report (diagnosing neuromuscular respiratory failure).  The Veteran has also been assessed with left lung atelectasis, also attributed to lung failure.  See a December 2024 VA-contract examiner's report and opinion.  A prior July 2023 VA-contract examiner identified the left lung atelectasis as the likely cause of shortness of breath, noting that the Veteran is a partial paraplegic spending most of his time in a recumbent position in a wheelchair.  The examiner indicated that the Veteran tends to lean toward the left side, and this prolonged positioning is likely the cause of his left lung base atelectasis.  Given these assessments, the evidence persuasively favors a finding that the Veteran's respiratory disabilities, to include neuromuscular respiratory disorder and left lung atelectasis, are related to his service-connected spine and neck disabilities.  Entitlement to service connection is therefore granted on a secondary basis.  

The Board adds that although the VA has recognized in-service exposure to asbestos, an asbestos-related lung disease (to include mesothelioma) has yet to be medically identified.  There are records of care suggesting that the Veteran is being monitored for potential development of lung cancer (a disability presumed to be related to herbicide agent exposure under VA's regulations), given the presence of lung nodules upon imaging.  However, no formal cancer diagnosis is shown by the record.  Should the Veteran develop additional lung disease related to asbestos exposure, or lung cancer in particular, he is invited to file new service-connection claims for such disabilities. 

In sum, entitlement to service connection for a lumbar and cervical spine disabilities, to include incomplete quadriplegia with chronic fatigue (claimed as joint and muscle pain and chronic fatigue) is granted.  Additionally, entitlement to service connection for bladder and bowel incontinence, as well as for respiratory disabilities, to include neuromuscular respiratory disorder and left lung atelectasis is granted.  

As mentioned above, the Veteran has sought compensation for his TBI, spine, neck and incontinence disabilities under two theories of entitlement-entitlement to compensation based on service connection awards, and entitlement to compensation under the provisions of 38 U.S.C. § 1151 based on VA negligence in 2010 and 2011.  As the AOJ, and now the Board, have granted the benefits sought for each of these disabilities based on service-connection awards, the claims for the same under the § 1151 theory of entitlement need not be addressed, and are rendered moot.  In so finding, the Board makes no judgment as to the merits of the § 1151 claims.  It merely points out that no further adjudication of the claims are necessary given that no additional monetary or ancillary benefit can be awarded under § 1151 for those disabilities.

4. Entitlement to service connection for disability manifesting in loss of balance and incoordination is granted. 

As noted above, although the Board remanded the issue of entitlement to service connection for a disability manifesting in loss of balance and incoordination to the AOJ for further evidentiary development in March 2024, the AOJ did not specifically readjudicate the issue before returning the Veteran's appeal to the Board.  Such is harmless error as
 finding, the Board makes no judgment as to the merits of the § 1151 claims.  It merely points out that no further adjudication of the claims are necessary given that no additional monetary or ancillary benefit can be awarded under § 1151 for those disabilities.

4. Entitlement to service connection for disability manifesting in loss of balance and incoordination is granted. 

As noted above, although the Board remanded the issue of entitlement to service connection for a disability manifesting in loss of balance and incoordination to the AOJ for further evidentiary development in March 2024, the AOJ did not specifically readjudicate the issue before returning the Veteran's appeal to the Board.  Such is harmless error as the evidence sufficiently establishes a causal connection between the claimed in-service head injury and resultant TBI, which is now service-connected.  Indeed, a January 2025 VA-contract examiner specifically linked the Veteran's problems with balance and coordination to the Veteran's TBI, which was in turn due to head injury from a fall in 1973 while serving on active duty.  Based on this evidence, entitlement to service connection for a disability manifesting in loss of balance and incoordination is granted.  

5. Entitlement to service connection for disability manifesting in foot pain is granted.

The Veteran has competently reported ongoing foot pain since his initial in-service fall, manifesting in functional impairment affecting his ability to stand and walk.  The AOJ has already been awarded service connection for polyneuropathy of each lower extremity based on his presumed in-service exposure to herbicide agents.  Insofar as this prior award may not specifically capture symptoms of foot pain since service (as opposed to lower leg pain in general) due to impact from his fall, the Board affords the Veteran the benefit of the doubt and finds the evidence sufficient to establish service connection for a foot pain disability on a direct basis.  

6. Entitlement to service connection for disability manifesting in loss of hair to the lower extremities is granted. 

7. Entitlement to service connection for disability manifesting in chills is granted.

The Veteran has claimed entitlement to service connection for loss of hair on his legs, and for disability manifesting in chills, asserting such may be due to his in-service toxic exposures.  The AOJ recently obtained medical opinions addressing the etiology of these conditions.  A January 2025 VA-contract examiner linked both conditions to the Veteran's service-connected diabetes mellitus, type II, which was itself recognized as an herbicide agent-related disease.  Regarding hair loss, the January 2025 examiner indicated diabetes can cause hair loss of the legs, as high blood sugar levels can damage blood vessels throughout the body, including those in the legs.  The impaired blood flow can restrict the delivery of oxygen and nutrients to the hair follicles, which may lead to hair loss.  The examiner opined that it was at least as likely as not that the Veteran's hair loss of the legs was due to, or the result of his service-connected diabetes.  

The examiner similarly linked the Veteran's history of chills with his diabetes, noting how blood sugar levels can affect the development of chills, feeling shaky or having clamminess of the skin.  The examiner also noted that the Veteran's TBI in service could also contribute to chills as a TBI can cause temperature regulation issues depending on which part of the brain was injured.  The examiner opined that it was at least as likely as not that the Veteran's chills were due to, or the result of his service-connected diabetes and/or his TBI.  

Based on this favorable medical evidence, the Board finds that entitlement to service connection for disability manifesting in loss of hair to the lower extremities and chills can be granted on a secondary basis.

 

ANTHONY C. SCIRÉ, JR

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	V. Chiappetta, 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.