CERVICAL SPINE LIMITATION OF MOTION

Summary

The veteran, who served in the Navy and Air National Guard from April 1987 to March 2004, including active duty for training from July 2001 to December 2001, appeals the denial of service connection for hypertension, a right foot disability, and a skin disability, while seeking service connection for cervical spine disability, bilateral upper extremity neuropathy, and right ankle degenerative arthritis. The Board granted service connection for cervical spine disability as secondary to a previously established low back disability, citing a positive nexus opinion from a VA examiner in October 2024 that linked the cervical condition to lumbar degenerative changes. The Board also granted service connection for right and left upper extremity neuropathy as secondary to the newly granted cervical spine disability, based on a favorable VA opinion. Service connection for right ankle degenerative arthritis was granted as secondary to the service-connected lumbar spine disability, supported by a positive nexus opinion from a VA examiner in October 2024, which noted a pathophysiological relationship between the lumbar and ankle conditions. However, the Board denied service connection for hypertension, finding that the evidence did not support chronic in-service symptoms, continuous post-service symptoms, or a nexus to service or TERA, with multiple VA examiners providing negative opinions. The claims for right foot disability and skin disability were also denied, as the evidence did not establish a nexus to service or TERA, with VA examiners providing negative opinions for both conditions.

Rationale

Positive nexus opinion from October 2024 VA examiner; Pathophysiological relationship between lumbar and cervical spine conditions; Awarded on a secondary service connection theory

Full Decision Text

Citation Nr: 26001978
Decision Date: 02/11/26	Archive Date: 02/11/26

DOCKET NO. 18-31 712
DATE: February 11, 2026

ORDER

Service connection for a cervical spine disability as secondary to a low back disability is granted.

Service connection for right upper extremity neuropathy, as secondary to a neck disability, is granted.

Service connection for left upper extremity neuropathy, as secondary to a neck disability, is granted.

Service connection for degenerative arthritis of the right ankle is granted, as secondary to a low back disability. 

Service connection for hypertension, to include as due to service connected low back and urinary track disabilities and in-service toxic exposure risk activity (TERA), is denied. 

Service connection for a right foot disability, to include as due to service connected low back and urinary track disabilities and in-service TERA, is denied. 

Service connection for a skin disability, to include as due to service connected low back and urinary track disabilities and in-service TERA, is denied.

FINDINGS OF FACT

1. The evidence of record is at least in approximate balance as to whether the Veteran's cervical spine condition was caused by his service-connected low back disability.

2. The persuasive evidence of record weighs in favor of a finding that the Veteran's right and left upper extremity neuropathy are secondary to his service-connected cervical spine disability.

3. The persuasive evidence of record weighs in favor of a finding that the Veteran's right ankle disability, diagnosed as degenerative arthritis, is secondary to his service-connected lumbar spine disability.

4. The evidence shows a current diagnosis of hypertension; symptoms of hypertension were not chronic in service, were not continuous since service separation, and did not manifest to a compensable degree within one year of service separation; the current hypertension did not have its onset during service and is not otherwise etiologically related to active service, or to an injury or disease sustained during any period of active duty for training (ACDUTRA) service or to an injury sustained during any period of inactive duty for training (INACDUTRA) service, is not related to a Toxic Exposure Risk Activity (TERA) and has not been caused or aggravated by a service connected disability. 

5. The persuasive evidence of record is against a finding that the Veteran's right foot strain had its onset during service, is otherwise etiologically related to active service, or to an injury or disease sustained during ACDUTRA or to an injury sustained during any period of INACDUTRA service, is related to a TERA or has been caused or aggravated by a service connected disability. 

6. The evidence persuasively weighs against finding that the Veteran's skin disability had its onset during service, is otherwise etiologically related to active service, or to an injury or disease sustained during any period of ACDUTRA service or to an injury sustained during any period of INACDUTRA service, is related to a TERA or has been caused or aggravated by a service connected disability. 

CONCLUSIONS OF LAW

1. The criteria for service connection for a cervical spine condition have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.310.

2. The criteria for service connection for right upper extremity neuropathy have been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.310.

3. The criteria for service connection for left upper extremity neuropathy have been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.310.

4. The criteria for service connection for right ankle degenerative arthritis have been met.  38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.303, 3.310.

5. The criteria for service connection for hypertension have not been met.  38 U.S.C. §§ 101, 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.159, 3.303, 3.304, 3.307, 3.309, 3.310.

6. The criteria for service connection for a right foot strain have not been met.  38 U.S.C. §§ 101, 1110, 1112, 1131, 5103, 5107; 38 C.F.R. §§ 
, 3.310.

5. The criteria for service connection for hypertension have not been met.  38 U.S.C. §§ 101, 1110, 1112, 1131, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.159, 3.303, 3.304, 3.307, 3.309, 3.310.

6. The criteria for service connection for a right foot strain have not been met.  38 U.S.C. §§ 101, 1110, 1112, 1131, 5103, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.159, 3.303, 3.310.

7. The criteria for service connection for a skin disability have not been met.  38 U.S.C. §§ 101, 1110, 1112, 1131, 5103, 5107; 38 C.F.R. §§ 3.6, 3.102, 3.159, 3.303, 3.310.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Navy from April 1987 until his honorable discharge in October 1991. The Veteran also served in the United States Navy Reserve from October 1991 until his honorable discharge in May 1998. Finally, the Veteran served in the Georgia Air National Guard from March 2001 until his honorable discharge in March 2004, with active duty for training service from July 26, 2001 until December 21, 2001.

This appeal was most recently before the Board in August 2023. At that time, the Board, in part, remanded the appeal to the Regional Office (RO) for additional development. The appeal has been returned to the Board for further appellate consideration. 

This appeal has been advanced on the Board's docket pursuant to 38 U.S.C.§ 7107(a)(2); 38 C.F.R. § 20.900(c).

The Veteran seeks service connection for a cervical spine disability, RUE and LUE neuropathy; right ankle disability; right foot disability; a skin disorder; and hypertension. After a brief discussion of the laws and regulations governing service connection, the Board will adjudicate the claims. 

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. 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 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 term "active military, naval, or air service" includes active duty and "any period of active duty for training during which the individual concerned was disabled or died from a disease or injury incurred or aggravated in the line of duty, and any period of inactive duty for training during which the individual concerned was disabled from an injury incurred or aggravated in the line of duty." 38 U.S.C. § 101 (24); 38 C.F.R. § 3.6 (a) (emphasis added). ACDUTRA includes full-time duty in the Armed Forces performed by Reserves for training purposes and includes full-time duty performed by members of the National Guard of any State. INACDUTRA generally means duty (other than full-time duty) prescribed for Reserves and duty (other than full-time duty) performed by a member of the National Guard of any State. 38 U.S.C. §§ 101 (21), 101(23) 101(24); 38 C.F.R. §§ 3.6 (a), (c), (d).

To establish veteran status based on ACDUTRA, the claimant must establish that he or she was disabled resulting from an injury or disease incurred in or aggravated during the line of duty during that period.  To establish Veteran status based on INACDUTRA, the claimant must establish that he or she was disabled resulting from an injury incurred in or aggravated in the line of duty during that period.  38 U.S.C. §§ 101 (2), 101(24); 38 C.F.R. §§ 3.1 (d), 3.6 (a), (c), (d); Paulson
); 38 C.F.R. §§ 3.6 (a), (c), (d).

To establish veteran status based on ACDUTRA, the claimant must establish that he or she was disabled resulting from an injury or disease incurred in or aggravated during the line of duty during that period.  To establish Veteran status based on INACDUTRA, the claimant must establish that he or she was disabled resulting from an injury incurred in or aggravated in the line of duty during that period.  38 U.S.C. §§ 101 (2), 101(24); 38 C.F.R. §§ 3.1 (d), 3.6 (a), (c), (d); Paulson v. Brown, 7 Vet. App. 466, 470 (1995); Brooks v. Brown, 5 Vet. App. 484, 485 (1993).

If the claimant does not qualify as a veteran with respect to a particular claim, then he or she is not entitled to the presumption of soundness or aggravation as to that claim. See Donnellan v. Shinseki, 24 Vet. App. 167, 172 (2010); Paulson, 7 Vet. App. at 469-471. Similarly, the claimant is not entitled to the benefit of the legal presumptions pertaining to service connection for certain disabilities. See Biggins v. Brown, 1 Vet. App. 474, 478 (1991).

Service connection has already been established for various disabilities for the Veteran in this case for his period of active service in the United States Navy from April 1987 to October 1991. The fact that a claimant has established status as a veteran for purposes of other periods of service does not obviate the need to establish that the claimant also is a veteran for purposes of a period of ACDUTRA and a period of INACDUTRA where, as here, the claims are premised on a period of ACDUTRA and on a period of INACDUTRA. Mercado-Martinez v. West, 11 Vet. App. 415, 419 (1998). The United States Court of Appeals for Veterans Claims (Court) has interpreted 38 U.S.C. § 101 (24) as meaning that ACDUTRA (and INACDUTRA) will not be considered "active military, naval, or air service" unless the claimant previously established service connection for a disability incurred in such service. See Mercado-Martinez, 11 Vet. App. at 419; Paulson, 7 Vet. App. at 469-470; Biggins, 1 Vet. App. at 477-478.  Thus, the allocation of service among active duty, ACDUTRA, and INACDUTRA can bring about conclusive results for a claimant with respect to certain medical conditions.

i) Service connection for a cervical spine disability as secondary to a low back disability is granted.

The Veteran asserts that his neck began to bother him in 1987 and has continued to worsen since discharge. 

In the analysis below, the Board will award service connection for a cervical spine disability on a secondary service connection theory of entitlement. Thus, the Board will not address the direct and presumptive service connection theories of entitlement in the discussion below

Pursuant to the Board's August 2023 remand, VA opinions were obtained in October 2024, November 2024 and March 2025. Although the November 2024 and March 2025 VA clinicians found the Veteran's neck condition to have been less likely than not related to active service, the October 2024 examiner provided an extensive rationale which unequivocally opined that the Veteran's cervical degenerative disc disease was proximately due to or the result of service-connected degenerative arthritis and spondylolisthesis lumbar spine. The October 2024 VA examiner reasoned that medical literature and studies showed that patients with degenerative changes in the upper lumbar segments were more likely to have certain degree of cervical spondylosis. The October 2024 VA examiner stated that the Veteran had multilevel lumbar disc degeneration, which could lead to cervical spine degeneration. The examiner further opined that with pain in the lower back related to lumbar degenerative disc disease, there was an impact on the Veteran's spinal alignment and posture, which could ultimately lead to abnormal strain on the neck, resulting in cervical disc degeneration. Therefore, according to the October 2024 VA examiner, the Veteran's current diagnosis of cervical degenerative disc disease was at least as likely as not caused by the service-connected degenerative arthritis and spondylolisthesis of the lumbar spine because medically there was a pathophysiological
 certain degree of cervical spondylosis. The October 2024 VA examiner stated that the Veteran had multilevel lumbar disc degeneration, which could lead to cervical spine degeneration. The examiner further opined that with pain in the lower back related to lumbar degenerative disc disease, there was an impact on the Veteran's spinal alignment and posture, which could ultimately lead to abnormal strain on the neck, resulting in cervical disc degeneration. Therefore, according to the October 2024 VA examiner, the Veteran's current diagnosis of cervical degenerative disc disease was at least as likely as not caused by the service-connected degenerative arthritis and spondylolisthesis of the lumbar spine because medically there was a pathophysiological relationship between the two conditions.  Accordingly, service connection for a cervical spine condition is warranted, and the claim is granted in full.

ii) Service connection for right upper extremity neuropathy as secondary to a neck disability is granted.

iii) Service connection for left upper extremity neuropathy as secondary to a neck disability is granted.

As service connection for a cervical spine disability has been granted herein, and because his bilateral upper extremity neuropathy has been shown to be a secondary to the cervical spine disability per an August 2025 VA clinician, service connection for right and left upper extremity neuropathy as secondary to cervical spine disability is warranted. See August 2025 VA opinions; 38 C.F.R. § 3.310.

iv) Service connection for a right ankle disability as secondary to low back disability is granted. 

The Veteran seeks service connection for a right ankle disability. He contends that his right ankle had its onset between 1987 and 1988 after he fell off a ladder while on the ship during his period of active duty in the United States Navy from April 1987 to October 1991. 

In the analysis below, the Board will award service connection for a right ankle disability on a secondary service connection theory of entitlement. Thus, the Board will not address the theories of direct and presumptive service connection in the discussion below. 

As noted in the Board's August 2023 remand, VA opinions obtained in December 2022 and March and April 2023 were found to have been inadequate because the December 2022 VA examiner relied on an absence of treatment records without consideration of the Veteran's reports, did not consider service connection on a secondary basis (due to the now service-connected lumbar spine disability) and did not adequately address the Veteran's lay statement(s) that the disabilities began between 1987 and 1988 after he fell off a ladder while on the ship.

Pursuant to the Board's August 2023 remand, VA opinions were obtained in October 2024, November 2024, and March 2025. Although the November 2024 and March 2025 VA clinicians found, in part, that the Veteran's right ankle strain was not proximately due to or the result of service-connected degenerative arthritis and spondylolisthesis lumbar spine, an October 2024 VA examiner provided a positive nexus opinion between the two disabilities. The October 2024 VA examiner reasoned that there was a relationship between the lumbar spine condition in that in led to an abnormal gait that attributed to the right ankle condition. The October 2024 VA examiner further indicated that according to medical literature, the human body functioned within a kinetic chain and no one movement was ever completely isolated and without effect on another region of the body. The October 2024 VA examiner stated that an abnormal gait caused abnormal load and strain on the lower legs, ankles and feet, and that those forces felt throughout the limb influenced the development or exacerbation of musculoskeletal overuse or stress injuries. In addition, gait deviation, caused by the lumbar spine condition, caused abnormal strain on the lower legs, including the ankles and feet, that contributed to lower extremity musculoskeletal conditions. Therefore, the October 2024 VA clinician concluded that the current diagnosis of right ankle strain was at least as likely as not caused by the degenerative arthritis and spondylolisthesis lumbar spine condition because medically there was a pathophysiological relationship between the two conditions. Accordingly, service connection for a right ankle disability is granted. 

v) Service connection for hypertension is denied. 

The Veteran seeks service connection for hypertension. 

The evidence shows a current diagnosis of hypertension. See August 2024 VA examination report.  

The "chronic disease" presumptive service connection (38 U.S.C. § 1112) questions for the Board are whether the Veteran has a chronic disease (hypertension as a cardiovascular-renal disease) that manifested chronic symptoms in service, or continuous symptoms since service, or to 10 percent within one year of separation from active service.  Starting with the period of active service
hesis lumbar spine condition because medically there was a pathophysiological relationship between the two conditions. Accordingly, service connection for a right ankle disability is granted. 

v) Service connection for hypertension is denied. 

The Veteran seeks service connection for hypertension. 

The evidence shows a current diagnosis of hypertension. See August 2024 VA examination report.  

The "chronic disease" presumptive service connection (38 U.S.C. § 1112) questions for the Board are whether the Veteran has a chronic disease (hypertension as a cardiovascular-renal disease) that manifested chronic symptoms in service, or continuous symptoms since service, or to 10 percent within one year of separation from active service.  Starting with the period of active service from April 1987 to October 1991, the Board concludes that, while the Veteran now has hypertension that is a chronic disease listed under 38 C.F.R. § 3.309(a), the persuasive weight of the lay and medical evidence shows that symptoms of hypertension were not chronic in service, were not continuous since service, and did not manifest to a compensable degree within one year of active service separation in October 1991. For these reasons, the chronic disease presumptions are not met.  38 U.S.C. §§ 101(3), 1110, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a).  Additionally, the Board finds that the persuasive weight of the evidence shows that the current hypertension did not have its onset during active service, was not caused by, or the result of, any injury or disease during ACDUTRA service, and was not caused by any injury during INACDUTRA service. 

Service treatment records during the Veteran's active service from April 1987 to October 1991 do not reflect any in service injury, complaints, symptoms, findings, diagnosis, or treatment for high blood pressure. An October 1991 service separation examination report shows the Veteran's blood pressure was measured at 120/84 and that his cardiovascular system was found to be clinically normal. Additionally, the Veteran denied a history of high blood pressure on the corresponding Report of Medical History.  As such, the above evidence does not demonstrate chronic symptoms of hypertension during the period of active service from April 1987 and October 1991. While the Veteran was found to have a diagnosis of hypertension and to have been on medication at a December 28, 2002 Report of Medical History with the Georgia Air National Guard, which was within a year after the termination of his period of ACDUTRA on December 12, 2001. However, the chronic disease presumptions are not applicable to periods of ACDUTRA and INACDUTRA. Biggins, supra. 

In addition, the Board notes that a November 1998 Enlistment examination report of for the Air National Guard showed an elevated blood pressure reading of 144/103, this was when the Veteran was in-between periods of military service.  

On the question of direct nexus between the current hypertension and active service, the Board finds that the persuasive weight of the evidence is against finding that the currently diagnosed hypertension is causally related to service. To this end, the Board notes that an August 2024 VA examiner related the Veteran's hypertension to his period of military service. See August 2024 VA opinion. This same examiner provided a negative addendum opinion in October 2024. In the October 2024 opinion, the VA examiner opined that after a review of the Veteran's medical records and physical examination, it was less likely than not that the Veteran's hypertension was related to military service. The VA examiner reasoned that the Veteran's service treatment records showed that he was initially seen and treated for hypertension complaints on December 8, 2002, but that was based on a period of ACDUTRA from July 26, 2001 to December 21, 2001. Therefore, it was at less likely than not (less than 50 percent or probability) that the Veteran's current diagnosis of hypertension was incurred in and/or caused by service. See October 2024 VA opinion. 

The October 2024 VA examiner's opinion was supported by an August 2025 VA examiner's finding. The August 2025 VA examiner opined, in part, that the Veteran's hypertension began in 2003, and that the evidence did not sufficiently demonstrate that it was caused by and continued from military service. The August 2025 VA examiner acknowledged the November 1998 elevated blood pressure reading of 144/103 and stated that it had occurred in-between active duty periods. Therefore, according to the August 2025 examiner, a nexus had not been established. See August 202
 or probability) that the Veteran's current diagnosis of hypertension was incurred in and/or caused by service. See October 2024 VA opinion. 

The October 2024 VA examiner's opinion was supported by an August 2025 VA examiner's finding. The August 2025 VA examiner opined, in part, that the Veteran's hypertension began in 2003, and that the evidence did not sufficiently demonstrate that it was caused by and continued from military service. The August 2025 VA examiner acknowledged the November 1998 elevated blood pressure reading of 144/103 and stated that it had occurred in-between active duty periods. Therefore, according to the August 2025 examiner, a nexus had not been established. See August 2025 opinion. The October 2024 and August 2025 VA  opinions are well-reasoned and consistent with the other evidence of record, namely the Veteran's service treatment records and are against the claim for service connection for hypertension on a direct service connection theory of entitlement.

 Thus, the evidence of record does not contain a competent opinion--aside from the August 2024 VA opinion that was reversed in October 2024--establishing a nexus between the current hypertension and a period of active service, or to an injury or disease incurred during a period of ACDUTRA service or injury during INACDUTRA service.  

The Board also finds that the persuasive evidence of record is against service connection for hypertension on a secondary service connection theory of entitlement. The Veteran is currently service connection for a lumbar spine disability and urinary tract symptoms. In opinions, dated in August 2024, October 2024 and August 2025, VA examiners collectively opined that the Veteran's hypertension was less likely than not the result of or aggravated beyond its natural progression by the Veteran's service-connected lumbar spine disability and urinary tract disability. The VA examiners reasoned that hypertension risk factors included aging and lifestyle factors like unhealthy eating patterns (including a diet high in sodium), lack of physical activity, high consumption of beverages containing alcohol, and being overweight or obese. In October 2024, the examiner stated that degenerative arthritis and spondylolisthesis of the lumbar spine are a defect, or fracture that occur in one or more of the vertebral bones that form the spinal column and spondylolisthesis occurred when one vertebral bone slips on top of another, usually at the base of the spine, and that there was no medical pathophysiological relationship between the three conditions. Therefore, a nexus cannot be established at this time. See August 2024 and October 2024 VA opinions. 

The August 2025 examiner opined that hypertension, degenerative arthritis and spondylolisthesis of lumbar spine and lower urinary tract symptoms were separate and unrelated conditions. For primary (essential) hypertension in most adults, there was no identifiable cause of high blood pressure, and that this type of high blood pressure, called primary (essential) hypertension, tended to develop gradually over many years, and that medical studies/literatures and pathophysiological mechanisms were lacking to show that degenerative arthritis and spondylolisthesis of the lumbar spine and lower urinary tract symptoms could directly cause an increase in peripheral arterial pressure or hypertension. The August 2024, October 2024 and August 2025 (signed) examiners' opinions are well-reasoned, supported by medical literature and research and are against the claim. There is no other opinion that is supportive of the claim for service connection for hypertension on a secondary service connection theory of entitlement. For these reasons, the Board finds that the persuasive weight of the evidence is against service connection for hypertension on a secondary service connection theory of entitlement. 

Finally, the Board finds that the persuasive evidence of record is against the claim for service connection for hypertension as due to a TERA. The records reflects that the Veteran was exposed to a TERA, namely asbestos and fumes/ solvents from having performed duties as Radioman/Welding during service. See TERA memorandums, dated in November 2023, February 2024 and July 2024. There are VA opinions that are against this theory of entitlement. In October 2024 and August 2025, VA clinicians collectively opined that the Veteran's hypertension was less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated toxic exposure risk activity(ies), after considering the total potential exposure through all applicable military deployments of the veteran and the synergistic, combined effect of all toxic exposure risk activities of the veteran. The examiners maintained that hypertension was a disease with a clear and specific etiology or diagnosis. There was no known association between hypertension and the claimed toxic exposures. The Veteran's hypertension was an idiopathic hypertension and was a consequence of interaction between environmental and genetic factors. The examiners outlined the risk factors for
 VA opinions that are against this theory of entitlement. In October 2024 and August 2025, VA clinicians collectively opined that the Veteran's hypertension was less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated toxic exposure risk activity(ies), after considering the total potential exposure through all applicable military deployments of the veteran and the synergistic, combined effect of all toxic exposure risk activities of the veteran. The examiners maintained that hypertension was a disease with a clear and specific etiology or diagnosis. There was no known association between hypertension and the claimed toxic exposures. The Veteran's hypertension was an idiopathic hypertension and was a consequence of interaction between environmental and genetic factors. The examiners outlined the risk factors for hypertension, such as include excessive salt consumption, a diet high in saturated fat and trans fats, low intake of fruits and vegetables), physical inactivity, consumption of tobacco and alcohol, and being overweight or obese. The examiners concluded that there was no known mechanism by which toxic exposures would cause idiopathic hypertension.  The Veteran's risk factors of diet and genetics outweighed the TERA. See October 2024 and August 2025 VA opinions. 

Although the Veteran has asserted that hypertension is causally related to his period of service, a service-connected disability and environmental exposures, he is a lay person and does not have the requisite medical training or credentials to be able to render a competent medical opinion regarding the cause of his hypertension.  The etiology of hypertension is a complex medical etiological question dealing with the origin and progression of the cardiovascular-renal system. Thus, while the Veteran is competent to report some cardiovascular symptoms, he is not competent to opine on whether there is a link between hypertension, symptoms of which were manifested many years after service, and active service because such a medical opinion requires specific medical knowledge and training.  For these reasons, under the facts of this case that include no in-service symptoms or symptoms for years after service, the Veteran's lay statement is of no probative value in making a nexus between current hypertension and service.

For these reasons, the Board finds that the persuasive weight of the evidence is against service connection for hypertension, on all theories; therefore, the appeal must be denied.

vi) Service connection for a right foot disability is denied. 

The Veteran asserts that he has a right foot disability that is related to an in-service fall off of a ladder, while on the ship in 1987 or 1988.

As noted in the Board's August 2023 remand, the Veteran's service treatment records (STRs) show that on February 2, 1989, he sustained a left ankle injury after his foot slipped while he was descending a ladder. He was diagnosed with a left ankle strain. See February 1989 Service Treatment Records. However, the Board notes that the Veteran's service treatment records do not reflect a right foot injury. Id. 

In its August 2023 remand, the Board found VA opinions, obtained in December 2022 and March and April 2023, to have been inadequate because the December 2022 VA examiner relied on the absence of treatment records without consideration of the Veteran's reports, did not consider service connection on a secondary basis (due to the now service-connected lumbar spine disability) and did not adequately address the Veteran's lay statement(s) that the disabilities began between 1987 and 1988 after he fell off a ladder while on the ship.

Pursuant to the Board's August 2023 remand, VA opinions on the direct service connection theory of the claim for service connection for a right foot disability in August 2024 and March 2025.

Regarding the direct service connection theory of entitlement, the August 2024 and March 2025 VA examiners opined that the Veteran's right foot strain was less likely than not (likelihood is less than approximately due to or the result of service-connected disability left ankle strain. The VA examiners reasoned that  pathophysiologically the injuries were on opposite sides and the Veteran's STRs were silent for any chronic or recurrent right foot complaints and/or right foot injury. In addition, x-rays of the right foot, performed in December and July 2002, were normal. Thus, according to the August 2024 and March 2025 VA examiner, there was no chronicity or continuity of care for the right foot condition while in service or in the immediate year after discharge from service. Thus, it was less likely than not that the Veteran's right foot disability is related to service or any incident in service to include the left ankle injury. See August 2024 and March 2025 VA opinions. 

Regarding the secondary service connection theory of the claim for service connection for a right foot disability, in March 2025. The March 2025 VA examiner opined that it was less likely as not that the
 x-rays of the right foot, performed in December and July 2002, were normal. Thus, according to the August 2024 and March 2025 VA examiner, there was no chronicity or continuity of care for the right foot condition while in service or in the immediate year after discharge from service. Thus, it was less likely than not that the Veteran's right foot disability is related to service or any incident in service to include the left ankle injury. See August 2024 and March 2025 VA opinions. 

Regarding the secondary service connection theory of the claim for service connection for a right foot disability, in March 2025. The March 2025 VA examiner opined that it was less likely as not that the Veteran's right foot disability, claimed as rheumatoid arthritis is proximately due to or the result of degenerative arthritis and spondylolisthesis of lumbar spine and urinary tract residuals. There is no evidence from review of orthopedic literature to suggest that Veteran's condition of the spine and urinary track residuals would have any impact on the foot condition. The Veteran's spine condition could not cause or aggravate the claimed foot condition in the absence of severe muscle or nerve injury with paralysis of the leg or shortening of the limb with a length discrepancy of more than five (5) centimeters, and that this level of severity was not supported based on a thorough review of the Veteran's clinical records including histories, physical findings and testing results. See March 2025 VA opinions.

The March 2025 opinions are well reasoned, supported by medical literature and research and are against the claim. There is no other opinion that is supportive of the claim for service connection for hypertension on a secondary service connection theory of entitlement. For these reasons, the Board finds that the persuasive weight of the evidence is against service connection for a right foot on a direct or secondary service connection theory of entitlement.

Regarding the Veteran's claim for service connection for a right foot disability as due to a TERA, an exception to this requirement exists where VA has determined that there is no indication of an association between the disability claimed by the veteran and the veteran's TERA. 38 U.S.C. § 1168(b). Sub-regulatory guidance issued in conjunction with the PACT Act indicates that this specifically includes non-presumptive claims based on physical trauma, and that physical trauma includes trauma due to repetitive use and resulting in repetitive strain injuries. VBA Letter 20-22-10. Here, the Veteran has been diagnosed with right foot strain, and specifically reported that he believed the injury was due to a slip-and-fall incident during service. Thus, the Board finds that an exception to the TERA examination requirements applies, and no examination is warranted on this basis. See 38 U.S.C. § 1168(b).

vii) Service connection for a skin disability is denied.

The Veteran seeks service connection for a skin disability. 

The Board finds that the persuasive evidence of record is against the claim for skin disability on direct and secondary service connection theories of entitlement. 

The Veteran has a diagnosis of eczematous dermatitis. See August 2024 VA skin DBQ. The Veteran reported that the condition began in 1998 with having changes in the skin over time. The August 2024 VA examiner opined after a review of the record and physical examination of the skin, that it was less likely than not that the veteran's eczematous dermatitis was related to military service. The VA examiner reasoned that there were no medical records showing either diagnosis of, or treatment for, the eczematous dermatitis condition during active duty. Therefore, per lack of evidence during or within one (1) year of separation of military service, a nexus could not be complete without evidence to support the diagnosis and connect it with military service.

Regarding secondary service connection, the VA examiner concluded that the skin disability was less likely than not aggravated beyond its natural progression as it was not present during military service, and there are no service treatment records for treatment of skin condition while in military service. Therefore, according to the August 2024 examiner, the condition could not have been aggravated during service. See August 2024 VA opinions. The August 2024 opinions are well reasoned, supported by medical literature and research and are against the claim. There is no other opinion that is supportive of the claim for service connection for a skin on direct or secondary service connection theories of entitlement. For these reasons, the Board finds that the persuasive weight of the evidence is against service connection for a skin disability on direct or secondary service connection theory of entitlement is denied. 

Finally, the Board finds that the persuasive evidence of record is against the claim for service connection for a skin disability as due to a TERA. As noted previously herein, the Veteran has been exposed to a TERA. In November 2024, a VA clin
 been aggravated during service. See August 2024 VA opinions. The August 2024 opinions are well reasoned, supported by medical literature and research and are against the claim. There is no other opinion that is supportive of the claim for service connection for a skin on direct or secondary service connection theories of entitlement. For these reasons, the Board finds that the persuasive weight of the evidence is against service connection for a skin disability on direct or secondary service connection theory of entitlement is denied. 

Finally, the Board finds that the persuasive evidence of record is against the claim for service connection for a skin disability as due to a TERA. As noted previously herein, the Veteran has been exposed to a TERA. In November 2024, a VA clinician provided an opinion that is against the claim for service connection for a skin disability as due to a TERA. The VA examiner opined, after reviewing medical records to include the TERA Memorandums and ILER and performing physical examination, the claimed condition is less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated toxic exposure risk activity(ies), after considering the total potential exposure through all applicable military deployments of the veteran and the synergistic, combined effect of all toxic exposure risk activities of the veteran. The VA examiner reasoned that the Veteran's exposure history was inhalation daily, and that eczematous, atopic dermatitis was related to a gene variation that affected the skin's ability to provide protection. With a weak barrier function, the skin was less able to retain moisture and protect against bacteria, irritants, allergens and environmental factors such as tobacco smoke. There is no evidence to show that specific exposure events experienced by the Veteran during service were related to the current eczematous dermatitis condition. Thus, it was less as likely as not that the disability pattern or diagnosed disease is related to a specific exposure event experienced by the Veteran during service. See November 2024 VA opinion. 

As there is no other evidence to the contrary, and the November 2024 VA medical opinion was based on a full review of the record and an interview and examination of the Veteran, the Board finds it persuasive.

Finally, the Veteran's own statements relating his skin disability to service are not competent evidence, as he is a layperson and lacks the training to provide adequate opinion regarding medical etiology. Specifically, the Veteran lacks the training to opine whether skin disability, in the absence of credible evidence of continuity from service, as here, is related to an incident in service, to include TERA. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007) (Whether lay evidence is competent and sufficient in a particular case is a fact issue to be addressed by the Board rather than a legal issue to be addressed by the Veterans Court). Also, the record does not show that the Veteran has training or education in the field of dermatology; therefore, lay evidence of the etiology is not competent nexus 

evidence as it is not capable of lay observation. See Barr v. Nicholson, 21 Vet. App. 303, 307-08 (2007); Layno v. Brown, 6 Vet. App. 465, 469-70. Thus, the Veteran is not competent or qualified, as a layperson, to render an opinion on medical causation.

In light of the foregoing, the Board concludes that the evidence persuasively weighs against the Veteran's claim of entitlement to service connection for skin disability on all theories of entitlement. Accordingly, the claim is denied.

 

MATTHEW W. BLACKWELDER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Carole Kammel, 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.