VERTIGO

EVAN M. DEICHERT · 2026 · Case ID: 26003113

GRANTED

Summary

The Veteran, an Army veteran who served from June 1990 to April 1992, including service in the Southwest Asia Theater of Operations, appeals the denial of service connection for vertigo. The Veteran's service treatment records were negative for vertigo complaints, and his separation examination found all systems normal. However, the Veteran later reported vertigo symptoms in 2015 and 2017. A September 2017 VA examination opined that the vertigo was less likely than not related to service, citing negative service records and post-service records, and stating it was not an undiagnosed illness or MUCMI. A July 2018 private treatment record noted vertigo with an unclear etiology, alongside chronic fatigue syndrome and fibromyalgia. Subsequent VA examinations in 2024 and 2025 also opined that the vertigo was less likely than not related to service or TERA, citing the lack of objective evidence and a significant gap between service and symptom onset. The 2025 examiner diagnosed Benign Paroxysmal Positional Vertigo (BPPV), attributing it to aging or crystal dislodgement, not TERA. Despite the negative VA opinions, the Board found the Veteran's vertigo complaints to be manifestations of a medically unexplained chronic multisymptom illness (MUCMI), potentially linked to his diagnosed fibromyalgia and chronic fatigue syndrome. Resolving all reasonable doubt in the Veteran's favor, the Board granted service connection for vertigo.

Rationale

Vertigo complaints may be a neurological manifestation of MUCMI; Negative VA examinations support variability of condition; Resolving all reasonable doubt in Veteran's favor

Service Branch

NAVY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

18-05 953

Full Decision Text

Citation Nr: 26003113
Decision Date: 03/09/26 Archive Date: 03/09/26

DOCKET NO. 18-05 953
DATE: March 9, 2026

ORDER

Entitlement to service connection for vertigo is granted.

FINDING OF FACT

Resolving all reasonable doubt in favor of the Veteran, his complaints of vertigo are symptoms of a medically unexplained chronic multi-symptoms illness (MUCMI), and the evidence is at least in approximate balance as to whether the condition is manifest to a degree of 10 percent or more.

CONCLUSION OF LAW

The criteria for service connection for vertigo are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.317.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the Unites States Navy from June 1990 to April 1992, to include service in Southwest Asia Theater of Operations. For his meritorious service, the Veteran was awarded (among other decorations) the Southwest Asia Service Medal with two stars.

This matter is before the Board of Veterans' Appeals (Board) on appeal from a September 2017 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO).

The Veteran testified at Board hearings in February 2020 and June 2022. Transcripts of the hearings have been associated with the claims file.

This appeal was denied by the Board in September 2022. The Veteran appealed the issue to the Court of Appeals for Veterans Claims (Court), which entered a Joint Motion for Partial Remand (JMPR). The issue was returned to the Board. The appeal was remanded by a Board decision for further development in December 2023. The appeal was returned to the Board and again remanded for development in a September 2025 Board decision. The issue has since returned to the Board for appellate review. The Board finds substantial compliance with its remand directives.

The Board acknowledges that the Veteran has previously presented testimony on this issue before two separate Veterans Law Judges, and that previous decisions of the Board have required a panel decision. Given the positive finding in this case, the Board finds no prejudice to having only the VLJ who conducted the most recent hearing decide this case alone.

Entitlement to service connection for vertigo is granted.

The Veteran asserts that he is entitled to service connection for vertigo.

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).

Service connection may be granted for a Persian Gulf veteran with objective indications of a qualifying chronic disability that became manifest to any degree at any time. 38 U.S.C. § 1117(a)(1). A qualifying chronic disability is a chronic disability that may result from an undiagnosed illness or a medically unexplained chronic multisymptom illness (MUCMI). 38 C.F.R. § 3.317(a)(2)(i). The term chronic means that the disability has existed for 6 months or more, to include intermittent episodes of improvement or worsening over that period. 38 C.F.R. § 3.317(a)(4).

To constitute as a "qualifying" chronic disability, the disability must not be attributed to any known clinical disease by history, physical examination, or laboratory tests. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(1). The term "objective indications of chronic disability" includes both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(3). Signs or symptoms which may be manifestations of undiagnosed illness or MUCMI include, but are not limited to: fatigue, signs or symptoms involving skin, headache, muscle pain, joint pain, neurologic signs and symptoms, neuropsychological signs or symptoms, signs or symptoms involving the respiratory system (upper or lower), sleep disturbances
.F.R. § 3.317(a)(1). The term "objective indications of chronic disability" includes both "signs," in the medical sense of objective evidence perceptible to an examining physician, and other, non-medical indicators that are capable of independent verification. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(3). Signs or symptoms which may be manifestations of undiagnosed illness or MUCMI include, but are not limited to: fatigue, signs or symptoms involving skin, headache, muscle pain, joint pain, neurologic signs and symptoms, neuropsychological signs or symptoms, signs or symptoms involving the respiratory system (upper or lower), sleep disturbances, gastrointestinal signs or symptoms, cardiovascular signs or symptoms, abnormal weight loss, menstrual disorders. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317(b).

A qualifying chronic disability means a chronic disability resulting from any of the following (or any combination of the following): an undiagnosed illness; the following MUCMIs that are defined by a cluster of signs or symptoms: chronic fatigue syndrome; fibromyalgia; irritable bowel syndrome; any diagnosed illness or which the Secretary determines that presumptive service-connection is warranted; or any other illness for which the Secretary determines that the following criteria for a MUCMI are met. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(2).

The term "medically unexplained chronic multi-symptom illness" means a diagnosed illness without conclusive pathophysiology or etiology that is characterized by overlapping symptoms and signs and has features, such as fatigue, pain, disability out of proportion to physical findings, and an inconsistent demonstration of laboratory abnormalities. Chronic multi-symptom illnesses of partially understood etiology and pathophysiology will not be considered medically unexplained. See 38 U.S.C. § 1117; 38 C.F.R. § 3.317(a)(2).

When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in approximate balance, with the veteran prevailing in either event, or whether the weight of the evidence is against the claim, in which case, the claim is denied. U.S.C. § 5107 (b); 38 C.F.R. § 3.102.

The service treatment records contain no complaint, treatment, or diagnosis of vertigo. On the April 1992 separation report of medical history, the Veteran specifically indicated that he did not experience dizziness or fainting spells. On the April 1992 separation examination, the medical provider found all of the Veteran's systems to be normal.

In a July 2015 VA treatment record the Veteran complained of symptoms, which included dizziness, and requested testing for Gulf War symptoms.

On a September 2017 VA ear conditions examination, while the Veteran complained that he suffered from vertigo symptoms that started years ago, the examiner indicated that the Veteran does not have a diagnosis of an ear or peripheral vestibular condition.

The September 2017 VA examiner opined that the Veteran's vertigo is less likely than not the result of service. The examiner reasoned that the Veteran's service treatment records are negative for vertigo and his post service medical records are negative for vertigo. The examiner also stated that the Veteran's vertigo is not an undiagnosed illness, not a diagnosable but medically unexplained chronic multi-symptom illness of unknown etiology, and not due to service in Southwest Asia, and not due to active military service.

A July 2018 private treatment record from the Veteran's included a questionnaire regarding possible signs and symptoms that could be attributed to the Veteran's service in Southwest Asia. In this questionnaire, the Veteran's private physician noted that he suffers from vertigo or other complaints with an etiology that is not readily ascertainable. That same record reflects the Veteran's suffering from chronic fatigue syndrome and fibromyalgia with the same lack of a readily ascertainable etiology.

A December 2022 VA memorandum establishes that the Veteran had military service that constitutes presumptive toxic exposure under 38 U.S.C. § 1119 (specifically, for exposure to burn pits). And a December 2023 VA memorandum establishes that the Veteran participated in TERA during service, identified as minimal exposure to asbestos due to service aboard a certain vessel.

A January 2024 VA examiner opined that it is less likely than not that the Veteran's vertigo is the result of TERA, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic combined effect of all TERA of the Veteran. The examiner reasoned that the Veteran's service treatment records are silent for vertigo.
iology.

The January 2024 VA examiner opined that it is less likely than not that the result of active service or TERA, after considering the total potential exposure through all applicable military deployments of the Veteran and synergistic combined effect of all TERA of the Veteran. The examiner reasoned that there is no medical or scientific evidence available that provides any indication of a relationship between the development of vertigo and TERA, to include burn pits.

On the October 2025 VA ear condition examination, the examiner indicated that the Veteran has a diagnosis of benign paroxysmal positional vertigo (BPPV). The Veteran stated that his vertigo began in the 2000s and has progressed or worsened since its onset.

The October 2025 VA examiner opined that it is less likely than not that the Veteran's vertigo is the result of service. The examiner reasoned that the records are silent for vertigo symptoms until 2017, which is almost 25 years after service. The examiner stated that there is a large gap indicating a lack of chronicity, and no evidence of nexus that current symptoms are due to service. Although the Veteran reports having symptoms in service, the examiner found no objective evidence of this.

The October 2025 VA examiner also opined that it is less likely than not that the Veteran's vertigo is the result of TERA, after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all TERA of the Veteran. The examiner stated that there is no medical evidence that burn pits or asbestos TERA causes vertigo. The examiner reasoned that when there is a known cause, BPPV is often associated with a minor to severe blow to the head. The examiner stated that less common causes of BPPV include disorders that damage the inner ear, or rarely, damage that occurs during ear surgery or long periods positioned on your back, such as in a dentist chair. The examiner stated that BPPV also has been associated with migraines. The examiner further explained that an organ of the ear contains crystals that make one sensitive to gravity and for many reasons and the crystals can become dislodged. The examiner stated that when the crystals become dislodged, they can move into the ear and cause the ear to become sensitive to head position changes, which is what causes dizziness. The examiner explained that risk factors for BPPV are being over the age of 50, being a woman, and a head injury or any other disorder of the balance organs of the ear. The examiner found that the Veteran's BPPV is likely due to aging or changes in the crystals in the ear, not due to TERA exposures. The examiner cited to medical literature.

Here, the Veteran had active service in the Red Sea in support of Operation Desert Sheild and Desert Strom from August 1990 to March 1991 and is thus considered a Persian Gulf veteran. 38 C.F.R. § 3.317(e).

Resolving all reasonable doubt in favor of the Veteran, the Board concludes that his complaints of vertigo represent manifestations of a MUCMI and warrant a grant of service connection.

As noted, in support of his claim, the Veteran submitted a private treatment record reflecting that the Veteran suffers from vertigo symptoms, and that it had an unclear etiology. Considering that this record also noted the Veteran's fibromyalgia and chronic fatigue symptoms (conditions for which the Veteran is now service-connected), the Board finds that his vertigo complaints may be a neurological manifestation of this multisymptom illness.

The negative VA examinations, rather than weighing against this conclusion, instead support this finding. Again, the 2017 VA examination determined that the Veteran did not suffer from vertigo, despite his complaints of symptoms. The fact that a later VA examiner diagnosed the Veteran as suffering from BPPV therefore reflects the variability of this condition, consistent with the guidance provided by 38 C.F.R. § 3.317.

In the end, the Board resolves all reasonable doubt in favor of the Veteran, and concludes that his complained of vertigo symptoms are part of a larger MUCMI
(conditions for which the Veteran is now service-connected), the Board finds that his vertigo complaints may be a neurological manifestation of this multisymptom illness.

In the end, the Board resolves all reasonable doubt in favor of the Veteran, and concludes that his complained of vertigo symptoms are part of a larger MUCMI, to include his fibromyalgia and chronic fatigue. Service connection for vertigo is thus granted.

Evan M. Deichert

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board M. Thompson, 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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