CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

GREGORY DEEMER · 2026 · Case ID: 26004058

MIXED

Summary

The veteran, an Army veteran who served from October 1966 to August 1968, appeals the denial of service connection for chronic obstructive pulmonary disease (COPD) and the remand of claims for Parkinson's disease and peripheral neuropathy in all extremities. The Board denied service connection for COPD, finding that while the veteran has the condition and served in Vietnam, his service treatment records were silent regarding any in-service complaints or diagnosis of COPD. The Board found the veteran's lay testimony regarding a private pulmonologist's opinion linking COPD to Agent Orange exposure to be outweighed by unfavorable VA medical opinions. The Board noted that the veteran's COPD, interstitial lung disease, and enlarged lymph nodes were diagnosed post-service and are more likely attributable to risk factors outside of military service, such as a history of smoking and employment as a firefighter. The Board found the VA's December 2025 addendum opinion inadequate for failing to fully address the nature and etiology of the claimed conditions and for inconsistencies with prior examinations. Consequently, the claims for Parkinson's disease and peripheral neuropathy in all extremities were remanded for further development, including new VA examinations to clarify diagnoses, assess functional impairment, and opine on the nexus to service, including herbicide exposure.

Rationale

No in-service complaints or diagnosis of COPD; Post-service risk factors (smoking, firefighter) more likely etiologies; Unfavorable VA opinion outweighed reported private opinion due to lack of rationale

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

18-39 927

Full Decision Text

Citation Nr: 26004058
Decision Date: 04/01/26 Archive Date: 04/01/26

DOCKET NO. 18-39 927
DATE: April 1, 2026

ORDER

Entitlement to service connection for chronic obstructive pulmonary disease (COPD), to include enlarged lymph nodes in the lungs and shortness of breath, is denied.

REMANDED

Entitlement to service connection for Parkinson's disease is remanded.

Entitlement to service connection for peripheral neuropathy of the right upper extremity is remanded.

Entitlement to service connection for peripheral neuropathy of the left upper extremity is remanded.

Entitlement to service connection for peripheral neuropathy of the right lower extremity is remanded.

Entitlement to service connection for peripheral neuropathy of the left lower extremity is remanded.

FINDING OF FACT

COPD, to include enlarged lymph nodes in the lungs and shortness of breath, did not manifest during service and is not etiologically related to service.

CONCLUSION OF LAW

The criteria for service connection for COPD, to include enlarged lymph nodes in the lungs and shortness of breath, have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from October 1966 until his honorable discharge in August 1968.

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).

This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In September 2022, the Veteran testified before the undersigned. A hearing transcript has been associated with the claims file.

In February 2023, October 2024, and May 2025, the Board remanded the case to the Regional Office for further development. Specifically, the most recent Board remand directed the Regional Office to (1) schedule the Veteran for an examination to assess the nature and etiology of his claimed COPD, (2) schedule the Veteran for an examination to assess the nature and etiology of his claimed Parkinson's disease, (3) schedule the Veteran for an examination to assess the nature and etiology of his claimed bilateral upper and bilateral lower peripheral neuropathy (neurological symptomatology), and (4) issue a Supplemental Statement of the Case.

In response, in September 2025, the Regional Office obtained VA examination(s) and Medical Opinion(s) for the issues on appeal; and in December 2025 the Regional Office obtained addendum opinion(s) for the issues on appeal.

As will be addressed in greater detail below, the Board finds that there has not been substantial compliance with the Board's previous remand directives regarding the issue(s) on appeal. Stegall v. West, 11 Vet. App. 268, 271 (1998).

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (1) the existence of a present disability; (2) 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. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

In addition, service connection for certain chronic diseases may be established on a presumptive basis by showing that the condition manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.
1163, 1167 (Fed. Cir. 2004)). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

In addition, service connection for certain chronic diseases may be established on a presumptive basis by showing that the condition manifested to a degree of 10 percent or more within one year from the date of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309(a); Fountain v. McDonald, 27 Vet. App. 258, 271-72 (2015). Although the disease need not be diagnosed within the presumptive period, it must be shown, by acceptable lay or medical evidence, that there were characteristic manifestations of the disease to the required degree during that time. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a).

Additionally, for certain chronic diseases with potential onset during service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge may support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

A Veteran who served in the Republic of Vietnam during the Vietnam era is presumed to have been exposed during to an herbicide agent, unless there is affirmative evidence to the contrary. 38 C.F.R. § 3.307(a)(6)(iii). The Vietnam era is the period beginning on February 28, 1961 and ending on May 7, 1975 for veterans who served in the Republic of Vietnam, and the period beginning on February 28, 1961 and ending on May 7, 1975, in all other cases. 38 U.S.C. § 101(29)(A). Service in the Republic of Vietnam is "service in the waters offshore and service in other locations if the conditions of service involved duty or visitation in the Republic of Vietnam." 38 C.F.R. § 3.307(a)(6)(iii). VA has interpreted this regulation to require "the service member's presence at some point on the landmass or the inland waters of Vietnam" for entitlement to a presumption of exposure to Agent Orange. Haas v. Peake, 525 F.3d 1168, 1197 (Fed. Cir. 2008), cert. denied, 129 S.Ct. 1002 (2009). Furthermore, the United States Court of Appeals for the Federal Circuit (Federal Circuit) held in 2019 that service in the Republic of Vietnam includes service in the territorial seas of the Republic of Vietnam. See Procopio v. Wilkie, 913 F.3d 1371 (Fed. Cir. 2019). The holding in Procopio was further codified in the Blue Water Navy Act of 2019. 38 U.S.C. § 1116A(c). Service on a U.S. Navy vessel may qualify as duty or visitation in Vietnam, as long as the veteran set foot on land or the vessel nevertheless was in the inland waterways or territorial waters of the Republic of Vietnam. 38 C.F.R. §§ 3.307(a)(6)(iii); Haas, 525 F.3d at 1195, 1197; Gray v. McDonald, 27 Vet. App. 313 (2015); Procopio v. Wilkie, 913 F.3d 1371 (Fed. Cir. 2019).

VA maintains a list of US Navy and Coast Guard ships associated with military service in Vietnam that addresses whether the ship was in the inland or offshore waterways and had possible exposure to Agent Orange or other herbicides.

Additionally, the PACT Act (Public Law Number 117-168) provides that a Veteran who served in Thailand at any United States or Royal Thai base during the period beginning on January 9, 1962 through June 30, 1976, without regard to where on the base the Veteran was located or what military job specialty the Veteran performed is presumed to have been exposed during to an herbicide agent, unless there is affirmative evidence to the contrary; a Veteran that performed in Laos during the period beginning on December 1, 1965 through September 30, 1969 is presumed to have been exposed during to an herbicide agent, unless there is affirmative evidence to the contrary; performed in Cambodia at Mimot or Krek, Kampong Cham Province during the period beginning on April 16, 1969 through April 30, 1969 is presumed to have been exposed during to an herbicide agent, unless there is affirmative evidence to the contrary; or performed on Guam or American Samoa, or in the territorial waters thereof, during the period beginning on January 9, 1962 through July 31, 1980, or served on a ship that called at Johnston Atoll during the period beginning on January 1, 1972 through September 30, 1977 is presumed to have been exposed during to an herbicide agent, unless there is affirmative evidence to the contrary. See Pub. L. 117-168.

For veterans presumed to have been exposed to herbicides, certain enumerated diseases shall be service connected even though there is no record of such disease during service, so long as the requirements of 38 U.S.C. § 1116 and 38 C.F.R. § 3.307(a)(6)(iii) are met, and the rebuttable presumption provisions of 38 U.S.C. § 1113 and 38 C.F.R. § 3.307(d) are also satisfied. 38 C.F.R. § 3.309(e). The enumerated diseases which are deemed to be associated with herbicide exposure include specific respiratory disorder(s) [respiratory cancers (cancer of the lung, bronchus, larynx, or trachea)], but exclusive of COPD. 38 C.F.R. § 3.309(e).

A presumption of service connection based on exposure to herbicides used in the Republic of Vietnam during the Vietnam era is not warranted for: hepatobiliary cancers; nasal and/or nasopharyngeal cancer; bone and joint cancer; breast cancer; female reproductive cancers; renal cancer; testicular cancer; abnormal sperm parameters and infertility; Amyotrophic Lateral Sclerosis (ALS); chronic persistent peripheral neuropathy; lipid and lipoprotein disorders; gastrointestinal and digestive disease including liver toxicity; immune system disorders; circulatory disorders; respiratory disorders (other than certain respiratory cancers); skin cancer; cognitive and neuropsychiatric effects; gastrointestinal tract tumors; brain tumors; endometriosis; and, any other condition for which VA has not specifically determined a presumption of service connection is warranted. See Diseases Not Associated with Exposure to Certain Herbicide Agents, 68 Fed. Reg. 27,630 (May 20, 2003); Diseases Not Associated with Exposure to Certain Herbicide Agents, 67 Fed. Reg. 42,600 (June 24, 2002); Diseases Associated with Exposure to Certain Herbicide Agents; Type 2 Diabetes, 66 Fed. Reg. 2,376 (Jan. 11, 2001); Diseases Not Associated with Exposure to Certain Herbicide Agents, 64 Fed. Reg. 59,232 (November 2, 1999); Pub. L. 117-168.

The Board notes that on the date the Pact Act is enacted, Veterans whom the Secretary of Veterans Affairs determines are (a) terminally ill; (b) homeless; (c) under extreme financial hardship; (d) more than 85 years old; or (e) capable of demonstrating other sufficient cause. For all others, the PACT Act is effective October 1, 2022 for claims of entitlement to service connection for monoclonal gammopathy of undetermined significance and October 1, 2026 for claims of entitlement to service connection for hypertension. See Pub. L. 117-168.

Finally, the Board notes that retroactive application under section 38 U.S.C. § 1116(a)(2)(L) in regards to the expansion of benefits afforded under the PACT Act shall only be applicable to claimants for dependency
ally ill; (b) homeless; (c) under extreme financial hardship; (d) more than 85 years old; or (e) capable of demonstrating other sufficient cause. For all others, the PACT Act is effective October 1, 2022 for claims of entitlement to service connection for monoclonal gammopathy of undetermined significance and October 1, 2026 for claims of entitlement to service connection for hypertension. See Pub. L. 117-168.

Finally, the Board notes that retroactive application under section 38 U.S.C. § 1116(a)(2)(L) in regards to the expansion of benefits afforded under the PACT Act shall only be applicable to claimants for dependency and indemnity compensation under chapter 13 of such title described in subparagraph (A)(i). See Pub. L. 117-168.

The Veteran's Benefits Act of 1998, enacted as Subtitle B of Public Law No. 105-178, § 8202, 112 Stat. 492, amended 38 U.S.C. §§ 1110 and 1131 to prohibit VA compensation for disabilities attributable to a Veteran's use of tobacco products in service.

That legislation was approved on June 9, 1998; and was made effective for all claims filed thereafter. Then, in Public Law No. 105-206, § 9014, 112 Stat. 865, approved on July 22, 1998, the amendments made by section 8202 of the previous statute were rescinded. Rather than amending 38 U.S.C. §§ 1110 and 1131, section 9014 created a new 38 U.S.C. § 1103 which provides, in pertinent part, as follows:

Notwithstanding any other provision of law, a Veteran's disability or death shall not be considered to have resulted from personal injury suffered or disease contracted in the line of duty in the active military, naval, or air service for purposes of this title on the basis that it resulted from injury or disease attributable to the use of tobacco products by the Veteran during the Veteran's service.

Thus, section 1103 bars an award of service connection for a disability arising long after service based upon a finding that such disability was caused by tobacco use during service. It does not, however, preclude the establishment of service connection based upon a finding that a disease or injury (even if tobacco-related) became manifest or was aggravated during active service or became manifest to the requisite degree of disability during any applicable presumptive period specified in 38 U.S.C. §§ 1112, 1116. See 38 U.S.C. § 1103(b). See also VAOPGCPREC 6-2003.

By its terms, section 1103 applies to all claims, like the current claim, which was filed after June 9, 1998. Therefore, the Board finds that [military smoking caused...]. See Sabonis v. Brown, 6 Vet. App. 426, 430 (1994) (where the law and not the evidence is dispositive, the Board should deny the claim on the ground of lack of legal merit).

The Board notes that the Veteran's VA treatment records reflect that the Veteran is a former smoker.

1. Entitlement to service connection for COPD, to include enlarged lymph nodes in the lungs and shortness of breath is denied.

The Veteran contends that he is entitled to service connection for COPD, to include enlarged lymph nodes in the lungs and shortness of breath, as a result of exposure to herbicides. See November 2017 VA Form 21-526EZ, (Application for Disability Compensation and Related Compensation Benefits).

First, the Board finds that there is a current disability. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). The Veteran is diagnosed with COPD. See September 2025 VA Examination.

Second, the Board finds that there was an in-service event, injury or disease. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). In June 2011 the National Personnel Records Center (NPRC) confirmed that the Veteran served in the Republic of Vietnam from February 1968 to August 1968. Memorandums in January 2023 and July 2023 show that the Veteran had toxic exposure risk activities (TERA) during service. The Veteran does not assert, nor does the record reflect an in-service onset of COPD. The Veteran's Service Treatment Records, entrance examination, and separation examination reflect a normal clinical evaluation with no complaints of COPD disabilities.

In reaching this
injury or disease. See Holton, 557 F.3d at 1366; 38 C.F.R. § 3.303(d). In June 2011 the National Personnel Records Center (NPRC) confirmed that the Veteran served in the Republic of Vietnam from February 1968 to August 1968. Memorandums in January 2023 and July 2023 show that the Veteran had toxic exposure risk activities (TERA) during service. The Veteran does not assert, nor does the record reflect an in-service onset of COPD. The Veteran's Service Treatment Records, entrance examination, and separation examination reflect a normal clinical evaluation with no complaints of COPD disabilities.

Third, the Board finds that the evidence of record does not support a finding that the Veteran's COPD is related to active service. [This section addresses all VA examinations and all private examinations. It should also address the first date of treatment and whether the Veteran alleges prior treatment or that he did not seek treatment. This may include a credibility determination, but not in every case. This section must do a competency and credibility analysis of the Veteran's lay statements, both regarding nexus (if made) and regarding statements of continuous symptoms since discharge].

Subsection (a) of 38 U.S.C. § 1168 does not apply if the VA determines there is no indication of an association between the disability claimed by the Veteran and the TERA for which the Veteran submitted evidence. 38 U.S.C. § 1168 (b). In VA's sub-regulatory guidance, one of the situations in which the exception applies is for a disorder determined to have no positive association with herbicide exposure. See VBA Letter 20-24-06, Exception to TERA Examination and Medical Opinion Requirement at pages 12-13 (June 12, 2024). VA has determined, based on cumulative scientific data reported by the National Academies of Science since 1993, that COPD, has no positive association with herbicide exposure. Id. Additionally, there is no suggestion of any other TERA in the record. Therefore, a COPD opinion under the PACT Act is not required.

On VA respiratory examination in February 2023 the examiner noted that the Veteran was diagnosed with COPD in 2015 and a lung nodule in May 2016.

On VA heart examination in November 2023, it was reported that a chest x-ray shows findings most consistent with interstitial fibrotic changes.

On VA respiratory examination in September 2025, the diagnosis was COPD. The examiner noted that a July 2019 CT scan shows subtle spine interstitial opacities in the lung bases and multiple borderline enlarged mediastinal lymph nodes.

In a September 2025 VA opinion, the examiner opined that the Veteran's COPD was less likely than not due to service as there is a lack of substantiating evidence to support a nexus and post-service event, illness or injury is considered the more likely etiology. The examiner also opined that COPD was less likely than not caused by TERA activities, noting that COPD is primarily caused by cigarette smoking and environmental/occupational exposures. The examiner stated that current medical literature has not established a direct causal link between Agent Orange and COPD. Some studies have explored associations, but results are inconclusive. The examiner further noted that the Veteran had a history of former tobacco use as well as employment as a firefighter, both of which are more likely to be causative factors of development of COPD.

In a VA exam addendum on December 8, 2025, the examiner opined that it was less likely than not that COPD was due to service to include Agent Orange exposure. The examiner explained that service treatment records are silent for chronic respiratory complaints or diagnosis, COPD and lung nodules were noted in April 2014, when the Veteran was seeing a private pulmonologist for mediastinal lymphadenopathy. An oncology note in May 2023 shows the Veteran was a former smoker with a history of one pack per day for 20 years and previously worked as a fireman. A CT scan in April 2025 shows extensive interstitial fibrosis, bronchiectasis changes, and emphysema. The impression was rheumatoid arthritis associated with interstitial lung disease (RA ILD). The examiner concluded that a review of available medical literature failed to demonstrate a causal relationship between the Veteran's exposure
service treatment records are silent for chronic respiratory complaints or diagnosis, COPD and lung nodules were noted in April 2014, when the Veteran was seeing a private pulmonologist for mediastinal lymphadenopathy. An oncology note in May 2023 shows the Veteran was a former smoker with a history of one pack per day for 20 years and previously worked as a fireman. A CT scan in April 2025 shows extensive interstitial fibrosis, bronchiectasis changes, and emphysema. The impression was rheumatoid arthritis associated with interstitial lung disease (RA ILD). The examiner concluded that a review of available medical literature failed to demonstrate a causal relationship between the Veteran's exposure to Agent Orange and the development of COPD and RA-ILD, including after consideration of the total potential exposure through all applicable military deployments of the Veteran and the synergistic combined effect of all toxic exposure risk activities. The examiner pointed out that the Veteran had risk factors outside of military service, to include smoking one pack per day for 20 years and a work history as a fireman that are a more likely etiology for his COPD and RA-ILD. The examiner noted that the Veteran's enlarged lymph nodes (mediastinal adenopathy) were an incidental finding on CT imaging and may have been related to his previous diagnosis of pneumonia or may be directly related to his interstitial lung disease. According to the National Institute of Health (NIH) mediastinal lymph node enlargement is commonly seen in patients with interstitial lung disease. The examiner explained that the lung nodule first refenced in the 2014 ambulatory care note was determined to be stable and benign. The Veteran's shortness of breath was likely due to his COPD and RA-ILD, which the examiner noted is commonly seen with these diagnoses. She stated that the dry cough also was associated with COPD and RA-ILD.

The Board finds the unfavorable December 2025 VA opinion to be probative as it was based on medical principles and applied to the facts of the case. Nieves-Rodriquez v. Peake, 22 Vet. App. 295 (2008). The opinion is consistent with the other competent evidence of record.

The Veteran during the September 2022 Board hearing indicated that a private pulmonologist told him that his COPD was due to Agent Orange exposure. Lay evidence is competent when reporting a contemporaneous diagnosis. Jandreau v. Nicholson, 492 F3d. 1372, 1377 (2007). However, the Board finds that the Veteran's report of the favorable opinion is outweighed by the unfavorable opinion discussed above. The Board rejects the Veteran's reported favorable medical opinion as no reasoning or rationale was provided for the conclusion reached. A mere conclusion statement is insufficient to allow the Board to make an informed decision as to the weight to assign to the medical statement. Stefl v. Nicholson, 21 Vet. App. 120, 125 (2007). Furthermore, the Veteran during the hearing stated that the private pulmonologist would not commit to writing an opinion that related COPD to his Agent Orange exposure.

As a lay person, the Veteran is competent to report symptoms pertaining to his COPD. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), the etiology of his claimed disorder falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n. 4 (Fed. Cir. 2007). The Veteran's respiratory disorder to include COPD is not the type of disorder that is readily amenable to mere lay diagnosis or probative comment regarding its etiology. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

The Veteran has not been shown to possess the requisite medical training, expertise, or credentials needed to render a diagnosis or a competent opinion as to medical causation. Nothing in the record demonstrates that the Veteran received any special training or acquired any medical expertise in evaluating COPD. Accordingly, the lay evidence does not constitute competent medical evidence and lacks probative value. As the lay evidence is not competent, the matter of whether it is credible is not reached.

For the above reasons, entitlement to service connection for COPD is denied.

In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the evidence persuasively weighs against the Veteran's claim, the doctrine is not for application. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir.
, or credentials needed to render a diagnosis or a competent opinion as to medical causation. Nothing in the record demonstrates that the Veteran received any special training or acquired any medical expertise in evaluating COPD. Accordingly, the lay evidence does not constitute competent medical evidence and lacks probative value. As the lay evidence is not competent, the matter of whether it is credible is not reached.

For the above reasons, entitlement to service connection for COPD is denied.

REASONS FOR REMAND

1. Entitlement to service connection for Parkinson's disease is remanded.

2. Entitlement to service connection for peripheral neuropathy of the right upper extremity is remanded.

3. Entitlement to service connection for peripheral neuropathy of the left upper extremity is remanded.

4. Entitlement to service connection for peripheral neuropathy of the right lower extremity is remanded.

5. Entitlement to service connection for peripheral neuropathy of the left lower extremity is remanded.

Due to the similar dispositions for the above claims on appeal, the Board will address them in a common discussion below.

For veterans presumed to have been exposed to herbicides, certain enumerated diseases shall be service connected even though there is no record of such disease during service, so long as the requirements of 38 U.S.C. § 1116 and 38 C.F.R. § 3.307(a)(6)(iii) are met, and the rebuttable presumption provisions of 38 U.S.C. § 1113 and 38 C.F.R. § 3.307(d) are also satisfied. 38 C.F.R. § 3.309(e). The enumerated diseases which are deemed to be associated with herbicide exposure include Parkinson's disease, Parkinsonism, and early onset peripheral neuropathy. 38 C.F.R. § 3.309(e).

January 31, 2017, private treatment records contain diagnoses for restless leg syndrome and hereditary and idiopathic neuropathy, unspecified.

The Veteran contends that he has Parkinson's disease and peripheral neuropathy of the upper and lower extremities as a result of exposure to herbicides. See November 2017 VA Form 21-526EZ, (Application for Disability Compensation and Related Compensation Benefits). During his September 2022 Board hearing, the Veteran testified that he went to a neurologist as a result of involuntary movements in his legs; these underlying symptoms served as the basis for his claim for Parkinson's disease, even though, as the Veteran acknowledged at this hearing, he had never been diagnosed with Parkinson's disease. The Veteran's claims for entitlement to service connection for peripheral neuropathy of his right and left upper and lower extremities were originally denied by the RO on a presumptive basis because there was no evidence of treatment or diagnosis for this condition within one year of the last date of exposure to herbicides; the RO also denied the Veteran's claims on a direct basis due to a lack of evidence in his service treatment records of complaints, treatment, or diagnoses for peripheral neuropathy. See April 2018 rating decision.

In the most recent remand in May 2025 the Board remanded the issues in order for the Veteran to be scheduled for VA examinations to determine the nature and etiology of his claimed Parkinson's disease and peripheral neuropathy of the upper and lower extremities. The examiner was instructed to clarify all disabilities potentially related to the claimed Parkinson's disease and peripheral neuropathy of the upper and lower extremities. The examiner was advised that for the sake of the questions, all neurological symptomatology resulting in functional impairment of earning capacity is to be considered a disability, regardless of whether a formal diagnosis has been rendered. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Thereafter the examiner was asked to opine whether each disability identified was related to service on a direct basis, to specifically include as a result of exposure to herbicides on a direct basis. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

On VA diabetic sensory-motor peripheral neuropathy examination in September 2025, the examiner determined that the Veteran did not have diabetes mellitus but did have right postoperative peripheral neuropathy. The Veteran reported fracturing his right hip and developed numbness in the right lower extremity and also noted that he had right hand surgery along with tingling in his fourth and fifth fingers. The examiner determined that there was right upper and lower extremity peripheral
asked to opine whether each disability identified was related to service on a direct basis, to specifically include as a result of exposure to herbicides on a direct basis. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

Subsequent VA examinations and unfavorable opinions were obtained, including in June 2025 and September 2025. By way of summary, in a June 2025 VA opinion, the examiner opined that the Veteran's claimed Parkinson's was less likely than not related to service as there was lack of substantiating evidence supporting a nexus between no diagnosis of Parkinson's, restless leg syndrome, and hereditary-idiopathic neuropathy and military service. The examiner stated that without chronicity during service or after service, a post-service event, illness, or injury is considered to be a more likely etiology. The examiner stated that the most significant etiology of restless leg syndrome as medical literature suggests is a genetic predisposition. The examiner stated that the confirmed diagnoses of restless leg syndrome and hereditary/idiopathic neuropathy did not onset within one year of toxic exposure of Agent Orange and they are caused by a genetic mutation of family origin that is unrelated to toxic exposure based upon available evidence. On VA examination for Parkinson's disease in September 2025 the examiner determined that the Veteran did not have a diagnosis of Parkinson's disease. The examiner noted that the evidence in the file shows a diagnosis of restless leg syndrome. In a September 2025 VA opinion, the examiner stated that it was less likely than not that the claimed Parkinson's was due to service to include Agent Orange exposure and TERA activities as the Veteran did not have a diagnosis of Parkinson's disease and instead his diagnosis was restless leg syndrome. In a September 2025 VA opinion, the examiner opined that it was less likely than not that right lower extremity peripheral neuropathy was due to service to include Agent Orange exposure as symptoms of right upper extremity neuropathy started after the right hip injury that were not related to service. The examiner opined that there was no diagnosis of left lower extremity peripheral neuropathy and left upper extremity peripheral neuropathy. The examiner opined that it was less likely than not that the Veteran's right upper extremity neuropathy was due to service to include exposure to Agent Orange based on the rationale that his symptoms started after his right wrist procedure that were unrelated to service.

In a December 2025 VA exam addendum, the examiner determined that the previous medial opinions should be disregarded as they were provided in error. The examiner opined that it was less likely than not that Parkinson's disease was related to service, to include Agent Orange exposure and consideration of his TERA activities based on the rationale that the Veteran did not have a diagnosis of Parkinson's and had an assessment of restless leg syndrome and hereditary and idiopathic neuropathy. As for peripheral neuropathy, the examiner opined that peripheral neuropathy of the right lower extremity and right upper extremity were less likely than not caused by service based on the rationale that service treatment records are silent for complaints of numbness and tingling and the Veteran was not diagnosed with peripheral neuropathy to include hereditary and idiopathic neuropathy until 2016, which is 48 years after separation from service. The examiner also noted that the Veteran did not have a formal or definitive diagnosis of right lower extremity peripheral neuropathy and right upper extremity peripheral neuropathy. The examiner pointed out that the Veteran had diagnoses of restless leg syndrome and hereditary and idiopathic neuropathy. The examiner opined that peripheral neuropathy of the left lower extremity and left upper extremity were less likely than not due to service to include Agent Orange exposure based on the rationale discussed above as well as normal objective physical exam findings indicating a lack of peripheral neuropathy in the left lower extremity and left upper extremity.

The Board finds the December 2025 VA exam addendum to be inadequate as the examiner did not address whether there are symptoms associated with Parkinson's disease, and peripheral neuropathy of the left upper extremity and left lower extremity that cause functional impairment that are separate from the Veteran's diagnosed restless leg syndrome and hereditary and idiopathic neuropathy. Further, the opinion also is inadequate regarding peripheral neuropathy of the right upper and right lower extremities as the examiner stated that there
ity and left upper extremity were less likely than not due to service to include Agent Orange exposure based on the rationale discussed above as well as normal objective physical exam findings indicating a lack of peripheral neuropathy in the left lower extremity and left upper extremity.

The Board finds the December 2025 VA exam addendum to be inadequate as the examiner did not address whether there are symptoms associated with Parkinson's disease, and peripheral neuropathy of the left upper extremity and left lower extremity that cause functional impairment that are separate from the Veteran's diagnosed restless leg syndrome and hereditary and idiopathic neuropathy. Further, the opinion also is inadequate regarding peripheral neuropathy of the right upper and right lower extremities as the examiner stated that there was no formal or definitive diagnosis of right lower extremity peripheral neuropathy and right upper extremity peripheral neuropathy, however the September 2025 exam clearly shows such diagnoses. Thus, there is a lack of compliance with the Board's remand directives. Where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance. Stegall v. West, 11 Vet. App. 268 (1998).

The Board notes that in a subsequent exam addendum in December 2025 a clarifying addendum was requested regarding the claimed Parkinson's disease, peripheral neuropathy of the left upper extremity, right upper extremity, right lower extremity, and left lower extremity based in part on the reasoning that the opinion did not address whether the Veteran's symptoms constitute functional impairment under Saunders and did not differentiate post-surgical neuropathy of the right wrist from potential service-related or herbicide neuropathy. As for right lower extremity peripheral neuropathy, it was noted in part that the opinion did not address whether herbicide exposure could be a direct causative factor under Combee. The clarification response to the above matters stated that the exam addendum dated December 8, 2025, contains the requested information and was based on review of the claims file as the "original provider" was unavailable. However, as discussed above the VA exam addendum dated December 8, 2025, is inadequate and does not comply with the May 2025 Board's remand directives. Thus, further development remains necessary.

By this remand the Board makes no determination, expressed or implied, as to the credibility of any statements on file.

The matters are REMANDED for the following action:

1. Obtain an opinion regarding the nature and etiology of the Veteran's claimed Parkinson's disease, preferably with a medical doctor. If necessary, schedule the Veteran for a VA examination with an appropriate examiner. After reviewing the claims folder, the examiner should:

a.) Identify/diagnose all current disabilities potentially related to the Veteran's claimed Parkinson's disease. If an underlying diagnosis cannot be provided the examiner is asked to determine whether there is associated symptomatology separate from restless leg syndrome and hereditary and idiopathic neuropathy that causes functional impairment.

b.) Thereafter, the examiner is asked to opine, for each disability identified, whether it is at least as likely as not (i.e., likelihood is at least approximately balanced, or nearly equal, if not higher), that such is related to service on a direct basis, to specifically include as a result of exposure to herbicides on a direct basis. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

The examiner must provide a detailed rationale for all opinions, including citations to any medical and/or scientific research that the examiner has relied upon. If the examiner is unable to provide an opinion, the examiner must note if the inability is due to a lack of personal knowledge (the examiner does not have the knowledge or training); or a lack of knowledge in the medical community (no one could respond given medical science and the known facts); or a deficiency in the record (additional facts are required).

2. Obtain an opinion regarding the nature and etiology of the Veteran's claimed left upper extremity peripheral neuropathy and left lower extremity peripheral neuropathy; and peripheral neuropathy of the right upper extremity and right lower extremity. If necessary, schedule the Veteran for a VA examination with an appropriate examiner. After reviewing the claims folder, the examiner should:

a.) Identify/diagnose all current disabilities potentially related to the Veteran's claimed peripheral neuropathy of the left upper and left lower extremities. If an underlying diagnosis cannot be provided the examiner is asked to determine whether there is associated symptomatology separate from restless leg syndrome and hereditary and idiopathic neuropathy that causes functional impairment.

b.) Thereafter, the examiner is asked to opine, for each disability identified, whether it is at least as likely as not (i.e., likelihood
extremity peripheral neuropathy; and peripheral neuropathy of the right upper extremity and right lower extremity. If necessary, schedule the Veteran for a VA examination with an appropriate examiner. After reviewing the claims folder, the examiner should:

b.) Thereafter, the examiner is asked to opine, for each disability identified, whether it is at least as likely as not (i.e., likelihood is at least approximately balanced, or nearly equal, if not higher), that such are related to service on a direct basis, to specifically include as a result of exposure to herbicides on a direct basis. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

c.) Opine whether it is at least as likely as not (i.e., likelihood is at least approximately balanced, or nearly equal, if not higher), that peripheral neuropathy of the right upper extremity and right lower extremity, separate from hereditary and idiopathic neuropathy, are related to service on a direct basis, to specifically include as a result of exposure to herbicides on a direct basis. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994).

3. The Agency of Original Jurisdiction (AOJ) must review the claims file and ensure that the foregoing development action has been completed in full. If any development is incomplete, appropriate corrective action must be implemented. If any report does not include adequate responses to the specific opinions requested, it must be returned to the providing examiner for corrective action.

4. After the above development, the AOJ must readjudicate the issues on appeal considering all pertinent evidence and legal authority. If the disposition remains unfavorable, the AOJ should furnish the Veteran and his representative with a Supplemental Statement of the Case and be afforded a reasonable opportunity to respond before the record is returned to the Board for further review. This Supplemental Statement of the Case must address the relevant laws and regulations applicable for the remanded issues on appeal.

Gregory Deemer

Acting Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Mac, M.

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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