Back to BVA DecisionsGRANTEDService Branch NAVY Special Benefit NO SPECIAL BENEFIT Docket No. 16-19 323
HYPERTENSION
B. MULLINS · 2026 · Case ID: 26004273
Summary
The Veteran, who served in the U.S. Navy from March 1975 to January 1998, appeals the denial of service connection for a heart disability and multi-joint rheumatoid arthritis. The Board granted service connection for both conditions. For the heart disability, the Veteran reported chest pains during service, and service treatment records documented evaluations for chest pain and an enlarged heart. While a VA examiner opined the condition was less likely than not related to service, another VA opinion linked the current coronary artery disease (CAD) with angina to in-service complaints. The Board found the evidence in approximate balance, resolving doubt in the Veteran's favor to grant service connection. For the multi-joint rheumatoid arthritis claim, the Board found a current diagnosis of rheumatoid arthritis in the hands, consistent with the Veteran's testimony. Although military records did not contain a specific arthritis diagnosis, they did note chronic joint pain and swollen joints during service, and post-service records showed ongoing reports of joint pain. The Board found this sufficient to establish the second element of service connection for a chronic condition, and resolving doubt in the Veteran's favor, granted service connection for the chronic joint pain, currently diagnosed as rheumatoid arthritis.
Rationale
Current diagnosis of CAD with angina; In-service complaints of chest pain and evaluations; Conflicting medical opinions, with Board favoring positive opinion; Benefit of the doubt applied due to approximate balance of evidence
Full Decision Text
Citation Nr: 26004273 Decision Date: 04/07/26 Archive Date: 04/07/26 DOCKET NO. 16-19 323 DATE: April 7, 2026 ORDER The claim of entitlement to service connection for a heart disability is granted. The claim of entitlement to service connection for multi-joint rheumatoid arthritis (claimed as chronic joint damage) is granted. FINDINGS OF FACT 1. The Veteran's heart disability began during active service. 2. The Veteran's chronic joint pain, currently diagnosed as multi-joint arthritis, began during active service. CONCLUSIONS OF LAW 1. The criteria for service connection for a heart disability have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for multi-joint rheumatoid arthritis have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had honorable active duty service in the United States Navy from March 1975 to January 1998. These matters come before the Board of Veterans' Appeals (Board) on appeal from a November 2013 rating decision of the Department of Veterans Affairs (VA) regional office, which is the Agency of Original Jurisdiction (AOJ). The Veteran testified in a virtual hearing before a Veterans Law Judge (VLJ) in April 2021. A copy of the hearing transcript is of record; however, the VLJ who held the hearing has since retired. The Veteran and his representative were notified via letter in January 2024 that the VLJ had retired and the Veteran was given the opportunity to request a new hearing. The Veteran did not respond to that notification and the evidence of record does not contain a pending hearing request. As such, the Board will proceed with the evidence currently of record. In June 2022 and March 2024, the Board remanded the issues on appeal for additional evidentiary development, to include obtaining personnel records and identifying all locations of the Veteran's service (such as verifying whether the Veteran had service in the Republic of Vietnam or its territorial waters or in the Southwest Asia Theater of Operations during the Persian Gulf War). The Board also directed the AOJ to obtain medical opinions regarding the claimed conditions, to include obtaining an opinion as to whether the claimed conditions were likely related to any identified toxic exposure risk activities (TERAs) the Veteran may have participated in during his service. Regrettably, the Board concludes that there has not been substantial compliance with its prior remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). For example, although the AOJ obtained a TERA Memorandum and took steps to request deck logs regarding the United States Ships (USS) the Veteran served aboard, it is not at all clear from the Memo or other development what, if any, TERAs the Veteran actually participated in. See March 2024 TERA Memorandum (conceding that the Veteran "participated in a TERA," without explaining the nature of the identified risk activities). This lack of specificity is problematic as the Veteran's service records indicate that he was placed in an Asbestos Medical Surveillance Program in May 1996 aboard the USS Tennessee, and that he underwent examinations for Occupational Exposure to Ionizing Radiation. See, e.g., March 1991 Report of Medical Examination. Because the TERA Memo is not specific, the extent of the Veteran's TERA participation is unknown, and the medical opinions obtained by the AOJ regarding whether the Veteran's heart and joint conditions are related to those TERAs are inadequate as they are based on an incomplete record. Nevertheless, the Board finds that for purposes of the Veteran's instant claims for service connection, the evidence of record is adequate to resolve the appeals without additional remand and further delay. Because the Board is granting the appeals, there is no prejudice to the Veteran in proceeding with the final adjudication of his claims at this time. Service Connection 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 connection, the evidence of record is adequate to resolve the appeals without additional remand and further delay. Because the Board is granting the appeals, there is no prejudice to the Veteran in proceeding with the final adjudication of his claims at this time. Service Connection 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). Certain chronic diseases will be presumed related to service if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013); 38 C.F.R. §§ 3.303, 3.307, 3.309. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). The benefit-of-the-doubt rule applies if the competing evidence is "nearly equal" or in "approximate balance." See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc). 1. The claim of entitlement to service connection for a heart disability. The Veteran contends he has a heart condition that began during his active service. See April 2021 Board hearing transcript (testifying that he had chest pains on multiple occasions during active service). The Board concludes that the Veteran has a current heart disability that began during active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). Private treatment records and VA examination reports show the Veteran has a current diagnosis of coronary artery disease (CAD). See, e.g., March and August 2019 University of Kansas Health System (noting CAD); April 2024 VA heart conditions disability benefits questionnaire (DBQ) (noting CAD with angina). Thus, the first element of service connection is met. The Veteran's service treatment records (STRs) document that the Veteran was evaluated for chest pains on multiple occasions during service. See, e.g., March 1991 Report of Medical History (endorsing pain or pressure in chest); January 1996 (emergency treatment for substernal pain); April 1996 Report of Medical History (endorsing pain or pressure in chest); October 1997 Report of Medical History (endorsing pain or pressure in chest). As such, the second element of service connection is met. Thus, the question becomes whether the current heart disability is related to service. On this question there are probative opinions in favor of and against the claim. The evidence in favor of the claim includes an April 2024 VA medical opinion that the Veteran's current diagnosis of CAD with angina is linked to the Veteran's in-service complaints of chest pain, which required hospitalization and cardiac workup. As for the negative evidence, the Board acknowledges that there are opinions of record that conclude that the Veteran's heart disability is less likely than not related to his service, such as a December 2024 opinion. This opinion ostensibly weighs against a nexus to service, with the opining clinician reasoning that there was no "chronicity during service or after service" relating to a heart condition. However, this clinician also conceded that an in-service chest x-ray revealed the Veteran had an enlarged heart and expressly noted that the Veteran "continued to have routine follow-up with cardiology at KU Medical Center after service and [was] diagnosed with stable angina and coronary artery disease." Accordingly, the Board finds this opinion to tend to support a link between the Veteran's heart condition and active service. of record that conclude that the Veteran's heart disability is less likely than not related to his service, such as a December 2024 opinion. This opinion ostensibly weighs against a nexus to service, with the opining clinician reasoning that there was no "chronicity during service or after service" relating to a heart condition. However, this clinician also conceded that an in-service chest x-ray revealed the Veteran had an enlarged heart and expressly noted that the Veteran "continued to have routine follow-up with cardiology at KU Medical Center after service and [was] diagnosed with stable angina and coronary artery disease." Accordingly, the Board finds this opinion to tend to support a link between the Veteran's heart condition and active service. In sum, upon review of the record, the Board finds the evidence to at least be in an approximate balance as to whether the Veteran's current heart condition, assessed as CAD with angina, began during service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for a heart disability is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 2. The claim of entitlement to service connection for multi-joint rheumatoid arthritis (claimed as chronic joint damage). The Veteran contends he has chronic joint pain (arthritis), particularly of the extremities. See October 2011 Third Party Correspondence. As noted earlier in this decision, the Veteran has not received an adequate medical examination and opinion regarding this specific claim. Adequate development has not been conducted regarding the Veteran's TERA participation during service. Additionally, April and December 2024 negative examination opinions appeared to be based almost solely on the Veteran's inability to clearly verbalize his symptoms on the date of the examination, without consideration of his past lay statements and testimony, and without acknowledging the Veteran's lowered neurological/cognitive functioning at the time of the most recent examination. See July 2022 Private neurology records (noting possible early dementia). Despite the above issues regarding development of this appeal, the Board finds the evidence to support a finding that the Veteran has a current chronic joint disability. The Veteran has a current diagnosis of rheumatoid arthritis as evidenced by a January 2025 VA examination. This clinician diagnosed the Veteran with multi-joint rheumatoid arthritis, specifically identified in the hands. This is consistent with the Veteran's testimony before the Board, during which he described joint pain and impairment in his hands. 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. The Veteran is already service connected for joint pain of the neck and back. Next, although the Veteran was not expressly diagnosed with arthritis by military clinicians during active duty, he reported chronic joint pain on multiple occasions prior to his separation, such as in an April 1996 Report of Medical History (endorsing swollen or painful joints) and in an October 1997 Report of Medical History prior to separation. On this occasion, the Veteran reported "arthritic joints," and pain and popping of the joints. While the evaluating clinician deemed this impairment "NCD," or not currently disabling, the Board finds this evidence sufficient to conclude that the condition of chronic joint pain was noted during service. (Continued on the next page) ? As to whether this condition continued chronically since service, and while the Board acknowledges that the Veteran's medical records are not entirely consistent regarding how joint pain symptoms were recorded, there are numerous notations relating to the Veteran's ongoing reports of "joint pain" and "swollen joints" in the Veteran's post-service private medical records. See e.g., May 2013 an August 2014 University of Kansas Health System records. As a chronic condition, any subsequent manifestations are service connected unless attributable to intercurrent causes. No intercurrent causes have been shown in this case regarding the Veteran's chronic joint pain. Therefore, resolving all doubt in favor of the Veteran, the Veteran's chronic joint pain, currently diagnosed as multi-joint rheumatoid arthritis, is considered attributable to service. As such, service connection is warranted and the appeal is granted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Hart, Associate 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. arthritis, is considered attributable to service. As such, service connection is warranted and the appeal is granted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Hart, Associate 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.