EPILEPSY

Summary

The veteran, who served from September 1966 to September 1968, appeals the denial of service connection for a neurobehavioral disorder, specifically a seizure disorder or epilepsy. The Board found that while a current diagnosis of a seizure disorder was established, the service treatment records did not indicate any in-service complaints, treatment, or diagnosis of such a condition. The separation examination in September 1968 reflected a normal neurological evaluation, and no treatment for neurobehavioral symptoms was received during service. A VA examiner in August 2024 opined it was less likely than not that the seizure disorder was incurred in or caused by service, citing a lack of substantiating evidence and suggesting a post-service etiology. This opinion was reiterated in February 2025, noting the disorder began approximately two years after separation. The Board also considered Camp Lejeune toxic exposure, but found conflicting medical opinions. While one VA examiner in April 2025 suggested a link between seizure disorders and Camp Lejeune TERAs, subsequent examiners in February, July, and December 2025 found it less likely than not, citing vague "neurobehavioral effects" in the literature and alternative etiologies for seizures. The Board afforded greater weight to the latter opinions, finding no causal relationship established. The veteran also argued for secondary service connection, claiming service-connected renal disorder and migraines disrupted sleep and circadian rhythms, but a January 2026 VA examiner found this unlikely, citing lack of medical literature support and alternative idiopathic/genetic causes. Presumptive service connection was also denied as the seizure disorder was not shown in service, nor did it manifest with continuity of symptomatology or within one year of separation. The Board found the veteran competent to report symptoms but not etiology, affording greater weight to medical opinions. Service connection was denied.

Rationale

No in-service complaints, treatment, or diagnosis of neurobehavioral disorder in STRs.; Separation examination showed normal neurological evaluation.; VA examiner opined less likely than not related to service, citing lack of substantiating evidence and post-service etiology.; Conflicting opinions regarding Camp Lejeune exposure, with majority finding no causal link to seizure disorder.; Secondary claim based on sleep disruption from service-connected disabilities found unlikely due to lack of medical literature support.; Presumptive service connection denied due to lack of in-service manifestation, continuity, or timely onset.

Full Decision Text

Citation Nr: 26004562
Decision Date: 04/15/26	Archive Date: 04/15/26

DOCKET NO. 20-24 393
DATE: April 15, 2026

ORDER

Service connection for a neurobehavioral disorder is denied.

FINDINGS OF FACT

1. The Veteran served on active duty from September 1966 to September 1968. 

2. A neurobehavioral disorder, diagnosed as seizure disorder and epilepsy, was not shown in service, was not shown to a compensable degree within one year of service, and symptoms were not continuous since service; a neurobehavioral disorder is not causally or etiologically related to service and was not caused by or permanently worsened in severity by a service-connected disability.

CONCLUSION OF LAW

A neurobehavioral disorder was not incurred in service, is not presumed to have been incurred in service, and is not proximately due to, aggravated by, or the result of a service-connected disability. 38 U.S.C. §§ 1110, 5103(a), 5103A, 5107 (2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309, 3.310 (2025).

REASONS AND BASES FOR FINDINGS AND CONCLUSION

As a procedural matter, the Board previously remanded the claim in June 2024, June 2025, and October 2025. The claim is now ready for adjudication. 

Turning to the relevant laws and regulations, service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (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 in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009). 

Service connection may be granted on a secondary basis for a disability which is aggravated by, proximately due to, or the result of a service-connected disease or injury under 38 C.F.R. § 3.310.  Allen v. Brown, 7 Vet. App. 439 (1995). In order to establish service connection on a secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical evidence establishing a link between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

Service connection may be granted on a presumptive basis for diseases listed in 38 C.F.R. § 3.309 under the following circumstances: (1) where a chronic disease or injury is shown in service and subsequent manifestations of the same disease or injury are shown at a later date unless clearly attributable to an intercurrent cause; or (2) where there is continuity of symptomatology since service; or (3) by showing that the disorder manifested itself to a degree of 10 percent or more within one year from the date of separation from service. See 38 C.F.R. § 3.307.

Service connection may also be granted on a presumptive basis for certain diseases associated with exposure to contaminated water at Camp Lejeune if a veteran, former reservist, or member of the National Guard shows: (1) that he or she served at Camp Lejeune for no less than 30 consecutive or nonconsecutive days between August 1, 1953 and December 31, 1987; (2) that he or she currently suffers from a disease associated with exposure to contaminants in the water supply at Camp Lejeune enumerated under 38 C.F.R. § 3.309(f); and (3) that the current disease manifested to a degree of 10 percent or more at any time after service. 38 C.F.R. §§ 3.307(a)(7), 3.309(f). This presumption may be rebutted by affirmative evidence to the contrary. 38 U.S.C. § 1113; 38 C.F.R. §§ 3.307, 3.309.

Notwithstanding the foregoing provisions regarding presumptive service connection, a veteran is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). 

Turning to the medical evidence, an August 2024 VA examiner diagnosed tonic-cl
 the current disease manifested to a degree of 10 percent or more at any time after service. 38 C.F.R. §§ 3.307(a)(7), 3.309(f). This presumption may be rebutted by affirmative evidence to the contrary. 38 U.S.C. § 1113; 38 C.F.R. §§ 3.307, 3.309.

Notwithstanding the foregoing provisions regarding presumptive service connection, a veteran is not precluded from establishing service connection with proof of direct causation. Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). 

Turning to the medical evidence, an August 2024 VA examiner diagnosed tonic-clonic seizures or grand mal epilepsy (generalized convulsive seizures). Further, they noted a diagnosis of psychomotor epilepsy (complex partial seizures, temporal lobe seizures). Further, the clinical treatment records reflect that symptoms of a seizure disorder were first noted in approximately 1970. As such, a diagnosis of a seizure disorder has been shown and the first element of service connection is met. 

Next, as to in-service incurrence, the service treatment records (STRs) do not reflect complaints of, treatment for, or a diagnosis of a neurobehavioral disorder, to include seizures. Importantly, the September 1968 separation examination reflected a normal clinical evaluation of the neurologic system. Further, while the Veteran sought treatment for other disorders during service, such as a urinary disorder, he did not receive treatment for a neurobehavioral disorder or related symptoms, such as seizures. As such, the medical evidence does not support the in-service incurrence of a neurobehavioral disorder. 

Further weighing against the claim, an August 2024 VA examiner opined it was less likely than not that a seizure disorder was incurred in or caused by service. Based on a review of all evidence, the examiner noted that there was a lack of substantiating evidence to support a nexus between a seizure disorder and service. Specifically, they found no evidence of neurobehavioral symptoms or treatment in the STRs. As such, they concluded that a post-service event, illness, or injury was a more likely etiology. 

Further, in February 2025, the same VA examiner provided an addendum opinion and reiterated that the Veteran did not report any seizure concerns during the separation examination in 1968. Moreover, the examiner noted that per the medical records, the seizure disorder began in 1970, approximately two years after separation. As such, they found no evidence that the seizure disorder began during active duty and a nexus could not be established. 

There are no conflicting medical opinions of record. Accordingly, the medical evidence does not support a nexus between a neurobehavioral disorder and service. Therefore, the medical evidence does not support service connection on a direct basis. 

Next, VA has conceded that the Veteran was exposed to contaminated water during service at Camp Lejeune. Although a seizure disorder is not presumptively associated with exposure to contaminated water, service connection based on Camp Lejeune exposure will be considered on a direct basis. 

In support of the claim, an April 2025 VA examiner opined that a seizure disorder was at least as likely as not caused by the indicated TERAs, after considering the total potential exposure and the synergistic combined effect of all TERAs of the Veteran. They explained that Camp Lejeune water was contaminated with chemicals such as trichloroethylene and tetrachloroethylene. Further, they noted that seizures, a neurobehavioral effect, could be caused by these chemicals. 

On the other hand, in February 2025, a VA examiner found it less likely than not that a neurobehavioral disorder, diagnosed as a seizure disorder, was caused by contaminated water exposure from Camp Lejeune. They explained that the ATSDR Public Health Assessment for Camp Lejeune Drinking Water noted a reported risk of neurobehavioral side effects from exposure to contaminated water; however, they noted that the term "neurobehavioral side effects" was vague and could encompass multiple complaints and symptoms which could be acute in nature and not pathognomonic or indicate of a chronic neurological condition. 

Moreover, the examiner explained that the medical literature showed a number of causative factors for epilepsy or seizure disorder. Specifically, they noted alternative causes including subacute and chronic stroke, late-onset unexplained epilepsy, neurodegenerative dementia, other static or progressive intracranial lesions, autoimmune-associated epilepsy, and psychiatric conditions. 

In sum, the February 2025 VA examiner found that the medical literature dictated significant risk factors and etiologies of epilepsy and seizure disorder, as noted above, which did not include exposure to Camp Lejeune drinking water. They explained that there was no pathophysiologic evidence which associated Camp Lejeune drinking water as an et
 and not pathognomonic or indicate of a chronic neurological condition. 

Moreover, the examiner explained that the medical literature showed a number of causative factors for epilepsy or seizure disorder. Specifically, they noted alternative causes including subacute and chronic stroke, late-onset unexplained epilepsy, neurodegenerative dementia, other static or progressive intracranial lesions, autoimmune-associated epilepsy, and psychiatric conditions. 

In sum, the February 2025 VA examiner found that the medical literature dictated significant risk factors and etiologies of epilepsy and seizure disorder, as noted above, which did not include exposure to Camp Lejeune drinking water. They explained that there was no pathophysiologic evidence which associated Camp Lejeune drinking water as an etiology for epilepsy and seizure disorder according to the medical literature. Therefore, they concluded that a nexus could not be established. 

Next, in July 2025, a VA examiner found it less likely than not that a neurobehavioral disorder was caused by exposure to Camp Lejeune contaminated water. They explained that there was a lack of clear medical evidence to show a relationship between the development of a seizure disorder and the indicated TERA. 

Specifically, the examiner noted that the Veteran had risk factors outside of exposure to contaminated water at Camp Lejeune which likely contributed to the development of the seizure disorder. For example, he noted that sleep deprivation, irregular sleep wake schedules, and disruptions in circadian rhythms could increase nocturnal seizure risk. Given these factors, the examiner concluded that it was less likely that the Veteran's seizures were due to toxic exposure. 

Further weighing against the claim, a December 2025 VA examiner specifically addressed the April 2025 VA examiner's positive nexus opinion, which provided a link between the Veteran's seizure disorder and Camp Lejeune contaminated water. The December 2025 VA examiner explained that the April 2025 VA examiner's opinion was based on an inaccurate understanding of the medical literature. 

Specifically, the December 2025 examiner reviewed the medical literature cited by the April 2025 examiner and noted that "neurobehavioral effects" have been linked to exposure to contaminated water. However, he explained that the medical study cited specifically did not include seizures or epilepsy as a "neurobehavioral effect". In sum, they found that Camp Lejeune exposures were associated with an increased risk of "neurobehavioral effects,", but not an increased risk of seizures or epilepsy. As such, the examiner concluded it was less likely than not that Camp Lejeune exposures caused the Veteran's seizure disorder. 

After review, the medical evidence weighs against the claim for service connection based on exposure to contaminated water at Camp Lejeune. While the April 2025 VA examiner provided a positive nexus opinion, the weight of the medical evidence found that it was based on an inaccurate review of the medical literature. As explained by the December 2025 VA examiner, the relevant medical literature did not indicate a causal relationship between exposure to contaminated water at Camp Lejeune and a seizure disorder. As such, the Board affords the April 2025 VA examiner's opinion less probative value. 

Moreover, the Board affords great probative value to the February 2025, July 2025, and December 2025 VA examiners' opinions. These opinions thoroughly considered the medical evidence of record and the relevant medical literature and concluded that a seizure disorder was less likely than not due to exposure to the indicated TERAs. Moreover, the examiners provided alternative, more likely etiologies for the development of a seizure disorder. As such, the medical evidence weighs against the claim for service connection based on exposure to contaminated water at Camp Lejeune. 

Next, the Veteran contends in the alternative that the seizure disorder is secondary to service-connected disabilities. Specifically, he argues that the July 2025 VA examiner's opinion supports the claim because it indicated that a seizure disorder could be caused by sleep deprivation, irregular sleep wake schedules, and disruptions in circadian rhythms. As such, he argues that his service-connected renal disorder and migraines disrupted his sleep and negatively affected his circadian rhythm and ability to sleep normally. 

Weighing against the claim, a January 2026 VA examiner opined that a seizure disorder was less likely than not proximately due to or the result of a service-connected disability. They explained that the Veteran's disabilities, including renal mass with voiding dysfunction and migraine headaches with sleep impairment, did not represent established primary etiologies of seizure disorder in the medical literature. Moreover, they noted that there were no published peer-reviewed medical studies which demonstrated sleep deprivation, irregular sleep-wake schedules, or disruption in circadian rhythm as a causative etiology of seizures. Rather, they concluded that the seizure disorder was more likely secondary to genetic predisposition or idiopathic etiology. 

In addition, the January 2026 VA examiner explained that there
ighing against the claim, a January 2026 VA examiner opined that a seizure disorder was less likely than not proximately due to or the result of a service-connected disability. They explained that the Veteran's disabilities, including renal mass with voiding dysfunction and migraine headaches with sleep impairment, did not represent established primary etiologies of seizure disorder in the medical literature. Moreover, they noted that there were no published peer-reviewed medical studies which demonstrated sleep deprivation, irregular sleep-wake schedules, or disruption in circadian rhythm as a causative etiology of seizures. Rather, they concluded that the seizure disorder was more likely secondary to genetic predisposition or idiopathic etiology. 

In addition, the January 2026 VA examiner explained that there was no evidence of significant aggravation of the seizure disorder from service-connected disabilities as the medical evidence did not demonstrate a worsening of the disorder. 

Moreover, the examiner pointed to medical evidence which showed that the seizure disorder was controlled by medication and has not necessitated the use of prior intervention or the use of assistive devices. As such, they concluded that the seizure disorder was following the projected natural history of the disorder. There are no conflicting medical opinions of record. As such, the medical evidence does not support the claim for service connection on a secondary basis. 

Next, as epilepsy is listed under 38 C.F.R. § 3.309, presumptive service connection will be considered. However, a seizure disorder was not shown in service. While the Veteran has asserted that he experienced seizures in service, no symptoms related to a seizure disorder, such as abnormal body movements, were recorded. Also significant is the lack of head injury complaints or seizures at service separation. 

Specifically, the September 1968 separation examination reflected a normal clinical evaluation of the neurologic system. Therefore, the medical evidence does not support presumptive service connection on a "chronic disease or injury shown in service" basis.

Next, the medical evidence does not support presumptive service connected based on continuity of symptomatology since service. Specifically, the Veteran was discharged in 1968 with a normal clinical evaluation of all systems. A July 1971 clinical treatment record indicated that he had a history of a seizure disorder since 1970. As he was discharged in 1968 with no seizure symptoms, and symptoms were not identified until 1970 at the earliest, the medical evidence does not support service connection on a "continuity of symptomatology" basis. 

Further, the disorder did not manifest itself to a degree of 10 percent or more within one year from the date of separation of service. The Veteran separated from service in 1968, but symptoms were not noted until 1970 at the earliest. This evidence does not support presumptive service connection on a "manifest within one-year from separation" basis. Therefore, the medical evidence does not support presumptive service connection on any basis.

The Board has considered the Veteran's lay statements that a seizure disorder was caused by service. While he is competent to report symptoms and to describe observations as this requires only personal knowledge as it comes to him through his senses, he is not competent to offer an opinion as to the etiology of the current disorder due to the medical complexity of the matter involved. 

Specifically, the Veteran is not competent to attribute the etiology of a neurobehavioral seizure disorder to exposure to contaminated water at Camp Lejeune or to a service-connected disability. Such competent evidence concerning the nature and extent of the seizure disorder has been provided by the medical personnel who examined him during the current appeal, and who rendered pertinent opinions in conjunction with the evaluations. 

Their findings (as provided in the examination reports and other clinical evidence) directly address the criteria under which this disorder is evaluated. The VA medical professionals explained their reasoning based on an accurate characterization of the evidence. Therefore, the Board attaches greater probative weight to the clinical findings than to the lay statements regarding etiology. 

In sum, after a careful review of the record, the evidence weighs persuasively against the claim for service connection and there is no doubt to be resolved. As such, the appeal is denied. 

Finally, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record).

 

L. HOWELL

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Kokolas, Thomas

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.