ASTHMA

NATHANIEL DOAN · 2026 · Case ID: 26004986

MIXED

Summary

The veteran, who served in the U.S. Navy from June 1995 to April 1999 as an Electrician's Mate, appeals the denial of service connection for asthma, bilateral shoulder strain, and right groin strain, as well as entitlement to TDIU. The Board granted service connection for asthma, finding it related to in-service toxic exposure risk activity (TERA) involving asbestos, based on a March 2024 VA DBQ and an August 2025 non-VA medical opinion. The Board applied the benefit of the doubt doctrine, finding the evidence approximately balanced. Service connection for bilateral shoulder strain and right groin strain was also granted. The veteran testified that these conditions began due to strenuous activity in service, and this testimony, along with a lay statement from her mother and a non-VA doctor's opinion, was found persuasive. The Board found the evidence in approximate balance and applied the benefit of the doubt doctrine. The claim for TDIU prior to September 7, 2023, was remanded. The Board noted the veteran's current 100% schedular rating from September 2023, but the TDIU claim for the prior period requires further adjudication, particularly regarding the veteran's employment history and the impact of her service-connected disabilities.

Rationale

March 2024 VA DBQ with positive nexus opinion; August 2025 non-VA medical opinion relating asthma to in-service TERA; Benefit of the doubt doctrine applied due to approximately balanced evidence

Service Branch

NAVY

Special Benefit

TDIU

Docket No.

13-09 158

Full Decision Text

Citation Nr: 26004986
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 13-09 158
DATE: April 28, 2026

ORDER

Service connection for asthma, from April 25, 2011, to September 6, 2023, is granted.

Service connection for a right shoulder disorder, diagnosed right shoulder strain, is granted.

Service connection for a left shoulder disorder, diagnosed left shoulder strain, is granted.

Service connection for right groin injury, diagnosed Group XV strain, bilaterally, is granted.

REMANDED

Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU), prior to September 7, 2023, is remanded.

FINDINGS OF FACT

1. The Veteran's asthma is etiologically related to service.

2. The Veteran's right shoulder disability, diagnosed right shoulder strain, is etiologically related to her active-duty service.

3. The Veteran's left shoulder disability, diagnosed left shoulder strain, is etiologically related to her active-duty service.

4. The Veteran's right groin injury is etiologically related to her active-duty service.

CONCLUSIONS OF LAW

1. The criteria for establishing entitlement to service connection for asthma from April 25, 2011, to September 6, 2023, have been met. 38 U.S.C. §§ 1110, 1154, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for right shoulder disability, diagnosed right shoulder strain have been met. 38 U.S.C. §§ 1110, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.303.

3. The criteria for service connection for left shoulder disability, diagnosed left shoulder strain have been met. 38 U.S.C. §§ 1110, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.303.

4. The criteria for service connection for right groin injury have been met. 38 U.S.C. §§ 1110, 1154(a), 5107(b); 38 C.F.R. §§ 3.102, 3.159, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active-duty service in the United States Navy from June 1995 to April 1999.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from?a March 2012 rating decision of?the?Department of Veterans Affairs (VA) Regional Office (RO).

The Veteran testified before a Veterans Law Judge (VLJ) at an August 2014 hearing. The transcript of the Board hearing is of record. This hearing was before a now-retired VLJ.

When this matter was before the Board in July 2017, the Board in pertinent part denied service connection for bilateral shoulder disability, right groin disability and asthma.

The Veteran appealed the Board's July 2017 decision to the United States Court of Appeals for Veterans Claims (Court), which in a July 2019 panel decision, vacated the July 2017 Board decision and remanded the case for further proceedings consistent with the Court's July 2019 opinion, noting the denial of the appellant's right to a hearing was error.

The Veteran testified before another VLJ at an August 2020 Board hearing. The transcript of the Board hearing is of record and reflects two appeal streams were addressed to include the issues in this appeal.

The Board remanded the matters of service connection for bilateral shoulder disability, right groin disability and asthma in June 2021, noting that in May 2021, the Veteran withdrew her request for a post-Court remand hearing before the Board.

Following a request for another Board hearing, the Veteran testified before another VLJ at an October 2023 hearing. The transcript of the Board hearing is of record.

The matters of service connection for bilateral shoulder disability, right groin disability and asthma, and TDIU were remanded by the Board in February 2024.

Following a June 2025 request for Board hearing, the Veteran testified before another VLJ at a December 2025 hearing. The transcript of the Board hearing is of record. The transcript reflects that the three VLJs who conducted the last three hearings would participate in a panel decision for this case. Thus, the three VLJs who chaired hearings in this appeal with adjudicate this matter as a panel.

Relevant
Board hearing, the Veteran testified before another VLJ at an October 2023 hearing. The transcript of the Board hearing is of record.

The matters of service connection for bilateral shoulder disability, right groin disability and asthma, and TDIU were remanded by the Board in February 2024.

Relevant to this appeal, service connection for asthma was granted in a May 2024 rating decision, effective September 7, 2023, the date VA received her Intent to File for a claim for asthma under VA's Modernized Appeal System (AMA). Because the claim for service connection for asthma in this Legacy appeal was pending prior to that date (the instant Legacy appeal dates to April 25, 2011) the matter remains part of this appeal as to the period from April 25, 2011, to September 6, 2023. See Concepcion-Maldonado v. Collins, 38 Vet. App. 294 (2025) (a Legacy appeal seeking service connection is not automatically moot by virtue of an AMA rating decision awarding the same benefit); see also Johnson v. Collins, 38 Vet. App. 151 (2025) (a pending appeal is not rendered moot by a subsequent award of service connection).

Service Connection

Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service, even if the disability was initially diagnosed after service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a).

Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Certain chronic diseases, to include arthritis, will be presumed related to service if they were noted as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if continuity of the same symptomatology has existed since service, with no intervening cause. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2012); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303(b), 3.307, 3.309(a).

Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. §§ 3.303(d).

The Board notes the recent enactment of the PACT Act of 2022, which expanded VA health care and benefits for veterans exposed to burn pits or other toxic substances during military service. A toxic exposure risk activity (TERA) memo January 2024 TERA memo reflects that the Veteran did participate in TERA, noting non-deployment related exposure consistent with the circumstances of the Veteran's service and her Navy MOS, EM Electrician's Mate, with the military occupational hazard of probable exposure to asbestos.

1. Service connection for asthma from April 25, 2011, to September 6, 2023, is granted.

In a May 2024 rating decision, the RO granted service connection for asthma, effective September 7, 2023, on the basis that the disease was related to the Veteran's in-service TERA of asbestos exposure.

A March 2024 VA Medical Opinion Disability Benefits Questionnaire (DBQ) contains a positive nexus opinion relating the current asthma to this TERA. The VA examiner concluded that it was at least as likely as not that asthma was caused by the indicated TERA, after considering the total potential exposure through all applicable military deployments of the veteran and the synergistic, combined effect of all toxic exposure risk activities of the veteran. The opinion supports direct service connection for asthma and was supported by extensive rationale and citations to medical literature. It was noted that asthma
the RO granted service connection for asthma, effective September 7, 2023, on the basis that the disease was related to the Veteran's in-service TERA of asbestos exposure.

As such, the RO granted direct service connection, the RO determined that the Veteran's asthma was directly related to her in-service exposure to environmental toxins.

In May 2025, the Veteran's sister asserted that the Veteran started to show symptoms of asthma in service and did not have any asthma prior to service.

As pointed out by a non-VA medical doctor who provided a positive opinion in August 2025 relating asthma to in-service TERA, the treatment record reflects findings of asthma dating to at least April 25, 2011. This clinician notes asthma has been continuously present since 2010 - 2011 with diagnosis and onset reported in the late 1990s.

The Board has reviewed the other evidence of record but finds the March 2024 DBQ and the August 2025 non-VA medical opinion thorough and well-supported evidence in support of the claim. These reports are consistent with the testimony and lay statement and are the most probative evidence as to the etiology of the Veteran's asthma. Because the competent and credible evidence is at least approximately balanced, and benefit of the doubt doctrine applies, service connection is warranted for asthma for the period on appeal from April 25, 2011, to September 6, 2023. 38 U.S.C. § 5107 (b). See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

2. Service connection for a right shoulder disorder is granted.

3. Service connection for a left shoulder disorder is granted.

4. Service connection for right groin strain is granted.

The Veteran testified in December 2025 that the diagnosed bilateral shoulder strain and groin injury began with strenuous activity in service and have been present since that time. The Veteran reported that the shoulder problems began when her ship was in the docking yard. She explained that the physical work required substantial upper body strength, going up and down the ladder wells, doing the sounding and pulling the short powered cables. She explained that it was hard on the upper body, and she had no idea the damage it was doing at the time because she was too young to understand the lasting effects of the painful strenuous prolonged over-use. She remembers she started to hear her shoulders click. As an electrician's mate on a Tomahawk Destroyer, the work was always very physical. She was on the DD-969, USS Peterson, a 30-year-old ship at the time. Her job was constantly going up and down the ladder well, working in the anchor room, working with all the shore power cables, 'up and overs' and anything that had to do with the engine room. She began to hear her shoulders constantly pop in her sleep and she began to have burning and pulling sensations in the shoulders. She feels the condition has progressed and she thinks she now has arthritis in the shoulders. She has been left with the choice of physical therapy or daily medication such as Gabapentin, but she wants to avoid medication due to reflux. While she was doing this rigorous work, she also tore her groin muscle but did not actually realize that is what happened.

The Veteran emphasized the repetitive heavy physical activities appear to her to have caused these issues because the pain and other symptoms began while she was doing the activity and the problems have continued.

The record reflects current disability as to the shoulders, with left and right shoulder strain diagnosed on November 2024 VA Shoulders DBQ and Group XV strain, bilaterally, diagnosed as to the right groin. See November 2024 Muscle injuries DBQ report.

Nonetheless, corresponding November 2024 VA DBQ medical opinion indicates that the conditions were less likely than not incurred in or caused by the claimed in-service injury, event, or illness because there was no documentation of these issues in the STRs.

As to secondary service connection, the examiner reasoned that there was no pathophysiological relationship between any service-connected condition and the shoulder or groin issues but did note that the shoulder and groin issues
activity and the problems have continued.

However, on clarification in May 2025, the November 2024 VA clinician explained that the Veteran stated that over usage in military led to the bilateral shoulder and right groin pain and this was medically plausible, so he referred to it in the secondary opinion. However, as there is no documentation in STRs for either shoulder or right groin pain, he made the negative direct opinion.

In his August 2025 opinion, the non-VA doctor opined that the bilateral shoulder and groin disabilities were as likely as not related to the strenuous activities in service. The doctor's opinion was supported by a lengthy discussion which included references to the documented history and the Veteran's report of onset of symptoms and was supported by extensive medical literature references.

The Board finds the Veteran's assertions as to that the ongoing symptoms of the shoulders and groin began in as described at the December 2025 hearing credible under the particular circumstances of this case.

A December 2025 lay statement from the Veteran's mother notes that when the Veteran returned from service, she began to complain about suffering from constant pain in her shoulders and inner thighs.

The Board finds the Veteran's December 2025 testimony, the lay statement and the opinion of the non-VA doctor to be persuasive as to these claims. While it has considered the evidence against the claims, the Board as finder of fact does not find this contrary evidence to be more probative than the evidence in support of the claims.

Thus, the evidence shows that the Veteran's bilateral shoulder disorders and right groin injury had their onset in service and service connection is warranted. See Flynn v. Brown, 6 Vet. App. 500, 503 (1994) (noting that "the element of cause and effect has been totally by-passed in favor of a simple temporal relationship between the incurrence of the disability and the period of active duty"). Because the competent and credible evidence is at least approximately balanced, and benefit of the doubt doctrine applies, service connection is warranted for these conditions. 38 U.S.C. § 5107 (b). See Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

REASONS FOR REMAND

TDIU for the period on appeal prior to September 7, 2023, is remanded.

In February 2024, the Board found the Veteran explicitly raised TDIU and remanded the matter to be evaluated by the Agency of Original Jurisdiction (AOJ) in the first instance. See Rice v. Shinseki, 22 Vet. App. 447 (2009).

TDIU was denied in a May 2025 rating decision, as well as in the June 2025 SSOC, with the RO noting that the Veteran had not returned a completed VA Form 21-8940, TDIU claim form.

Rating code sheets dated from August 2024 forward reflect that the Veteran's combined rating is 100 percent on a schedular basis from September 7, 2023, with a 90 percent rating from August 7, 2014, and a 60 percent rating from April 25, 2011.

The Veteran and her attorney maintain that an award of a TDIU is warranted based on the aggregate impact of her service-connected disabilities. See Veteran's January 2026 VA Form 21-8940 (Application for Increased Compensation Based on Unemployability).

As noted above, the Veteran contends that an award of a TDIU is warranted. She maintains that she meets the criteria for TDIU due to the combined effects of his service-connected disabilities in aggregate for the period on appeal prior to September 7, 2023.

In support, in January 2026 she submitted a VA Form 21-8940 wherein she discusses the impact of her service-connected PTSD and genitourinary issues as the reason she is unable to work.

A review, however, of her VA Form 21-8940 shows her employment history
service-connected disabilities. See Veteran's January 2026 VA Form 21-8940 (Application for Increased Compensation Based on Unemployability).

In support, in January 2026 she submitted a VA Form 21-8940 wherein she discusses the impact of her service-connected PTSD and genitourinary issues as the reason she is unable to work.

A review, however, of her VA Form 21-8940 shows her employment history is unclear and suggests she is currently employed. She has indicated that she has "struggled with employment" on and off since her discharge from active duty in April 1999 but struggled 'a lot more' around 2008 and 2009. The Veteran appears to report that the most annual income she has ever made was this year, when she made '$145k' in her current occupation of PBM benefits at United Healthcare, where she worked since 2015.

In addition, the Veteran indicates that she logs off or adds hours when she is spiraling emotionally and feels she is in protective environment, so she does not know how many hours she has lost due to illness. She is always worried about layoffs. She reports she has a sophomore level of post high school education and notes she had vocational rehabilitation training sometime around 2013.

Employment information she submitted in October 2016 indicates she worked for United Healthcare full time and made $42,000.00 per year.

The Court defined "employment in a protected environment" within 38 C.F.R. § 4.16(a) to unambiguously mean "a lower-income position that, due to the veteran's service-connected disability or disabilities, is shielded in some respect from competition in the employment market." LaBruzza v. McDonough, 37 Vet. App. 111, 123-24 (2024). The existence of unemployment or marginal employment does not automatically allow for a TDIU. Rather, the pertinent inquiry turns to consideration of the noneconomic component.

Notably, the claim for TDIU is impacted by the grant of benefits in this decision, as the AOJ will effectuate the awards which will impact her total combined rating.

The Board will not issue a decision on the TDIU claim at this time. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (issues are 'inextricably intertwined' when they are so closely tied together that a final Board decision cannot be rendered unless both are adjudicated).

The matters are REMANDED for the following action:

1. Associate outstanding records of the Veteran's VA treatment with the claims file.

2. Then, after the awards of service connection granted in this decision have been implemented, readjudicate the claim for TDIU.

Nathaniel Doan

Veterans Law Judge

Board of Veterans' Appeals

JIMMY L. BARDIN

Veterans Law Judge

Board of Veterans' Appeals

STEVEN D. REISS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Nancy Rippel

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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