HEARING LOSS

Summary

The veteran, who served in the United States Navy from September 1960 to October 1963, appeals the denial of service connection for several conditions. The Board granted service connection for hearing loss, neuropathy, prostate condition, COPD, heart condition, and vertigo. The decision highlights the application of the benefit of the doubt rule, as the Board found the evidence in approximate balance for each condition. For hearing loss, the Board relied on a private medical opinion that linked the veteran's bilateral hearing loss to hazardous noise exposure and TERA, assigning it high probative value. For neuropathy, the Board considered the veteran's credible testimony about an in-service fall and subsequent symptoms, supported by a private medical opinion linking TERA to neurotoxicity. The prostate condition claim was granted based on a private medical opinion connecting PFAS and asbestos exposure to BPH, citing scientific literature. COPD was granted service connection, with the Board giving high probative value to a private medical opinion linking PFAS and asbestos exposure to the condition, supported by the veteran's lay statements and medical literature. The heart condition claim was granted after the Board found a private medical opinion more persuasive than conflicting VA opinions, linking PFAS and asbestos exposure to cardiovascular disease. Vertigo was granted service connection, with the Board relying on a private medical opinion that hypothesized a link between toxic exposure and vestibular deficits, despite ongoing research.

Rationale

Favorable finding of diagnosis and in-service event from RO; Veteran's credible testimony regarding in-service noise and post-service symptoms; High probative value assigned to private medical opinion linking hearing loss to noise exposure and TERA; Application of benefit of the doubt rule due to approximate balance of evidence

Full Decision Text

Citation Nr: A25084576
Decision Date: 10/01/25	Archive Date: 10/01/25

DOCKET NO. 250304-522378
DATE: October 1, 2025

ORDER

Entitlement to service connection for hearing loss is granted.

Entitlement to service connection for neuropathy is granted.

Entitlement to service connection for prostate condition is granted.

Entitlement to service connection for chronic obstructive pulmonary disease (COPD) is granted.

Entitlement to service connection for heart condition is granted.

Entitlement to service connection for vertigo is granted.

FINDINGS OF FACT

1. The evidence is in approximate balance regarding whether the Veteran's current hearing loss is related to his active service and therefore, the benefit of the doubt is resolved in favor of the Veteran.

2. The evidence is in approximate balance regarding whether the Veteran's current neuropathy is related to his active service and therefore, the benefit of the doubt is resolved in favor of the Veteran.

3. The evidence is in approximate balance regarding whether the Veteran's current prostate condition is related to his active service and therefore, the benefit of the doubt is resolved in favor of the Veteran.

4. The evidence is in approximate balance regarding whether the Veteran's current COPD is related to his active service and therefore, the benefit of the doubt is resolved in favor of the Veteran.

5. The evidence is in approximate balance regarding whether the Veteran's current heart condition is related to his active service and therefore, the benefit of the doubt is resolved in favor of the Veteran.

6. The evidence is in approximate balance regarding whether the Veteran's current vertigo is related to his active service and therefore, the benefit of the doubt is resolved in favor of the Veteran.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for hearing loss have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for entitlement to service connection for neuropathy have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for entitlement to service connection for prostate condition have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for entitlement to service connection for COPD have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for entitlement to service connection for heart condition have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for entitlement to service connection for vertigo have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served in the United States Navy on active duty from September 1960 to October 1963.

The issue comes before the Board of Veterans' Appeals (Board) on appeal from an October 2024 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO).

In the March 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on May 12, 2025.

Therefore, the Board may only consider the evidence of record at the time of the October 2024 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously
 during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. 

If the Veteran would like VA to consider any evidence that was submitted that the Board could not consider, the Veteran may file a Supplemental Claim (VA Form 20-0995) and submit or identify this evidence. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claims, considering the new evidence in addition to the evidence previously considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision. 

Regarding the Veteran's claim for service connection for heart condition, the Veteran submitted an initial claim in September 2023, which was deferred in a May 2024 AOJ rating decision. Even though the September 2023 claim was still pending, the Veteran filed another claim for service connection for a heart condition in May 2024, which led to the denial in the October 2024 rating decision on appeal.

Service Connection

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303 (a). Service connection may be warranted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that disease was incurred in service. 38 C.F.R. § 3.303 (d).

As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004).

Additionally, certain chronic diseases, including organic diseases of the nervous system such as hearing loss, coronary artery disease, neuropathy, vertigo, and prostate cancer, may be presumed to have been incurred during service if the disorder becomes manifest to a compensable degree within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309(a). Alternatively, for chronic diseases shown in service, the third element of service connection may be established through demonstrating chronicity or continuity of symptomatology in accordance with 38 C.F.R. § 3.303 (b). See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013).

For purposes of applying the laws administered by VA, impaired hearing will be considered to be a disability when the auditory threshold in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; when the auditory thresholds for at least three of the above frequencies are 26 decibels or greater; or when speech recognition scores using the Maryland CNC Test are less than 94 percent. 38 C.F.R. § 3.385.

Moreover, certain diseases associated with herbicide agent exposure in service, including CAD and prostate cancer, are presumed to be service connected if the disease is manifested to a compensable degree within a time period specified for each disease. 38 U.S.C. § 1116. If a veteran was exposed to an herbicide agent, including Agent Orange, during active military, naval, or air service, certain diseases shall be service-connected if the requirements of 38 U.S.C. § 1116 ; 38 C.F.R. § 3.307 (a)(6) are met, even though there is no record of such disease during service, provided further that the rebuttable presumption provisions of 38 U.S.C. § 1113 ; 38 C.F.R. § 3.307 (d) are also satisfied.

Service connection on a secondary basis requires evidence sufficient to show: (1) that a current disability exists; and (2) that the current disability was either caused or aggravated by a service-connected disability. 38 C.F.R. § 3.310.

In the October 2024 rating decision, the AOJ issued favorable findings as to the Veteran's in-service toxic exposure risk activity (TERA) of asbestos and perfluoroalkyl and polyfluoroalkyl substances (PFAS).

1. Entitlement to service connection for hearing loss

The Veteran contends that his
table presumption provisions of 38 U.S.C. § 1113 ; 38 C.F.R. § 3.307 (d) are also satisfied.

Service connection on a secondary basis requires evidence sufficient to show: (1) that a current disability exists; and (2) that the current disability was either caused or aggravated by a service-connected disability. 38 C.F.R. § 3.310.

In the October 2024 rating decision, the AOJ issued favorable findings as to the Veteran's in-service toxic exposure risk activity (TERA) of asbestos and perfluoroalkyl and polyfluoroalkyl substances (PFAS).

1. Entitlement to service connection for hearing loss

The Veteran contends that his current bilateral hearing loss is related to his active-duty service.

In the AOJ's October 2024 rating decision, it issued favorable findings, in pertinent part, of the Veteran's diagnosis of bilateral hearing loss and evidence showing a qualifying event, injury, or disease had its onset during service. Specifically, the RO conceded that the Veteran's military occupational specialty as Seaman and Quartermaster had a low probability of hazardous noise exposure. Thus, the Board is bound by these favorable findings and finds that the first two elements of service connection are met.

The Board now turns to the final element, or nexus between the Veteran's current disability and his in-service hazardous noise exposure.

During the May 2025 hearing, the Veteran testified that there was constant noise on the ship during active service, and that his berthing room was right in front of the engine room. See May 2025 hearing transcript. He testified that he began having trouble hearing approximately within one year after service. He testified that his hearing worsened and that he currently uses hearing aids. Id. The Veteran also testified that he could not attend his scheduled VA examination as it was 80 or 90 miles away, and his conditions require him to stop driving every 15 minutes. Id. 

The Veteran submitted an August 2025 private medical opinion. The private clinician reviewed the Veteran's service and post-service medical records, as well as his lay statements. The examiner noted the Veteran's conceded in-service exposures to PFAS and asbestos. The private clinician found that the Veteran was "routinely exposed to high levels of continuous noise while stationed aboard an aircraft carrier-including sleeping in proximity to propellers, general shipboard operations, and weapons firing." See August 2025 private medical opinion. The private clinician detailed the Veteran's noise exposures, as well as medical literature on acoustically hazardous environments, including low- and high- frequency background noises, and bilateral sensorineural hearing loss. Id. She noted that active noise-cancelling technologies were not available or readily dispersed at the time of the Veteran's service. 

The private clinician also found that medical literature supported a finding that the Veteran's long-term cumulative effects of his in-service TERA could also lead to hearing loss. Id. The private clinician concluded that it was at least as likely as not that the Veteran's bilateral hearing loss was due to his in-service hazardous noise exposure and TERA.

The Board assigns the August 2025 private medical opinion high probative value as the only competent medical nexus opinion of record. Therefore, the Board finds that the evidence of record is at least in approximate balance on this matter. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, by law, the Board must resolve all reasonable doubt in favor of the Veteran. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also, Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Accordingly, based on the totality of the evidence, and with application of the benefit of the doubt rule of 38 U.S.C. § 5107 (b), the Board finds that the evidence of record provides an adequate basis on which to grant service connection for bilateral hearing loss.

2. Entitlement to service connection for neuropathy

The Veteran contends that his current neuropathy is related to his active-duty service.

Based on a sympathetic assessment of a veteran's claim, the Board may recharacterize an issue on appeal, or expand or restrict the scope of a particular claim to ensure the veteran is compensated for the full benefit sought. DeLisio v. Shinseki, 25 Vet. App. 45, 53 (2011); see Clemons v. Shinseki, 23 Vet. App. 1 (2009); see also, Brokowski v. Shinseki, 23 Vet. App. 79 (2009). Turning to the evidence, the Veteran initially filed a claim for service connection for neuropathy. See May 2024 claim.
 his current neuropathy is related to his active-duty service.

Based on a sympathetic assessment of a veteran's claim, the Board may recharacterize an issue on appeal, or expand or restrict the scope of a particular claim to ensure the veteran is compensated for the full benefit sought. DeLisio v. Shinseki, 25 Vet. App. 45, 53 (2011); see Clemons v. Shinseki, 23 Vet. App. 1 (2009); see also, Brokowski v. Shinseki, 23 Vet. App. 79 (2009). Turning to the evidence, the Veteran initially filed a claim for service connection for neuropathy. See May 2024 claim. The Veteran has also claimed experiencing sciatica. See March 2024 lay statement. Therefore, the Board will consider service connection for peripheral neuropathy, to include sciatica. 

In the AOJ's October 2024 rating decision, it issued a favorable finding of the Veteran's diagnosis of peripheral neuropathy. Thus, the Board is bound by this favorable finding and finds that the first element of service connection is met.

Regarding the second element of service connection, during the May 2025 hearing, the Veteran testified that he fell through a manhole or scuttle cover during service, falling on his left leg and thigh. He stated that he experienced symptoms of neuropathy since that time. See May 2025 hearing transcript. He stated that although he went to sick call, there was no medical doctor to help him and he was provided with strong aspirin. Id. He also reported conducting watches while standing, even out on the deck during hurricanes. The Veteran experienced throbbing pain down his left leg, and currently required the use of a cane. The Veteran is competent to report an in-service fall and subsequent symptoms of neuropathy. Layno v. Brown, 6 Vet. App. 465 (1994); see also, 38 C.F.R. § 3.159 (a)(2). The Board finds that the Veteran competently and credibly testified as to the in-service injury, and consequent symptoms that followed, and finds that the second element of service-connection is met. 

The Board now turns to the final element, or nexus between the Veteran's current disability and his in-service TERA.

The Veteran testified as to his statements of severe numbness and tingling of his left lower extremity during a February 2025 VA examination. Although the examination was conducted outside of the evidentiary window, the Board may consider the Veteran's hearing testimony regarding the examination. 

The Veteran submitted an August 2025 private medical opinion. The private clinician reviewed and noted the Veteran's service and post-service medical records, as well as his lay statements regarding his neuropathy and sciatica. The examiner noted the Veteran's conceded in-service exposures to PFAS and asbestos. The private clinician found that the Veteran experienced "neuropathic symptoms in his feet beginning in service, including burning pain and sensory changes, which he states led him to seek care at the infirmary multiple times." See August 2025 private medical opinion. The private clinician detailed the Veteran's sciatica and radiculopathy symptoms. Id. 

The private clinician also found that medical literature supported a finding that the Veteran's long-term cumulative effects of his in-service TERA could also lead to neurotoxicity and impair nerve function. Id. The private clinician concluded that it was at least as likely as not that the Veteran's neuropathy was due to his in-service TERA.

The Board assigns the August 2025 private medical opinion high probative value as the only competent medical nexus opinion of record. Therefore, the Board finds that the evidence of record is at least in approximate balance on this matter. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, by law, the Board must resolve all reasonable doubt in favor of the Veteran. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also, Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Accordingly, based on the totality of the evidence, and with application of the benefit of the doubt rule of 38 U.S.C. § 5107 (b), the Board finds that the evidence of record provides an adequate basis on which to grant service connection for neuropathy.

3. Entitlement to service connection for prostate condition

The Veteran contends that his current prostate condition is related to his active-duty service. Specifically, he contends that his prostate condition is due to his in-service TERA. See May 2025 hearing transcript. 

Based on a sympathetic assessment of a veteran's claim, the Board may recharacter
 Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Accordingly, based on the totality of the evidence, and with application of the benefit of the doubt rule of 38 U.S.C. § 5107 (b), the Board finds that the evidence of record provides an adequate basis on which to grant service connection for neuropathy.

3. Entitlement to service connection for prostate condition

The Veteran contends that his current prostate condition is related to his active-duty service. Specifically, he contends that his prostate condition is due to his in-service TERA. See May 2025 hearing transcript. 

Based on a sympathetic assessment of a veteran's claim, the Board may recharacterize an issue on appeal, or expand or restrict the scope of a particular claim to ensure the veteran is compensated for the full benefit sought. DeLisio v. Shinseki, 25 Vet. App. 45, 53 (2011); see Clemons v. Shinseki, 23 Vet. App. 1 (2009); see also, Brokowski v. Shinseki, 23 Vet. App. 79 (2009). Turning to the evidence, the Veteran initially filed a claim for service connection for prostate surgery. See May 2024 claim. The Veteran has also been found to have a diagnosis of enlargement of the prostate and benign prostatic hyperplasia (BPH). See October 2024 rating decision. Therefore, the Board will consider service connection for a prostate condition, to include prostate surgery, enlargement of the prostate, and BPH. 

In the AOJ's October 2024 rating decision, it issued a favorable finding of the Veteran's diagnosis of enlargement of the prostate and BHP, in addition to his in-service TERA of asbestos and PFAS. Thus, the Board is bound by these favorable findings and finds that the first two elements of service connection are met.

The Board now turns to the final element, or nexus between the Veteran's current disability and his in-service TERA.

During the May 2025 hearing, the Veteran testified that he was exposed to PFAS and asbestos continuously while in service. See May 2025 hearing transcript. He specifically mentioned the firefighting chemicals he worked with, as well as asbestos on the Navy ships he was stationed on. Id. The Veteran reported he began experiencing issues with urinary frequency when he was about 45 years old, and it progressed until he needed to urinate every 10 minutes. He had prostate surgery in 2013. Id. 

The Veteran submitted an August 2025 private medical opinion. The private clinician reviewed and noted the Veteran's service and post-service medical records, as well as his lay statements regarding his prostate condition. The examiner noted the Veteran's conceded in-service exposures to PFAS and asbestos. The private clinician found that medical literature supported a nexus between PFAS and asbestos exposure with the development and progression of BPH. Id. 

The private clinician also found that medical literature supported a finding that the Veteran's long-term cumulative effects of his in-service TERA could also lead to a prostate condition. Id. The private clinician concluded, "[g]iven the mounting scientific evidence linking PFAS to endocrine disruption, prostatic inflammation, and cellular dysregulation, it is at least as likely as not that [the Veteran's] prostate pathology was caused or significantly aggravated by his toxic exposure during service." Id. 

The Board assigns the August 2025 private medical opinion high probative value as the only competent medical nexus opinion of record. Therefore, the Board finds that the evidence of record is at least in approximate balance on this matter. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, by law, the Board must resolve all reasonable doubt in favor of the Veteran. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also, Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Accordingly, based on the totality of the evidence, and with application of the benefit of the doubt rule of 38 U.S.C. § 5107 (b), the Board finds that the evidence of record provides an adequate basis on which to grant service connection for a prostate condition. 

4. Entitlement to service connection for COPD

The Veteran contends that his current COPD is related to his active-duty service. Specifically, he contends that his COPD is due to his in-service TERA. See May 2025 hearing transcript. 

Based on a sympathetic assessment of a veteran's claim, the Board may recharacterize an issue on appeal, or expand or restrict the scope of a particular claim to ensure the veteran is compensated for the
 based on the totality of the evidence, and with application of the benefit of the doubt rule of 38 U.S.C. § 5107 (b), the Board finds that the evidence of record provides an adequate basis on which to grant service connection for a prostate condition. 

4. Entitlement to service connection for COPD

The Veteran contends that his current COPD is related to his active-duty service. Specifically, he contends that his COPD is due to his in-service TERA. See May 2025 hearing transcript. 

Based on a sympathetic assessment of a veteran's claim, the Board may recharacterize an issue on appeal, or expand or restrict the scope of a particular claim to ensure the veteran is compensated for the full benefit sought. DeLisio v. Shinseki, 25 Vet. App. 45, 53 (2011); see Clemons v. Shinseki, 23 Vet. App. 1 (2009); see also, Brokowski v. Shinseki, 23 Vet. App. 79 (2009). Turning to the evidence, the Veteran initially filed a claim for service connection for COPD. See May 2024 claim. The Veteran has also reported other respiratory symptoms of shortness of breath and low oxygen. See October 2024 attorney correspondence. Therefore, the Board will consider service connection for COPD, to include other respiratory issues such as shortness of breath and low oxygen. 

In the AOJ's October 2024 rating decision, it issued a favorable finding of the Veteran's diagnosis of COPD, in addition to his in-service TERA of asbestos and PFAS. Thus, the Board is bound by these favorable findings and finds that the first two elements of service connection are met.

The Board now turns to the final element, or nexus between the Veteran's current disability and his in-service TERA.

During the May 2025 hearing, the Veteran testified that he was exposed to PFAS and asbestos continuously while in service. See May 2025 hearing transcript. He specifically mentioned the firefighting foam he worked with, oil fires and consequent fumes, as well as asbestos on the Navy ships he was stationed on. Id. The Veteran reported he began experiencing shortness of breath after being exposed to the foam and oil fires and fumes, and the symptoms remained after service. Id. The Veteran sought treatment when his symptoms became severe. Id. 

The Veteran submitted an August 2025 private medical opinion. The private clinician reviewed and noted the Veteran's service and post-service medical records, as well as his lay statements regarding his COPD. The examiner noted the Veteran's conceded in-service exposures to PFAS and asbestos. The private clinician found that medical literature supported a nexus between PFAS and asbestos exposure with the development and progression of COPD. Id. 

The private clinician noted the Veteran's lay statements that he began experiencing shortness of breath during service, and his repeated and long-term exposure to oil fires and firefighter extinguishers. The private clinician found that medical literature on similar chemicals supported a finding that the Veteran's long-term cumulative effects of his in-service TERA could also lead to COPD "by instigating chronic inflammation and airway remodeling," and cited countless medical science to support the medical opinion Id. The private clinician concluded that the Veteran's COPD was at least as likely as not the result of his in-service TERA. Id. 

The Board assigns the August 2025 private medical opinion high probative value as the only competent medical nexus opinion of record. Therefore, the Board finds that the evidence of record is at least in approximate balance on this matter. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, by law, the Board must resolve all reasonable doubt in favor of the Veteran. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also, Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Accordingly, based on the totality of the evidence, and with application of the benefit of the doubt rule of 38 U.S.C. § 5107 (b), the Board finds that the evidence of record provides an adequate basis on which to grant service connection for COPD.

5. Entitlement to service connection for heart condition

The Veteran contends that his current heart condition is related to his active-duty service. Specifically, he contends that his heart condition is due to his in-service TERA. See May 2025 hearing transcript. 

Based on a sympathetic assessment of a veteran's claim, the Board may recharacterize an issue on appeal, or expand or restrict the scope of a particular claim to ensure the veteran is compensated for the full benefit sought. DeL
ality of the evidence, and with application of the benefit of the doubt rule of 38 U.S.C. § 5107 (b), the Board finds that the evidence of record provides an adequate basis on which to grant service connection for COPD.

5. Entitlement to service connection for heart condition

The Veteran contends that his current heart condition is related to his active-duty service. Specifically, he contends that his heart condition is due to his in-service TERA. See May 2025 hearing transcript. 

Based on a sympathetic assessment of a veteran's claim, the Board may recharacterize an issue on appeal, or expand or restrict the scope of a particular claim to ensure the veteran is compensated for the full benefit sought. DeLisio v. Shinseki, 25 Vet. App. 45, 53 (2011); see Clemons v. Shinseki, 23 Vet. App. 1 (2009); see also, Brokowski v. Shinseki, 23 Vet. App. 79 (2009). Turning to the evidence, the Veteran initially filed a claim for service connection for a heart condition. See May 2024 claim; see also, September 2023 claim. The Veteran has been found to have diagnoses of arteriosclerotic heart disease (CAD), automatic implantable cardioverter defibrillator (AICD), valvular heart disease, coronary artery bypass graft, and hypertrophic cardiomyopathy. See October 2024 rating decision. Therefore, the Board will consider service connection for a heart condition, to include CAD, AICD, valvular heart disease, coronary artery bypass graft, and hypertrophic cardiomyopathy. 

In the AOJ's October 2024 rating decision, it issued a favorable finding of the Veteran's diagnoses of CAD, AICD, valvular heart disease, coronary artery bypass graft, and hypertrophic cardiomyopathy, in addition to his in-service TERA of asbestos and PFAS. Thus, the Board is bound by these favorable findings and finds that the first two elements of service connection are met.

The Board now turns to the final element, or nexus between the Veteran's current disability and his in-service TERA.

The Veteran underwent a VA examination in May 2024, in which his heart conditions of CAD, AICD, valvular heart disease, coronary artery and bypass graft, and hypertrophic cardiomyopathy were confirmed. One VA examiner provided a May 2024 medical opinion. In the opinion, she concluded that the Veteran's heart condition was less likely than not due to the Veteran's in-service TERA. However, she noted that medical findings suggest that "higher levels of exposure to PFAS could lead to elevated risk of [cardiovascular disease (CVD)], although further studies are needed to clarify the risk, to the researchers. Therefore a connection can not be made since further research on PFAS is needed." 

Another VA examiner provided a June 2024 medical opinion, also finding that the Veteran's heart condition is not due to his in-service TERA. In the rationale, the examiner stated "there is no medical evidence or scientific evidence that provides any indication that a causal relationship between the development of Veteran's heart condition... and toxic exposures." See June 2024 VA medical opinion. However, the examiner did not consider or address the prior May 2024 VA medical opinion that referenced the medical studies suggesting a relationship between PFAS exposure and elevated risk of CVD. The Board finds the June 2024 VA medical opinion to be inadequate in failing to consider current relevant medical science regarding the association between CVD and TERA. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). 

During the May 2025 hearing, the Veteran testified that he was exposed to PFAS and asbestos continuously while in service. See May 2025 hearing transcript. He specifically mentioned the firefighting foam he worked with, oil fires and consequent fumes, as well as asbestos on the Navy ships he was stationed on. Id. He also noted that the drinking water was contaminated with gasoline. The Veteran reported that he was diagnosed with heart problems in the early 2000s. Id. He stated again that he began experiencing shortness of breath during service, which worsened and he required heart surgery in 2023. The Veteran testified that during the May 2024 VA examination, the examiner did not ask him about his in-service TERA. 

The Veteran submitted an August 2025 private medical opinion. The private clinician reviewed and noted the Veteran's service and post-service medical records, as well as his lay statements regarding his heart condition. The examiner noted the Veteran's conceded in-service exposures to PFAS and asbestos. The private clinician found and cited many medical studies that supported a nexus between heart conditions and asbestos
. The Veteran reported that he was diagnosed with heart problems in the early 2000s. Id. He stated again that he began experiencing shortness of breath during service, which worsened and he required heart surgery in 2023. The Veteran testified that during the May 2024 VA examination, the examiner did not ask him about his in-service TERA. 

The Veteran submitted an August 2025 private medical opinion. The private clinician reviewed and noted the Veteran's service and post-service medical records, as well as his lay statements regarding his heart condition. The examiner noted the Veteran's conceded in-service exposures to PFAS and asbestos. The private clinician found and cited many medical studies that supported a nexus between heart conditions and asbestos and PFAS exposure. Id. 

The private clinician noted the Veteran's lay statements that he began experiencing shortness of breath during service, and his repeated and long-term exposure to oil fires and firefighter extinguishers. The private clinician additionally stated that PFAS exposure rarely occurs in isolation, and that they often accompanied "burning oil fields, solvents, carbon monoxide, and sustained psychological stress." Id. Given all of this, the private clinician concluded that the Veteran's heart condition was at least as likely as not the result of his in-service TERA. Id. 

The Board assigns the August 2025 private medical opinion higher probative value than the May 2024 and June 2024 VA medical opinions, as it was a competent medical nexus opinion of record that was supported by a fully articulated rationale with consideration of the Veteran's medical history and established medical literature. See Prejean v. West, 13 Vet. App. 444 (2000); see also, Guerrieri v. Brown, 4 Vet. App. 467 (1993). Therefore, the Board finds that the evidence of record is at least in approximate balance on this matter. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, by law, the Board must resolve all reasonable doubt in favor of the Veteran. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also, Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Accordingly, based on the totality of the evidence, and with application of the benefit of the doubt rule of 38 U.S.C. § 5107 (b), the Board finds that the evidence of record provides an adequate basis on which to grant service connection for the Veteran's heart condition. 

6. Entitlement to service connection for vertigo

The Veteran contends that his current vertigo is related to his active-duty service. Specifically, he contends that his vertigo is due to his in-service TERA. See May 2025 hearing transcript. Alternatively, he contends that his vertigo is due to his COPD. Id. 

In the AOJ's October 2024 rating decision, it issued a favorable finding of the Veteran's diagnosis of vertigo, in addition to his in-service TERA of asbestos and PFAS. Thus, the Board is bound by these favorable findings and finds that the first two elements of service connection are met.

The Board now turns to the final element, or nexus between the Veteran's current disability and his in-service TERA. 

During the May 2025 hearing, the Veteran testified that he was exposed to PFAS and asbestos continuously while in service. See May 2025 hearing transcript. He specifically mentioned the firefighting foam he worked with, oil fires and consequent fumes, as well as asbestos on the Navy ships he was stationed on. Id. The Veteran reported that he began experiencing symptoms of vertigo while in service. Id. He stated that he became seasick every time he was at sea during his years deployed at sea. Id. He stated that he was only provided with aspirin for relief, which was ineffective and he had to complete his duties regardless. He reported that he continued to experience dizziness until the present time. He also reported that breathing treatments for his respiratory conditions and sleep apnea exacerbated his vertigo. Id. 

The Veteran submitted an August 2025 private medical opinion. The private clinician reviewed and noted the Veteran's service and medical records, as well as his lay statements regarding his vertigo. The examiner noted the Veteran's conceded in-service exposures to PFAS and asbestos. The private clinician found and cited many medical studies that supported a nexus between vertigo and hazardous noise exposure and PFAS exposure. Id. 

The Board notes that the AOJ's October 2024 rating decision issued a favorable finding that the Veteran's military occupational specialty as Seaman and Quartermaster had a low probability of hazardous noise exposure for his claim for service connection for hearing
 that breathing treatments for his respiratory conditions and sleep apnea exacerbated his vertigo. Id. 

The Veteran submitted an August 2025 private medical opinion. The private clinician reviewed and noted the Veteran's service and medical records, as well as his lay statements regarding his vertigo. The examiner noted the Veteran's conceded in-service exposures to PFAS and asbestos. The private clinician found and cited many medical studies that supported a nexus between vertigo and hazardous noise exposure and PFAS exposure. Id. 

The Board notes that the AOJ's October 2024 rating decision issued a favorable finding that the Veteran's military occupational specialty as Seaman and Quartermaster had a low probability of hazardous noise exposure for his claim for service connection for hearing loss. See October 2024 rating decision. The private clinician found that the medical literature has "demonstrated impairments in vestibular-evoked responses and neuroplastic compensation," and concluded that "it is reasonable to hypothesize that [the Veteran's] prolonged toxic exposure may have induced subtle yet functionally significant vestibular deficits, manifesting as chronic vertigo and balance impairment." Id. 

Although the private clinician found that literature for the connection of vertigo and PFAS exposure was still under development, she found that "given his documented exposure, diagnosis, and functional limitations, further investigation and service connection for his vestibular impairment are strongly justified." See August 2025 private medical opinion. Given all of this, the private clinician concluded that the Veteran's vertigo was at least as likely as not the result of his in-service TERA. Id. 

The Board assigns the August 2025 private medical opinion high probative value as the only competent medical nexus opinion of record. Therefore, the Board finds that the evidence of record is at least in approximate balance on this matter. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, by law, the Board must resolve all reasonable doubt in favor of the Veteran. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; see also, Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

Accordingly, based on the totality of the evidence, and with application of the benefit of the doubt rule of 38 U.S.C. § 5107 (b), the Board finds that the evidence of record provides an adequate basis on which to grant service connection for the Veteran's vertigo. 

 

 

JENNIFER HWA

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Matta, Martina Y.

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.