DIABETES MELLITUS

THOMAS H. O'SHAY · 2025 · Case ID: A25098818

MIXED

Summary

The veteran, who served from June 1970 to January 1972, including service in Vietnam and earning the Combat Infantryman Badge, appeals the denial of service connection for arterial disease, neuropathy, residuals of a stroke, and stomach disability, and seeks an increased rating for hypertension. The Board granted service connection for diabetes mellitus type II, finding it presumptively linked to the veteran's conceded herbicide exposure in Vietnam, despite a VA examiner's opinion stating otherwise. The Board found the examiner's opinion insufficient to rebut the presumption, noting the examiner failed to explain why diabetes could not be due to TERA exposure and that the evidence was at least evenly balanced. Service connection for arterial disease, neuropathy, stroke residuals, and stomach disability was denied due to lack of in-service event, continuity of symptoms, or probative medical opinion linking them to service or service-connected conditions. The Board also denied secondary claims for these conditions due to lack of nexus evidence. For hypertension, the Board granted a 10 percent rating, finding the veteran's systolic pressure predominantly 160 or more and requiring continuous medication, resolving reasonable doubt in his favor, but denied a higher rating.

Rationale

Presumptive service connection for diabetes mellitus under 38 C.F.R. § 3.309(e) due to herbicide exposure.; Veteran served in Vietnam and was exposed to herbicide agents.; VA examiner's opinion finding no link between toxic exposure and diabetes was insufficient to rebut the presumption.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

241226-510352

Full Decision Text

Citation Nr: A25098818
Decision Date: 11/13/25 Archive Date: 11/13/25

DOCKET NO. 241226-510352
DATE: November 13, 2025

ORDER

Entitlement to service connection for diabetes mellitus type II is granted.

Entitlement to service connection for arterial disease, to include on a secondary basis, is denied.

Entitlement to service connection for neuropathy, to include on a secondary basis, is denied.

Entitlement to service connection for residuals of a stroke, to include on a secondary basis, is denied.

Entitlement to service connection for stomach disability, to include on a secondary basis, is denied.

Entitlement to an initial 10 percent rating, but no higher, for hypertension is granted.

FINDINGS OF FACT

1. The Veteran's diabetes mellitus type II is etiologically related to his herbicide agent exposure during active service.

2. The Veteran's arterial disease did not originate in service and did not manifest within a year of service discharge, nor is arterial disease otherwise etiologically related to service, to include herbicide exposure, or a service connected disability.

3. The Veteran's neuropathy did not originate in service and did not manifest within a year of service discharge, nor is otherwise etiologically related to service, to include herbicide exposure, or a service connected disability.

4. The Veteran's stroke did not originate in service and did not manifest within a year of service discharge, nor is his stroke otherwise etiologically related to service, to include herbicide exposure, or a service connected disability.

5. The Veteran's stomach disability did not originate in service and did not manifest within a year of service discharge, nor is his stomach disability otherwise etiologically related to service, to include herbicide exposure, or a service connected disability.

6. Resolving reasonable doubt in the Veteran's favor, his systolic pressure is predominately 160 or more; however, his diastolic pressure was not predominantly 110 or more, nor was his systolic pressure predominantly 200 or more.

CONCLUSIONS OF LAW

1. The criteria for service connection for diabetes mellitus type II have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309.

2. The criteria for service connection for arterial disease have not been. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

3. The criteria for service connection for neuropathy have not been. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

4. The criteria for service connection for residuals of a stroke have not been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

5. The criteria for service connection for a stomach disability have not been. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310.

6. The criteria for an initial 10 percent disability rating, but no higher, for hypertension have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.104, DC 7101.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had active service from June 1970 to January 1972, to include service in the Republic of Vietnam. The Veteran's awards and decorations for his service include a Combat Infantry Badge.

The rating decisions on appeal were issued in June 2024 with regard to hypertension and September 2024 with regard to each of the remaining issues and constitute initial decisions; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies.

In the December 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on July 28, 2025.

Therefore, the Board may only consider the evidence of record at the time of the June 25, 2024, and September 26, 2024,
The Veteran's awards and decorations for his service include a Combat Infantry Badge.

In the December 2024 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on July 28, 2025.

Therefore, the Board may only consider the evidence of record at the time of the June 25, 2024, and September 26, 2024, agency of original jurisdiction (AOJ) decisions on appeal, respectively, as well as any evidence submitted by the Veteran or his 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 considered. Id. Specific instructions for filing a Supplemental Claim are included with this decision.

Service Connection

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

Service connection may also be established on a secondary basis. In this instance, the evidence must demonstrate an etiological relationship between a service-connected disability or disabilities on the one hand and the condition said to be proximately due to the service-connected disability or disabilities on the other. 38 C.F.R. § 3.310(a); Wallin v. West, 11 Vet. App. 509 (1998).

The Board must assess the credibility and weight of all the evidence, including the medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614 (1992); Hatlestad v. Derwinski, 1 Vet. App. 164 (1991); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Equal weight is not accorded to each piece of evidence contained in the record; every item of evidence does not have the same probative value.

The Board notes that the AOJ has conceded that the Veteran was exposed to herbicide agents during his service in Vietnam. VA regulations provide that, if a veteran was exposed to an herbicide agent during active military, naval, or air service, certain enumerated diseases shall be service connected if the requirements of 38 U.S.C. § 1116, 38 C.F.R. § 3.307(a)(6)(iii) 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. 38 C.F.R. § 3.309(e).

Further, the recently passed Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 (PACT Act) provides that where a Veteran submits a service connection claim with evidence of a disability and evidence of participation in a toxic exposure risk activity (TERA) during active military service and such evidence is not sufficient to establish service connection for the disability, the Secretary shall provide the Veteran with a medical examination and secure a nexus opinion unless the claimed disability is based on physical trauma; is a mental disorder; has not been shown to have any positive association with herbicide exposure; or manifested during service or with a clear etiology that is
are also satisfied. 38 C.F.R. § 3.309(e).

1. Entitlement to service connection for diabetes mellitus type II is granted.

The Veteran contends that service connection is warranted for diabetes mellitus type II due to his herbicide agent exposure.

At the outset, the Board notes that the Veteran does not claim, nor does the record reflect, that he had any symptoms related to diabetes mellitus type II during, or on an ongoing basis, since service. The earliest relevant medical evidence of record indicating the presence of diabetes mellitus type II is many years after separation from active service. Rather, the Veteran's sole theory of recovery is based on presumptive service connection due to exposure to herbicide agents, including Agent Orange.

The AOJ found that the Veteran had participation in a toxic exposure risk activity for the period June 23, 1970, to February 10, 1972, noting that he received the Combat Infantryman Badge (CIB) and served in Vietnam from December 10, 1970, to December 09, 1971. However, the evidence at the time of the rating decision on appeal did not reflect a diagnosis of diabetes mellitus type II.

Veterans who, during active military, naval, or air service, served in the Republic of Vietnam from February 28, 1961, to May 7, 1975, shall be presumed to have been exposed to an herbicide agent, including Agent Orange, unless there is affirmative evidence to establish that the Veteran was not exposed to any such agent during that service. 38 C.F.R.§ 3.307(a). Here, the Board notes that the Veteran's DD 214 reflects that he had service in the Republic of Vietnam from December 10, 1970, to December 9, 1971, and the August 2023 and August 2024 VA Memorandums reflect that the Veteran was exposed to herbicide agents.

As noted above, if a veteran was exposed to an herbicide agent during active military, naval, or air service, certain diseases shall be service connected if the requirements of § 3.307(a)(6) are met, even though there is no record of such disease during service, provided that the rebuttable presumption provisions of 38 C.F.R. § 3.307(d) are also satisfied. 38 C.F.R. § 3.309(e). The diseases listed at § 3.309(e) include diabetes mellitus.

The Veteran was afforded a VA examination in July 2024, which indicated that the Veteran had impaired glucose intolerance; it indicates that the Veteran did not meet the criteria for a diagnosis of diabetes. After noting that the cause of diabetes varies by type and discussing how insulin works generally, the examiner indicated that there is no substantial medical literature to support that any toxic exposure can lead to diabetes mellitus. Therefore, the examiner opined that the claimed condition was less likely than not caused by the indicated toxic exposure risk activity, 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.

Medical treatment records received in October 2025, within an appropriate evidence period, reflect a diagnosis and treatment for diabetes mellitus type II. As such, the Veteran now has a current diagnosis of diabetes mellitus, a disease for which presumptive service connection is warranted based upon herbicide exposure under 38 C.F.R. § 3.309(e).

The Board has considered the July 2024 VA opinion and finds that it is not sufficient to rebut the presumption of service connection in this case. The July 2024 VA examiner, while noting that the cause of diabetes varies, failed to explain why, in this case, his diabetes could not be due to his TERA exposure. Therefore, the evidence does not, with sound medical reasoning and in the consideration of all evidence of record, support a conclusion that diabetes mellitus was not due to his established herbicide agent exposure. Indeed, it is at least evenly balanced that diabetes mellitus type II was caused by the in-service exposure to herbicide agents. As any reasonable doubt must be resolved in favor of the Veteran, the Board finds that the presumption is not rebutted.

As the Veteran has a current diagnosis of diabetes mellitus, a disease for which presumptive service connection is warranted based upon herbicide exposure under 38 C.F.R. § 3.309(e), and the presumption is not rebutted, the Board finds that service connection for diabetes mellitus type II is warranted, and the Veteran's claim is granted. 38 U.S.C. §§ 1318, 5107; 38 C.F.R. §§ 3.22, 3.102.

2. Entitlement to service connection for arterial disease, to include on a secondary basis, is denied.

The Veteran contends that service connection is warranted for arterial disease as secondary to his diabetes mellitus type II. Specifically, during his Board hearing, the Veteran's representative argued that diabetes mellitus type II and peripheral artery disease (PAD) are closely related, noting that PAD is a common cardiovascular complication in patients with diabetes and has extremely high-risk factors.

The AOJ found that the Veteran had participation in a toxic exposure risk activity for the period June 23, 1970, to February 10, 1972, noting that he received the CIB and served in Vietnam from December 10, 1970, to December 09, 1971. Additionally, the AOJ found that the Veteran was diagnosed with a disability, noting that the Veteran had peripheral vascular disease (PVD).

Service treatment records (STRs) are silent for any complaints, treatment, or diagnosis for any arterial disease, including PAD or PVD. Post-service treatment records reflect complaints of leg and feet burning and cramps/pain when he walked in October 2017; the record further indicates that the Veteran had poor pedal pulses in his feet. The Veteran received a diagnosis of PVD following an ankle-brachial index (ABI) in November 2017.

The Veteran was afforded a VA examination in July 2024, which notes a diagnosis of PAD. The examination notes that the date of onset was 2018, noting that the Veteran had recurrent pain in the feet/legs when walking. He had an ABI done in 2019, which was abnormal, and he started on medication. The examiner opined that arterial disease was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that military personnel records and STRs were reviewed, and his separation examination did not note arterial diagnosis/peripheral arterial disease. The examiner indicated that medical treatment records show onset of neurogenic claudication around 2015, and subsequent testing with ABI and MRA abdomen confirmed peripheral arterial disease post-service.

As an initial matter, the Board observes that atherosclerotic cardiovascular disease is included among the types of ischemic heart disease that is entitled to presumptive service connection under 38 C.F.R. § 3.309(e) for veterans with conceded herbicide exposure, as is the case here. However, Note 2 to subsection 38 C.F.R. § 3.309(e) explains that, "For purposes of this section, the term ischemic heart disease does not include hypertension or peripheral manifestations of arteriosclerosis such as peripheral vascular disease or stroke" Consequently, and as the Veteran's representative also acknowledged during the Board hearing, presumptive service connection for arterial disease is not warranted under the provisions of 38 C.F.R. § 3.309(e).

Although TERA exposure has been established and the July 2024 VA examiner did not offer a TERA opinion, the Board finds that such an opinion is not necessary in this case. Specifically, a TERA examination is not required for disabilities resulting from physical trauma; mental disorders; disabilities that have not
38 C.F.R. § 3.309(e) explains that, "For purposes of this section, the term ischemic heart disease does not include hypertension or peripheral manifestations of arteriosclerosis such as peripheral vascular disease or stroke" Consequently, and as the Veteran's representative also acknowledged during the Board hearing, presumptive service connection for arterial disease is not warranted under the provisions of 38 C.F.R. § 3.309(e).

Although TERA exposure has been established and the July 2024 VA examiner did not offer a TERA opinion, the Board finds that such an opinion is not necessary in this case. Specifically, a TERA examination is not required for disabilities resulting from physical trauma; mental disorders; disabilities that have not been shown to have any positive association with herbicide exposure; and disabilities that manifested during service or with a clear etiology that is not associated with toxic exposure. See VBA Letter 20-24-6, Processing Claims Involving the PACT Act, 87 Fed. Reg. 78,543 (June 12, 2024). Here, the Veteran's arterial disease, a circulatory disorder, is a disability which the Secretary has determined is not shown to have any positive association with herbicide agent exposure. Thus, the Board finds that an exception to the TERA examination requirements applies, and an additional examination is not warranted on this basis. See 38 U.S.C. § 1168(b).

After a review of the evidence, the Board finds that service connection is not warranted for the Veteran's arterial disease. Here, there is no documentation related to arterial disease in STRs, nor within one year after his separation from active service. Even considering the Veteran's report that his arterial disease began in 2014, as noted in his initial February 2024 claim for the disorder, the earliest indication of the presence of arterial disease is still more than 40 years after his separation from service. Thus, there is no evidence that arterial disease was present during the Veteran's period of active duty, manifested to a compensable degree within one year of separation, or that he experienced continuity of symptoms since service.

Moreover, there is no probative medical opinion of record indicating that the Veteran's arterial disease was incurred in or caused by his active service, to include any incident or exposure event therein. Thus, there is no documentation in any of his medical records supporting a relationship between his arterial disease and active service, and the Veteran has not provided a medical opinion or any other evidence for this connection.

To the extent that there are deficiencies in the VA opinion of record, the Board, although mindful of Barr v. Nicholson, 21 Vet. App. 303 (2007), finds that a remand to obtain another VA medical opinion is not warranted, and thus, there has been no pre-decisional duty to assist error because the record contains no probative evidence establishing a possible relationship between arterial disease and his active service, including herbicide agent exposure. See McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010) (noting that a conclusory lay statement that a current condition is related to service is insufficient to warrant a medical examination because it would "eliminate the carefully drafted statutory standards governing the provision of medical examinations and require the Secretary to provide such examinations in virtually every veteran's disability case").

Finally, to the extent that the Veteran asserts that his arterial disease is secondary to a service connected disability, to include his now service connected diabetes mellitus, the Board notes that there is no probative medical opinion of record indicating that the Veteran's arterial disease was caused or aggravated by a service connected disability, to include diabetes mellitus type II. Although the Board acknowledges that the Veteran's representative indicated at the Board hearing that he would be submitting evidence that shows that PAD is a common cardiovascular complication in patients with diabetes and has extremely high-risk factors, the Board notes that the neither the Veteran nor his representative have submitted any evidence supporting such an assertion. Thus, as there is no probative evidence that the Veteran's arterial disease is due to or caused by a service connected disability, to include his diabetes mellitus, secondary service connection is not warranted. 38 C.F.R. § 3.310.

The Board acknowledges that the Veteran is competent to report on his symptoms and the history of those symptoms. However, the questions of diagnosis and causation of arterial disease extend beyond an immediately observable cause-and-effect relationship. As the Veteran is not shown to possess the medical training to render competent opinions about such specialized medical matters, the Veteran is not competent to address the diagnosis or etiology of his arterial disease. See Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). Thus, the Veteran's assertions that his arterial disease is directly related to service, to include herbicide agent exposure, or secondary to a service connected disability, to include diabetes mellitus type II, are afforded no probative value.

Based on the foregoing, the Board finds that the evidence is persuasively against a grant of service connection on a direct and secondary basis for arterial disease. In reaching this conclusion, the Board has considered the benefit-of-the-doubt doctrine. However, as the evidence is persuasively against the Veteran's claim, that doctrine is not applicable, and service connection must be denied. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102.

3. Entitlement to service connection for neuropathy is denied.

The Veteran contends that service connection is warranted for neuropathy as due to his herbicide agent exposure during active service. The Veteran also appears to suggest that service connection for neuropathy should be awarded on a secondary basis. Specifically, during his Board hearing, the Veteran described his symptoms as associated with a back disability; it was also suggested that it may be due to diabetes mellitus.

The Veteran's February 2024 claim indicates that he had neuropathy for 25 to 30 years.

Medical treatment records reflect complaints of back, leg, and hip pain in April 2011. The record notes that the Veteran reported tingling and numbness in the right lower extremity. The assessment notes that the Veteran presented with signs and symptoms consistent with some sciatica, noting decreased hip mobility on the left lower extremity, pain and tightness in the lower leg, and tingling and numbness of the lower extremity. A March 2012 record notes that the Veteran had chronic back pain, knee pain, leg pain, and feet pain; he reported tingling in his toes in November 2013.

A September 2023 VA treatment record notes that the Veteran had continued neuropathic foot pain and decreased sensation in his feet. The Veteran also reported shooting pain from his low back down both legs. He indicated that he had been told he had sciatica. The record notes an assessment of peripheral neuropathy. A September 2023 private treatment record notes a diagnosis of peripheral nerve disease.

A December 2023 record notes that the Veteran reported that his feet were numb, tingle, burn and have shooting pain; he also reported a pins-and-needles sensation. The assessment notes that the Veteran likely had polyneuropathy or pinched nerve in his back contributing to tingling, numbness, burning and shooting pain to his feet; pain to both feet is noted to be nerve pain.

A March 2024 diabetes mellitus VA examination notes that the Veteran did not have any complications of diabetes mell
back down both legs. He indicated that he had been told he had sciatica. The record notes an assessment of peripheral neuropathy. A September 2023 private treatment record notes a diagnosis of peripheral nerve disease.

A March 2024 diabetes mellitus VA examination notes that the Veteran did not have any complications of diabetes mellitus. A September 2024 VA examination for diabetic peripheral neuropathy indicates that the Veteran did not have diabetic peripheral neuropathy. A July 2024 VA examiner opined that the Veteran's claimed neuropathy was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that military personnel records and STRs were reviewed, and his separation examination did not note neuropathy. The examiner indicated that private medical treatment records show he was treated for neuropathy. The examiner also noted that the Veteran was diagnosed with PAD.

During his Board hearing, the Veteran testified that he had symptoms of pain, tingling, weakness, and numbness in his legs for years, although he could not recall when it started. He did indicate, however, that he remembered some pain in the 1970s, which had drastically increased by the 1980s. The Veteran testified that in approximately 1989 or 1990, he sought treatment from a chiropractor. He reported that recently, he was told he had sciatica.

As an initial matter, the Board observes that "early onset" peripheral neuropathy is included among the types of diseases that is entitled to presumptive service connection under 38 C.F.R. § 3.309(e) for veterans with conceded herbicide exposure. However, there is no indication in the evidence, nor does the Veteran contend, that the he has been diagnosed with "early onset" peripheral neuropathy. Consequently, presumptive service connection for neuropathy is not warranted under the provisions of 38 C.F.R. § 3.309(e).

On the question of additional examination, the Veteran has participation in a TERA, due to his presumed exposure to herbicide agents. Although VA has an obligation to provide VA examinations for any service connection claim which cannot be presumptively granted where there is evidence of a TERA, similar to the above, here, the Veteran's neuropathy, a chronic peripheral nervous system disorder, is a disability which the Secretary has determined is not shown to have any positive association with herbicide agent exposure. See VBA Letter 20-24-6, Processing Claims Involving the PACT Act, 87 Fed. Reg. 78,543 (June 12, 2024). Thus, the Board finds that an exception to the TERA examination requirements applies, and an additional examination is not warranted on this basis. See 38 U.S.C. § 1168(b).

After a review of the evidence, the Board finds that service connection is not warranted for the Veteran's neuropathy. The Board notes that there is no evidence in this case, nor does the Veteran contend, that his neuropathy had its onset during his period of active service. Nor is there evidence to suggest the presence of neuropathy until many years after the Veteran's service, and thus, there is no indication of continuity of symptoms since service or that the Veteran's neuropathy manifested to a compensable degree within one year of his separation from military service. Indeed, as noted above, medical treatment records reflect complaints of leg pain as early as 2011, and even considering his reports of onset as occurring 25 to 30 years prior to initial claim, this would suggest that his symptoms began in the 1990s, still many years after his active service. Thus, there is no evidence that peripheral neuropathy was present during the Veteran's period of active duty, manifested to a compensable degree within one year of separation, or that he experienced continuity of symptoms since service.

The Board has considered the Veteran's recent reports during his Board hearing that his symptoms may have started in the 1970s. However, the Board finds that the probative value of the Veteran's recollections regarding his symptoms made during his July 2025 Board hearing are inconsistent with his own previously reported symptoms; further, the Veteran even indicated during his hearing that he could not recall when his symptoms started. Therefore, to the extent that the Veteran asserts onset and continuity of symptoms of his neuropathy symptoms since the 1970s, the Board finds that his statements are outweighed by the remaining evidence of record.

Moreover,
duty, manifested to a compensable degree within one year of separation, or that he experienced continuity of symptoms since service.

Moreover, there is no probative medical opinion of record indicating that the Veteran's neuropathy was incurred in or caused by his active service, to include any incident or exposure event therein. Thus, there is no documentation in any of his medical records supporting a relationship between his neuropathy and active service, and the Veteran has not provided a medical opinion or any other evidence for this connection.

To the extent that there are deficiencies in the VA examination or opinion of record, the Board, although mindful of Barr v. Nicholson, 21 Vet. App. 303 (2007), finds that a remand to obtain another VA medical opinion is not warranted, and thus, there has been no pre-decisional duty to assist error because the record contains no probative evidence establishing a possible relationship between neuropathy and active service. See McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010) (noting that a conclusory lay statement that a current condition is related to service is insufficient to warrant a medical examination because it would "eliminate the carefully drafted statutory standards governing the provision of medical examinations and require the Secretary to provide such examinations in virtually every veteran's disability case").

Finally, to the extent that the Veteran asserts that his neuropathy is secondary to a service connected disability, to include his diabetes mellitus, the Board notes that there is no probative medical opinion of record indicating that the Veteran's neuropathy was caused or aggravated by a service connected disability, to include diabetes mellitus type II. Indeed, the available evidence indicates that the Veteran did not have diabetic peripheral neuropathy. To the extent that the evidence reflects that the Veteran's neuropathy may be secondary to a back disability or PAD, the Board notes that the Veteran is not service connected for a back disability or PAD. Therefore, secondary service connection is not available on this basis, as neuropathy cannot be service-connected secondary to a nonservice-connected disability, and there is no indication in the record that his neuropathy is otherwise related to a service-connected disability. 38 C.F.R. § 3.310.

The Board acknowledges that the Veteran is competent to report on his symptoms and the history of those symptoms. However, the questions of diagnosis and causation of neuropathy extend beyond an immediately observable cause-and-effect relationship. As the Veteran is not shown to possess the medical training to render competent opinions about such specialized medical matters, the Veteran is not competent to address the diagnosis or etiology of his neuropathy. See Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). Thus, the Veteran's assertions that his neuropathy is directly related to service, to include herbicide agent exposure, or secondary to a service connected disability, to include diabetes mellitus type II, are afforded no probative value.

Based on the foregoing, the Board finds that the evidence is persuasively against a grant of service connection on a direct and secondary basis for neuropathy. In reaching this conclusion, the Board has considered the benefit-of-the-doubt doctrine. However,
2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). Thus, the Veteran's assertions that his neuropathy is directly related to service, to include herbicide agent exposure, or secondary to a service connected disability, to include diabetes mellitus type II, are afforded no probative value.

Based on the foregoing, the Board finds that the evidence is persuasively against a grant of service connection on a direct and secondary basis for neuropathy. In reaching this conclusion, the Board has considered the benefit-of-the-doubt doctrine. However, as the evidence is persuasively against the Veteran's claim, that doctrine is not applicable, and service connection must be denied. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102.

4. Entitlement to service connection for residuals of a stroke, to include on a secondary basis, is denied.

The Veteran contends that service connection is warranted for his stroke, to include on a secondary basis. Specifically, during his Board hearing, the Veteran testified that he believed that his stroke was due to his hypertension. His representative pointed out that, at that time, his systolic number was over 200 and his diastolic number was in the hundreds.

STRs are silent for any complaints, treatment, or diagnosis for a stroke. Post-service medical treatment records reflect that the Veteran had a stroke on April 5, 2021. The records from this hospital admission indicate that the Veteran had a history of high blood pressure and hyperlipidemia. Upon admission, the Veteran had a blood pressure reading of 211/106. These VA treatment records reflect that the Veteran was then transferred to a community care hospital for treatment. Following his Board hearing, the Veteran submitted the private treatment records for his stroke treatment. These records indicate, in pertinent part, that the Veteran had vascular risk factors for stroke of diabetes, hypertension, and PVD.

The Veteran was afforded a VA examination in March 2024, which noted a diagnosis of history of cerebral infarction. The examiner, noting review of the records, provided a negative nexus opinion addressing the Veteran's TERA exposure. The examiner explained how ischemic strokes and hemorrhagic strokes occur and indicated that the most common type of stroke is caused by the brain's blood vessels becoming narrowed or blocked. The examiner then, citing to medical literature, indicated that there was no substantial medical literature to support that any toxic exposure can lead to stroke, and therefore opined that the claimed condition was less likely than not caused by the indicated toxic exposure risk activity 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.

Initially, the Board observes that strokes are not included among the types of diseases that are entitled to presumptive service connection under 38 C.F.R. § 3.309(e) for veterans with conceded herbicide exposure. Consequently, presumptive service connection for his stroke is not warranted under the provisions of 38 C.F.R. § 3.309(e).

After a review of the evidence, the Board finds that service connection is not warranted for the Veteran's stroke. The Board notes that there is no evidence in this case, nor does the Veteran contend, that his stroke had its onset during his period of active service. Nor is there evidence to suggest the presence of a stroke until many years after the Veteran's service, and thus, there is no indication of continuity of symptoms since service or that the Veteran's stroke manifested to a compensable degree within one year of his separation from military service. Indeed, as noted above, medical treatment records reflect treatment for his stroke in April 2021, almost 50 years after his separation from service. Thus, there is no evidence that a stroke occurred during the Veteran's period of active duty, manifested to a compensable degree within one year of separation, or that he experienced continuity of symptoms since service.

Moreover, there is no probative medical opinion of record indicating that the Veteran's stroke was incurred in or caused by his active service, to include any incident or exposure event therein. The March 2024 VA examiner noted review of the Veteran's records and the Veteran's TERA exposure, and the examiner provided supporting rationale based on medical literature for
within one year of his separation from military service. Indeed, as noted above, medical treatment records reflect treatment for his stroke in April 2021, almost 50 years after his separation from service. Thus, there is no evidence that a stroke occurred during the Veteran's period of active duty, manifested to a compensable degree within one year of separation, or that he experienced continuity of symptoms since service.

Moreover, there is no probative medical opinion of record indicating that the Veteran's stroke was incurred in or caused by his active service, to include any incident or exposure event therein. The March 2024 VA examiner noted review of the Veteran's records and the Veteran's TERA exposure, and the examiner provided supporting rationale based on medical literature for the opinion offered. See Stefl v. Nicholson, 21 Vet. App. 120, 140 (2007); Monzingo v. Shinseki, 26 Vet. App. 97, 106 (2012) (the fact that the rationale provided by an examiner "did not explicitly lay out the examiner's journey from the facts to a conclusion," did not render the examination inadequate). Thus, there is no documentation in any of his medical records supporting a relationship between his stroke and active service, and the Veteran has not provided a medical opinion or any other evidence for this connection.

Finally, with regard to the Veteran's assertion that his stroke is secondary to a service connected disability, to include his hypertension and diabetes mellitus, the Board notes that there is no probative medical opinion of record indicating that the Veteran's stroke was caused or aggravated by a service connected disability, to include hypertension or diabetes mellitus type II. Therefore, secondary service connection is not available. 38 C.F.R. § 3.310.

To the extent that the blood pressure readings were elevated at the time of his stroke and medical records reflect that diabetes and hypertension are risk factors of stroke, the Board finds that this evidence, without more, is not sufficient for addressing the question of nexus. The United States Federal Circuit Court has held that a "causal" relationship is required for service connection. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004) ("nexus" means a connection or link, often a causal one). Merriam-Webster defines "risk factor" as "something that increases the risk or susceptibility." See https://www.merriam-webster.com/dictionary/risk%20factor. Therefore, evidence that discusses the presence of certain symptoms or general risk factors, alone, is insufficient to determine causation and does not serve as probative evidence of a nexus in this case.

Although a VA opinion has not been obtained addressing secondary service connection, the Board finds that a remand for an opinion is not necessary. Here, at the time of the September 2024 AOJ decision on appeal, the evidence did not indicate that his stroke was caused or aggravated by a service-connected disability. Indeed, the record at the time of the AOJ decision on appeal only documented his symptoms and treatment at the time of his admission. The Board notes that although the Veteran has submitted additional treatment records suggesting that hypertension and diabetes were risk factors for stroke, this evidence was received after the September 2024 rating decision on appeal. Thus, other than the Veteran's claim, the evidence did not indicate that his stroke was caused or aggravated by a service-connected disability. Therefore, it was insufficient to trigger VA's duty to assist by providing a medical opinion addressing secondary service connection for his stroke. See 38 C.F.R. §§ 3.159(c); see also McLendon v. Nicholson, 20 Vet. App. 79, 84 (2006); Waters v. Shinseki, 601 F.3d 1274, 1278 (Fed. Cir. 2010).

The Board acknowledges that the Veteran is competent to report on his symptoms and the history of those symptoms. However, the questions of diagnosis and causation of a stroke extend beyond an immediately observable cause-and-effect relationship. As the Veteran is not shown to possess the medical training to render competent opinions about such specialized medical matters, the Veteran is not competent to address the diagnosis or etiology of his stroke. See Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). Thus, the Veteran's assertions that his stroke is directly related to service, to include herbicide agent exposure, or secondary to a service connected disability, to include hypertension or diabetes mellitus type II, are afforded
to possess the medical training to render competent opinions about such specialized medical matters, the Veteran is not competent to address the diagnosis or etiology of his stroke. See Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). Thus, the Veteran's assertions that his stroke is directly related to service, to include herbicide agent exposure, or secondary to a service connected disability, to include hypertension or diabetes mellitus type II, are afforded no probative value.

Based on the foregoing, the Board finds that the evidence is persuasively against a grant of service connection for the Veteran's stroke and associated residuals. In reaching this conclusion, the Board has considered the benefit-of-the-doubt doctrine. However, as the evidence is persuasively against the Veteran's claim, that doctrine is not applicable, and service connection must be denied. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102.

5. Entitlement to service connection for stomach disability, to include on a secondary basis, is denied.

The Veteran contends that service connection is warranted for a stomach disability on a direct or secondary basis. Specifically, during his Board hearing, the Veteran's representative suggested that gastritis may be due to the malaria tablets that the Veteran took during service, or alternatively, it was due to stress caused by his service connected posttraumatic stress disorder (PTSD).

STRs reflect that the Veteran received and took malaria tablets following his departure from Vietnam in June 1970. STRs dated in July 1971 reflect that the Veteran sought several days of treatment for fever, chills, weakness, headache, and diarrhea; the assessment notes "probably viral syndrome." STRs are otherwise silent for any complaints, treatment, or diagnosis for any stomach related disorder or symptoms, to include his January 1972 separation examination.

September 2015 post-service treatment records reflect that the Veteran reported having abdominal discomfort and bloating for the last three years. An April 2018 medical treatment record notes that the Veteran had chronic abdominal bloating for the last 6 years; previous scan done in 2014, computed tomography (CT) scan of the abdomen, did not show any significant abnormality and normal appendix. A November 2019 record reflects that biopsy revealed, in part, gastritis.

The Veteran was afforded a VA examination in July 2024, which notes diagnoses of chronic gastritis, helicobacter pylori infection, and hiatus hernia. The examination notes that the date of onset of his disability was 2015. The Veteran reported heartburn, bloating of the abdomen, and indigestion at onset. He indicated that he was evaluated with EGD and found to have hiatus hernia, esophagitis and H pylori infection. He was successfully treated with antibiotics and PPI in 2015, and he repeated an EGD in 2019 that showed no recurrence of the H Pylori infection. The examiner opined that the Veteran's stomach disability was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner noted that military personnel records and STRs were reviewed, and his separation examination did not note any stomach disorder. The examiner indicated that private medical treatment records show he was treated for GERD, hiatus hernia, gastritis, and esophagitis post-service.

During his July 2025 Board hearing, the Veteran's spouse testified that when the Veteran returned from service he complained of feeling sick and achy, noting that he started having stomach problems soon after his return, although he did not have an enlarged stomach then. She reported current symptoms of not eating much but still gaining weight. The Veteran testified that his enlarged stomach came on slowly approximately 15 years ago. The Veteran's representative indicated that the Veteran was on chloroquine and primaquine as malaria content, indicating that those cause gastric problems while taking them. The Veteran indicated that he did not recall having stomach problems during service. Additionally, the
he was treated for GERD, hiatus hernia, gastritis, and esophagitis post-service.

During his July 2025 Board hearing, the Veteran's spouse testified that when the Veteran returned from service he complained of feeling sick and achy, noting that he started having stomach problems soon after his return, although he did not have an enlarged stomach then. She reported current symptoms of not eating much but still gaining weight. The Veteran testified that his enlarged stomach came on slowly approximately 15 years ago. The Veteran's representative indicated that the Veteran was on chloroquine and primaquine as malaria content, indicating that those cause gastric problems while taking them. The Veteran indicated that he did not recall having stomach problems during service. Additionally, the Veteran's representative indicated that the Veteran is service connected for PTSD, and stress is a significant contributor to gastritis. The Veteran indicated that he believed that his stress level is probably considered low. Nevertheless, he suggested that it could be possible that he had stomach symptoms during service from the malaria tablets or that it could be due to stress from his PTSD.

Initially, the Board observes that the Veteran's stomach disorder, to include gastritis, is not included among the types of diseases that are entitled to presumptive service connection under 38 C.F.R. § 3.309(e) for veterans with conceded herbicide exposure. Consequently, presumptive service connection for his stomach disorder is not warranted under the provisions of 38 C.F.R. § 3.309(e).

On the question of additional examination, the Veteran has participation in a TERA, presumed exposure to herbicide agents, by virtue of his service in Vietnam. Although VA has an obligation to provide VA examinations for any service connection claim which cannot be presumptively granted where there is evidence of a TERA, as noted above, VA has identified several exceptions to this general obligation. Here, the Veteran's stomach disability, a gastrointestinal or digestive disorder, is a disability which the Secretary has determined is not shown to have any positive association with herbicide agent exposure. See VBA Letter 20-24-6, Processing Claims Involving the PACT Act, 87 Fed. Reg. 78,543 (June 12, 2024). Thus, the Board finds that an exception to the TERA examination requirements applies, and an additional examination is not warranted on this basis. See 38 U.S.C. § 1168(b).

After a review of the evidence, the Board finds that service connection is not warranted for the Veteran's stomach disability. The Board notes that there is no evidence in this case that his stomach disorder had its onset during his period of active service. Nor is there evidence to suggest the presence of a stomach disability until many years after the Veteran's service, and thus, there is no indication of continuity of symptoms since service or that the Veteran's stomach disability manifested to a compensable degree within one year of his separation from military service. Indeed, as noted above, medical treatment records reflect complaints of stomach related symptoms may have existed since approximately 2012, and even considering his reports of onset as occurring 10 years prior to his initial claim, this would suggest that his symptoms began in 2014. Thus, there is no evidence that a stomach disorder was present during the Veteran's period of active duty, manifested to a compensable degree within one year of separation, or that he experienced continuity of symptoms since service.

The Board has considered the Veteran's recent reports during his Board hearing that his symptoms may have started during service. However, the Board finds that the probative value of the Veteran's recollections regarding his symptoms made during his July 2025 Board hearing are inconsistent with his own previously reported symptoms; further, the Veteran even indicated during his hearing that he could not recall experiencing symptoms in service. Therefore, to the extent that the Veteran asserts onset and continuity of symptoms of his stomach disorder symptoms during and since service, the Board finds that his statements are outweighed by the remaining evidence of record. To the extent that the Veteran's spouse testified that the Veteran complained of stomach problems shortly after service, the Board does not find that this suggests that his symptoms began during service or within one year of his separation from service. Thus, the Board finds that the Veteran's stomach disability did not manifest during active or within one year of separation, and he did not experience continuity of symptoms since service.

Moreover, there is no probative medical opinion of record indicating that the Veteran's stomach disability was incurred in or caused by his active service, to include herbicide agent exposure or malaria tablets. There is no documentation in any of his medical records supporting a relationship between his peripheral neuropathy and active service, and the Veteran has not provided a medical opinion or any other evidence for this connection.

To the extent that there are deficiencies in the VA examination or opinion of record, the Board, although mindful of Barr v. Nicholson,
during service or within one year of his separation from service. Thus, the Board finds that the Veteran's stomach disability did not manifest during active or within one year of separation, and he did not experience continuity of symptoms since service.

To the extent that there are deficiencies in the VA examination or opinion of record, the Board, although mindful of Barr v. Nicholson, 21 Vet. App. 303 (2007), finds that a remand to obtain another VA medical opinion is not warranted, and thus, there has been no pre-decisional duty to assist error because, other than the assertion of the Veteran and/or his representative, the record contains no probative evidence establishing a possible relationship between his stomach disability and active service. See McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010) (noting that a conclusory lay statement that a current condition is related to service is insufficient to warrant a medical examination because it would "eliminate the carefully drafted statutory standards governing the provision of medical examinations and require the Secretary to provide such examinations in virtually every veteran's disability case").

Finally, to the extent that the Veteran asserts that his stomach disability is secondary to a service connected disability, to include his PTSD, the Board notes that there is no probative medical opinion of record indicating that the Veteran's stomach disorder was caused or aggravated by a service connected disability, to include PTSD. Neither the Veteran nor his representative have submitted such an opinion or any other evidence suggesting such a relationship, and there is no indication in the record that his stomach disability is otherwise related to a service-connected disability. Therefore, secondary service connection is not available. 38 C.F.R. § 3.310.

The Board acknowledges that the Veteran and his spouse are competent to report on his symptoms and the history of those symptoms. However, the questions of diagnosis and causation of a stomach disorder extend beyond an immediately observable cause-and-effect relationship. As the Veteran and his spouse are not shown to possess the medical training to render competent opinions about such specialized medical matters, neither is competent to address the diagnosis or etiology of the Veteran's stomach disability. See Davidson v. Shinseki, 581 F. 3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F. 3d 1331 (Fed. Cir. 2006). Thus, the assertions that his stomach disability is directly related to service, to include herbicide agent exposure or taking malaria tablets, or secondary to a service connected disability, to include PTSD, are afforded no probative value.

Based on the foregoing, the Board finds that the evidence is persuasively against a grant of service connection on a direct and secondary basis for a stomach disability. In reaching this conclusion, the Board has considered the benefit-of-the-doubt doctrine. However, as the evidence is persuasively against the Veteran's claim, that doctrine is not applicable, and service connection must be denied. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102.

Increased Rating

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis
the Board has considered the benefit-of-the-doubt doctrine. However, as the evidence is persuasively against the Veteran's claim, that doctrine is not applicable, and service connection must be denied. See 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 C.F.R. § 3.102.

Increased Rating

Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. The basis of disability ratings is the ability of the body as a whole, or of the psyche, or of a system or organ of the body, to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10.

Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria required for that particular rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When a reasonable doubt arises regarding the degree of disability, that reasonable doubt will be resolved in favor of the Veteran. 38 C.F.R. § 4.3.

6. Entitlement to an initial 10 percent rating, but no higher, for hypertension is granted.

The Veteran is currently in receipt of a noncompensable evaluation for his hypertension pursuant to Diagnostic Code 7101. He contends that he is entitled to a higher rating. Further, the Veteran's representative has argued that extraschedular consideration is warranted; however, the representative did not offer any specific evidence or argument on this contention.

The Board notes that VA amended the rating criteria for the cardiovascular system effective November 14, 2021. However, the rating criteria under Diagnostic Code 7101 for hypertension were not changed.

Under Diagnostic Code 7101, a 10 percent rating is warranted for diastolic pressure predominantly 100 or more, or; systolic pressure predominantly 160 or more, or; minimum evaluation for an individual with history of diastolic pressure predominantly 100 or more who requires continuous medication for control; a 20 percent rating is warranted for diastolic pressure predominantly 110 or more, or; systolic pressure predominantly 200 or more; a 40 percent rating is warranted for diastolic pressure predominantly 120 or more; and, a 60 percent rating is warranted for diastolic pressure predominantly 130 or more. 38 C.F.R. § 4.104, DC 7101.

In rating hypertension under Diagnostic Code 7101, the Board may consider blood pressure readings taken while a veteran is using medication. McCarroll v. McDonald, 28 Vet. App. 267, 271 (2016) (holding that Diagnostic Code 7101 contemplates the effects of medication and therefore Jones v. Shinseki, 26 Vet. App. 56 (2012) does not apply.

The term "predominant" is not defined in the rating criteria. Merriam-Webster defines predominant to mean "being most frequent or common" See, e.g., "predominant," Merriam-Webster.com Online Dictionary, https://www.merriam-webster.com/dictionary/predominant.

A December 2013 treatment record notes that the Veteran had a blood pressure reading of 150/90; an April 2014 medical treatment record reflects a blood pressure reading 140/98; a June 2014 record notes a reading of 157/96; an October 2015 record reflects blood pressure readings of 137/96 and 124/92; a November 2019 treatment record notes blood pressure readings of 130/84, 123/82, 126/80; and April 2021 treatment records reflect blood pressure readings of 211/106 and 160/90; a September 2023 record notes a blood pressure reading of 132/86; March 2024 treatment records not blood pressure readings of 134/87 and 137/80; a March 2025 record notes a blood pressure reading of 186/94; an April 2025 treatment record notes a blood pressure reading of 173/96; a September 2025 record notes a reading of 163/101.

The Veteran was afforded a VA examination in March 2024 for his hypertension. The examination notes that the Veteran's treatment plan includes taking continuous medication for hypertension. The examination notes that the Veteran does not have a history of a diastolic blood pressure elevation to predominantly 100 or more. It also provided three
September 2023 record notes a blood pressure reading of 132/86; March 2024 treatment records not blood pressure readings of 134/87 and 137/80; a March 2025 record notes a blood pressure reading of 186/94; an April 2025 treatment record notes a blood pressure reading of 173/96; a September 2025 record notes a reading of 163/101.

The Veteran was afforded a VA examination in March 2024 for his hypertension. The examination notes that the Veteran's treatment plan includes taking continuous medication for hypertension. The examination notes that the Veteran does not have a history of a diastolic blood pressure elevation to predominantly 100 or more. It also provided three blood pressure readings from September 2023 and March 2024: 134/87, 137/80, and 132/86. The examiner indicated that the Veteran did not have any other pertinent physical findings, complications, conditions, signs or symptoms related to his hypertension. Additionally, the examiner indicated that the Veteran's hypertension did not impact his ability to work.

After a review of the evidence and resolving doubt in the Veteran's favor, the Board finds that the Veteran's symptoms more nearly approximate the criteria for a 10 percent disability rating for hypertension. In this regard, while the Veteran does indeed require continuous medication for control, the Board does not find that he has diastolic pressure predominantly 100 or more or a history of diastolic pressure predominantly 100 or more. Indeed, the record reflects diastolic pressure was predominantly below 100, with only a couple of records reflecting diastolic pressure above 100. However, the Board finds that the Veteran's systolic pressure has been predominantly 160 or more, as noted in March 2025, April 2025, and September 2025. Therefore, the Board affords the Veteran the benefit of the doubt and finds that his hypertension warrants a 10 percent disability rating under Diagnostic Code 7101.

However, the Veteran's hypertension does not meet the criteria for a higher rating. Specifically, at no time has the record shown that his diastolic pressure has been predominantly 110 or more or that his systolic pressure has been predominantly 200 or more. 38 C.F.R. § 4.104, DC 7101.

To the extent that the Veteran's representative has raised extraschedular consideration, the Board notes that there is a sequential three-step analysis to determine whether a case should be referred for extraschedular consideration. See Thun v. Peake, 22 Vet. App. 111 (2008). Step one is to determine whether the schedular rating adequately contemplates a claimant's disability picture. If the criteria reasonably describe the claimant's disability level and symptomatology, then the claimant's disability picture is contemplated by the Rating Schedule. The assigned schedular evaluation would, therefore, be adequate, and no referral to the Under Secretary for Benefits or the Director of the Compensation Service for consideration of an extraschedular rating would be required.

If the schedular criteria do not contemplate the claimant's level of disability and symptomatology and the schedular criteria are therefore found to be inadequate, then step two is to determine whether the claimant's disability picture is exceptional with related factors such as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular criteria. If the disability picture is exceptional, then the third step is to refer the case to the Under Secretary for Benefits or the Director of the Compensation Service to determine whether an extraschedular rating is warranted. Id.

With respect to the first prong of Thun, the Board finds that the hypertension symptomatology and impairment, including the need for medication, are specifically contemplated by the schedular rating criteria, and no referral for extraschedular consideration is required. In this regard, as noted above, the Veteran's hypertension has been rated as 10 percent disabling because the Veteran's systolic pressure has been predominantly 160 or more; notably, however, a 10 percent disability rating also specifically contemplates the use of continuous medication for control. Thus, the Board finds that this level of disability is expressly considered under 38 C.F.R. § 4.104, Diagnostic Code 7101. Based on the foregoing, the Board finds that the Veteran's hypertension symptoms, including his use of medication, are contemplated by the schedular criteria, and referral for an extraschedular evaluation is not warranted.

Accordingly, the Board finds that a rating of 10 percent, but no higher, is not warranted for the Veteran's hypertension. 38 U.S.C. § 5107(b).

Thomas H. O'Shay

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board D. Hite, Counsel

The Board's decision

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