DEGENERATIVE ARTHRITIS OF THE SPINE (SPONDYLOSIS)

B. MULLINS · 2026 · Case ID: A26008538

DENIED

Summary

The veteran, who served in the United States Army from April 1959 to July 1963, appeals the denial of service connection for multiple conditions. The claims on appeal include a lumbar spine condition (arthritis and stenosis), diabetes mellitus type II, diabetic retinopathy, bilateral upper and lower extremity neuropathy, essential tremors, coronary artery disease (CAD) with bypass graft, hypertension, and bilateral hearing loss. The Board reviewed the evidence, including VA examinations conducted in December 2024 and January 2025, and the veteran's testimony from an October 2025 hearing. The Board applied the standard for service connection, requiring evidence of a current disability, in-service incurrence or aggravation, and a medical nexus. For each condition, the Board found that the criteria for service connection were not met. Specifically, the Board concluded that none of the claimed conditions were documented in service, manifested to a compensable degree within one year of separation, or were otherwise etiologically related to active service, including as due to service-related toxic exposure risk activities (TERA). Consequently, all claims for service connection were denied.

Rationale

Not documented in service; Did not manifest to a compensable degree within one year of separation; Not otherwise etiologically related to active service

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250617-548803

Full Decision Text

Citation Nr: A26008538
Decision Date: 01/29/26 Archive Date: 01/29/26

DOCKET NO. 250617-548803
DATE: January 29, 2026

ORDER

Entitlement to service connection for a lumbar spine condition, to include arthritis and stenosis is denied.

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

Entitlement to service connection for diabetic retinopathy is denied.

Entitlement to service connection for neuropathy, left upper extremity is denied.

Entitlement to service connection for neuropathy, right upper extremity is denied.

Entitlement to service connection for neuropathy, right lower extremity is denied.

Entitlement to service connection for neuropathy, left lower extremity is denied.

Entitlement to service connection for essential tremors is denied.

Entitlement to service connection for coronary artery disease (CAD) with bypass graft (claimed as heart condition with two triple bypass procedures) is denied.

Entitlement to service connection for hypertension is denied.

Entitlement to service connection for bilateral hearing loss is denied.

FINDINGS OF FACT

1. The Veteran's lumbar spine condition, to include arthritis and stenosis was not documented in service and did not manifest to a compensable degree within one year of separation, and the disability is not otherwise etiologically related to active service; to include as due to service-related toxic exposure risk activities (TERA).

2. The Veteran's diabetes mellitus type II was not documented in service and did not manifest to a compensable degree within one year of separation; and the disability is not otherwise etiologically related to active service, to include as due to service-related TERA.

3. The Veteran's for diabetic retinopathy was not documented in service and did not manifest to a compensable degree within one year of separation; and the disability is not otherwise etiologically related to active service, to include as due to service-related TERA.

4. The Veteran's bilateral upper and lower extremity neuropathy was not documented in service and did not manifest to a compensable degree within one year of separation; and the disability is not otherwise etiologically related to active service, to include as due to service-related TERA.

5. The Veteran's essential tremors were not documented in service and did not manifest to a compensable degree within one year of separation; and the disability is not otherwise etiologically related to active service, to include as due to service-related TERA.

6. The Veteran's coronary artery disease (CAD) with bypass graft (claimed as heart condition with two triple bypass procedures) was not documented in service and did not manifest to a compensable degree within one year of separation; and the disability is not otherwise etiologically related to active service, to include as due to service-related TERA.

7. The Veteran's hypertension was not documented in service and did not manifest to a compensable degree within one year of separation; and the disability is not otherwise etiologically related to active service, to include as due to service-related TERA.

8. The Veteran's bilateral hearing loss was not documented in service and did not manifest to a compensable degree within one year of separation; and the disability is not otherwise etiologically related to active service, to include as due to service-related TERA.

CONCLUSIONS OF LAW

1. The criteria for establishing entitlement to service connection for a lumbar spine condition, to include arthritis and stenosis have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for establishing entitlement to service connection for diabetes mellitus type II have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for establishing entitlement to service connection for diabetic retinopathy have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for establishing entitlement to service connection for neuropathy, left upper extremity have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for establishing entitlement to service connection for neuropathy, right upper extremity have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for establishing entitlement to service
1, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for establishing entitlement to service connection for neuropathy, left upper extremity have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for establishing entitlement to service connection for neuropathy, right upper extremity have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for establishing entitlement to service connection for neuropathy, right lower extremity have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

7. The criteria for establishing entitlement to service connection for neuropathy, left lower extremity have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

8. The criteria for establishing entitlement to service connection for essential tremors have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

9. The criteria for establishing entitlement to service connection for coronary artery disease (CAD) with bypass graft (claimed as heart condition with two triple bypass procedures) have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

10. The criteria for establishing entitlement to service connection for hypertension have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

11. The criteria for establishing entitlement to service connection for bilateral hearing loss have not been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had periods of honorable active-duty service with the United States Army from April 1959 to August 1959 and from August 1959 to July 1963.

Pursuant to a July 2024 Rating Decision (RO), the claims on appeal were denied. Thereafter, the Veteran filed VA Form 20-0996 Request for Higher-Level Review.

In December 2024, the RO indicated that a duty to assist error had been identified during the higher-level review informal hearing conference. Additional VA examination opinions were deemed necessary. The required opinions were obtained and associated with the record in December 2024 and January 2025.

Pursuant to an April 2025 Rating Decision, the claims on appeal were again denied. The Veteran timely appealed the above referenced rating decision to the Board via VA Form 10182 Notice of Disagreement and requested a hearing before a Veterans Law Judge.

In October 2025, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the claims file.

In rendering a decision in this matter, the Board has reviewed the file in accordance with the applicable evidentiary restrictions. 38 C.F.R. §§ 20.300, 20.301, 20.801. In the event that evidence was submitted outside the applicable evidentiary window, the Veteran may file a Supplemental Claim (VA For 20-0995) and submit or identify this evidence, along with a request for VA to consider any evidence that was submitted that the Board could not consider. 38 C.F.R. § 3.2501. If the evidence is new and relevant, VA will issue another decision on the claim[s], 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, generally

Service connection may be granted for any current disability that is the result of a disease contracted, or an injury sustained while on active-duty service. 38 U.S.C. § 1110, 1131 (2012); 38 C.F.R. §§ 3.303 (a), 3.304 (2020).

Entitlement to service connection benefits is established when the following elements are satisfied: (1) the existence of a current disability; (2) in-service incurrence
evidence is new and relevant, VA will issue another decision on the claim[s], 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, generally

Entitlement to service connection benefits is established when the following elements are satisfied: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and, (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service (the medical 'nexus' requirement). See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); 38 C.F.R. § 3.303 (a) (2020).

Service connection also is permissible on a secondary basis for disability that is proximately due to, the result of, or aggravated by a service-connected disability. 38 C.F.R. § 3.310 (a) and (b) (2020). See also Allen v. Brown, 7 Vet. App. 439, 448 (1995). In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

Furthermore, in determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether the evidence weighs pervasively against the claim, in which case the claim is denied. 38 U.S.C. § 5107 (2012); 38 C.F.R. § 3.102 (2020); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of the matter, the benefit of the doubt will be given to the Veteran. Id.

The Board notes that it has thoroughly reviewed the record in conjunction with this case. Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss, in detail, the extensive evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (the Board must review the entire record but does not have to discuss each piece of evidence). Rather, the Board's analysis below will focus specifically on what the evidence shows, or fails to show, on the claim. See Timberlake v. Gober, 14 Vet. App. 122, 129 (2000) (noting that the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant).

Lay evidence, if competent and credible, may serve to establish a nexus in certain circumstances. See Davidson v. Shinseki, 581 F.3d 1313 (2009) (noting that lay evidence is not incompetent merely for lack of contemporaneous medical evidence). When considering whether lay evidence may be competent, the Board must determine, on a case-by-case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that "[w]hether lay evidence is competent and sufficient in a particular case is a factual issue.

1. Entitlement to service connection for a lumbar spine condition, to include arthritis and stenosis

The Veteran contends that he is entitled to service connection for a lumbar spine condition as causally related to active service, to include as due to service-related TERA activities. As discussed in further detail below, the evidence weighs pervasively against his claim.

In analyzing the Veteran
v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007) (holding that "[w]hether lay evidence is competent and sufficient in a particular case is a factual issue.

1. Entitlement to service connection for a lumbar spine condition, to include arthritis and stenosis

In analyzing the Veteran's claim, the threshold inquiry before the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease.

The Board concludes, while the Veteran has a current diagnosis of mild degenerative arthritis and right meralgia paresthetica, the medical evidence is silent for a diagnosis of a chronic lumbar spine condition either in-service or within one year of separation; and there is no nexus between his current diagnoses and TERA activities performed in service.

Review of service treatment records are silent for disqualifying abnormalities or chronic conditions at enlistment in March 1959. In a corresponding report of medical history, the Veteran endorsed eye trouble. Despite the noted reference, he reported being in good health with no known impairments or abnormalities. A physical examination revealed normal findings. No vision or hearing impairments were documented. Other treatment records document sporadic treatment for bilateral foot and hand pain with swelling due to cold weather exposure or frostbite in January and February 1963. In August 1959, October 1960 and January 1963, the Veteran sought treatment for eye irritation, eye sensitivity, and an abrasion to the left eye. A physical examination revealed normal visual acuity. Other treatment records document a pain, pressure, and a muscle strain to the left leg in August 1960 and May 1961. X-ray films of the left knee revealed normal findings. At separation, a physical examination revealed normal findings. In a corresponding report of medical history, the Veteran reported that he was in excellent health. Despite that contention, he also reported shortness of breath, chronic or frequent colds, dizziness/fainting spells, eye trouble, palpitations or pounding heart, foot trouble, painful or trick shoulder, leg cramps, and kidney stones/blood in the urine. No specific medical conditions or current diagnoses were listed or indicated.

In December 2024, VA issued a Toxic Exposure Risk Activity (TERA) Memorandum. Therein it was noted that the Veteran's official military occupation as a heavy weapons infantryman was associated with a high probability of exposure to fumes and chemicals from firearms, cleaning oils, lead, and hazardous noise from discharging weapons. Therefore, exposure to non-deployment related toxins and hazardous noise is conceded.

Post service treatment records confirm complaints of back pain in June 2020. Prescribed treatments include steroid injections. Other treatment records confirm a current diagnosis of multiple lumbar spine disabilities.

On examination in January 2025, current diagnoses were listed as degenerative arthritis of the lumbar spine, intervertebral disc syndrome (IVDS), and bilateral lower extremity radiculopathy. During the clinical interview, the Veteran reported an onset of back and joint pain 30 years earlier. Current symptoms include minor pain and stiffness. Flare-ups of pain occur daily and include severe symptoms that persist for 3 or 4 hours after onset causing reduced mobility. Symptom alleviation was reported with use of oral medications. Functional loss was described as pain with prolonged walking or standing.

Abnormal range of motion was observed with active and passive motion. Evidence of pain was endorsed with all ranges of motion, weight bearing and non-weight bearing. A reduced ability to bend and twist the lumbar spine was noted. Mild localized tenderness impacted the lumbar spine and lower extremities. It did not result in an abnormal gait or spinal contour. Pain, fatigability, weakness, and lack of endurance were noted. There was no evidence of muscle spasms, guarding, muscle atrophy, or ankylosis. Muscle strength was slightly reduced. Sensation was normal. Favorable findings of radiculopathy were described as moderate intermittent pain, paresthesias and/or dysesthesias, and numbness. Involvement of the sciatic nerve roots was noted, bilaterally. Although evidence of IVDS was observed, no incapacitating episodes were indicated. The Veteran endorsed regular use of a cane.

Following a review of the record, the examiner opined that it is less likely than not (likelihood is less than approximately balanced or nearly
contour. Pain, fatigability, weakness, and lack of endurance were noted. There was no evidence of muscle spasms, guarding, muscle atrophy, or ankylosis. Muscle strength was slightly reduced. Sensation was normal. Favorable findings of radiculopathy were described as moderate intermittent pain, paresthesias and/or dysesthesias, and numbness. Involvement of the sciatic nerve roots was noted, bilaterally. Although evidence of IVDS was observed, no incapacitating episodes were indicated. The Veteran endorsed regular use of a cane.

Following a review of the record, the examiner opined that it is less likely than not (likelihood is less than approximately balanced or nearly equal) that the Veteran's lumbar spine disability, to include IVDS, degenerative arthritis, and bilateral lower extremity radiculopathy was incurred in or caused by active service, to include as due to service-related TERA exposures.

In support of the stated conclusion, the examiner acknowledged consideration of the Veteran's lay reporting of an onset of back pain while on active duty with persistent symptoms since separation. However, review of service treatment records is largely silent for complaints, treatment or symptoms of a low back condition. Post-service treatment records initially document complaints of symptoms on or about June 2020, 60 years after separation. While the Veteran's military personnel records confirm duties as a heavy weapons infantryman which included lifting or carrying heavy firearms and related ammunition, there is insufficient evidence to suggest an onset of pain or treatment for a back condition related thereto either in-service or within one year of separation.

During a Board hearing in October 2025, the Veteran reported jumping out of helicopters and performing training exercises that required carrying heavy equipment including weapons, ammunition, and a large backpack. He also endorsed hazardous noise exposure within the scope of performing his official military occupation as a heavy weapons infantryman. As a result, he experienced hearing loss, back and bilateral upper and lower extremity joint pain, with exposure to related toxins or fumes. He continues to experience symptoms and has received treatment at VA medical centers.

The Board has reviewed and considered the relevant lay and medical evidence of record. Although the Veteran is competent to report on his symptoms and their worsening, there is no evidence that he possesses the specialized education or training necessary to diagnosis a lumbar spine or radicular abnormality or opine as to its etiology.

In this case, the Board accords more probative weight to the negative nexus opinion of record as the medical evidence does not support a correlation between the Veteran's current lumbar spine diagnoses and service-related events which concluded more than 60 years earlier. Of note, the record is silent for any significant history of treatment prior to separation or within one year thereafter. In reaching the stated conclusion, the Board has not ignored the possibility that the Veteran's lower extremity radicular symptoms are likely secondary to his lumbar spine condition. However, a nexus has not been established between the Veteran's lumbar spine condition and active service.

2. Entitlement to service connection for diabetes mellitus type II

See below.

3. Entitlement to service connection for diabetic retinopathy

See below.

4. Entitlement to service connection for neuropathy, left upper extremity

See below.

5. Entitlement to service connection for neuropathy, right upper extremity

See below.

6. Entitlement to service connection for neuropathy, right lower extremity

See below.

7. Entitlement to service connection for neuropathy, left lower extremity

The Veteran contends that he is entitled to service connection for diabetes mellitus with related residuals as causally related to active service, to include as due to service-related TERA activities. As discussed in further detail below, the evidence weighs pervasively against his claim.

Prelimin
II

See below.

3. Entitlement to service connection for diabetic retinopathy

See below.

4. Entitlement to service connection for neuropathy, left upper extremity

See below.

5. Entitlement to service connection for neuropathy, right upper extremity

See below.

6. Entitlement to service connection for neuropathy, right lower extremity

See below.

7. Entitlement to service connection for neuropathy, left lower extremity

Preliminarily, the Board incorporates by reference the factual and procedural arguments listed in Section One.

Post service treatment records document treatment for diabetes mellitus and multiple related residual conditions.

On examination in January 2025, current diagnoses were listed as diabetes mellitus, type II, diabetic peripheral neuropathy, diabetic nephropathy, and diabetic retinopathy. During the clinical interview, the Veteran reported an onset of symptoms in 1995. Current symptoms include vision issues and dizziness. Prescribed treatments include an oral hypoglycemic agent, and a daily insulin injection. Activity restrictions are not required. The Veteran's frequency of diabetic care for ketoacidosis or hypoglycemia occurred less than two times per month. A functional impact was described as pain and numbness in both feet which impair balance while walking.

Following a review of the record, the examiner noted that it was less likely than not (likelihood is less than approximately balanced or nearly equal) that the Veteran's diabetes mellitus with related residual diagnoses were caused by his service-related toxic exposure risk activity(ies), 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.

In reaching the stated conclusion, the examiner acknowledged review of the Veteran's lay contentions regarding exposure to fumes, chemicals from firearms, cleaning oils, lead and hazardous noise within the scope of his official duties as a heavy weapons infantryman. Consideration was also given to the relevant medical literature and the inhaled route of exposure which allegedly occurred daily without use of personal protection equipment. However, there is no known connection between diabetes with related residuals and exposure to firearms, cleaning oils, lead and hazardous noise.

Diabetes mellitus has been associated with obesity, a history of excessive smoking, alcoholism, lifestyle choices, other comorbidities and heredity. This Veteran has a history of hypertension, heart disease and smoking cigarettes.

Regarding his diabetic peripheral neuropathy, the Veteran reported moderate intermittent pain, numbness, tingling and paresthesias and/or dysesthesias in the upper and lower extremities, to include the hands and feet. Muscle strength was slightly reduced in the bilateral lower extremities. Deep tendon reflexes were within normal ranges. Vibration and sensation findings were decreased in the upper and lower extremities. Evidence of muscle atrophy impacted the left side. Trophic changes were described as shiny skin with evidence of hair loss. Favorable findings of bilateral upper extremity diabetic peripheral neuropathy impacted the radial or musculospiral nerve causing moderate incomplete paralysis. Moderate incomplete paralysis also impacted the sciatic nerve of bilateral lower extremities in connection with diabetic peripheral neuropathy. The Veteran described a functional impact as pain and numbness in both feet which impair his balance while walking and severely limit his ability to engage in physical activity. An electromyography (EMG) study was not performed in connection with the current examination.

Peripheral neuropathy is caused by diabetes, medication complications, vitamin deficiencies and other causes. The Veteran has a history of diabetes which is likely the cause of his upper and lower extremity peripheral neuropathy.

Regarding the Veteran's diabetic eye conditions, the VA examiner documented current diagnoses of diabetic retinopathy, age related macular degeneration, and pseudophakia of the bilateral eyes. During the clinical interview, the Veteran reported an onset of his bilateral eye conditions 15-20 years ago with his initial diagnosis of diabetes. At that time, his symptoms included watery eyes, blurred vision, impaired eye focus, and headaches. He denied seeking treatment. Current symptoms include dry eyes, visual floaters or glare, redness, sensitivity to light, watering, discharge or crusting, impaired focus, and loss of peripheral vision. Prescribed treatments include bilateral eye injections with daily drops for diabetic retinopathy. The Veteran contends that his bilateral eye condition impacts his activities of daily living in terms of difficulty reading and driving.

On physical examination, visual acuity findings revealed uncorrected and corrected distance vision of 20/20 or better in the right eye, and both uncorrected and corrected distance in the left
-20 years ago with his initial diagnosis of diabetes. At that time, his symptoms included watery eyes, blurred vision, impaired eye focus, and headaches. He denied seeking treatment. Current symptoms include dry eyes, visual floaters or glare, redness, sensitivity to light, watering, discharge or crusting, impaired focus, and loss of peripheral vision. Prescribed treatments include bilateral eye injections with daily drops for diabetic retinopathy. The Veteran contends that his bilateral eye condition impacts his activities of daily living in terms of difficulty reading and driving.

On physical examination, visual acuity findings revealed uncorrected and corrected distance vision of 20/20 or better in the right eye, and both uncorrected and corrected distance in the left eye of 20/40. Uncorrected and corrected near vision of 20/200 bilaterally; and corrected near vision in the left eye of 20/20 or better in the right eye and 20/40 in the left eye. There was no evidence of other impairments including anatomical loss, light perception only, extremely poor vision or blindness in either eye. Slight lamp testing yielded abnormal findings to the corneas and lenses, bilaterally. An internal eye exam also yielded abnormal findings to the macula which evidenced degeneration bilaterally, and periphery consistent with diabetic retinopathy, bilaterally. No visual field impairments were observed. The Veteran described a functional impairment as a minor decrease in visual acuity in the left eye which causes difficulty with binocular vision tasks in dry/dusty environments due to dry eye syndrome.

Following a review of the record, the examiner opined that it is less likely than not (likelihood is less than approximately balanced or nearly equal) caused by the indicated toxic exposure risk activity(ies) that the Veteran's diabetic retinopathy, age-related macular degeneration, pseudophakia, and bilateral dry eye syndrome, are etiologically related to active service, to include service-related exposures 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.

Conversely, the Veteran's diabetic retinopathy is directly related to his current diagnosis of diabetes mellitus. While the Veteran's official military occupation included exposure to fumes and chemicals from firearms, cleaning oils, lead, and hazardous noise from discharging weapons, none of these exposures have been linked to the development of diabetes mellitus, type II or any related residuals many decades after that exposure has ceased. The Veteran's pseudophakia, dry eye syndrome, and age-related macular degeneration are not caused by toxic exposures. They are all age-related.

Given the above, there is insufficient evidence to support a nexus between the Veteran's diabetes with related residuals and his active-duty service, to include his service-related TERA and hazardous noise exposures.

The Board observes that the Veteran's diabetes mellitus, type II has not been deemed presumptively related to his service-related TERA exposure associated with his role as a heavy weapons infantryman, as there is no evidence of treatment for diabetes mellitus type II or any related residuals in service, within one year of separation, or for decades after separation. See Horn v. Shinseki, 25 Vet. App. 231, 239 (2012).

In this case, there is no evidence that the Veteran possessed the required training, skills or medical expertise to provide a complex medical diagnosis. Therefore, the Board accords greater probative weight to the negative nexus opinion of record as well as the lack of evidence establishing that the Veteran's symptoms began during or became chronic in service, or within one year thereafter. Similarly, the lay and medical evidence is silent for any basis to support an etiological linkage between the Veteran's diabetes mellitus type II and related residuals and active service, to include any TERA exposures which occurred therein.

Accordingly, as the evidence weighs pervasively against the claim, the benefit of the doubt rule is inapplicable. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102, 3.303, 3.309; Gilbert v. Derwinski, 1 Vet. App. at 53. Thus, service connection for the Veteran's
that the Veteran's symptoms began during or became chronic in service, or within one year thereafter. Similarly, the lay and medical evidence is silent for any basis to support an etiological linkage between the Veteran's diabetes mellitus type II and related residuals and active service, to include any TERA exposures which occurred therein.

8. Entitlement to service connection for essential tremors

The Veteran contends that he is entitled to service connection for essential tremors as causally related to active service, to include as due to service-related TERA activities. As discussed in further detail below, the evidence weighs pervasively against his claim.

Preliminarily, the Board incorporates by reference the factual and procedural arguments listed in Section One.

Post service treatment records document treatment for essential tremors in November 2023.

On examination in January 2025, a current diagnosis of essential tremors was indicated. During the clinical interview, the Veteran reported an onset of shaking hands and muscle weakness 30 years earlier. Prescribed medications include Primidone.

Following a review of the record and clinical interview, the examiner opined that it is less likely than not (likelihood is less than approximately balanced or nearly equal) that the Veteran's essential tremors was caused by or otherwise etiologically related to active service, to include as due to service-related toxic exposure risk activity(ies), 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.

In so finding, the examiner acknowledged review of the Veteran's service records, a VA TERA memorandum, and post-service treatment records. However, there is no known connection between peripheral neuropathy and exposure to firearms, fumes, cleaning oils, lead or hazardous noise. Moreover, essential tremors are caused by Parkinson's disease, genetics, advanced age, medication complications and other causes. The available medical evidence does not suggest that the Veteran has any risk factors for developing an essential tremor. Given the insufficient evidence of an association between essential tremors and exposure to firearms, cleaning oils, lead and hazardous noise; a nexus has not been established.

The Board observes that the Veteran's essential tremors has not been deemed presumptively related to his service-related TERA exposure associated with duties as a heavy weapons infantryman, as there is no evidence of treatment for essential tremors in service, within one year of separation, or for decades after separation. See Horn v. Shinseki, 25 Vet. App. 231, 239 (2012).

In this case, there is no evidence that the Veteran possessed the required training, skills or medical expertise to provide a complex medical diagnosis. Therefore, the Board accords greater probative weight to the negative nexus opinion of record as well as the lack of evidence establishing that the Veteran's symptoms began during or became chronic in service, or within one year thereafter. Similarly, the lay and medical evidence is silent for any basis to support an etiological linkage between the Veteran's essential tremors and active service, to include any TERA exposures which occurred therein.

9. Entitlement to service connection for coronary artery disease (CAD) with bypass graft (claimed as heart condition with two triple bypass procedures)

See Below.

10. Entitlement to service connection for hypertension

The Veteran contends that he is entitled to service connection for hypertension and coronary artery disease (CAD) with bypass
evidence weighs pervasively against the claim, the benefit of the doubt rule is inapplicable. 38 U.S.C. § 5107 (b); 38 C.F.R. §§ 3.102, 3.303, 3.309; Gilbert v. Derwinski, 1 Vet. App. at 53. Thus, service connection for the Veteran's essential tremors must be denied.

9. Entitlement to service connection for coronary artery disease (CAD) with bypass graft (claimed as heart condition with two triple bypass procedures)

See Below.

10. Entitlement to service connection for hypertension

The Veteran contends that he is entitled to service connection for hypertension and coronary artery disease (CAD) with bypass graft (claimed as heart condition with two triple bypass procedures), as due to service-related participation in TERA activities. As discussed in more detail below, the evidence weighs pervasively against the claim.

Preliminarily, the Board incorporates by reference the procedural and factual arguments listed in Section One.

Post service treatment records confirm treatment for hypertension, and a heart condition many decades after separation.

On examination in April 2024, current diagnoses were listed as arteriosclerotic heart disease (coronary artery disease), and coronary artery bypass graft. During the clinical interview, the Veteran reported frequent bouts with shortness of breath. Prescribed treatments include Carvedilol. A physical examination revealed a normal heart rate, rhythm and heart sounds with an elevated blood pressure of 140/80. A functional impact was described as difficulty with prolonged walking, standing, and lifting heavy weights.

In support of the stated conclusion, the examiner acknowledged review of the relevant medical evidence, medical literature and VA TERA memorandum. Consideration was also given to the Veteran's lay contentions regarding lack of use of personal protective equipment in-service. However, post-service treatment records indicate that the Veteran's medical history includes a current diagnosis of diabetes mellitus type II and a history of excessive smoking. Coronary artery disease with related complications have been associated with excessive smoking, diabetes, alcoholism, obesity, lifestyle choices, and other causes. Given that there is insufficient evidence that the Veteran's coronary artery disease, MI, ACVD, Unstable angina, CHF, Valvular heart disease, CABG, PVCs, Cardiomyopathy and Hyperlipidemia has been associated with exposure to firearms, cleaning oils, lead and hazardous noise, a nexus has not been established.

On subsequent examination in January 2025, a current diagnosis of hypertension was indicated. Other diagnoses included coronary artery disease. During the clinical interview, the Veteran reported experiencing heart palpitations and shortness of breath in June 1963. No treatment or related diagnoses was documented at separation. Current symptoms include dizziness. Prescribed treatments include oral medications. On physical examination there was no evidence of tenderness on palpation of the chest. Lung and breath sounds were normal.

In support of the stated finding, the examiner indicated that there is no known connection between hypertension and exposure to firearms, cleaning oils, lead and hazardous noise. While the examiner acknowledged review of the Veteran's service treatment records, a VA TERA memo, and other relevant medical evidence, no nexus was found between his current diagnosis and active service, to include as due to related exposures.

Hypertension is caused by smoking, alcoholism, obesity, lifestyle choices, diabetes and other causes. This Veteran has a history of diabetes and excessive smoking. Given that there is insufficient evidence that hypertension has been associated with exposure to firearms, cleaning oils, lead and hazardous noise, a nexus has not been established.

In making all determinations, the Board has fully considered all medical evidence and lay assertions of record. Generally, the Veteran is presumed competent to report on the onset of current symptoms, their impact on daily living and employment, and such reporting is deemed credible. However, as to the etiology of a particular claimed disability, the issue of causation of a medical condition is a medical determination outside the realm of common knowledge of a lay person. Jandreau v. Nicholson,
ism, obesity, lifestyle choices, diabetes and other causes. This Veteran has a history of diabetes and excessive smoking. Given that there is insufficient evidence that hypertension has been associated with exposure to firearms, cleaning oils, lead and hazardous noise, a nexus has not been established.

The Board observes that the Veteran's hypertension has not been deemed presumptively related to his service-related TERA exposure associated with his role as a heavy weapons infantryman, as there is no evidence elevated blood pressure, heart disease or related treatment in service, within one year of separation, or for decades after separation. See Horn v. Shinseki, 25 Vet. App. 231, 239 (2012).

In this case, there is no evidence that the Veteran possessed the required training, skills or medical expertise to provide a complex medical diagnosis. Therefore, the Board accords greater probative weight to the negative nexus opinion of record as well as the lack of evidence establishing that the Veteran's symptoms began during or became chronic in service, or within one year thereafter. Similarly, the lay and medical evidence is silent for any basis to support an etiological linkage between the Veteran's hypertension, heart condition and active service, to include any TERA exposures which occurred therein.

11. Entitlement to service connection for bilateral hearing loss

The Veteran contends that he is entitled to service connection for bilateral hearing loss, to include as due to service-related participation in TERA activities. As discussed in more detail below, the evidence weighs pervasively against the claim.

Preliminarily, the Board incorporates by reference the procedural and factual arguments listed in Section One.

For the purposes of applying the laws administered by VA, hearing impairment is considered a disability when the auditory threshold level in any of the frequencies 500, 1000, 2000, 3000, 4000 Hertz is 40 decibels or greater; or when the auditory thresholds for at least three of the frequencies 500, 1000, 2000, 3000, or 4000 Hertz 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.

For purposes of determining whether service connection for bilateral hearing loss is warranted, the Board has thoroughly reviewed and analyzed all the evidence in the Veteran's claims file, placing an emphasis on the evidence relevant to this appeal. Although the Board has an obligation to provide reasons and bases supporting its decision, there is no obligation to discuss, in detail, the extensive evidence of record. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that the Board must review the entire record; but does not have to discuss each piece of evidence). Therefore, the Board will summarize the relevant evidence where appropriate, and show, as it relates to the Veteran's claim.

According to his DD-214, the Veteran's official military occupation (MOS) was listed as a heavy weapons infantryman. That role has been associated with a high probability of hazardous noise exposure. Thus, hazardous noise exposure is conceded.

Post service treatment records confirm a current diagnosis of bilateral hearing loss.

On the authorized audiological evaluation in December 2024 pure tone thresholds, in decibels, were as follows:

HERTZ

500 1000 2000 3000 4000

RIGHT 45 55 75 95 100

LEFT 15 20 30 55 55

Pure tone threshold averages were 81.25 dB for the right ear and 40 dB for the left ear. Speech audiometry revealed speech recognition ability of 4 percent in the right ear and of 94 percent in the left ear.

hazardous noise exposure. Thus, hazardous noise exposure is conceded.

Post service treatment records confirm a current diagnosis of bilateral hearing loss.

On the authorized audiological evaluation in December 2024 pure tone thresholds, in decibels, were as follows:

HERTZ

500 1000 2000 3000 4000

RIGHT 45 55 75 95 100

LEFT 15 20 30 55 55

Given the above, a current diagnosis of bilateral sensorineural hearing loss and tinnitus. During the clinical interview, the Veteran reported an onset of hearing loss in the 1970's with progressive worsening over time. While on active duty, he reported exposure to hazardous noise from mortars, 106 howitzers, shooting on the rifle range, and driving large trucks. He denied use of hearing protection.

Following a review of the record and clinical interview, the examiner opined that it is less likely than not (likelihood is less than approximately balanced or nearly equal) that the Veteran's bilateral hearing loss was caused by the indicated toxic exposure risk activity(ies), 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. In reaching the stated conclusion, the examiner noted that Veteran's service records not exposure events from Vaccinations, Oil Well Fires, Chemical and Biological Weapons, Depleted Uranium, CARC Paint, Pyridostigmine Bromide, Pesticides, chemical or pain exposure, Sand, dust and particulates, toxic embedded Fragments, Infectious diseases, or burn pits. None of the identified exposure events are consistent with a current diagnosis of bilateral hearing loss other there hazardous noise exposure. The Veteran did not report any event suggesting an ototoxic exposure. After considering the total potential exposure through all applicable military deployments and of the Veteran in the synergistic, combined effect of all toxic exposure risk activities of the veteran, the claimed condition was less likely than not caused by the indicated toxic exposure or risk activity.

A previous VA opinion, dated March 2024, acknowledged consideration of the Veteran's lay reporting of an onset of hearing loss a few years after his return from a tour of duty in Korea. Review of the Veteran's official military occupation confirms hazardous noise exposure as a heavy weapons infantryman. Post-service he reported a functional impact as difficulty hearing in verbal conversations with a need for speakers to repeat themselves.

Following a review of the relevant lay and medical evidence, the examiner noted that service treatment records are silent for any evidence of a significant threshold shift beyond test variability which is suggestive of permanent auditory damage during active duty. Service treatment records document normal audiological findings at separation. Further, no complaints of impaired hearing were reported in service or within one year of separation. Although hazardous noise exposure is conceded and the relationship of noise, auditory damage and hearing loss is well-established. Auditory damage and hearing loss are not conceded based on noise alone. As evidence of service-related auditory damage and the Veteran's current hearing loss has not been established, a nexus to military noise exposure has not been established. Accordingly, it is less likely than not that the Veteran's hearing loss is etiologically related to military noise exposure.

In making all determinations, the Board has fully considered all medical evidence and lay assertions of record. Generally, the Veteran is presumed competent to report on the onset of current symptoms, their impact on daily living and employment, and such reporting is deemed credible. However, as to the etiology of a particular claimed disability, the issue of causation of a medical condition is a medical determination outside the realm of common knowledge of a lay person. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). In the instant case, there is no evidence that rhe Veteran possesses the required training to diagnose bilateral hearing loss opine as to the etiology of hearing loss or tinnitus. To the extent his statements may be competent, the Board ultimately assigns greater probative weight to the medical evidence of record, to include opinions rendered by trained medical professionals based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale.

In this case, the Board has thoroughly reviewed the evidence of record, to include relevant service and post-treatment records, a correlation between hazardous noise exposure and service-related TERA has not been established. The Board also recognizes the possibility that whisper tests were conducted in service, which do not comply with the Maryland CNC test. However, a separation physical examination made no reference to audiological findings suggestive of bilateral hearing loss or related complaints of symptoms
bilateral hearing loss opine as to the etiology of hearing loss or tinnitus. To the extent his statements may be competent, the Board ultimately assigns greater probative weight to the medical evidence of record, to include opinions rendered by trained medical professionals based on appropriate diagnostic testing and reasonably drawn conclusions with supportive rationale.

The Veteran's lay contentions regarding service-related hazardous noise exposure have been fully considered. Even given the recognition of some level of hazardous noise and TERA exposure, the extent of the Veteran's performance of role-related duties, their frequency and severity of exposure related thereto is unknown. In this case, such a complex analysis is not required as the record evidence documents an onset of symptoms many decades after separation. Under the circumstances, the lengthy delay in symptom onset extends beyond any reasonable conclusion regarding nexus. Therefore, the Veteran's lay contentions are accorded minimal probative weight.

On review of the above, the Board finds that service connection is not warranted for the Veteran's bilateral hearing loss.

While the Board recognizes the Veteran's subjective belief that his current hearing loss is etiologically related to in-service exposure events, the evidence of record does not support his contentions. Here, the medical evidence is largely silent for evidence of symptoms or a diagnosis for many decades after separation. Although the VA examiner has confirmed the presence of current diagnosis, no etiological linkage to active service or military noise exposure or his service-related TERA has been found.

Accordingly, as the evidence weighs pervasively against the claim, the provisions of 38 U.S.C. § 5107 (b) regarding reasonable doubt are not applicable. The claim of entitlement to service connection for bilateral hearing loss must be denied.

B. MULLINS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Whitaker, Nakiya E.

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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