INTERVERTEBRAL DISC SYNDROME

R. BISIGNANI · 2026 · Case ID: A26017107

MIXED

Summary

The Veteran served from December 1959 to December 1963. The Veteran appeals the denial of service connection for bilateral hearing loss and seeks service connection for a low back disability, respiratory disability, coronary artery disease, supraventricular arrhythmia, and hypertension. The Board found that the evidence was approximately evenly balanced for the respiratory disability, coronary artery disease, supraventricular arrhythmia, and hypertension claims, and therefore resolved the reasonable doubt in the Veteran's favor, granting service connection for these conditions. The Board also granted service connection for the low back disability as secondary to the Veteran's service-connected left ankle disability. For the bilateral hearing loss claim, the Board found that the evidence preponderated against service connection, noting that while the Veteran had hearing acuity of Level II in both ears, service treatment records did not indicate any in-service complaints or treatment for hearing loss, and the VA examiner opined that the hearing loss was not related to service. Therefore, service connection for bilateral hearing loss was denied.

Rationale

Low back disability found secondary to service-connected left ankle disability.; Criteria for secondary service connection met.

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250416-538079

Full Decision Text

Citation Nr: A26017107
Decision Date: 02/25/26 Archive Date: 02/25/26

DOCKET NO. 250416-538079
DATE: February 25, 2026

ORDER

Entitlement to service connection for a low back disability is granted as secondary to service-connected left ankle disability.

Entitlement to service connection for respiratory disability, to include as due to toxic exposure risk activity (TERA), is granted.

Entitlement to service connection for coronary artery disease, to include as due to TERA, is granted.

Entitlement to service connection for supraventricular arrhythmia, to include as due to TERA, is granted.

Entitlement to service connection for hypertension, to include as due to TERA, is granted.

Entitlement to a compensable rating for bilateral hearing loss is denied.

FINDINGS OF FACT

1. The Veteran's low back disability is secondary to his service-connected left ankle disability.

2. The evidence is approximately evenly balanced as to whether the Veteran's respiratory disability is related to TERAs during active service.

3. The evidence is approximately evenly balanced as to whether the Veteran's coronary artery disease is related to TERAs during active service.

4. The evidence is approximately evenly balanced as to whether the Veteran's supraventricular arrhythmia is related to TERAs during active service.

5. The evidence is approximately evenly balanced as to whether the Veteran's hypertension is related to TERAs during active service.

6. The Veteran's bilateral hearing loss has been manifested by hearing acuity of no worse than Level II in the right ear and no worse than Level II in the left ear.

CONCLUSIONS OF LAW

1. The criteria for entitlement to service connection for a low back disability as secondary to the service-connected left ankle disability are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310.

2. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for a respiratory disability have been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for coronary artery disease have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for supraventricular arrhythmia have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for hypertension have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for a compensable rating for bilateral hearing loss have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6100.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from December 1959 to December 1963.

These matters come before the Board of Veterans' Appeal (Board) on appeal from December 2024 and March 2025 rating decisions. In April 2025, the Veteran filed a VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement). Although the Veteran selected the hearing lane, he withdrew his hearing request on August 26, 2025.

Pursuant to 38 C.F.R. § 20.302(b), if a claimant commences an AMA appeal and initially selects the Hearing Lane but withdraws his/her hearing request before the hearing is held, the Board adjudicates the claimant's challenges by issuing a decision based on a review of the evidence that is of record at the time of the underlying decision by the agency of original jurisdiction (AOJ), as well as the evidence submitted within 90 days following receipt of the claimant's request for withdrawal.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection requires evidence of three elements: (
a claimant commences an AMA appeal and initially selects the Hearing Lane but withdraws his/her hearing request before the hearing is held, the Board adjudicates the claimant's challenges by issuing a decision based on a review of the evidence that is of record at the time of the underlying decision by the agency of original jurisdiction (AOJ), as well as the evidence submitted within 90 days following receipt of the claimant's request for withdrawal.

Service Connection

Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection requires evidence of three elements: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship or nexus between the current disability and the disease or injury incurred or aggravated during active service. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004).

However, a Veteran can also establish service connection on a secondary basis. Secondary service connection may be established for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires (1) a current disability not already service-connected; (2) at least one service-connected disability; and (3) evidence that the nonservice-connected disability either is (a) caused by or (b) aggravated by (has any incremental increase in severity due to) a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc); Spicer v. McDonough, 61 F.4th. 1360, 1363-65 (Fed. Cir. 2023).

In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence persuasively favors the claim or is in approximate balance, with the Veteran prevailing in either event, or whether the evidence persuasively weighs against the claim, in which case the claim is denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Lynch v. McDonough, 21 F.4th 776 (2021). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the claimant. Lynch, 21 F.4th, at 780-81.

In evaluating the Veteran's claim for disability benefits, the Board gives due consideration to all pertinent medical and lay evidence. 38 U.S.C. § 1154(a). Lay testimony is competent to prove that a claimant exhibited certain lay-observable symptoms and the time that those symptoms appeared. Layno v. Brown, 6 Vet. App. 465, 470 (1994); see generally 38 C.F.R. § 3.159(a)(2). Lay evidence cannot be determined to be not credible merely because it is unaccompanied by contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1336 37 (Fed. Cir. 2006).

Entitlement to service connection for a low back disability is granted as secondary to service-connected left ankle disability.

The Veteran asserts that he has a low back condition that is related to service. Specifically, he asserts that his low back disability is associated with service-connected left ankle disability. See January 2024 VA Form 20-0995 Supplemental Claim Application.

Favorable findings in the December 2024 rating decision are: the Veteran has been diagnosed with low back disc surgery with severe degenerative joint disease and spinal stenosis; the claimed disability is a chronic disease which may be presumptively linked to the Veteran's military service; the claimed primary disability of left ankle sprain is service-connected; and the evidence shows that a qualifying event during the Veteran's service, namely a September 1963 service treatment record (STR) documents an episode of low back pain.

The Veteran underwent VA examination in July 2024. The examiner noted that the Veteran had injury to his left ankle while on active duty and claimed continual pain and discomfort since. The examiner further stated that the Veteran's perspective and knowledge was that his ankle injury had precipitated his chronic back pain. The examiner found there was no record of injury to back and the Veteran could not recall any specific etiology of the lumbar pain. Additionally, the examiner noted that review of the claims file shows the longterm care for
of left ankle sprain is service-connected; and the evidence shows that a qualifying event during the Veteran's service, namely a September 1963 service treatment record (STR) documents an episode of low back pain.

The Veteran underwent VA examination in July 2024. The examiner noted that the Veteran had injury to his left ankle while on active duty and claimed continual pain and discomfort since. The examiner further stated that the Veteran's perspective and knowledge was that his ankle injury had precipitated his chronic back pain. The examiner found there was no record of injury to back and the Veteran could not recall any specific etiology of the lumbar pain. Additionally, the examiner noted that review of the claims file shows the longterm care for chronic back pain including surgeries, chiropractic treatment, physical therapy treatment, and acupuncture; per the Veteran, none has improved his chronic pain.

Following interview and examination of the Veteran as well as review of the claims file, the July 2024 VA examiner opined the claimed condition was less likely than not proximately due to or the result of the Veteran's service-connected condition. As rationale, the examiner stated,

"There is no clear evidence from review of orthopedic literature to suggest that an injury to one joint would have any significant impact on another or opposite uninjured joint or limb, unless the injury resulted in a major muscle or nerve damage causing partial or complete paralysis, or shortening of the injured limb resulting in length discrepancy of more than 5cm so that the individual's gait pattern has been altered to the extent that clinically there is an obvious Trendelenburg gait. This level of severity is not supported based on record review, history or exam. It is not unusual for two joints to share properties in the same person, but one joint's disease does not 'spread' to another or cause damage to it. Therefore, the lumbar back condition is less likely than not related to the Residuals, left ankle. (Oxford's Textbook on Orthopedics and Trauma)."

The July 2024 VA opinion does not adequately address the issue of secondary service connection. Opinions must address secondary service connection on a causation and aggravation basis separately. El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). The Board therefore concludes that the July 2024 VA medical opinion is inadequate and it is afforded little, if any, probative weight.

In November 2025, the Veteran, by way of his representative, submitted argument and evidence that included mention of a September 2025 private opinion by R. P., DO. R. P., DO, upon review of the Veteran's medical records, positively opined that,

"[The Veteran's] degenerative arthritis of the thoracolumbar spine is at least as likely as not secondary to his service-connected left ankle sprain. The chronic instability and altered biomechanics resulting from his ankle injury have caused compensatory changes in his gait and posture, leading to abnormal stress on the lumbar spine. These mechanical inefficiencies have accelerated the degeneration of the intervertebral discs and facet joints, resulting in the development of DOD, IVDS, and lumbar radiculopathy. Given the direct link between his service-connected ankle condition and the progressive deterioration of his thoracolumbar spine, his back condition is a foreseeable consequence of the altered weight distribution and compensatory movement patterns that arose from the initial ankle injury."

The clinician's opinion is probative because it is based on an accurate medical history, considers lay evidence from the Veteran, supported by medical literature, and provides a clear rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

After careful consideration of the opinions of record, the Board finds that the weight of competent and probative evidence is in approximate balance as to whether the Veteran's current low back disability is secondary to his service-connected left ankle disability. The Board finds no adequate reason to favor the negative opinion over the positive opinion that is favorable to the Veteran's claim.

Therefore, resolving all reasonable doubt in the Veteran's favor, the evidence of record sufficiently establishes the elements for service connection for a low back disability as secondary to service-connected left ankle disability. The appeal is granted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102.

Entitlement to service connection for a respiratory disability is granted.

The Veteran asserts that he has a respiratory disability related to service. See May 2024 VA Form 21-526EZ.

Entitlement to service connection for a respiratory disability is granted.

The Veteran asserts that he has a respiratory disability related to service. See May 2024 VA Form 21-526EZ.

Favorable findings in the December 2024 rating decision are: participation in a TERA is conceded based on the Veteran's MOS of Seaman and minimal probability of asbestos exposure; and the Veteran has been diagnosed with asthma, chronic obstructive pulmonary disease (COPD), and chronic bronchitis.

The remaining issue is a relationship to service. The Veteran underwent VA examination in October 2024. Following interview and examination of the Veteran as well as review of the claims file, the examiner opined the claimed condition was less likely than not 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. As rationale, the examiner stated, "The Veteran's claimed respiratory condition diagnosed as asthma, COPD, chronic bronchitis, lung nodule are less than likely caused by exposure to asbestos 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. Veteran with a 40-pack year smoking history - a significant risk factor for asthma, COPD, chronic bronchitis, lung nodule. https://pubmed.ncbi.nlm.nih.gov/35965049/; https://utswmed.org/conditions-treatments/pulmonary-nodules-and-lung-lesions/."

The Board finds the October 2024 VA medical opinion is inadequate. As noted, an April 2024 TERA memorandum contained an indication that there is evidence of non-deployment-related TERA exposure in the record, with citation to the relevant records. See April 2024 TERA Memorandum. Additionally, the February 2025 VA TERA memorandum contained an indication that there is evidence of non-deployment-related TERA exposure based on the Veteran's MOS of SN-Seaman that was consistent with the circumstances of the Veteran's service, specifically exposure to asbestos, AFFF, PFOA, PFAS, and PFOS. See February 2025 TERA Memorandum.

The October 2024 VA examiner rendered an opinion that did not acknowledge or discuss the Veteran's conceded exposure to asbestos, AFFF, PFOA, PFAS, and PFOS during service based on his in-service fire fighters' training and his MOS of SN-Seaman. The opinion did not include any discussion of the interaction or synergistic impact of all conceded TERAs.

The Board therefore concludes that the October 2024 VA medical opinion is inadequate and it is afforded little, if any, probative weight.

In November 2025, the Veteran, by way of his representative, submitted argument that included mention of a September 2025 private opinion by R. P., DO. R. P., DO, upon review of the Veteran's medical records, positively opined that,

"[The Veteran's]" exposure to asbestos and perfluoroalkyl substances (PFAs), including PFOA, PFOS, and AFFF, during his military service has likely played a pivotal role in the development and exacerbation of his asthma. The pathophysiological mechanisms associated with these environmental exposures, such as cellular stress, inflammatory responses, oxidative stress, and airway remodeling, contribute significantly to the clinical manifestations of asthma. Asbestos exposure has been linked to respiratory inflammation and lung injury, while PFAs have been shown to disrupt immune function, promote airway hyperresponsiveness, and increase asthma severity. The cumulative effect of these toxic exposures has led not only to acute inflammatory episodes but also to long-term structural changes in his airways, resulting in persistent respiratory symptoms. Given the established connection between these environmental factors and asthma pathogenesis, it is at least as likely as not that [the Veteran's] asthma is caused by his service-related exposures, emphasizing the critical role that environmental toxins play in the development of respiratory conditions in veterans."

Additionally, R. P., DO provided a thorough opinion concluding that,

"[C]hronic obstructive pulmonary disease (COPD) is at least as likely as not related to his exposure to environmental toxins, including asbestos and perfluoroalkyl substances (PFAs) such as PFOA, PFOS, and AFFF, during his military service.
inflammatory episodes but also to long-term structural changes in his airways, resulting in persistent respiratory symptoms. Given the established connection between these environmental factors and asthma pathogenesis, it is at least as likely as not that [the Veteran's] asthma is caused by his service-related exposures, emphasizing the critical role that environmental toxins play in the development of respiratory conditions in veterans."

Additionally, R. P., DO provided a thorough opinion concluding that,

"[C]hronic obstructive pulmonary disease (COPD) is at least as likely as not related to his exposure to environmental toxins, including asbestos and perfluoroalkyl substances (PFAs) such as PFOA, PFOS, and AFFF, during his military service. These toxic substances have been well-documented as risk factors for lung injury and COPD, with mechanisms including chronic inflammation, oxidative stress, and airway remodeling. The combination of asbestos exposure, which induces inflammatory responses and lung fibrosis, alongside PFAs, which exacerbate oxidative damage and immune dysregulation, has likely contributed to the progressive decline in [the Veteran's] lung function. Given the nature and duration of his exposure, it is reasonable to conclude that his COPD is significantly related to his service, with these environmental factors playing a pivotal role in the pathogenesis of his condition."

R. P., DO also opined that the Veteran's "exposure to asbestos during his military service likely contributed to the development of his chronic bronchitis, as the prolonged presence of asbestos fibers in the airways leads to chronic inflammation, mucus hypersecretion, and airway remodeling. This cycle of injury and repair, perpetuated by continuous exposure, exacerbates airway obstruction and reduces lung function over time (Hunting & Welch, 1993; "Diagnosis and Initial Management of Nonmalignant Diseases Related to Asbestos," 2004). Consequently, [the Veteran's] chronic bronchitis is at least as likely as not related to his in-service exposure to asbestos."

The Board finds Dr. R. P's opinions are probative because they are based on an accurate medical history, considers lay evidence from the Veteran, supported by extensive medical literature, and provide clear rationales. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

After careful consideration of the opinions of record, the Board finds that the weight of competent and probative evidence is in approximate balance as to whether the Veteran's has a respiratory disability that is related to his active service. The Board finds no adequate reason to favor the negative opinion over the positive opinions that are favorable to the Veteran's claim.

Therefore, resolving all reasonable doubt in the Veteran's favor, the evidence of record sufficiently establishes the elements for service connection for a respiratory disability. The appeal is granted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102.

Entitlement to service connection for coronary artery disease is granted.

Entitlement to service connection for supraventricular arrhythmia is granted.

The Veteran asserts that he has a heart disability, to include coronary artery disease and supraventricular arrhythmia, related to service. See May 2024 VA Form 21-526EZ. Alternatively, the Veteran asserts that he has a heart disability that is secondary to service-connected conditions or related to toxic exposure in service. Id.

Favorable findings in the March 2025 rating decision as to coronary artery disease are: participation in a TERA is conceded; VA has determined the Veteran was exposed to asbestos and possible exposure to AFFF, PFOA, PFAS, and PFOS; Veteran has been diagnosed with coronary artery disease and ischemic heart disease; ischemic heart disease is a condition that has been presumptively linked to herbicide exposure; the claimed primary disability is service-connected; and the Veteran is service-connected for hearing loss, tinnitus, and residuals, left ankle sprain.

Favorable findings in the March 2025 rating decision as to supraventricular arrhythmia are: participation in a TERA is conceded; VA has determined the Veteran was exposed to asbestos and possible exposure to AFFF, PFOA, PFAS, and PFOS; Veteran has been diagnosed with supraventricular arrhythmia; the claimed primary disability is service-connected; and the Veteran is service-connected for hearing loss, tinnitus, and residuals, left ankle sprain.

An April 2024 VA TERA Memo reflects the Veteran participated in a TERA. It was noted that he completed a Fire Fighters' training course.

The remaining issue is a relationship to service. The Veteran underwent VA examination in June 2024. Following interview and examination of the Veteran as well as review of the
arrhythmia are: participation in a TERA is conceded; VA has determined the Veteran was exposed to asbestos and possible exposure to AFFF, PFOA, PFAS, and PFOS; Veteran has been diagnosed with supraventricular arrhythmia; the claimed primary disability is service-connected; and the Veteran is service-connected for hearing loss, tinnitus, and residuals, left ankle sprain.

An April 2024 VA TERA Memo reflects the Veteran participated in a TERA. It was noted that he completed a Fire Fighters' training course.

The remaining issue is a relationship to service. The Veteran underwent VA examination in June 2024. Following interview and examination of the Veteran as well as review of the claims file, the examiner opined the claimed condition was less likely than not 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. As rationale, the examiner stated, "There [is] no nexus in the Veteran's medical history that relates any problems with regards to his heart... The Veteran showed no TERA related involvement that would result [this diagnosis]. Therefore, it is less likely than not that...his cardiac problems are related to his military sojourn when he served in the Navy dating back from 1959 to 1963."

The June 2024 VA examiner also provided a secondary service connection opinion, finding that the claimed condition was less likely than not proximately due to or the result of the Veteran's service connected condition. As rationale, the examiner stated, "There is no medical correlation between heart condition...to left ankle sprain."

A February 2025 VA TERA Memo was additionally associated with the Veteran's claims file confirming that he participated in a TERA. Specifically, the VA Memo indicates the "Veteran's DD 214 shows [military occupational specialty (MOS)] as SN-Seaman minimal for asbestos exposure. VIII.iii.7.C.1.b. Veteran's military records show the Veteran had Fire Fighting Training" and "possible exposure to AFFF (Aqueous Film Forming Foam), PFOA and PFAS, PFOS (Perfluorooctane sulfonic acid)."

The Board finds the June 2024 VA medical opinion is inadequate. As noted, the April 2024 TERA memorandum contained an indication that there is evidence of non-deployment-related TERA exposure in the record, with citation to the relevant records. See April 2024 TERA Memorandum. Additionally, the February 2025 VA TERA memorandum contained an indication that there is evidence of non-deployment-related TERA exposure based on the Veteran's MOS of SN-Seaman that was consistent with the circumstances of the Veteran's service, specifically exposure to asbestos, AFFF, PFOA, PFAS, and PFOS. See February 2025 TERA Memorandum.

The June 2024 VA examiner rendered an opinion that did not acknowledge or discuss the Veteran's conceded exposure to asbestos, AFFF, PFOA, PFAS, and PFOS during service based on his in-service fire fighters' training and his MOS of SN-Seaman. The opinion did not include any discussion of the interaction or synergistic impact of all conceded TERAs.

The Board therefore concludes that the June 2024 VA medical opinion is inadequate and it is afforded little, if any, probative weight.

"[The Veteran's] coronary artery disease (CAD) is at least as likely as not related to his military service, particularly due to his documented exposure to asbestos and periluoroalkyl substances (PFAS). The pathophysiological mechanisms linking these environmental toxins to cardiovascular disease are well-supported by recent studies, which demonstrate how chronic exposure to these substances can contribute to endothelial dysfunction, oxidative stress, and the development of atherosclerosis. Given the nature of [the Veteran's] service-related exposures and the emerging evidence of their adverse effects on cardiovascular health, it is reasonable to conclude that his CAD is significantly influenced by these exposures. Therefore, service connection for CAD should be considered in light of these service-related environmental hazards."

Additionally, R. P.,
] coronary artery disease (CAD) is at least as likely as not related to his military service, particularly due to his documented exposure to asbestos and periluoroalkyl substances (PFAS). The pathophysiological mechanisms linking these environmental toxins to cardiovascular disease are well-supported by recent studies, which demonstrate how chronic exposure to these substances can contribute to endothelial dysfunction, oxidative stress, and the development of atherosclerosis. Given the nature of [the Veteran's] service-related exposures and the emerging evidence of their adverse effects on cardiovascular health, it is reasonable to conclude that his CAD is significantly influenced by these exposures. Therefore, service connection for CAD should be considered in light of these service-related environmental hazards."

Additionally, R. P., DO opined,

"[The Veteran's] history of supraventricular arrhythmia, confirmed by electrocardiographic findings, must be considered in the context of his documented in-service exposure to asbestos and perfluoroalkyl substances (PFAS). Both toxins are recognized for their systemic inflammatory and cardiotoxic effects, including the promotion of oxidative stress, endothelial dysfunction, and myocardial remodeling, all of which are well-established contributors to arrhythmogenesis (Taylor, 1996; Yang et al., 2017; Xue et al., 2023; Bezna et al., 2023). Given the chronicity of his condition, the absence of structural heart disease, and the strong biological plausibility linking these exposures to cardiac rhythm disturbances, it is at least as likely as not that [the Veteran's] supraventricular arrhythmia was caused or aggravated by his toxic exposures during military service."

After careful consideration of the opinions of record, the Board finds that the weight of competent and probative evidence is in approximate balance as to whether the Veteran's has a heart disability that is related to active service. The Board finds no adequate reason to favor the negative opinion over the positive opinions that are favorable to the Veteran's claim.

Therefore, resolving all reasonable doubt in the Veteran's favor, the evidence of record sufficiently establishes the elements for service connection for coronary artery disease and supraventricular arrhythmia. The appeals are granted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102.

The Board need not discuss the theory of secondary service connection (38 C.F.R. § 3.310) as the Board is granting service connection on an alternative basis.

Entitlement to service connection for hypertension is granted.

The Veteran asserts that he has hypertension related to service. See May 2024 VA Form 21-526EZ. Alternatively, the Veteran asserts that he has hypertension that is secondary to service-connected conditions or related to toxic exposure in service. Id.

Favorable findings in the March 2025 rating decision as to hypertension are: participation in a TERA is conceded; VA has determined the Veteran was exposed to asbestos and possible exposure to AFFF, PFOA, PFAS, and PFOS; Veteran has been diagnosed with hypertension; hypertension is a condition that has been presumptively linked to herbicide exposure; the claimed primary disability is service-connected; and the Veteran is service-connected for hearing loss, tinnitus, and residuals, left ankle sprain.

An April 2024 VA TERA Memo reflects the Veteran participated in a TERA. It was noted that he completed a Fire Fighters' training course.

The remaining issue is a relationship to service. The Veteran underwent VA examination in June 2024. Following interview and examination of the Veteran as well as review of the claims file, the examiner opined the claimed condition was less likely than not 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. As rationale, the examiner stated, "There [is] no nexus in the Veteran's medical history that relates any problems with regards to his...hypertension. The Veteran showed no TERA related involvement that would result in either one of these diagnoses. Therefore, it is less likely than not that...hypertension is related to his military sojourn...when he served in the Navy dating back from 1959 to 1963."

The June 2024 VA examiner also provided a secondary service connection opinion, finding that the claimed condition was less likely than not proximately due to or the result
through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. As rationale, the examiner stated, "There [is] no nexus in the Veteran's medical history that relates any problems with regards to his...hypertension. The Veteran showed no TERA related involvement that would result in either one of these diagnoses. Therefore, it is less likely than not that...hypertension is related to his military sojourn...when he served in the Navy dating back from 1959 to 1963."

The June 2024 VA examiner also provided a secondary service connection opinion, finding that the claimed condition was less likely than not proximately due to or the result of the Veteran's service-connected condition. As rationale, the examiner stated, "There is no medical correlation between...hypertension to left ankle sprain."

Moreover, the June 2024 VA opinion does not adequately address the issue of secondary service connection. Opinions must address secondary service connection on a causation and aggravation basis separately. El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). Additionally, the opinion only addressed the Veteran's service-connected left ankle sprain and not his other service-connected disabilities.

The Board therefore concludes that the June 2024 VA medical opinion is inadequate and they are afforded little, if any, probative weight.

"[The Veteran's] longstanding diagnosis of hypertension must be understood in the context of his military service and documented exposures to asbestos and PFAS. Both toxicants are recognized for their ability to persist in the body, provoke chronic systemic inflammation, induce oxidative stress, and impair endothelial function - mechanisms central to the development and persistence of elevated blood pressure (Moitra et al., 2023; Moitra et al., 2022; Liu, 2025; Yang et al., 2023). Asbestos contributes through pulmonary deposition and systemic inflammatory cascades, while PFAS bioaccumulate in vascular and renal tissues, disrupting nitric oxide pathways, vascular tone regulation, and renal sodium handling. Together, these exposures create a biologically plausible pathway to hypertension that is consistent with [the Veteran's] clinical history and reliance on continuous medication. Given this interplay of environmental toxicology and cardiovascular pathology, his hypertension should be viewed as at least as likely as not related to the cumulative impact of his in-service exposures."

The Board finds Dr. R. P's opinion is probative because they are based on an accurate medical history, considers lay evidence from the Veteran, supported by extensive medical literature, and provide clear rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008).

After careful consideration of the opinions of record, the Board finds that the weight of competent and probative evidence is in approximate balance as to whether the
is consistent with [the Veteran's] clinical history and reliance on continuous medication. Given this interplay of environmental toxicology and cardiovascular pathology, his hypertension should be viewed as at least as likely as not related to the cumulative impact of his in-service exposures."

After careful consideration of the opinions of record, the Board finds that the weight of competent and probative evidence is in approximate balance as to whether the Veteran's has hypertension that is related to service. The Board finds no adequate reason to favor the negative opinion over the positive opinions that are favorable to the Veteran's claim.

Therefore, resolving all reasonable doubt in the Veteran's favor, the evidence of record sufficiently establishes the elements for service connection for hypertension. The appeal is granted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102.

The Board need not discuss the theory of secondary service connection (38 C.F.R. § 3.310) as the Board is granting service connection on an alternative basis.

Increased Ratings

Disability evaluations are determined by the application of a schedule of ratings which is based, as far as can practically be determined, on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Each service-connected disability is rated based on specific criteria identified by Diagnostic Codes. When there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Generally, the degrees of disability specified are considered adequate to compensate for a loss of working time proportionate to the severity of the disability. 38 C.F.R. § 4.1.

Where the question for consideration is the propriety of the initial ratings assigned, evaluation of the evidence since the effective date of the grant of service connection is required. Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Where VA's adjudication of the claim for increase is lengthy and factual findings show distinct time periods where the service-connected disability exhibits symptoms which would warrant different ratings, different or "staged" ratings may be assigned for such different periods of time. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007); Fenderson, 12 Vet. App. at 126-27. A Veteran's entire history is to be considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995).

Entitlement to a compensable rating for bilateral hearing loss is denied.

The Veteran is seeking a compensable rating for his bilateral hearing loss. Evaluations of defective hearing range from noncompensable to 100 percent based on organic impairment of hearing acuity as measured by the results of a controlled Maryland CNC speech discrimination test together with the average hearing threshold level measured by pure tone audiometry tests in the frequencies of 1000, 2000, 3000, and 4000 cycles per second (Hertz). 38 C.F.R. § 4.85, Diagnostic Code 6100.

To evaluate the degree of disability from bilateral service-connected hearing loss, the schedule establishes 11 auditory hearing acuity levels designated from Level I for essentially normal hearing acuity through Level XI for profound deafness. 38 C.F.R. § 4.85, Tables VI and VII.

An exceptional pattern of hearing impairment occurs when the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more. 38 C.F.R. § 4.86(a). In that situation, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. Further, when the average pure tone threshold is 30 decibels or less at 100
levels designated from Level I for essentially normal hearing acuity through Level XI for profound deafness. 38 C.F.R. § 4.85, Tables VI and VII.

An exceptional pattern of hearing impairment occurs when the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more. 38 C.F.R. § 4.86(a). In that situation, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral. Further, when the average pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIA, whichever results in the higher numeral, and that numeral will then be elevated to the next higher numeral. 38 C.F.R. § 4.86(b).

A November 2024 VA examination reveals that the Veteran reported when the TV volume is high, he needed people to look at him, so he could understand them. He had a hard time when people spoke quietly. 38 C.F.R. § 4.10; Martinak v. Nicholson, 21 Vet. App. 447 (2007). On the authorized audiological evaluation from this examination pure tone thresholds, in decibels, were as follows:

Hertz 1000 Hz 2000 Hz 3000 Hz 4000 Hz AVG CNC

Right 20 35 40 60 38.75 84

Left 20 45 65 60 47.5 88

Speech audiometry revealed speech recognition ability of 88 percent in the left ear and 84 percent in the right ear.

Applying the results to Table VI, the findings yield a numeric designation of Level II in the right ear and Level II in the left ear. Entering the resulting bilateral numeric designation of Level II for the right ear and Level II for the left ear to 38 C.F.R. § 4.85, Table VII, equates to a zero percent, noncompensable disability rating under Diagnostic Code 6100.

An exceptional pattern of hearing impairment under 38 C.F.R. § 4.86 is not shown in either ear.

Based on the evidence above, a compensable rating for the Veteran's bilateral hearing loss is not warranted.

The Board expressly acknowledges its consideration of the lay evidence of record when adjudicating this claim, including the Veteran's reports of increased difficulty hearing conversations. The Veteran is competent to report difficulty hearing; however, disability ratings for hearing loss are derived from a mechanical application of the rating schedule to the numeric designations resulting from audiometric testing. See Lendenmann v. Principi, 3 Vet. App. 345 (1992).

All the Veteran's hearing loss symptoms and described hearing impairments are contemplated by the schedular rating criteria. The rating criteria contemplate speech reception thresholds and ability to hear spoken words on Maryland CNC testing. The schedular rating criteria specifically provide for ratings based on all levels of hearing loss in various contexts, as measured by both audiometric testing and speech recognition testing. Doucette v. Shulkin, 28 Vet. App. 366 (2017). The Veteran's main complaint is reduced hearing acuity and clarity, which is what is contemplated in the rating assigned. See Rossy v. Shulkin, 29 Vet. App. 142, 145 (2017).

Accordingly, the most probative evidence of record persuasively weighs against the claim of entitlement to a compensable rating for bilateral hearing loss. As the most probative evidence of record persuasively weighs against a compensable rating, the benefit-of-the-doubt rule does not apply. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021). The appeal is denied.

R. Bisignani

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Griffith, S.

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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