POSTTRAUMATIC STRESS DISORDER (PTSD)

Summary

The Veteran, a U.S. Marine Corps Reserve member who served on active duty for training from February 1964 to August 1964, appeals a May 2025 rating decision. The Veteran sought service connection for an acquired psychiatric disorder (PTSD, MDD, GAD), hypertension, heart disabilities (CAD, atrial fibrillation, post-MI residuals), residuals of ischemic stroke, bilateral visual field defects, gastrointestinal disability (GERD), lung disability (interstitial lung disease/cryptogenic pneumonia), shoulder, back, and hip disabilities, and hiatal hernia. The Board granted service connection for the acquired psychiatric disorder, hypertension, heart disabilities, residuals of ischemic stroke, and bilateral visual field defects. The Veteran's claims for PTSD, MDD, and GAD were granted based on favorable findings from Drs. D. and D.-H., who opined that the conditions were at least as likely as not related to in-service stressors, corroborated by a fellow service member's statement. Hypertension was granted secondary to the acquired psychiatric disorder, based on Dr. C.'s opinion linking PTSD to hypertension. Heart disabilities were granted secondary to hypertension, based on Dr. C.'s opinion. Stroke residuals were granted secondary to the now-service-connected heart disabilities. The Board remanded claims for gastrointestinal disability (GERD), lung disability, shoulder, back, and hip disabilities, and hiatal hernia due to pre-decisional duty to assist errors, specifically the failure to obtain records from the Veteran's primary care provider, Dr. S., and Bethesda Hospital, which were deemed relevant to these remanded claims. The Board noted that GERD was not presumptively linked to Camp Lejeune exposure, and while the Veteran's in-service physical abuse was corroborated for PTSD, a direct link to GERD was not established in the record.

Rationale

Favorable findings from Drs. D. and D.-H. linking conditions to service; Corroboration from fellow service member's statement; Resolution of reasonable doubt in Veteran's favor

Full Decision Text

Citation Nr: A26027591
Decision Date: 03/26/26	Archive Date: 03/26/26

DOCKET NO. 250528-549290
DATE: March 26, 2026

ORDER

Service connection for an acquired psychiatric disorder, variously diagnosed as posttraumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), is granted.

Service connection for hypertension is granted.

Service connection for coronary artery disease (CAD) and atrial fibrillation, status/post myocardial infarction (heart disabilities), is granted.

Service connection for residuals of ischemic stroke is granted.

Service connection for bilateral visual field defects is granted.

REMANDED

Entitlement to service connection for a gastrointestinal disability, to include gastroesophageal reflux disease (GERD), to include as due to exposure to contaminated water at Camp Lejeune, is remanded.

Entitlement to service connection for a disability of the lungs, to include interstitial lung disease and/or cryptogenic pneumonia, to include as due to exposure to contaminated water at Camp Lejeune, is remanded.

Entitlement to service connection for disabilities of the shoulders is remanded.

Entitlement to service connection for a back disability is remanded.

Entitlement to service connection for disabilities of the hips is remanded.

Entitlement to service connection for hiatal hernia is remanded.

FINDINGS OF FACT

1. It is at least as likely as not that the Veteran suffers from an acquired psychiatric disorder, variously diagnosed as PTSD, MDD, and GAD, that is causally related to his military service.

2. The Veteran has hypertension; it is at least as likely as not that the condition is secondary to his service-connected acquired psychiatric disorder.

3. The Veteran has CAD and atrial fibrillation, status/post myocardial infarction; it is at least as likely as not that the conditions are secondary to his service-connected hypertension.

4. The Veteran has residuals of an ischemic stroke; it is at least as likely as not that the stroke occurred secondary to his service-connected heart disabilities.

5. The Veteran has bilateral visual field defects; it is at least as likely as not that the defects are secondary to his service-connected residuals of ischemic stroke.

CONCLUSIONS OF LAW

1. Resolving reasonable doubt in the Veteran's favor, the criteria for an award of service connection for an acquired psychiatric disorder, variously diagnosed as PTSD, MDD, and GAD, have been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.

2. Resolving reasonable doubt in the Veteran's favor, the criteria for an award of service connection for hypertension have been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310.

3. Resolving reasonable doubt in the Veteran's favor, the criteria for an award of service connection for CAD and atrial fibrillation, status/post myocardial infarction, have been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. 

4. Resolving reasonable doubt in the Veteran's favor, the criteria for an award of service connection for residuals of ischemic stroke have been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. 

5. Resolving reasonable doubt in the Veteran's favor, the criteria for an award of service connection for bilateral visual field defects have been met. 38 U.S.C. §§ 1101, 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. 

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had service in the U.S. Marine Corps Reserve, to include a period of active duty for training (ACDUTRA) from February 1964 to August 1964. 

This matter comes to the Board of Veterans' Appeals (Board) on appeal from a May 2025 rating decision issued by a Department of Veterans Affairs (VA) Regional Office. The Veteran timely appealed to the Board by filing a VA Form 10182 (Decision
1101, 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. 

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran had service in the U.S. Marine Corps Reserve, to include a period of active duty for training (ACDUTRA) from February 1964 to August 1964. 

This matter comes to the Board of Veterans' Appeals (Board) on appeal from a May 2025 rating decision issued by a Department of Veterans Affairs (VA) Regional Office. The Veteran timely appealed to the Board by filing a VA Form 10182 (Decision Review Request: Board Appeal (Notice of Disagreement)) later that same month, selecting the hearing review option. 38 C.F.R. §§ 20.201, 20.202(b)(2).

In October 2025, the Veteran and his spouse testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing has been associated with the record. Under the hearing review option, the Board may only consider the evidence of record at the time of issuance of the agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. §?20.302(a). The Board cannot consider (1) evidence submitted during the period after the AOJ issued the decision on appeal and before the hearing was held, or (2) evidence submitted more than 90 days after the hearing was held. 38 C.F.R. § 20.302.

That said, for the reasons set forth below, the Board is remanding the Veteran's claims for service connection for a gastrointestinal disability, a lung disability, shoulder disabilities, a back disability, hip disabilities, and hiatal hernia to the AOJ for correction of pre-decisional duty to assist errors. The AOJ will consider any additional evidence that has been submitted when those claims are readjudicated. 38 C.F.R. § 3.103(c)(2)(ii).

The Board notes that in the May 2025 rating decision on appeal, the AOJ denied service connection for both "all mental health conditions" and insomnia. The Veteran's claim for service connection for his mental health diagnoses as well as his symptoms of insomnia have been combined and recharacterized to include all psychiatric disorders reasonably raised by the record. Clemons v. Shinseki, 23 Vet. App. 1 (2009).

As a final introductory matter, the Board notes that it is cognizant of the decision issued by the United States Court of Appeals for Veterans Claims (Court) in the case of Williams v. McDonough, 37 Vet. App. 305 (2024). There, the Court held, in essence, that the Board must refrain from deciding a case until the case proceeds to the point where a docket switch is no longer permitted under the terms of 38 C.F.R. § 20.202(c)(2). In the present case, as noted above, the Veteran appeared at a Board hearing and provided testimony in support of his appeal pursuant to 38 C.F.R. § 20.302. As such, a docket switch is no longer possible. See 38 C.F.R. § 20.202(c)(2) ("Requests to modify a Notice of Disagreement will not be granted if the appellant has submitted evidence or testimony as described in 20.302 and 20.303."). Under the circumstances, the Board may proceed with adjudication of the Veteran's appeal without further delay.?

Service Connection

Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a).

Generally, in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999).

Service connection can be established for disability due to disease or injury incurred or aggravated in the line of duty during a period of ACDUTRA. 38 U.S.C. §§ 101(2), (22
 in order to prove service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999).

Service connection can be established for disability due to disease or injury incurred or aggravated in the line of duty during a period of ACDUTRA. 38 U.S.C. §§ 101(2), (22), (24), 1110; 38 C.F.R. §§ 3.1(d), 3.6(a), (c), 3.303; Harris v. West, 13 Vet. App. 509, 511 (2000); Paulson v. Brown, 7 Vet. App. 466, 470 (1995). "Active duty for training" is defined, in part, as full-time duty in the Armed Forces performed by Reserves for training purposes, or full-time duty performed by members of the National Guard of any State under 32 U.S.C. §§ 316, 502, 503, 504, or 505, or the prior corresponding provisions of law. 38 U.S.C. § 101(22); 38 C.F.R. § 3.6(c).

A veteran, or former reservist or member of the National Guard, who had no less than 30 days (consecutive or nonconsecutive) of service at Camp Lejeune during the period beginning on August 1, 1953, and ending on December 31, 1987, shall be presumed to have been exposed during such service to contaminants in the water supply, unless there is affirmative evidence to the contrary. 38 C.F.R. § 3.307(a)(7)(iii).

For purposes of this presumption, "contaminants in the water supply" means the volatile organic compounds trichloroethylene (TCE), perchloroethylene (PCE), benzene and vinyl chloride, that were in the on-base water-supply systems located at United States Marine Corps Base Camp Lejeune, during the period beginning on August 1, 1953, and ending on December 31, 1987. 38 C.F.R. § 3.307(a)(7)(i). "Service at Camp Lejeune" means any service within the borders of the entirety of the United States Marine Corps Base Camp Lejeune and Marine Corps Air Station New River, North Carolina, during the period beginning on August 1, 1953, and ending on December 31, 1987, as established by military orders or other official service department records. Id.

If a veteran, or former reservist or member of the National Guard, was exposed to contaminants in the water supply at Camp Lejeune during military service and the exposure meets the requirements of § 3.307(a)(7), the following diseases shall be service-connected even though there is no record of such disease during service, subject to the rebuttable presumption provisions of § 3.307(d): kidney cancer; liver cancer; non-Hodgkin's lymphoma; adult leukemia; multiple myeloma; Parkinson's disease; aplastic anemia and other myelodysplastic syndromes; and bladder cancer. 38 C.F.R. § 3.309(f). Provided, however, that such disease shall have become manifest to a degree of 10 percent or more at any time after service. 38 C.F.R. § 3.307(a)(7)(ii).

Under applicable law, disability which is due to or the result of a service-connected disease or injury shall also be service connected. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show: (1) that a current disability exists; and (2) that the current disability was either (a) caused or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995).

Aggravation for purposes of 38 C.F.R. § 3.310(b) does not require that there be "permanent worsening" of a non-service-connected disability. Instead, secondary service connection is warranted for "any incremental increase in disability-any additional impairment of earning capacity-in nonservice-connected disabilities resulting from service-connected conditions, above the degree of disability existing before the increase-regardless of its permanence." Ward v. Wilkie,
) that a current disability exists; and (2) that the current disability was either (a) caused or (b) aggravated by a service-connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439 (1995).

Aggravation for purposes of 38 C.F.R. § 3.310(b) does not require that there be "permanent worsening" of a non-service-connected disability. Instead, secondary service connection is warranted for "any incremental increase in disability-any additional impairment of earning capacity-in nonservice-connected disabilities resulting from service-connected conditions, above the degree of disability existing before the increase-regardless of its permanence." Ward v. Wilkie, 31 Vet. App. 233, 239 (2019).

In Spicer v. McDonough, 61 F.4th 1360 (Fed. Cir. 2023), the United States Court of Appeals for the Federal Circuit (Federal Circuit) held that 38 U.S.C. § 1110 employs only "but-for" (rather than proximate) causation in direct and secondary service connection claims. In that regard, the Federal Circuit held that 38 C.F.R. § 3.310(b) is unlawful because it requires proximate causation to establish aggravation of a disability, rather than but-for causation. The but-for causation standard is not limited to a single cause and effect, but rather contemplates multi-causal links, including action and inaction. The Federal Circuit explained that secondary service connection is warranted where a non-service-connected disability would have been less severe but-for a service-connected disability, either because there is an etiological link (to include worsening of functionality) between the two, or because the service-connected disability resulted in the inability to treat the non-service-connected disability. Stated another way, but-for causation is broad and undisputedly broader than proximate cause. Thus, a service-connected disability need only be a contributing cause, not the contributing cause, to establish secondary service connection.

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt shall be given to the claimant. 38 U.S.C. § 5107(b). An approximate balance of the evidence includes, but is not limited to, equipoise. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).

1. Entitlement to service connection for an acquired psychiatric disorder

The Veteran contends that he has an acquired psychiatric disorder that was caused by service. He attributes the onset of his symptoms to physical and verbal abuse that he suffered during boot camp training. In an October 2024 non-VA examination report, he described several in-service stressor events to a J.D., Psy.D., the examining physician. The first was that he experienced repeated physical injury which was directed at him by a boot camp drill instructor who punched him in the abdomen every night during boot camp training, causing him to fall on his back between bunk beds. The second was when he was forced to engage in pugil stick fighting with a service member from another platoon when he knocked out his opponent's teeth and remembered a strong blow to the left side of his head by an officer in order to stop the fight. The third was witnessing fellow platoon mates who did not know how to swim being deliberately left under water by the drill instructors, experiencing near drowning up to three times before they were helped out of the pool. The fourth was learning about and being exposed to the details of 11 Marine recruits who drowned during swamp training in an incident known as the Ribbon Creek Massacre. The fifth was witnessing a fellow platoon member experiencing a mental health crisis following mental and physical abuse where he repeatedly smashed his head against radiator pipes in a hallway until 4 men pulled him away. The Veteran reported further that the man was thereafter forced to do pushups and kicked in the ribs each time, left standing in a broom closet overnight, and was not seen again. 

Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f).

38 C.F.R. § 3.304(f)(5) contains special provisions pertaining to PTSD claims based on in-service personal assault, including that evidence from sources other than a claimant's service records may corroborate the account of the stressor. Examples of such evidence include, but are not limited to: records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually
 condition in accordance with 38 C.F.R. § 4.125(a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304(f).

38 C.F.R. § 3.304(f)(5) contains special provisions pertaining to PTSD claims based on in-service personal assault, including that evidence from sources other than a claimant's service records may corroborate the account of the stressor. Examples of such evidence include, but are not limited to: records from law enforcement authorities, rape crisis centers, mental health counseling centers, hospitals, or physicians; pregnancy tests or tests for sexually transmitted diseases; and statements from family members, roommates, fellow service members, or clergy. Id. Evidence of behavior changes following the claimed assault is one type of relevant evidence that may be found in these sources. Id.

The United States Court of Appeals for the Federal Circuit has observed that 38 C.F.R. § 3.304(f)(5) specifically provides that a medical opinion may be used to corroborate a personal assault stressor, noting "medical opinion evidence may be submitted for use in determining whether the occurrence of a stressor is corroborated." See Menegassi v. Shinseki, 683 F.3d 1379, 1382 (Fed. Cir. 2011) (observing that the United States Court of Appeals for Veterans Claims erred when it determined that a medical opinion based on a post-service examination of a Veteran could not be used to establish the occurrence of a stressor); see also Patton v. West, 12 Vet. App. 272, 280 (1999) (rejecting the requirement that "something more than medical nexus evidence is required for 'credible supporting evidence'" in personal assault cases).

As an initial matter, the Board notes that in the May 2025 rating decision on appeal, the AOJ made a favorable finding that the Veteran had been diagnosed with PTSD per non-VA treatment records from a Dr. D. That favorable finding is binding on the Board, and is not in dispute. The first element of service connection, as to the presence of a current disability, has therefore been established.

The Board notes that the AOJ also made favorable findings that the Veteran had served at Camp Lejeune and conceded his participation in toxic exposure risk activity (TERA) (i.e., exposure to contaminated water). While these favorable findings are also binding on the Board, they do not relate to the issue of service connection for an acquired psychiatric disorder. The Veteran does not contend, nor does the record otherwise suggest, that his acquired psychiatric disorder is in any way related to his exposure to contaminated water at Camp Lejeune. 

As to an in-service event, injury, or disease, the Board notes that the Veteran's service treatment records are silent for complaints of, treatment for, or any diagnoses related to his mental health. However, he submitted an examination report and opinion from Dr. D. in October 2024. Dr. D. noted that she performed testing and found that the Veteran had PTSD, depression, and anxiety, and stated that in her expert opinion, his problems were related to specific incidents that he experienced during his service. She next noted the Veteran's reported in-service stressors and found that he met all of the diagnostic criteria for a diagnosis of PTSD. She stated that the Veteran first began experiencing symptoms of depression, anxiety, and eventually PTSD due to life-threatening events and significant physical injuries suffered during boot camp and beyond it during his service.

The Veteran also submitted a statement from a treating provider, H. D.-H.. Psy.D. in October 2024. Dr. D.-H. found that the Veteran had PTSD, MDD, and GAD, adding that he had also been battling chronic insomnia. He performed testing, finding that the Veteran met all of the criteria for a diagnosis of PTSD based on his reported in-service stressor events. He then opined that after a review of all available records and examination results, it was his professional opinion that the Veteran's PTSD and depression symptoms, as well as his sleep impairment were at least as likely as not to have been incurred or caused by his active service. He continued that the Veteran reported no mental health issues prior to service, but that during service he began to experience symptoms due to exposure to life-threatening situations and serious physical injuries during boot camp training. He then cited to those situations and injuries by way of the Veteran's reported in-service stressors. 

The Veteran submitted a lay statement from a fellow service member, a B.S., in October 2025. Mr. S. stated that he had known the Veteran since childhood and that they also went through boot camp together. He stated that one of the drill instructors specifically targeted the Veteran
 that the Veteran's PTSD and depression symptoms, as well as his sleep impairment were at least as likely as not to have been incurred or caused by his active service. He continued that the Veteran reported no mental health issues prior to service, but that during service he began to experience symptoms due to exposure to life-threatening situations and serious physical injuries during boot camp training. He then cited to those situations and injuries by way of the Veteran's reported in-service stressors. 

The Veteran submitted a lay statement from a fellow service member, a B.S., in October 2025. Mr. S. stated that he had known the Veteran since childhood and that they also went through boot camp together. He stated that one of the drill instructors specifically targeted the Veteran and would punch him so hard that he would fall on his back, and that this went on for several weeks. He also stated that he witnessed two of the Veteran's other reported stressor events, including the event in which a fellow service member hit his head against metal pipes during a mental health crisis, and the event where drill instructors nearly let fellow service members drown. 

Following review, the Board finds that the competent and probative evidence supports a finding that the Veteran's PTSD, MDD, GAD, and symptoms of insomnia are etiologically related to his active service. Drs. D. and D.-H. both found that the Veteran had PTSD and other psychiatric diagnoses, to include PTSD; and both of them opined that it was at least as likely as not that his in-service stressors caused his current acquired psychiatric disorders. The Board notes that Mr. S.'s October 2025 lay statement also corroborates the Veteran's account of his in-service personal assault stressors. Each of the elements for an award of service connection for PTSD, MDD, and GAD have therefore been satisfied. The evidence, at a minimum, gives rise to a reasonable doubt on the matter. 38 C.F.R. § 3.102. The appeal of this issue is granted.

2. Entitlement to service connection for hypertension, to include as due to exposure to contaminated water at Camp Lejeune and/or as secondary to a service-connected acquired psychiatric disorder

The Veteran contends that his hypertension had its onset in or is otherwise attributable to service. At the October 2025 Board hearing, he testified that he thought that the condition had been diagnosed during service, but that he did not know for sure. During a February 2025 VA examination, he reported that it had started a long time ago, estimating that it maybe had its onset in the 1970s. He has also contended that hypertension is secondary to his service-connected acquired psychiatric disorder. The Board notes that the AOJ also obtained a VA medical opinion as to whether the Veteran's hypertension was due to his participation in TERA (i.e., his conceded in-service exposure to contaminated water at Camp Lejeune) in February 2025. The theory that his hypertension is due to that exposure has therefore also been reasonably raised by the record. 

In the May 2025 rating decision, the AOJ made favorable findings that the Veteran had hypertension and that he had been exposed to contaminated water at Camp Lejeune. Those favorable findings are binding on the Board, and are not in dispute. The first element of service connection has therefore been established, as has the second insofar as it pertains to the theory that the Veteran's hypertension is due to exposure to contaminated water at Camp Lejeune. The primary questions for the Board are whether there is a nexus, or link, between the Veteran's hypertension and his exposure to contaminated water at Camp Lejeune, or between his hypertension and his now service-connected acquired psychiatric disorder. 

The Veteran submitted a statement from C.S., M.D., his primary care provider, in October 2024. Dr. S. stated that he had treated the Veteran as his primary care provider for 35 years, and that he also had the Veteran's records from other providers going back to his teenage years. He noted that the Veteran had a longstanding history of high blood pressure which started after he was discharged from service. He noted further that he had reviewed records from the Veteran's cardiologist, to include heart evaluations. Dr. S. stated that the Veteran's high blood pressure was not related to a congenital disease or genetic abnormalities or due to a family history of the disease, and that it was also not related to cholesterol. He then stated that based on medical history and laboratory findings as to the heart and blood, he believed that high blood pressure was caused by the Veteran's PTSD.

The Veteran submitted another statement from G.C., M.D., F.A.C.C., in October 2025. Dr. C. stated that he was a board-certified doctor specializing in interventional cardiology, and that he had reviewed the medical history, records, and relevant documentation of the
 he had reviewed records from the Veteran's cardiologist, to include heart evaluations. Dr. S. stated that the Veteran's high blood pressure was not related to a congenital disease or genetic abnormalities or due to a family history of the disease, and that it was also not related to cholesterol. He then stated that based on medical history and laboratory findings as to the heart and blood, he believed that high blood pressure was caused by the Veteran's PTSD.

The Veteran submitted another statement from G.C., M.D., F.A.C.C., in October 2025. Dr. C. stated that he was a board-certified doctor specializing in interventional cardiology, and that he had reviewed the medical history, records, and relevant documentation of the Veteran. Dr. C. opined that it was more likely than not that the Veteran's PTSD caused or significantly contributed to the development of hypertension. He reasoned that scientific evidence consistently demonstrated a strong correlation between chronic PTSD and the development of hypertension, stating that PTSD activated the sympathetic nervous system and disrupted the hypothalamic-pituitary-adrenal axis. He added that this, in turn, led to sustained increase in vascular tone, heart rate, and blood pressure, ultimately resulting in chronic hypertension. In support of his opinion, he cited to various medical articles that addressed the relationship between PTSD and hypertension. 

The Board finds that Dr. C.'s October 2025 statement is the most probative evidence of record as to the question of whether the Veteran's hypertension is secondary to his service-connected PTSD. The opinion was based on a complete review of the record, to include the Veteran's statements, cited to medical literature for support, and included a rationale. As such, it is entitled to significant probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 303-304 (2008). There are no medical opinions of record to the contrary regarding secondary service connection. 

In this regard, the Board acknowledges that a February 2025 VA examiner offered a negative nexus opinion. However, the examiner considered only whether the Veteran's participation in TERA during service caused his hypertension. As the Veteran was not service connected for an acquired psychiatric disorder at that time, the examiner was not asked, and she did not offer, an opinion as to secondary service connection. 

In light of the foregoing, the Board finds that the criteria for an award of service connection for hypertension have been met. The appeal of this issue is granted. 

3. Entitlement to service connection for a heart disability, to include as due to exposure to contaminated water at Camp Lejeune and/or as secondary to service-connected hypertension

The Veteran contends that his heart disabilities were incurred in or caused by service, to include as due to exposure to contaminated water at Camp Lejeune. He has also contended that his heart disabilities are secondary to his service-connected hypertension. 

As an initial matter, the Board notes that in the May 2025 rating decision, the AOJ made favorable findings that the Veteran had been diagnosed with CAD, residuals of myocardial infarction, and atrial fibrillation, and that his exposure to contaminated water at Camp Lejeune had been conceded. Those favorable findings are binding on the Board, and are not in dispute. As with his claim for service connection for hypertension, the primary questions for the Board are whether there is a nexus, or link, between the Veteran's heart disabilities and his exposure to contaminated water at Camp Lejeune, or between his heart disabilities and his now service-connected hypertension.

In his October 2024 statement, Dr. S. stated that the Veteran's high blood pressure led to cardiac arrest and a stroke in September 2023. In his October 2025 statement, Dr .C. opined that hypertension contributed materially to the Veteran's myocardial infarction and all heart-related complications. He reasoned that hypertension was the most significant modifiable risk factor for CAD and myocardial infarction. He stated that prolonged high blood pressure accelerated atherosclerotic plaque formation, caused endothelial injury, and increased myocardial oxygen demand, all of which predisposed one to ischemic cardiac events. In support of his opinion, Dr. C. cited to several medical studies. 

The Board finds that Dr. C.'s October 2025 statement the most probative evidence of record as to the question of whether the Veteran's heart disabilities are secondary to his service-connected hypertension. The opinion was based on a complete review of the record, to include the Veteran's statements, cited to medical literature for support, and includes a rationale. As such, it is entitled to significant probative weight. See Nieves-Rodriguez, supra. There are no contrary medical opinions of record as to secondary service connection. 

In this regard, the Board acknowledges that a February 2025 VA examiner offered a negative nexus opinion
 ischemic cardiac events. In support of his opinion, Dr. C. cited to several medical studies. 

The Board finds that Dr. C.'s October 2025 statement the most probative evidence of record as to the question of whether the Veteran's heart disabilities are secondary to his service-connected hypertension. The opinion was based on a complete review of the record, to include the Veteran's statements, cited to medical literature for support, and includes a rationale. As such, it is entitled to significant probative weight. See Nieves-Rodriguez, supra. There are no contrary medical opinions of record as to secondary service connection. 

In this regard, the Board acknowledges that a February 2025 VA examiner offered a negative nexus opinion. However, the examiner considered only whether the Veteran's participation in TERA during service caused his heart disabilities. As he was not service connected for hypertension at that time, the examiner was not asked, and she did not offer, an opinion as to secondary service connection. 

In light of the foregoing, the Board finds that the criteria for an award of service connection for CAD and atrial fibrillation, status/post myocardial infarction, have been met. The appeal of this issue is granted. 

4. Entitlement to service connection for residuals of ischemic stroke, to include as due to exposure to contaminated water at Camp Lejeune and/or as secondary to a service-connected heart disability

The Veteran contends that residuals of ischemic stroke were incurred in or caused by service, as due to exposure to contaminated water at Camp Lejeune. He also contends that they are secondary to his now service-connected heart disabilities. 

As an initial matter, the Board notes that in the May 2025 rating decision, the AOJ made favorable findings that the Veteran had been diagnosed with residuals of ischemic stroke, that his exposure to contaminated water at Camp Lejeune had been conceded, and that the condition was secondary to his heart disabilities. These favorable findings are binding on the Board, and are not in dispute.

Inasmuch as the Veteran was not service connected for a heart disability at the time of the issuance of the May 2025 rating decision, the AOJ denied the claim. However, upon review of the favorable findings, and in light of the fact that the Veteran's heart disabilities are now service-connected, the Board finds that an award of service connection for residuals of ischemic stroke is warranted. 

The Board need not analyze the issue further given the AOJ's favorable findings and the Board's further finding herein as to the award of service connection for heart disabilities. For informational purposes, however, the Board will address the pertinent evidence of record. 

In his October 2024 statement, Dr. S. stated that the Veteran's high blood pressure led to both his cardiac arrest and a stroke in September 2023. The Veteran was subsequently afforded a VA examination in connection with his claim in February 2025. The VA examiner noted the Veteran's report that he sought emergency care with chest pain and then underwent a cardiac catheterization with stenting. She further noted his report that the following day he was confused nad disoriented, and that workup including a CT (computed tomography) scan of the brain showed an ischemic stroke. The examiner offered a negative nexus opinion as to whether the Veteran's stroke residuals were caused by his participation in TERA during service. She found, however, that review of the claims file showed that the Veteran had a stroke in September 2023 during a cardiac catheterization, and that neurological records at that time showed that the cause was either a new onset of atrial fibrillation or a possible plaque embolization during the catheterization. 

In light of the evidence outlined above, the AOJ made favorable findings that the Veteran had a current disability and that it was proximately due to his heart disabilities, which have now been service connected. The criteria for an award of service connection for residuals of ischemic stroke have therefore been satisfied. While the February 2025 VA examiner offered a negative nexus opinion as to direct service connection, her rationale was essentially that the Veteran's stroke was due to another etiology; namely, his now service-connected heart disabilities. 

Taken as a whole, and resolving any reasonable doubt in the Veteran's favor, the Board finds that an award of service connection for residuals of ischemic stroke is warranted. The appeal of this issue is granted. 

5. Entitlement to service connection for bilateral visual field defects, to include as due to exposure to contaminated water at Camp Lejeune and/or as secondary to service-connected residuals of ischemic stroke

The Veteran contends that his visual field defects are secondary to his now service-connected residuals of ischemic stroke. In April 2025, the AOJ obtained a TERA opinion as to the Veteran's visual field defects. The theory that the defects are due to his participation in T
; namely, his now service-connected heart disabilities. 

Taken as a whole, and resolving any reasonable doubt in the Veteran's favor, the Board finds that an award of service connection for residuals of ischemic stroke is warranted. The appeal of this issue is granted. 

5. Entitlement to service connection for bilateral visual field defects, to include as due to exposure to contaminated water at Camp Lejeune and/or as secondary to service-connected residuals of ischemic stroke

The Veteran contends that his visual field defects are secondary to his now service-connected residuals of ischemic stroke. In April 2025, the AOJ obtained a TERA opinion as to the Veteran's visual field defects. The theory that the defects are due to his participation in TERA during service (i.e., that it is due to his conceded in-service exposure to contaminated water at Camp Lejeune) has therefore also been reasonably raised by the record. 

In the May 2025 rating decision, the AOJ made favorable findings that the Veteran had been diagnosed with visual field defects and that the claimed issue was secondary to his residuals of ischemic stroke. Those favorable findings are binding on the Board, and are not in dispute. Inasmuch as the Board has granted the Veteran's claim for service connection for residuals of ischemic stroke, an award of service connection for visual field defects is also warranted in light of the AOJ's binding favorable findings.

The Board need not analyze the issue further given the AOJ's favorable findings and the Board's further finding herein as to the award of service connection for residuals of ischemic stroke. For informational purposes, however, the Board will address the pertinent evidence of record. 

As noted, the Veteran was afforded a VA examination in connection with his claim in April 2025. The examiner offered a negative nexus opinion as to the Veteran's participation in TERA, reasoning that the Veteran's visual field defects were directly related to his stroke of September 2023. She stated that the stroke occurred during treatment for a heart attack at that time, and that the visual field defect was only able to be service connected secondary to the stroke. 

In light of the April 2025 VA examination and opinion, the AOJ made favorable findings that the Veteran had a current disability and that it was proximately due to his residuals of ischemic stroke, which has now been service-connected. The criteria for an award of service connection for visual field defects have therefore been satisfied. While the February 2025 VA examiner offered a negative nexus opinion as to direct service connection, her rationale was that the Veteran's visual defect was caused by his stroke.

Taken as a whole, and resolving any reasonable doubt in the Veteran's favor, the Board finds that an award of service connection for visual field defects is warranted. The appeal of this issue is granted. 

REASONS FOR REMAND

1. Entitlement to service connection for a gastrointestinal disability, to include GERD, to include as due to exposure to contaminated water at Camp Lejeune and/or as secondary to hiatal hernia, is remanded.

The Veteran contends that GERD was incurred in or caused by service. At a February 2025 VA examination, he reported that his drill instructor hit him in the upper abdomen and/or diaphragm every night, which knocked him back. He reported further that this caused damage, which resulted in heartburn. The AOJ also obtained a medical opinion as to whether the Veteran's GERD was caused by his conceded in-service exposure to contaminated water at Camp Lejeune. That theory has therefore also been reasonably raised by the record. Finally, a February 2025 VA examiner found that hiatal hernia was a contributing factor to GERD. The theory that the Veteran's GERD is secondary to non-service-connected hiatal hernia has therefore also been reasonably raised by the record. 

As an initial matter, the Board notes that in the May 2025 rating decision, the AOJ made favorable findings that the Veteran had been diagnosed with GERD and that his exposure to contaminated water at Camp Lejeune had been conceded. Those favorable findings are binding on the Board, and are not in dispute. The first element of service connection, as to the presence of a current disability, has therefore been established, as has the second insofar as it relates to the theory that the Veteran's GERD was caused by his conceded in-service exposure to contaminated water at Camp Lejeune. The primary questions for the Board are whether there is a nexus, or link, between the Veteran's GERD and his conceded in-service service exposure to contaminated water at Camp Lejeune, or between his GERD and another in-service event, injury, or disease. 

The Board initially notes that inasmuch as GERD is not a disease that is recognized as presumptively due to exposure to contaminated water at Camp Lejeune, an award of service connection on that
 element of service connection, as to the presence of a current disability, has therefore been established, as has the second insofar as it relates to the theory that the Veteran's GERD was caused by his conceded in-service exposure to contaminated water at Camp Lejeune. The primary questions for the Board are whether there is a nexus, or link, between the Veteran's GERD and his conceded in-service service exposure to contaminated water at Camp Lejeune, or between his GERD and another in-service event, injury, or disease. 

The Board initially notes that inasmuch as GERD is not a disease that is recognized as presumptively due to exposure to contaminated water at Camp Lejeune, an award of service connection on that basis is not warranted. 

As to an in-service event, injury, or disease aside from the Veteran's participation in TERA, the Board notes that his STRs are silent for complaints of, treatment for, or any diagnoses related to GERD. At an annual reserve examination in April 1969, all systems were indicated to be normal, and the Veteran denied having any problems, to include frequent indigestion and stomach or intestinal trouble. 

As noted, in February 2025, the Veteran was afforded a VA examination in connection with his claim. While he reported that he believed his GERD was related to repeated punching in the abdomen by his drill instructor, the examiner considered and offered an opinion only as to whether his GERD was due to his participation in TERA during service. She offered a negative nexus opinion, reasoning that GERD was a gastrointestinal disability of known etiology. She explained that it was due to esophageal sphincter laxity, esophageal dysmotility, or sequela of gastroparesis, prior stomach and/or foregut surgery, or hiatal hernia. She noted that other contributing factors included obesity, stating that medical literature did not support that toxic exposure (i.e., exposure to contaminated water at Camp Lejeune) was causative of GERD. In support of her opinion, she cited to medical literature. 

The Board finds that the February 2025 VA medical opinion adequately addresses the question of whether the Veteran's GERD is due to his conceded in-service exposure to contaminated water at Camp Lejeune. While acknowledging that the VA examiner did not consider the Veteran's contention that being hit in the abdomen and/or diaphragm repeatedly during service caused his GERD, the Board notes that the opinion was obtained pursuant to 38 U.S.C. § 1168. In this regard, the Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics (PACT) Act of 2022 led to the promulgation of 38 U.S.C. § 1168, which requires VA to provide a VA medical examination and opinion to any veteran with confirmed toxic exposure and a current disability (with some exceptions, to include for disabilities due to physical trauma). While the February 2025 VA examination and opinion as to GERD was therefore required, 38 U.S.C. § 1168 requires an opinion only as to whether a claimant's participation in TERA caused a current disability. It does not require an examiner to consider all theories of service connection. 

Here, the Board finds that a further VA medical opinion as to direct service connection, at least at present, is not warranted. While there is no material dispute that the Veteran has GERD, and while acknowledging that his reports of being hit repeatedly by a drill instructor during service have been corroborated insofar as they pertain to his claim for service connection for PTSD, there is still no indication of a nexus, or link, between that event and his GERD, to include in treatment records, medical opinions, or medical articles and/or treatises. An opinion that addresses the theory that the Veteran's GERD was caused by repeated blows to his abdomen and/or diaphragm during service, at least at present, is therefore not warranted. 

The Board finds further, however, that there appear to be outstanding relevant non-VA treatment records. In his October 2024 statement, Dr. S. stated that he had been the Veteran's primary care physician for 35 years. To date, the AOJ has not attempted to assist the Veteran in obtaining a copy of records from that provider, despite the fact that he was reasonably identified as a non-VA treating provider prior to the issuance of the May 2025 rating decision on appeal. The Board acknowledges that the Veteran did not list Dr. S. as a provider when he submitted a release and identified several other non-VA providers in December 2024. However, a claimant need not identify every non-VA provider at one time, or even in an express way, in order to trigger VA's duty to assist. All that is required is that a provider is reasonably identified
. stated that he had been the Veteran's primary care physician for 35 years. To date, the AOJ has not attempted to assist the Veteran in obtaining a copy of records from that provider, despite the fact that he was reasonably identified as a non-VA treating provider prior to the issuance of the May 2025 rating decision on appeal. The Board acknowledges that the Veteran did not list Dr. S. as a provider when he submitted a release and identified several other non-VA providers in December 2024. However, a claimant need not identify every non-VA provider at one time, or even in an express way, in order to trigger VA's duty to assist. All that is required is that a provider is reasonably identified somewhere in the record. See, e.g., 38 C.F.R. § 3.159(e)(2) (if VA becomes aware of the existence of relevant records before deciding a claim, VA will, among other things, request that the claimant provide a release for the records). 

Inasmuch as Dr. S. is a primary care provider, the Board must conclude that a copy of his records are relevant to each of the claims remaining on appeal. The AOJ's failure to assist the Veteran in obtaining a copy of records from that provider when they were reasonably identified prior to the issuance of the May 2025 rating decision on appeal constitutes a pre-decisional duty to assist error that must be corrected. Under the circumstances, a remand on that basis is required. ?

2. Entitlement to service connection for a disability of the lungs, to include interstitial lung disease and/or cryptogenic pneumonia, to include as due to contaminated water at Camp Lejeune, is remanded.

The Veteran contends that his lung disabilities were incurred in or caused by service. At the October 2025 hearing, he testified that he was hospitalized twice during service for pneumonia, and that he first got pneumonia after gas masking training. He then stated that he did not know if it was pneumonia, and that it was fever. In a December 2025 submission, he again asserted that he was hospitalized for pneumonia during service and that he was later diagnosed with cryptogenic pneumonia and that he has had flareups up pneumonia since service. In February 2025, the AOJ obtained a medical opinion as to whether the Veteran's pneumonia was due to his conceded in-service exposure to contaminated water at Camp Lejeune. The theory that his lung disabilities are due to that exposure has therefore also been reasonably raised by the record. 

In the May 2025 rating decision, the AOJ made favorable findings that the Veteran had been diagnosed with interstitial lung disease with a history of cryptogenic pneumonia and that his exposure to contaminated water at Camp Lejeune had been conceded. Those favorable findings are binding on the Board, and are not in dispute. The first element of service connection, as to the presence of a current disability, has therefore been established, as has the second element of service connection insofar as it relates to the theory that the Veteran's lung disabilities are due to his in-service exposure. The Board also notes, however, that the Veteran's STRs are silent for complaints of, treatment for, or any diagnoses related to the lungs and/or breathing. At an April 1969 annual reserve examination, he expressly denied having shortness of breath, pain or pressure in the chest, and/or a chronic cough.  

The Board initially notes that inasmuch as neither interstitial lung disease nor cryptogenic pneumonia are diseases recognized as presumptively due to exposure to contaminated water at Camp Lejeune, an award of service connection on that basis is not warranted.

As noted, the Veteran was afforded a VA examination in connection with his claim in February 2025. At the examination, the Veteran reported that he passed out and went to the emergency room and was told he had pneumonia. He reported further that he had cold symptoms in 2021 which did not improve, and that he sought treatment and was diagnosed with pneumonia. The examiner offered a negative nexus opinion as to whether the Veteran's lung disabilities were due to his conceded in-service exposure to contaminated water. The examiner reasoned that there was no objective evidence of pneumonia complaints, diagnosis, or treatment in service, and that his August 1964 separation examination was silent for pneumonia. The examiner noted that post-service records included reports of medical history and examinations, and that there was no pneumonia or lung conditions noted in them. He stated that the record was silent until 2022, when the Veteran was diagnosed with COVID-related pneumonia. He described what that type of pneumonia was and found that it was less likely than not that it was related to his active service. 

On review, the Board finds that there appear to be outstanding non-VA treatment records related to a lung disability, and that there also may be outstanding STRs related to a lung disability. As
 The examiner reasoned that there was no objective evidence of pneumonia complaints, diagnosis, or treatment in service, and that his August 1964 separation examination was silent for pneumonia. The examiner noted that post-service records included reports of medical history and examinations, and that there was no pneumonia or lung conditions noted in them. He stated that the record was silent until 2022, when the Veteran was diagnosed with COVID-related pneumonia. He described what that type of pneumonia was and found that it was less likely than not that it was related to his active service. 

On review, the Board finds that there appear to be outstanding non-VA treatment records related to a lung disability, and that there also may be outstanding STRs related to a lung disability. As to non-VA treatment records, the Board notes that in October 2024, the Veteran submitted a release and identified five non-VA providers who had treated him. While the AOJ initially noted that the Veteran's release did not include his signature and therefore took no action as to obtaining a copy of records from those non-VA providers, in January 2025 the Veteran provided a signed release. Review of the claims file shows that, thereafter, the AOJ obtained and associated with the claims file records from two of the identified providers (H. D.-H., Psy.D. and S.H., M.D.). While the AOJ made two requests for records from the other providers, including J.D., Psy.D., Boca Regional Medical Center in Boca Raton, Florida, and Bethesda Hospital in Boynton Beach, Florida, it did not thereafter inform the Veteran that it had made two requests but had been unable to obtain a copy of the records, or invite him to submit a copy of the records himself. 

In this regard, the Board notes that records from Dr. D. relate to the Veteran's claim for service connection for an acquired psychiatric disorder, which the Board has granted herein. The Veteran indicated in his December 2024 submission that records from Bethesda Hospital pertained to his claims for service connection for heart disabilities and residuals of ischemic stroke, both of which the Board has also granted herein. Records from Boca Regional Medical Center, however, pertained specifically to the Veteran's lung disabilities. The AOJ's failure to inform the Veteran that it was unable to obtain a copy of those records constitutes a pre-decisional duty to assist error that must be corrected. Under the circumstances, a remand on that basis is required.   

With respect to in-service hospital records, the Board notes that, historically, records of in-service hospital treatment were sometimes stored separately from other records. While the Veteran's STRs do not currently contain any complaints of, treatment for, or diagnoses related to any lung disabilities, the Board acknowledges that STRs containing that information might be found in hospital records which have not yet been associated with the claims file. The Board also notes, however, that it is unable to find that the AOJ made any pre-decisional duty to assist errors with respect to those records. The first time that the Veteran reported that he had been hospitalized for pneumonia during his service was at his October 2025 hearing.

Notably, the Veteran did not report to the February 2025 examiner that he had been hospitalized for that condition during service. Instead, he appears to have reported that he first got pneumonia in 2021, after having cold symptoms which did not improve. The Board also notes that nothing else in the evidence of record before the AOJ suggests that the Veteran was hospitalized for any reason during service. 

In any event, because the Veteran did not report that he was hospitalized for a respiratory disability during service until after the issuance of the May 2025 rating decision on appeal, and the record before the AOJ did not otherwise suggest that he was hospitalized during service, the Board is unable to find that the AOJ made any pre-decisional duty to assist errors with respect to records of any such hospitalization, and is therefore unable to direct the AOJ to attempt to obtain a copy of any such records on remand.

3. Entitlement to service connection for disabilities of the shoulders is remanded.

4. Entitlement to service connection for a back disability is remanded.

5. Entitlement to service connection for disabilities of the hips is remanded.

6. Entitlement to service connection for hiatal hernia is remanded.

The Veteran contends that his shoulder, back, hip, and hiatal hernia disabilities were incurred in or caused by service, as due to the general rigors of service and/or as due to injuries sustained during service. At the October 2025 Board hearing, he testified that as to the shoulders, he was pretty sure they were injured in service in the same way as his back and hips were injured. With respect to the back, he testified that his current back disability was due to forced marches with heavy packs, which made his back start
 connection for a back disability is remanded.

5. Entitlement to service connection for disabilities of the hips is remanded.

6. Entitlement to service connection for hiatal hernia is remanded.

The Veteran contends that his shoulder, back, hip, and hiatal hernia disabilities were incurred in or caused by service, as due to the general rigors of service and/or as due to injuries sustained during service. At the October 2025 Board hearing, he testified that as to the shoulders, he was pretty sure they were injured in service in the same way as his back and hips were injured. With respect to the back, he testified that his current back disability was due to forced marches with heavy packs, which made his back start hurting. He stated that it had hurt continuously since service, but that because he is a physical therapist, he was treating his back on his own after service, which is why there are not a lot of records as to the back. He asserted that his hip condition was also due to marching and having bad rucksacks during service, as well as in-service injuries. With respect to a hiatal hernia, he testified that that developed from being punched so much. 

As an initial matter, the Board notes that in the May 2025 rating decision, the AOJ made favorable findings that the Veteran had been diagnosed with right shoulder degeneration, degenerative changes of the lumbar spine, and right hip pain. Those favorable findings are binding on the Board, and are not in dispute. With respect to the presence of a current disability, the Board notes that July 2024 magnetic resonance imaging (MRI) of the left shoulder showed degeneration and tearing of the labrum, as well as atrophy of the rotator cuff muscles. An x-ray of the hips dated in August 2024 showed moderate degenerative changes in the left hip and advanced degenerative changes in the right hip. A January 2022 CT of the chest showed a moderate hiatal hernia. Given the favorable findings of the AOJ, along with the evidence cited, the Board finds that the first element of service connection, as to the presence of a current disability, has been established as to each of these issues. 

As to an in-service event, injury, or disease, the Board notes that the Veteran's STRs are silent for complaints of, treatment for, or any diagnoses related to any of the foregoing conditions. Reserve examinations are consistently silent for any mention of problems with the shoulders, back, hips, or any other system. Of note, at an April 1969 reserve examination, the Veteran denied having swollen or painful joints, frequent indigestion, stomach or intestinal trouble, a rupture and/or hernia, arthritis, bone, joint, or other deformity, recurrent back pain, or a painful or trick shoulder. 

To date, inasmuch as the Veteran's STRs are silent for any mention of problems related to these conditions, and because VA medical opinions for disabilities due to physical trauma are excepted from 38 U.S.C. § 1168, the Veteran has not been afforded VA examinations and/or opinions in connection with these claims. 

With respect to the shoulders, back, and hips, the Veteran submitted a statement from E.H., M.D., in October 2025. Dr. H. stated that he had treated the Veteran for 20 years, and that he first saw him in 2008 for complaints of bilateral hip and lower back pain. Dr. H. then noted the Veteran's diagnoses and stated that after a comprehensive review of the medical records, imaging, and a detailed medical history, it was his professional opinion that the Veteran's orthopedic injuries and degenerative conditions were directly related to the cumulative physical trauma sustained during his years of active service. He noted the Veteran's report that during service he was routinely subjected to 8 to 10 hours of forced marches carrying approximately 65-pound packs, and that he also described recurrent physical abuse by commanding officers. Dr. H. reasoned that these repetitive stresses and traumatic impacts were medically consistent with the development of chronic spinal disc degeneration and an accelerated breakdown of the hip joints. He added that the Veteran was a physical therapist, which was a job that involved no manual labor, and that the Veteran had no history of high-impact sports, vehicular trauma, or any other non-service-connected injuries that could otherwise account for his disabilities. 

While clearly supportive of the Veteran's claims for service connection for shoulder, back, and hip disabilities, the Board finds that Dr. H.'s October 2025 statement is insufficient for awards of service connection for those disabilities. Most problematic is the fact that Dr. H. does not appear to have reviewed evidence of record, including the Veteran's STRs, wherein the Veteran expressly denied having any problems with these conditions, even near the conclusion of his service in the U.S. Marine
 He added that the Veteran was a physical therapist, which was a job that involved no manual labor, and that the Veteran had no history of high-impact sports, vehicular trauma, or any other non-service-connected injuries that could otherwise account for his disabilities. 

While clearly supportive of the Veteran's claims for service connection for shoulder, back, and hip disabilities, the Board finds that Dr. H.'s October 2025 statement is insufficient for awards of service connection for those disabilities. Most problematic is the fact that Dr. H. does not appear to have reviewed evidence of record, including the Veteran's STRs, wherein the Veteran expressly denied having any problems with these conditions, even near the conclusion of his service in the U.S. Marine Corps Reserve. The claims file also does not currently contain a copy of records from Dr. H. Here again, because Dr. H. was not reasonably identified as a treating provider prior to the issuance of the May 2025 rating decision on appeal, the Board is unable to find that the AOJ made any pre-decisional duty to assist errors with respect to obtaining a copy of records from Dr. H., and it is therefore unable to direct the AOJ to obtain a copy of those records on remand.

With respect to the Veteran's claim for service connection for hiatal hernia, the Board notes that inasmuch as the Board is granting his claim for service connection for an acquired psychiatric disorder, in part, based on evidence which corroborates his report that he was punched in the stomach and/or diaphragm repeatedly during service, it finds that an in-service injury as to hiatal hernia has been established. However, the Board finds that VA examinations and/or opinions, at least at present, are not required as to any of these claims. See McLendon v. Nicholson, 20 Vet. App. 79 (2006).

With respect to hiatal hernia, there is no evidence which indicates that there is a nexus between an in-service injury and a hiatal hernia, to include in treatment records, medical statements, or any other evidence aside from the Veteran's lay assertion that that injury caused his hernia. Because STRs are silent for any complaints of, treatment for, or diagnoses related to the shoulders, back, or hips, and because the Veteran expressly denied having problems with these areas at the time of his separation from reserve service, the Board finds that the second element of service connection as to the shoulders, back, and hips has not been established. Still further, while Dr. H.'s October 2025 statement indicates that there is a link between the shoulders, back, and hips, and in-service events and/or injuries, that statement was not submitted until after the issuance of the May 2025 rating decision on appeal. The Board therefore must conclude that the AOJ made no pre-decisional duty to assist errors with respect to VA examinations and or opinions with regard to these issues. 

However, inasmuch as the AOJ made a pre-decisional duty to assist error when it failed to fully assist the Veteran in obtaining a copy of records from Dr. C., his primary care provider, and because those records are very likely relevant to these issues, the Board finds that a remand of these claims is required.  

These matters are REMANDED for the following action:

Ask the Veteran to provide a release for relevant records of treatment from Dr. C.S. (his primary care provider, who submitted a statement in October 2024) and Boca Regional Medical Center in Boca Raton, Florida (identified in a December 2024 submission). If he provides the necessary release(s), assist him in obtaining the records identified, following the procedures set forth in 38 C.F.R. § 3.159. Any new or additional (i.e., non-duplicative) evidence received should be associated with the record. If any of the records sought are not available, the record should be annotated to reflect that fact, and the Veteran and his representative should be notified and offered an opportunity to submit the records themselves.  

 

DAVID A. BRENNINGMEYER

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	R. Oldroyd, Counsel

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.