STOMACH NEOPLASM OF

FREDERIC P. GALLUN · 2026 · Case ID: A26029229

MIXED

Summary

The Veteran, who served in the Air Force from January 1985 to February 2002 with additional Reserve service, appeals the denial of service connection for several conditions, including a stomach condition, degenerative arthritis of the neck, lumbar disc herniation, bulging discs, uterine fibroids, and asthma. The Board denied service connection for the stomach condition, neck disability, lumbar disc issues, uterine fibroids, and asthma. For the stomach condition, the Board found no diagnosed disability and no nexus to service, relying on a VA examination that noted subjective symptoms but no objective findings or pathology. For the neck and back conditions, the Board denied service connection due to a lack of in-service complaints or treatment in service records, and the VA examinations found the conditions less likely than not related to service, with post-service events being a more likely etiology. The Board also denied service connection for uterine fibroids and asthma, noting a lack of in-service complaints or diagnoses and unfavorable VA opinions finding no nexus to conceded toxic exposures. The Board found the negative evidence more persuasive in all denied claims, rendering the benefit of the doubt inapplicable. Service connection for Graves' disease, hypertension, and tachycardia were remanded for further development, specifically to determine if active duty or service-connected disabilities aggravated these conditions.

Rationale

No diagnosed stomach disability; VA exam found no pathology; No nexus to service or toxic exposure

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

250219-523080

Full Decision Text

Citation Nr: A26029229
Decision Date: 03/31/26 Archive Date: 03/31/26

DOCKET NO. 250219-523080
DATE: March 31, 2026

ORDER

Entitlement to service connection for a stomach condition is denied.

Entitlement to service connection for degenerative arthritis of the neck (a neck disability) is denied.

Entitlement to service connection for degenerative arthritis with lumbar disc herniation (a lower back disability) is denied.

Entitlement to service connection for bulging discs in back (a lower back disability) is denied.

Entitlement to service connection for uterine fibroids is denied.

Entitlement to service connection for connection for asthma (claimed as breathing problems) is denied.

REMANDED

Entitlement to service connection for connection for Graves' disease (thyroid disability) is remanded.

Entitlement to service connection for hypertension is remanded.

Entitlement to service connection for tachycardia (also claimed as rapid heartbeats) is remanded.

FINDINGS OF FACT

1. The evidence of record persuasively weighs against finding that the Veteran has had a stomach disability at any time during or approximate to the pendency of the claim.

2. The evidence of record persuasively weighs against finding that the Veteran's neck disability began during active service or is otherwise related to an in-service injury or disease.

3. The evidence of record persuasively weighs against finding that the Veteran's lower back disability began during active service or is otherwise related to an in-service injury or disease.

4. The evidence of record persuasively weighs against finding that the Veteran's bulging discs began during active service or are otherwise related to an in-service injury or disease.

5. The evidence of record persuasively weighs against finding that the Veteran's fibroids began during active service, is otherwise related to an in-service injury or disease, and was not related to the Veteran's conceded in-service toxic exposures.

6. The evidence of record persuasively weighs against finding that the Veteran's asthma began during active service, is otherwise related to an in-service injury or disease, and was not related to the Veteran's conceded in-service toxic exposures.

CONCLUSIONS OF LAW

1. The criteria for service connection for a stomach disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for service connection for a neck disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for service connection for degenerative arthritis with lumbar disc herniation are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

4. The criteria for service connection for a bulging disc disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for service connection for uterine fibroids are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for service connection for asthma are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the Air Force from January 1985 to April 1985, August 1990 to August 1991, February 1997 to June 1997, and November 2001 to February 2002, with additional service in the Air Force Reserves. The Board recognizes the Veteran's service to our country, and the sacrifices it necessarily entailed.

This case comes before the Board of Veterans' Appeals (Board) on appeal from September 2023 and October 2023 rating decisions issued by the Agency of Original Jurisdiction (AOJ), Department of Veterans Affairs (VA) Regional Office (RO) which denied service connection for all the Veteran's claimed conditions. In December 2023 through March 2024, the Veteran requested higher level review. In an April 2024 higher level review decision, a duty to assist error was discovered for the Veteran's conditions. Following
and November 2001 to February 2002, with additional service in the Air Force Reserves. The Board recognizes the Veteran's service to our country, and the sacrifices it necessarily entailed.

This case comes before the Board of Veterans' Appeals (Board) on appeal from September 2023 and October 2023 rating decisions issued by the Agency of Original Jurisdiction (AOJ), Department of Veterans Affairs (VA) Regional Office (RO) which denied service connection for all the Veteran's claimed conditions. In December 2023 through March 2024, the Veteran requested higher level review. In an April 2024 higher level review decision, a duty to assist error was discovered for the Veteran's conditions. Following new VA examinations, the Veteran's claims were again denied in an October 2024 rating decision. In October 2024, the Veteran again requested higher level review. In November 2024 and February 2025 rating decisions, the AOJ again denied service connection for the Veteran's claims.

On August 23, 2017, the Veterans Appeals Improvement and Modernization Act, Pub. L. No. 115-55, 131 Stat. 1105 (2017), also known as the Appeals Modernization Act (AMA), was enacted. This law creates a new framework for Veterans dissatisfied with VA's decision on their claim to seek review. The Veteran timely appealed the November 2024 and February 2025 rating decisions to the Board by requesting Direct Review under the AMA. See VA Form 10182 Notice of Disagreement (NOD), February 2025. Accordingly, the Board's current review is limited to the evidence of record at the time of the November 6, 2024, rating decision, as the AOJ ordered additional development for that claim, but not for the claims denied in the subsequent February 2025 rating decisions.

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

Service Connection

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). "To establish a right to compensation for a present disability, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service"- the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Active service includes periods of active duty for training (ACDUTRA) when service connection may be granted for disabilities resulting from a disease or injury incurred in or aggravated while performing ACDUTRA. 38 U.S.C. § 101(22), (24); 38 C.F.R. § 3.6(a), (c). Active service also includes periods of inactive duty for training (INACDUTRA) when service connection may be granted for disabilities resulting from an injury, but not a disease, incurred in or aggravated while performing INACDUTRA. 38 U.S.C. § 101(23), (24); 38 C.F.R. § 3.6(a), (d).

Entitlement to service connection for a stomach condition is denied.

The Veteran asserts that she was struck by protruding cargo in her stomach during service and continues to experience pain. See VA 21-526EZ, Fully Developed Claim (Compensation), May 2023.

The Veteran's service treatment records were absent for any stomach injury.

The Veteran asserts that she was struck by protruding cargo in her stomach during service and continues to experience pain. See VA 21-526EZ, Fully Developed Claim (Compensation), May 2023.

The Veteran's service treatment records were absent for any stomach injury.

A VA examination for the Veteran's stomach was conducted in September 2024. No stomach diagnosis was rendered. The examiner stated, "Veteran reports that [in 1990] she was loading an aircraft and a piece of protruding pallet which hit her right abdomen. Reports that she underwent X-rays and other evaluation and cannot find anything. Reports that she can still feel the pain on the right side of her abdomen. 6/2022 CT of the Abdomen was normal." Regarding the diagnosis, the examiner stated, "No Diagnosis of stomach and duodenum condition confirmed. Symptom is subjective only. Objective exam and medical record were silent for chronic complaints, treatment and clinical diagnosis for the stomach condition. Ct scan in 6/2022 was normal. No pathology to render diagnosis." In the opinion section of the examination, the examiner concluded,

Symptom is subjective only. Objective exam and medical record were silent for chronic complaints, treatment and clinical diagnosis for the stomach condition. Ct scan in 6/2022 was normal. No pathology to render diagnosis. Therefore, service connection related to toxic exposure risk activity is not plausible. See C&P Exam, September 2024.

When assessing the probative value of a medical opinion, the access to claims files and the thoroughness and detail of the opinion must be considered. The opinion is considered probative if it is definitive and supported by detailed rationale. See Prejean v. West, 13 Vet. App. 444, 448-49 (2000). The Court has held that claims file review, as it pertains to obtaining an overview of a claimant's medical history, is not a requirement for private medical opinions. A medical opinion that contains only data and conclusions is not entitled to any weight. Further a review of the claims file cannot compensate for lack of the reasoned analysis required in a medical opinion, which is where most of the probative value of a medical opinion comes from. "It is the factually accurate, fully articulated, sound reasoning for the conclusion, not the mere fact that the claims file was reviewed, that contributes probative value to a medical opinion." Id.

With respect to the current claim, the Board finds that the medical evidence demonstrating an absence of diagnosed stomach disability is particularly probative. Critically, the September 2024 VA examination report indicated that the Veteran does not in fact suffer from any stomach disability, and the examiner identified no nexus between the claimed disability and the Veteran's military service and/or to a toxic exposure.

As indicated above, the September 2024 VA examination report is based on review of the Veteran's medical history, as well as interview and physical examination. The Board therefore places significant weight on the findings of the VA examiner as expressed in the September 2024 VA medical opinion. See Bloom v. West, 12 Vet. App. 185, 187 (1999) (the probative value of a physician's statement is dependent, in part, upon the extent to which it reflects "clinical data or other rationale to support his opinion").

Moreover, the Veteran has not produced any medical evidence to contradict the conclusions of the September 2024 VA examiner. The Veteran has been afforded ample opportunity to present competent medical evidence in support of her claim. She has not done so. See 38 U.S.C. § 5107(a) (it is the claimant's responsibility to support a claim for VA benefits).

In the absence of disability, service connection is not warranted. In order for a claimant to be granted service connection for a claimed disability, there must be evidence of a current disability. The presence of a disability at the time of filing of a claim or during its pendency warrants a finding that the current disability requirement has been met, even if the disability resolves prior to the Board's adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Moreover, evidence prior to the date of claim must be considered in determining whether the current disability requirement has been met. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013) (Board erred in failing to address pre-claim evidence in assessing whether a current disability existed, for purposes of service connection, at the time the claim was filed or during its pendency). Here, however, there is no evidence
its pendency warrants a finding that the current disability requirement has been met, even if the disability resolves prior to the Board's adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Moreover, evidence prior to the date of claim must be considered in determining whether the current disability requirement has been met. Romanowsky v. Shinseki, 26 Vet. App. 289, 293 (2013) (Board erred in failing to address pre-claim evidence in assessing whether a current disability existed, for purposes of service connection, at the time the claim was filed or during its pendency). Here, however, there is no evidence to support findings that the Veteran has a stomach disability, nor has she identified any such documentation.

To the extent the Veteran asserts that she currently has a stomach disability, lay evidence may be competent on a variety of matters concerning the nature and cause of disability. Jandreau v. Shinseki, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). To this end, the Board recognizes that lay witnesses are competent to opine as to some matters of diagnosis and etiology, and the Board must determine on a case by case basis whether a Veteran's particular disability is the type of disability for which lay evidence is competent. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Kahana v. Shinseki, 24 Vet. App. 428, 433, n.4 (2011). In this case, the Veteran's assertions as to etiology concern an internal medical process, which extends beyond an immediately observable cause-and-effect relationship that is of the type that the courts have found to be beyond the competence of lay witnesses. Cf. Jandreau, 492 F.3d at 1376 (lay witness capable of diagnosing dislocated shoulder); Barr, 21 Vet. App. at 308-9; Falzone v. Brown, 8 Vet. App. 398, 403 (1995) (lay person competent to testify to pain and visible flatness of his feet); with Clemons v. Shinseki, 23 Vet. App. 1, 6 (2009) ("It is generally the province of medical professionals to diagnose or label a mental condition, not the claimant"); Woehlaert v. Nicholson, 21 Vet. App. 456, 462 (2007) (unlike varicose veins or a dislocated shoulder, rheumatic fever is not a condition capable of lay diagnosis); Jandreau, 492 F.3d at 1377 ("sometimes the layperson will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer"). See also Colantonio v. Shinseki, 606 F.3d 1378, 1382 (Fed. Cir.2010) (recognizing that in some cases lay testimony "falls short" in proving an issue that requires expert medical knowledge).

The Board has also considered the holding of the Federal Circuit in Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). In that case, the Federal Circuit held that pain alone, without an accompanying diagnosis of a present disease, can qualify as a disability if it reaches the level of a functional impairment of earning capacity. In this case, however, the record contains no credible evidence tending to show the Veteran's claimed stomach disability rises to a level to affect her earning capacity, to include manifestations of similar severity, frequency, and duration as those VA has determined by regulation would cause impaired earning capacity in an average person, and no functional impact was noted. Wait v. Wilkie, 33 Vet. App. 8 (2020).

In sum, the Veteran has not been diagnosed as having a stomach disability, and she has not alleged that she suffers from any symptomatology associated with the claimed disability that results in functional impairment of earning capacity. Cf. Saunders v. Wilkie, 866 F.3d 1356 (2018). As described above, the September 2024 VA examiner indicated that the Veteran does not have a stomach disability, or functional impact from her claimed stomach disability. See C&P Exam, September 2024.

The Board is charged with weighing the positive and negative evidence and resolving reasonable doubt in the Veteran's favor when the evidence is in relative equipoise. Considering the record, including post-service medical evidence and evidence presented by the Veteran, the Board finds that the negative evidence is more
a stomach disability, and she has not alleged that she suffers from any symptomatology associated with the claimed disability that results in functional impairment of earning capacity. Cf. Saunders v. Wilkie, 866 F.3d 1356 (2018). As described above, the September 2024 VA examiner indicated that the Veteran does not have a stomach disability, or functional impact from her claimed stomach disability. See C&P Exam, September 2024.

The Board is charged with weighing the positive and negative evidence and resolving reasonable doubt in the Veteran's favor when the evidence is in relative equipoise. Considering the record, including post-service medical evidence and evidence presented by the Veteran, the Board finds that the negative evidence is more persuasive and of greater evidentiary weight. In conclusion, the Board finds that the evidence is not in approximate balance and is persuasively against the Veteran's claim; thus, the benefit of the doubt rule is therefore inapplicable. See 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

Entitlement to service connection for degenerative arthritis of the neck (a neck disability) is denied.

The Veteran has asserted that while in the military she had an accident that cracked the bone in the back of her neck. See VA 21-526EZ, Fully Developed Claim (Compensation), May 2023.

The Veteran's service treatment records were absent for any neck injury.

The Veteran was afforded a VA examination for her neck in September 2024. The examiner diagnosed the Veteran with degenerative arthritis of the neck. The Veteran reported that she worked as air transportation during active service loading hazardous cargo and lifting pallets and stated that since then she complained of upper back/neck pain. The examiner opined that the Veteran's neck condition was less likely than not due to service. The examiner concluded:

Veteran has claimed arthritis of the neck as being directly related to military service. Based on review of the available evidence, it is less likely than not that the claimed condition is due to service as there is a lack of substantiating evidence supporting a nexus between the current diagnosis of degenerative arthritis of the spine and military service. Service treatment record is silent for chronic complaints, evaluation, treatment and clinical diagnosis for degenerative arthritis of the cervical spine during service. There is no evidence of articular damage on the spine during active service. Without chronicity during service or after service, a post-service event, illness, or injury is considered to be a more likely etiology. See C&P Exam, September 2024.

After reviewing the record, the Board finds that the record contains no indication that the currently diagnosed neck disability is associated with the Veteran's service. As set forth above, the service treatment records do not show any treatment for a neck disorder or related complaints. Further, no medical professional has suggested that the Veteran currently suffers from a neck disorder that was incurred in or aggravated by her active duty service, and the Veteran has not presented, identified, or even alluded to the existence of any such medical evidence or opinion. Finally, the Veteran first complained of chronic neck pain in June 2023, while denying neck pain prior to that date. See CAPRI, November 2023. The complaints of neck pain occurred decades after the Veteran's last active duty service. As such, the Board finds that the probative evidence of record does not establish a medical nexus.

The Board is charged with weighing the positive and negative evidence and resolving reasonable doubt in the Veteran's favor when the evidence is in relative equipoise. Considering the record, including post-service medical evidence and evidence presented by the Veteran, the Board finds that the negative evidence is more persuasive and of greater evidentiary weight. In conclusion, the Board finds that the evidence is not in approximate balance and is persuasively against the Veteran's claim; thus, the benefit of the doubt rule is therefore inapplicable. See 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

Entitlement to service connection for degenerative arthritis with lumbar disc herniation (a lower back disability) is denied.

Entitlement to service connection for bulging discs in back (a lower back disability) is denied.

The Veteran has asserted that while in the military she lifted heavy pallets of cargo, injuring her back and causing bulging discs in her back. See e.g., VA 21-526EZ, Fully Developed Claim (Compensation), June 2024.

The Veteran's service treatment records were absent for any back injury.

The Veteran was first afforded
§ 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

Entitlement to service connection for degenerative arthritis with lumbar disc herniation (a lower back disability) is denied.

Entitlement to service connection for bulging discs in back (a lower back disability) is denied.

The Veteran's service treatment records were absent for any back injury.

The Veteran was first afforded a VA examination for her back in July 2024. The examiner noted the Veteran was diagnosed with lower back pain in 2022. The examiner stated the Veteran reported the onset of pain was 1990 and, "Vet states onset of symptom are a result of her duties while serving active duty. Vet states her job entailed lifting and carrying heavy equipment onto a 10-63L steel pallet loading aircraft & hazardous cargo for 13 years of active duty. She denies an injury." The examiner opined that the Veteran's back condition was less likely than not due to service. The examiner concluded:

Veteran has claimed Bulging Disc in the back as being directly related to military service. Based on review of the available evidence, it is less likely than not that the claimed condition is due to service as there is a lack of substantiating evidence supporting a nexus between the current diagnosis of Low Back Pain and military service. Without chronicity during service or after service, a post-service event, illness, or injury is considered to be a more likely etiology. See C&P Exam, July 2024.

The Veteran was afforded a second VA examination for her back in September 2024. Lumbar disc herniation was diagnosed in 2023. The Veteran reported her back condition onset in 1990. The examiner noted, "[the Veteran] started to have low back pain in the 1990's. States that she used to carry hazardous cargo as part of her job during active service. States that she also lifted some pallet which caused strain on her lower back." The examiner opined that the Veteran's back condition was less likely than not due to service. The examiner concluded:

Veteran has claimed mid/lower back condition as being directly related to military service. Based on review of the available evidence, it is less likely than not that the claimed condition is due to service as there is a lack of substantiating evidence supporting a nexus between the current diagnosis of degenerative arthritis of the spine and lumbar disc herniation and military service. Service treatment record is silent for chronic complaints, evaluation, treatment and clinical diagnosis for degenerative arthritis of the cervical spine during service. There is no evidence of articular damage on the spine during active service. Without chronicity during service or after service, a post-service event, illness, or injury is considered to be a more likely etiology. See C&P Exam, September 2024.

After reviewing the record, the Board finds that the record contains no indication that the currently diagnosed back disabilities are associated with the Veteran's service. As set forth above, the service treatment records do not show any treatment for a back disorder or related complaints. Further, no medical professional has suggested that the Veteran currently suffers from a back disorder that was incurred in or aggravated by her active duty service, and the Veteran has not presented, identified, or even alluded to the existence of any such medical evidence or opinion. Finally, the Veteran first complained of back pain in May 2022, while denying back pain prior to that date. See CAPRI, November 2023. The complaints of back pain occurred decades after the Veteran's last active duty service. As such, the Board finds that the probative evidence of record does not establish a medical nexus.

The Board is charged with weighing the positive and negative evidence and resolving reasonable doubt in the Veteran's favor when the evidence is in relative equipoise. Considering the record, including post-service medical evidence and evidence presented by the Veteran, the Board finds that the negative evidence is more persuasive and of greater evidentiary weight. In conclusion, the Board finds that the evidence is not in approximate balance and is persuasively against the Veteran's claim; thus, the benefit of the doubt rule is therefore inapplicable. See 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

Entitlement to service connection for uterine fibroids is
positive and negative evidence and resolving reasonable doubt in the Veteran's favor when the evidence is in relative equipoise. Considering the record, including post-service medical evidence and evidence presented by the Veteran, the Board finds that the negative evidence is more persuasive and of greater evidentiary weight. In conclusion, the Board finds that the evidence is not in approximate balance and is persuasively against the Veteran's claim; thus, the benefit of the doubt rule is therefore inapplicable. See 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

Entitlement to service connection for uterine fibroids is denied.

The Veteran has asserted that stress of military service caused her uterine fibroids, which she did not have prior to service. See VA 21-526EZ, Fully Developed Claim (Compensation), May 2023.

The Board notes that the AOJ has conceded that the Veteran was exposed to toxic exposure risk activity as an air transportation specialist and exposed to hazardous materials, including engine fluids and fuels. See Rating Decision - Narrative, October 2024.

The Veteran's service treatment records were absent for any uterine fibroid related issues.

The Veteran was first afforded a VA examination for her fibroids in August 2023. Uterine fibroids were diagnosed in 2021. The examiner noted the Veteran stated her fibroids onset in the 1990s with pelvic pain while in the military that Veteran originally thought was menstrual cramps. The examiner opined that the Veteran's fibroids were less likely than not due to toxic exposures in service. The examiner concluded,

Reviewed TERA memo, ILER not available. There is no clear evidence to suggest that the Veteran's uterine fibroids were caused by toxic exposure activities by the veteran. A nexus has not been established. See C&P Exam, August 2023.

The Veteran was afforded a second VA examination for her fibroids in October 2024. The examiner noted that in 2021 the Veteran, "Was being evaluated for chronic pelvic pain and had pelvic imaging done with 'incidental finding' of uterine fibroid." The examiner opined that the Veteran's fibroids were less likely than not due to service. The examiner concluded,

The claimed condition is fibroids and the diagnosis is fibroids. There is no medical or scientific evidence available that identifies a causal relationship between the TERA(s) (toxic exposure risk activity) and the development of the claimed condition of fibroids. It is therefore less likely than not fibroids [are] related to service. A nexus has not been established. See C&P Exam, October 2024.

After reviewing the record, the Board finds that the record contains no indication that the currently diagnosed uterine fibroids are associated with the Veteran's service. As set forth above, the service treatment records do not show any treatment for fibroids or related complaints. Further, no medical professional has suggested that the Veteran currently suffers from uterine fibroids that were incurred in or aggravated by her active duty service, and the Veteran has not presented, identified, or even alluded to the existence of any such medical evidence or opinion. Finally, the Veteran was first diagnosed with uterine fibroids in 2021 or 2022, decades after the Veteran's last active duty service. As such, the Board finds that the probative evidence of record does not establish a medical nexus.

The Board is charged with weighing the positive and negative evidence and resolving reasonable doubt in the Veteran's favor when the evidence is in relative equipoise. Considering the record, including post-service medical evidence and evidence presented by the Veteran, the Board finds that the negative evidence is more persuasive and of greater evidentiary weight. In conclusion, the Board finds that the evidence is not in approximate balance and is persuasively against the Veteran's claim; thus, the benefit of the doubt rule is therefore inapplicable. See 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

Entitlement to service connection for connection for asthma (claimed as breathing problems) is denied.

The Veteran has asserted that her military service working with hazardous cargo caused breathing problems. See VA 21-526EZ, Fully Developed Claim (Compensation), May 2023.

The Veteran
licable. See 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

Entitlement to service connection for connection for asthma (claimed as breathing problems) is denied.

The Veteran has asserted that her military service working with hazardous cargo caused breathing problems. See VA 21-526EZ, Fully Developed Claim (Compensation), May 2023.

The Veteran's service treatment records were absent for lung issues.

The Veteran was first afforded a VA examination for respiratory conditions in August 2023. No diagnosis was rendered upon examination. The examiner concluded:

Veteran has claimed breathing problems due to toxic exposure during service. No diagnosis for a lung condition is rendered during this exam. C-file is silent for a pulmonary diagnosis. PFT is normal, DCLO is low. Further examination by a specialist is warranted to determine a diagnosis. See C&P Exam, August 2023.

The Veteran was afforded a second VA examination for respiratory conditions in September 2024. The examiner noted asthma was diagnosed in June 2023, onset in 2019. The examiner stated, "Veteran reports that she is having rapid heartbeat and shortness of breath. Reports that she was seen at the VA ER and was given treatment and was told she has asthma. Reports that she also given Propranolol for tachycardia. Noted in 6/15/2023 that she was diagnosed with allergy induces-asthma." The examiner opined the Veteran's asthma was less likely than not due to service. The examiner concluded:

Veteran was diagnosed with Allergy induced asthma and was treated with inhaler in 6/2023. Medical literature states that Allergic or allergy-induced asthma is a condition where your airways tighten when you breathe in an allergen. Most often, these allergens are in the air - like dust mites, pollen, animal dander or mold spores. Veteran was exposed to different chemicals during service such as Inorganic Lead, Tetraethyl Lead Cadmium, Chromium, Nickel, and Zinc aircraft metals, jet fuel, diesel fuel, jet exhaust, vehicle exhaust, Petroleum, Oils & Lubricants (POL), hazardous cargo material, human remains, ammunition toxins such as - Lead and Inorganic Compounds as WA, Lead Hydrogen Arsenate, Carbon Monoxide, Copper dust and Mists as copper(CU), Emissions of metals containing high levels of particles of lead (Pb; leaded ammunition), Cadmium(Cd), Antimony(Sb), Chromium(Cr), Nickel (Ni) and Zinc(Zn) as noted on her TERA Memorandum. Service treatment record is silent for any complaints of shortness of breath or difficulty breathing during those exposures. Medical literature also does not support late onset breathing issue reaction to certain exposure which happened long time ago. Therefore, a nexus has not been established.

The examiner further cited medical literature in making their assessment. See C&P Exam, September 2024.

After reviewing the record, the Board finds that the record contains no indication that the currently diagnosed asthma is associated with the Veteran's service. No medical professional has suggested that the Veteran currently suffers from a respiratory disability that was incurred in or aggravated by her active duty service, and the Veteran has not presented, identified, or even alluded to the existence of any such medical evidence or opinion. As such, the Board finds that the probative evidence of record does not establish a medical nexus.

The Board is charged with weighing the positive and negative evidence and resolving reasonable doubt in the Veteran's favor when the evidence is in relative equipoise. Considering the record, including post-service medical evidence and evidence presented by the Veteran, the Board finds that the negative evidence is more persuasive and of greater evidentiary weight. In conclusion, the Board finds that the evidence is not in approximate balance and is persuasively against the Veteran's claim; thus, the benefit of the doubt rule is therefore inapplicable. See 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

Entitlement to service connection for connection for Graves' disease (thyroid disability) is remanded.

The Veteran has asserted that her military service caused a thyroid condition, stating, "While in the military I was diagnosed with Graves' disease which affected my body due to the fact of
negative evidence is more persuasive and of greater evidentiary weight. In conclusion, the Board finds that the evidence is not in approximate balance and is persuasively against the Veteran's claim; thus, the benefit of the doubt rule is therefore inapplicable. See 38 U.S.C. § 5107(b); Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc).

Entitlement to service connection for connection for Graves' disease (thyroid disability) is remanded.

The Veteran has asserted that her military service caused a thyroid condition, stating, "While in the military I was diagnosed with Graves' disease which affected my body due to the fact of producing too much cortisol because of the stress I was experiencing, and affecting my thyroids in the process." See VA 21-526EZ, Fully Developed Claim (Compensation), May 2023.

Graves' disease was noted in April 1997 and July 1997. See STR - Medical, January 2002. A history of Graves' disease was noted in a May 2000 report of medical evaluation. See Medical Treatment Record - Government Facility, January 2002.

The Veteran was first afforded a VA examination for thyroid conditions in October 2023. Graves' disease diagnosed September 2023, which the examiner noted onset in 1995 with sporadic development. The examiner opined the Veteran's Graves' disease was less likely than not due to toxic exposures in service. The examiner concluded:

The Veteran and medical records were reviewed. Upon reviewing medical records there is evidence of diagnosis and treatment during and post service. Upon evaluating the Veteran her symptoms consist of fatigue, loss of appetite, glands swelling, and dysphagia. She is treated with Kelp Iodine Vitamins daily. Review of the TERA Memorandum shows MOS Air Transportation specialist: responsible for securing various loads ranging from equipment, supplies, vehicles (to include engine fluids and fuel), and hazardous and dangerous materials. DOR: 01/17/2002. Review of https://www.publichealth.va.gov/exposures/burnpits/index.asp does not list conditions such as Grave's disease as conditions resulting due to Airborne Hazards and Burn Pit Exposures. Therefore, the Veteran does not have a diagnosis that was caused by (the) Indicated toxic exposure risk activity(ies) after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic combined effect of all toxic exposure risk activities of the Veteran. See C&P Exam, October 2023.

The Veteran was afforded a second VA examination for her thyroid conditions in September 2024. The examiner noted that hyperthyroidism was diagnosed in 1997. The examiner noted, "Veteran reports that she was found to have large thyroid during annual physical. States that during that time that she was very tired. Reports that she was given one radioactive pill in 1998." The examiner opined that the Veteran's thyroid conditions were less likely than not due to service. The examiner concluded:

Veteran has a diagnosis of Hyperthyroidism which includes Grave's disease. Medical literature states that Graves' disease is an autoimmune disorder that causes the immune system to attack the thyroid gland. That prompts the thyroid to make too much thyroid hormone. Graves' disease is the most common cause of hyperthyroidism. Veteran was exposed to solvents and chemicals during service which includes Inorganic Lead, Tetraethyl Lead Cadmium, Chromium, Nickel, and Zinc aircraft metals, jet fuel, diesel fuel, jet exhaust, vehicle exhaust, Petroleum, Oils & Lubricants (POL), hazardous cargo material, human remains, ammunition toxins such as - Lead and Inorganic Compounds as WA, Lead Hydrogen Arsenate, Carbon Monoxide, Copper dust and Mists as copper(CU), Emissions of metals containing high levels of particles of lead (Pb; leaded ammunition), Cadmium(Cd), Antimony(Sb), Chromium(Cr), Nickel (Ni) and Zinc(Zn). Medical literature states that Grave's disease which causes Hyperthyroidism is precipitated by environmental factors like stress, smoking, infection, iodine exposure, and postpartum, as well as after highly active antiretroviral therapy (HAART) due to immune reconstitution. TERA memorandum is silent for iodine exposure during service. Review of medical literature failed to show connection between the exposures and the Hyperthyroid
Hydrogen Arsenate, Carbon Monoxide, Copper dust and Mists as copper(CU), Emissions of metals containing high levels of particles of lead (Pb; leaded ammunition), Cadmium(Cd), Antimony(Sb), Chromium(Cr), Nickel (Ni) and Zinc(Zn). Medical literature states that Grave's disease which causes Hyperthyroidism is precipitated by environmental factors like stress, smoking, infection, iodine exposure, and postpartum, as well as after highly active antiretroviral therapy (HAART) due to immune reconstitution. TERA memorandum is silent for iodine exposure during service. Review of medical literature failed to show connection between the exposures and the Hyperthyroidism which includes Grave's disease. A nexus has not been established.

The examiner cited medical literature in making their assessment. See C&P Exam, September 2024.

However, despite multiple VA examinations and opinions, no VA examiner has yet to opine as to whether the Veteran's periods of active duty which occurred subsequent to her diagnosed thyroid issues may have aggravated her Graves' disease. Therefore, a new VA examination is required to determine if the Veteran's active service may have aggravated her thyroid disability.

Entitlement to service connection for hypertension is remanded.

The Veteran has asserted that her stresses during military service caused her high blood pressure (hypertension). See VA 21-526EZ, Fully Developed Claim (Compensation), May 2023.

A May 2000 report of medical history showed heart palpations/pounding heart. See Medical Treatment Record - Government Facility, January 2002. A two year history of palpations was noted in June 1997, and heart palpations were again noted in September 1999. Hypertension was noted in September 2001. See STR-Medical, January 2002.

The Veteran was first afforded a VA examination for her hypertension in October 2023. Hypertension was diagnosed in September 2023. The examiner noted the condition began with sporadic development in 1988. The examiner concluded:

The Veteran and medical records were reviewed. Upon reviewing medical records there is evidence of diagnosis and treatment of hypertension post service. Upon evaluating the Veteran her symptoms consist of palpitations, occasional dizziness, occipital headaches 3 times a month, and non-pitting lower extremity edema. She is treated with anti- hypertensive medication daily. Review of the TERA Memorandum shows MOS Air Transportation specialist: responsible for securing various loads ranging from equipment, supplies, vehicles (to include engine fluids and fuel), and hazardous and dangerous materials. DOR: 01/17/2002. Review of https://www.publichealth.va.gov/exposures/burnpits/index.asp does not list conditions such as hypertension as conditions resulting due to Airborne Hazards and Burn Pit Exposures. Therefore, the Veteran does not have a diagnosis that was caused by (the) Indicated toxic exposure risk activity(ies) after considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic combined effect of all toxic exposure risk activities of the Veteran. See C&P Exam, October 2023.

The Veteran was afforded a second VA examination for hypertension in September 2024. The examiner noted the Veteran's hypertension was diagnosed in 1995 during her annual physical. The examiner opined the Veteran's hypertension was less likely than not due to service. The examiner concluded:

Medical literature states that there's no identifiable cause of high blood pressure. This type of high blood pressure, called primary (essential) hypertension, tends to develop gradually over many years. HTN has many risk factors including advanced age, race, family history, being overweight or obese, sedentary lifestyle, using tobacco, too much salt intake, drinking alcohol, stress and certain conditions such as kidney problem, diabetes and sleep apnea. Veteran was exposed to chemicals during service as she worked as Air Transportation Specialist. Review of medical literature regarding the toxic exposure risk activities, including but not limited to solvents, fuel, cleaning agents, ammunition, and shop or maintenance materials and by-products related to hypertension failed to show connection or causality between exposure and Hypertension. A nexus has not been established.

The examiner further cited medical literature in making their assessment. See C&P Exam, September 2024.

However, despite multiple VA examinations and opinions, no VA examiner has yet opined as to whether the Veteran's periods of active duty which occurred subsequent
too much salt intake, drinking alcohol, stress and certain conditions such as kidney problem, diabetes and sleep apnea. Veteran was exposed to chemicals during service as she worked as Air Transportation Specialist. Review of medical literature regarding the toxic exposure risk activities, including but not limited to solvents, fuel, cleaning agents, ammunition, and shop or maintenance materials and by-products related to hypertension failed to show connection or causality between exposure and Hypertension. A nexus has not been established.

The examiner further cited medical literature in making their assessment. See C&P Exam, September 2024.

However, despite multiple VA examinations and opinions, no VA examiner has yet opined as to whether the Veteran's periods of active duty which occurred subsequent to her complaints of high blood pressure may have aggravated her hypertension. Therefore, a new VA examination is required to determine if the Veteran's active service may have aggravated her hypertension.

Entitlement to service connection for tachycardia (also claimed as rapid heartbeats) is remanded.

The Veteran has asserted that her stresses during military service caused her rapid heartbeats. See VA 21-526EZ, Fully Developed Claim (Compensation), May 2023.

The Veteran was first afforded a VA examination for her tachycardia in August 2023. Atherosclerotic cardiovascular disease and palpitations were diagnosed in 2022. The Veteran asserted that his rapid heart rate and palpitations onset in 1991 while in the military. The examiner concluded:

Veteran has claimed tachycardia due to the stress experienced while in the military. No objective evidence of tachycardia during exam and medical records are silent for the diagnosis of tachycardia. No diagnosis rendered for tachycardia. See C&P Exam, August 2023.

The Veteran was afforded a second VA examination for tachycardia in July 2024. The examiner noted that the Veteran was diagnosed with tachycardia in 2022. The tachycardia onset in 2007. The examiner opined the Veteran's tachycardia was less likely than not due to service. The examiner concluded:

There is no medical evidence that the vet was evaluated, diagnosed, nor treated for tachycardia while on active duty. vet began having palpitations in 2022 and the vet was prescribed medication for tachycardia on 11/21/202 by her Hampton VA primary care provider. See C&P Exam, July 2024.

The Veteran was afforded a third VA examination for tachycardia in September 2024. The examiner noted tachycardia was diagnosed in 2023, onset in 2021. The examiner stated, "Veteran reports complaints of palpitations at the random moments and was hooked on Holter monitor in 2021 which revealed normal. States that she was seen again at the ER VAMC Hampton due to palpitations and shortness of breath which she was found to have asthma but also started with Propranolol." The examiner concluded:

Veteran has been complaining of tachycardia and she was being treated with Propranolol daily. Veteran was also noted to have history of Grave's disease which can cause hyperthyroidism and she had treatment in 1998 with Radioactive iodine capsule. Medical literature states that Hyperthyroidism happens when the thyroid gland makes too much thyroid hormone. This condition also is called overactive thyroid. Hyperthyroidism speeds up the body's metabolism. That can cause many symptoms, such as weight loss, hand tremors, and rapid or irregular heartbeat. Veteran's tachycardia or palpitations is one of the symptoms of hyperthyroidism. Veteran was exposed to solvents and chemicals during service such as Inorganic Lead, Tetraethyl Lead Cadmium, Chromium, Nickel, and Zinc aircraft metals, jet fuel, diesel fuel, jet exhaust, vehicle exhaust, Petroleum, Oils & Lubricants (POL), hazardous cargo material, human remains, ammunition toxins such as
states that Hyperthyroidism happens when the thyroid gland makes too much thyroid hormone. This condition also is called overactive thyroid. Hyperthyroidism speeds up the body's metabolism. That can cause many symptoms, such as weight loss, hand tremors, and rapid or irregular heartbeat. Veteran's tachycardia or palpitations is one of the symptoms of hyperthyroidism. Veteran was exposed to solvents and chemicals during service such as Inorganic Lead, Tetraethyl Lead Cadmium, Chromium, Nickel, and Zinc aircraft metals, jet fuel, diesel fuel, jet exhaust, vehicle exhaust, Petroleum, Oils & Lubricants (POL), hazardous cargo material, human remains, ammunition toxins such as - Lead and Inorganic Compounds as WA, Lead Hydrogen Arsenate, Carbon Monoxide, Copper dust and Mists as copper(CU), Emissions of metals containing high levels of particles of lead (Pb; leaded ammunition), Cadmium(Cd), Antimony(Sb), Chromium(Cr), Nickel (Ni) and Zinc(Zn). Review of medical literature failed to show connection between the exposures and Tachycardia. A nexus has not been established.

The examiner further cited medical literature in making their assessment. See C&P Exam, September 2024.

Finally, a VA medical opinion was again provided in October 2024 in which the examiner clarified,

I have reviewed the conflicting medical evidence According to the Mayo Clinic, one complication of graves' disease is "Heart conditions. Graves' disease that isn't treated can lead to irregular heart rhythms and changes in the heart and how it works. The heart might not be able to pump enough blood to the body. That condition is called heart failure." Retrieved from: https://www.mayoclinic.org/diseases-conditions/graves-disease/symptoms-causes/syc-20356240 C&P examination on 07/11/2024 confirmed tachycardia. on 6/22/2023 noted Atherosclerotic disease of the aorta (incidentally found on CT of abdomen and pelvis). C&P examination on 9/29/2023 noted that veteran has hypertension and graves' disease/ Medical records noted obesity. Even though some chemical exposure can cause tachycardia, the veteran has a condition of graves' disease which outweighs toxic chemical exposure. Therefore, the veteran's tachycardia cause by her [G]raves' disease and is not a result of toxic chemical exposure. See C&P Exam, October 2024.

However, despite multiple VA examinations and opinions, no VA examiner has yet to opine as to whether the Veteran's periods of active duty which occurred subsequent to her complaints of rapid heartbeats may have aggravated her tachycardia. Therefore, a new VA examination is required to determine if the Veteran's active service may have aggravated her tachycardia.

Additionally, the examiner who provided the October 2024 VA opinion stated that the Veteran's tachycardia was due to her Graves' disease. See C&P Exam, October 2024. Therefore, the adjudication of the tachycardia claim must await development and readjudication of the Veteran's Graves' disease claim, as a claim that is inextricably intertwined with another claim that remains undecided and pending before VA must be adjudicated prior to a final order on the pending claim, so as to avoid piecemeal adjudication. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991).

The matters are REMANDED for the following action:

1. Refer the VA claims file to a medical professional to provide an examination as to the claimed thyroid disability to include Graves' disease. After reviewing the record, the clinician should address the following:

(a) Is it at least as likely as not (likelihood is balanced or nearly equal, if not higher) that the diagnosed thyroid disability which existed before service was aggravated by the Veteran's service or service connected disabilities? If aggravation is found, the examiner must attempt to establish a baseline level of severity prior to aggravation.

2. Refer the VA claims file to a medical professional to provide an examination as to the claimed hypertension. After reviewing the record, the clinician should address the following:

(a) Is it at least as likely as not (likelihood is balanced or nearly equal, if not higher) that the diagnosed hypertension which existed before service was aggravated by the Veteran's service or service connected disabilities? If aggravation is found, the examiner must attempt to establish a baseline level of severity prior to aggravation.

3. Refer the VA claims file to a medical professional to provide an
by the Veteran's service or service connected disabilities? If aggravation is found, the examiner must attempt to establish a baseline level of severity prior to aggravation.

2. Refer the VA claims file to a medical professional to provide an examination as to the claimed hypertension. After reviewing the record, the clinician should address the following:

3. Refer the VA claims file to a medical professional to provide an examination as to the claimed tachycardia. After reviewing the record, the clinician should address the following:

(a) Is it at least as likely as not (likelihood is balanced or nearly equal, if not higher) that the tachycardia which existed before service was aggravated by the Veteran's service or service connected disabilities? If aggravation is found, the examiner must attempt to establish a baseline level of severity prior to aggravation.

(b) If not, is it at least as likely as not (likelihood is balanced or nearly equal, if not higher) that the diagnosed tachycardia is secondary to the Veteran's service-connected disabilities?

Complete rationale should be provided to support the opinions rendered.

(Continued on the next page)

In addressing these questions, the clinician should consider the Veteran's reports of symptoms in service and thereafter, including the nature, onset, progression, and severity of the Veteran's reported symptoms.

Thereafter, readjudicate the claims on appeal.

Frederic P. Gallun

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Axelrad, E

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

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