HYPERTENSION

R. BISIGNANI · 2026 · Case ID: A26030325

MIXED

Summary

The veteran served from March 1980 to April 1981. The veteran appeals the denial of service connection for hypertension, tinnitus, traumatic brain injury (TBI), nausea, muscle weakness and pain, bowel incontinence, and urinary incontinence. The Board denied service connection for hypertension, finding no evidence of its manifestation in service or within one year of separation, and no continuity of symptomatology. The Board also denied service connection for tinnitus, noting negative service treatment records and an unfavorable VA opinion that it was less likely than not related to service. For TBI, the Board denied service connection, finding no current diagnosis or residuals of TBI, despite some in-service head injury documentation. The claims for nausea, muscle weakness and pain, bowel incontinence, and urinary incontinence were also denied, as the Board found no etiological connection to service, and the secondary claims to TBI failed because TBI itself was not service-connected. The Board remanded claims for vertigo and migraine headaches due to insufficient VA opinions that failed to adequately address in-service complaints of headaches and dizziness.

Rationale

Service treatment records negative for hypertension; No evidence of hypertension within one year of service; No continuity of symptomatology; No competent medical nexus to service

Special Benefit

NO SPECIAL BENEFIT

Docket No.

201007-127624

Full Decision Text

Citation Nr: A26030325
Decision Date: 04/02/26 Archive Date: 04/02/26

DOCKET NO. 201007-127624
DATE: April 2, 2026

ORDER

Entitlement to service connection for hypertension is denied.

Entitlement to service connection for tinnitus is denied.

Entitlement to service connection for a traumatic brain injury (TBI) is denied.

Entitlement to service connection for nausea is denied.

Entitlement to service connection for muscle weakness and pain is denied.

Entitlement to service connection for bowel incontinence is denied.

Entitlement to service connection for urinary incontinence is denied.

REMANDED

Entitlement to service connection for vertigo is remanded.

Entitlement to service connection for migraine headaches is remanded.

FINDINGS OF FACT

1. Hypertension was not shown in service, did not manifest to a compensable degree within one year of service separation and is not otherwise related to service.

2. Tinnitus was not shown during service or for many years thereafter, and the weight of the probative evidence is against a finding that tinnitus is related to active military service.

3. The Veteran does not have a TBI disability.

4. The Veteran's nausea, muscle weakness and pain, bowel incontinence, and urinary incontinence disabilities were not manifest in service and were not caused or aggravated by a service-connected disability.

CONCLUSIONS OF LAW

1. The criteria for service connection for hypertension, are not met. 38 U.S.C. §§ 1101, 1112, 1113, 1116, 1131, 5103, 5103(A); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2021).

2. Tinnitus was not incurred in or aggravated by active military service. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2021).

3. A TBI disability was not incurred or aggravated during service. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304 (2021).

4. Service connection for a nausea disability, to include as secondary to a service-connected disability, is not warranted. 38 U.S.C. §§ 1110, 1131 (2012) 38 C.F.R. §§ 3.303, 3.304, 3.310, 3.317 (2021).

5. Service connection for a muscle weakness and pain disability, to include as secondary to a service-connected disability, is not warranted. 38 U.S.C. §§ 1110, 1131 (2012) 38 C.F.R. §§ 3.303, 3.304, 3.310, 3.317 (2021).

6. Service connection for a bowel incontinence disability, to include as secondary to a service-connected disability, is not warranted. 38 U.S.C. §§ 1110, 1131 (2012) 38 C.F.R. §§ 3.303, 3.304, 3.310, 3.317 (2021).

7. Service connection for a urinary incontinence disability, to include as secondary to a service-connected disability, is not warranted. 38 U.S.C. §§ 1110, 1131 (2012) 38 C.F.R. §§ 3.303, 3.304, 3.310, 3.317 (2021).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty from March 1980 to April 1981.

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2020 rating decision of a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ).

In his October 7, 2020, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. On December 16, 2020, the Veteran requested to switch to the Hearing docket. The Veteran's request was approved in a March 26, 2024, Board letter.

In July 2024, the Veteran withdrew the hearing request.

Therefore, the Board may only consider the evidence of record at the time of the July 2020 agency
comes before the Board of Veterans' Appeals (Board) on appeal from a July 2020 rating decision of a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ).

In July 2024, the Veteran withdrew the hearing request.

Therefore, the Board may only consider the evidence of record at the time of the July 2020 agency of original jurisdiction (AOJ) decision on appeal, as well as any evidence submitted by the Veteran [or representative] within 90 days following receipt of the withdrawal of the hearing request. 38 C.F.R. § 20.302(b). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to receipt of the withdrawal, or (2) more than 90 days following receipt of the withdrawal, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(b), 20.801.

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

However, because the Board is remanding the claims of service connection for headache and vertigo disabilities, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii).

Service Connection

Laws and Regulations

Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active military service. 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." Davidson v. Shinseki, 581 F.3d 1313, 1315-16 (Fed. Cir. 2009); Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004).

Certain diseases, to include hypertension, may be presumed to have been incurred in service when manifest to a compensable degree within one year of discharge from active duty. 38 U.S.C. § 1112 (2012); 38 C.F.R. §§ 3.307, 3.309 (2021).

Under 38 C.F.R. § 3.303(b), an alternative method of establishing the second and third Shedden for certain chronic disabilities such as hypertension is through a demonstration of continuity of symptomatology.

In relevant part, 38 U.S.C. § 1154(a) requires that the VA give "due consideration" to "all pertinent medical and lay evidence" in evaluating a claim to disability or death benefits. Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional." Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed.Cir.2007). In fact, competent medical evidence is not necessarily required when the determinative issue involves either medical etiology or a medical diagnosis. Id. at 1376-77; see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno, supra (distinguishing between competency
." Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed.Cir.2007). In fact, competent medical evidence is not necessarily required when the determinative issue involves either medical etiology or a medical diagnosis. Id. at 1376-77; see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009).

Once evidence is determined to be competent, the Board must determine whether such evidence is also credible. See Layno, supra (distinguishing between competency ("a legal concept determining whether testimony may be heard and considered") and credibility ("a factual determination going to the probative value of the evidence to be made after the evidence has been admitted").

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b).

Under 38 C.F.R. § 3.310(a), service connection may be granted for disability that is proximately due to or the result of a service- connected disease or injury. Such permits a grant of service connection not only for disability caused by a service-connected disability, but for the degree of disability resulting from aggravation to a nonservice- connected disability by a service- connected disability. Id. See also Allen v. Brown, 7 Vet. App. 439, 448 (1995); 38 C.F.R. § 3.310(b).

In order to prevail on the issue of entitlement to secondary service connection, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

Hypertension

Regulations provide that hypertension for VA purposes means that the diastolic blood pressure is predominantly 90 or more or systolic blood pressure is predominantly 160 or more. Hypertension must be confirmed by readings taken two or more times on three different days. 38 C.F.R. § 4.104, Diagnostic Code 7101, Note (1).

The Veteran's service treatment records are negative for complaints or treatments of elevated blood pressure or hypertension. Notably, his March 1981 separation examination showed a blood pressure reading of 102/60.

When considering the pertinent evidence of record in light of the above-noted legal authority, the Board finds that service connection for hypertension is not warranted.

The Board initially notes that there is some question as to whether the Veteran has a current diagnosis of hypertension. Notably, VA treatment reports reflect blood pressure readings of 123/87 and 130/86 in March 2020.

As reflected above, hypertension for VA purposes means that the diastolic blood pressure is predominantly 90 or more or systolic blood pressure is predominantly 160 or more.

However, even assuming the Veteran has a current diagnosis of hypertension, a veteran seeking disability benefits must establish not only the existence of a disability, but also an etiological connection between his military service and the disability. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); D'Amico v. West, 209 F.3d 1322, 1326 (Fed. Cir. 2000); Hibbard v. West, 13 Vet. App. 546, 548 (2000).

As noted above, service connection may be granted on a presumptive basis for certain chronic diseases, including hypertension if such a disability is shown to be manifest to a degree of 10 percent or more within one year following the Veteran's separation from active military service. See 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. However, service connection for hypertension on a presumptive basis is not warranted as the record does not show evidence of hypertension within one year of the Veteran's separation from active duty.

To the extent that the Veteran is asserting that he experienced continuing symptoms of hypertension thereafter, the Board acknowledges that a layperson is competent to testify in regard to the onset and continuity of symptomatology. Heuer v. Brown, 7 Vet. App. 379, 384 (1995); Falzone v. Brown, 8 Vet. App. 398, 403 (1995); Caldwell v. Der
1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. However, service connection for hypertension on a presumptive basis is not warranted as the record does not show evidence of hypertension within one year of the Veteran's separation from active duty.

To the extent that the Veteran is asserting that he experienced continuing symptoms of hypertension thereafter, the Board acknowledges that a layperson is competent to testify in regard to the onset and continuity of symptomatology. Heuer v. Brown, 7 Vet. App. 379, 384 (1995); Falzone v. Brown, 8 Vet. App. 398, 403 (1995); Caldwell v. Derwinski, 1 Vet. App. 466 (1991). Furthermore, lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (finding that the Board's categorical statement that "a valid medical opinion" was required to establish nexus, and that a layperson was "not competent" to provide testimony as to nexus because she was a layperson, conflicts with Jandreau).

However, as the Veteran was not diagnosed with hypertension until many years after service and there was a significant period between his service and his post-service complaints where the medical record was silent for complaints of hypertension, the Board concludes that the weight of the evidence is against a finding of any continuity of symptomatology.

Regarding service connection on a direct basis, the Board notes that the Veteran's service treatment records are negative for complaints or treatments of elevated blood pressure or hypertension.

Further, there is no competent evidence or opinion even suggesting that there exists a medical nexus between a current hypertension disability and the Veteran's service and the Veteran has not presented or identified any such existing medical evidence or opinion.

As a result, the Board finds that the competent evidence of record, while showing the currently diagnosed hypertension disability, does not demonstrate that the Veteran's hypertension is related to the Veteran's service on a direct basis.

The Board notes that the Veteran was not provided with a VA examination and opinions to assess the current nature and etiology of his claimed hypertension disability. However, VA need not conduct an examination with respect to the claim on appeal, as information and evidence of record contains sufficient competent medical evidence to decide the claim. See 38 C.F.R. § 3.159(c) (4). Under McLendon v. Nicholson, 20 Vet. App. 79 (2006), in disability compensation (service connection) claims, the VA must provide a VA medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. Simply stated, the standards of McLendon are not met in this case as there is no credible evidence that the hypertension disability manifested in service or within a year of separation from service. There is also no competent evidence suggesting that this disability is otherwise associated to service. Thus, remand for a VA examination is not necessary.

In sum, the Board finds that service connection for hypertension must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the most persuasive evidence is against the claims, that doctrine is not applicable. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990).

Tinnitus

The Veteran's service treatment records are negative for complaints of, treatment for, or findings of tinnitus.

The Veteran underwent a VA examination in June 2020. The examiner opined that it was less likely than the Veteran's claimed tinnitus was caused by or a result of military noise exposure. The examiner noted that there was no significant permanent shift in hearing thresholds from enlistment to separation examination which was objective evidence of no permanent auditory damage from conceded noise on active duty. There was also no report of tinnitus in the service treatment records or on separation. There was also no chronicity of care for tinnitus since the onset occurred after service. In this instance, the onset of tinnitus from 5 to 15 years post separation did not support late onset noise-induced t
are negative for complaints of, treatment for, or findings of tinnitus.

When considering the pertinent evidence of record in light of the above-noted legal authority, the Board finds that service connection for a tinnitus disability is not warranted.

The record shows that the Veteran currently has a diagnosis of bilateral tinnitus. As a result, the first element of service connection is satisfied.

However, a veteran seeking disability benefits must establish not only the existence of a disability, but also an etiological connection between his military service and the disability. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); D'Amico v. West, 209 F.3d 1322, 1326 (Fed. Cir. 2000); Hibbard v. West, 13 Vet. App. 546, 548 (2000).

Turning to in-service injury, the Board notes that the Veteran has asserted that he sustained acoustic trauma during service. In this regard, the Veteran is competent to give evidence about what he experienced, and acoustic trauma is subject to lay observation. See e.g., Layno v. Brown, 6 Vet. App. 465 (1994); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1337 (2006). Therefore, the Board finds that the Veteran was exposed to hazardous noise during service and noise exposure has been conceded.

However, the Veteran's service treatment records are negative for complaints or treatments regarding a tinnitus disability.

Additionally, the Board notes that there are no clinical findings or diagnoses of tinnitus during service or for several years thereafter.

None of the VA treatment records show that the Veteran was diagnosed with tinnitus to a compensable degree within one year of service. To the extent that the Veteran is asserting a continuity of symptomatology since service, the Board does not find the Veteran to be credible with regard to any assertions that he has had symptoms of tinnitus since service. There was no indication in the record, to include any statements from the Veteran of hearing trouble or tinnitus within one year of his separation. On the contrary, the lack of any findings pertaining to hearing loss during service weigh against a finding that the Veteran's current tinnitus was originally manifested during service and have continued since service.

As the Veteran's service treatment records were negative for any complaints, treatment, or diagnoses of a hearing loss disability or tinnitus and there was a significant period between his service and his post-service complaints where the medical record was silent for complaints of tinnitus, the Board concludes that the weight of the evidence is against a finding of continuity of symptomatology since service.

Additionally, the most probative opinions do not show a relationship between the tinnitus disability and the Veteran's in-service noise exposure.

As noted above, the June 2020 VA examiner determined that it was less likely as not that the Veteran's tinnitus was caused by or a result of military noise exposure.

The Board finds the June 2020 VA examiner's opinions to be highly probative, as they were based on a thorough review of the Veteran's medical records, cited to relevant medical principles and specifically addressed the Veteran's contentions. The opinions are also consistent with the other evidence of record and are supported by detailed rationale. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (noting that factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion.).

None of the competent medical evidence currently of record refutes this conclusion, and the Veteran has not presented any such existing medical evidence or opinion.

Given that the most probative opinions are against a finding of a relationship between a claimed tinnitus disability and service, the Board finds that service connection is not warranted.

For the foregoing reasons, the Board concludes that the most persuasive evidence is against the claim of entitlement to service connection for tinnitus. The benefit of the doubt
v. West, 13 Vet. App. 444, 448-9 (2000) (noting that factors for assessing the probative value of a medical opinion are the physician's access to the claims file and the thoroughness and detail of the opinion.).

None of the competent medical evidence currently of record refutes this conclusion, and the Veteran has not presented any such existing medical evidence or opinion.

Given that the most probative opinions are against a finding of a relationship between a claimed tinnitus disability and service, the Board finds that service connection is not warranted.

For the foregoing reasons, the Board concludes that the most persuasive evidence is against the claim of entitlement to service connection for tinnitus. The benefit of the doubt doctrine is therefore not applicable, and the claim must be denied. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Fagan v. Shinseki, 573 F.3d 1282, 1287 (Fed. Cir. 2009).

TBI

The Veteran contends that he has a current TBI that resulted from service to include his time as a boxer while in service.

The Veteran's service treatment records are negative for complaints, treatments or diagnoses of a TBI. However, a September 1980 service treatment record noted that the Veteran had a scalp laceration and contusion while the Veteran on his March 1981 Report of Medical History for separation noted a history of headaches and a head injury.

The Veteran underwent a VA examination in June 2020. The examiner noted that the Veteran did not have a diagnosis of a TBI. The examiner opined that it was less likely than not that the Veteran had a TBI disability that was incurred in or caused by the claimed in-service event, injury or illness. It was noted that the Veteran boxed for a few months while in service but there was no documentation of any injury or head treatment as a result of a boxing injury. In September 1980, he suffered a laceration and contusion on his scalp as a result of a fall, but he recovered with no sequelae. The examiner concluded that the Veteran did not suffer a TBI as a result of an in-service head injury.

The Board concludes that service connection is not warranted for a TBI disability as the Veteran has not been shown to have a current TBI disability.

Notably, the Veteran's service treatment records demonstrate that he sustained a head laceration and contusion from a fall in September 1980.

However, despite this in-service head injury, the Board again notes that the record does not demonstrate that the Veteran has a current TBI disability or residuals of a TBI injury.

In this case, the persuasive medical evidence demonstrates that the Veteran does not currently have a diagnosis or history of a TBI or residuals of a TBI injury.

Additionally, the June 2020 VA examiner's opinion specifically found that the Veteran did not have a current TBI or a history of a TBI or residuals of a TBI. The June 2020 VA examiner conducted a review of the record, an examination and provided a medical explanation for why the Veteran's symptoms did not meet the diagnosis of a TBI or residuals of a TBI.

The June 2020 VA examiner's opinion is plausible and consistent with the evidence of record. Caluza v. Brown, 7 Vet. App. 498 (1995).

Consequently, the Board considers the June 2020 VA examination to be highly probative evidence weighing against a current diagnosis of a TBI.

Additionally, while statements from the Veteran reflect his continued assertion that he has a TBI, the most probative medical evidence does not support his opinion. While the Veteran is competent to report symptoms, he is not necessarily competent to attribute such symptoms to a specific underlying TBI disorder. In this regard, the Board ultimately places more weight on the medical opinions and clinical findings of record on the matter of whether the Veteran has a current diagnosis of a TBI.

Accordingly, the Board finds that the most persuasive evidence is against the claim as the Veteran does not have a current diagnosis of a TBI to include residual headaches.

Hence, whereas here, the competent evidence establishes that the Veteran does not have the disability for which service connection is sought, there can be no valid claim for service connection. See Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). In the instant appeal, the claim for service connection for a TBI must be denied because the first criterion for the grant of service connection-competent evidence of the disability for which service connection is sought-is not met.

In sum, for
the Veteran does not have a current diagnosis of a TBI to include residual headaches.

In sum, for the reasons and bases expressed above the Board finds that the most persuasive evidence is against the Veteran's claim of entitlement to service connection for a TBI disability. The benefit-of-the-doubt rule does not apply, and the claim must be denied. 38 U.S.C. § 5107(b).

Nausea, Muscle Weakness and Pain, Bowel and Urinary Incontinence

The Veteran's service treatment records are negative for complaints or treatments related to nausea, muscle weakness and pain or bowel or urinary incontinence disabilities.

When considering the pertinent evidence of record in light of the above-noted legal authority, the Board finds that service connection for nausea, muscle weakness and pain, bowel incontinence and urinary incontinence disabilities is not warranted.

The Board initially notes that there is some question as to whether the Veteran has current diagnoses of nausea, muscle weakness and pain or bowel or urinary incontinence disabilities.

Notably, no specific nausea, muscle weakness and pain or bowel or urinary incontinence disabilities are demonstrated in the record. However, the Veteran has presented with reports of nausea, muscle weakness and pain and bowel and urinary incontinence disabilities.

As a result, and when affording the Veteran the benefit of the doubt, the Board finds that the Veteran has current nausea, muscle weakness and pain, and bowel and urinary incontinence disabilities.

As there is a current diagnosis of nausea, muscle weakness and pain, and bowel and urinary incontinence disabilities, the first element of service connection is satisfied. However, a veteran seeking disability benefits must establish not only the existence of a disability, but also an etiological connection between his military service and the disability. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); D'Amico v. West, 209 F.3d 1322, 1326 (Fed. Cir. 2000); Hibbard v. West, 13 Vet. App. 546, 548 (2000).

However, the Board finds that the evidence is against a finding that the Veteran's nausea, muscle weakness and pain, and bowel and urinary incontinence disabilities are otherwise etiologically related to his service.

As noted above, the service treatment records were negative for any or diagnoses of any nausea, muscle weakness and pain, and bowel and urinary incontinence disabilities.

Further, there is no competent evidence or opinion even suggesting that there exists a medical nexus between current nausea, muscle weakness and pain, and bowel and urinary incontinence disabilities and the Veteran's service and the Veteran has not presented or identified any such existing medical evidence or opinion.

The Board finds that the competent evidence of record, while showing the currently diagnosed nausea, muscle weakness and pain, and bowel and urinary incontinence disabilities, does not demonstrate that the Veteran's nausea, muscle weakness and pain, and bowel and urinary incontinence disabilities are related to the Veteran's service.

Regarding service connection on a secondary basis, as noted above, service connection may be granted for a disability that is proximately due to or the result of an established service-connected disability. 38 C.F.R. § 3.310 (2021).

The Veteran has claimed that his nausea, muscle weakness and pain, and bowel and urinary incontinence disabilities are the result of his TBI which was incurred during his service. However, the Veteran is not currently service connected for a TBI disability as addressed above.

Hence, as a matter of law, the claims for service connection for nausea, muscle weakness and pain, bowel incontinence and urinary incontinence disabilities as secondary to a TBI disability are without legal merit, and must be denied as a matter of law. See 38 C.F.R. § 3.310(a); Sabonis v. Brown, 6 Vet. App. 426, 430 (1994).

As a result, the Board finds that service connection for nausea, muscle weakness and pain, bowel incontinence and urinary incontinence disabilities on a secondary basis is not warranted.

The Board
his service. However, the Veteran is not currently service connected for a TBI disability as addressed above.

As a result, the Board finds that service connection for nausea, muscle weakness and pain, bowel incontinence and urinary incontinence disabilities on a secondary basis is not warranted.

The Board notes that the Veteran was not provided with VA examinations and opinions to assess the current nature and etiology of his claimed nausea, muscle weakness and pain, bowel incontinence and urinary incontinence disabilities. However, VA need not conduct an examination with respect to the claims on appeal, as information and evidence of record contains sufficient competent medical evidence to decide the claims. See 38 C.F.R. § 3.159(c) (4). Under McLendon v. Nicholson, 20 Vet. App. 79 (2006), in disability compensation (service connection) claims, the VA must provide a VA medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the VA to make a decision on the claim. Simply stated, the standards of McLendon are not met in this case as there is no credible evidence that the nausea, muscle weakness and pain, bowel incontinence and urinary incontinence disabilities manifested in service. There is also no competent evidence suggesting that these disabilities are otherwise associated to service. Thus, remand for VA examinations is not necessary.

In sum, for the reasons and bases expressed above the Board finds that the most persuasive evidence is against the Veteran's claims of entitlement to service connection for nausea, muscle weakness and pain, bowel incontinence and urinary incontinence disabilities. The benefit-of-the-doubt rule does not apply, and the claims must be denied. 38 U.S.C. § 5107(b).

All Disabilities

The Board notes the Veteran and his representative's contentions regarding the etiology of the claimed hypertension, tinnitus, TBI, nausea, muscle weakness and pain, bowel incontinence, and urinary incontinence disabilities. To the extent that the Veteran and his representative themselves contend that a medical relationship exists between the Veteran's claimed hypertension, tinnitus, TBI, nausea, muscle weakness and pain, bowel incontinence, and urinary incontinence disabilities and his service, the Board acknowledges that the Veteran is competent to testify as to his observations. Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). Furthermore, lay witnesses may, in some circumstances, opine on questions of diagnosis and etiology. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) (finding that the Board's categorical statement that "a valid medical opinion" was required to establish nexus, and that a layperson was "not competent" to provide testimony as to nexus because she was a layperson, conflicts with Jandreau). In the instant case, however, the Board finds that hypertension, tinnitus, TBI, nausea, muscle weakness and pain, bowel incontinence, and urinary incontinence disabilities are not disabilities subject to lay diagnosis as these diagnoses require medical training. More significantly, the Veteran and his representative do not have the medical expertise to provide an opinion regarding the claimed hypertension, tinnitus, TBI, nausea, muscle weakness and pain, bowel incontinence, and urinary incontinence disabilities etiologies. Specifically, where the determinative issue is one of medical causation, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. See Jones v. West, 12 Vet. App. 460, 465 (1999). Additionally, the VA examiners provided detailed rationales in support of their opinions and cited to the relevant evidence. For this reason, the VA examiners' opinions are the most probative evidence of record. See Prejean v. West, 13 Vet. App.
to provide an opinion regarding the claimed hypertension, tinnitus, TBI, nausea, muscle weakness and pain, bowel incontinence, and urinary incontinence disabilities etiologies. Specifically, where the determinative issue is one of medical causation, only those with specialized medical knowledge, training, or experience are competent to provide evidence on the issue. See Jones v. West, 12 Vet. App. 460, 465 (1999). Additionally, the VA examiners provided detailed rationales in support of their opinions and cited to the relevant evidence. For this reason, the VA examiners' opinions are the most probative evidence of record. See Prejean v. West, 13 Vet. App. 444, 448-9 (2000) (noting that a factor for assessing the probative value of a medical opinion includes the thoroughness and detail of the opinion).

Thus, the Veteran and his representative's assertions that there is a relationship between the claimed hypertension, tinnitus, TBI, nausea, muscle weakness and pain, bowel incontinence, and urinary incontinence disabilities and the Veteran's service are not sufficient in this instance and are outweighed by other probative evidence of record. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007).

REASONS FOR REMAND

The Board finds that more development is necessary prior to final adjudication of the claims remaining on appeal.

Regarding the Veteran's claimed migraine headache and vertigo disabilities, the Veteran underwent VA examination in July 2020. The VA examiner opined that the Veteran's current migraine headache and vertigo disabilities were less likely than not incurred in or caused by claimed in-service event, injury or illness. In making this determination, the VA examiner indicated that the Veteran's service treatment records do not show any treatment for migraine headache and vertigo "during active service nor during the presumptive timeline period".

However, the July 2020 VA opinions were insufficient as the examiner did not acknowledge the Veteran's prior medical history regarding his migraine headache and vertigo disabilities. While the July 2020 VA examiner indicated that there were no service treatment records to indicate that these conditions occurred in service, the Veteran's service treatment records document that the Veteran, on the March 1981 Report of Medical History at his separation, presented with complaints of recurrent headaches and dizziness. The service treatment records additionally demonstrate that in September 1980, the Veteran had a scalp laceration and contusion for which he was treated for headaches. Despite these complaints, the July 2020 VA examiner again found that there were no in-service migraine headache or vertigo complaints.

Thus, the Board finds that the evidence currently of record is insufficient to resolve the claims for entitlement to service connection for migraine headache and vertigo disabilities and that further opinion in connection with these claims is necessary for a fully informed evaluation of the claims on appeal. Green v. Derwinski, 1 Vet. App. 121, 124 (1991); 38 C.F.R. § 3.159(c) (4).

The Board noted that AMA provides that remands are warranted based on VA's duty to assist prior to the AOJ decision. Pub. L. No. 115-55, § 2(d)(2). The AMA structure allows remand only where VA has committed error in the duty-to-assist (DTA) prior to the decision on appeal. After a thorough review of the record, the Board finds the arguments of the Veteran's representative to be compelling. In requesting additional development on remand in this case, the Board notes that the basis for this remand arises from deficiencies in the record existing prior to the appealed AMA decision. Notably, prior to the rating decision, there was evidence of a possible in-service incurrence of migraine headache and vertigo disabilities as the Veteran's service treatment records demonstrate complaints of migraine headache and dizziness. As noted above, despite the in-service complaints of migraine headache and dizziness, the VA examinations in July 2020 failed to address the Veteran's in service migraine headache and dizziness complaints as the examiner instead opined that that there were no service treatment records to indicate that these conditions occurred in service.

Thus, the Board finds that a remand is necessary in order to provide the Veteran with etiological opinions with respect to these claimed conditions as there exists a pre-decisional duty to assist error and the claims must be remanded.

The matters are REMANDED for the following action:

The Veteran should be scheduled for a VA examination to determine the etiology of the claimed migraine headache and vertigo disabilities.

Based on a review of the record and an examination of the Veteran, the examiner should provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly
dizziness complaints as the examiner instead opined that that there were no service treatment records to indicate that these conditions occurred in service.

The matters are REMANDED for the following action:

The Veteran should be scheduled for a VA examination to determine the etiology of the claimed migraine headache and vertigo disabilities.

Based on a review of the record and an examination of the Veteran, the examiner should provide an opinion as to whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's has current migraine headache and vertigo disabilities that are related to any incident of the Veteran's active-duty service.

The examiner should specifically consider the Veteran's documented in-service complaints of migraine headache and dizziness on his March 1981 Report of Medical History.

All opinions expressed by the examiner must be accompanied by a complete rationale.

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Adequate reasons and bases for any opinion rendered must be provided. All studies deemed appropriate in the medical opinion of the examiner should be performed, and all the findings should be set forth in detail. The claims file should be made available to the examiner, who should review the entire claims folder in conjunction with this examination.

R. Bisignani

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board James A. DeFrank

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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