PERIPHERAL VESTIBULAR DISORDERS

Summary

The Veteran, an Air Force Veteran who served honorably from July 1966 to July 1970, appeals the denial of service connection for benign paroxysmal positional vertigo (BPPV). The Veteran claims BPPV is secondary to his service-connected bilateral hearing loss and tinnitus, citing noise exposure during service as a jet engine mechanic. The Board reviewed evidence including the Veteran's July 2024 VA claim form, an October 2024 AOJ denial, a November 2024 HLR request, a March 2025 HLR denial, and the Veteran's October 2025 Notice of Disagreement. A July 23, 2024 VA examination found BPPV but opined it was less likely than not proximately due to service-connected hearing loss and tinnitus, using an unlawful "proximate cause" standard. A private medical opinion from Dr. J.D. in July 2024, however, found it more likely than not that BPPV is secondarily connected to and aggravated by the service-connected hearing loss and tinnitus. The Board found the VA opinion inadequate due to the Spicer v. McDonough ruling on "but-for" causation. Given the conflicting opinions and the positive private opinion, the Board found the evidence in approximate balance, resolving doubt in the Veteran's favor. Service connection for BPPV is granted as secondary to bilateral hearing loss and tinnitus.

Rationale

Private medical opinion found BPPV more likely than not secondary to and aggravated by service-connected tinnitus and hearing loss.; VA opinion found BPPV less likely than not proximately due to service-connected hearing loss and tinnitus, deemed inadequate due to unlawful "proximate cause" standard.; Evidence in approximate balance; doubt resolved in Veteran's favor.

Full Decision Text

Citation Nr: A26031028
Decision Date: 04/06/26	Archive Date: 04/06/26

DOCKET NO. 251010-597138
DATE: April 6, 2026

ORDER

Entitlement to service connection for benign paroxysmal positional vertigo (BPPV) is granted.

FINDING OF FACT

The Veteran's BPPV is secondary to his service-connected bilateral hearing loss and tinnitus.  

CONCLUSION OF LAW

The criteria for entitlement to service connection for BPPV are met.  See 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served honorably on active duty in the United States Air Force from July 1966 to July 1970.  His awards and decorations include the National Defense Service Medal, among others.

Preliminary Matters

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2025 rating decision issued by a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ).  The rating decision constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. 

Evidence Windows

In July 2024, the Veteran filed a VA Form 21-526EZ seeking service connection for vertigo.  In an October 22, 2024 rating decision, the AOJ denied entitlement to service connection for BPPV.  In November 2024, the Veteran submitted a VA Form 20-0996, Decision Review Request: Higher Level Review (HLR) of the October 2024 rating decision.  The March 2025 HLR rating decision on appeal again denied entitlement to service connection for BPPV.

The Veteran appealed the March 2025 rating decision by filing an October 10, 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), in which he requested a hearing with a Veterans Law Judge (VLJ).  The Veteran testified at a hearing before the undersigned on March 17, 2026.  

Under the AMA framework, the Board may consider (1) evidence in the record at the time of the October 22, 2024 rating decision; (2) evidence submitted by the Veteran or her representative at the March 17, 2026 Board hearing, including testimony; and (3) evidence submitted by the Veteran or his representative within the 90-day period following the March 17, 2026 Board hearing, which is June 15, 2026.

If additional evidence was submitted between the date of the AOJ decision and the hearing, the Board will not consider it unless it is resubmitted during the 90 days following the hearing.  If the Veteran would like VA to consider any evidence that was added to the claims file that the Board could not consider, the Veteran may file a supplemental claim (VA Form 20-0995) and submit or identify this evidence.  See 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.  See also Cook v. McDonough, 36 Vet. App. 175 (2023).

The Board acknowledges that the hearing transcript is not yet associated with the record.  However, considering the Veteran's AOD status and the Board's intent to grant the issue on appeal, the Board exercises its judicial discretion and determines it to be in the Veteran's best interest to proceed with adjudication.  See 38 C.F.R.    §§ 20.1; 20.800(b); Brack v. McDonough, 37 Vet. App. 172 (2024) (citing Veteran's Justice Group, LLC v. Secretary of Veterans Affairs, 818 F. 3d 1336 (Fed. Cir. 2016).

Entitlement to service connection for BPPV is granted.

The Veteran contends that his vertigo is due to noise exposure during his service as a jet engine mechanic and secondary to his hearing loss and tinnitus.  See July 2024 VA Form 21-526EZ.

Establishing direct service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability.  See Davidson
's Justice Group, LLC v. Secretary of Veterans Affairs, 818 F. 3d 1336 (Fed. Cir. 2016).

Entitlement to service connection for BPPV is granted.

The Veteran contends that his vertigo is due to noise exposure during his service as a jet engine mechanic and secondary to his hearing loss and tinnitus.  See July 2024 VA Form 21-526EZ.

Establishing direct service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability.  See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table).

Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability.  See 38 C.F.R. § 3.310(a)-(b).  

Secondary causation exists when, but for the service-connected disability, the non-service-connected was caused by a service-connected disability either in a direct,

etiological way or via multiple steps in a causal chain.  See Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023) (citations omitted).  

Secondary aggravation exists when the non-service-connected disability not caused by a service-connected disability would be less severe were it not for a service-connected disability.  Id. at 1364.  For example, secondary aggravation may be established where the natural progression of the non-service-connected disability could have been arrested or improved but for the service-connected disability.  For "aggravation of non-service-connected disabilities" it is enough to show that "but for" the service-connected disability the incremental-increase in severity of a non-service-connected disease or injury would not have occurred.  Id.

In the March 2025 rating decision on appeal, the AOJ favorably found that the Veteran had a diagnosis of BPPV as shown at the July 23, 2024 VA examination.

Service connection is in effect for bilateral hearing loss and tinnitus.

On July 12, 2024, the Veteran submitted a private medical opinion written by Dr. J.D.  Following a review of the Veteran's medical records, review of the lay statements in support of his claim, and a telehealth visit, Dr. J.D. determined that it is more likely than not that the Veteran's BPPV is secondarily connected to and aggravated by his service-connected tinnitus and hearing loss.

The Board acknowledges that the July 23, 2024 VA examiner provided a negative nexus opinion regarding the relationship of the Veteran's BPPV and his service on a direct basis.  In regard to secondary service connection, the examiner found that the Veteran's BPPV was less likely than not proximately due to or a result of the Veteran's service-connected bilateral hearing loss and/or tinnitus.

The Board finds that the July 23, 2024 VA medical opinion is not compliant with Spicer v. McDonough, 61 F.4th 1360, 1365 (Fed. Cir. 2023).  In Spicer, the Federal Circuit held that 38 U.S.C. § 1110 employs only "but-for" causation in direct and secondary service connection claims.  Therefore, it held 38 C.F.R. § 3.310(b) was unlawful because it required "proximate causation" to establish aggravation of a disability, rather than but-for causation.  The "but-for" causation standard is not limited to a single cause and effect, but rather contemplates multi-causal links, including action and inaction.  Stated another way, "but-for" causation is broad, undisputedly broader than proximate cause.  Thus, a service-connected disability need only be a contributing cause to establish secondary service connection.  In rendering an opinion regarding secondary service connection, the July 23, 2024 VA examiner in this case used the "proximate cause" standard, which has been deemed unlawful by Spicer.  As such, the Board finds that the July 2024 VA medical opinions are inadequate for adjudication purposes.

In light of the positive private
-for causation.  The "but-for" causation standard is not limited to a single cause and effect, but rather contemplates multi-causal links, including action and inaction.  Stated another way, "but-for" causation is broad, undisputedly broader than proximate cause.  Thus, a service-connected disability need only be a contributing cause to establish secondary service connection.  In rendering an opinion regarding secondary service connection, the July 23, 2024 VA examiner in this case used the "proximate cause" standard, which has been deemed unlawful by Spicer.  As such, the Board finds that the July 2024 VA medical opinions are inadequate for adjudication purposes.

In light of the positive private medical opinion relating the Veteran's BPPV to his service-connected bilateral hearing loss and tinnitus, the Board finds the evidence is in approximate balance and resolves doubt in the Veteran's favor.  See 38 U.S.C. § 5107(b), Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021).  Accordingly, service connection for BPPV is warranted as secondary to the Veteran's service-connected bilateral hearing loss and tinnitus.  The claim is granted.

 

 

Colleen M. Glaser-Allen

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	C. Samuelson, Counsel

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