Case A26031189

A. P. SIMPSON · 2026 · Case ID: A26031189

MIXED

Summary

The veteran, who served in the United States Army from April 25, 2009, to December 11, 2009, and again from May 26, 2018, to May 11, 2019, with additional Reserve duty, appealed the denial of service connection for several conditions, including bilateral hearing loss, left elbow disability, psychiatric disorder, bilateral vision disability, left foot plantar fasciitis, and headache disability. During a November 2024 hearing, the veteran withdrew the appeals for bilateral hearing loss and left elbow disability, which were subsequently dismissed. The Board granted an earlier effective date of October 14, 2020, for the service connection of unspecified trauma-and stressor-related disorder, finding the veteran's claim for an earlier date warranted. The Board denied service connection for bilateral vision disability, finding the evidence persuasively weighed against a current disability, noting the veteran's separation physicals and subsequent medical records did not document such a condition. Similarly, service connection for left foot plantar fasciitis was denied, as the evidence did not support an in-service injury or disease, with the Board finding the veteran's contentions about the onset of his condition not credible and the private medical opinion submitted lacking probative value due to factual inaccuracies. The Board remanded the claim for headache disability for a new VA examination and opinion to determine its relationship to toxic exposure risk activity, acknowledging the veteran's participation in TERA and a private opinion linking headaches to a psychiatric disorder.

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

210421-154437

Full Decision Text

Citation Nr: A26031189
Decision Date: 04/06/26 Archive Date: 04/06/26

DOCKET NO. 210421-154437
DATE: April 6, 2026

ORDER

1. The appeal for entitlement to service connection for a bilateral hearing loss disability has been withdrawn and is dismissed.

2. The appeal for entitlement to service connection for a left elbow disability, to include status post bicep tendonitis, has been withdrawn and is dismissed.

3. Entitlement to an effective date of October 14, 2020 for the award of service connection for unspecified trauma-and stressor-related disorder is granted.

4. Entitlement to service connection for a bilateral vision disability is denied.

5. Entitlement to service connection for left foot plantar fasciitis is denied.

REMANDED

6. Entitlement to service connection for a headache disability is remanded.

FINDINGS OF FACT

1. During the November 2024 Board hearing, the Veteran withdrew the appeal for service connection for a bilateral hearing loss disability.

2. During the November 2024 Board hearing, the Veteran withdrew the appeal for service connection for a left elbow disability, to include status post bicep tendonitis.

3. The Veteran first submitted a claim for service connection for anxiety disorder on October 14, 2020, which was pending at the time of the award of service connection for unspecified trauma-and stressor-related disorder.

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

5. The evidence persuasively weighs against finding that the Veteran's left foot plantar fasciitis was incurred in or otherwise related to service.

CONCLUSIONS OF LAW

1. The criteria for withdrawal of service connection for a bilateral hearing loss disability by the appellant have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

2. The criteria for withdrawal service connection for a left elbow disability, to include status post bicep tendonitis, by the appellant have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.205.

3. The criteria for effective date of October 14, 2020 for the award of service connection for unspecified trauma-and stressor-related disorder have been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.155; 3.400.

4. The criteria for service connection for a bilateral vision disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a).

5. The criteria for service connection for left foot plantar fasciitis have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a).

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from April 25, 2009 to December 11, 2009 and from May 26, 2018 to May 11, 2019 with additional periods of Reserve duty.

This appeal comes to the Board of Veterans' Appeals (Board) from a December 2020 rating decision by the agency of original jurisdiction (AOJ), which denied service connection for a bilateral hearing loss disability, a left elbow disability, a psychiatric disorder, a bilateral vision disability, left foot plantar fasciitis, and a headache disability. The Veteran appealed the decision to the Board by submitting an April 2021 VA Form 10182, Notice of Disagreement, and electing the Hearing docket. The hearing before the Board was held on November 13, 2024.

In a Hearing appeal under the Appeals Modernization Act, the Board may consider only the evidence of record at the time of the December 2020 decision on appeal, as well as any evidence submitted by the Veteran and/or the representative on or within 90 days from the date of the Veteran's hearing, which would have been on February 11, 2025. 38 C.F.R. § 20.302. The Board cannot consider (1) evidence submitted during the period after the AOJ issued the decision on appeal and before the date of the Veteran's Board hearing or (2) evidence submitted more than 90 days after the Veteran's Board hearing. 38 C.F.R. § 20.302. Following the hearing, additional evidence has been submitted, which the Board has considered
Board may consider only the evidence of record at the time of the December 2020 decision on appeal, as well as any evidence submitted by the Veteran and/or the representative on or within 90 days from the date of the Veteran's hearing, which would have been on February 11, 2025. 38 C.F.R. § 20.302. The Board cannot consider (1) evidence submitted during the period after the AOJ issued the decision on appeal and before the date of the Veteran's Board hearing or (2) evidence submitted more than 90 days after the Veteran's Board hearing. 38 C.F.R. § 20.302. Following the hearing, additional evidence has been submitted, which the Board has considered.

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 claim for service connection for a headache disability, 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).

1. The appeal for entitlement to service connection for a bilateral hearing loss disability

2. The appeal for entitlement to service connection for a left elbow disability, to include status post bicep tendonitis

In November 2024, the Veteran testified at a virtual hearing before a Veterans Law Judge (VLJ). The Veteran testified that he wished to withdraw the appeal with relation to the claims for service connection for a bilateral hearing loss disability and a left elbow disability. At the hearing, the Veteran was represented by an experienced counsel in veterans law.

The VLJ informed the Veteran of the consequences for the withdrawal of the two issues. For example, she stated that if he withdrew the issues, it would mean that he was no longer pursuing these two issues, and that the Board would not make a decision on the merits. She added that he would be able to obtain additional compensation based on these particular issues only if he filed a new claim. She asked if he fully understood the consequences that she had discussed with him and asked if he still wanted to withdraw these two claims, and the Veteran replied, "Yes, I understand and would like to move forward, Your Honor." See Transcript on p. 2.

The Board finds that the Veteran's statements under oath of wanting to withdraw the two issues of entitlement to service connection for a bilateral hearing loss disability and for a left elbow disability at the November 2024 Board hearing were (1) explicit, (2) unambiguous, and (3) done with a full understanding of the consequences of such action on the part of the claimant. DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011); see Acree v. O'Rourke, 891 F.3d 1009, 1014 (Fed. Cir. 2018).

The Board may dismiss any appeal which fails to allege specific errors of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.205. Withdrawal may be made by the appellant or by his or her authorized representative. 38 C.F.R. § 20.205.

In the present case, the Veteran, in attendance with his attorney, has withdrawn these two issues and, hence, there remain no allegations of errors of fact or law for appellate consideration. Accordingly, the Board does not have jurisdiction to review these two claims, and they are dismissed.

3. Entitlement to service connection for unspecified trauma-and stressor-related disorder prior to November 15, 2021.

The Veteran contends that he is entitled to an earlier effective date for the award of service connection for unspecified trauma-and stressor-related disorder, prior to November 15, 2021. At the November 2024 Board hearing, the Veteran stated that as he had been granted service connection for unspecified trauma-and stressor-related disorder since the time of his appeal, he wished his claim to be construed as a claim for an earlier effective date for the grant of service connection. The Board finds that the issue is not necessarily an earlier effective date versus entitlement to service connection for unspecified trauma-and stressor-related disorder prior to November 15, 2021
to service connection for unspecified trauma-and stressor-related disorder prior to November 15, 2021.

On October 14, 2020, the Veteran submitted a completed VA Form 21-526EZ, Fully Developed Claim, seeking service connection for anxiety. In the December 2020 rating decision currently on appeal, service connection for anxiety was denied, and the Veteran appealed this decision with the submission of an April 2021 VA Form 10182.

While the appeal was pending, on November 15, 2021, the Veteran submitted a new VA Form 21-526EZ, seeking service connection for posttraumatic stress disorder (PTSD). In a January 2022 rating decision, the AOJ granted service connection for unspecified trauma-and stressor-related disorder, effective November 15, 2021. The AOJ explained that this was the date of the Veteran's claim. While this is technically correct, as the Veteran submitted a new VA Form 21-526EZ on November 15, 2021, the Board finds that, in this case, because the Veteran submitted an October 14, 2020 VA Form 21-526EZ, and the subsequent appeal stream was pending before VA at the time of the grant of service connection, the Veteran is entitled to an effective date of October 14, 2020 for the award of service connection for the psychiatric disorder.

In summary, resolving all doubt in favor of the Veteran, the Board finds that an effective date of October 14, 2020 for the award of service connection for unspecified trauma-and stressor-related disorder is warranted.

Service Connection

Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by 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. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d).

4. Entitlement to service connection for a bilateral vision disability

At the November 2024 Board hearing, the Veteran contended that the psychiatric disorder has caused or impacted a bilateral vision disability. Specifically, he stated that his left eye would twitch, which he believed was related to the psychiatric disorder.

The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the award of service connection for a bilateral vision disability. The reasons follow.

The question before the Board in this case is whether the Veteran has a current bilateral vision disability that began during service or is at least as likely as not related to an in-service injury, event, or disease or is caused or aggravated by a service-connected disability. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. §§ 3.303, 3.310. For service connection to be established, there needs to be competent evidence of a current disability. However, here the Board finds that the evidence persuasively weighs against a finding that the Veteran has a current a bilateral vision disability and has not had one at any time during the pendency of the claim or recent to the filing of the claim, to include symptoms that cause functional impairment of earning capacity.

A March 2019 Report of Medical Examination at separation from service shows that the Veteran had a clinically normal psychiatric evaluation and normal evaluation of the eyes, although an ophthalmoscopic examination was not performed. A March 2019 Report of Medical History shows that the Veteran denied a history of eye disorder or trouble. A January 2020 service treatment record (STR) from the Veteran's reserve duty showed that he underwent a vision screening with findings of normal distance vision. This is evidence against a finding of symptoms indicative of a bilateral vision disability at any time during the pendency of the claim or recent to the filing
during the pendency of the claim or recent to the filing of the claim, to include symptoms that cause functional impairment of earning capacity.

The Board concludes that the evidence persuasively weighs against a finding that the Veteran has a bilateral vision disability, to include symptoms that cause functional impairment that affects earning capacity, and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b), 38 C.F.R. § 3.303(a), (d). For example, of record are medical records from 2008 to 2021, and the evidence during this time period does not support a current a bilateral vision disability, to include symptoms that cause functional impairment that affects earning capacity. These records cover a 13-year period, and the lack of documentation of a bilateral vision disability, to include pain, is evidence against the claim for service connection for a bilateral vision disability. The Veteran's representative had stated during the hearing that a medical opinion would be provided; however, in submitting a medical opinion in February 2025, the examiner did not address a vision disability or left eye twitching disability.

VA did not provide the Veteran with a VA examination or opinion in connection with this claim. VA must provide a medical examination and/or medical opinion when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (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) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006).

Here, at the time of the December 2020 rating decision, the evidence did not establish that the Veteran had a current disability or persistent or recurrent symptoms of a disability. For a VA examination and/or medical opinion to be warranted, all the McLendon criteria have to be met, and at least one of the criteria is not met. Therefore, entitlement to a VA examination and/or medical opinion was not warranted for this claim, and there was no pre-decisional duty to assist error in not providing one or both.

As explained above, the Veteran has not provided evidence of a current disability for the claim of service connection for a bilateral vision disability. Thus, a TERA examination and medical opinion were not required, and there was no pre-decisional duty to assist error in VA not obtaining a TERA examination and medical opinion with regard to this claim.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether entitlement to service connection for a bilateral vision disability is warranted. Rather, the evidence persuasively weighs against service connection. The benefit of the doubt doctrine, see 38?U.S.C. §?5107(b), is therefore not for application. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

5. Entitlement to service connection for left foot plantar fasciitis

At the November 2024 Board hearing, the Veteran testified that his left foot plantar fasciitis had its onset in service, and that he experienced related symptoms during service.

The Board has carefully reviewed the
. Rather, the evidence persuasively weighs against service connection. The benefit of the doubt doctrine, see 38?U.S.C. §?5107(b), is therefore not for application. Lynch v. McDonough, 21 F.4th 776 (Fed. Cir. 2021) (en banc) (only when the evidence persuasively favors one side or another is the benefit of the doubt doctrine not for application).

5. Entitlement to service connection for left foot plantar fasciitis

At the November 2024 Board hearing, the Veteran testified that his left foot plantar fasciitis had its onset in service, and that he experienced related symptoms during service.

The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the award of service connection for left foot plantar fasciitis. The reasons follow.

The Veteran has been diagnosed with left foot plantar fasciitis, and thus there is evidence of a current disability. For example, in a November 2020 VA examination report the Veteran was diagnosed with left foot plantar fasciitis. In the December 2020 rating decision, the AOJ found that there is evidence of a current disability of left foot plantar fasciitis. The Board is bound by this favorable finding. See 38 C.F.R. § 3.104(c). Thus, the facts establish that the first element of a service-connection claim is met.

However, as to an in-service disease or injury, the evidence does not support a finding of a disease or injury in service indicative of left foot plantar fasciitis. The STRs do not support complaints, symptoms, evaluation, diagnosis, or treatment indicative of left foot plantar fasciitis. In the October 2020 VA Form 21-526EZ, Fully Developed Claim, the Veteran contended that his plantar fasciitis was due to ruck marches during service that resulted in wear and tear in his feet.

In a November 2020 VA examination report, the examiner documented that the Veteran reported that his bilateral plantar fasciitis began five years prior, in 2015. However, in a March 2019 Report of Medical Examination at separation from service, the examiner documented that the Veteran had a normal clinical evaluation of his lower extremities and his feet. In a concurrent March 2019 Report of Medical History, while the Veteran reported a positive history of foot trouble, he explained that it was in relation to his right foot. Specifically, he wrote, "Sharp pain in the arch of my right foot." (Italics added.) The fact that the Veteran did not report a history left foot symptoms at this time is indicative of his not having such a history. It is logical to infer that if he was experiencing left foot symptoms, he would have reported them, particularly as he was reporting specific symptoms in his right foot at that time.

Similarly, VA treatment records from this time period do not support symptoms, diagnosis, evaluation, or treatment for left foot plantar fasciitis. The Board affords more probative value to the facts provided within the Veteran's STRs, as they were created contemporaneously with service, and to his VA treatment records, which were made in the context of seeking medical treatment, which records tend to be highly reliable as individuals are motivated to provide accurate information to seek appropriate care. Thus, the Board finds that the Veteran's contentions of when his left foot plantar fasciitis began are not credible.

Accordingly, for all these reasons, the Board finds the evidence persuasively weighs against a finding of disease or injury related to left foot plantar fasciitis during service, and the in-service disease or injury element is not met.

Additionally, the evidence persuasively weighs against a nexus between left foot plantar fasciitis and service. For example, the first diagnosis of left foot plantar fasciitis at a November 2020 VA examination, which is more than one year after separation from, and does not lend to a finding that left foot plantar fasciitis had its onset in service.

In a November 2020 VA medical opinion, the examiner opined that the Veteran's left foot plantar fasciitis was not incurred in or otherwise related to service. The examiner explained that there is no documentation of left foot condition while in the service. Based on this, a nexus cannot be established between the current left foot condition and military service.

The examiner reviewed the evidence and provided an opinion with a rationale that was based on the specific facts of the case and medical principles. In light of the VA examiner's consideration of the etiology of the Veteran's current disability, the Board affords this opinion probative value and finds that it is evidence against a finding that left foot plantar fasciitis had its onset in service and is otherwise related
a November 2020 VA medical opinion, the examiner opined that the Veteran's left foot plantar fasciitis was not incurred in or otherwise related to service. The examiner explained that there is no documentation of left foot condition while in the service. Based on this, a nexus cannot be established between the current left foot condition and military service.

The examiner reviewed the evidence and provided an opinion with a rationale that was based on the specific facts of the case and medical principles. In light of the VA examiner's consideration of the etiology of the Veteran's current disability, the Board affords this opinion probative value and finds that it is evidence against a finding that left foot plantar fasciitis had its onset in service and is otherwise related to service. The facts upon which the examiner based the opinion are the same facts that the Board finds are the most accurate facts, which is that the Veteran's STRs do not support complaints of left foot symptoms during service. Thus, the VA examiner's medical opinion is based on an accurate set of facts.

In a February 2025 private medical opinion, Dr. Maud Meulstee, DNP, CNP, opined that the Veteran's left foot plantar fasciitis is related to service. Dr. Meulstee explained that it is well known that musculoskeletal conditions and micro-trauma occur in young men in the military during active combat as well as during their intense trainings. She cited to literature to indicate that "Although injuries are recognized as a leading health problem in the military, the size of the problem is underestimated when only acute traumatic injuries are considered. Injury-related musculoskeletal conditions are common in this young, active population. Many of these involve physical damage caused by micro-trauma (overuse) in recreation, sports, training, and job performance."

Dr. Meulstee documented that the Veteran reported in his separation exam in 2019 that he had pain in his feet. She wrote he had since been service connected for plantar fasciitis in his right foot. Additionally, she wrote the Veteran had been diagnosed with plantar fasciitis in his left foot. She stated his condition had left him in constant pain and had been affecting his ability to stand for long periods of time. Dr. Meulstee wrote that a U.S. Defense study of the effect of tropical and leather combat boots on recruits (1976) states: "the feet of the military man are a principal and enduring concern. As early as the reign of Valentine 1 (375-393 AD), Vegetius published a treatise on the physical characteristics of the young recruit.. In peacetime, there is also a high frequency of foot disorders in the military population, particularly among recruits experiencing for the first time, prolonged periods of marching, the use of military footwear and the general rigors of training." She noted that literature shows that scientists evaluated foot disorders among recruits at the Great Lakes Naval Training Center. Over a period of 1.5 years, approximately 26 percent of all recruits reported to the podiatry clinic with foot-related complaints. Approximately 65 percent of these complaints were attributed to a structural or mechanical abnormality of the foot such as pes planus, hallux valgus, hammer or mallet toes, and pes cavus. These were experienced by 25, 12, 12, and 2% of the recruits seen, respectively"

Dr. Meulstee stated the November 2020 VA examiner incorrectly assessed the Veteran's STRs and noted that in the March 2019 Report of Medical Examination at separation, the Veteran complained of pain in his feet that "increased with running while deployed." She added that current medical literature supports the wear and tear from training and active combat is linked to a significant damaging effect on the feet of soldiers.

With regard to Dr. Meulstee's opinion, the Board finds that it is not probative. While directly referencing the March 2019 Report of Medical Examination at separation, she still did not discuss the fact that the Veteran was found to have a clinically normal evaluation of his lower extremities and feet. She claimed that the Veteran complained of bilateral foot pain at service discharge, but the March 2019 Report of Medical History clearly shows that when referring to his positive report of foot trouble, he clarified this to be, "Sharp pain in the arch of my right foot." (Italics added.) It is clear that the Veteran distinguished the pain as involving his right foot. The failure to consider relevant evidence robs this opinion of its probative value, as her opinion is based on an inaccurate factual premise. Furthermore, the record does not support that the Veteran's March 2019 Report of Medical Examination included complaints of pain while running.

While the Veteran alleges that the left foot plantar fasciitis is related to service, he is not competent to attribute it to service
of bilateral foot pain at service discharge, but the March 2019 Report of Medical History clearly shows that when referring to his positive report of foot trouble, he clarified this to be, "Sharp pain in the arch of my right foot." (Italics added.) It is clear that the Veteran distinguished the pain as involving his right foot. The failure to consider relevant evidence robs this opinion of its probative value, as her opinion is based on an inaccurate factual premise. Furthermore, the record does not support that the Veteran's March 2019 Report of Medical Examination included complaints of pain while running.

While the Veteran alleges that the left foot plantar fasciitis is related to service, he is not competent to attribute it to service, as medical expertise is required. In this regard, the question of causation involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship. As such, the question of etiology in this case may not be competently addressed by lay evidence, and the Veteran's opinion is nonprobative evidence. At the present time, there is no competent and probative evidence of a nexus between the left foot plantar fasciitis and service to weigh against the November 2020 VA medical opinion, and the nexus element of a service-connection claim is not met.

Additionally, the Board notes that that VA has conceded that the Veteran participated in a toxic exposure risk activity (TERA). Under 38 U.S.C. § 1168(a)(1), it provides that the Secretary of VA shall provide a veteran with a medical examination and obtain a medical opinion "if a veteran submits to the Secretary a claim for compensation for a service-connected disability [] with evidence of a disability and evidence of participation in a toxic exposure risk activity during" service. This requirement does not apply if the Secretary determines there is no indication of an association between the disability claimed by the veteran and the toxic exposure risk activity for which the veteran submitted evidence. 38 U.S.C. § 1168(c). The Secretary has determined that physical traumas have no positive association with participation in a TERA. Thus, a TERA examination and medical opinion was not required in connection with the Veteran's claim for service connection for left foot plantar fasciitis. A TERA examination is different than the November 2020 VA examination that was provided by VA during the appeal period.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether entitlement to service connection for left foot plantar fasciitis is warranted. Rather, the evidence persuasively weighs against service connection. The benefit of the doubt doctrine, see 38?U.S.C. §?5107(b), is therefore not for application. Lynch, 21 F.4th 776.

REASONS FOR REMAND

6. Entitlement to service connection for a headache disability is remanded.

Under 38 U.S.C. § 1168(a)(1), it provides that the Secretary of VA shall provide a veteran with a medical examination and obtain a medical opinion "if a veteran submits to the Secretary a claim for compensation for a service-connected disability [] with evidence of a disability and evidence of participation in a toxic exposure risk activity during" service and such evidence is not sufficient to establish a service connection for the disability.

In a February 2024 VA memorandum, it was found that the Veteran participated in a TERA. In a February 2025 private medical opinion, Dr. Meulstee opined that the Veteran has a current headache disability.

As there is evidence of a current disability and participation in a TERA, and the evidence is not sufficient to establish service connection, a VA examination and a VA medical opinion considering whether a headache disability is related to a TERA must be obtained.

The matter is REMANDED for the following action:

Schedule an examination and obtain an opinion from an appropriate clinician to determine the nature and etiology of a headache disability. The examiner should have access to the Veteran's claims file.

The agency of original jurisdiction must provide a copy of the below facts to the examiner.

To assist in a review of the claims file, the examiner is informed of the following facts with citations in the record, when applicable:

" The Veteran served on active duty from April 25, 2009 to December 11, 2009 and from May 26, 2018 to May 11, 2019 with additional periods of Reserve duty.

" A November 2009 service treatment record (STR) shows that the Veteran completed a Post Deployment Health Assessment (PDHA), in which he denied being bothered by or reporting to sick call for bad headaches (item 8). See VBMS entry with Document Type, "STR," Receipt Date 10/16/2020, with "#1" in the Subject field, at pgs.
of the claims file, the examiner is informed of the following facts with citations in the record, when applicable:

" The Veteran served on active duty from April 25, 2009 to December 11, 2009 and from May 26, 2018 to May 11, 2019 with additional periods of Reserve duty.

" A March 2019 Report of Medical History that the Veteran completed shows that he denied a history of frequent or severe headaches (item 15.b.). See VBMS entry with Document Type, "STR," Receipt Date 10/16/2020, with "#1" in the Subject field, at pgs. 207-208.

" A March 7, 2019 STR shows that the Veteran completed an Annual Periodic Health Assessment in which when asked if he had "Recurrent headaches/migraines," he responded, "NO/Does not apply to me" (Part A, section IV, item 2). See VBMS entry with Document Type, "STR," Receipt Date 10/16/2020, with "#1" in the Subject field, at pgs. 129-131.

" A March 27, 2019 STR shows that the Veteran completed another PDHA and reported that he was not bothered at all by headaches (item 11.e.). See VBMS entry with Document Type, "STR," Receipt Date 10/16/2020, with "#1" in the Subject field, at pgs. 55-63.

" A January 2020 STR shows that the Veteran completed an Annual Periodic Health Assessment in which when asked if he had "Recurrent headaches/migraines," he responded, "NO/Does not apply to me" (Part A, section IV, item 2). See VBMS entry with Document Type, "STR," Receipt Date 10/16/2020, with "#1" in the Subject field, at pgs. 103-105.

" At the November 2024 Board hearing, the Veteran testified that he was bothered by headaches during service, particularly during deployments. See VBMS entry with Document Type, "Hearing Transcript," Receipt Date 11/14/2024, at pgs. 6-11.

" The Board does not find the allegation of in-service headaches credible, as the Veteran consistently denied experiencing headaches on multiple occasions from 2009 to 2020, including while on deployment.

" A February 2025 private medical opinion from Dr. Maud Meulstee, DNP, CNP showed that she opined that the Veteran was now diagnosed with headaches and that they were due to his psychiatric disorder. See VBMS entry with Document Type, "Medical Treatment Record - Non-Government Facility," Receipt Date 02/05/2025.

" The Veteran is service-connected for unspecified trauma-and stressor-related disorder.

" The examiner's review of the record is NOT restricted to the evidence listed above. This list is provided to assist the examiner in locating potentially relevant evidence.

The examiner is asked to answer the following question:

Whether it is at least as likely as not that there is a nexus between the Veteran's headache disability and toxic exposure risk activity. The examiner shall consider 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. Please explain upon what facts, medical principles, and/or medical literature the opinion is based.

If the examiner is unable to provide an opinion without resorting to mere speculation, he or she should explain why this is so. The examiner shall then explain whether the inability to provide a more definitive opinion is the result of a need for more information and indicate what additional evidence is necessary, or whether he or she has exhausted the limits of current medical knowledge in providing an answer to the question.

A. P. SIMPSON

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Husain, Rahat

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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