DIVERTICULITIS

A. P. SIMPSON · 2026 · Case ID: A26031607

MIXED

Summary

The veteran, who served in the United States Air Force from October 27, 1999, to November 23, 1999, and again from February 14, 2005, to June 1, 2005, appeals the denial of service connection for diverticulitis, allergic rhinitis, and sensitivity to cleaning products, as well as an increased rating for obstructive sleep apnea. The Board denied service connection for diverticulitis, finding no evidence of an in-service injury or disease related to the condition, and no competent nexus to service, as the diagnosis occurred many years after service. For allergic rhinitis, the Board found no in-service complaints or diagnosis, and the first diagnosis occurred over 10 years post-service, weighing against service connection. Similarly, for sensitivity to cleaning products, the Board found no in-service indication, and the diagnosis over 15 years post-service, coupled with the Veteran's failure to report such symptoms to VA, weighed against service connection. Regarding obstructive sleep apnea, the Board denied an increased rating beyond 50 percent, as the evidence did not support the criteria for a 100 percent rating, such as chronic respiratory failure or need for tracheostomy. The Board remanded the claim for service connection for benign paroxysmal positional vertigo (BPPV), to include as secondary to obstructive sleep apnea, due to a pre-decisional duty to assist error in failing to obtain a VA medical opinion on the direct service connection for BPPV.

Rationale

No in-service complaints, symptoms, evaluation, diagnosis, or treatment for diverticulitis.; Diagnosis occurred many years after service discharge.; VA medical opinions found no nexus to service-connected irritable bowel syndrome.

Service Branch

AIR FORCE

Special Benefit

NO SPECIAL BENEFIT

Docket No.

241108-493126

Full Decision Text

Citation Nr: A26031607
Decision Date: 04/07/26 Archive Date: 04/07/26

DOCKET NO. 241108-493126
DATE: April 7, 2026

ORDER

1. Entitlement to service connection for diverticulitis is denied.

2. Entitlement to service connection for allergic rhinitis, to include as secondary to service-connected schizoaffective disorder with traumatic brain injury, is denied.

3. Entitlement to service connection for sensitivity to cleaning products, to include as secondary to service-connected schizoaffective disorder with traumatic brain injury, is denied.

4. Entitlement to an initial increased rating in excess of 50 percent for obstructive sleep apnea is denied.

REMANDED

5. Entitlement to service connection for benign paroxysmal positional vertigo (BPPV), to include as secondary to the service-connected obstructive sleep apnea, is remanded.

FINDINGS OF FACT

1. The evidence persuasively weighs against finding that the Veteran's diverticulitis was incurred in or otherwise related to service.

2. Allergic rhinitis did not have its onset in service, was not manifested within one year of service discharge and is not otherwise related to service. Allergic rhinitis is not caused or aggravated by service-connected schizoaffective disorder with traumatic brain injury.

3. The evidence persuasively weighs against finding that the Veteran's sensitivity to cleaning products was incurred in or otherwise related to service. Sensitivity to cleaning products is not caused or aggravated by service-connected schizoaffective disorder with traumatic brain injury.

4. The Veteran's obstructive sleep apnea manifested as requiring the use of a breathing assistance device such as a CPAP machine, but not as symptoms of chronic respiratory failure with carbon dioxide retention, cor pulmonale, or the need for a tracheostomy.

CONCLUSIONS OF LAW

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

2. The criteria for service connection for allergic rhinitis, to include as secondary to service-connected schizoaffective disorder with traumatic brain injury, have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.310.

3. The criteria for service connection for sensitivity to cleaning products, to include as secondary to service-connected schizoaffective disorder with traumatic brain injury have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.310.

4. The criteria for an initial increased rating in excess of 50 percent for obstructive sleep apnea have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.14, 4.97, DC 6847.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Air Force from October 27, 1999 to November 23, 1999 and from February 14, 2005 to June 1, 2005.

This appeal comes to the Board of Veterans' Appeals (Board) from August 2024 and October 2024 rating decisions by the agency of original jurisdiction (AOJ), which denied service connection for BPPV, diverticulitis, allergic rhinitis, and sensitivity to cleaning products and assigned an initial 50 percent rating for service-connected obstructive sleep apnea. The Veteran appealed the decisions to the Board by submitting a November 2024 VA Form 10182, Notice of Disagreement, and electing the Direct Review docket.

In a Direct Review docket, the Board may consider only the evidence of record at the time of the August 2024 and October 2024 rating decisions on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 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 claim for service connection for BPPV, 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

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).

1. Entitlement to service connection for diverticulitis

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

The Veteran has been diagnosed with diverticulitis, and thus there is evidence of a current disability. For example, in a May 2024 VA examination report the Veteran was diagnosed with diverticulitis. In the August 2024 rating decision, the AOJ found that there is evidence of a current disability of diverticulitis. 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 disease or injury in service indicative of diverticulitis. For example, the service treatment records (STRs) do not support complaints, symptoms, evaluation, diagnosis, or treatment indicative of diverticulitis. In an August 2004 Report of Medical Examination at enlistment into his second period of service, the Veteran was found to have a clinically normal evaluation of his abdomen and viscera, and in the concurrent Report of Medical History, the Veteran denied a history of stomach, liver, intestinal trouble, or ulcer. Additionally, the Veteran has not alleged experiencing diverticulitis symptoms in service or that there was in-service incident that resulted in his developing diverticulitis. Accordingly, for all these reasons, the Board finds the evidence persuasively weighs against a finding of disease or injury related to diverticulitis during service, and the in-service disease or injury element is not met.

The evidence persuasively weighs against a nexus between diverticulitis and service. When the Veteran was treated in January 2007 and November 2007 and a review of systems was performed, when addressing the Veteran's gastrointestinal system, the examiner documented that the Veteran denied abdominal pain, nausea, vomiting, and diarrhea. In other words, the Veteran was not complaining of gastrointestinal symptoms more than one year following service discharge. An October 2011 private treatment record includes a description of the Veteran's medical history, which did not include gastrointestinal symptoms. Diverticulitis was not diagnosed until many years following service discharge, which does not lend to a finding of in-service incurrence.

VA did not provide the Veteran with a VA examination or opinion in connection with the direct theory of entitlement. 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
. An October 2011 private treatment record includes a description of the Veteran's medical history, which did not include gastrointestinal symptoms. Diverticulitis was not diagnosed until many years following service discharge, which does not lend to a finding of in-service incurrence.

VA did not provide the Veteran with a VA examination or opinion in connection with the direct theory of entitlement. 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 rating decision on appeal, the evidence did not establish evidence that an event, injury, or disease occurred in service or that the disability may be related to service. 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 as to the direct theory of entitlement, and there was no pre-decisional duty to assist error in not providing one or both as tot his particular theory.

While the Veteran alleges that the diverticulitis is related to service, he is not competent to attribute the diverticulitis 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 diverticulitis and service, and the nexus element of a service-connection claim is not met.

In a May 2024 VA medical opinion, the examiner opined that the Veteran's diverticulitis was not caused by service-connected irritable bowel syndrome. The examiner explained that medical literature risk factors for diverticulitis include: a diet low in fiber and high in red meat, physical inactivity, obesity, smoking, a change in the balance of microbes (good bacteria) in your digestive tract, the use of steroids and nonsteroidal anti-inflammatory drugs (NSAIDs), and genetic factors. The examiner stated that the Veteran was diagnosed with diverticulitis in 2017, and that medical records reviewed failed to show any evidence that irritable bowel syndrome can cause diverticulitis. In another May 2024 VA medical opinion, the examiner opined that the Veteran's diverticulitis was not aggravated by service-connected irritable bowel syndrome. The examiner explained that medical literature does not suggest that irritable bowel syndrome can aggravate diverticulitis.

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 medical literature, the Board affords these opinions probative value and finds they are evidence against a finding that diverticulitis is caused or aggravated by service-connected irritable bowel syndrome. 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 was diagnosed with diverticulitis in 2017. Thus, the VA examiner's medical opinions are based on an accurate set of facts. At the present time, there is no competent evidence to weigh against this medical opinion that diverticulitis was not caused or aggravated by service-connected irritable bowel syndrome, and the nexus element of a secondary service-connection is not met.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether entitlement to service connection for diverticulitis is warranted. Rather, the evidence persuasively weighs against service connection, to include on a secondary basis. 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).

2. Entitlement to service connection for allergic rhinitis, to include as secondary to service-connected schizoa
the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether entitlement to service connection for diverticulitis is warranted. Rather, the evidence persuasively weighs against service connection, to include on a secondary basis. 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).

2. Entitlement to service connection for allergic rhinitis, to include as secondary to service-connected schizoaffective disorder with traumatic brain injury

The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the award of service connection for allergic rhinitis. The reasons follow.

The Veteran has been diagnosed with allergic rhinitis, and thus there is evidence of a current disability. For example, in a September 2023 VA examination report the Veteran was diagnosed with allergic rhinitis. In the October 2024 rating decision, the AOJ found that there is evidence of a current disability of allergic rhinitis. 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 disease or injury in service indicative of allergic rhinitis. The STRs do not support complaints, symptoms, evaluation, diagnosis, or treatment indicative of allergic rhinitis. Additionally, the Veteran has not alleged experiencing allergic rhinitis symptoms in service or that there was in-service incident that resulted in his developing allergic rhinitis. Accordingly, for these reasons, the Board finds the evidence persuasively weighs against a finding of disease or injury related to allergic rhinitis during service, and the in-service disease or injury element is not met.

The evidence also persuasively weighs against a nexus between allergic rhinitis and service. For example, in a June 2017 private treatment record, the Veteran was first diagnosed with allergic rhinitis, which is more than 10 years after service, and does not lend to a finding that allergic rhinitis had its onset in service. At the time of this record, the diagnosis was referred to as a "new problem," which is evidence against ongoing allergic rhinitis symptoms in the years following service discharge.

VA did not provide the Veteran with a VA examination or opinion in connection with this claim. It has laid out above the criteria for entitlement to an examination and/or medical opinion above. Here, at the time of the rating decision on appeal, the evidence did not establish evidence that an event, injury, or disease occurred in service or that the disability may be related to service. 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.

While the Veteran alleges that allergic rhinitis is related to service or a service-connected disability, he is not competent to attribute allergic rhinitis to service or another disability, 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 allergic rhinitis and service, and the nexus element of a service-connection claim is not met. The final element of a secondary service connection claim is also not met.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether entitlement to service connection for allergic rhinitis 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.

3. Entitlement to service connection for sensitivity to cleaning products, to include as secondary to service-connected schizoaffective disorder with traumatic brain injury

The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the award of service connection for sensitivity to cleaning products. The reasons follow.

3. Entitlement to service connection for sensitivity to cleaning products, to include as secondary to service-connected schizoaffective disorder with traumatic brain injury

The Veteran has been diagnosed with sensitivity to cleaning products, and thus there is evidence of a current disability. For example, in a September 2023 VA examination report the Veteran was diagnosed with hypersensitivity to cleaning products. In the October 2024 rating decision, the AOJ found that there is evidence of a current disability of sensitivity to cleaning products. 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 disease or injury in service indicative of sensitivity to cleaning products. The STRs do not support complaints, symptoms, evaluation, diagnosis, or treatment indicative of sensitivity to cleaning products. Additionally, the Veteran has not alleged experiencing sensitivity to cleaning products symptoms in service or that there was in-service incident that resulted in his developing sensitivity to cleaning products. Accordingly, for these reasons, the Board finds the evidence persuasively weighs against a finding of disease or injury related to sensitivity to cleaning products during service, and the in-service disease or injury element is not met.

The evidence also persuasively weighs against a nexus between sensitivity to cleaning products and service. For example, in the above mentioned September 2023 VA examination report, the Veteran was first diagnosed with sensitivity to cleaning products, which is more than 15 years after service, and does not lend to a finding that sensitivity to cleaning products had its onset in service.

VA treatment records do not support symptoms, complaints, diagnosis, evaluation, or treatment for sensitivity to cleaning products. The Board finds that the Veteran's failure to discuss sensitivity to cleaning products while seeking treatment from VA prior to September 2023 to be indicative of his not having such symptom prior to this time, as he had the wherewithal to report numerous other issues, including psychiatric symptoms, which he explicitly attributed to service. The Veteran was presenting for a physical examination, where the purpose is to address one's overall health. In such circumstances, it is logical to assume that the Veteran would report medical concerns.

At this point, it had been more than 15 years since service discharge, and the Veteran was not reporting sensitivity to cleaning products. If the Veteran had been experiencing symptoms indicative of sensitivity to cleaning products for more than 15 years, the Board finds he would have reported such symptom, as he expressly reported psychiatric symptoms, which he attributed to service. Thus, the Board finds that symptoms of sensitivity to cleaning products were not continuous since service.

In a June 2024 medical opinion, the examiner determined that there was no relationship between schizophrenia and sensitivity to chemicals.

While the Veteran alleges that the sensitivity to cleaning products is related to service or to a service-connected disability, he is not competent to attribute the sensitivity to cleaning products to service or a service-connected disability, 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 sensitivity to cleaning products and service, and the nexus element of a service-connection claim is not met. The final element of a secondary service connection claim is also not satisfied.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether entitlement to service connection for sensitivity to cleaning products 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.

Increased Rating

Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects the Veteran's ability to function under the ordinary conditions of daily life, including employment, by comparing the Veteran's symptomatology with the criteria set forth in the Schedule for Rating Disabilities. 38 C.F.R. Part 4. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to
benefit of the doubt doctrine, see 38?U.S.C. §?5107(b), is therefore not for application. Lynch, 21 F.4th 776.

Increased Rating

Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects the Veteran's ability to function under the ordinary conditions of daily life, including employment, by comparing the Veteran's symptomatology with the criteria set forth in the Schedule for Rating Disabilities. 38 C.F.R. Part 4. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3.

4. Entitlement to an initial increased rating in excess of 50 percent for obstructive sleep apnea

In an August 2023 rating decision, the AOJ granted service connection for obstructive sleep apnea and assigned a 30 percent rating effective May 15, 2023. In the November 2023 rating decision currently on appeal, the Veteran was assigned a 50 percent rating effective May 15, 2023. The Veteran's obstructive sleep apnea is rated under DC 6847.

Under DC 6847, a 50 percent rating is warranted for sleep apnea requiring use of breathing assistance device such as a CPAP machine; and a 100 percent rating is warranted for sleep apnea causing chronic respiratory failure with carbon dioxide retention or cor pulmonale; or that requires tracheostomy. 38 C.F.R. § 4.97, DC 6847.

The Board has carefully reviewed the evidence of record and finds that the evidence persuasively weighs against the award of an initial increased rating in excess of 50 percent for obstructive sleep apnea. The reasons follow.

The evidence shows that the Veteran's obstructive sleep apnea does not result in chronic respiratory failure with carbon dioxide retention or cor pulmonale; or that requires tracheostomy, to warrant a 100 percent rating.

In a June 2023 VA examination report, it was documented that the Veteran did not require the use of a breathing assistance device, such as a Continuous Positive Airway Pressure (CPAP) machine. The Veteran had findings, signs, or symptoms attributable to sleep apnea, specifically persistent daytime hypersomnolence. The Veteran did not have any other pertinent physical findings, complications, conditions, signs, or symptoms related to any conditions listed in the diagnosis section. Additionally, the Veteran did not have any scars (surgical or otherwise) related to obstructive sleep apnea. The Veteran's sleep apnea impacted his ability to work. He could sleep a lot but still felt tired all the time, causing daytime somnolence that decreased his ability to perform work, activities, and tasks. He missed work and doctor's appointments due to oversleeping.

VA treatment records do not support a finding of chronic respiratory failure with carbon dioxide retention or cor pulmonale; or that the Veteran required a tracheostomy.

For the above reasons, the evidence is neither evenly balanced nor approximately so with regard to whether entitlement to an initial 100 percent rating for obstructive sleep apnea is warranted. Rather, the evidence persuasively weighs against an increased rating. 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

5. Entitlement to service connection for benign paroxysmal positional vertigo (BPPV), to include as secondary to the service-connected obstructive sleep apnea, is remanded.

The Veteran has been diagnosed with BPPV, and thus there is evidence of a current disability. For example, in a June 2023 VA examination report the Veteran was diagnosed with BPPV. In the November 2023 rating decision, the AOJ found that there is evidence of a current disability of BPPV. 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.

The Veteran's STRs show that he suffered a syncopal fall in October 1999, and had related complaints of dizziness. In the August 2024 rating decision, the AOJ stated that based on these reports and related subsequent treatment during service,
and thus there is evidence of a current disability. For example, in a June 2023 VA examination report the Veteran was diagnosed with BPPV. In the November 2023 rating decision, the AOJ found that there is evidence of a current disability of BPPV. 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.

The Veteran's STRs show that he suffered a syncopal fall in October 1999, and had related complaints of dizziness. In the August 2024 rating decision, the AOJ stated that based on these reports and related subsequent treatment during service, a qualifying event or injury had its onset during service. The Board is also bound by this favorable finding, and the in-service injury or disease element is also met.

VA did not provide the Veteran with a VA medical opinion in connection with the direct theory of entitlement. VA must provide a 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, the Board finds that the McLendon criteria were satisfied prior to the time of the August 2024 rating decision currently on appeal, and that it was a pre-decisional duty to assist error for the AOJ to have decided this issue without obtaining a VA medical opinion considering whether the Veteran's BPPV was directly incurred in or otherwise related to service.

The matter is REMANDED for the following action:

Obtain an opinion from an appropriate clinician to determine the nature and etiology of benign paroxysmal positional vertigo (BPPV). Schedule an examination if deemed necessary. 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 October 27, 1999 to November 23, 1999 and from February 14, 2005 to June 1, 2005.

" The Veteran is service connected for schizoaffective disorder with traumatic brain injury, tension headaches, and obstructive sleep apnea.

" An October 1999 service treatment record (STR) shows that the Veteran suffered a syncopal episode and underwent related evaluation and treatment throughout November 1999, which included complaints of dizziness. See VBMS entry with Document Type, "STR - Medical," Receipt Date 09/10/2014, at pp. 22, 26, 55, and 66.

" A February 2011 private medical record shows that the Veteran had a complaint of dizziness and weakness. See VBMS entry with Document Type, "Medical Treatment Record - Non-Government Facility," Receipt Date 01/30/2014, with "#2" in the Subject field, at pg. 12.

" A June 2023 VA examination report shows that the Veteran was diagnosed with BPPV in February 2011, and the Veteran reported that his symptoms first began in the 2011 to 2012 timeframe. See VBMS entry with Document Type, "C&P Exam," Receipt Date 07/20/2023, with Subject field "DBQ GI Gallbladder & pancreas".

" A July 2023 VA medical opinion shows that the examiner opined that BPPV is not caused or aggravated by service-connected schizoaffective disorder with traumatic brain injury. See VBMS entry with Document Type, "Medical Opinion," Receipt Date 07/20/2023.

" A September 2023 VA medical opinion clarified the previous opinion and noted that medications for service-connected schizoaffective disorder with traumatic brain injury do not cause or aggravate the Veteran's BPPV. See VBMS entry with Document Type, "C&P Exam," Receipt Date 09/10/2023.

" An October 2023 VA medical opinion shows that the examiner opined that BPPV was not caused by service-connected tension headaches. See VBMS entry with Document Type, "C&P Exam," Receipt Date 10/22/2023.

" An August 202
with traumatic brain injury. See VBMS entry with Document Type, "Medical Opinion," Receipt Date 07/20/2023.

" An August 2024 VA examination report confirmed the Veteran's diagnosis of BPPV in 2011. See VBMS entry with Document Type, "C&P Exam," Receipt Date 08/08/2024.

" An August 2024 VA medical opinion shows that the examiner opined that the Veteran's BPPV is not caused by service-connected obstructive sleep apnea. See VBMS entry with Document Type, "Medical Opinion," Receipt Date 08/08/2024.

" None of the medical opinions addressed whether BPPV had its onset in service or was otherwise related to the syncope with subsequent dizziness that occurred in service.

" 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 questions:

(a.) Is the Veteran's BPPV due to his service from October 27, 1999 to November 23, 1999 and/or from February 14, 2005 to June 1, 2005? 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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