VERTIGO

Summary

The Veteran, an Army Veteran who served from August 1975 to August 1995, including a deployment to Haiti in 1994-1995, appeals the denial of service connection for vertigo. The Veteran contends that vertigo symptoms began after being prescribed anti-malaria medication, specifically Mefloquine, during his Haiti deployment. The Board found that the Veteran's current vertigo diagnosis was already established by the agency of original jurisdiction and was not clearly and unmistakably erroneous. The Board also found that the Veteran credibly testified to taking anti-malaria medication and that military records indicated Mefloquine was prescribed to 10th Mountain Division soldiers during a prior deployment. Given the approximate balance of evidence regarding the prescription of Mefloquine and the nexus to vertigo, the Board afforded the Veteran the benefit of the doubt. Two VA examinations were considered: the first opined less likely than not related to service due to lack of records, while the second, acknowledging the potential link if Mefloquine was prescribed, was found to have strong probative value. The Veteran's spouse also provided credible testimony corroborating the onset of symptoms post-deployment. Ultimately, the Board found the evidence in approximate balance regarding the nexus between vertigo and service, granting service connection for vertigo on a direct basis.

Rationale

Current vertigo diagnosis established by AOJ; Veteran credibly testified to taking anti-malaria medication; Service records silent on anti-malaria medication; Mefloquine prescribed to 10th Mountain Division soldiers prior; Approximate balance of evidence regarding prescription and nexus; Benefit of the doubt afforded to Veteran; Second VA exam provided strong probative value for positive nexus

Full Decision Text

Citation Nr: A26031615
Decision Date: 04/07/26	Archive Date: 04/07/26

DOCKET NO. 210625-168466
DATE: April 7, 2026

ISSUE

Entitlement to service connection for vertigo

ORDER

Entitlement to service connection for vertigo is granted. 

FINDINGS OF FACT

1. The probative evidence is in approximate balance as to whether the Veteran was prescribed anti-malaria medication, to include Mefloquine, while deployed to Haiti in 1994 to 1995. 

2. The probative evidence is in approximate balance as to whether the Veteran's diagnosed vertigo was caused by or related to active duty service.  

CONCLUSION OF LAW

The criteria for entitlement to service connection for vertigo have been met or approximated. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty from August 1975 to August 1995.  

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2021 rating decision by a Department of Veteran's Affairs (VA) Regional Office (RO), which is the agency of original jurisdiction (AOJ).

By way of background, following a July 2020 rating decision in which the AOJ denied entitlement to service connection for vertigo, the Veteran submitted a December 2020 supplemental claim. Following a June 2021 supplemental claim rating decision in which the AOJ again denied the claim, the Veteran submitted a timely June 2021 VA Form 10182, Decision Review Request: Board Appeal, Notice of Disagreement (VA Form 10182) appealing the June 2021 rating decision and selecting the Hearing docket.  

The Veteran testified at a Board hearing in October 2024 before the undersigned Veterans Law Judge (VLJ). A transcript of the proceeding is associated with the claims file. 

The Board may only consider the evidence of record at the time of the June 2021  rating decision, as well as any evidence submitted by the Veteran or representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) after the June 2021 rating decision and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801.

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

Entitlement to service connection for vertigo. 

The Veteran claims entitlement to service connection for vertigo. He contends specifically that while deployed to Haiti he was prescribed anti-malaria medication to include Mefloquine, after which vertigo symptoms began. See October 2024 Board hearing.

In order to obtain service connection under 38 U.S.C. § 1131 and 38 C.F.R. § 3.303(a) a Veteran must satisfy a three-element test: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service - the so-called 'nexus' requirement. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Walker v. Shinseki, 708 F.3d 1331, 1333 (Fed. Cir. 2013).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter (which includes but is not limited to equipoise), VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see Lynch v. McDonough, 21 F.4th 776, 778 (Fed. Cir. 2021).

In this case, as an initial matter, in the June 2021 rating decision the AO
 Cir. 2004); Walker v. Shinseki, 708 F.3d 1331, 1333 (Fed. Cir. 2013).

When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter (which includes but is not limited to equipoise), VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see Lynch v. McDonough, 21 F.4th 776, 778 (Fed. Cir. 2021).

In this case, as an initial matter, in the June 2021 rating decision the AOJ found that the Veteran has a current vertigo disability. The Board is bound by this prior favorable finding, which was not clearly and unmistakably erroneous. 38 C.F.R. § 3.104(c). Additionally, the Board notes that in 1994 the Veteran was deployed to Haiti while assigned to the 10th Mountain Division. See Military Personnel Records.

Regarding the key question as to whether the Veteran was prescribed anti-malaria medication, to include Mefloquine, in preparation for or during his 1994  Haiti deployment while assigned to the 10th Mountain Division, the record is unclear. Service Treatment Records (STRs) do not note that anti-malaria medication, Mefloquine or otherwise, was ever prescribed to the Veteran. However, in the October 2024 Board hearing the Veteran testified that while deployed to Haiti he was required to take anti-malaria tablets on a daily basis. The Board has no reason to question his credibility in regard to taking anti-malaria medication, but also notes that as he is not a medical expert, the specific type and dose of medication prescribed may not have been known to the Veteran. The Board also notes articles submitted by the Veteran reporting that Mefloquine was prescribed to soldiers before and during Army deployments, including during the 10th Mountain Division's deployment to Somalia in 1992 and 1993. See October 2024 Correspondence.

Given the above, that is, that the Veteran was deployed to Haiti in 1994 while assigned to the 10th Mountain division, that he credibly testified that he was prescribed anti-malaria medication while deployed, and that submitted articles noted that 10th Mountain Division soldiers were provided Mefloquine during a deployment to Somalia just a year prior to the Veteran's deployment to Haiti, the Board finds that the evidence is in approximate balance, and thus affords the benefit of the doubt to the Veteran, that he was prescribed anti-malaria medication, to include Mefloquine, while deployed to Haiti in 1994. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102; Lynch, 21 F.4th at 781-82.  

Therefore, this appeal primarily hinges on whether the Veteran's vertigo was caused by or related to active duty service, namely the prescribed anti-malaria medication, to include Mefloquine.

To that end, the Veteran underwent two VA examinations regarding his vertigo service connection claim. In the first examination, in July 2020, the examiner diagnosed the Veteran with benign paroxysmal positional vertigo and noted the Veteran's report that he started having extreme dizziness, nausea, vomiting, and unsteadiness upon returning from Haiti in 1995. Ultimately, the examiner opined that it was less likely than not that the Veteran's vertigo was due to the antimalaria  medication Mefloquine, with the rationale that the Veteran's STRs did not show antimalaria treatment. As the Board has presently found that the Veteran was prescribed anti-malaria medication, to include Mefloquine, during his 1994 Haiti deployment, it finds this nexus opinion of little probative value. 

In the second examination, in May 2021, the examiner confirmed the diagnosis of benign paroxysmal positional vertigo and noted the Veteran's report that his symptoms began in 1995. Although ultimately opining that the Veteran's vertigo was less likely than not caused by the administration of Mefloquine because the Veteran's C-file was silent in that regard, the examiner stated that if there were records indicating that Mefloquine was administered during service, at that time a nexus could be established as there was supporting literature documenting an association between Mefloquine and auditory and vestibular manifestations. Again, given that the Board has found that the Veteran was prescribed anti-malaria medication, to include Mefloquine, during his 1994 Haiti deployment, the Board finds this examination to be of strong probative value in providing a positive nexus opinion, that is, that the Veteran's vertigo was caused by or related
. Although ultimately opining that the Veteran's vertigo was less likely than not caused by the administration of Mefloquine because the Veteran's C-file was silent in that regard, the examiner stated that if there were records indicating that Mefloquine was administered during service, at that time a nexus could be established as there was supporting literature documenting an association between Mefloquine and auditory and vestibular manifestations. Again, given that the Board has found that the Veteran was prescribed anti-malaria medication, to include Mefloquine, during his 1994 Haiti deployment, the Board finds this examination to be of strong probative value in providing a positive nexus opinion, that is, that the Veteran's vertigo was caused by or related to active duty service, namely the prescribed anti-malaria medication, to include Mefloquine. 

The Board also acknowledges the testimony of the Veteran's spouse that upon his return from Haiti in April 1995 she observed the Veteran's dizziness and nausea, with a subsequent diagnosis of vertigo. The Board has no reason to question the spouse's credibility, and notes that the Veteran's credibility was enhanced by her  corroboration of the disability symptoms and timeline. See October 2024 Board hearing. 

Given the above, the Board finds that the probative evidence is in approximate balance as to whether the Veteran's vertigo was related to active duty service, namely the prescribed anti-malaria medication, to include Mefloquine. Therefore, affording the Veteran the benefit of the doubt, entitlement to service connection for vertigo is granted on a direct basis. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102; Lynch, 21 F.4th at  781-82.  

 

 

Michael A. Pappas

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Matthew Leahy, Associate 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.