COSTOCHONDRITIS

Summary

The Veteran, who served from October 1997 to January 2002, appeals the denial of service connection for costochondritis. The Board found favorable evidence for a current disability and an in-service event, specifically chest wall pain reported in November 2001. However, medical nexus opinions were conflicting. Three VA examiners provided opinions: two concluded it was less likely than not that costochondritis was related to service, citing lack of chronic care or in-service documentation. One VA examiner, however, opined it was at least as likely as not that the condition was related to service, noting the in-service chest wall pain and the Veteran's testimony of recurrent symptoms since 1999. The Board found the Veteran credible regarding recurrent chest wall pain, noting the in-service report and the positive opinion. Due to the conflicting medical evidence and the Veteran's credible testimony, the Board found the evidence in equipoise regarding the nexus. Applying the benefit of the doubt, service connection for costochondritis was granted.

Rationale

Favorable findings on current disability and in-service injury (chest wall pain).; Conflicting medical opinions on nexus: two negative, one positive.; Positive opinion based on recurrent chest wall pain and service demands.; Veteran found credible regarding recurrent chest wall pain since 1999.; Evidence in equipoise regarding nexus to in-service chest pain.

Full Decision Text

Citation Nr: A26032431
Decision Date: 04/08/26	Archive Date: 04/08/26

DOCKET NO. 250709-563335
DATE: April 8, 2026

ORDER

Entitlement to service connection for costochondritis is granted.

FINDING OF FACT

The evidence is in equipoise as to whether the costochondritis is related to in-service chest pain.

CONCLUSION OF LAW

Resolving all reasonable doubt in the Veteran's favor, the criteria for service connection for costochondritis have been met. 38 U.S.C. §§ 1110, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2026).

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service from October 1997 to January 2002.  

This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2025 rating decision of a Department of Veterans Affairs (VA) regional office (RO). 

In a June 2021 higher-level-review rating decision, a RO denied service connection for costochondritis.  The Veteran appealed that denial to the Board.  In August 2024, the Board remanded the claim for further development.  

In the March 2025 rating decision, the RO denied service connection for costochondritis on the merits.  Later in March 2025, the Veteran requested a higher-level review of the denial of service connection for costochondritis in the March 2025 rating decision.  

In a July 7, 2025, rating decision, the RO denied service connection for costochondritis based on the evidence of record at the time of the March 2025 rating decision.  The RO notified the Veteran of that decision on July 9, 2025.  On July 9, 2025, the Veteran filed a VA Form 10182 (decision review request: Board appeal (notice of disagreement)) appealing the denial of service connection for costochondritis in the March 2025 rating decision.   A final adjudication of the higher-level review was not pending at the time of the filing of the VA Form 10182.  Thus, there is no concurrent election.  38 C.F.R. § 3.2500 (2026).  Pursuant to Terry v. McDonough, 37 Vet. App. 1, 12-13 (2023), the Board will address the claim on the merits based on the Veteran appealing the March 2025 rating decision.

In the March 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket.

Therefore, the Board may only consider the evidence of record at the time of the March 2025 agency of original jurisdiction (AOJ) decision on appeal.  38 C.F.R. § 20.301 (2026).  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 (2026). 

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 (2026).  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. 

Service Connection

1. Entitlement to service connection for costochondritis

Governing law and regulations

In general, service connection may be granted for disability or injury incurred in or aggravated by active military service.  38 U.S.C. § 1110.  Notwithstanding the above, service connection may be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred or aggravated in service.  38 C.F.R. § 3.303(a).  To establish service connection for a claimed disorder, there must be (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability.  See Hickson v. West, 12 Vet. App. 247, 253 (1999).

Analysis

In the June 2023
, service connection may be granted for disability shown after service, when all of the evidence, including that pertinent to service, shows that it was incurred or aggravated in service.  38 C.F.R. § 3.303(a).  To establish service connection for a claimed disorder, there must be (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the current disability.  See Hickson v. West, 12 Vet. App. 247, 253 (1999).

Analysis

In the June 2023 rating decision, the RO made the following favorable findings:  the Veteran has a current disability and a qualifying event, injury, or disease had its onset in service.  More specifically, the RO noted that a January 2021 VA examination reports reveal a diagnosis of costochondritis and that service treatment records document the reporting in November 2001 of chest wall pain due to being blown from a flight deck in 1999.  Thus, there are favorable findings on current disability and in-service injury or disease, Hickson elements (1) and (2).  

As for Hickson element (3), nexus, there is conflicting medical evidence. In a December 2020 opinion, a VA doctor opined that it is less likely than not (less than 50 percent probability) that the diagnosis of chest pain was incurred in or caused by the claimed in-service injury, event, or illness.  The clinician stated that there was no diagnosis of a chest disability.  Similarly, in a January 2021 opinion, a January 2021 VA examiner opined that it is less likely than not that costochondritis was incurred in or caused by the claimed in-service injury, event, or illness.  The clinician stated that the in-service chest wall pain was acute only and that there was no evidence of chronicity of care.

In an October 2024 opinion, an October 2024 VA examiner opined that it is less likely than not that costochondritis was incurred in or caused by the Veteran's military service.  The clinician noted that the service treatment records do not reveal any documented complaints, diagnosis, or treatment for costochondritis, which makes it unlikely costochondritis originated during or was caused by service.  The nurse practitioner added that there was an absence of clinical evidence of a chronic condition or ongoing symptoms.

Later in that October 2024 opinion, the October 2024 examiner opined that it is at least as likely as not (50 percent probability or greater) that the Veteran's currently diagnosed costochondritis was incurred in or caused by in-service costochondritis.  The clinician noted that the Veteran's in-service chest wall pain was consistent with costochondritis, which suggests a connection between the in-service chest wall pain and the current diagnosis of costochondritis.  The nurse practitioner added that the in-service significant physical demands could have contributed to or exacerbated the development of costochondritis.  The examiner stated that given the record of chest wall pain in service, the Veteran's service history, and recurrent nature of the symptoms, it is plausible that costochondritis had its onset in service.  

In a March 2025 opinion, the October 2024 VA examiner opined that it is less likely than not that costochondritis was incurred in or caused by the claimed in-service injury, event, or illness.  The clinician noted that the service treatment records do not reveal any documentation of costochondritis, chest wall pain, direct trauma, repetitive mechanical stress, or related symptoms during service.  The nurse practitioner added that there were no in-service complaints, diagnostics, or treatment related to costochondritis or chronic chest wall pain.  The examiner noted that the costochondritis was diagnosed post service with no evidence of symptoms or related conditions during service.  The clinician indicated that the absence of in-service documentation suggests that the disability developed after military service rather than as a result of service.  The nurse practitioner added that there was no documented continuity of symptoms from service to date of diagnosis, which further weakened a finding of direct service connection.

The Board notes that the October 2024 VA examiner rendered three different medical opinions on whether costochondritis is related to service - two negative and one positive.  The two negative opinions were predicated on no continuity of the symptom of chest wall pain since service.  The positive medical opinion is predicated on recurrent chest wall pain since service.  While private treatment records reflect that in August 2019, the Veteran reported chest discomfort for two weeks, the January 2021 VA examination report reveals that the Veteran reported the onset of chest wall pain being in 1999.  The Veteran is competent to report
 practitioner added that there was no documented continuity of symptoms from service to date of diagnosis, which further weakened a finding of direct service connection.

The Board notes that the October 2024 VA examiner rendered three different medical opinions on whether costochondritis is related to service - two negative and one positive.  The two negative opinions were predicated on no continuity of the symptom of chest wall pain since service.  The positive medical opinion is predicated on recurrent chest wall pain since service.  While private treatment records reflect that in August 2019, the Veteran reported chest discomfort for two weeks, the January 2021 VA examination report reveals that the Veteran reported the onset of chest wall pain being in 1999.  The Veteran is competent to report that he has had recurring chest wall pain since 1999, and the Board finds him credible because the Veteran reported chest wall pain in 1999 at his 2001 separation examination.  

Given that the two negative medical opinions are predicated on no recurrent chest wall pain since service, the evidence is in equipoise as to whether the costochondritis is related to in-service chest pain.  Hence, Hickson element (3), medical nexus, is satisfied.  In summary, the Board is of the opinion that the Veteran has met all requirements needed to establish service connection for costochondritis .  The benefit sought on appeal is accordingly allowed.  38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304.  

As the Board is granting service connection for costochondritis on the basis of in-service chest wall pain, the Board does not have to address whether costochondritis is related to toxic risk exposure activity or secondary to the service-connected psychiatric disorders.

 

 

MICHAEL LANE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	Cherry, David T.

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.